The way out of burnout

By Josh Cohen

A patient of mine named Elliot recently took a week off from his demanding job as a GP. He felt burnt out and badly needed to rest. The plan was to sleep late, read a novel, take the odd leisurely walk, maybe catch up on “Game of Thrones”. But somehow he found himself instead packing his schedule with art museums, concerts, theatre, meetings with friends in hot new bars and restaurants. Then there were the visits to the gym, Spanish lessons, some flat-pack furniture assemblage.

During the first of his twice-weekly evening sessions, he wondered if he shouldn’t slow down. He felt as exhausted as ever. Facebook and Twitter friends were joking about how it all sounded like harder work than work. “I’m trying to figure out how I’ve managed to be doing so much when I didn’t want to be doing anything. Somehow not doing anything seems impossible. I mean, how can you just…do nothing?!”

When Elliot protests that he can’t just do nothing, he is seeing and judging himself from the perspective of a culture that looks with disdain at anything that smacks of inactivity. Under constant self-scrutiny as to whether he is being sufficiently productive, he feels ashamed when he judges himself to have come up short in this regard. But this leaves him at once too drained to work and unable to rest.

As I describe in my feature for the August/September issue of “1843”, this is the basic predicament of the burnout sufferer: a feeling of exhaustion accompanied by a nervy compulsion to go on regardless is a double bind that makes it very difficult to know how to cope. Burnout involves the loss of the capacity to relax, to “just do nothing”. It prevents an individual from embracing the ordinary pleasures – sleep, long baths, strolling, long lunches, meandering conversation – that induce calm and contentment. It can be counterproductive to recommend relaxing activities to someone who complains that the one thing they cannot do is relax.

So what does it take to recover the capacity to do nothing, or very little? I might be expected at this point to leap to psychoanalysis as an instant remedy. But psychoanalysis is emotionally demanding, time-consuming and often expensive. Nor does it work for everyone (a basic truth of all therapies, physical or mental).

In less severe cases of burnout, it is often the case that difficulties inducing nervous exhaustion are more external than internal. Time and energy may be drained by life events (bereavement, divorce, changes in financial status and so on) as well as the demands of work.

In such cases, it is worth turning in the first instance to more external solutions – cutting working hours as much as possible, carving out more time to relax or for contemplative practices such as yoga and meditation. This is as much a matter of discovering a remedy as the remedy itself. Merely listening and attending to the needs of the inner self as opposed to the demands of the outside world can have a transformative effect.

But such solutions will seem unrealistic to some sufferers both practically and psychologically. Practically in the sense that many of us are employed in sectors that demand punishing hours and unstinting commitment; psychologically in the sense that reducing working hours, and so taking oneself out of the highest levels of the game, is likely to induce more rather than less anxiety in someone driven relentlessly to achieve more.

So while there are many means by which we can be helped to relax, the predicament of severe burnout is precisely that you cannot be helped to relax. Where burnout has psychological roots, psychoanalysis may be able to help.

One way is its “form”. The nervous exhaustion of burnout results from their enslavement to an endless to-do list packed with short- and long-range tasks. In a psychotherapy session, you sit or lie down and begin to talk with no particular agenda, letting yourself go wherever your minds takes you. For portions of a session you might be silent, discovering the value of simply being with someone, without having to justify or account for yourself, instilling an appreciation for what the American psychoanalyst Jonathan Lear calls “mental activity without a purpose.”

Another way is the “content” of psychoanalysis. Talking to a therapist can help us discover those elements in our own history and character that make us particularly vulnerable to specific difficulties such as burnout. In my feature for “1843”, I discuss how two patients came from early childhood to associate their worth and value with their levels of achievement. Under constant pressure from within to “be their best”, they were liable to feel empty and exhausted when, inevitably, they felt they’d failed to live up to this ideal self-image.

This was very much the case for Elliot, and goes some way to explaining why the idea of “just doing nothing” so scandalised him. Even today, as they approach old age, Elliot could never imagine his parents putting their feet up talking, reading or watching TV. He remembers family meals taken quickly, with one or both parents in a hurry to rush off to one commitment or another. His own life was heavily scheduled with homework and extra-curricular lessons, and he was never more forcefully admonished by either parent than when he was being “lazy”. “They were kind of compulsively active”, he said, “and made me feel it was shameful to waste time. You could imagine the seats of their chairs were rigged to administer a jolt of current if they sat on them for more than ten minutes.” Only now is he beginning to ask why they, and he in turn, are like this, and why being at rest for any length of time is equivalent in their minds to “wasting” it.

Insight like this can be helpful to challenge our unthinkingly internalised habits of working and our dogmas as to what constitutes a “productive” use of our time. It encourages us to think about what kind of life would be worth living, rather than simply living the life we assume we’re stuck with.

Illustration Izhar Cohen