Self-Care Is Not The Cure For Burnout

Photo by Max Kukurudziak on Unsplash

Most online discussions of burnout take the form of some coach on Twitter listing 20 ways to cope with it and then asking, “what would you add?” The list items range from reasonable entries like “get 7-9 hours of sleep each night” to rather extreme ones like “wake up at 5 AM, take a cold shower, drink a gallon of water, and deadlift.”

The problem is, the last thing a person actually suffering from burnout needs is a list of 20 more things to do.

In fact, although it can be helpful, self-care is not the solution to burnout. Nor is a lack of self-care the cause of burnout. While these online discussions may be well-meaning, they perpetuate the myth that preventing burnout is primarily the responsibility of individual employees. In reality, the true cause of burnout is a toxic workplace culture and unreasonable expectations on the part of owners and managers. 

The ICD-11 (the global standard for healthcare diagnosis) defines burnout as a syndrome caused by chronic workplace stress. It has three main components: exhaustion, cynicism or negative feelings toward work, and a reduced sense of efficacy or control over outcomes. 

Research on burnout overwhelmingly points not to lack of self-care, but to workplace factors like excessive workload, unrealistic expectations, lack of control, and lack of social support at work as its most important causes.

I know a thing or two about burnout. I worked as the Clinical Director of a treatment center for women with serious mental health problems from February 2020 to September 2021–essentially, the first year and a half of the pandemic. To say that this was stressful would be a severe understatement. Our treatment center offered both residential and outpatient care, and after working from home for several weeks during the initial lockdowns, I was back to working in-office and at least potentially exposed to the virus on a daily basis. In addition to figuring out the logistics of how to provide mental health care during a pandemic, I often found myself providing compassion, courage, and comfort to patients when I myself was freaked out, stretched thin, or low on resources. But although these circumstances were harrowing, they were not the reason I burned out. 

Instead, the causes of my burnout were both more prosaic and more insidious. There seemed to be more paperwork than I could ever keep up with: most of it mind-numbingly boring, like signing off on progress notes or checking over the interminable forms needed to keep our patients’ insurance companies from prematurely booting them out of treatment. My inbox was an endless flood of emails. Our HIPAA-compliant instant messaging platform was the bane of my existence. At one point, I estimated that someone knocked on my door every five minutes to ask me a question. And then there were on-call weeks, when I would sometimes be woken up at three in the morning or pulled away from a family dinner to deal with a crisis.

Throughout this time, I was the world’s biggest advocate for self-care. I meditated every day. I got eight hours of sleep every night (unless I was on call). I even took an actual lunch break every day in order to model that behavior for my team. During clinical supervision and annual reviews with my direct reports, I checked in with them about their stress levels and coached them to find self-care practices that worked for them. My team saw me as a kind of Zen master, cool and collected even when work was a three-alarm dumpster fire. 

But in the end, burnout still came for me. By the end of my tenure at the treatment center, I was exhausted. I’d started getting acid reflux for the first time in my life, and it felt like the job was taking a toll on my physical as well as my mental health. I started having more negative thoughts about work, and eventually started planning my escape. In September of 2021, I quit and started my private practice.

As someone supervising a team of psychotherapists, I also got a close-up view of the burnout arc as it manifested in my team members. 

People who choose to become therapists and work with patients with severe mental illness tend to be highly empathetic and compassionate individuals, with a sincere desire to help. 

Although the therapists I worked with cared deeply about their patients–and were frequently perplexed, annoyed, befuddled, flabbergasted, and brought to tears by them–they never really complained about it. As a Tibetan Buddhist monk once told me, real compassion is not a limited resource. My team members had chosen to work with these patients and they knew it. Instead, the factors that burned them out were–once again–an overload of paperwork, constant communication, and greater demands than they had the resources to meet. 

One of the most frequent gripes of modern knowledge workers is the demand placed on their attention by constant electronic communication via email and Slack. Author and computer science professor Cal Newport has argued forcefully that the toll this ceaseless chatter takes on our attention makes us incapable of focused work on what matters–what he calls deep work.

I saw this phenomenon first hand in my workplace. Therapists were interrupted so frequently during work hours–by emails, texts, or clients in crisis–that they couldn’t sit down and focus long enough to complete their paperwork. They coped by bringing it home and doing it in the evenings–cutting into the precious free time they might have used for self-care, or simply having dinner and connecting with their families.

Beyond just the hours of leisure or self-care lost, having to bring work home is demoralizing. It often leads workers to feel resentful of their jobs and hopeless that they will ever be able to catch up. These emotional factors are the horsemen of the burnout apocalypse, leading directly to the cynicism and reduced self-efficacy that distinguish burnout from simple exhaustion.

It’s not just therapists and healthcare providers who are experiencing this. Among the therapy and executive coaching clients I work with in my practice, taking work home seems to be the new normal. And it’s not because there is suddenly somehow more work to do than before–it’s often because employees can’t get these tasks done during work hours (whether in the office or at home) without being interrupted. 

In my position as Clinical Director, I tried to address these more systemic factors. I often found myself advocating on behalf of my team to keep caseloads and expectations in check. I argued, unsuccessfully, for deleting our infernal HIPAA-compliant messaging app. But I was only one person, and there was too much pressure from ownership, insurance companies, and other systemic forces to make a real difference. The frustration I felt with this intractability only deepened the burn.

While self-care can be helpful, it’s ultimately not enough. All the meditation apps, yoga classes, and aromatherapy in the world are not enough to make up for the soul-crushing demands of our current work culture. It’s like putting a Band-Aid on a gaping wound. Worse, our single-minded obsession with self-care falsely shifts the responsibility for preventing burnout from companies to individual employees, thus burdening them with even more unrealistic expectations. 

In order to stem the tide of the burnout epidemic, company owners and managers need to take responsibility for shifting the culture by reducing workloads to humane and manageable levels, reality-checking their expectations, and giving employees more agency in their work lives. Only then will workers have enough time and energy left over for meaningful self-care.

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This post is part of a series of essays I’m publishing on Wednesdays, in addition to my regular Monday newsletter.

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