Living with Loneliness
Loneliness, a normal part of the human condition, has reached epidemic proportions in recent years. Amplified by the social isolation that the COVID pandemic imposed (and continues to demand of the elderly and the immune-compromised), loneliness as a social issue was already on the rise. As I wrote in a 2017 post on social support (1), a national survey revealed that 25% of Americans said they had no one in whom they could confide or share a personal problem. (A similar survey in 1985 had reported that most people had at least 2 – 3 trusted confidants.)
The highest reported rates of loneliness are among seniors, who are more likely to be living alone, retired from the workforce, and needing to protect themselves from the risks of catching not only COVID but all of the other viruses circulating out there. One of the most unfortunate consequences of our modern society, particularly in this country, is the sidelining of elders, who in earlier generations were considered a necessary part of a family, whether as caregivers for grandchildren and keepers of the home fire, or as sources of wisdom and familial history and traditions. Now, many elders are left feeling superflous, invisible, not belonging anywhere.
Right behind seniors in reported rates of loneliness are teens, who are developmentally still learning social interaction rules and skills, and who were hit hard by the closing of schools during the lockdown. Some still have not returned, or have dropped out. Teens lack the perspective that “this too shall pass,” giving more urgency to current distressing circumstances. And they are more reliant on their smart phones and social media, which create a false sense of being connected while not requiring any direct social interaction at all.
And in between are the rest of us, who may be experiencing loneliness for a variety of reasons, and to a greater degree than before. Everyone feels lonely sometimes, but as a recent article in The Atlantic says, “emerging evidence suggests that we are in the midst of a long-term crisis of habitual loneliness, in which relationships were severed and never reestablished.”(2)
According to Vivek Murthy, US Surgeon General, this is a public health issue.(3) Indeed, research has shown that loneliness is a risk factor for several kinds of health problems, including cardiovascular disease and dementia, as well as mental health, especially depression and suicide.(4)
While other nations (Japan,England) have created governmental agencies tasked with finding solutions to loneliness (5) the US has tended to regard it as an individual problem rather than a societal one, leaving Americans to cope with loneliness on their own. Ironic, but not surprising!
So if you are experiencing loneliness, you’re not alone! Know that this is a common condition in today’s world, caused by many factors over which we have little or no control (including the pandemic, political polarization, and over-reliance on smart phones and social media) so you are not to blame. I repeat, it is not your fault.
However, it is up to you to do something about it. The best remedy for loneliness is to reach out to other people – not to ask for help, but rather to offer it, either as a volunteer or a friend. There’s truth to the old adage, “get busy helping others and you’ll soon forget your own troubles.” As I have written previously,
It is easier to give than receive. Most people find it much easier to offer help, than to be the one asking for help. Research on the health benefits of social support shows that while giving support is correlated with health and living longer, receiving support conveys no longevity benefit. Perhaps this is because it’s stressful to ask for help, or because those who receive support are already suffering more ill-effects of stress. (6)
Find something you can do that will force you to get out and interact with other people. Make an effort to be kind and friendly to others. Look for opportunities to interact in person, from taking a walk with a friend to signing up for a class at a senior center or community college. Don’t be afraid to call someone you haven’t spoken to in a while – there’s a good chance that they may also be feeling lonely! And finally, if you’re not already seeing a therapist, consider contacting one. It can help just to talk about it.
NOTES
1. Here’s the blog post I wrote in 2017 on social support, that includes this startling statistic: Social Support – The Survey
2. “How We Learned to be Lonely,” by Arthur C. Brooks, The Atlantic, 1/5/23 (if you can’t access this online, let me know and I can send you a copy of the article from the print edition)
3. “The Pandemic of Loneliness,” article on the California Health Care Foundation website, published 8/2/21
4. “How Loneliness is Damaging Our Health,” by John Leland, New York Times online edition, 4/20/22
5. Vivek Murthy speaking at online international conference on loneliness, sponsored by the UK’s Campaign to End Loneliness (2/8/23)
6. Quote from my second blog post on social support in 2017
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8 Tips to Relieve Seasonal Depression
Today, the shortest day of the year (in the northern hemisphere) is a good day to talk about seasonal depression. At my latitude, there are fewer than ten hours between sunrise and sunset. That’s bad news for people like me, who have a hard time getting up before daylight. If it’s cold outside too, that makes it harder to fight the urge to stay in bed, or at least in PJs, all day. In the winter months I’m more sluggish, prone to irritability and sadness, and more likely to take a negative view of things. I’m not clinically depressed, however, I’m just very affected by sunlight, and the absence of it.
