Antidote to Burnout

In The House of the Dead, Doestoevsky remarked that “man is a pliable animal—he must be so defined—a being who gets accustomed to everything! That would be perhaps, the best definition that could be given to him.”¹

But if man is indeed pliable, then why do a large number of secular and religious workers alike suffer burnout? Pastors², doctors, physical therapists and other workers across the board who have left their professions in droves, which seems to disprove Doestoevsky’s observation. As a way of illustration, let me confine myself to my own profession of physical therapy.

In its February 2019 issue, the American Physical Therapy Association (APTA) Magazine featured an article entitled “Beating Burnout.”³ On its front cover, it used the image of a burning matchstick as a visual equivalent of “Burnout,” and rightly so but one cannot press this metaphor too far.

Limitation of metaphor

When I light a matchstick and watch it burning until it is reduced to ashes, I notice a “substantial” change. It changes from one form to another, from a matchstick to ashes. I cannot say that those ashes are still the same matchstick for the fire consumes it; the matchstick is no more but ashes.

While it is a visual equivalent of “burnout,” it does not seem to fully capture the fundamental experience of the person suffering burnout. Of course, an image, a metaphor or a simile and other literary devices can only do so much.

While a physical therapist suffering from burnout and a matchstick that is burning share a common term —“burn”— these two realities do not provide us a universal meaning. At its most fundamental level, a burning matchstick fulfills what it is made for—to be lit and burned, and reduced to ashes. In contrast, a physical therapist suffering from burnout refuses to accept responsibility to fulfill what he is made for. Burnout leads him to an inevitable diminution of his being, of his freedom to rise above the dehumanizing situation in which he finds himself. 

Burnout saps one’s vitality. A physical therapist suffering from burnout goes through the motion of treating his patients without passion and purpose. He treats his patients for the sake of treating them – no rapport, no semblance of interpersonal connection between the physical therapist and the patient. It is a treatment encounter that ignores the whole person of the patient. This happens because the therapist himself has lost his own individuality. Unlike the burning matchstick, a physical therapist suffering burnout does not turn into ashes. He remains Dr. So-and-So. He moves. He speaks. He treats. But he is becoming an automaton.

Automaton

This devolution of a worker, resulting in robot-like characteristics probably stems from the third stage of motor learning. Fitts and Posner were the first to describe the three stages of learning.³ These authors have claimed that we go through three stages of motor learning when we are learning a new task or skill. 

Let me only dwell on the third stage of motor learning. When the learner begins to perform the task with precision and without extraneous effort, he is said to be in the final stage of motor learning—the autonomous stage. During this stage, the timing of execution coordinates perfectly with the angle from which the task or the movement is performed, producing highly refined patterns of movement. Because the learner is barely conscious of the movement, he performs it without much attention. In contrast to the first two stages of learning, consciousness of the act of doing recedes into the background. Subconscious performance of the task predominates, and therefore becomes automatic. Performance of the task seems to have a life of its own, independent of the learner’s attention.

Is the final stage of motor learning a boon and a bane at the same time? While the learner’s performance of the task is highly efficient, his consciousness is less engaged, if not disengaged, from the very act of performing the task. Does it not make him like a robot, a machine, an automaton? When a physical therapist who is on autopilot finds himself in a very demanding setting, does it not speed up burnout? 

The philosopher Colin Wilson observes that “[w]hen I make an effort, it sends a spurt of energy into my vital batteries. And when I do something mechanically, there is no spurt of energy.”⁴

He continues, “Nietzche, incidentally, was the only great western thinker who recognized that the basic answer was conscious reinforcement of the will to health—that is, of the secret life.”

But Wilson seems to ignore one important factor that incites us to perform tasks with determined effort. Without this factor, no amount of cajoling, self-suggestion, or what have you will ever spur us into attentive, purposeful action. This factor is finding meaning in what we do, even in a seemingly intolerable situation.

But how can a physical therapist find meaning when he comes face-to-face with mounting documentation demands? Every single day, he brings his work laptop home to type for hours. If he is a married man with kids, the inner tension is more manifest. He longs to play with his kids or bond with his wife, but the deadline is drawing near. He has no choice but to finish his PT notes.

Or how can a physical therapist draw meaning from unrealistic productivity requirements? A home health physical therapist drives his car from interstates to city streets, from ghettos to secluded roads, to get to his patients’ homes. Only one thing matters to him: seeing as many patients as he can to meet the required weekly quota. Is it not a paradox to find meaning in a meaningless setting he finds himself in?

