The agony of acceptance

Cycle of Hercules by Francisco de Zurbaran (1634)

“It’s no good trying to get rid of your aloneness. You’ve got to stick to it all your life. Only at times, at times, the gap will be filled in. At times! But you have to wait for the times. Accept your aloneness and stick to it, all your life. And then accept the times when the gap is filled in, when they come. But they’ve got to come. You can’t force them.”

D. H. Lawrence, Lady Chatterley’s Lover

Why is acceptance so hard?

Part of the reason appears to be the uncertainty of what we should accept. We are often bound by the tension that exists between being grateful for what we have, and the desire to stretch beyond our current capacity. Acceptance isn’t about any particular situation at work or in life; it is coming to terms with who you are, and letting go of thoughts and behaviours that lead to self-sabotage

This kind of acceptance is recognising your frailties and flaws, whilst honouring your strengths. Ultimately, acceptance is self-awareness. Self-awareness can provide you with the confidence to act in accordance with your values, rather than being pulled by others expectations. Without understanding your own values, it is easy to fall for someone else’s. It is when we are pulled by a “should” that we descend into the morass of self-deception, and its resulting cynicism and resentment.

Acceptance is hard because it is uncomfortable. It is often confused with passivity, when in fact it is in direct opposition to passivity. Acceptance implies wrestling with uncertainty and contradiction; of accepting and coming to terms with uncomfortable truths. Through acceptance, there can still be change, however this change can only occur without being forced or pushed by fear. Fear of being inadequate, of not having enough, pushes us to distraction. This distraction manifests itself in the blind ambition and greed that tries to plug an emptiness that can never be filled, like Tantalus and his grapes. 

Acceptance appears to be a willingness to become who we wish to be, by having the willpower and patience to conform into who we think we should be. So much of how we think is determined by our social environment, and so we may not even realise that we are being led astray by the ‘Royal Should’. Putting up with the discomfort that arises from the resistance of ‘shoulds’, can open up the space needed to listen, examine and, let go. This process is uncomfortable because our thoughts and actions don’t exist in a bubble of isolation; it can be difficult to find the space needed to begin this process of uncovering. Indeed, we may even fear what lies underneath, instead choosing to distract ourselves with busyness, pushing away the pain that needs to be addressed.

Acceptance appears fundamental to the experience of the good life. It is also a key aspect of many psychotherapeutic techniques that are used to treat those struggling with mental suffering or illness. The difficulty of acceptance lies in its opposition to our intuition. Our mental life is so often focused on solving problems, moving from one to the next, that it can be very difficult to accept a problem, rather than trying to remove it. The problem that we rush to fix may only be the tip of a much larger iceberg of issues that we are unconscious of, and therefore unwilling to approach. Trying to fix problems without understanding their root cause is like cutting the head off a hydra. Acceptance starts with the psychological flexibility of making peace with contradiction and uncertainty. It can be the inflexibility and rigidness of our mental life that starves us of the vitality we crave.

Burnout: The long shadow of idealism?

“Almost Once” – Brett Whiteley

In order to burn out, a person needs to have been on fire at one time

Ayala Pines

COVID-19 has shone an overdue light on the indispensability of workers that we often take for granted. Nurses, doctors, social workers, taxi drivers, cashiers, cleaners and many others. Whilst many of us have had to adjust to the comparatively mild inconveniences of working from home, these workers are often putting their health at risk to deliver essential services and care. As this emergency and lockdown continues, these workers will need access to comprehensive support to stave off and manage the effects from burnout. The term burnout is most commonly used with reference to those who exert significant “emotional labour” in their work, which refers to the requirement of managing emotions and feelings whilst dealing with people (i.e patients or customers) with the term becoming ubiquitous across not just healthcare but also professional services occupations.

Burnout, more than just exhaustion

A recent definition by Christina Maslach of the University of California, who originally coined the term and Michael Leiter, currently at Deakin University, provided a concept of burnout as: 

“…the index of dislocation between what people are and what they do. It represents an erosion of value, dignity, spirit and will – an erosion of the human soul. It is a malady that spreads gradually and continuously over time, pulling people into a downward spiral from which it is hard to recover.” 

For Maslach and Leiter there is a dislocation of what people are and what they do, causing a split where actions no longer reflect values. This split leads to a chasm of meaningless that in turn can become a downward spiral of rumination, self-doubt and eventually depression. The dislocation means that the underlying values that supported an initial devotion or idealism have shifted or dissolved, usually as the result of some perceived or actual failure or a head-on collision with a difficult occupational reality. 

