Monday Must: AMA — Dr. Kayla Simms

We're thrilled to introduce our brand new series of Ask an Expert. Twice a month our expert will pick a couple reader questions to answer. We hope they resonate with you, as much as they do with us!

Dr. Kayla Simms is a physician specializing in general adult Psychiatry, based out of McMaster University’s Waterloo Regional Campus. Her clinical interests include emergency and outreach psychiatry, student mental health, and collaborative care. She is committed to providing patient-centred care and enhancing medical practice and training through the arts and humanities. Kayla is also a new mom, and is a passionate advocate for equitable, intersectional models of practice.

How do I get out of the obsessive work/burnout cycle? I work from home, independent

 There are many factors that influence our relationship with work - financial, cultural, relational, and personal. In our productivity-obsessed society, it's all too easy to be swept away by the pressures of deadlines, evaluations, and supervisory oversight. This has been ever more present during the pandemic, where the boundaries between work and life have become hazy: Are we working from home? Living at work? Did we ever leave? Suddenly, our sacred spaces have become overwhelmingly infiltrated by the supposed convenience of being reachable 24/7. It's become all the more important to set boundaries between these two spaces, but for most of us riding the fast-moving professional locomotive, that is a privilege we just can't afford. If everyone in the office is responding to the boss's emails in the wee hours of the morning, how do we establish a healthy relationship with work when "everyone else is doing it"? And these behavioural ideals can be even more tricky to navigate when we are our own boss. 

So how do we reconcile the work obsession/burnout cycle? First, we need to differentiate ourselves from our work. In addition to dismantling the productivity workhorse perpetuated by a capitalistic dogma (simple, really), there comes a time when we realize that work isn't going to love us back in the ways we were promised. Like any relationship, we can't get everything we need from one person. Your friend Eileen might be a cool cat to catch a flick with on a Saturday night, but spending every minute of every waking day with them and expecting they fulfill your every complex and multifactorial need is bound to get tiresome and leave you running on empty (Come On, Eileen). The same is often true for work. It can sustain us financially, stretch our brains in exciting ways, and invigorate our creativity. It can also keep us from our loved ones, exhaust us mentally and physically, and leave us feeling existentially wrought. Expecting any singular thing we do for 40-plus hours a week to satisfy us for 40-plus hours a week is bound to set most of us up for disappointment. And worse yet, we're socialized to believe that this felt disappointment is somehow our fault, and not a fault of the system. So let's remind ourselves first and foremost that work is the thing we do - not the thing we are. And it's more than okay to be "a good enough" worker.

Next, we need to establish our N.E.S.T.S - the things we need to stay mentally okay: Nutrition, Exercise, Sleep, Time for self, and Supports. These 5 principles are often mislabeled as "basic", but in reality they are challenging to implement on a day-to-day basis. Using a 'progress, not perfection' approach, try accomplishing just one of these things a day, and then work your way through each to establish a foundation of self-care that is meaningful for you and your lifestyle. Do some stretches while brushing your teeth; try a bedtime routine that limits screen-time; take the stairs over the elevator at work; or call a friend for a chat. And above all else, be kind to yourself on the days where these things don't happen.  

Next, let's pay attention to the core drivers of "work": Accomplishment and Pleasure. Accomplishment drives our feelings of mastery - the things we do for the outcome (e.g. cooking a meal, catching up on e-mails, watering the houseplants, folding laundry). Making your bed every morning is an excellent example of this, and can be a simple way to feel accomplished. Pleasure, on the other hand, drives our feelings of fulfillment - the things we do for the process (e.g. watching a show, reading a book, painting, making music, journaling, taking a bath). Scheduling these into your weekly calendar, like you would a doctor's appointment or dinner party, can be a great way to ensure you "follow your plan, not your mood". Take a moment to reflect on the value of your work and why you chose it while also reflecting on other sources of purpose and meaning. It's normal (and totally expected) that work won't check your every box. If a workday provides you with one of these two things, be sure to supplement for the other. 

And finally, there's coping with the things we can't control, managing the things we can control, and finding meaning in the in-betweens. Accepting help, avoiding emotional isolation, and being open with your supervisors and co-workers about where you're at mentally and how they can best support you can't be understated. Remember that what you're experiencing with work is often shared by others, and expressing it can help to create the space for colleagues to connect with those same feelings and share in the task of meaning-making. Initiating these dialogues may be the first step to challenging the norm and shifting workplace culture. And if you're really stuck, take the time you need from work to check-in with yourself and rebalance those scales. Work is one part of who we are, and we can only show up for it meaningfully if the other parts of ourselves are nurtured, seen, and felt. 

How do you deal with a person who lashes out constantly while experiencing a burnout?

 Let's start by establishing a shared definition of burnout. Burnout is an occupational syndrome characterized by emotional exhaustion, feelings of detachment and cynicism toward people and work, and a reduced sense of accomplishment. Although burnout is work-induced, its symptoms are experienced in both a professional and personal context. Recognizing ourselves as burnt out is extremely challenging - early warning signs exist, but once we're in it, stigma and denial can set in and it can be very difficult to rectify the experience. The silent suffering of burnout can lead us to mistakenly believe that we are isolated in the experience, or that how we feel is a right-of-passage of the workplace. Both of these conclusions are inaccurate, and each has very dangerous implications. 

Let's also establish a very low tolerance of mistreatment. If the person lashing out at you is a supervisor or a co-worker, then my suggestion is you seek out immediate help from your workplace supports (e.g. HR department, a colleague, upper management). I would label this workplace abuse, and it's a nonstarter as far as I'm concerned. 

 If this person is a loved one, then burnout may explain their behaviours, but it does not excuse it. You are likely coming from a place of understanding and compassion for their circumstances, and knowing their lashing out is a product of the burnout is a red flag for this needing to be brought forward to them. Make explicit what they're doing to you as a result of how they're feeling, that you're concerned and want to help them, and that you are on their team. If doing so comes at a cost to your own mental health or subjects you to more harm, then it's also okay to connect them with the appropriate resources and take a step back from the situation.