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Playing: 3: Burnout with Myk and Mimi



Myk Bilokonsky
Mimi Winsberg

3: Burnout with Myk and Mimi

August 08, 2019

In this episode, we'll take an in-depth look at burnout. We're talking to Myk Bilokonsky, an autistic and ADHD software engineer living in New York City, and Dr. Mimi Winsberg, a Stanford-trained psychiatrist with over 20 years of clinical experience and Chief Medical Officer at Brightside Health.


Myk Bilokonsky

Myk Bilokonsky is an autistic and ADHD software engineer living in New York City. When he's not writing abstractions he's ranting on twitter about absential properties, metaphysics and the primacy of narrative to human consciousness.

Dr. Mimi Winsberg

Dr. Mimi Winsberg is a Stanford-trained psychiatrist with over 20 years of clinical experience. She promotes wellness through education, insight, behavioral change, as well as psychopharmacology. She’s currently the Chief Medical Officer at Brightside Health, Psychiatrist at Facebook Health Center and maintains a small private practice.


Kurt: 00:07 Hello everyone, and welcome to Fullstack Health, the podcast exploring mental and physical health in the tech industry. I'm Kurt.

Amberley: 00:14 And I'm Amberley.

Kurt: 00:16 And we're really excited to bring you these conversations today. We're turning our attention in our next two episodes to something that affects a lot of people, burnout.

Amberley: 00:25 First, we're talking to Myk Bilokonsky who is an autistic and ADHD software engineer living in New York. When he's not writing abstractions he's ranting on Twitter about absential properties which, side note, I'll ask him to define for us, metaphysics, and the primacy of narrative to human consciousness.

Kurt: 00:44 After that, we'll talk with Dr. Mimi Winsberg who is a Stanford trained psychiatrist with over 20 years of clinical experience. She promotes wellness through education, insight, behavioral change, as well as psychopharmacology. She's currently the chief medical officer at Brightside Health, psychiatrist at Facebook Health Center and maintains a small private practice.

Amberley: 01:07 And just a couple of notes, in our conversation with Myk, we used a few acronyms which we don't define in context. And those are DSM, which is the Diagnostic and Statistical Manual of mental disorders, and WHO, which is the World Health Organization.

Kurt: 01:23 So, thanks again for joining us and let's get going with our conversation with Myk.

Amberley: 01:34 So, hi Myk. Thank you so much for talking to us today. Really, really excited to chat with you.

Myk: 01:39 Thanks so much for inviting me. I'm really happy to be here.

Amberley: 01:42 Yeah. So, first off would you just introduce yourself a little bit more. Anything else you want to add?

Myk: 01:49 Yeah. I'm a, let's see, you got autistic ADHD software engineer in New York ranting about things on the internet. Other than that I realized I was autistic about two years ago. And about maybe four months ago I found myself really excited and interested in doing some outreach and activist work around that and have fortunately stumbled into the visibility around that. So I've got some, I've got a subreddit that I set up to talk about this and I talk about this stuff on Twitter a lot.

Amberley: 02:23 Yeah. And that's actually how I came to be familiar with you is you posted this really amazing thread for autism awareness month earlier this year about, well, not about but with the #actuallyautistic. Do you want to talk a little bit about what #actuallyautistic is?

Myk: 02:49 Yes. So, gosh, I think it was a Twitter user named, her username is neurorebel that came up with it in about 2015, if I have my history great. But basically the actually autistic hashtag is for content that is written by and for autistic people. The more autistic people have found each other and compared notes and actually talked about what it means to be this way, the more we have all increasingly arrived at the conclusion that this is not a disease this is how we are.

Myk: 03:21 And the biggest problems in a lot of our lives are just that it's difficult to be how we are. And we have to work hard to fit into society. And so, the actually autistic hashtag is really important because not only does it allow us to communicate with each other, but it explicitly centers autistic voices and not people speaking on behalf of autistic which has been a major problem.

Amberley: 03:45 We should talk about burnout here in a second. But I wanted to ask really quickly, in your intro you talked about absential properties and I just the one quick one, two sentence explanation because I've never heard that ever. What are absential properties?

Myk: 04:07 Nobody has ever heard this term. It's a relatively new concept from philosopher of mind called Terence Deacon. And it's published in a book called Incomplete Nature: How The Mind Emerged from Matter. And it is a way to reason about the way that the absence of a thing can in some cases be a presence. In the same way that sometimes we write a zero and sometimes we don't write anything, right? And there's a different between zero and no, for instance, in programing, right?

Myk: 04:40 So, absential properties basically says that if you have a goal, for instance, in your mind, we can't currently say that that goal has any cause or relation to the behaviors that you do, right? Because the goal has no physical properties, it's just like an abstract idea and your behaviors are physical and what's non-physical can't inform the physical. And Deacon says "Well, what if the absence of that particular goal state is like a thing that characterizes that goal? The absence is like a zero where something should be a one?" Right?

Myk: 05:13 And so, if we think about the absence of specific physical properties on non-physical things as the presence of the absence of certain things, then it closes that gap and we can start thinking about things like, how do we bridge the divides between subjected and physical and things like that.

