In pandemic times: a twitter message for colleagues from AMAV member Dr Eric Levi

15 October 2021 

Don’t confuse stress, exhaustion, moral injury, burnout and mental illness. They’re different shades of human emotions with different causes and different treatments. 1/

Stress is a normal physiological or psychological response to a challenge. It’s normal to be stressed. Stress is good for muscle training and cognitive growth. A stress-free life is not possible. Stress encourages growth. 2/

Stress and rest. Stress and rest. That’s the rhythm of life. Too much stress breaks the load. Enough stress inspires growth. We should embrace reasonable stress interspersed with rest. That’s what every high performing teams do. 3/

Exhaustion is different. Exhaustion is a state of physical, mental and emotional depletion from excessive challenge. You can be stressed without being exhausted. You can be exhausted without being stressed. Exhaustion shows you your limits. Exhaustion may result in errors. 4/

The solution to exhaustion is physical/mental rest and nutrition. Sleep and feed. Sleep and feed. Again, high performance teams know the boundaries of exhaustion and plans for sleep and feed of the body & mind. 5/

Moral injury is a state arising from the inability to do certain things that one feels is the moral right thing to do. Resource or leadership limitations restricts you from doing the right thing. For example, not being able to care for a patient because there is no ICU bed, 6/

Knowing that airborne protection is safest but not given PPE, cancelling cases because of government restrictions. These are moral anguish, distress or trauma that happens regularly in Medicine. 7/

Resources and leadership are the keys to managing moral injury. Being aware of one’s limitations and boundaries of responsibility matters too. Knowing how to intervene or let go at the right time matters. 8/

Burnout is different. Burnout is a psychological state arising from chronic occupational stress characterised by emotional exhaustion, low efficacy and cynicism. The problem and the solution are occupational. 9/

You can be exhausted and not be burned out. You can be stressed but not be burned out. Burnout requires a cultural and leadership approach. Asking staff to be more resilient in a toxic culture is not appropriate. 10/

Burnout is a reflection of the system not the individual. Meditation, yoga, mindfulness helps but they’re not the mainstay of treatment for a diseased workplace causing individual burnout. 11/

Mental illness is altogether different. It is a clinical diagnosis, not a temporary feeling. Mental illness diagnosis is based on specific guidelines. The treatment requires engagement with a mental health professional. 12/

Sometimes articulating these thoughts are the first steps to considering the solutions. Not everything is mental illness. Not everything is burnout. Not everything is moral trauma. They all obviously interplay. Especially in a stressful global pandemic. 13/

You can have depression, but not be exhausted or burned out. You can have anxiety but not be stressed. Right definition points to the right solution. These are various shades of human experience. Solutions need to be simple but not simplistic. Tailored but not complicated. 14/

Take care. Really. Take good care of yourselves. Self-care is not self-indulgence. Eating & drinking is not selfish. It’s a basic human need. So too is nurturing your heart and soul and mind and strength. 15/end

Dr Eric Levi provided permission for AMA Victoria to share this series of tweets.