A century ago, a “nervous breakdown” was a socially acceptable way to just take a break and recharge. Now, it’s not. In order to refresh yourself and mitigate burnout, consider scheduling regular time off.
Lifelong Learning in Clinical Excellence | April 12, 2021 | 4 min read
By David Kopacz, MD, University of Washington
Lately, I’ve found that I have some kind of breakdown almost every day. I think of it as a mini-burnout, or sometimes I call it Zoomout when it feels like my brain can’t take in any more digital information. I now have another name for it—my daily “nervous breakdown.”
Last month, Jerry Useem published “Bring Back the Nervous Breakdown: It used to be okay to admit that the world had simply become too much,” in “The Atlantic.” He wrote a cultural critique of the American work ethic and harkens back to the concept of the nervous breakdown which rose to popularity in the 1930s, after the Great Depression and a decade or so after World War I and the Influenza Epidemic of 1918-1920. Having a nervous breakdown became a socially acceptable way of saying, “I need a break!” Many famous people of the time talked about their nervous breakdowns, including John D. Rockefeller, Jane Addams, Max Weber, and F. Scott Fitzgerald wrote about his nervous breakdown in “The Crack Up.” The nervous breakdown was the circuit breaker in the rat race, a recognition that human beings can only take so much before they break down, and then they need a break so they can build back up.
Useem writes of the French term, reculer pour mieux sauter—“to withdraw in order to make a better jump.” Not only do we not have universal healthcare in the United States, we lack a culture of care in which it’s ok to take care of ourselves. Useem points out that Rockefeller did some of his best work after his nervous breakdown. It can be creative to breakdown, to retreat from the world, and to withdraw in order to make a better jump.
Useem quotes historian Peter Stearns, “The very general and ill-defined characteristics of the nervous breakdown were its benefits.” This flies in the face of our compulsion to make everything sharply defined and evidence-based, but holism is also a valid way for gaining knowledge about the world, and is a better philosophy for life than reductionism. The term “burnout,” which all of us in the health professions know in our minds, bodies, hearts, and souls, has been criticized for being too general and ill-defined. This is the perspective of researchers—but the average physician experientially knows what burnout means—“I’m reaching a breaking point.” We need words that are broad and inclusive when we talk about human suffering, just as we need diagnostic words that are specific. We need healing, not a specific “diagnosis.”
The mini-rest cure
The rest cure, a holistic program of self-care, was prescribed for the nervous breakdown. UK psychiatrist Sue Stuart-Smith, in her book, The Well-Gardened Mind: The Restorative Power of Nature, describes a modern-day rest cure at Alnarp in Sweden, a 12-week garden therapy program for “high-achieving, conscientious people whose health has collapsed through a combination of work overload and family commitment.” Throughout her book, Stuart-Smith reminds us that as “we cultivate the earth, we cultivate an attitude of care, but a caring stance is not something that is actively promoted in contemporary life.” How can we cultivate caring? Maybe plants can remind us.
We know that taking a vacation for a week or two only temporarily addresses burnout—many of the drivers of burnout are institutional and systemic, not individual (my next piece for CLOSLER is on this topic, “The Social Determinants of Clinician Health.”) If you can’t take three months at Alnarp, or change the system, you can still reculer pour mieux sauter—“withdraw in order to make a better jump.” Here are a few mini-rest cures you can build into your daily life to reconnect with the restorative power of nature:
1. Take a breath—we breathe in oxygen that plants give off and plants breathe in carbon dioxide that we breathe out.
2. Take a walk—moving the body can give the mind a rest.
3. Connect to Nature—she’s always going through cycles of rest and growth.
4. Sit outside—watch the birds, watch the clouds, or watch the grass grow.
5. Look for spring flowers—signs of rejuvenation after a long winter.
6. Plant something outdoors or indoors. Herbs are great to grow indoors and use for cooking.
7. Start a healing relationship with plants.
8. Talk with a plant about your “nervous breakdown,” they’re excellent listeners and never interrupt.
9. Visit a plant nursery. You can just look around, or you may want to buy something.
10. Schedule regular time off to reculer pour mieux sauter—a day each month, or a week each quarter, even if you have nowhere to go—that might just be what you need, a little time going nowhere!
“Plants are like people because people are like plants,” Sue Stuart-Smith tells us. Maybe nervous breakdown and burnout are telling us that something is out of balance in the ecosystems of our lives—perhaps turning to the ancient, restorative wisdom of our leafy, green friends can help us come back into balance in our lives and work.
Toward a New Way of Being with Plants Conference, June 17-18, 2021 (free registration)
Sue Stuart-Smith, “The Well-Gardened Mind: The Restorative Power of Nature”
Katherine May, “Wintering: The Power of Rest and Retreat in Difficult Times”
Robin Wall-Kimmerer, “Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge, and the Teachings of Plants”