Book Review-Compassion Fatigue and Burnout in Nursing

I’m not a nurse, but I’m married to one. My daughter is also a nurse. If nursing could rub off onto someone, I’d be covered in it. That’s one of the reasons why I was so curious about what Compassion Fatigue and Burnout in Nursing had to offer to help me understand.

When Terri (my wife) was working in a pediatric intensive care unit, there were days I knew she would come home to go directly to our room, and I knew I needed to just hold her and let her weep. The things she saw were horrific. How she was able to face it day after day was beyond me. While I can’t say I understand compassion fatigue directly, I can understand some of the burden that is borne by healthcare workers trying to ease the world’s suffering.

I also understand burnout and largely see it as an overarching container that includes compassion fatigue as well as other specific types of burnout. While this view isn’t uniformly held, it’s one that many people agree with.

Compassion Fatigue

Compassion fatigue is the experience that workers sometimes get while caring for others who have experienced trauma. It happens in nursing and other workers who have care at the center of their lives. It’s sometimes called “secondary trauma,” because it’s the trauma suffered by people caring for those who experienced the trauma directly. However, care must be exercised to not minimize the trauma or dismiss it because it’s not primary.

Our egos are amazing things. They allow us to ignore the very real and present fact that we’re all vulnerable. We’re not nearly as powerful as we’d like to believe. Our psyches couldn’t cope with the idea that, at any moment, an asteroid could come raining down and destroy our lives as we know it. (See Change or Die for more along this line.) When you witness the harm that happens to others – particularly when that harm comes at the hand of other human beings – it forces you to confront your own vulnerability and recognize that there are many intentionally and unintentionally cruel people on the planet. The only way to blunt out these feelings is to stop caring about others. You can still care for their physical needs but disconnect emotionally to protect yourself. This is the heart of compassion fatigue.

Burnout

Burnout, on the other hand, is a result of the gap between our expectations and our results. When we expect that we can do much and then see results that are not much, we’ll eventually experience this as burnout. Another way to think about burnout is as the exhaustion of our personal agency. (See Extinguish Burnout for more about these and other aspects of burnout)

For most caring professionals, the expectation is that they can prevent, alleviate, or heal the trauma that others experience. When the patients keep coming, it takes great strength to maintain the belief that you’re making a difference. When the traumatized doesn’t seem to be getting immediately better, the caregiver is faced not only with their own vulnerability but also the understanding that their expectation of their capacity to help others was likely very over blown.

Compassion fatigue is viewed as an acute event associated with the care of others, and burnout is more frequently viewed as a chronic condition that doesn’t have a precipitating event. However, burnout is often triggered by an event that causes someone to question the gap between their expectations and their results. In this context, it makes sense that compassion fatigue is a form of, and triggering factor for, a broader condition of burnout.

The Unseen Impact

Combatting burnout often means recognizing the impact we have that might otherwise be ignored or overlooked. The patients who get better don’t come back, so the only observations are that patients don’t get better. We begin to believe that what we see is all there is. (See Thinking, Fast and Slow for more on this.) The most prevalent image in our minds is the image of the person who didn’t recover and is back again.

Combatting compassion fatigue is a bit different. Our natural tendency will be for our ego’s defenses to attempt to “right the ship” and make us feel as if we’re more powerful than we are. However, this takes time, and when you’re bombarded by pain and suffering, it may not be possible for our egos and our faith in humanity to get a foothold. For that, we need to create space by focusing on the beauty, joy, and compassion in the world.

It’s easier said than done. But the more we can find comfort in the fact that most people are decent human beings, and few people face the kinds of trauma that caregivers witness every day, a sense of balance and normalcy can be regained.

Care and Compassionate Care

It’s entirely possible to do one’s role as a nurse and not care. The technicalities of the role can be learned and executed, like a robot making their millionth widget. However, that’s not the role of nurses – or any caregiver. The technical aspects of care are necessary but not sufficient to be a good nurse. Good nurses have a genuine concern for those in their care. They don’t become overly involved with the patient’s (and the family’s) needs, but they do adapt their way of working to maximize the things that are important to the patient and the family.

Without losing their own identity, they place themselves in the position of the patient and respond from a place of compassion – the same place that drew them to the career in the first place. Compassion is empathy – understanding another’s situation – and the desire to alleviate suffering. (See more about compassion in Sympathy, Empathy, Compassion, and Altruism.) When a caregiver suffers from compassion fatigue, they no longer have the strength to connect with someone – to understand them – and protect themselves from becoming overwhelmed with their circumstance.

As a result, the best care that nurses offer, the kind of care they all became nurses to give, cannot be done while experiencing compassion fatigue. Organizations are well served to identify and support nurses in resolving their compassion fatigue for better nurse retention and patient outcomes.

Moral Distress

If you want to find something that will steal the motivation and personal agency for someone, put them into a situation of moral distress. Moral distress is knowing the right thing but feeling as if you can’t do it. There are times when this moral distress is real, times when it is perceived, and, unfortunately, times when there should be moral distress but is not.

Shortly after the second World War, the world was asking how it was possible that so many German soldiers were able to assist with the mass extermination of Jews. Milgram devised an experiment where a test subject thought they were shocking another test subject –even when the shocks were presumed lethal. Milgram showed that many people could be coerced into these acts. (See Moral Disengagement and The Lucifer Effect for more on this set of experiments.)

For those cases where a nurse feels moral distress because of a difference in point of view, perspective, or diagnosis, the pain they feel is real. The organization (and the nurse) are missing an opportunity to understand the problem more fully so that the moral distress can be alleviated. In medicine, there’s rarely one right answer. The truth is that most patients are complex, and there are a variety of risk factors that the team navigates to try to return the patient to health. When the whole team – including the nurse – can openly discuss the challenges and agree upon a plan, the moral distress of some situations can be addressed.

There are, however, some cases of moral distress that are real. A surgeon won’t scrub up when walking into the operating room or picks up an instrument after it’s been dropped to the floor and continues to use it. Providers ignore nurses’ pleas for more pain medications or a different course of treatment for patients who are suffering. In some cases, nurses don’t feel as if they’ve got the opportunity to safely communicate their concerns, and that is their moral distress. (See The Fearless Organization for more about creating a culture of safety.) In other cases, even after a nurse voices the concern, they’re ignored or minimized. These are organizational challenges that eventually need addressed, or they’ll rip the organization apart.