And yet, we have known some men and women from all walks of life who find meaning in the most oppressive, dehumanizing conditions. Viktor Frankl was a case in point. He found meaning even as he went through a harrowing ordeal in the Holocaust and dealt with the death of his wife and his parents who had been gassed. 

Of course, one cannot compare the horrors prisoners suffered in a concentration camp with the stresses therapists go through in a very demanding setting. But at the most fundamental level, these apparently disparate experiences are the same.

Apathy

In Man’s Search for Meaning, Frankl recounts his experience as a prisoner. Frankl observes that the reaction of prisoners when they are first admitted to the concentration camp is one of shock. The barbaric situation in the concentration camp far exceeds their preconceived ideas of evil and suffering.  

Viktor Frankl observes that prisoners in the camp subjected to dehumanizing conditions react with disgust. But this feeling of disgust and other natural reactions to what is evil, to suffering, to “all the ugliness” are suspended after a few weeks in the camp. Prisoners become apathetic. “Apathy,” Frankl notes, “[is] the blunting of the emotions and the feelings that one could not care anymore.”⁵

Frankl records this blunting of emotion across several passages. One of the passages was about the boy who had been forced to work barefoot for hours in the snow and sustained severe frostbite in his toes in the process. He was then taken to the infirmary. A prisoner, who happened to be there, was unmoved at the sight of the boy while the “doctor on duty was pick[ing] off the black gangrenous stumps.”

This holds true of a physical therapist suffering from burnout. At first, he reacts with disgust at the vicious cycle of endless documentation and the high number of patients to be seen every day. But after a few weeks or months of the daily grind, he loses his capacity to react to what is around him. He becomes hollow inside. He loses his mooring to his inner reserve. To a certain degree, he regresses to a primitive level of his human capacity. He is disconnected from his innate tenacity which in turn disconnect him from his surroundings. His patients’ suffering no longer affects him.

I have worked in various physical therapy settings either on a PRN basis or a full-time PT. And I have seen physical therapists who showed signs of burnout. Let me cite one.

A patient in her 80s was recently discharged to a skilled nursing facility (SNF) following a right total knee arthroplasty (TKA). One morning her knee swelled up, making it more severe than it had been. She was groaning in pain when a physical therapist entered her room. She asked him if he could get her an ice pack. Unmoved and without saying a word, he left the room and moved on to see his next patient.

Expansion of inner orientation

But why do some therapists, who go through the same stresses common to the physical therapy profession show no signs of burnout? Instead of indifference, they find themselves engaged in what they do; they are animated and connected with their patients. These therapists have sincere intentions to help alleviate their patients’ pain or help them to walk again. They show no signs of apathy despite seeing high volume of patients in a fast-paced rehabilitation center. Apathy they have none but sense of humor. They find something amusing in the most unlikely situation. They don’t crack under pressure but crack jokes with their colleagues and patients. 

In Adele Levine’s Run, Don’t walk, we find an amusing account of therapists at Walter Reed National Military Medical Center, whose collective sense of humor creates a positive atmosphere in a rehabilitation center that caters to patients with mangled legs, broken spines, misshapen faces, ripped sciatic nerves and other injuries sustained in the battlefields. The heavy workload does not seem to affect Levine and her colleagues at Walter Reed. Yes, stresses are ever present just as in other settings but these stresses don’t lead them to the brink of burnout. How do they keep burnout at bay? To answer this question, I can do no better than quote a paragraph or two from her book:

“The phone rings in the amputee clinic and it is one of Darcy’s patients. He is on a ski strip sponsored by Disabled Sports USA and wants to tell Darcy that he just went down the ski slope on a mono-ski (seated ski). It’s his first trip away from the hospital since an improvised explosive device (IED) in Iraq blew his legs away four months ago.

His exhilaration is reflected in Darcy’s face. She downplays it when she hangs up the phone, but I can tell she’s secretly thrilled. Getting these phone calls, hearing these stories, are huge victories. It is what we live for as physical therapists—whether it’s seeing a patient head back to the ski slope, or, because we work for the US Army, back to combat. It’s what makes the long hours and the physicality of our work worth it.”⁶

But this does not hold true for some, if not most, physical therapists who are inundated with twenty patients or so on a daily basis, not to mention the endless cycles of documentation demands. They have lost their sense of meaning and resigned to distressing situations they are in. 

