Because for most of us, the doing is what takes up 99.99% of our lives. We’re all about the doing. We are constantly trying to keep things under control, or keeping ourselves busy to distract ourselves from thoughts or feelings that we are trying to avoid.
The problem here is that most of what happens to us is outside of our control. And despite my best efforts of distraction, the harder I try to avoid thoughts and feelings I don’t want, the more intrusive they tend to be.
The doing is actually what causes most of my stress, worry and anxiety.
How about you?

The being of life is that feeling we have when we are totally immersed in something, perhaps it’s playing with our kids, or playing a sport or doing something else we love. That state of ‘being in the zone’, where all we are aware of is exactly the task we have at hand. In that being state, our minds tend to let go of all those worries we carry. The worries of the things we need to do, or mistakes we’ve made in the past or even things that haven’t happened yet, they all seem to fall to the wayside in favour of the awareness of being present. Right in that moment, present for what is happening to us right then. No more, no less.


The skills we learn through practicing mindfulness are about grounding ourselves in the present. Allowing the natural human preoccupation with doing to simply wash over us, each moment a chance to “begin again”. Our meditations simply a practicing ground for this ability to find our way back to the present again and again, no matter how many times our mind wanders.
We use anchors like our breath, or the sounds we can hear around us, or our bodily sensations to help to guide us back. And as we leave our cushion each time we finish our meditation, we take this awareness with us through out our day. This knowledge that no matter what happens to us, no matter how much our mind wanders, or how far ‘off course’ we feel, we can always find our way back to those anchors we place and strengthen each time we meditate.
Our sense of awareness grows.

For in this state of being, we know that we can always come back to the present moment. With grace and humility, again and again.
That is equanimity.
That is self compassion.

In mindfulness we learn that we can’t control thoughts, but that we can learn how to be with them.
All of them, even the uncomfortable ones. Like our tendency to be harsh with ourselves.

So what is the link between mindfulness and self compassion?
Well it is through the practice of mindfulness that we can start to notice these thoughts that have been leading us to not be kind to ourselves in the first place. Not to change them or to inflict further hurt and harm by berating ourselves for having them in the first place.
Just to sit with them.
To notice that these self flagellating thoughts tend often to appear in response to similar triggers.
That when these thoughts come, our mind and body often follows them to familiar places- of self loathing or criticism. Or we attempt to dull or suppress them with our chosen vice- whether it be food, social media scrolling or other such distractions.
We can notice what feelings and sensations sitting with these thoughts brings up within us.
Is there a visceral reaction? Does our body physically rebel against the discomfort of these uncomfortable observations?
Or does it trigger a cascade of emotional memories, held within the vault of our sub conscious?
What tends to happen, is that we realise that those thoughts that have been leading us to be self critical or unkind to ourselves, are only a very small part of our inability to practice self compassion.
That simply changing how we speak to ourselves is just one part. Albeit a very important part.
That in fact, a much larger part is noticing these ‘flow on’ effects of those original self critical words and learning how to stop that process from eventuating.

So how do we go about changing this?
How can we show ourselves more self compassion?

1. Learning how to practice mindfulness is an important skill. Being able to sit with these uncomfortable thoughts and feelings as we begin to process them is a great first step. From this grounding, we can begin to allow the self critical thoughts to come, and just leave it that. No guilt or rumination- just simply noticing those thoughts and letting them go.
2. Journalling can be another wonderful way to learn how to process our thoughts and feelings in a more compassionate way. By getting our thoughts out of the echo chamber of our minds and into the tangible realm of the written word, we are forced to look at them differently. It is very easy to think awful things about ourselves, but much more difficult to physically write them down.
3. We can remind ourselves that we all share the common desire to live a happy life filled with health, support and love. We are not alone in this. The practice of Loving Kindness meditation (or Metta) is based on this shared thread of humanity. That in the same way we see that others in the world are worthy of kindness, as are we.
4. You can also know that you’re not alone. That the ability to practice self compassion is a skill that we must all work on. That our brains are wired to remember the negative as learning from mistakes and surviving ‘near-misses’ has historically been what kept us alive. We have literally evolved to look at ourselves critically and always strive to be and do better. That counterbalancing this inherent negativity bias can be tough sometimes. 
5. And finally, being kind to ourselves means remembering that humans are all beautifully rich and complex creatures who together create an amazing tapestry of humanity. Connection with those around us, with our natural world and then ultimately taking this sense of connection inwardly to ourselves helps us to realise that just as all beings deserve our love and kindness, so to do we.