Emotional Violence

Compassion Fatigue and Burnout in Nursing contains more than a few semi-related nuggets of information, including the revelation that emotional violence is still violence. While this may seem obvious, our world treats our words differently than our actions. “Sticks and stones may break my bones, but words will never hurt me” just isn’t true. Most of our hurts in the modern world come from words and the emotions they stir inside of us. While there’s a law against striking someone else, there’s nothing protecting us from a tongue lashing.

Emotional violence, or the words we say to each other and the non-verbal ways we communicate our disapproval with another person, are a form of violence that is all too often ignored. They’re the kinds of senseless attacks that we see around us and do nothing about. Left unchecked, they’re also one of the ways that we encourage Compassion Fatigue and Burnout in Nursing.

Extinguish Burnout Launch!

Terri and I are excited to announce the launch of our brand new website, https://ExtinguishBurnout.com to support our forthcoming book, Extinguish Burnout: A Practical Guide to Prevention and Recovery. While the book doesn’t publish until June 21st, the site and online course are available today.

Burnout is pervasive. As we speak about this topic and ask who has experienced it, nearly every hand goes up. When we ask how many people feel as if they’re actively in burnout during our talk, a sheepish 20% or more of the hands are raised. Burnout isn’t new, but its prevalence is increasing. An estimated 50% of physicians and 30% of nurses are currently experiencing burnout. I first wrote about burnout in 2003, and it’s been a recurring theme over the years as I worked with clients and led teams.

There’s some literature on burnout, but the problem was that it either blamed the individual – that they’re not strong enough – or the organization – that they’re not taking care of their employees. The problem is that neither view resolves the burnout, it just assigns blame.

We set out to identify the key causes for burnout and find strategies for preventing burnout or recovering from it if you’re already stuck in it. We found the answers were hidden in the research. All the clues necessary to find the answers were already available – they were just hard to find through all the misdirection.

The book is roughly 200 pages, with chapters that can be read in 5-10 minutes. The online course has an average module length of 13 minutes. The point was to keep them short and easy to consume if you are already in – or near – burnout.

We’re honored to have already received a substantial amount of positive feedback about the book and the materials. Some of those comments are available on the home page of the website. If you’re struggling with burnout – or you know someone who is – we’d like to invite you join us at https://ExtinguishBurnout.com, where you can preorder the book for shipment on June 21st (when it publishes) or order the course and start today. If you’re just interested, you can sign up for our newsletter, and we’ll keep you up to date.

Book Review-The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It

It’s rare that I choose to take a contrary view to what an author (or set of authors) says in their book. However, I did when I started digging into The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. It’s not that I don’t think that organizations have a role to play in helping their employees avoid burnout – or recover from it if they get there. That’s not the issue. I believe that employers are responsible to their employees for good working conditions, and getting the most from employees means helping them be their best in life.

The issue is whether I choose to place blame or not. Christina Maslach and Michael Leiter put crosshairs on the organization to blame them for employee burnout. The problem is that this is no fairer than placing the blame on the employee. In truth, there’s no blame to be had. It’s circumstances that cause people to burn out – whether they’re employees or entrepreneurs or volunteers. People burn out. We need to stop that no matter what the cause.

Dim View

My first highlight from the book is, “The workplace today is a cold, hostile, demanding environment, both economically and psychologically. People are emotionally, physically, and spiritually exhausted.” I see this as a dim view. It presumes that every organization is an inhuman place that squeezes the soul out of their employees. While I’m sure that there are organizations like this, there are equally as many that have a caring relationship with their employees.

Maslach and Leiter continue by listing the CEOs who they believe have excessive compensation packages and how things aren’t fair for employees. I’ll agree that many executives are overpaid. I’ll agree that it’s sad that, by 1994, the ratio between the CEO and the average “industrial wage” had jumped to 187:1. However, at the same time, I recognize the bias in the statements. As Richard Florida uncovers in The Rise of the Creative Class, the creative class is different than the working class or the service class. While Florida has primarily petitioned for the rise of wages for the service class – who are receiving the lowest wages – so, too, does the working class receive less compensation than the creative class. To compare CEOs – in the creative class – with those in the working class is capturing more than just the bias between leadership and the workers. It’s capturing a differential based on skills.

So, again, there are things that corporations can – and should – do to help employees recover from burnout and avoid it in the first place, but the perspective of Maslach and Leiter seems pejorative.

Burnout Misalignment

Maslach and Leiter write, “Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.” While this true, it misses the essential point. Burnout happens when people don’t believe that they’re effective at accomplishing their personal goals. As a result, when the organization’s goals aren’t aligned with one’s personal goals, or the role a person is in and their skills and natural tendencies are mismatched, there will be misalignment. This misalignment will diminish the capacity for a person to meet their personal goals.

So, at one level, there is truth that there’s an increase in burnout when the goals of the organization aren’t matched with the individual’s goals. However, at a completely different level, this is about how burnout surfaces in the ability of the individual to meet their goals.

The great opportunity that exists for organizations is in the capacity to allow employees to bend their personal goals towards those of the organization and for the organization to likewise bend towards the will of the employees. We see this in the recent tendency for organizations to have corporate responsibility statements and the trend towards B Corporations. (See Red Goldfish for more.) When employees are able to bend their personal goals towards the unified goals of the organization, the alignment will help to create a sense of community.

Community

Developing a community is a messy process. Bringing together people with different values and perspectives is necessarily messy. However, the resulting solutions and raw performance can be amazing. (See The Difference for more on how diversity of thought can be powerful.) Whenever you bring people together, there will be conflict. Maslach and Leiter write, “what is most destructive to a sense of community is chronic and unresolved conflict.” However, John and Julie Gottman would argue that unresolved conflict is a part of every intimate relationship. It’s not the presence of unresolved conflict that is the measure of a bad relationship but rather how it’s managed. (See The Science of Trust for more.)

Furthermore, I teach that conflict comes from only one of two sources. The first source is a difference in perspective. I see things one way, and you see it a different way. With good practices for dialogue, we can eventually discover what these perspectives are and, frequently, align them. (See Dialogue and Motivational Interviewing for good tips on how to discover and resolve perspective differences.)

The second source of conflict is value misalignment. Steven Reiss speaks of his 16 motivators (in other words, values) in The Normal Personality and Who Am I?. Johnathan Haidt discusses different foundations for morality (values) in The Righteous Mind. When you get the macro and micro values aligned between the organization and the person – and particularly from one person to another – much of the conflict evaporates.

