Leading Burnout Expert | How to Finally Feel Better

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Episode Transcript:

Neha Sangwan, MD: [00:00:00] I want people to know that they’re not fine on Monday and burned out on Friday. That’s not how that works. That triad of exhaustion, cynicism and ineffectiveness occurs over time, and you’re adjusting to all of that. It’s not your fault. It’s actually a wake-up call. Burnout is a wake-up call telling you that the way that you’ve done this has served you until now. We want to thank that. Thank you. Thank you for those mechanisms. Thank you for getting me here. But this is a wake-up call telling you that what’s gotten you here isn’t going to get you where you’re going. Crises in our life are here to tell us, like, huh? Is this where you really want to go? Let’s double-check. Let’s make sure that the choices we’re making fill our hearts with meaningful, purposeful steps on the journey. And are we just doing them because that’s what other people say we should do? Or are we doing it because this is what really fuels us and what we want to do.

Jonathan Fields: [00:00:54] So have you ever felt so exhausted, drained at the end of your rope? Even downright cynical about everything from relationships to work and the world that you just knew that this wasn’t you, but you couldn’t quite figure out how to get out of that feeling. That is the reality of something a lot of people experience that we call burnout. It’s a state of just physical and mental and emotional depletion that can leave us feeling hopeless and helpless. And in case you’re wondering, no, it’s not just about work. It can happen to anyone and be brought on by a piling-on effect that comes from nearly any and all directions. I have experienced this a number of times myself, and in truth, not even that long ago. And I’ve had so many conversations with friends and colleagues who have experienced the same thing and sometimes kind of not even wanted to share it and just suffered alone. So I wanted to find out what’s really going on here and what we can do about it. And that’s why I invited Doctor Neha Sangwan, a physician, engineer and author and communication expert, to just take me into her game changing work on the topic. Neha is the founder and CEO of Intuitive Intelligence. It’s an organization on a mission to empower people and teens with mindful communication tools, and as a speaker and author and consultant to top companies like Google and American Express, she’s just upfront and deeply invested in bridging the worlds of physical and mental health with truly deep insights from her own intense burnout experience, which she shares.

Jonathan Fields: [00:02:18] Neha really peels back the layers to reveal the surprising root causes in her groundbreaking book Powered By Me: from burned out to fully charged at work and in life, she shares a revolutionary framework to really help us rebuild personal power and reclaim energy and passion and purpose to break the cycle of burnout. So excited to share this conversation with you! I’m Jonathan Fields and this is Good Life Project.

Jonathan Fields: [00:02:48] You know, I feel like the, um, the phrase burnout has been just so popularized, for better and for worse, probably, you know, the fact that it actually has become such a part of the common conversation is a signpost of how many people are experiencing this weird phenomenon. But at the same time, I also feel like we’re not always speaking the same language when we use the word burnout. What does that actually mean? And I think that’s an interesting starting point for us, is when we talk about burnout, what are we actually talking about?

Neha Sangwan, MD: [00:03:18] That’s a really good point. You know, in general, I think it’s people experiencing an overwhelm. So if I just said it in layman’s terms, I would say it’s, you know, they’ve been functioning a certain way for a long time. Mother nature gives us so many beautiful coping mechanisms, like our blood pressure changing and our heart rate changing, and all of these things to adjust to the world around us. We also have our own patterns that we use. For me, it was sugar and caffeine to get me through 36-hour shifts at the hospital, and so we all come up with our own creative ways to augment our own physiology changing. But at the end of the day, really, after we’ve we’ve used up the strategies and mechanisms to keep going, perhaps against our own biology and our own fatigue and our own ways of the world. It’s like the external world is speeding up, and at some point we are adjusting to it. And there comes a point where perhaps our coping mechanisms, our strategies, we’re out of them. And I think that’s when people start to experience that overwhelm that many people refer to as burnout. But just straight up, what does the research say? Let’s talk about that. So it’s a triad. Burnout is a triad. It begins with physical mental, emotional exhaustion. So the first word is exhaustion. It occurs over time. Just like I explained to you, there are many ways that even when things are stressful or hard, our biology is built for that. We know how to get out of danger. Animals know how to run away and rev everything up right? We know how to do that. But when it becomes a way of life, when it is the pace of emails coming in that you can never catch up to, when you’re taking in data and communication in so many ways that you have to be asking, how did you send that to me? Was it on slack, or chat or WhatsApp or email? Or how how am I like? We start getting so inundated by faster is better and do more with less.

