Valerie Brooke, MD
The meaning of depersonalization has always alluded me. How can one not feel like a person? I finally understood it when I experienced burnout last year. Depersonalization is one of the three characteristics of burnout, in addition to emotional exhaustion and a low sense of personal achievement in the workplace.
Does de-personalization actually mean to not feel like a person? To be outside of oneself? In one sense of the word yes, depersonalization can be described as not feeling like yourself, feeling unreal like a robot, feeling cut off from reality, or losing your personal sense of identity.
When it comes to healthcare worker burnout, depersonalization has more to do with one’s connection to patients and colleagues. It is the act of depriving another human being of their individuality or their human characteristics. It’s the loss of empathy and compassion for patients, that often results in treating them as impersonal objects.
Depersonalization can be necessary in order to protect us from the trauma of watching people suffer day in and day out. It’s what is needed to get the job done in a fearful situation such as running a code (when a physician leads a team of healthcare workers trying to resuscitate a patient who is not breathing or doesn’t have a pulse), when trying to save a rapidly declining patient in the operating room whose blood pressure is dropping dangerously low, or even just when trying to hold space for family members after telling them their loved one just died, without getting emotional at the same time.
Depersonalization includes emotional numbness to what’s going on around you as well as emotional disconnection from those you care about, either your patients or your colleagues. The depersonalization I experienced last summer was partly accelerated by all the personal protective equipment (PPE) that was required before seeing any patients. This PPE, while necessary in order to stop the spread of the virus, also put up a wall between myself and my patients. Prior to becoming a physician, I was a massage therapist. Using my hands to touch my patients, along with showing them a compassionate smile, was no longer an option, at least not without several protective layers of masks, gloves and gowns.
Not only did I feel like I was unable to connect to my patients in a meaningful way, I also felt like a robot, numbly doing what I needed to do each day to take care of patients. I also became disconnected because I was overwhelmed and emotionally exhausted, surrounded by so much uncertainty every single day. Shutting down was the only option in order for me to keep showing up.
The key is that depersonalization is only meant to be temporary. With the prolongation of the pandemic, the continued high volumes of patients in our hospitals, the constant hyper-vigilance of trying not to get infected, developed into a hard emotional shell. I found myself thinking of patients as their diagnoses and not as individuals. “I’m admitting a stroke and an amputation,” rather than “I’m admitting a patient who had a stroke and another patient that had an amputation.” I became more callous and less sympathetic to their suffering. Their physical and emotional struggles were becoming a burden for me to care for, rather than a privilege to help heal. I shut down from my colleagues and became isolated, using the pandemic as an excuse to shut in.
There was a pivotal moment when I finally realized the truth: that I was burned out. It occurred during a particularly stressful call week, in between the first two COVID surges, when my battery and coping skills were extremely low. It was the start to my healing. The start to under-covering all the choices I was making in my daily life that pushed the needle toward more burnout. The start toward learning new tools to treat my burnout. The first step was recognizing it and saying it out loud. You cannot fix what you cannot name.