What is interesting about the above is the inclusion of words such as values, spirit and soul. This definition by Maslach and Leiter alludes to the fact that burnout syndrome, cannot be viewed simply as exhaustion but as something related to existential loss of meaning and purpose. Viktor Frankl, the late psychiatrist, holocaust survivor and founder of Logotherapy could have the key to understanding why burnout is becoming more common. Frankl’s overarching philosophy of the “will to meaning” suggested that to avoid depression and existential despair, one had to authentically live out one’s underlying values by paying attention to what is meaningful. These values are not necessarily moral, but are related to a deeper sense of what attracts your attention, focus and sustained, conscious action; an integrated embodiment of an individual’s orientation toward and action within their framework of meaning.  

For Frankl, he believed that the decline in spiritual and religious life, what he referred to as the noetic dimension, had led to a vacuum of meaning which had been filled by a new kind of devotion to work and it is this devotion, which can sew the seed for burnout. In research published last year by Norbert Riethof and Petr Bob, in Frontiers of Psychiatry, the initial stage of burnout actually involves very intense experiences of meaningful life and work, a kind of idealism or devotion that by the end of the burnout process has been lost following a perceived failure to live up to impossibly high expectations. 

A bright burning candle casts a long shadow and the shadow of idealism appears to be burnout.

There is a counterintuitive element here, which is that burnout appears more likely to affect those that demonstrate a higher level of idealism in their work. Idealism can be a valuable trait for an individual and the organisation they work for as it motivates people to make a difference and go beyond what is asked of them. However, the resulting excitement elicited by this acute sense of meaning, can lead to excessive dedication (perfectionism), a lack of clinical or personal detachment and an obscuring of insight into the knowledge of one’s own limitations. A bright burning candle casts a long shadow and the shadow of idealism appears to be burnout.

Excitement and stress are two sides of the same coin with both of these emotions releasing the stress hormone cortisol, which the body uses to prepare for action. The secretions of these hormones build up over time and if behaviours and work practices aren’t changed, they can have a serious effect on physical and mental health leading to a potential breakdown and in the most extreme cases, suicide. In the United Kingdom a 2018 study found that the probability of doctor’s committing suicide was five times higher than the general population, with a significant factor being the pressure that doctor’s are under due to a lack of resources. 

The difficulty with the term “Burnout”

The trouble with managing burnout partly comes from the difficulty in its definition and diagnosis. In a recent survey of intensive care health professionals the overall number of those categorised as suffering from burnout ranged from 3% to 40% depending on how the syndrome was defined. Part of the difficulty of “diagnosing” burnout is due to its interaction with other mental health issues like depression, begging the question, how much is the term ‘burnout’ simply a socially acceptable label for someone actually suffering from depression? Some of the key descriptions of burnout; loss of enjoyment in things you used to find enjoyable (such as work), persistent fatigue, apathy and cynicism are actually key diagnostic criteria of the American Psychological Association for major depressive disorder. In addition to this, 2017 research in the Journal of Neuroscience and Biobehavioral Reviews, found that there was no distinction between the biological markers in the brain of those diagnosed with burnout compared to those diagnosed with major depressive disorder.

The ubiquity of the term ‘burnout’ leads to a number of issues. Overdiagnosis of the syndrome leads to a perceived normalisation of this as a necessary occupational hazard, resulting in acceptance and no urgency in developing the appropriate support frameworks. This resulting lack of support can lead to declining levels of work productivity, job satisfaction, employee engagement and increasing levels of stress and depression. Finally, it appears as though using the term is becoming a euphemistic veil for what is actually depression, something which could prevent someone seeking help due to a normalisation of this as a facet of professional life.

Beyond burnout

Mindfulness training has recently received a lot of attention from researchers and organisations as a technique for reducing physical and mental stress. Mindfulness meditation, leveraging present moment awareness, can help to create space between thoughts, emotions and actions. This “space” can help to improve cognitive empathy, otherwise known as detached concern, whilst learning to manage and not get caught up in emotional empathy, or taking on the emotional states of other people (patients, customers). This awareness can also provide an insight into an individual’s limits, informing them of when to take a step back and some time out, whilst also providing a positive perspective on purpose and achievements. The practice can act as a kind of ‘reset’ of the mind, a process that un-conceals values and brings awareness of actions, allowing a restoration of meaning through integration of both.

Beyond personal practices, a broader shift in how workplace mental health is dealt with, including the communication and support for those with occupationally specific depression could also have a significant impact. A comprehensive review of burnout treatments in 2010 found that a combination of personal and group interventions provided by organisations had the largest effect on managing burnout in individuals. This was partially due to a greater level of acknowledgement about burnout and its potential as an occupational hazard, in turn providing people with support and also an implied understanding that those suffering weren’t alone in how they were feeling.

Bringing it all together

The after-effects from the strain of this crisis are likely to be felt most acutely when the lives of most of us go back to normal. The present moment is a critical opportunity for us to re-evaluate the importance of these individuals, putting in place the proper resources and support to ensure that we protect those that are under so much strain at this time. By developing the adequate support structures for those in critical care industries, organisations can reduce the number of workers lost to burnout and workplace depression, in turn maintaining continuity of standards, care and service for those that rely on them.