Responding to Moral Distress and Burnout

“I feel overwhelmed, tired, and don’t know what to think or do anymore.”

I met a number of people in my practice this week who professed that they felt stressed, anxious, and confused by the roller coaster of political and environmental events that are unfolding by the hour — the sense of not knowing where our country or the world is going.

Kevin, a neighbor and a grandfather of six, worries whether his grandchildren can grow up in a free-thinking, democratic country, one that gives equal opportunity and education to all.

Amina, a therapist of Palestinian origin, told me that she had to close her practice as she feels too sad and anguished to be working with her clients. She told me that she feels physically depleted, has frequent headaches, and trouble sleeping.  

John, a 42-year-old journalist who has worked for more than a decade covering conflicts and crises around the world, told me he could no longer function as an objective journalist. He feels haunted by images of schoolchildren crushed by a bombarded building, their feet dangling from the rubble.

These symptoms are part of a condition called “moral distress,” which can lead to burnout. Moral distress, first described in the nursing literature, is a psychological state that occurs when a person witnesses what they feel are ethically incorrect actions but is constrained from doing anything about it by external circumstances. We see something that we know is wrong, we want to help, to do something, anything, but we can’t. We’re left feeling devalued, overwhelmed, and powerless.

There are three commonly recognized stress disorders. First, there is burnout itself, which is experienced as a sense of profound exhaustion, physical and emotional, a feeling of being detached or “checked-out,” and a sense of the futility and inadequacy of attempting to make things better.

Next comes compassion fatigue, more accurately called “vicarious traumatization,” which results from being secondarily affected by another’s suffering. An example of this would be first responders who arrive at a scene of devastation to help people who have lost their homes because of climate-related wildfires or floods.

And then there is the above mentioned “moral distress syndrome,” which arises when a person feels their hands are tied and they are powerless to do the right thing. Of all the stress syndromes, this is perhaps the most relevant for all of us living in these times. These are the young people who are frustrated by how politicians are failing to take this danger of climate change seriously. This is the volunteer working for the homeless who hears that a judge has just ordered a removal of their make-shift homes. This is the relative of a pregnant girl who needs a life-saving abortion in the South part of our country.

Research shows about two-thirds of us are already experiencing symptoms of burnout. Review the following symptoms and see if this could be you:

·  Do you still feel depleted after a weekend off work when you’ve had a chance to rest, or even after a good vacation?

·   Do you feel numb, surreal, or disengaged from work and life? 

·  Do you find that you’re always falling short in your efforts but notice that you don’t care about this as you might have in the past?

If you answered “yes” to some or all of these questions, you may be burned out. If you are, what can you do? Is it possible to stay healthy and engaged without shutting down?

Here are 10 steps that will help you to find your way through the wasteland of burnout to a more verdant, healthy, and engaged life:

1. Recognize what’s happening and don’t make it worse by beating yourself up for being burned out. Pause and look at yourself with compassion and understanding.
2. Decide to take some time to reflect on what’s really going on. Think about how you can better take care of yourself. It is often wise to ask for advice from a friend, a counselor, or a spiritual guide.
3. Take a self-care inventory. What are you already doing to protect yourself from stress and restore your batteries? For example, are you getting enough sleep, eating healthy food, staying away from excessive toxicants, taking your meal breaks, and leaving work on time? What additional steps can and will you take to lessen stress and have more time for what makes you feel happy and well?
4. Mindfulness is a highly effective and well researched way of boosting your self-care. Mindfulness, the nonjudgmental attention of breathing, body, thoughts and feelings, has beneficial effects including quieting our “monkey minds” and prompting the relaxation response.
5. Journaling is also a powerful way to become aware of our complex internal landscapes and to express emotions in a safe and healthy environment.
6. If, despite doing all the above, you feel deeply troubled, seek a counselor or therapist who can offer psychological insights and give you perspective.
7. Edwin Rutsch’s “Empathy Circles” help create a way to safely build bridges between ourselves and others. Listening deeply and being heard allows us to feel open-hearted, open-minded, and generous. Please check out The Empathy Center: theempathycenter.org.
8. Non-dual meditation practices create solid positive results as well. They touch into the deeper ground of life and cultivate resilience. Through non-dual meditation practice, we transcend a sense of exaggerated self-preoccupation that can exacerbate feelings of isolation and alienation. When we learn to recognize and rest in our primary awareness, a state which is naturally spacious, at ease, awake, and lucid, we tap into deep, inner sources of wellness.
9. We cannot do it alone. From 12-step programs, we know how important community support is. We need to find a community of support with like-minded people that works for us.
10. In her book Trauma and Recovery, Judith Lewis Herman, MD, recommends engaging in what she calls a “survivor mission.” An example would be a parent of a teenager who committed suicide starting a group for other parents who have lost their child to suicide. Healing and meaning can come through social or spiritual action. Such acts can really make a difference. As historian Howard Zinn puts it, “small acts, when multiplied by millions of people, can transform the world.”

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In October the authors will start a Deep Resilience Group at the Empathy Center, 1964 Las Canoas Rd., every Wednesday at 6 p.m. This free series will also be offered online, as a hybrid presentation.  The link for more information is mindfulheartprograms.org.

Radhule Weininger, Ph.D. is a clinical psychologist in private practice and a founder of Mindful Heart Programs. She has been a student and teacher of mindfulness, compassion, and non-dual awareness practices since 1981. See mindfulheartprograms.org, and radhuleweiningerphd.com.

Michael Kearney, MD., is a palliative care and hospice physician, author, and teacher. He is especially interested in deep resilience for those in care-giving professions. See michaelkearneymd.com and becomingforest.com.

Bella Weininger, Psy.D. is a psychologist who worked for six years on a suicide hotline for teenagers and wrote her dissertation on how to lower the risk of suicide in young people.