While many people are similarly affected, some do experience a true clinical depression during the winter, whether caused or simply made worse by the absence of sunlight. Here are some tips for coping with seasonal depression, or SAD (Seasonal Affective Disorder, as it’s known in the clinical literature), gathered from both my experience as well as scientific research.
Wherever you are on the SAD – Depression spectrum, I’ve learned that giving in to those urges to hide under the covers, sleep all day, isolate from people, or use alcohol, food, or other substances to numb your emotional sensitivity just doesn’t work. These things actually feed the depression, and keep it going longer. What works better instead:
1) Move your body! Even though it might feel like slogging through molasses, and your stiff joints may complain loudly, get up and do physical exercise, or some kind of movement. Exercise has been well documented to be one of the most effective treatments for depression – more effective than medication, and without any negative side effects.
When we get depressed, stressed, anxious or fearful, there’s an unconscious tightening of muscles, and a holding in of emotion, that produces a tension throughout the body. We have many expressions for this, including “putting the armor on,” “hardening our shell,” or “holding it together.” This takes effort, and expends physical energy, so if we’re doing it for a long time, we’ll get tired, even to the point of exhaustion. Have you ever felt so exhausted you couldn’t relax or sleep? When that happens, what actually helps the most is to start moving your body.
Don’t overdo it at first, just take a walk, do some gentle yoga or stretching, or any easy movement that will allow those tense muscles to loosen, and will also release neurotransmitters that can improve mood. I recommend this slightly dated but still excellent article on the benefits of exercise in Scientific American Mind: The Exercise Cure – Why it may be the best fix for depression
2) Stop feeding your depression. When mood and energy are low, we’re much more likely to crave sugary foods and drinks, as well as caffeine, to get us going. While anything with sugar will often give a brief burst of energy, it’s the wrong kind of energy, leaving you more depleted after the quick high wears off. And although the temptation to imbibe may be strong, especially around the holidays, keep in mind that alcohol is actually a central nervous system depressant. Both alcohol and sweets will feed depression far more than relieve it. If you want to learn more about why we crave sugar, and how it affects mood, cognitive function and health, I highly recommend Gary Taube’s 2017 book, The Case Against Sugar.
If you are a coffee or tea drinker, it may help to increase your consumption of caffeine a little during the dark days of winter. But leave the sugar out, and try stevia, or any kind of milk (almond, oat, soy, or dairy) instead. If you simply must have a sweet treat, balance it with lean protein (e.g. low fat milk, cheese, or yogurt). Add more fruits and vegetables to your diet. If you’re not a big fan of vegetables, try putting them in a smoothie with some fruit, cook them in soup or stew, or stir fry them. My colleague Susan Blanc, nutritionist and cooking teacher, has some great classes and recipes to improve mood and brain health: Kitchen Table Remedies
3) Let the sunshine in. Seasonal depression is often a function of lack of sunlight, which helps our bodies produce Vitamin D, needed to help us regulate sleep, energy, and mood. Fortunately for those of us who live in California, we rarely have to wait very long for a sunny day. If the sun is shining right now as you’re reading this, stop! Use this time instead to get outside and go for a walk, or at the very least, find a sunny spot to sit and soak up some rays for 10 -15 minutes. If the sun hasn’t been out for awhile where you are, and/or you’re particularly sensitive to seasonal depression, you might want to look into getting a light box. Here’s a link to some solidly researched information on how light boxes help, and how to use them safely: Light therapies for depression
4) Do an enjoyable activity. Research from Mindfulness-based Cognitive Therapy has shown that doing an activity that gives you pleasure or mastery, or both, is one of the most effective ways to get out of a low mood. When we’re down in the dumps, that self-critical inner voice is most active, telling us we shouldn’t do something fun or pleasurable until we get our work done. But if you’re not getting your work done because your mood and energy are low, then you need to reverse-engineer this, because motivation works backwards in depression. So give yourself permission to do a fun activity, something you enjoy and that just might put a smile on your face. Play an instrument, do a craft or hobby, watch a favorite TV show or funny movie – you get the idea. One caveat: do it for 30 minutes to a couple of hours; you don’t get to do this all day!