Neha Sangwan, MD: [00:05:25] That exhaustion. Exhaustion is the first pillar of the three in the triad of burnout, and it’s usually physical, mental, and emotional types of exhaustion. So that’s been going on for a while. We’ve been adjusting to it. And then the second pillar comes in, which is it’s almost like imagine it like an undercurrent. I think of the, you know, the ocean. It’s like you can’t see it, but boy, you can feel it. And it’s when in that exhaustion, you start to hear your own mind saying things like. It doesn’t matter how hard I try, I’ll never make a dent in changing health care. I’ll never be able to make a difference in my. You fill in the blank on industry, whatever it is that you’re on fire for, you’re passionate about, you’re an entrepreneur. You are wanting to make a difference. There’s this undercurrent that is your own thinking that after a while starts to undermine you. And that’s cynicism. Now, in that same space, even though you may be longing for connection, you may do something called depersonalization where you start distancing yourself from other people, not because you don’t need the community or want it. You just don’t have the energy left to engage. So exhaustion, cynicism with a bit of depersonalization as well. And then the third part of the triad is ineffectiveness, where you literally become ineffective. You’re making mistakes, you aren’t functioning the way that you need to. And so the triad is exhaustion, cynicism, and ineffectiveness.

Jonathan Fields: [00:06:59] Hmm. It’s interesting. I think the cynicism part of it is especially interesting to me. I’ve been thinking, actually, about that word and that experience a lot lately, and a lot of different domains, and also contrasting it a bit with skepticism, which I think often can be sort of tapped in a healthy way. But cynicism is sort of like you lose the sense of possibility. Yeah, cynicism and futility. I feel like there’s a really close relationship there. Yeah. The way you’re describing it, these three different elements, you know, like one of the questions that comes to mind is when you think about this, okay. So we’re experiencing this now on a, on a broad scale. And I think you kind of tease this a little earlier. This is not about working hard, you know, because when you look back generations, you’re like agricultural workers, like a lot of people put in long hours. They work really hard physically and cognitively. And yet, you know, even though maybe it wasn’t as well defined and the word wasn’t sort of coined back then, my guess would be you’d have a lot fewer people saying, well, I feel burned out, you know? And I wonder if sometimes we make this wrong connection that says that it’s the number of hours that we’re putting in that’s really the driver of this, but really it’s more complex and nuanced. What’s your take on that?

Neha Sangwan, MD: [00:08:11] Yeah. So I’m going to finish one thought about what came to me about putting this in context for people. And then I’m going to answer this second piece that you just spoke about. I want people to know that they’re not they’re not fine on Monday and burned out on Friday. That’s not how that works. Literally, that triad of exhaustion, cynicism and ineffectiveness occurs over time, and you’re adjusting to all of that. And the first phase is the alarm phase. It’s almost like you’re jumping on a treadmill that’s going like a little too fast. That’s sensation. But most people don’t get off the treadmill. They not only adjust to that faster pace, and then they themselves start turning up the pace and taking on more and more. And so then it becomes a way of life. And as as soon as the alarm phase of burnout becomes the way you live, you’re now using all your coping mechanisms and you’ve moved into the second phase, which is chronic adaptation, and you are literally hanging on by a thread. You’re walking in and you’re saying things like, you know what, make it a double today. You’re at the barista and you’re like, hey, make it a double. You don’t even notice that one cup of coffee isn’t enough anymore. You need two. And it hasn’t even gotten to 8 a.m., right? So there’s ways that those mechanisms, we start upping them and we’re on this trajectory, but we don’t even realize it. I need a glass of wine after work.

