How Not to Crack Under Pressure

Human pillars need holding too.

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People who are pillars aren't hard to find. They come in many forms. Caring nurses. Ardent social workers. Loving volunteers. Committed citizens. Devoted teachers. Conscientious doctors. Always-on parents and caregivers. Servant leaders. But those who bear extraordinary loads run the risk of cracking. And collapsing.

A couple of weeks ago, I was given the honor of presenting a Grand Rounds lecture at Harvard Medical School on this very topic. For anyone in health and social impact professions, there’s a disproportionate risk of burnout. It is a serious public health issue that begs collective attention and will. Human walls aren’t made of steel or cement, and when they buckle, we all suffer.

Here are some of the points I raised:

Burnout is a thief.

It robs of many things: zest, your "why," and any semblance of peace. In many cases, it affects physical health and the ability to enjoy anything at all. Burnout is considered a tridimensional process marked by emotional exhaustion, depersonalization, cynicism, and decreased sense of accomplishment. Emotional exhaustion is the most common consequence suffered among health and social impact professionals.

Burnout isn’t a matter of personal failing or weakness.

Many tirelessly devoted practitioners are haunted by the pervasive, haunting question: “Am I doing enough?” (My naming convention for this is “Underperformance Dysmorphic Disorder." I doubt it will make its way into the DSM-5 anytime soon—but maybe it’s worth writing to the committee.) Practitioners need to find a wider mirror that helps them see themselves within a context that breeds indisposition, rather than believing one is not meeting the mark, burdened with guilt and despair.

The risk of burnout is especially off the charts for health and social impact professionals.

Don’t count on staying well if you’re in the helping professions. When one’s vocation and ethos call them to a life of service to humanity, they often suffer inhumanely. Patronizing slogans minimize the problem—like being told to put your mask on first, even when there’s a critical shortage of masks, with no instructions on how to use them or time to do so. Noble professions deserve more than trite slogans and forced martyrdom.

Burnout made headlines in 2019.

You know it’s serious when the World Health Organization (WHO) makes the bold move of reclassifying burnout as a health syndrome resulting from various aspects of how we are required to work or how the work environment itself adversely affects our well-being. In other words, context matters. It is hard to stay functional within dysfunction. I doubt that the WHO’s decision was cavalier—ICD reclassifications aren’t impulsive, random whims. They are data-driven calls to action worth paying heed to.

People aren't meant to bear constant weight without reprieve.

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Burnout incubates in human systems.

Addressing burnout takes courage and candor. The structures that demand human bearing walls have serious structural flaws. Social policies, if they continue to exist, must reflect a devotion to treating people who provide care with care, not as infinite resources to burn through.

Burnout isn’t inevitable or insurmountable.

Research has shown there are protective factors that can be leveraged—both by individuals and organizations—to protect against burnout. This starts, as most things do, by recognizing the problem and taking steps to prevent and mitigate its consequences.

Realistic recovery opportunities must be offered.

Sure, we can’t all just toss our phones in the woods and go on a six-month sabbatical. But shortening lunches, inflexible schedules, inhumane shifts, and expectations galore aren’t cited anywhere as factors that contribute to increased resilience. Constant load-bearing isn’t sustainable, especially given the critical shortage of skilled professionals.

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Behavioral science has a lot to offer frayed systems and workers.

Fixes for crumbling, dysfunctional systems include applied approaches like reducing the friction that makes work tasks cumbersome and inefficient. Then there are temporal landmarks—known as the “fresh start effect”—that can help ignite effective change approaches. Research has shown that devoting a set point in time to advance progress helps. And “commitment devices”—stating intention and holding each other accountable—show promise as catalysts for change.

Relationships can reshape culture.

The literature offers some interesting caveats on the importance of relationships—specifically, that it’s not the classic supervisory setup that matters most but the informal networks developed inside and outside work that offer a daily help process to bolster resilience and inspire collective efficacy. Also, civility is underrated. Workplaces that encourage positive citizenry are more likely to flourish.

During my time in this field, I’ve seen a lot of crumbled walls. Every time I see colleagues languish or leave—watch another support beam give way—my heart drops.

We can’t treat human and social impact providers like infinite resources. People aren’t made of cement.

If cultures and societies want better health, it seems reasonable to ask for better standards of care for the walls holding them up, lest we all run the risk of getting crushed. The tacit expectation for professionals to take care of everyone but themselves is inhumane and illogical. Tired walls need more than a fresh coat of trendy paint. They need reinforcement to stand tall and a closer look at the foundation in which they're situated.