5) Clean or declutter your space.. If nothing sounds like it would be fun or give you pleasure, you may be suffering from one of the hallmark symptoms of clinical depression: anhedonia, a loss of interest in things that normally are pleasurable. So if that’s where you’re at right now, think of something you can do that will give you a sense of mastery or accomplishment. Pick a fairly simple task, one that will yield a visible result, like decluttering your desk or work space, organizing a drawer, or even washing dishes, and set a timer for 15 minutes so that you don’t get bogged down in it. When the timer goes off, take a break. Then you can choose whether to continue working on the task, or do something else. Clearing a space can help clear the mind. For more tips on how to clean & declutter, 15 minutes at a time, visit The FlyLady (no, she’s not an insect, she’s a human who loves fly fishing and helping people get control of their clutter).
6) Don’t be a hermit.. Depression can make contact with others challenging, so we isolate instead. And the pandemic has made social contact even more challenging, and isolation more common. But humans are social animals, and we are hard-wired for face-to-face connection to help regulate our moods and emotions. Among other benefits, it releases oxytocin, a chemical that promotes feelings of safety, security, and connectedness. So if you’ve been hiding out, relying on social media to feel connected, use your phone the old-fashioned way, and call a friend, or put the phone down and just go talk to someone. Don’t start the conversation with how depressed you are (and don’t talk about politics!) – instead, ask them about what they’ve been up to, or pick a more neutral topic, like the weather, sports, or the latest crop of movies. Make eye contact, and maybe even try a hug.
7) Listen to music. Music not only soothes the soul, but helps us feel connected with others. I recently attended a concert where the audience was asked, “in the midst of chaos, how do you find peace?” As I listened, I meditated on how music has helped people throughout history transcend their suffering. I thought about the origins of jazz and the blues, the protest songs of the 60’s, and my own personal soundtrack of favorite albums and artists that have helped me through troubled times (including the song with this line: “Everybody’s had the blues sometime, and everybody knows the tune.”) What are your favorite tunes? Can you sing or play one of them right now?
8) Get out in nature. I have found that one of the most effective ways to relieve my depression, stress, or anxiety, is to go for a walk in the hills near my home, or drive to a nearby regional park for a hike. Not only do I get the benefits of fresh air, maybe some sunshine, and moving my body, but it’s very powerful to ground myself in the natural world. Even if you don’t have access to a park, there are birds, trees, and wild creatures that exist in almost every environment. (The photo with the monarch butterflies was taken in Pacific Grove in February 2016.)
Putting it all together: Reach out to a friend you haven’t seen in awhile, and make a commitment to do an activity together: have coffee or lunch, take a walk in the park, go to a musical performance or art exhibit. Or go for the Trifecta and do all three!
If this sounds overwhelming, remember that motivation works backwards in depression, so you’re going to have to challenge yourself. Consider also that face-to-face contact with people you care about, especially sharing a meal together, stimulates the production of oxytocin, the chemical in your brain that helps you feel safe and connected. Remember that moving your body will release the tension that comes from resisting reality, and may actually give you more energy as it helps produce mood-enhancing neurotransmitters. And finally, don’t forget that fresh air and sunshine replenish essential nutrients that improve mood; and that music (and art) soothe the soul and stimulate right-brain creativity and positivity.
(This article has been updated from a previous article I wrote on 12/21/16.)