Myk: 05:35 And I find it really interesting because it applies in all these categories way beyond like where Deacon was talking. But it's not really irrelevant to this conversation to mention.

Amberley: 05:46 The presence of the absence sounds like a line from a poem.

Myk: 05:52 Yeah, well, honestly what it sounds most like to me is, if you've ever read the Dao De Jing, the ancient [inaudible 00:05:58] text, a lot of what they talk about is very similar to this.

Amberley: 06:04 I have not.

Kurt: 06:06 No, but definitely sounds interesting. All right?

Amberley: 06:09 Yeah. Well, moving over into talking about burnout.

Myk: 06:13 Sure.

Amberley: 06:14 Something that I thought was interesting was in talking about the diagnostic criteria for autism that made me think about the diagnostic criteria for burnout, because burnout is not in the DSM and it is just earlier this year recognized by the WHO. And the description for burnout as a recognized syndrome centers the experience of chronic workplace stress?

Myk: 06:47 Yep.

Amberley: 06:48 And you tweet, correct me if I'm wrong but just from reading through your tweets you seem to categorize the burnout that you experience into three categories in autistic burnout, which I would love to talk to you more about. Workplace burnout and then emotional burnout you've said before. So, can you talk a little bit about all that?

Myk: 07:14 Yeah. So, I have my own way to think about what burnout is, and I'm not sure how much it aligns with more conventional definitions but let me try to express what I meant by that. To me, everybody has a certain amount of energy that they can just use to apply to tasks every day. Everything from small tasks like brushing your teeth to large tasks like taking on the giant work project and leading a team to shape the future.

Myk: 07:46 Every day you spend some of that energy and every day you get some of that energy back. And in a healthy life, you maintain a full tank of energy from day-to-day. You manage to recoup at least as much as you spend. You might have a period of crunch where you're spending more than you're recouping for a while, but unless you're doing something really unhealthy you're going to get back to normal like soon enough.

Myk: 08:09 If you don't, if you instead spend every day, day after day as a lifestyle spending more energy that you recoup, then eventually you're going to wake up in the morning and you're not going to have any energy. And this is going to manifest behaviorally, right? Like you're going to have a hard time closing your tickets at work, sure. And if all your stress comes from work, then yeah, you have put yourself into a situation where you have spent more energy than you have for long enough at your job that you now need significant rest to recover.

Myk: 08:48 And I think it's interesting that these days millennial burnout is such a topic, but we still talk about burnout as fundamentally a work related phenomenon. There's something that privileges the energy use spent in service to capital or employment as like a meaningful thing. Now that it's affecting productivity, we need to care about this, right? But what about all the people that burnout for other reasons? Life is just stressful. What about somebody who's living with an abuser and who every day is afraid for their life?

Myk: 09:23 They're going to be operating below their capacity every day. They're going to be burned out in the sense that would be recognizable to somebody who knows the symptoms even if they're like stay-at-home mom or whatever, right?

Myk: 09:37 So, when we talk about autistic burnout, there's a very specific thing that that word means. And learning this phrase, autistic burnout actually really changed my life. It's the thing that made me realize what was actually going on. Because look, I've been dealing with burnout for years, and like everyone else at first I thought it was work-related. I thought like, "Okay, I need to cut back on my hours." I was doing a start-up thing, like doing this amazing work, ridiculous sprints, and just burning the candle at both ends.

Myk: 10:09 And I thought, "Okay, obviously I've burned out, I'll take it easy at work a little bit." I left that job, I did some consulting, I traveled. Burnout was still there. So, okay. I moved to New York, I got settled in. I found a low stress job that I liked when I was still there. Took vacations, worked from home, do everything that everybody tells you to get over your burnout. Sometimes the burnout actually got worse, and I'm like, "What the hell is going on? Why can't I recover from this?"

Myk: 10:38 And that's around the time I discovered autism, and that's around the time I discovered autistic burnout. And it made me understand immediately that burnout has nothing to do with work. You're burned out because of the sources of stress in your life that are costing you energy that you don't have. And if you don't want to be burned out, then all you have to do is end every day with enough energy that you're going to be fine the next day.

Myk: 11:05 And that's what things like self-care are about. Right? Really at the end of the day. It's not about just relaxing and having fun, it's about understanding what your needs are, especially in terms of something like energy and attention. And then taking the steps necessary to ensure that you can meet those needs while also doing everything else you have to do in life.

Myk: 11:23 And so, when I talk about different kinds of burnout, I mean, it's not really different kinds of burnout, I guess, it's like burnout triggered by overwhelming stress in a number of dimensions. Autistic burnout in particular, I want to make sure I talk about this, is something that a lot of autistic people talk about. I learned this phrase from other autistic adults. This is not something that doctors, therapists, psychiatrists often are even familiar with. It's not in the DSM, right?

Myk: 11:53 And if it's not in the DSM it's not real to a lot of people in the medical community. But when you talk to autistic adults there's this very common experience, "God, I'm just... I had to spend time with a bunch of people for like days, I had to go see my family maybe, and like..." or, "I have a job where every day I'm doing customer service." And if you're autistic and you're interacting with people, it's a little bit like speaking in a foreign language, right?