Self compassion is not self indulgent or weak. Self compassion is simply the training ground for how you then treat the world. We perfect these skills on ourselves so we unlock the very best of ourselves for the world.
Like anything worthwhile, it takes times, commitment and practice.
But you’re worth it.

I had an amazing conversation with a wonderful friend tonight. The conversation was about life, mental health and the all round messiness that often surrounds both those things. 
She said "I wish people talked about this more".

I couldn't help but agree.

For a long time I didn't talk about it openly. 
I certainly helped my patients with their mental health and I think I was good at it. But I honestly didn't see my own impending burnout. I couldn't see the looming storm clouds heralded by 3am wake ups and unfulfilling sleepless nights, by constant worry about making a mistake, by bone aching empathy fatigue. 
I couldn't see it, because I was so blinded by my compulsion to help others. 
A noble compulsion for sure, but a blinding one none the less.
I also couldn't see it, because so many of my friends and colleagues were exactly the same as I was.

There are obviously individual factors at play here as most of my colleagues haven't (officially) burnt out despite my observation that so many of them were and still are feeling similarly. 
Is that a marker of resilience? Perhaps.
Or is it a marker that my path was just going to be a different one? 
That the barrier between me and change was thinner?
My yoga teacher training introduced me to the concept of ahimsa, of doing no harm to other living beings. 
But here I was unwittingly harming myself everyday by my inability to place caring for myself high enough on my own agenda to protect my own mental health.

So when it all came crashing down, I crumbled into a series of debilitating panic attacks. The first one lasting almost 48 hours. An entire weekend of sheer internal panic that left my aching body depleted and empty. 
I thought to myself in that moment "OK, I'll take a week off work".
One week off work, booked in 2 weeks ahead of that date because I was already booked up with patients for those two weeks. 
Looking back now I can't believe that I was still unable to see the storm that was now gathering ominously overhead.

I still didn't know I was burnt out. I just thought I was stressed. That I needed a holiday. 
The second panic attack put an end to my plans to see out the two weeks of patients that were booked in.
I was dressed and ready for work, the kids all ready for school. 
I went to walk out the front door of my house, when all of a sudden I was gripped with completely unmitigated fear. 
The vice around my chest and throat told me that this wasn't going to be like that first panic attack that I could quietly implode inward with. 
This one literally brought me to my knees. My 3 and 5 year old children worriedly watching on while I burst into panicked tears at simply the thought of being outside my house. The thought of leaving it's safety, even though I had rapidly come to realise that even my home didn't provide me sanctuary from my thoughts. 
The rising heat in my chest, the crushing feelings of suffocation. 
I had this unrelenting sense that I needed to run away, yet no where to run and an acute awareness that this feeling would follow me wherever I went.
To remember that feeling now still brings tears to my eyes. 

Since that time, I've been re-building myself. I've been immensely fortunate to have a supportive family, colleagues and friends in this time.
I have talked very openly about my struggles.
Burning out and even more than that, my process of active decision making as to the path I take forward since then has formed such an integral part of the person I have become that I do feel grateful in a sense that it happened to me.
I now know where my 'peak operating point' is. Perhaps it's lower than other peoples? That's OK.
Because ultimately, I know what happens when I go beyond it. 

The path back from burn out is no easier than the path there. Both fraught with uncertainty and fear.
But one is more active. The dark clouds begin to gather overhead again and you ease back the throttle, mindful that it was lack of self awareness that contributed to me arriving there in the first place.
The compassionate voice in my head now reminding me to slow down, to notice the physical warning signs of stress and allow them to complete their journey through my body rather than carrying them with me, unheeded, forever held and accumulated.
I am more mindful. Content. 
We are all on a different path in life. My goal is no longer to 'keep up'.
The 'doorway of change' that I sensed when I burnt out is now wide open, with the expanse that lies in front of me both exhilarating and unnerving.
My hope now is that I can continue to speak my truth and to walk beside others who find themselves on this path to burn out and back again. ​

This morning as I drove my kids to school, I noticed that there weren’t all the usual students walking to school along our route there would normally be.
I noticed this small fact then my mind set to work creating a story around it.
Perhaps the first day back after school holidays was a curriculum day and I’d missed it? A very easy thing to do as I am absolutely terrible at reading the school newsletter.
​Then my mind went down that path of chastising me for never reading the newsletter.
Then I started thinking how I was going to rearrange my day because I was sure now I would have to find someone to look after my kids at late notice.
A veritable cascade of thoughts and worries all stemming from that split second observation- “gee, there don’t seem to be any kids walking to school this morning”.
Now I’m not sure about you, but my mind is actually VERY good at doing this. Creating stories out of tidbits of information and observations about the world around me.
No doubt this skill would have stood me in good stead had I been born tens of thousands of years earlier and I was reliant on this ability to stay safe in a world full of predators and dangers.
My nervous system has evolved to be perfectly wired to perceive small bits of information so that I can kick my early warning system into gear and respond appropriately.