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Depression Treatment News
Reported rates of depression have increased dramatically in the last few years, possibly related to the COVID-19 pandemic and its associated stressors, like social isolation (1). However, it seems that many people who report depression symptoms are not getting treatment (2) while others are questioning whether antidepressant medications are as safe and effective as we’ve been told (3). And while there have been some new and promising treatments, they are not widely available due to cost and lack of access. That’s the bad news, in a nutshell. The good news is that there are many proven effective non-medical alternatives for treating depression. This article will briefly summarize current medical treatments for depression as well as alternative treatment options.
New(ish) medical treatments include Transcranial Magnetic Stimulation (TMS) and Psychedelic-assisted therapy, of which ketamine or Spravato is the most well known. TMS and Spravato have both been approved by the FDA for “treatment-resistant” depression, which simply means depressive symptoms that haven’t responded to conventional treatment with a medication like Prozac or Zoloft, the selective serotonin reuptake inhibitors (SSRIs).
TMS involves having your brain “zapped” by electromagnetic charges. While that may sound scary, it is painless and relatively risk-free, with a fairly good success rate. The downside: it must be administered at a doctor’s office in a series of sessions, usually about 30 over six weeks, and it’s expensive if your insurance plan doesn’t cover it. Recently, researchers at Stanford University School of Medicine have developed a new version that can be completed within five days, which could be a game-changer if it’s approved by the FDA and covered by insurance (4).
Ketamine has been around for a long time. Originally developed as an anesthetic, it became popular as a party drug due to its hallucinogenic properties. Some doctors have been using ketamine infusions on an experimental (“off label”) basis to treat depression, which again is fairly costly and not covered by most insurance plans. I have a few patients in my practice who’ve had this treatment; while one experienced remarkable results, the others did not. In 2019, the FDA approved a nasal spray version of ketamine, Spravato (5). I don’t know anyone who’s used Spravato, so I can’t speak to its effectiveness, but at $3000 to $6000 per month, and with no research on its long-term effects, it’s simply not a viable option for most people. If you’d like to learn more about ketamine treatment for depression, see the notes below for a link to a fairly readable scientific article (6).
Another psychedelic drug currently being studied as a depression treatment is psilocybin, the active ingredient in “magic mushrooms” (7). A recent study found that just 2 doses could relieve depressive symptoms for up to 12 months (8). Psilocybin is classified by the federal government as a controlled substance, and therefore cannot be prescribed by a doctor nor obtained over-the-counter, though a number of states and cities have recently passed legislation to decriminalize it. There’s a lot of money being poured into psilocybin research right now, and many universities have established centers for psychedelic research, so one way to get this treatment may be to join a clinical trial (9).
Meanwhile, as doctors are prescribing more antidepressant medications than ever, others are questioning the efficacy of these medications, and whether their risks outweigh any benefits. A recent analysis in a respected medical journal concluded that “the real-world effect of using antidepressant medications does not continue to improve patients’ health-related quality of life over time.” (10)
We have been taught to believe that SSRIs (selective serotonin reuptake inhibitors) are safe and non-habit forming, so they can be taken indefinitely, and also discontinued easily. This is only partially true. SSRIs do have fewer harmful side effects than the older generation of depression meds. They are not addictive in the same way that opiates or benzodiazepines are, meaning you won’t develop cravings. However, their effects and side effects are definitely not harmless, quitting them abruptly can have negative consequences, and many people have found that even a tapered withdrawal may cause unpleasant effects, which can last for months or years in some cases. A study published in The Lancet, the British medical journal, in 2019 demonstrated that withdrawal from standard antidepressant medications is much more protracted and difficult than most doctors believe. (11)
I just watched a very interesting webinar on Antidepressant Drug Withdrawal Syndrome, which is a real problem for many people, so whether you are on an SSRI, thinking about taking one, or wanting to get off one, you might want to watch it too!
So what can we conclude from all of these studies? First, the mechanisms of how antidepressant medications work are still poorly understood. The theory that depression is caused by a chemical imbalance, specifically a lack of serotonin, has not been scientifically proven, in fact there’s very little evidence for it.
