When You Just Can’t Face Another Day of Pandemic

As we head into year 3 of Covid, many of us are feeling burned-out, depressed and anxious. Today, Dr. Saltz and her special guest, Dr. Aditi Nerurkar, co-host of the Time Out podcast, tell how we can bring joy and energy back into our lives.

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Episode Transcript

Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help. I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,

(00:27):
hopefully with understanding, insight and advice. So I began this
podcast in due to the emergence of the pandemic and
the rise as a result of mental health issues for
so many And here we are in two and unfortunately,
so is the pandemic, and with a continued rise in

(00:48):
the number of people struggling with mental health issues. While
for many people, the high levels of fear have decreased,
the sustained uncertainty, anxiety, required safety measures, the work burden
losses many people have suffered, and loneliness that many people
are suffering, have increased levels of anxiety, burnout, depression, substance

(01:13):
use and abuse, and overwhelming stress in many more people.
So today I'm answering a question from a listener who
is struggling with feelings of burnout, and to help me,
I've brought a special guest today, Dr Adity newra Car
is a physician, speaker, and correspondent with expertise and stress, resilience, burnout,

(01:37):
and mental health during the COVID nineteen pandemic and of
course before that, and of course beyond that. She's a
lecturer at Harvard Medical School and the Division of Global
Health and Social Medicine and serves as the co director
of the Clinical Clerkship in Community Engagement. Previously, she's worked
in global public health at the World Health Organization, which

(01:58):
will be important in our dis cushion today actually, as
well as a medical director at Boston's Beth Israel Deaconess
Medical Center. And importantly, she has a new podcast that
is out from both My Heart and from Hello Sunshine.
It is called time Out, a fair play podcast. It
is co hosted by best selling author Eve Rodsky, and

(02:21):
it really covers a lot of this kind of content,
the content about stress and burnout. And so I'm really
delighted that she can be with me here today to
help us out in this podcast. So thank you first
of all for joining me and tell us a little
bit about how you're you're feeling about your new podcast.
It's a pleasure to be here. Dr Gail so Eve

(02:44):
Rodsky is a dynamo and she truly has spearheaded this
podcast with her work in family mediation, gender equity and
all of the ways in which we can make our
home our most important resource. So even I partnered together

(03:04):
in this podcast. As you said, it's a co production
of Hello Sunshine and I Heart Media. It's one of
the first co productions and podcasts of these two as
a joint venture, and we were thrilled to both be
a part of this because it really speaks to all
of these relevant themes that you talked about, you know,
particularly as it relates to women, so stress, resilience, burnout,

(03:27):
mental health, but in the context of the pandemic that
she session, the great resignation, and in many ways all
of the stressures that we face as parents during the
pandemic and pandemic parenting. And so in this particular podcast,
what's so neat for both of us is that Eve
is the storyteller and I'm the scientist. So we really

(03:49):
do look at these themes from two different lenses. We're
both researchers, we've both done this work for a long time,
but through our different vantage points. I'm a doctor at Harvard.
She trained at Harvard in the law school. She's a
Harvard law graduate, and so we really have that nice pairing.
There's a lot of humor, but also very deep research. Wonderful, wonderful.

(04:11):
We love science based stuff on this podcast. So before
we get to my listeners question, what have you been
observing in terms of the rising mental health issues that
I alluded to earlier, and what would you cite as
the biggest factors right now in driving what's happening? You know,
Dr Gail, It should come as no surprise to you,

(04:32):
of course, and likely neither your listeners, But these statistics
are so bleak, they're actually worse than what we imagine.
We're all, in some way, shape or form, really facing
that sense of burnout and stress, and our resilience is
really being taxed. We're entering, as you said at the
introduction of our conversation, year three of this pandemic. We

(04:53):
thought and we were mentally prepared for a pandemic sprint.
Initially at the start of the pandemic, we thought, oh,
it'll be a few weeks, perhaps a few months. Now
this is just dragged on and on. The finish line
is changing, and it's a never ending pandemic marathon. It's
a cognitive shift that we weren't prepared for, and so
many of the drivers are because of that, that sense