Well, as it turned out, it was the first day of school camp today so many of the students had been driven to school laden down with suitcases, sleeping bags and pillows (hence the paucity of late primary aged children walking themselves to school this morning).
Never in a million years would that have been the conclusion that my brain took me to today.
Yes, I probably should start reading the school newsletter. But notwithstanding that minor point, my brain would simply not have connected that innocuous observation I made with school camp as my children are much younger and school camp is just not in my perceptual sphere at this point in time.
So how can I believe anything that my brain tells me, if I am so obviously capable of creating a ‘truth’ based simply on a combination of what I observe and the many experiences that my mind has encountered before?

Well the great thing is that we don’t HAVE to believe everything our brain tells us.
The input of our brain is simply another input source to the input of our senses (except our senses are much less likely to skew the truth than our brain does). We can choose whether or not we follow our brain down that perception pathway.
​The alternate option being that we mindfully step back from the workings of our brain and see this delicate interplay between what happens to us, how we interpret that and then ultimately how we act on that interpretation.
And yes, perhaps I also start reading the school newsletter…

Blogging for me has been an interesting thing. It’s so easy to think that the thoughts I have and the problems I encounter are mine alone. To identify myself with them and define myself by them. To think that no one else in the world has these thoughts or problems.
Blogging has opened my eyes to the fact that this really isn’t true.
We share so much of our humanity with those around us, yet often we feel like we must keep those ‘uncomfortable human bits’ to ourselves. To project our best self forward only.

Thinking back on when I burnt out, I remember how I felt then.
Alone.
Overwhelmed.
Tired. So tired.
Depended on. Suffocated.
Yet, I was still functioning.
Outwardly at least, I was ‘good’. Perhaps slightly ‘stressed’, but ‘good’.

When in fact I didn’t even know how ‘not good’ I was.
I remember saying at the time that I felt like my “doctor light globe had gone out”.
I was still happy at home as a wife and mother, but my fuse was shorter.
I wasn’t depressed, but my sleep was affected. I would wake most nights in the early hours and lie there, unable to get back to sleep. But I was productive in those early morning hours. Ever the lark, I got work done to maximise my bodies inability to hold onto the fitful slumber of those cold moments pre-dawn before my household and the world awoke.
I had started a new business. I had done all the branding and marketing myself. The website a shining example of my early morning exploits.

My body’s subtle calls to slow down and find balance were duly noted.
I threw the full force of over a decade of personal mindfulness practice to bringing mindful awareness to myself and what in hindsight was my impending burn out.
I practiced gratitude and self compassion.
I journalled.
I practiced my beloved yoga. In fact, ever the Type A person I was, I was in the process of undertaking a full 200hr Yoga Teacher Training. So yoga too had become a ‘job’ to me.
I ate well, I went to bed early (to counteract the 3am wakefulness).
I saw a psychologist.
I did everything that I told my patients to do when they found themselves in these difficult times.

But I still burnt out.
Why?

In the time since then, I’ve been blessed to be able to spend a lot of time in reflection on this. I’ve also been graciously supported through an intense period of personal growth and discovery by my husband and family. I feel like I have a better understanding of the stones that paved the path towards burn out for me.
This is of course only my path.
Perhaps others may find a stone or two common with their own and find these reflections helpful?
Perhaps not.
But here are some of the things that I have learned by walking this path to burn out and back again.


That a step back is often infinitely harder to make than a step forward in life.
Life has a certain inertia to it. Each day rolls around, as the seasons change, the world keeps turning. Life keeps moving on.
Even in the most untenable situations there is still momentum to time alone.
In choosing to take a step back from work, socialising, the online world, what ever it is we are considering taking a step back from, we are innately aware that these ‘worlds’ keep going without us. Nothing is on pause.
Stepping forward, in whatever capacity we can, continues to indulge us in the idea that we are ‘keeping up’.
Stepping back (or even sideways) involves the reality of falling behind.