Understanding of both perspective and values precedes the development of a firm community. However, while Maslach and Leiter see a sense of community as the ultimate goal to be aspired to, the writings of Richard Hackman, in Collaborative Intelligence, state that communities (or, in his terminology, “teams”) need to be permeable to accept new members. When the community becomes too insular and defined, it can reject attempts for new people to enter it. In today’s organizations, where turnover is an expected result, we must consider how we form our teams and our community.

Communities occur at all levels of the organization. Often, leadership is threatened or at least confused by allegiances to the community instead of to the broader organization. Communities are about developing mutual trust, and trust is contextual. Some trust is expressed in the local community of the immediate team and other – different – trust is expressed at the organizational level. (See Trust: Human Nature and the Reconstitution of Social Order for more on the dynamics of trust.)

Ultimately, we don’t want community; we want productive teams that can collaborate (work together) towards the goals of the organization.

Mutual Respect

Two of our basic human needs are to be accepted and respected. Acceptance is a prerequisite to working on diverse teams but is generally well understood. (See How to Be an Adult in Relationships for more on acceptance.) Respect is, however, often confused with agreement. It is possible to respect someone else’s perspective, values, and, ultimately, position even if you don’t agree with it. Respect starts with acceptance of the other person and their right to hold a different a position, but it builds upon it. Respect is built with the understanding of the other person’s position – even without agreement. (See The Titleless Leader for more on respect.)

Respect develops as people have the self-awareness to accept others, the conversational (dialogue) skills to truly understand the others’ positions, and the trust that the others will accept and understand you.

Basic Survival Mode

One of the quotes in the book from a high school teacher ends with, “So I’m just in a basic survival mode now.” This is a form of burnout. There’s no yearning, no reaching, and no trying. In short-term situations, this can be useful and necessary. When you’re in “survival mode,” you clamp down on the demands that are being made of you so that you can have time to recover. The problem is that sometimes people get stuck in basic survival mode without the opportunity to get out of it.

Survival mode clamps down on the demands that are being made so completely that it’s often impossible to start the self-care that allows you to recover, because self-care is in itself a demand. When employees are in this position, the best thing that the organization can do is to develop and implement techniques for temporarily supporting an employee – to give them a little slack that they can use to make investments in self-care. This could be systemic support like offering discounts on health care if they commit to a health regimen. It’s important that any support that doesn’t have secondary benefits be defined as temporary, so that the employee learns to stand on their own and doesn’t lean on the support as a crutch.

Sustainable Pace

A valid concern for burnout in today’s world is the reality that we are often working at a pace that is not sustainable. Every business struggles with short- and long-term priorities. It’s dividing in a way to try to ensure that day-to-day operations continue while finding ways to make strategic investments that pay off and allow for greater expansion, more revenue, and greater sustainability. However, in most organizations, this looks like trying to divide four by two and get four.

What we’ve learned from agile software development practices – and life – is that there is such a thing as a sustainable pace. We can push past the sustainable pace for a while, but to do so draws upon our reserves that eventually must be replenished. Organizations are at risk of increasing burnout when they’re unable to recognize the sustainable pace of their employees and only push them past it infrequently and in times of real need.

Fairness

The feeling that things aren’t fair – because they don’t meet your values of meritocracy or some other measure – are another friction point that makes it harder – but not impossible – for employees to avoid burnout. Fairness is fairly relative, being based on someone’s values and cultural expectations. For instance, in union shops, promotions are expected (and sometimes contracted) to be made based on tenure rather than merit. In some Eastern cultures, nepotism is the rule. If you approach an organization with the expectation of one system and find another, you’re likely to believe this isn’t fair. If organizations say one thing and do another, you’re likely to feel frustration, which will rob you of your power to get things done.

For my own sense of fairness, Maslach and Leiter have a wealth of great content in The Truth About Burnout. I just believe that sometimes they were so into the details that they missed the point. In a few places, I feel like their pejorative perspective on companies doesn’t reflect the symbiotic relationship that employees and companies are developing today. However, don’t take my word for it: read The Truth About Burnout for yourself and see what you think.

Book Review-Women’s Burnout: How to Spot It, How to Reverse It, and How to Prevent It

It might seem that I lack a fundamental characteristic that would make me able to use the information from Women’s Burnout: How to Spot It, How to Reverse It, and How to Prevent It; however, it’s a book that is most frequently referred to as a core book on burnout. It’s cited far more frequently than Freudenberger’s other book, Burn-out: The High Cost of High Achievement. That seems largely because, in Women’s Burnout, Freudenberger and North outline a 12-step continuum of burnout. In my continuing research of burnout, I had to make sure I read the classic.

Self-Awareness is Key

Very early in the book, the point is made that self-awareness is a critical step in battling burnout. The point is reiterated both subtly and directly as the book unfolds. The more clearly that you understand who you are, what you stand for, and where you’re going, the more clearly you can withstand the temptation to slip into burnout.

Of course, self-awareness is easy to say but difficult to achieve and perhaps more difficult to maintain. The more you become self-aware, the more you change – and thus the more you must consider who you are again.

Lies, Shame, Expectations, and Guilt

Much of the writing in Women’s Burnout speaks to the situational components that predispose women to patterns of thinking which aren’t helpful. The expectations are set up that a woman must be willing to deny their own feelings so that they can be charming – or entertaining, or pleasant, or whatever other words were used in their childhood. It’s not – generally – acceptable for a woman to have a voice. Changing social roles and perspectives are still in a state of flux, where the old Leave it to Beaver roles that many women’s mothers had are clashing with the expectations of today.

The unspoken message is that women today should be able to have everything. They should be able to keep a perfect home, a perfect marriage, and a perfect career. If they don’t, there is something wrong with them. After all, other people have it, what makes it so that I can’t? What is the flaw in me?

The lie is “if I could just work harder, or toughen myself up, it would all be working.” Of course, this isn’t a realistic or self-compassionate view. It’s built on shame and guilt. The chief concern when arriving at burnout isn’t how to be self-compassionate but is instead how to regain previous levels of productivity. If the voices are sending messages of shame and guilt — they will need to be altered to a more self-compassionate message.