Myk: 12:23 Because the way you model things, the way you communicate is not natively the same as most people. You think of things in terms of systems often. You think of things in terms of relational truths where the answer to a question depends on the answer to a bunch of other questions. You get really hyper-focused maybe on discontinuities in models, right? If somebody says something that seems to disagree with something they just said, that makes you really want to unpack and understand that. These are all behaviors that drive people crazy.

Myk: 12:58 And so, if you're autistic and you're in a situation where you need to deal with a lot of non-autistic people, then you need to constantly be subverting your own native natural behaviors in order to perform an identity that works socially. And if you're an undiagnosed autistic, then this is horrible. Because you probably are not even aware that you're doing it. You just think that everybody is living like this. You think that everybody is carrying all this weight, everybody is constantly managing their social... the best way I've heard it described, and this is a tech podcast I can use this analogy, a lot of social stuff for most people seems to operate on the hardware.

Myk: 13:39 But for me I had to learn it and I had to learn to operate it on my software in my brain. Right? And so that means when I'm having an interaction with somebody, I am thinking about everything I'm saying, I'm reminding myself to make eye contact, I'm reminding myself to ask about their day, I'm remembering to manage my tone, I'm remembering to manage my facial expression. These are all things that if I do not do, I face consequences. And I'm straight white guy in tech. I've got a lot of privilege, my consequences tend to be small.

Myk: 14:13 People that don't have my privilege though, are going through every day having to perform an identity that isn't theirs. Often not even realizing that this is the case. And then wondering why they're so burned out and why nothing seems to help. Right?

Amberley: 14:29 Yeah, yeah. It's interesting. I had never heard of autistic burnout until following you and hearing about it from you. And you in one of your tweets had an article that described autistic burnout and autistic burnout on thinking person's guide to autism. And it had another tech analogy that I thought was interesting, which is if you've ever had a problem with a computer and it's had to go into safe mode, that would describe what happens to the brain. It runs on limited functions, not all services are available and it's access to the internet is denied and unable to connect.

Myk: 15:07 Yeah, exactly. So then imagine you're booting up in safe mode how your hardware works, right?

Amberley: 15:13 Mm-hmm (affirmative).

Myk: 15:13 If your social skills were in your hardware then that wouldn't affect you. But if it's in software, then suddenly you start getting really weird glitches, you get weird bugs that other people don't get that you're embarrassed and confused by, right?

Amberley: 15:33 Yeah and one thing also that this reminds me of is you talk a lot about coping energy, like coping energy being really core to this, how you experience burnout or how you understand burnout. And it reminds me a lot of spoon theory.

Myk: 15:49 Yeah, yeah.

Amberley: 15:52 Do you want to describe what spoon theory... I was going to, but do you want to describe it?

Myk: 15:59 Oh, go for it. Yeah, go for it. I talk a lot.

Amberley: 16:00 No, no. Spoon theory is essentially a metaphor used primarily by people who experience chronic illness to describe the capacity that they have to accomplish everyday things. Like you have a set number of spoons that you can spend over the course of a day. And maybe getting out of bed costs a spoon, and taking a shower costs a spoon. But this same general idea in what you were talking about of you have this finite capacity that can be hard for, in the context of what you were talking about, autism, be hard for people who are neurotypical to understand.

Amberley: 16:48 And that article that you linked to it also linked to another post by Ryan Born. And aligned from that what I thought was really interesting was wearing the mask of neurotypicality drains my battery and melts my spoons. And I thought that line, marrying those two concepts was really descriptive.

Myk: 17:11 Yep. Yeah, absolutely. Like spoon theory is great. I have used that metaphor in the past. There's something specific to the autistic experience that I feel like spoon theory doesn't obviously cover, although you can use spoon theory to refer to it. I've actually, this is addressed by an interesting alternative I've heard discussed called fork theory.

Myk: 17:35 Fork theory says, look, I have energy to do stuff, no problem. Every time you need me to do something, everything that I do, it's like you're sticking a fork in me. And that's fine, I don't care I can take it. Until one time you stick a fork in me after I had accidentally run out of the energy that I need to tolerate being stuck with forks. And then, I can't take it. And I'm probably not just going to lose function in some way, I'm probably going to get upset.

Myk: 18:09 We're going to have... the thing that is so hard, I think, to articulate, the thing that I don't see talked about, the thing that people don't generally understand is that being autistic in a neurotypical world among the many other invisible challenges that it comes with requires me to regularly get really upset but not show it and not give into it, because the thing that's making me upset would be considered unreasonable by anybody else.

Myk: 18:46 And so, I'm not really entitled to that, right? And spoon theory doesn't really speak to that exactly unless you wanted to say like not getting upset caused some spoons. Right? "Oh, well, how often are you not getting upset?" "You wouldn't believe me if I told you." It's just like I don't know, does that make sense?

Amberley: 19:10 It does, yeah. And I'm not the authority on spoon theory by any means but yeah, I would say that makes a lot of sense that yeah, it cost you energy, it cost you a spoon to handle a situation this way.

Myk: 19:21 To just be. To just exist and consume passively social interaction can have a high spoon cost. And that's weird and hard to understand.