But according to Elisabeth Lukas in her book titled “Meaningful Living,” “Distress does not inevitably cause psychological collapse; it may contain the possibility of finding new meaning.” It is therefore “important to widen and strengthen [their] inner meaning orientation so they can grow from distress situations instead of being defeated by them, to discover potentials and to become more mature.”⁷ They can then reclaim it by deepening their understanding of themselves and expanding their awareness of life outside of themselves. It is a reorientation of how they see their current situation from different angles.

I am not, of course, espousing masochism. Suffering in itself is evil. A person who seeks suffering or any situation that causes unnecessary stress is contrary to human nature. We are naturally drawn to what makes us happy. Everything we do is always in view of that end goal—happiness. “So happiness appears to be something complete and self-sufficient, it being an end of our actions.”⁸

If a physical therapist is stressed out and on the verge of burnout, then he needs to move to another company or setting that has reasonable productivity requirements. Or better yet “switch to an environment in which documenting for reimbursement isn’t a factor.”

But what if he cannot find one, or for various reasons he has no choice but to remain in the stressful clinic? He still has a choice how to approach the problem within the confines of his current situation. Will he choose to let the situation overcome him? Or, will he choose to create a space within himself and assume a different inner orientation through which he views his situation in a new light?

When everything was taken away from him but his naked existence, Frankl continued to cling to his inner freedom. He looked at his current situation from a new vantage point and in so doing gained insight into the meaning of life. It was an epiphany for him. His epiphany happened at that moment when he slipped into reverie, lost in contemplation of his wife. 

“I understood how a man who has nothing left in this world still may know bliss, be it only for a brief moment, in the contemplation of this beloved. In a position of utter desolation, when man cannot express himself in positive action, when his only achievement may consist in enduring his suffering in the right way—an honorable way—in such a position man can, through loving contemplation of the image he carries of his beloved, achieve fulfillment. For the first time in my life, I was able to understand the meaning of the words, ‘“The angels are lost in perpetual contemplation of an infinite glory.”’ 

And again, if the documentation demands and productivity requirements in a physical therapy setting have rendered a physical therapist’s life distressing and meaningless, it calls forth an expansion of his “inner meaning orientation.” For example, a physical therapist may draw strength from his wife and his young children who depend on him for their daily sustenance. Or, he may rediscover meaning in his job through his patients who have high hopes to walk again or get rid of their bodily pains. Or, if he has a special vocation outside his profession, he has something to look forward to every single day. He tries his best to be efficient at work finishing his notes in the clinic so that he can devote his time to his special vocation when he gets home from work. In the words of A.G. Sertillanges, “You can turn to your ideal [or your special vocation] and enjoy the relaxation of some chosen activity after the labor imposed by the hard necessity of getting a livelihood.”⁹

In this Preface to Frankl’s Man’s Search for Meaning, Wallport writes, “Hunger, humiliation, fear, and deep anger at injustice are rendered tolerable by closed guarded images of beloved persons, by religion, by a grim sense of humor, and even by glimpses of the healing beauties of nature—a tree or a sunset.”

Doestoevsky was right after all when he said that “man is pliable.” If by pliable he means flexible or adaptable, then man has a high threshold for stress in any given situation. But man’s adaptability only comes to the fore when he has a reason to live. “[A physical therapist or a pastor] who has a why to live can bear almost any how” (Nietzsche).

(R.O. Legaspi)

References 

1. Dostoevsky F. The House of the Dead. Garnett C, trans. SAGA Egmont; 2022.
2. Renn A. Pastoral burnout and Pauline strength. First Things. February 22, 2022.  Accessed May 9, 2025. https://firstthings.com/pastoral-burnout-and-                pauline-strength/
3. Ries E. Beating burnout. PT in Motion. February 2019.
4. Fitts P, Posner M. Human Performance. Brooks/Cole; 1967
5. Wilson C. The Super Consciousness. Watkins; 2019.
6. Frankl V. Man’s Search for Meaning. Lasch I, trans. Simon & Schuster; 1984.
7. Levine A. Run, Don’t Walk. Penquin Group; 1984.
8. Lukas E. Meaningful Living. 2^nd ed. Fabry JB, trans. Purpose Research, LLC; 2020.
9. Aristotle. Nicomachean Ethics. Barlett RC, Collins SD, trans. The University of Chicago Press; 2011.
10. Sertillanges AG. The Intellectual Life: Its Spirit, Conditions, Method. Ryan M, trans. Catholic University of America Press; 1998.