Altered Thinking

When caught by the pull of burnout, we often find ourselves in denial. Denial isn’t all bad. It allows us the luxury of continuing to endure unreasonable pressures for the short term – but we can’t remain in denial forever. At some point, we need to accept reality; but until we do, denial has many tools:

  • Suppression – Active denial of the information, whether conscious or not.
  • Displacement – Feelings are transferred to another object, person, or situation.
  • Humor – A sleight of hand designed to distract from a serious condition or situation
  • Projection – Like displacement, there is a transference to another object, person or situation, but this time to shift the blame.
  • Fantasy and Daydreaming – The invention of a reality that’s more interesting or preferable to distract us from the reality we actually live in.
  • Selective Memory – Quickly sweeping ideas from consciousness and forgetting about them, so that they can’t be recalled.
  • Lying – Both denying to our self and to others that the situation exists. (However, denying to ourselves wouldn’t be considered a lie by some – see Telling Lies.)
  • Self-Labeling – Excusing behaviors as a part of your character – and minimizing them. “That’s just the way that I am” denies that there is a problem.
  • Selective Incomprehension – “I don’t know what you mean that I’m not myself.” Here, you deny the problem by making it difficult for the person who is trying to gently confront you to articulate the problem in a way that you can both understand.

Stress

Stress is a useful adaption that allows animals to survive. However, the way that we as humans process stress is the source of many health problems today. (See Why Zebras Don’t Get Ulcers for more.) While some stress can be useful, we often hold on to stress too long. There are some events that will cause us stress that we cannot change. However, one thing that we can do is to keep from holding on to that stress. It’s one thing to have the stress, it’s quite another to keep experiencing it. Here are five ways that Freudenberger and North say that we extend stress:

  • Backed-Up Anger – When we don’t allow ourselves to express our anger, we keep reliving it. Understanding that anger is disappointment directed (see Emotional Awareness) can help us release it and let it go. However, if your family didn’t accept any displays of emotion, this can be hard.
  • Denied Hostility – Failure to accept hostilities of our past, our broken and bruised places, makes it hard to live as people unintentionally keep bumping into these raw places.
  • Neglected Needs – When you don’t learn to tend to your own needs, you’re constantly feeling a “soul hunger” that keeps you from being whole.
  • Guilt – Though the word used is “guilt,” I’d suggest that it’s closer to shame. When you don’t believe that you’re good, you’re in constant state of fear that you’ll be found out. On the guilt side, you’re constantly having to make difficult tradeoffs that make you feel pain.
  • Low Self-Esteem – If you don’t think that you’re inherently valuable – or valuable enough – even small stresses linger as you wonder if they’re because of something you’ve done.

Reliving Family Dynamics

Imagine walking up to your new home and expecting the key that unlocks your parents’ home to unlock yours. On the surface, this seems silly. You wouldn’t expect that their key would open your lock. However, every day, we attempt to use the patterns we witnessed and experienced with them in our new relationships. The way that your family of origin worked is the way that you expect that your family will work today.

Each of us had a role to play in our family of origin, but those are not the roles that we should be playing – or should expect to be playing – today. Can you identify yourself in the following?

  • Appeaser – Quieting arguments or flare ups
  • Neutralizer – Anticipating and diverting trouble
  • Referee – Mediating the rules of balance and fair play
  • Caregiver – Providing sympathetic support for everyone
  • Sparkler – Garnering attention to divert attention from other problems and issues
  • Comedienne – Using humor to deflect confrontations, suspicions, and anger
  • Troublemaker – Provoking passion to gain attention
  • Leave-taker – Threatening a hasty exit to maintain control of the situation
  • Quiet absorber – Remaining mute though this implied consent.

It turns out that we’re mostly reliving these roles in our adult lives – or at least we may be – and these roles can be unrealistic and can lead to burnout.

Stages of Burnout

According to Freudenberger and North, the 12 stages of burnout are:

  1. Compulsion to Prove
  2. Intensity
  3. Subtle Deprivations
  4. Dismissal of Conflict and Needs
  5. Distortion of Values
  6. Heightened Denial
  7. Disengagement
  8. Observable Behavior Changes
  9. Depersonalization
  10. Emptiness
  11. Depression
  12. Total Burnout Exhaustion

They’re careful to say that the stages aren’t a strictly linear sequence with people having to go through each state. However, it’s clear that there’s a perception that each stage is more critical than the previous. There’s a sense that the higher you are in the stages, the more critical your state is.

What Is Wrong with Me?

Sometimes when reading a book, you see a single phrase that captures something that the author has been trying to convey for pages. The message has been hinted at, teased, and walked around but never addressed directly.

Sometimes the thought is so present and at the same time hidden that, when it finally is crystalized, you want to palm your forehead and say, “Duh.” When I stumbled across a quote that said, “Sometimes, I wonder what is wrong with me?” I realized that this is a key feeling or perspective that is deeply felt by those in burnout. There’s an inner shame that they’re not able to live up to their expectations.

Whether the expectations are internally or externally driven, they’re, well, expected. As a result, when you don’t meet them, there must be something wrong with you. This feeling of shame (see Rising Strong) so permeates with the feeling of burnout that you forget that it’s there.

The key to addressing the problems of burnout may be self-awareness, but part of it is the awareness that it’s not that there’s something wrong with you. There’s nothing you need to add to be the person that you need to be.

Drugs

The topic of drugs was woven throughout Women’s Burnout. The use of uppers and downers – coke and marijuana – was in no way hidden. There were two very interesting comments that reveal the challenges with addiction. First, one woman began budgeting coke into her monthly budget, like paying the mortgage or her car payment. It wasn’t an optional thing any longer, it was a requirement to live. Second, most people use drugs to escape their lives. Drugs as a broad category allow people to escape something painful in their lives for a time. Women in burnout, it seems, use them differently. They use them to regain their vigor. (See Chasing the Scream for more on drugs and addiction.)

They look to feel more fully alive, to recapture some of what the burnout had taken from them – and, at the same time, get the energy to do the same things that caused burnout in the first place.

Women’s Burnout isn’t itself a drug, but it may just help you recapture some of what’s lost – though you likely won’t continue doing the things that lead to burnout in the first place. If you are or know someone who may be suffering from burnout, it’s a better solution than drugs.

Book Review-Acedia & Me: A Marriage, Monks, and a Writer’s Life

Depression is a deeply personal thing. Each person confronts the demon differently. Acedia & Me: A Marriage, Monks, and a Writer’s Life is the story of one woman’s journey through suicide, depression, and, particularly, acedia. I got drawn into the story by the distinction between acedia and depression.

I wanted to understand if what we were seeing in our world today was not depression but was instead something called “acedia.” Along the twisting road that Acedia & Me follows, I had to solidify my understanding of depression.

What is Depression?

Depressive disorders get their own section inside of the DSM-5. The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association. In the previous edition, depressive disorders were lumped in with bipolar disorders; but the prevalence and importance warranted additional space, attention, and focus. DSM-5 considers depression a cluster of disorders but says, “The common feature of all of these disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function” (p. 155). A key distinguishing factor for depression isn’t found in the mainline text but is instead buried in a footnote on page 161 – “In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in an MDE it is a persistent depressed mood and the inability to anticipate happiness or pleasure.” Depression is the presence of a depressed mood, but, more critically, it’s an inability to feel pleasure.