Now I know that this isn’t a bad thing. Logically, we ALL know that this isn’t a bad thing. But I want you to think about the last time you turned down an opportunity or opted to take a leave of absence. How did you feel?
For most of us, the FOMO is strong!
And when we inevitably return to our own forward path in life, we are acutely aware of the momentum we feel we’ve missed.
Again, this is not a bad thing. Simply my own observation as to how I felt pre ‘stepping back’. That sometimes continuing to do something, even if we know it is bad for us, seems easier than making a change.

There is a threshold at which my brain functions optimally.
When I stress my operating system above that threshold, all functions tend to suffer. I and I alone am the one who knows where that limit is and therefore I and I alone am the one who must honour that limit.

That flattery of the Ego will often cause us to go beyond what we know we are capable of.
Is this a good thing or a bad thing? I guess it depends how much point 2) affects you or not?

That the thing that hooks our Ego in the first place, often begins to harm our Ego when we use it as an excuse to go beyond our optimal functioning limits.
For example, for me as a doctor it was helping people, a noble cause for sure. But when it became something that I allowed myself to make excuses for continuing to cause stress to my body as I watched it crumble around me, it was in fact merely a ‘hook’ that kept my Ego in the game. Helping people isn’t something you do as you’re drowning, that’s ‘saving’ people. And when your Ego is in the game, it becomes less about helping and more about saving and being a saviour.
Think about it, there’s got to be something valuable on the table to keep playing as you watch your world falling apart around you.
Now this was an uncomfortable truth for me to learn. My Ego story made it very easy for me to talk myself out of this fact. The praise and adulation of those around me made it even easier. But the more I made friends with my own Ego, seeing it not as a ‘bad’ thing but simply a construct that I had built around me over time. A reflection of the stories the world had told me and that I had absorbed about myself.
I was a ‘good person’.
I was smart.
I was a helper.
I could put aside my own needs for the needs of others.
As I began to see my own Ego as a small child in want and need of protection and affection. I saw that this steadfast push beyond even what I knew I was capable of at the time was not in fact ‘personal growth’, it was survival. Survival of an Ego and a person simply doing their best.

And this brings me to my final point.

No amount of mindfulness or yoga can outweigh a lack of self awareness.
Self awareness is about knowing when to say ‘no’ more than it is about knowing when to say ‘yes’.
It is about learning where that ‘optimal functioning point’ is for your brain and respecting it. Not about never going beyond it (after all that is where we are able to grow) but more about bringing mindful awareness to when you are existing at your growth edges. Being in control of that time. Knowing when to pull the throttle and when to hit the brakes.
It is about making friends with your Ego. I mean true, laugh until you wet your pants kind of friends with your Ego. About seeing your Ego with the most compassionate of eyes and thanking it for always being there to protect you when the chips were down. About loving it and then carefully strapping it into the back seat so your True Self can take over from now on.
Awareness of the Self is about knowing that we are beautiful, dynamic and complex creatures who need to commit to a daily practice of exploration and compassion as we move and grow over time.

Like I said, this story is not all burn out stories. It is just mine.
It is however, a road I walk with many other travellers and I’m sure there is a step or two we may walk together on.

by Dr Emily Amos

This is an excerpt from a blog post that was originally published on my website about 18 months ago. ​

What do we say to our colleagues who express a desire to 'step off' the treadmill at any point? Whether for a short break or even forever?

I experienced a lot of well intentioned encouragement not to do that.
That I would have to work too hard to "get back". Or that I would "miss opportunities". That it would be a "waste of my skills".

The dialogue here is really important I think.

As it turned out, I ended up needing to 'step off' for a while anyway. Perhaps I could have done this in a more intentional way sooner? Perhaps not. 

For me personally, I am immensely grateful for the journey I have been on as a result of the last couple of years and my 'burning out'. That doorway I felt myself standing in all that time ago was in fact this doorway into working to support the wellness of the healthcare workforce. Healing the healers. Caring for the carers.

I am excited and hopeful for the future. 

If you are feeling swept up on the medical treadmill, passively shuttled through your professional life towards some seemingly far off goal, I'd encourage you to try and familiarise yourself with the concepts of mindfulness.
Of presence.
Of perception.
Of non-attachment. 
Of self compassion.

Self awareness comes as we take our consciousness inwards to become more familiar with our own internal environment rather than only focussing on those things outside of ourselves and our control. 

Sometimes it involves some time "off the treadmill" for self reflection. And that is OK. 
Sometimes it involves staying "on the treadmill" but building a support structure around you so that you can lean on that and just lift your feet up every now and again. 
Sometimes it involves the speed and incline being turned up so far that eventually you end up flying off the end of the treadmill, unable to keep up anymore (like I did...). Look, it's not ideal- but that too is manageable.