Kurt: 19:32 Yeah, I mean, it totally makes sense and what's interesting to me is especially when you zero in like put it through the lens of technology and the tech industry as a whole, which is a very high communication industry, right? Like you could do a lot of jobs like as a truck driver, right? And you'll probably be able to save more spoons because you're spending most of your day in isolation. Right? You're just driving by yourself, you don't have to interact with too many people. However, in the tech industry, it's constant interaction with others, in most cases.

Kurt: 20:06 So, do you find that that has a more specific effect on your, the amount of energy that you have to get throughout the day? And then as a follow-up to that is, what do you do to recharge? To make sure you do have enough energy to keep going the next day?

Myk: 20:24 So that's a good question. What I've actually found is actually really a little surprising to me, which is that all of the communication and staff at work, in fact, going to work and working can often actually be a thing that gives me more energy and not less. And the reason for that, I think, is that when I'm working. So first of all, I often work from home. So I don't have a lot of face to face interaction.

Myk: 20:48 Second of all, the interactions that I do have are, they're bounded by a specific system that like after 15 years in this industry I understand. I understand how to communicate as a software engineer. I know how to communicate to junior DEMs, I know how to communicate to management, I know how to communicate to customers and clients. There are systems that you can learn.

Kurt: 21:12 Right. Like rules and guidelines essentially that are developed.

Myk: 21:15 Exactly. Where things tend to get a little harder for me is like with, actually with interpersonal stuff. Conversations with loved ones that are really emotionally fraud where I'm like, "If I say something I need to be very aware of the nuances of how my word choice and my tone are going to emotionally affect them," for instance, right? Like having to do that all the time is the sort of thing that leads to my burnout way more than spending too much time at the office, if that makes sense.

Kurt: 21:45 Yes, totally. Totally it does. And then just again to follow-up. So, let's say that your battery gets drained, what do you do to recharge? How do you reset?

Myk: 22:02 Yes. So, there's all sorts of ways to do this. Honestly, it depends on my overall state. If I'm in a pretty good place then I recharge by doing little side projects, I recharge by playing video games, I love to read, I go on a date with my wife, I'll, any number of stuff. But when I'm in a bad place, when I'm in a sustained bad place, I think anybody who's struggled with burnout understands that burnout kills your executive functions, right? Executive function, for those who don't know, is the cognitive mechanism that allows you to go from an intention to an action, right?

Myk: 22:47 When you have poor executive function, you may want to do all sorts of stuff, you just can't and it feels weird. It's like, "Well, why can't I? I don't understand, I want to, I'm trying to, I can't make myself do it." Autism first of all and ADHD and a lot of neurodivergent traits often come with severe executive function problems. When you lay your burnout on top of that which manifests as additional executive functions problems, it becomes really quite a bit to manage.

Myk: 23:15 And so, when I'm in a bad place, honest to God, I'm just going to come home after work, smoke some weed, play video games and stay up too late. And like, "I'm going to feel better."

Kurt: 23:25 Yeah. Yeah, yeah, yeah.

Myk: 23:27 And that's just what it is, you know. You have to find systems that meet you where you are.

Kurt: 23:34 So, just like a quick follow-up to that, do you find that working remote is beneficial because it helps you have less interactions? And so, I know that communication is pretty much laid out, but in an office environment there is still that small talk, or going to lunch, or having drinks with coworkers. And all those seem to open up the door for those types of unplanned interactions.

Myk: 24:02 They do. They do. And again, I didn't realize I was autistic till I was 34. I'd been in tech for almost 10 years, whatever that timeline works up to. Social interaction costs me energy, but that doesn't mean that I'm bad at it, it doesn't mean that I find it unpleasant all the time, it doesn't mean that water cooler conversations or whatever are like triggering to me or whatever, it just means that there's a cost doing it.

Myk: 24:34 What I have found is, so I live in New York and I work in New York. I have a 35 minute commute to my office, but I often just work from my apartment. I try to come in once or twice a week to get face time and talk to people. Some weeks I don't come in at all. And it's fine, I really look forward to coming, and I look forward to that face time. I look forward to having these connections with my coworkers and colleagues. So, it's not the case that... I don't want to give anybody here the impression that as an autistic person every human interaction is torture for me, that's not what it is.

Kurt: 25:09 Yeah, sure. Totally.

Myk: 25:12 It's just that like... it's almost like unpredictability raises the cost. You start to think in terms of multipliers on costs, right? Like maybe having just a totally normal or small talk chat with my coworker costs me one unit of energy on a good day. But maybe they mention something that is connected to something that I'm trying hard not to think about because I just have a giant meltdown about it and suddenly that one cost interaction through no fault to them has become a 10 blast interaction and I need to reevaluate. And that's all fine. That's just what it means to live in the world as an autistic person.

Kurt: 25:48 Yeah. Yeah, okay. Awesome. Thank you so much for sharing all of this. This has been an amazing conversation.

Amberley: 25:57 Yeah.

Myk: 25:58 I appreciate that. It took me a long time to be comfortable talking about this stuff. And the reason that I finally decided... like if you had told me a year ago the things that I have publicly posted on the internet, I would be so modified that I wouldn't be able to function. And a large part of my own recovery process has been recognizing that, like a lot of autistic people, I have been accidentally taught to feel shame about my own experience and my struggles and the things that are hard for me. Like a lot of autistic people whose autistic traits are not obvious I have internalized modes of behavior that are not intuitive to myself and I'm like it's just what it is.