Here though we see the problem with the diagnosis of depression and the associated definitions. It’s too broad. It includes too much. Someone who feels the need to get out and contribute to the world but simultaneously feels like the weight of doing so is too heavy fits the criteria. So, too, does someone who is sad. The guidelines in DSM-5 calls the duration of the mood two weeks or longer to qualify as depression – with a few exceptions – so there is established a time component to distinguish it from grief, but the qualifications are still needed to be clear.

Depression and Suicide

Why Zebras Don’t Get Ulcers has something important to say about the relation of depression to suicide: “The psychomotor retardation accounts for one of the important clinical features of depressions, which is that severely, profoundly depressed people rarely attempt suicide.” Despite this direct inverse correlation, depression is often associated with suicide.

That isn’t to say that there isn’t an incidence of suicide and depression together – it happens, Acedia & Me explains, as Kathleen Norris discusses her husband’s struggles with a suicide attempt. It’s to say that though depression and suicidal ideation are often assessed together – and indeed DSM-5 calls out suicidal ideation as one of several diagnostic criteria for depression – there seems to be pointers that make depression and suicidal thoughts different.

Choosing Depression

Making things even more complicated is that Why Zebras Don’t Get Ulcers predicts depression will be the largest medical reason for disability by the year 2020. William Glassier directly warns against the ills of believing in the change of brain chemistry, including the use of selective serotonin reuptake inhibitors (SSRIs) in Warning: Psychiatry May Be Hazardous to Your Health. With SSRI effectiveness in the range of 50-60% and placebo effects in the 47-50% range, it’s easy to see why there may not be much effect. This is a part of broader thoughts that some folks need to realize that they can choose something other than their depression as expressed in Choice Theory. This aligns well with Carol Dweck’s work in Mindset, where she explains that a growth (or malleable) mindset is more valuable than a fixed one.

For my own perspective, I accept that there are some people with neurochemical deficiencies in the brain that impact their ability to avoid depression. In those cases, drugs like SSRIs can be helpful. However, the research seems to say that cognitive behavior therapy (CBT) should be used. Only if that’s ineffective should SSRIs be added – and only for as long as necessary to allow the CBT to be effective. (See Redirect for more about CBT.) The long-term consequences of SSRIs (and other psychotropic drugs) are still being discovered. Recently a friend was published with a link between dementia and SSRI use.

Whatever you or I might believe about depression, acedia is something different. It’s something that gets swooped up into the broad definition of depression, yet it has a different mark on the person who is afflicted.

How is Acedia Different from Depression?

The definitions for acedia vary but often contain the words “apathy,” “boredom,” and “torpor.” At its Greek root, it means “absence of care.” Acedia & Me spends much of the book trying to precisely define what it is. The problem with the definition is that much of what acedia is has been swallowed up into the idea of depression. Depression has picked up more than sadness or lack of joy but also is diagnosed with “fatigue or loss of energy nearly every day.” The criteria for depression may inadvertently be picking up folks afflicted by something different – acedia.

Acedia misses the other symptoms of depression, unless you take a path through burnout.

Bridging through Burnout

In the review of Burnout: The Cost of Caring, I discussed how the classic definitions of burnout include being overwhelmed, cynical, or having a reduced personal efficacy. The outcomes of burnout are quite often depression. A cynical attitude sounds depressing to me. The road to depression from acedia may only have one stop – and that stop is burnout.

However, when defined in the context of a perceived lack of personal efficacy and therefore a lack of ability to control outcomes, we may find that acedia is caused by burnout. After all, if you’re feeling like there’s nothing you can do to control your life or your outcomes, what’s the point in caring about them?

The causality of the arrow isn’t clear. Does burnout cause acedia, or does acedia cause burnout – or neither? What is clear is that there is a relationship between burnout, acedia, and depression. So, while acedia may be something separate, because it is so often followed closely by depression, it makes sense that it might get misdiagnosed that way.

Misdiagnosis aside, how do you avoid the trio of conditions: burnout, acedia, and depression? How do you hold onto that idea that you are effective at moving towards your goals – particularly when you don’t know what your goals are?

Finding Life’s Purpose

In reading Acedia & Me, I was struck by the twists and turns that Norris’ life followed and the quest to find what mattered most to her. Writing was a part of who she was and what she wanted to do, but the stories conveyed that this was just one part of her world, that there remained an inner turmoil which couldn’t quite be tamed. In explaining her fears of having children and her time running the family farm, she exposed the lack of articulated goals. It wasn’t that she wouldn’t have a great impact on the world – she has. It wasn’t that she wasn’t learning deeply her faith, something that so few people even try. Instead, there was this yearning for something that was missing or wasn’t quite set right.

Most people wander through life never really pondering the mark they want to make. For some, there are unconscious answers, like having kids and raising them to be “fine upstanding citizens.” They want to teach children to help them be better prepared to contribute to the world. For others, their careers are important. The scientists want to make the next big discovery that will change the course of humankind – even if only slightly.

Few have had the patience and persistence to really understand what they want to leave the world with. Simon Sinek suggests that we Start with Why as we seek to motivate others – and that’s good advice we should accept for ourselves. However, it was the earliest monks who first described acedia. Didn’t they have their big why – to devote their lives to God?

In a sense, yes. They knew whom they were serving, but I suspect they may have had trouble articulating how they were going to make their unique contribution. What good can an individual monk in a monastery make? It turns out quite a lot, if you read the writings of some of the more famous monks. However, it’s hard to articulate a specific goal. It’s easier to answer with the platitude to know more about God or to be more Christ-like.

Perhaps they had their “why”, but they didn’t have Clayton Christensen’s insight to ask, “How Will You Measure Your Life?” The question is subtly different, but that subtlety matters. If you ask how you’ll measure your life, you’re asking a question that helps you know if you’re making progress. The monotony of the life of a monk is legendary. If you have nothing to measure your progress with, how will you keep from not caring and simply going through the motions – or not even doing that?

In the end, Acedia & Me seems to draw no firm conclusions. There’s no redemptive end to acedia for Norris (that she shares in the book, at least). There is, however, a chronicle of how she experienced it, lived through it, and learned to persevere. Perhaps that’s all we can ask for. I’d prefer to think that there’s a resilience from burnout and acedia in shaping our perceptions about what we want to do in the world – and how we think we’re doing. (See Hardwiring Happiness for changing our perspective.) Generation X – of which I am a member – was supposed to have lost their faith (see America’s Generations). I, however, continue to hold on to the belief that the world is getting better, and I’m doing my part to change it for the better. I hope to say that I never have to walk such that I feel it’s just Acedia & Me.