The most important thing to realise is that ultimately, you control the treadmill.
​Even at the times when you feel like you don't, you always have the choice to step off for a while. 

What I’ve realised in the process of break down and re-build is that some of the best things about me exist in those ‘corners’. My creativity for one. My self awareness- that innate sense of who I am and what I need. My ability to connect with other humans in a really meaningful, two-sided kind of way. My unquenchable thirst for knowledge in the most obscure and broad ranging topics.

Specialty training programs. Hospital jobs we have to apply for each year. The way "things have always been done". 

It's easy to think that we need to be 'round' to fit in and succeed in medicine. To some extent we do. The medical world has a way of doing things and there is always going to be round holes that we cannot change. What we can change is how we talk about this and how we support people who like I did, find the endless round holes of the medical world to be exhausting at times.

Since burning out I found that there are a lot of people with advice on how to avoid burning out. Usually, it’s people who themselves have burnt out. I’m no different really. I’ve been through an immense amount of pain, I’ve been exceedingly fortunate to have been well supported during that time and I have come out of the other side passionate about preventing someone else from also going through this experience.
Except this isn’t that kind of advice. This isn’t about burn out. This is about self-awareness. 

My self awareness existed in one of those all important corners that I had shaved off on my path towards trying to “fit in”. I didn’t realise that I had lost it and therefore didn’t realise how much of myself I was compromising as I tried harder and harder to make myself happier or less stressed. I had jumped onto the "medical treadmill" (the seemingly unstoppable inertia that takes us through graduation from medical school, through internship, residency, specialty training and beyond) without ever giving myself permission to consider other paths until I was so burnt out I needed to step away for a while. The thing about losing your self awareness (or not having it to begin with) is that you don’t know why you feel awful. You can’t see what it is that is making you so unhappy and you begin to feel like you just have to "keep going" because you've lost sight of any other options.

So here I am telling other empathetic individuals it's not about simply "not caring as much" to avoid burning out (which I was told more than once in my career)  but rather about giving yourself the space and permission to really 'know' yourself, what is important to you and what you need. About having the courage to be introspective, even if it means you might find things about yourself that you wish were different (for me personally it was that medicine was perhaps never the "calling" that I thought it was for me) and holding strong and healthy boundaries based on that new found knowledge. 

This is a story from a square peg, about finding happiness in a world full of both round and square holes without compromising yourself or expecting others to change for you. It’s an encouragement to keep searching both within and outside of medicine until you find fulfilment in places you might not expect, without shaving off the best parts of you. The Creative Careers in Medicine website is an amazing place to check out if you end up finding yourself searching for other avenues within medicine. Or you could seek out mentors who might not be professionally where you aspire but personally they have a lot in common with you to seek their guidance in how they made their path work. But mostly, it's to let you know that you're not alone.

Because there really are enough stories from round pegs about how everyone just needs to be flexible and change to fit into round holes to avoid burning out. It’s not what I needed to hear. And it’s not my story.

By Anonymous

Having always been strong, fit and healthy and part of the ‘doing’ group, becoming a patient challenged my identity. I also had fears that others would no longer perceive me as strong, fit, and capable. Which ultimately I believe, is part of what led me to remain silent. 

I had assumed breast loss to be hard but had not fully thought through the impact this has on the whole self. It wasn’t that I was particularly proud of my breasts prior to surgery. I was small-busted and thanks to breastfeeding there was nothing I’d show off. But the tissue was my body, had served a practical function in feeding my babies, and was part of my sexual identity as well. Comments from well meaning nurses or therapists after the surgery (comments that I too had previously made) such as “the surgeon did a good job” or “your scar is so neat” were met by my own resistive thoughts like “there is nothing neat about this at all”. The truth for me is that, despite a “successful surgery”, my body will never be the same, and for that I feel grief and loss. What I longed for was for someone to acknowledge that loss, to recognise that none of this was wanted, and that change is difficult.

Having never previously had major surgery, I had no appreciation for the utter exhaustion that comes with recovering from surgery and anaesthesia. This exhaustion encompassed mind, body and my sense of self. I returned to work after four weeks, much to the bemusement of my surgeon. I remember his words clearly, "What makes you so different from anybody else that you would heal at a faster rate?"

For some reason as health professionals, we believe we are different, that somehow physical or mental health and healing would be different for us. But truthfully, it’s not. ​