Neha Sangwan, MD: [00:09:32] You know what? Hand me the bottle. Right? Like we start knowing that we need more and more of this. Those are signs. And then one more thing happens. Whether it’s the pandemic, whether it’s a disappointment, you don’t get the promotion, you get a review that was not what you expected it to be, and you start sliding down the slippery slope of exhaustion to ineffectiveness. So I just want to I just wanted to, you know, say there’s a triad that occurs and that occurs over three phases. So this is a gradual experience of patterns and coping mechanisms and ways that we have adjusted. When that happens, the first thing I want people to know is it’s not your fault, okay. You do have a part in it, but it is not your fault. Meaning it is a combination of me/we world. There is a way that you’re adjusting and choosing to cope with an environment that is moving quickly, moving fast. Maybe you’re an entrepreneur, or maybe you’re in an environment where more is better. Do more with less. Every year there is a system, right? Whether it’s healthcare, whether it’s entrepreneurship, whether it’s funding. I don’t know what it is for whoever’s listening, but there’s a system in which you function, where the social rewards of what makes you successful often drive you. And so we have lost paying attention to our own definition of success and have surrendered to societal definition of success. And in that space, we probably don’t even do it consciously. We’ve done it since we were little.

Neha Sangwan, MD: [00:11:10] We want to make our parents proud. We want to fit in and belong. We want to get an A, we want to be the athlete that other people recognize. Then we go into work, we get married, and it just all transfers. You want to make everybody proud. You want to be the one who’s seen and recognized and celebrated. So as we speak about this, I just want people to know. That it’s not your fault. It’s actually a wake-up call. It’s a wake-up call. Burnout is a wake-up call telling you that the way that you’ve done this has served you until now. We want to thank that. Thank you. Thank you for those mechanisms. Thank you for getting near me here. Thank you for all of that. But this is a wake-up call telling you that what’s gotten you here isn’t going to get you where you’re going. Yeah. So that kind of a framing I think is really important to kind of dispel this as some failure or problem. It’s it’s just crises in our life are here to tell us, like, huh? Is this where you really want to go? Let’s double check. Let’s make sure that the choices we’re making fill our hearts with meaningful, purposeful, you know, steps on the journey. And are we just doing them because that’s what other people say we should do? Or are we doing it because this is what really fuels us and what we want to do?

Jonathan Fields: [00:12:29] Yeah, that makes so much sense to me. It’s like what you’re describing is we we put ourselves in situations because we’re sort of tracking towards what we, we believe is, well, this is how we, quote, succeed in the different domains of life. And we kind of like follow along that path. And then the demands ratchet up, the pace ratchets up the the acceleration of all of that ratchets up. So we create these adaptive coping mechanisms and then we’re okay. We’re okay. Like we’re kind of like cruising along. We’re doing the thing we’re supposed to do and we’re kind of okay. And we’re doing like we’re doing the coffee, we’re doing the this and it’s kind of like helping us get through. But at some point, it sounds like what you’re describing is like adaptive turns maladaptive. Yes. And we don’t we don’t see it coming because we are on the treadmill already. We’re in the system. We’re inside the jar. We can’t read the label from there, you know? And all of a sudden we don’t realize that we’re like, we’re doing the double and then the triple and then we’re. So it’s almost like it’s building inside of us and all around us, but we don’t really realize the toll that it’s taking because we keep doing things that kind of prop ourselves up in all the different ways. Until finally, I think for most people, this is the way it happens. There’s a moment where everything comes crashing down and God willing, that moment doesn’t involve a profound health crisis. But sometimes it does for some people. How can we recognize these signs? How can we recognize both the signs and our tipping from adaptive to maladaptive coping mechanisms before we actually hit that point where everything crashes and burns?