Book Review-Burn-out: The High Cost of High Achievement

I like tracking back to the beginning of a topic. I want to know where things started. That’s what I found in Burn-out: The High Cost of High Achievement. I had previously reviewed some of Christina Maslach’s work – Burnout: The Cost of Caring – but her work started after or near the same time as Herbert Freudenberger. The writing is very different. Freudenberger’s perspective is down in the trenches and real.

As a working therapist – and someone who had personally experienced burnout by trying too hard to save the world without recognizing limitations – Freudenberger’s work is real and, in some places, raw.

Something is Missing

Have you ever struggled with something that was at the far edge of your consciousness? Maybe it’s song lyrics that you just can’t quite place. Maybe it’s a someone you saw, but you can’t remember their name – or where you know them from. Most people have experienced the sensation of knowing that something is there, but they just cannot get to it.

That’s one of the ways that Freudenberger describes his experience. His patients kept looking for that something missing in their world. They felt like their lives would be complete with their next accomplishment. The next rung on the ladder is all they had to reach to make themselves whole. However, the problem is, as Oscar Wilde put it, “In this world there are two tragedies. One is not getting what one wants, the other is getting it.”

If you do get what you want, then what next? On the other side, not getting what you want leaves you with a longing. That longing, properly modulated, provides the pull forward into the future. However, improperly managed, it can cause stress that you’re not enough – or that you’re never going to make it.

For high achievers, who were Freudenberger’s clients, there’s always that something missing. Those who learned to manage it well found a way to leave his office whole. Those who couldn’t figure out how to modulate that pull continued to struggle.

Not Whole

There are two ways to look at our strivings. First, we’re looking to fill a hole in our soul. It’s that something missing that Freudenberger’s clients struggled with. This is working from the perspective of a deficit that must be redeemed. Second, you can approach the struggle as a way to build upon a firm foundation. You can view the strivings as a “+1” to everyone’s life.

For those who are struggling in the pit of burnout, it’s the first – deficient –perspective that they hold. It’s that things are not enough. It’s that, individually, they are not enough. This is the trap of burnout. You begin to feel like you’re not enough. Instead of your strivings being life-giving, being a way that you can share your light with the world, it becomes more and more proof that you’re not enough.

Like the burnt-out shells of buildings, burned out people feel like they’re empty, hollow, and missing something. They feel as if they’re not whole.

Blindness

In every case of burnout, there’s some element of blindness. There’s a blindness to the person’s truth about themselves, including their completeness as a rational and emotional being, or about the world around them. The blindness results in a misalignment with themselves or the world. This misalignment makes it difficult for someone to function effectively.

Blindness to oneself and your own identity is tragic. It’s like never getting to know the only person you’ll never get away from – yourself. You never find out who the person really is, because you can’t see some aspect of them. This kind of blindness leads us to doing things in ways that deny part of ourselves.

Blindness to the world prevents us from seeing how the world really is. In doing so, we can’t adapt and function in ways that are harmonious. It’s like walking through the dark and constantly stubbing our toes on furniture, because we just don’t know it’s there. It’s much easier to walk across the room safely when you can see where to step – and where not to. You can expect to make it across the room quickly and without injury only when you can see the room completely.

Expectation Management

With blindness, we land in a world where our expectations – of ourselves and our world – are out of whack. This leads us to believe that we’re incapable of our goals – or that our goals are too easy and should be within our grasp too soon.

Both perspectives lead us to burnout. One because we can’t see the path that leads us to success, and the other because we become frustrated and disillusioned that we’re not seeing the results we expect. Reality keeps leaking in around our blindness to make us aware that we’re not achieving the goals we set for ourselves.

Instead of finding ways to adjust our expectations into the appropriate range, we find ourselves disturbed by the experience and looking for escapes. We find ourselves looking to coping skills to ease the pain that our reality doesn’t match our perceptions.

Luxury to Necessity

The path to addiction isn’t one step. One drink of alcohol does not afflict you with alcoholism. The path to disfunction, and addiction, is converting a coping skill from a luxury or occasional indulgence into a necessity. An addiction counselor colleague said that it’s not that the alcoholic wants a drink, it’s that they feel this overwhelming, visceral need to have a drink.

What may have started as a luxury to help them cope in a difficult time has become for them the only way they know how to survive. It’s no different to them than eating, drinking water, or breathing. To use Freudenberger’s words, their luxury had become a necessity.

The burned-out person is susceptible to addiction, because they need the coping strategy to function. Instead of the coping helping them deal with life, they’ve transitioned to the coping being required for life.

Staring into the Darkness

Because burnout is, in Freudenberger’s perspective, somewhat about the blindness, it’s important to find that blindness. Finding the blindness about ourselves and our perspectives on the world is not easy. Our views of the world are deeply held, and our brains work diligently to reinforce their beliefs, so disconfirming data is difficult to see. However, seeing the world as it truly is – seeing past the blind spots for the outside world – is relatively speaking easy.

Looking into the blind spots inside ourselves is substantially harder. It’s harder for people to peer into the darkness of their own soul to see the parts of themselves that they want to deny and ignore. It’s hard to accept that the perfect image they’ve been projecting isn’t the real person.

Finding the blindness inside of oneself is much like staring into the darkness and waiting for the light to emerge. It takes courage to stand and face the darkness for a long period of time. Physiologically, our eyes become more sensitive to light the longer we’re exposed to low levels. Thus, the more that we stare into darkness, the more we can see. However, it’s difficult to be willing to avoid looking at the light for long enough for this to happen.

Psychologically staring into the darkness is similarly difficult and similarly we get more clarity the more we’re willing to stare into the darkness of ourselves the more likely it is that we can cure – or partially cure – the blindness that we have about ourselves as a whole person.

False Cures

The darkness is easy to turn away from with something that’s new and exciting. Taking up SCUBA diving or skydiving gives a momentary thrill that is capable of making someone feel more alive at a time when they’re burned out and empty inside. These kinds of thrills – and thrills like doing illegal things – provide a momentary high that make it appear that everything is alright. It’s possible to feel once again and the feelings are good. However, the suppression of feelings that is caused by burnout returns soon enough.