Second, depression is not like getting the flu or strep throat. There’s often no clearly identifiable cause, such as a virus or bacteria that can be tested for. There isn’t a predicatable course of illness. It shows up differently in different people, and even in the same person at different times. There’s debate about whether it should be considered an illness, for these reasons. Maybe it’s just part of the human condition? And third, we need to keep in mind that research on new treatments is usually funded or sponsored by pharmaceutical companies, who routinely sacrifice scientific rigor in their drive to push a new product to market, putting profits before people’s health and well-being.
There are many alternative treatments for depression, most of which are cheaper and have few or no side effects; many have been scientifically proven to be effective. Let’s start with dietary changes. Did you know that 95% of the body’s serotonin is produced in the gut? As Leslie Korn writes in Nutrition Essentials for Mental Health, “the standard American diet, consisting of overly processed foods containing refined sugars, leads to chronic inflammatory states and neurotransmitter imbalances. Inflammation is now understood to underlie most mental illness, including depression. Chronic low-level inflammation contributes to depression and cognitive decline.” (12) Read my blog post about how dietary changes can improve mood here.
Other effective approaches for treating depression include behavioral changes, especially improving sleep quality and increasing exercise; herbal remedies (St. John’s wort, tryptophan, 5HTP); nutritional supplements (Omega 3 fish oil, vitamin D, and B vitamins, especially folate); self-help groups (the Depression and Bipolar Support Alliance); social support networks, and various forms of psychotherapy, including cognitive-behavioral therapy (CBT and ACT) and of course my favorite, Mindfulness-based Cognitive Therapy (MBCT). MBCT has been proven to be at least as effective as antidepressant medication in preventing the recurrence of depression (13).
That’s the real news about depression treatment: if you start with improving sleep, exercise, and nutrition, then add social support, CBT, and mindfulness, it’s possible to achieve better and longer-lasting recovery from depressive symptoms, at least for many people. So rather than keep chasing after that elusive “magic pill” (which I don’t believe exists) doesn’t it make more sense to try some of these alternatives?
NOTES
- According to the most recent National Survey on Drug Use and Health, taken prior to 2020, depression rates were already rising among teens and young adults
- Trends in U.S. Depression Prevalence From 2015 to 2020: The Widening Treatment Gap, published in the American Journal of Preventive Medicine, 63(5)
- Antidepressants Don’t Work the Way Many People Think, by Dana G Smith, New York Times online edition,11/8/22
- The short timeframe Transcranial Magnetic Stimulation developed at Stanford University School of Medicine, NPR 2/6/22
- FDA approves Spravato (esketamine), a nasal spray for “treatment-resistant” depression, New York Times online edition 3/5/19
- A fairly readable scientific article to learn more about Ketamine treatment for depression
- This is a good overview of Psychedelic-assisted therapy
- Recent study on Psilocybin treatment for depression at Johns Hopkins University
- If you’re interested in How to find Psychedelic therapy, including how to enroll in a clinical trial
- Analysis concluding that antidepressants don’t improve quality of life
- The seminal study in The Lancet demonstrating the antidepressant withdrawal syndrome is real
- Korn, L (2016) Nutrition Essentials for Mental Health
- Kuyken, W., et al. (2016). Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials.
Back from Burnout
It’s been a while since I’ve written here – let me explain my absence. Early this year I began to recognize the signs of something resembling burnout in myself, and decided to take the advice I often give to my patients, to take a step back from some of my activities and responsibiilities in order to focus more on my well-being. The activities I chose to give up were writing blog posts and newsletters, teaching online mindfulness classes, and taking new patients.
At the time I thought this “break” might last for a month or two, but as it turned out, I needed much longer to heal and restore what was depleted in me. It wasn’t as simple as “get more rest,” nor was it about setting boundaries or saying no to excessive demands on my time. That’s the prescription for typical burnout, but this was a different kind of emotional exhaustion. I practice what I preach about self-care, so I was getting plenty of sleep, regular exercise, and healthy nutrition, and I’ve got good boundaries. Then why was I so exhausted?