Amberley: 26:45 Yeah. Before we wrap up, is there anything, are there any parting thoughts that you really want to make sure you share?

Myk: 26:55 I want to be very clear about one thing. I don't speak for all autistics. Nobody does, you can't. Every autistic trait, for every trait that some autistic person has, some other autistic person has the opposite of that trait, right? Autism is so broadly defined in such a diverse field that we're still trying to understand what it is. And no one autistic experience can ever be treated as universal.

Myk: 27:20 Saying is that when you've met one autistic person you've met one autistic person. And that's really important to keep in mind with everything I say here. I'm not an authority on anything other than my own life, my experience and the conversations and interactions I have had. I really encourage everybody to please educate yourself about this stuff, seek out stuff on the actually autistic hashtag, read the autism translated subreddit.

Myk: 27:44 Autism is not what you think and especially if you're somebody who has tried everything to get over your burnout and nothing works, feel free to reach out to me. This stuff is important, this makes a great entire lives. Thanks so much for having me on here.

Amberley: 28:00 I can't tell you how much we appreciate you sharing your perspective. We so much enjoyed this conversation.

Myk: 28:07 Thank you so much.

Amberley: 28:10 And so, thank you for your time. We'll be making a small donation to an org of your choice and you chose The Aspergian. Could you please tell folks a little bit about what The Aspergian is and why you picked it?

Myk: 28:24 Yeah. The Aspergian is a writers' collective of autistic adults who come from all walks of life, diagnosed and undiagnosed, speaking autistics, non-speaking autistic, people with any number of comorbid disabilities just writing about their experiences and what it means to be autistic. And they host a lot of the best writing specifically because they're not just looking at visible straight white autistic men, which is who gets to do most of the conversations setting.

Myk: 28:55 And they're not looking at parents of autistic kids or other people who want to frame autism as a disease or anything like that. They're affirming and important and valuable and you should check them out, you'll learn a lot.

Kurt: 29:07 I absolutely will be checking them out. Yeah, thank you.

Myk: 29:12 Thanks so much.

Kurt: 29:13 Thank you for sharing that and thank you again for joining us.

Myk: 29:15 My pleasure.

Amberley: 29:24 All right thank you so much Dr. Winsberg for joining us. Would you prefer that I call you Dr. Winsberg or Mimi?

Mimi: 29:30 Mimi is great, thanks and great to be here.

Amberley: 29:33 Yeah. So, we shared a little bit about you already, but would you like to introduce yourself a little bit and a little bit more about who you are?

Mimi: 29:41 Sure. As you said, I've been in practice for over 20 years and my career shifted a little bit over the years. I was doing more basic neuroscience research and brain imaging research in my Stanford days, have been in clinical practice throughout, but in the last five years I've really been focusing on digital health and in the tech sector. So, trying to come up with new innovative ways to deliver mental health, address the shortage of psychiatrists that we're seeing in this country and the raising rates of anxiety and depression.

Amberley: 30:14 Yeah. So, it's interesting that you mentioned the shortage because in the previous episode we talked to two folks who organized a conference around mental health and tech and we talked about that shortage. Do you, A, was there a particular reason why you were attracted towards the digital health space. And, B, do you think that, that's helping to address a little bit of that gap almost?

Mimi: 30:41 Yeah. It's interesting. I got into digital health, in particular, because I'm an athlete. And so, I'm in the habit of tracking certain metrics around athletics performance and I was doing that and working with other athletes as well. And I found that it was very helpful also for my patients who were suffering potentially from mood disorders, or recurrent episodes of mood disorders. And it was very important to have them track things like sleep and other factors that were going on. And this whole quantified self-movement was developing at the same time. So that's what first got my interest in digital health.

Mimi: 31:19 But then as I got deeper into that space, I realized all of the ways in which mental healthcare could be optimized using digital tools. And so, I do think that it is starting to make a dent in both access and quality of care that we can deliver to the population at large.

Amberley: 31:42 Yeah, that's interesting. I mean, the topic of access and how it can open it up to more folks to me is a huge [inaudible 00:31:51] experimenting with all these different types of digital innovations, with delivery particularly.

Mimi: 32:00 Yeah. One of the things that we know is that we have a shortage of psychiatrists in this country right now. And we're seeing rising levels of depression and anxiety, they're hitting epidemic proportions. Many of the psychiatrists are clustered in dense urban areas like New York, San Francisco. There are entire states where it's difficult to find a psychiatrist or get mental healthcare. And the cost in accessing a psychiatrist can also be prohibitive for many people.

Mimi: 32:36 So, one of the things we can do with telemedicine and using digital health tools is we can connect patients in more remote areas with doctors who can deliver high quality care. And we can use digital tools and screening tools, and other triage tools built into the digital health platform to both enhance and improve the care the patients are getting.

Amberley: 33:02 Yeah. And I would love to ask you some questions about Brightside, the company you're with, but would you like to just give a short summary about the philosophy you practice for Brightside?