When Freudenberger wrote his book, self-harm “wasn’t a thing.” However, today it’s a challenge that counselors deal with as children and adults seek to feel something by inflicting pain on themselves. These poor folks, as I understand it, have suppressed their feelings to such a degree that the only way for them to feel is to cut. Sure, it’s pain, but it’s something. They’ve denied feelings to such an extent that nothing else cuts through the blockade. They’ve literally got to find a way to inflict pain to be able to feel anything again. This too is, of course, a false cure. It’s only temporarily relieving the core problem that they have – which is their lack of feeling.

It’s easier to fall into the trap of a false cure rather than stare into the darkness and develop a sensitivity to how we feel and to let those feelings out – no matter how scary that may be initially. By externalizing the solution to the problem, we’re looking outside for relief from the disharmony that exists inside.

Being Content

Freudenberger makes the point that our reality is subjective by saying that one man may be perfectly content making $20,000 per year. (You may need to adjust his numbers, since they’re from a few decades ago.) Another man may be unhappy making $100,000. Our expectations drive our acceptance of our reality, but there’s something more.

There is an aspect of being content. That is, there’s a tension between accepting things as they really are and, at the same time, the desire to make them better. Instead of feeling like it’s broken, incomplete, or not enough, you can feel like it can be improved, that there’s a better answer, and that there’s more that can be done.

Successes Amply Balance Out Failures

Evolution favors the organism that pays attention to their failures. (See Hardwiring Happiness for more.) As a result, we’re predisposed to ruminate more on our failures than to celebrate our accomplishments. Over time, this imbalance of attention leads us to believe that our failures outweigh our successes. We gloss over the accolades that we receive and instead see only the negative feedback – constructive or otherwise.

One of the difficulties that leads to burnout is the belief that we are a failure – or that our failures mean we won’t ultimately be successful in our goals. We believe that we aren’t enough, because we see the ledger with more red ink than black. However, we neglect the fundamental understanding that we are human beings with both faults and function. All of us can do great things – and fail at others.

You Are Not What You Do

High achievers tend to see their value in terms of how they’re able to accomplish things. They’ve grown accustomed to constant reinforcement that they are valuable or interesting or special because of the things that they do. What happens when the accomplishments temporarily falter? It’s like breaking the surface tension of a bubble. The bubble falls apart when a small break occurs in the surface tension.

There will be breaks in the feedback and accolades coming in. The random nature of our world ensures this will be a reality. One of the ways that high achievers can avoid burnout is to avoid building a dependence on these accolades – and perhaps by reading Burn-out: The High Cost of High Achievement.

Book Review-Burnout: The Cost of Caring

It’s been many years now since I first experienced burnout – and since I have written about it. I was not – and am not – in the kind of professions that Christina Maslach focuses on in her book Burnout: The Cost of Caring, but I experienced burnout just the same. My works were Tips for Identifying Burnout in Yourself and Your Staff (June 23, 2003) and Breaking Out of Burnout Mode at Work (June 30, 2003). They were part of a weekly column I was writing at the time. I expressed a general sense of what burnout is and some useful tips for getting out of it, but I didn’t have the clarity on the topic that I now have. Unfortunately, Burnout: The Cost of Caring doesn’t seem to offer any more clarity than my articles so many years ago. However, there some nuggets to be gained.

Compassion Fatigue

Most people in IT aren’t labeled with compassion fatigue. They’re assumed to have no compassion to begin with. However, in professions such as nursing, psychiatric counseling, and others, the people who start out with a great deal of compassion for others seem to have lost their way and become burdened by that same compassion. What once was the primary gift they wanted to give the world has become the burden that they can’t lift.

To some degree, it can be that no one ever bothered to look to see what compassion really was. It felt good to take care of others and receive that recognition that you were being a good girl or boy. As people grow up, they continue to look for that same recognition and find roles or professions where that is designed to be the case. You can go into nursing, teaching, or counseling to be told what a great job you’re doing with patients – or what a noble cause it is.

However, compassion is the awareness of desire to alleviate the suffering of another human being. (See the post Sympathy, Empathy, Compassion and Altruism for more.) This is not the benefit that people want from compassion-focused professions. They want a result that involves being recognized for their compassion.

Lack of Recognition

The problem with doing compassionate professions in a way that meets expectations is that there is generally no recognition. While working on productions – whether church services or plays – if the technical team did their jobs right, no one noticed. That’s the point. We’d serve in a way that removed the distractions from the performance. When meeting expectations in compassion-based professions, you rarely hear any feedback or praise.

Perhaps it’s because there is so little recognition for a job done well, even if the role is vital, that it has made getting meaningful feedback from managers, peers, and subordinates such a big factor in whether people stay in their jobs or leave. However, the larger issue is not whether they stay with a company but whether they stay happy and engaged.

Burnout Basics

I disagree with Maslach about the basics of burnout and how it functions, more in sequence and severity rather than the observations of its results. Maslach says that burnout is defined by exhaustion, cynicism, and inefficacy. However, I believe that the root that allows burnout to grow is perceived inefficacy. That is, observationally in myself and others, I find that burnout has nothing – or little – to do with hard work. Attitude influences whether someone believes that they’re being effective or not – but it’s an influence on the perception of efficacy.

So, while burnout – according to Maslach – seems to have three roots, I believe the real root cause is the belief in personal efficacy.

Nothing Ever Happens

There’s a Del Amitri song titled “Nothing Ever Happens.” It’s about the continual monotony of life and our struggle to make it better. The truth is that life is monotony. Wake up, eat, do some work, and, ultimately, go to sleep again. The cycle repeats endlessly.

There is, however, inside of us a desire to make our world or our society something better. That desire to make things better distorts our expectations such that we expect that each day will be just a little bit brighter, a little bit less work, and a little easier. So, while we repeat the same patterns, we long to make them different – better.

Mind the Gap

Ultimately, our perceived lack of personal efficacy is the gap between what we expect that we can and should do and the results we see. Change or Die explains that we’re all slightly delusional. We all think we’re more powerful than we are. We believe that we’re better than other people, and we ultimately have more control than we do. Consider that depressed people aren’t viewing the world negatively, they’re viewing it realistically. They have more realistic perspectives on their power and capabilities than their non-depressed contemporaries.

So the problem with personal efficacy is to set the bar high enough that we strive to reach it – and not so high that we’re disappointed in ourselves when we don’t reach it. The mental state of flow and the research around it suggests that we should have the right balance between skills and challenge – and that gap might be around 4%. (See The Rise of Superman for more.)