I am a “silver lining” person, usually able to find the good or beneficial even in the worst of circumstances, and I had been doing that for the first year of the pandemic, but then it stretched into two (now three) with no clear end in sight. Those first months of the lockdown were hard, but there was a sense of “we’re all in this together” that made it feel more like an adventure. Then when vaccines became available, there was a sense of relief, and hope that this would be over soon. Instead, it got worse, fueled in large part by all of the people who refused to get vaccinated, mostly for reasons that made no sense to me. I no longer felt like we were all in this together.
I am also a person who has always felt a deep connection to Mother Nature, and when my batteries need recharging, I head to the woods, or the ocean, or just my garden. During the lockdown, I was grateful to have a yard and garden, and to live in a neighborhood that’s safe to walk in, where I could access trails into the hills. I was able to spend more time outdoors, which helped, but it’s also depressing to try to grow things during a prolonged drought, and with all of the extreme weather events (remember that day in August 2020 where the sun never came out, and it felt like we were on Mars?) Forest fires, hurricanes, floods and mudslides – we are experiencing the harsh reality of what our reliance on fossil fuels has done to the planet, and yet, people aren’t changing their habits, and fossil fuel companies have doubled down.
On a related note, I’d been working hard to maintain my optimism for the benefit of my patients and students, as well as colleagues and friends, all throughout the dark years of the previous administration. But here we are, still living under that dark cloud six years later, with nearly a third of adult Americans still believing the lies about a stolen election and voter fraud. Those lies and the people who promote them threaten the very foundations of our democracy.
As I write that last paragraph I realize I risk losing a few of you as readers, which points to one of the gravest concerns that I have about the world we are living in today: we seem to have lost the ability to even listen to, let alone respect differing views, opinions and perspectives. That factor alone has affected my motivation to write, because I believe what makes something worth reading is its potential to stimulate thought, challenge existing views, and offer a new perspective. And I simply can’t pretend things are okay when they are definitely not okay.
My training as a psychotherapist was traditional, in that I was taught to keep my personal views and opinions separate from my work with patients, and to not share anything about my personal life. When I was a young therapist, still in therapy myself to heal my own childhood wounds, that proscription suited me nicely. But over time, as I healed and matured, and as the field of psychotherapy itself changed, I began to share more of myself with patients. I brought my experience with therapy, 12-Step programs, and mindfulness meditation into sessions. I “showed up” for my patients in a new way, which not only felt more authentic for me, but also allowed the work we were doing together to go to a deeper level. This was more satisfying for me as a therapist, and led to deeper levels of insight and healing for my patients.
I experienced a similar sense of satisfaction teaching mindfulness classes, as I was able to observe my students struggle with the practices week after week, and then suddenly have an “aha” moment that was transformational, perhaps life-changing. Even when I was teaching in the evening, after a long day of seeing patients, I would come home feeling grateful to be doing this work.
But the satisfaction, gratification, even joy that I experienced from my therapy sessions and mindfulness classes began to dissipate once everything moved online. I didn’t notice this right away, as I was so busy just mastering the technology, and relieved when it all worked and we could see and hear each other. And I was glad to be able to still provide support to my patients and students, as we all struggled through that initial phase of the pandemic.
Soon it became clear, however, that something was getting “lost in translation.” A day of Zoom sessions would leave me depleted, rather than nourished. Many of my colleagues noticed this, too (though I wasn’t seeing my colleagues in person anymore, either). Eye strain was part of it, as was the distraction of seeing myself as well as my patient on the screen. Phone sessions were easier in a way, and yet the challenge remained one of establishing a genuine connection. Telehealth can easily become simply a check-in. I noticed that mindfulness classes became more superficial, too. It’s difficult to dig deep into someone’s experience when you can’t see what’s happening in their body.
What I’m getting to here is what I’ve come to understand as a primary cause of my burnout: the loss of personal connection. Zoom and FaceTime are great tools that clearly have value as a way to connect, and I appreciate their convenience, but I think we’ve all come to realize that something gets lost, and that something is an intangible, hard to measure or define, energy. Without getting all “woo woo” I’ll just say, science has shown us humans are energetic beings, and we are biologically hardwired to read each other via “body language.” We also need each other’s physical presence for emotional regulation. We are “wired for touch.”