(05:15):
of impending. You know, there's no closure, there's no finite end,
and so it just drags. And therefore all of our
inner reserves and that inner fortitude that we have has
really just you know, we're all running on fumes here.
What's been remarkable for us, even I in this podcast journey,
this is our first podcast, both of us together. What's

(05:38):
been remarkable is at the start, when you're working on
a podcast, you're not sure if there's going to be
if it's going to resonate, if there's going to be
a reception. And we were floored within the first week
the outpouring of messages and emails and texts and just
people feeling like this message resonates so deeply because it
really speaks to our communal suffering, the burnout and mental

(06:00):
health challenges, and there's so many drivers. It's a pressure
cooker situation and it truly is the perfect storm. So
one thing that I've discussed on this podcast before in
different ways, is that willpower is finite, right, we don't
have infinite willpower. It's not a bottomless well. And so
you're you just tire of sort of using that muscle,

(06:21):
and that resilience isn't a matter of just sticking it
out no matter what. That too much trauma on and
on and on sort of washes over us and doesn't
help us build coping tools and doesn't ultimately really lead
to resilience. But that measured amounts of difficulty or some
failures that you find your way through and do develop

(06:43):
a means of coping with. Ultimately, that's what builds resilience.
So in that sense, as you said, we thought we
were in this sprint and we thought, Okay, I'll hold
my breath and do what I have to do because
I see there's a light at the end of the tunnel.
So I can maintain I will power and I can
and use certain coping tools in order to build resilience

(07:06):
out of this. And now for many people it's feeling
like I just I don't know if I can do
it anymore. I just don't know if I can do
it anymore. So one of the things that I want
to be able to address is is just that that
feeling I think that you're describing, and that from this
other sort of viewpoint, I'm describing that many people, whereas
we're like, okay, well homecron is not as severe. Many

(07:29):
people are vaccinated, and those things are true, and they
should give us a lot of let's say, optimism or
good feeling. But at the same time, we know, hey,
another mutation could come along. We still aren't out of
this wave. It still has a lot of meaning for
what we should do. And meanwhile, it's been almost three
years of battening down the hatches and being afraid and

(07:53):
dealing with uncertainty, and that is taking a toll without
assurances of relief. So, not surprisingly I got a listener
question and let's see, how can we help, dear doctor Salts.
My place of work has delayed returning to in person

(08:14):
due to the Omicon wave of COVID. They are saying
they plan to have us come back to the office
in about a month. In the meantime, I have increasingly
become so unhappy with work. I feel like there are
never enough hours in the day for me to complete everything,
and at the same time I feel completely bored, unmotivated.

(08:37):
I'm having trouble concentrating, and to be truthful, I feel
like my work quality has slipped. I dread signing on
every morning to my computer, and my days feel endless. Generally,
I'm feeling pretty miserable and sitting alone at my computer.
I don't know how long I can keep this up.

(08:58):
At the same time, need my job. I used to
like my work. I'd like to get that feeling back.
I just feel all this time sitting alone in my home,
I become totally burnt out. While I'm nervous too about
going back in, even though it would seem like that's
the good thing to do. I think it might be

(09:20):
better for my psyche. But what can I do to
feel better in the meantime, and what can I do
about the anxiety about going back. I truly feel stuck
and miserable. So I'm gonna let you take it away
with your thoughts on that one. Wow, such a powerful letter,
Dr Gail. You know I've been speaking to corporations throughout

(09:43):
this pandemic about this very issue, and if there is
a silver lining, and they're very few during COVID, is
that in the workforce and in corporate America, there's a
greater awareness of mental health, particularly as it relates to
burnout and the pandemic. So what your reader as expressed
in the letter is the rule and not the exception.