Mimi: 33:16 Sure, yeah. So, we founded Brightside close to two years ago now, and we're live in about 30 states. And we are treating depression and anxiety. Our goal and our mission is to really provide the highest quality depression care and anxiety care and make it accessible to people at an affordable rate. But we use, as a I said, both telemedicine. So, being able to connect people from wherever they are whenever they need help.

Mimi: 33:46 And we also use digital tools like machine learning clinical decision support that served up to the doctors to help them decide what the best treatment for any given patient is and track those patients' progress ruthlessly over time so that they get check-ins frequently to see how they're doing, do they need some modification or augmentation or treatment strategy?

Mimi: 34:10 And what that allows people to do is instead of being stuck in a healthcare system where they have a scheduled appointment whether they need it or not, and that appointment might or might not happen in a timely fashion, this way the people can get care at the time when they need it. And they don't have to wait for an appointment that they can connect with the platform and connect with their doctor at the time of symptoms.

Mimi: 34:33 One of the things we see in mental health is that, I mean, this relates directly to burnout too is that if you break your leg you're going to get treatment for that broken leg right away. Whereas in mental health, what we see often is people who've been walking around on a broken leg for weeks, to months, to sometimes years. And there are all kinds of downstream effects from that. Their back might be out, their foot hurts. And you can just deliver much better care if you address the symptoms as they present rather than waiting for somebody to really get into trouble.

Amberley: 35:06 Yeah. So, you started, on this episode we're talking about burnout and you started talking about it a little bit, but can we, would you mind helping us take a step back and define burnout. Because my understanding is that this year burnout itself was recognized as a syndrome by the World Health Organization, but it doesn't really have a diagnostic criteria.

Mimi: 35:37 Yeah, the WHO recognized a syndrome in their, what's called International Classification of Disease ICD11. And it isn't recognized as a medical condition, it's described as an occupational phenomenon. So, it's something that happens as a result of the work that you do. It's been widely recognized among healthcare workers, in particular doctors and nurses. But they characterize it by the presence of a couple of different symptoms or manifestations.

Mimi: 36:10 And they describe it as a feeling of exhaustion, or feeling as if your energy is depleted, a feeling of distance from your job. So, maybe feeling more like an automaton or feeling negative or cynical about your job.

Mimi: 36:27 And then also there's a component of reduced efficacy. So, feeling less productive or good at your job.

Kurt: 36:34 You said that you're the onsite psychiatrist for Facebook. I'm also curious is it only you? Are you the only per working with the employees at Facebook?

Mimi: 36:45 No. So, we have a large mental health team at our onsite Life at Facebook Clinic that's run by Crossover Health. So we have a large number of therapists there. I was the first psychiatrist, I joined in 2017. And to my knowledge, I think I'm the first onsite psychiatrist in the country because I don't know of other positions like this.

Mimi: 37:05 So, Facebook was actually innovative and Crossover was innovative in bringing on a psychiatrist to address their employees' needs. We've now hired another psychiatrist because the need outpaced my ability to deliver care alone.

Kurt: 37:23 Yeah. I mean, that makes sense, right? It's a very large company. I imagine that can be quite difficult. So, a follow-up to that, essentially what are some of the signs that someone may be at risk of burnout? Like how are you trying to detect a burnout in employees, particularly in tech companies, do you see a lot of repeated patterns?

Mimi: 37:45 Sure. I will say that I think it's important to both recognize burnout but also recognize when burnout may just be the tip of the iceberg and what you're really dealing with is depression or anxiety. So, depression and anxiety, as I said, they're common. Anxiety affects about 18% of the population and depression 10-13%. And tech workers are by no means immune from this. So, just because you work at a high profile company doesn't mean that you can't get depressed or anxious. And so, I think recognizing these diagnoses among the workers is important.

Mimi: 38:33 Signs of burnout can be, as we said, a sense of feeling a little bit dehumanized, feeling ineffective or depleted of energy. Let's keep in mind that a company like Facebook, they are recruiting top students, top employees from other companies. So these are folks who are generally very driven, are used to being at the top of their class, and are going to work as hard as what's expected and more. And that in itself can lead to a sense of depletion because standards are high and expectations, internal expectations are high.

Amberley: 39:21 And what kind of, talking about these patterns, what kind of factors do you feel like contribute the most to the people that you see experiencing burnout?

Mimi: 39:33 Yeah. In terms of personality traits or symptoms that they might present with?

Amberley: 39:40 In terms of maybe some of the environmental factors around the workplace, maybe.

Mimi: 39:46 Sure. Yeah, I mean, I think that brings up an important point which is that we do have this tendency in this country to medicalize certain things instead of frame it as a diagnosis rather than looking at some of the systemic issues that may be contributing to those symptoms. And we have seen this with Type 2 diabetes, hypertension, obesity, these are all on the rise.

Mimi: 40:14 They are illnesses. They're real illnesses that require real treatments, no question. But there are certain lifestyle choices and systemic environmental factors that are contributing to their rise. I think the same can probably be said about burnout, stress, anxiety, depression. We oftentimes, because depression and anxiety come with some stigma, it becomes easier to express things as a workplace problem or a burnout problem.