There’s another piece here for me, which is so personal that I’m hesitant to share it. During the past two years both of my adult sons moved to the East Coast, one of them taking my new grandson with. Talk about a loss of personal connection through touch! I wholeheartedly supported their moves as being right for them, and was able to appreciate what the Buddhists call “sympathetic joy,” when you’re happy for someone else’s happiness, even if it may cause you unhappiness. But still, it’s been a loss, one that I know many of you can relate to.
It’s not just my own lost connections that depleted me. As an empathic and highly sensitive person, I have felt a collective grief for the loss of millions of lives to COVID (a trauma that we have not fully acknowledged as a society). And I feel the effects of the many ways in which all of us have become isolated and disconnected from each other, both as a result of the pandemic as well as the polarized political climate. The positive energy I had once felt from the #MeToo movement and Black Lives Matter dissolved into despair, as women’s rights and BIPOC rights are increasingly threatened everywhere, ultimately at the level of the US Supreme Court.
There are objective data that confirm this societal trauma: we’ve seen significantly higher rates of anxiety, depression, substance abuse and suicide, not to mention increases in domestic violence and gun violence, over the past couple of years. Besides political and economic factors, there’s a biological explanation for this too: when human beings lose their sense of connection with other humans, despair, hopelessness and alienation take over.
I didn’t arrive at this self-diagnosis until after I’d already embarked upon its cure. Sometimes we can only see clearly in hindsight; action is necessary before insight appears. As I began to see more patients in the office, led a few mindfulness meditation groups in-person in the park, and finally felt safe enough to travel to visit my sons and their families, my personal dark cloud began to lift. I also focused on “changing the things I can,” as the Serenity Prayer reminds us. This turned out to involve a move to a new home, with a dedicated and Zoom-friendly home office (after two and a half years of improvising) as well as a last-minute decision to find a way to keep my Pleasanton office, which I’d barely been using. Both decisions required navigating through uncertainty and letting go of control, but ultimately feel right.
Now I’m gearing back up to see patients two days a week in the office, following COVID protocols, while continuing to offer telehealth sessions the other weekdays, which feels like a more sustainable balance. I am also planning some in-person mindfulness classes for 2023, starting at Las Positas College in January-February. Today I’m meeting some new colleagues for lunch. And I am really looking forward to taking a week off next month for my first in-person meditation retreat in several years!
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Burnout in the Helping Professions
“There’s no shame in taking a step back to focus on self-care.” As I was saying this to one of my clients recently, it hit me: if I truly believe that, then I need to practice what I preach! It was obvious to me that my client was suffering from burnout, due to the demands of her job as a mental health professional as well as her family caregiver responsibilities, and equally obvious that she absolutely deserved to set some boundaries, ask for help, and take a break to recharge her batteries. And yet, even though I was beginning to see signs of burnout in myself, it was a real struggle to acknowledge this, and give myself the same permission to step back.
This is the dilemma that many of us in the helping professions face: if you’re a nurse, doctor, psychotherapist, social worker, or teacher, you may have received training to recognize the signs of burnout, and you may know what to tell your patients, clients, or colleagues to do to relieve it. In fact, you might spend your days counseling others to take a step back, set some boundaries, reach out for help, and get some rest. But when it comes to you, you’re far more likely to tell yourself to just push through the exhaustion, and ignore the growing cynicism and feeling of detachment from the work that you used to love.
So what exactly is burnout? The World Health Organization (WHO) defines burnout as “a syndrome resulting from chronic work-related stress, with symptoms characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”[1] It is not a medical condition or mental disorder.
Christina Maslach, professor emerita of psychology at UC Berkeley and co-author of the Maslach Burnout Inventory (MBI), describes burnout as “feelings of exhaustion, inefficiency and cynicism, defined by a detachment from work and a lost sense of meaning.”[2] Developed in 1981, the MBI was the first instrument to measure burnout, and remains widely used today.
Are people in the helping professions more likely to experience burnout? According to recent surveys [3,4], burnout seems to be growing among workers across occupations, fueled by COVID-19 pandemic-related trends in working from home, remote schooling for children, and staffing shortages. But healthcare workers and educators have been hit the hardest, and even prior to the pandemic, these occupations have historically been most impacted by burnout. To understand why, we can examine the traits of people who are most vulnerable to burnout, but even more importantly, we need to look at the characteristics of jobs that burn people out.