(10:04):
STA statistics show that seven out of ten people note
that this past year has been the most difficult of
their professional career, sev of the workforce has at least
one feature of burnout, and about sixty say that COVID
is the culprit. So it's not so much that COVID
is just a public health crisis, you know, I speak
on air for NBC and MSNBC about COVID in public

(10:26):
health because, as you said, my former background and with
the w h O. But COVID is not just a
public health crisis. It isn't also an occupational health crisis
in that we are really learning how to reframe what
it means to work and live and parent within four walls.
As you know, being a psychiatrist, the brain functions well

(10:49):
with compartments. Compartmentalization is an important part of our brain
and its ability to process, whether it be difficult emotions
or complex problems, or reasoning or cognitive functions. When we
are forced and confined to the same four walls, and
doing all of our roles. You know, we're multidimensional creatures.
We are workers and parents and siblings and friends and spouses.

(11:15):
But yet when we are doing all of those roles
in one place, our sanity, frankly is really undermined. And
so it's no wonder with this reader. You know what's
shocking and often startling to me is people have the
same story and yet they feel so alone. So we
are having a collective experience of isolation, loneliness, feeling burnt

(11:41):
out and anxious at the same time. It is a
collective experience, but we are going through it alone, which
is the great irony of this situation. How can I
help with Dr Gael Salts will be back after the
short break. Yeah, So, to return to the question at hand,

(12:09):
the World Health Organization did really not that many years ago,
define burnout or make it a diagnosis. Let's put it
that way. It's not a d s M five diagnosis.
It's not a psychiatric diagnosis, but it is for the
World Health Organization in terms of it being a medical
issue that is really stress related but really generated by
employment specifically, as opposed to a psychiatric cause. The implication

(12:34):
being removed the employment, or remove the stressors of the
employment and you remove the burnout. So that leaves people
in a in a real dilemma, um in terms of
you know, as this person is saying, like I need
to work, and in fact, I even enjoyed my work
and I'd like to recoup that. But in addition, it's
now causing me this symptom complex that is very akin

(12:58):
to many psychiatric problems like depression, like anxiety disorders. And
so what can we advise this person who is experiencing
something they could have even experienced before COVID. But it's
just become much more frequent because as you said, where
now we don't even have the social interruptions during our day,
like somebody comes over, strolls over and does like some

(13:20):
creative thinking with you about a problem or some problem solving,
or it's just supportive. We don't have, as you said,
the breaks like now I've left work and I have
come home and I will be with my family or
I will just relax. Now it all feels like one
big commission and and like you're working all the time,
and you're parenting all the time, and you're everything all

(13:41):
the time, which of course is something that would lead
to burnout, So how can we help this person who
is feeling stuck with having to do it all? You know?
The first sort of step is that sense of awareness.
So I'm so glad that this reader of yours named
it and said, I think I'm experiencing burnout. Well, we're
often realizing, especially now, is that, like you said, the

(14:03):
w h O defined it as an occupational phenomenon. Many
people know that there are typical features of burnout apathy,
not feeling very productive, increased errors. But what we are
noticing now more than ever, is that the atypical features
of burnout are much more pronounced. Six people have an
inability to disconnect from work, which is an a typical

(14:26):
feature of burnout. So I'm so pleased that your reader
has identified many of these themes as burnout, because they
might not always look like burnout, you know, the classical
expression or meaning or what we think of as burnout,
and yet they are. The first step is awareness and
recognition of their being an issue. The second, really important

(14:49):
step is understanding that you are not alone. It is
incredibly validating and normalizing when you can share your experience
like your reader has, other people will listen to this
podcast and then perhaps mine and eves podcast time out
and then realize, Wow, I'm going through such an intense
and difficult and isolating experience and so is everyone else

(15:14):
in our world, in the medical world, you and I
know that that is called the group effect. That is
why group therapy is so effective. Is because when you
go through a traumatic, difficult experience that you're going through alone,
spending some time in a group, sharing your experience with others.
Getting that sense of validation from others helps to normalize
the experience, and in our brains it regulates because we

(15:37):
are social creatures ultimately as human beings, So even this process,
as difficult as it is and as isolating as it is,
when we can share with others and express our grief
and they also, rightfully so have the same grief and
shared experience that somehow boys us up. And then the
third step would be to concretely make change. Like your

(16:00):
reader said, it is impractical for them due to financial obligations,
rental obligations, that they just walk away. You know, it's
really difficult, but there are ways, very science back strategies,
tips and tricks that we can employ in our day
to day to help minimize our stress, improve our mental health,