Our ego is a powerful thing capable of bending our perception of reality. (See Incognito for more about how our perceptions are important, not objective reality.) However, at some point, even the ego feels the strain of repeatedly having one expectation and not being able to meet those expectations. Burnout is the perception that things won’t get better – because we’re not seeing the results that we expect.

Perception

Ultimately, it doesn’t matter whether we’re objectively making progress. What does matter is the perception of whether we’re making progress. Given the “What you see is all there is” bias, it’s easy to believe that not seeing immediate progress means there isn’t any progress. (See Thinking, Fast and Slow for more about this bias.)

Even folks for whom the outside measures appear to be going well don’t necessarily feel like they’re making progress – or making enough progress. We can ride over these moments of feeling like we’re not getting anything accomplished if they don’t occur for too long or come too frequently. In effect, we can say, “I know it doesn’t look like we’re making progress now, but overall we are.”

The problem when the impacts come too strongly or too frequently is that we’re not able to smooth over the rough patches, and all we end up with is rough times trying to reach our goals.

Find Your Why

To figure out whether you’re making progress or not, it’s necessary to understand your goals – or not. One of the challenges that face most humans is that they’re not clear about their goals. Their goals are uninspiring and unarticulated like “just to survive another day;” or they’re lofty, poorly-formed, and unrealistic such as “end world hunger.” In both cases, the lack of clarity has a negative impact on the ability to see progress towards the goal.

Simon Sinek wrote Start with Why, which explains that we as humans need to know why we’re doing something before we’ll want to do it. Clayton Christensen, James Allworth, and Karen Dillon wrote How Will You Measure Your Life? In it, they seek to focus readers on the things that are important to them in the long term. Books like these – and others – encourage self-reflection to understand what we’re doing and why. It’s these “why” questions that focus us on the ways that we measure progress. Whether we know our why or not, we’ll still measure everything on its ability to move us towards that why.

Framework not Foundation

A word of caution about finding your why and articulating it exactly. Robert Pozen shares dozens of life tips in Extreme Productivity, including the expected tips about having a plan and executing against that plan. However, as he closes the book, he admits that the greatest opportunities and successes in his life didn’t come from the well-measured and planned activities. They came from the random things that chance and life brought him.

Most of the great people I’ve known didn’t set out to be exactly who they are. Often times, the contributions that people make to society are in the general field that they intended to be in but not exactly where they left their mark.

How to Measure

Nebulous things like where you want to go in life, your why, are often difficult to nail down. They’re not the kinds of goals that can be defined as SMART. SMART goals are specific, measurable, achievable, realistic, and time-bound. The goals of our life aren’t like that. There aren’t any stopping rules. (Which would make them a wicked problem, as defined by Dialogue Mapping.)

Despite their nebulous nature, you can seek to find indicators that help you know you’re making progress along the path. Sometimes you can define specific components of the goal that you can measure. For instance, if you want to feel like you’re making a difference in people’s lives, you might have a specific goal like: “I’ll receive more written compliments this year than last.” As long as you don’t try to manipulate the system to get more written compliments, this can be a good measure of whether you’re making progress. (If you want to understand how interference may have negative long-term effects, you might look at Thinking in Systems.)

Ultimately, nothing is impossible to get more information about by measurement; it’s just that some measurements are easier than others to make. Some are more accurate – or indicative – than others. Douglas Hubbard explains in How to Measure Anything, well, how to measure anything. If you’re struggling to find a way to measure progress towards your goals, it’s worth a look.

Burnout Doesn’t Require Clarity

Though finding your why and understanding how you’re making progress towards your life goals, it’s important to recognize that whether you can articulate your goals or not, they’re still there. And much like the framework suggested in The ONE Thing, there is generally a why at the heart of each area of your life. Collectively these “whys” make you who you are.

Equally important to recognize is that progress in one area of your life may discourage burnout in another area. If you’re seeing great rewards and progress with your children, you may find it possible to withstand soul-crushing work experiences without the slightest hint of burnout.

Burnout Is Not Your Fault

It used to be that employers expected employees to leave their personal problems at home. They were aware that employees were humans with lives outside of work, but that wasn’t what they were being paid for – so it shouldn’t interfere with work. A part of this attitude included that burnout, whatever it might be, is a personal problem – a defect of character – and shouldn’t enter the workplace. This led burnout to be treated in silence and shame rather than being viewed as a business problem.

Times have changed. The way that businesses run has changed, because they’ve had to. Employees want to bring their whole selves to whatever they do. They expect organizations to accept and embrace the fact that they’ve got personal lives outside of work. Organizations have learned that employee engagement is a problem that’s sucking productivity out of employees. They’ve learned – some begrudgingly – that an employee’s problem is their problem.

Employee assistance programs were developed to allow employees to seek counseling and other services. These kinds of problems were once considered outside of the corporate purview, but the issues addressed by these programs are seen as causing performance problems at work – and thus worthy of employer concern.

So we’ve moved from a place where burnout wasn’t talked about or accepted to a world where burnout is a part of the larger problem of a lack of engagement, and it’s something that organizations want to address – cheaply and easily, of course.

This is good news for the employee who doesn’t have to feel isolated and alone in their experience of burnout. The bad news is that few people still understand its causes and what to do about them.

Personal Efficacy

The heart of burnout is, as stated above, the lack of belief in personal efficacy. However, this is a fine line. There is a level of self-agency that’s required – the belief in the ability to impact the outcomes in your life. However, too much self-agency leads to the belief that you control the outcomes, and therefore when you don’t get the outcomes you want or expect, you’ve somehow failed.

Too little self-agency, and you’ll feel learned helplessness. You’ll feel like what you do doesn’t matter. Too much and you’ll be a narcissist who believes that you can get the outcomes that you want in the face of insurmountable odds.

To manage burnout well, it’s necessary to manage the perception of personal efficacy such that you believe you have influence on the outcome – but not control.

Detachment

Learning to detach from the outcome – that is, to accept that you can only do what you can do, and the outcome will be whatever it is – is critical to mitigating the risk of burnout. When you realize that you don’t control the outcome – that you only influence it – you don’t have to accept that a failure to get the desired result means you’re a failure. (The Happiness Hypothesis has a more detailed conversation about detachment and it’s importance.)

But Wait, There’s More

Through a set of unusual circumstances, we’ve decided to put together a new training program titled “Burnout: Prevention and Recovery.” It picks up where this review leaves off – and where Burnout: The Cost of Caring couldn’t go. If you believe that we’re on the right track with this thinking that builds on the work of others but also converts it into something more tangible, real, and addressable, reach out and let us know, so we can keep you up to date on our progress.