Burnout doesn’t happen to slackers, but rather to those who are the most conscientious and hardest working, and who regard their work as a calling.[5] The traits of people who are most vulnerable to burnout include:
- Being a helper, by nature or occupation;
- Scoring high on conscientiousness and agreeableness (Big Five Personality test);
- Taking pride in one’s work ethic and dedication;
- When the going gets tough, they don’t quit, they just work harder; and
- They believe that asking for help is a sign of weakness.
Do any of those ring true for you?
Burnout is caused by chronic and excessive job-related stress, not by any deficiency in the individual. The characteristics of occupations that have highest rates of burnout include:
- Involving the provision of direct services to people in the areas of health, mental health, and primary education;
- Responsibilities are loosely or vaguely defined, additional responsibilities are constantly being added;
- Success is difficult to measure, there’s never an endpoint or goal post;
- Rewards are intangible, few, or fleeting;
- Job demands exceed what is humanly possible, given time and resource constraints.
Therefore, it is increasingly difficult to do the job well, or meet the needs of those you are supposed to serve. Does this sound like your job?
How do you know if you’re suffering from burnout? In my experience, these are the key signs:
- You’re more impatient or irritable than usual;
- You don’t feel well-rested after a night’s sleep;
- You’ve stopped doing activities that normally bring you pleasure or involve self-care;
- You find yourself saying or thinking more often, “I just don’t care” about your job; and
- You don’t feel ready to go back to work after your regular days off.
You may also find yourself getting more and more behind on routine work and household tasks, and thinking more often about quitting, changing jobs, or retirement.
A key point: burnout is not the same as depression. Because there is a significant overlap of symptoms, those who are suffering from burnout may believe, or may be told, that they’re clinically depressed, however, the causes of burnout are different, and so is the treatment. (Of course, it’s possible to have both burnout and clinical depression, in which case you will need to address both conditions.)
What is the treatment for burnout? Ideally, a signficant amount of time off work. For some people, a couple of weeks might be enough, for others, a month to a year may be needed. Of course, this is not possible or realistic for many people, so then you will need to implement these self-care tasks while continuing to work:
- Start with setting some boundaries. Learn to say “no,” or “not now,” and let go of any non-essential tasks;
- Ask for help from colleagues, or delegate if you can;
- Prioritize getting more sleep and exercise, eating healthier, and reaching out to family and friends for social connection;
- Change your attitude or approach to work. Become willing to be “good enough” rather than “great;” commit to leaving work on time, or if you work from home, create boundaries to separate work from home and family life;
- Take some time to review your life goals, and what gives you a sense of meaning and purpose. If it’s not your job anymore, then begin to explore other options.
- Finally, I highly recommend seeking out a psychotherapist to assist you in this process.
When I saw my client again, she seemed a bit happier, and reported that she had set some limits with the family members who had been most demanding of her time. She’d also resumed her exercise routine, was making plans for a trip with friends, and was actively looking for a job that was less direct-service oriented. And how did I address my own incipient burnout? I have decided to take a break from teaching mindfulness classes, even though I love doing so, to give myself more time for rest, relaxation, exercise, and visits with friends and family.
Notes:
1. Burnout an “occupational phenomenon”: International Classification of Diseases WHO. 28 May 2019. Referenced in Wikipedia page on occupational burnout.
2. Christina Maslach, quoted in Zuckerman, C (2021, April 30) How to Beat Burnout without Quitting Your Job. NYT online, retrieved March 28 2022.
3. Survey by Robert Half Int’l, referenced in Maurer, J. (2020, December 16) Remote Employees Are Working Longer Than Before. Retrieved from SHRM HR Today, online ed.
4. Threlkeld, K. (2021, March 11) Employee Burnout Report: Covid-19’s Impact and 3 Strategies to Curb It. Retrieved from Indeed.com.
5. From “The Exhaustion Funnel,” handout from my MBCT course.