(16:21):
and build resilience from the inside out. I hope this
was helpful to my listener. Let's now maybe if you
could list a few of the top strategies you used
to tell people, Hey, this is something you can employ

(16:43):
in your employment, you know, to help yourself if you
are experiencing burnout. So even I talk a lot about
these practical everyday strategies in Time Out the podcast. One
very clear and concrete strategy is a meeting yet diet.
I've written a lot about this. I've spoken a lot
about this when we are keyed up and have a

(17:05):
sense of hyper vigilance with our fight or flight syndrome
in high gear like we do during a pandemic, because
it is stoking our primal urge and our primal response
of fear. Checking the news as a primal urge, constantly
being online what's the latest, you know? And setting your
setting a timer, making sure that you're not checking the

(17:26):
news first thing in the morning when you wake up.
It elevates your cortisol level and naturally will biologically prime
your body for stress and ultimately down the road if
it continues to burn out Because of all of these
external factors, the second is to protect our sleep. We
don't realize the depth of how important sleep is, and

(17:49):
sleep could truly be a therapeutic intervention right now, so
aiming for an early bedtime and there are many strategies
around how we can really protect our sleep. Moving our
body another incredibly important and effective tool, getting out of
our heads and into our bodies. A simple twenty minute
walk has been shown to have lots of psychological and
mental health benefits. And the fourth that we talk about

(18:12):
extensively in our podcast is this idea of creativity and
finding ways to spark our creativity. You know, we often
think of creativity as something that only happens during leisure time,
or happens when everything is rosy and then oh, let
me just pick up a new hobby. But as we've
learned through speaking to various guests and in our own research,

(18:35):
is that creativity really flourishes and blossoms during periods of strife, stress, grief,
and it is an incredibly powerful coping tool for the brain.
And there are many ways that creativity can foster resilience,
minimized stress, minimized burnout, and we lay it all out
in our podcast and an Eaves book Finding Your Unicorn Space,

(18:58):
and in a lot of my work about the idea
of taking concrete steps every day. They don't have to
be revolutionary. It doesn't have to be a great declaration,
but small incremental changes that you can make every single
day from that minute when you wake up and check
your phone, rather keep that phone away from you, even
out of your bedroom, all the way through to the

(19:20):
end of the day as you go to bed. There
are so many things we can do throughout the day
to really build up your resilience, minimize stress, and really
we have to learn how to work with our biology
rather than against it. You know, our brain is always
changing and it responds to what we do, and so
when we do better, we feel better. And I'm just
going to add to that that creating an artificial, concrete

(19:42):
end to your day, so you know, whatever that might be.
It's six pm, it's seven pm, letting your boss know
you're gonna put a limitum when you answer emails, and
don't answer the emails, don't look at the emails, because
when you answer your email eleven pm, then everybody is like,
oh good, you're available at eleven pm. That's that's great. Um,
So you can creating an end to your day, the

(20:03):
end being the end of the computer or whatever it
is that might end your day, so that you do
have a discreete ending. Um. Looking at your workload, it's
okay to discuss with an employer. You know what is reasonable,
what has become unreasonable and really just can't be done
by anyone, And so how you can delegate, how you
can offload. Can you plan something that would be enjoyable

(20:26):
to do on the weekend, that is play that is
defined ly different from work that you have to think
of ways to basically make work more discreet again and
rise the level of other elements of your life that
do create the play the break. Um. So there is
this definition between the two that that turns out to

(20:48):
be very helpful as well. With burnout, I want to
thank you so much for being with me today and
helping to answer the question. And of course there is
probably more information as you're saying, even more information on
your podcast, which is time out if their play podcast,
which is a co production between Hello Sunshine and I
Heart Media, And so you can hear more of Dr

(21:12):
Nora car on her podcast if you want some more
information about this really important topic. Thank you so much
for being with me today. Thanks Dr Gail, it was
such a pleasure. Do you have a problem I can
help with? If so, email me yet. How can I help?
At Seneca women dot com, All centers remain anonymous and

(21:35):
listen every Friday too. How can I help with me?
Dr Gail's Salts