Mimi: 40:46 And we see quite a bit of that I think where people are rather than maybe acknowledge that they might be struggling with depression or anxiety, it becomes easier to just phrase it as "I'm burnt out, work is really getting to me."

Mimi: 41:00 But that said, I think there are systemic issues in the workplace that may be contributing to this, the 24-hour work cycle, a feeling that one can't take one's eye off the ball, and pressure and expectations about growth.

Kurt: 41:19 A little side step to that, which just talking about the 24 hour essentially work day. I don't know if Facebook supports remote work, but have you noticed any correlation between working remote and people feeling like they can't turn off? Like need to be always available and that potentially leading to burnout?

Mimi: 41:42 Yeah. I mean, I think whether people are working remotely or not there's certainly a sense of not being able to turn things off. And we see that contributing to insomnia, we see that contributing to lack of exercise and lack of other activities that are antidotes to burnout. So, one of the things that I encourage people to do is to zoom out essentially. So when you're focused on your work, you got your nose pressed right up against the glass and I think it's important to zoom out in each 24 hour period for minutes.

Mimi: 42:23 Whether that's a short meditation session, or an exercise session. And then to do it weekly for hours. So, to find some real break in the course of the week usually on the weekend. And then once a month to do it for a full weekend. And then once a year to really do it for, to unplug for a prolonged vacation.

Mimi: 42:46 So, I think building in those recovery cycles is really, really important. We see this in high performing athletes too that they need to periodize their training. You can't just go, go, go. You have to adapt, absorb, take in what you've learned, to re-assess, think about where you want to go next. And so, enforcing some of those zoom outbreaks to re-assess your goals and the meaning you're getting from your work and what you want to do next is really important.

Amberley: 43:14 One question that I have to ingest what we've already talked about is there's, it's generally regarded that the tech industry experiences a high rate of burnout and I'm wondering if that's because there's a relatively higher amount of conversation around it or press around it. Like you see more articles around burnout in the tech industry? And I'm wondering if that has something to do with tech or if you think there's a reason why it's just covered more widely on the tech industry in particular?

Mimi: 43:58 Yeah. I think that tech workers may have the luxury of being more vocal about this. I mean, in some ways it is somewhat of a luxury and a privilege to be able to express it as burnout in the sense that there are a lot of, let's say, hospital healthcare workers, call center workers, Walmart employees, factory workers who may be experiencing burnout but don't have any choice around it. In other words, it's their job, they have to do it to pay the bills. And so, they may be experiencing burnout as well, but it's not expressed as such.

Mimi: 44:37 So, part of it is giving a language to something that is real and experienced by people through all sorts of life. And part of it, as I said, may be a way of expressing some anxiety and depression in a destigmatized way.

Amberley: 44:56 Yeah. Do you think it's most often that those, I guess, I'm rephrasing it to restate it, do you think they're more often co-occurring and presented as burnout, or do you think there's a state of burnout that occurs without, maybe, a different underlying more medical condition?

Mimi: 45:19 Yeah. I mean, I think it can be chicken and egg in the sense that burnout can be the tip of the iceberg and really the result of long standing stress and anxiety and potentially depression and so then it finally gets manifest as burnout. Or I think sometimes burnout can be the early stages of depression and anxiety, so I think they go hand in hand. Stress and anxiety and depression go hand in hand. And so, it's important to screen for these illnesses, which do have good treatments associated with them. And ignoring them is really can be very detrimental to one's health overtime.

Mimi: 46:05 I will say, just to circle back to your question about why this is more front and central. With tech companies is I think the speed at which many tech companies have to grow, and the pressure the employees are under, again, will contribute to this 24/7 work schedule and can exacerbate the symptoms of stress that they're experiencing. So, they are not stepping away from it.

Mimi: 46:33 And many times that can take years to catch up with. You will see higher level executives who are now successful may not be under as much stress and yet they are asking themselves, "Hmm I thought this would make me happier and I'm not happier now, I still feel I'm still stuck in this stress cycle even though I've accomplished many of the goals I had set out to accomplish."

Mimi: 47:06 And so, there what you're looking at is maybe a need to address some underlying issues about goals and satisfaction, and what people are really, sort of how people are trying to find meaning in their lives.

Amberley: 47:17 Mm-hmm (affirmative). Yeah. One thing I'm curious about is in the all the definitions that I've seen of burnout it's generally very narrowly scoped to work. Like workplace-centered stress. Do you think, I guess, why do you think that is and do you think there's other types of burnouts as well? I mean, that's a tough question to ask because like we talked about already there's no diagnostic criteria, it's not a medical condition but a lot of the conversation around burnout that I live in the tech industry world so, specifically in the tech industry I see a lot of conversation about burnout that's not necessarily only focused around workplace stress.

Mimi: 48:11 No, I think you bring up an important point that it's defined as a phenomena around the workplace, but what it really represents is a sense of dehumanization, right? Or maybe a lack of meaning in work or whatever the activity is. And so, that's a much deeper problem of how does one feel human? How does one feel creative? How does one find meaning in what we're doing? And when you get into a cycle of losing that, losing your own sense of autonomy, losing a sense of meaning, losing the why in what you're doing, then that can create symptoms that are central to burnout.

