Self-Care..."by the road to the contagious hospital"*
As I sit in my office exploring research in addictions treatment and the relative efficacy of various approaches, I am drawn to reading about burnout in the addictions profession. Not surprisingly, there is great similarity in the causes of burnout among multiple helping professions during a pandemic with all the dangers and uncertainty we have been forced to tolerate. Disparate recommendations from multiple sources, an impact of political viewpoints, roll out of a new vaccine, followed by potentially frightening mutations emerging across the globe; all of these and more combine to create an atmosphere in which it takes a deliberate, concerted, and sustained effort to maintain focus and hope. And both are required for the resilience necessary to be present for effective care in mental health, and in medicine.
The literature on self-care has grown exponentially in recent times, seemingly overnight like Jack’s beanstalk, and much of it seems like simple common sense, perhaps questionably useful. Or, maybe good advice, but not for those swamped with sick patients, documentation burdens, administrative duties, and household responsibilities, all with none of the usual outlets now shut down by a pandemic. Hailed as the holy grail for mitigating burnout, it is even more challenging to implement self-care strategy in an atmosphere of uncertainty with chaos looming around the corner. Features of burnout in addiction work are easily generalized to other areas in mental health, and the practices of frontlines physicians. Dombrowski (2020) describes feelings of powerlessness, isolation, unrelenting focus on work, and discouragement as chief contributing factors. I can hardly argue with these though I might be tempted to add to the list. I would be curious to know what individual clinicians are doing, if anything, to shore up a sense of well being, achievement, of possibility and hope. I would be curious to know what clinicians are doing to negotiate intense feelings of anxiety, overwhelm, anger, betrayal, disappointment, dread, and grief.
So, what is self-care exactly, and how does it help if it does? Is it more than a contemporary cliché, or a set of dubious recommendations by an administration removed from the vagaries of day-to-day critical care? Frequently mistaken for simple luxuries like bubble baths and pedicures (which can be rejuvenating), self- care is actually a deeper concept, and one that is particularly foreign to medicine. Traditional medical culture expects clinicians to be strong and steadfast amid all adversarial circumstances. It doesn’t make time for exploring one’s personal response to exposure to the tragedy of those in our care. To be a healer in medicine is often equated with being stoic, not admitting to or showing fear, anxiety, or grief. Or if so, only fleetingly. Compartmentalization, a typical defensive strategy among clinicians, is effective in the short-term. It gets us through a crisis, allows us to focus, do the work. But in the long run this begins to wear thin and in a pandemic it isn’t enough. We are struggling with burnout at record levels.
Not everyone functions this way of course, there are practicing clinicians immersed in the specific impacts of compassion for our own experiences, but it isn’t the norm (for more on this find Dr. James Doty, a neurosurgeon who researches altruism and compassion in medicine). Self-care extends to oneself the same grace, compassion, and empathy that one extends to clients or patients, friends and family. It means admitting to personal needs, recognizing these, and making the time and space to meet these without feeling judged, guilty, weak, inadequate. It means facing our difficult reality head on and adjusting expectations accordingly. It encourages us to find ways to disconnect from our work without feeling guilty, whatever that looks like to each individual. It means making concerted efforts to stay meaningfully connected to those around us. For a culture focused almost exclusively on doing for others, unused to self-reflection, all of this can sound as impactful as listening to a foreign movie with no subtitles. The problem with articles on self-care is they sometimes require learning a whole new language, and who has time amid all our responsibilities? And faced with the fact that maybe, despite everything we try, we might find ourselves feeling burnt out anyway, because we are coping with extraordinary circumstances day to day, minute to minute.
Hopefully, we will have ample opportunity to sift through our experiences in retrospect and make new meaning of the traumas we are currently negotiating, putting our shattered assumptions to new use. Meanwhile I am back to the toll the pandemic has taken on those struggling with addictions, another of the many faces of burn out, and what therapeutic approaches hold out the best hopes for recovery and a rich life. And perhaps, a new terminology for self-care, that is, stepping down from the lonely pedestal we have been sold, and rejoining the human race- reacquainting ourselves with other instincts and seemingly frivolous joys.
Drombowski, F. (2020). Advances in Addiction & Recovery, 8(4), 33-34.
Williams, W.C. (2011). Spring and All. New York, NY: New Directions