Amberley: 48:57 I searched for some of your writing, and you've written quite a bit about specifically sports psychiatry and sports burnout. And I know that you yourself are an athlete. Would you mind speaking a little more personally about if you've experienced burnout personally and how you experienced it and how you handled it?

Mimi: 49:25 Sure. Yeah. I mean, just till the first part about athletics that what I like about sports it's an arena for life in some ways. And I think looking at athletes, athletes choose to go, professional athletes chose that because they get to do what they love, right? We think that they're so lucky that they get to do what they love, but to be really great in sport it takes everything you have and then some training and practice can certainly become very monotonous and take away from other focus like family, friends, leisure.

Mimi: 50:00 So, yes, athletes are lucky to get to do what they love, but they need to also be aware of grueling schedules, pressures, exhaustion and have some balance in their life and keep the passion alive. As far as my own experience with burnout, my mentors that I've had in my life, two of the traits that I've observed in all my favorite mentors is, are both curiosity and a contrarian mindset. Those are two things that I always respect. And I think that it's so important in whatever you're doing to maintain curiosity and continue to learn and to not get stuck in a fixed routine or fixed mindset about anything.

Mimi: 50:53 It's so important to think about growth and how you're growing, and what more you can learn. And with that, I think to be weary of group thinking some ways, just because everybody is doing things a certain way doesn't mean there isn't another way to look at things or another way to do things. And I think both of those traits of maintaining curiosity and thinking about new ways to do things can actually be powerful ways to avoid burnout.

Mimi: 51:28 Because it keeps the interest and passion in what you're doing alive, and it's interesting with healthcare workers are very, very prone to burnout. A lot has been written about that, doctors with their increasing demands for reimbursements and documentation and feeling that they've lost the joy and the reason why they went into the field.

Mimi: 51:54 And one of the things we've seen in developing Brightside is not only are we providing innovative ways for patients to get treatment for their mental health, but the doctors love it too because they get to practice more innovative ways. And it's re-integrating their joy in work. And so, again, I think this notion of curiosity and invasion are very central to avoiding burnout.

Kurt: 52:20 Yeah. I mean, I feel like with pretty much anything you do, right? Like staying curious and staying active is just helps to keep that flame alive, keep things going.

Mimi: 52:31 And sometimes it means re-inventing yourself, you know.

Kurt: 52:33 Yeah. Do you think that that was key to helping you overcome burnout or avoid it completely?

Mimi: 52:40 Yeah. Like I said, I think that I had the luck of re-inventing myself several times in my life, and so, no, I haven't quite experienced burnout. I think when something starts to feel anywhere close to that I change it up a little bit to give myself new challenges. And I've always been good at taking on new challenges whether they're physical, or mental, or whatever they might be.

Mimi: 53:05 What I will say though is that making change when you're very busy is hard. It's hard to make change, period. But to do it when you're really busy is much, much harder. And so, that's the importance of stepping back periodically to consider how you might want to make that change.

Kurt: 53:23 Yeah. Yeah, no, absolutely. So, before we wrap up here, I wanted to ask, do you have any final thoughts or anything that you would want to add, anything you want anybody who might be listening to know about burnout or anything regarding that?

Mimi: 53:39 Sure. I mean, I think first is make sure you're not suffering from depression or anxiety. There are really good screening tools. You can take ours at Brightside if you want to. There are also good treatments. So, people need to ask themselves if there are unaddressed issues that feel too hard to tackle that might benefit from having to look at. I think the other thing is this importance of stepping back from the grind to reconsider what your goals were, where you want to go, do this in a periodized way. Take time every week, every month. The longer the involved, the longer you should step back for.

Mimi: 54:17 And then, I think lastly just don't lose sight of social beings that we need time with people, with friends, with whoever is important to you in your life. We need time to play, not just work, and we need time in nature. So, that's something that I see missing in a lot of tech workers' lives in particular. Friends, play and nature.

Mimi: 54:40 And making ourselves physically uncomfortable is probably something our bodies have been evolved to do. So, there's no harm in taking on physically uncomfortable activities a few times a week either. I think all those things are helpful in terms of reconnecting with other aspects of ourselves that are not our work life.

Kurt: 55:02 Yeah, that's great. That's amazing. I just wanted to thank you again, one last time for taking the time to speak with us. This has been very informative.

Mimi: 55:12 Thanks so much for having me, it's a pleasure.

Kurt: 55:14 Yeah. Thank you. Thanks so much for joining us for our third episode. We really appreciate it. We hope you'll join us again next time and if you know someone who you think would really enjoy the show, we'd love it if you'd send it to them so they can check it out too.

Amberley: 55:35 And thanks once again to Myk and Mimi for joining us and sharing their perspectives and expertise. To thank them for their time, we'll be making donations to organizations of their choice. Myk chose The Aspergian, which he told us a little bit about. And after we talked to Mimi she let us know later that she'd like us to contribute to Crisis Text Line, which is a free 24/7 support service for people in crisis. And all of their counselors are 100% volunteer.

Kurt: 56:04 We're really loving putting these episodes out into the world and we're hoping that you're getting something out of it as well. And we just want to say as always, be well everyone.