Neha Sangwan, MD: [00:13:59] So I want to I want to just say as, as a doctor, uh, you know, I’m a mechanical engineer. I’m an internal medicine physician. My training taught me to tune out of me and tune in to Taking Care of You. And so me being good at my job was me peeing when I can, sleeping when I can, and eating when I can. But really, my success depended on me tuning out of me. So the first time I ever realized that I was burned out was literally the day I walked into the hospital, had 18 patients, you know, was doing all this, you know, incoming transfers from other hospitals, walked up to a nurse five hours into my shift and said, Nina, could you please get 40 milliequivalents of IV potassium to the gentleman in 636? And she said, Doctor Sangwan, are you okay? And that was my first indication that I might not be. And I said, yeah, why? And she said, because that’s the fourth time in under five minutes that you’ve asked me the same question, and I’ve answered you every time. I had no recollection of that. And that’s how I knew something was wrong now. I am not a great example because that’s how tuned out I was. So did it make me a good doctor? You bet. If you were in the hospital, you wanted me to do whatever it took to take care of you in a crisis, right? And at the same time, was I a good doctor? You probably didn’t want me if I didn’t even know what was actually happening.

Neha Sangwan, MD: [00:15:39] Right. So it’s all kind of a mix. It’s almost like it’s a paradox because the we Revere each other for the excellence that we achieve in the world. But to get to be on the extremes, there’s something we must push through, and it’s our own biology. And so if what we learn to do is push through our body rather than partner with it, at some point we’re going to crash. Thank God that nurse that day went against power and hierarchy and questioned me, because sometimes we’re so in it and we have these structures built in, but we need each other. In this world, the pace of our world. Now generative AI is a big deal. Our world is not slowing down in any way, shape or form, and our biology runs in a series of feedback loops we are supposed to exert ourselves, and then we’re supposed to rest. We’re supposed to exert our muscles and stress them, and then we’re supposed to let them repair. Our biology does not work with a world that says faster is better, do more with less, profit over people. All the things that we say more and more and more, we have now used our collective brains collectively together, use our minds to speed up the external world. And the only way we can survive in this world is by blocking the signals that come from our body.

Neha Sangwan, MD: [00:17:11] The cries of our heart saying, oh my gosh, like this doesn’t feel good, I feel heavy. Well, you got to do it. You got to make a living. You got to do this. Or are the passion and our soul and our spirit the meaning of what we’re doing? What if this isn’t fulfilling? We’re like silent, silent, silent. Faster is better, and we collectively use our brains to speed up an external world that our biology no longer can function in. So this idea of burnout, the reason there’s so much research being done and all we keep seeing is rising numbers. Rising numbers. I’m over that. I’m done with reading research about how burnout is growing, and I’m ready to have a world where we figure out how to expand our own capacity. A world where we up-level our own human software. A world where we do what you’re asking, which is how do we pick up these signs earlier? How do we actually know earlier that something could be happening? So I told you about the alarm phase, the chronic adaptation phase, and the exhaustion phase. In the alarm phase, it’s like you feel agitated. You might have muscle aches, pains because why stress causes or exacerbates more than 80% of all illness. Just by the way physical illness stress depletes magnesium. A low magnesium gives you muscle cramps, pain, all of that.

Neha Sangwan, MD: [00:18:40] So headaches maybe you’re having insomnia, intestinal issues. Now, if you’re having any of these things that I just spoke about, you don’t think burnout first. The first thing you do is go get a clean bill of physical health, because this could mean many things. But these are also if you go to the doctors and you say, yeah, I’m struggling with these things, and they say like, oh, you’re fine. We ran the tests, you’re fine, but you don’t feel fine. Now I want you to start thinking about burnout or some other explanation of what’s happening. What doctors are actually saying to you is there’s nothing going on, on a physical level that I can use to explain these physical symptoms. And so I wish that they would say that. But instead they say things like, you’re fine and patients go away saying, wow, that’s really weird because I’m not sleeping and my chest feels weird and I don’t think I’m fine. Right. And so that’s the disconnect. When I teach doctors and nurses, I teach them to say things like this. There’s good news and there’s bad news. You came in with this chest discomfort. Here’s the good news. We ran the EKG. We tested your heart. Everything on a physical level. Electrical function of your. Everything is great. Physically, I’m wondering if there’s something on a mental, emotional, social, or spiritual level that’s unresolved for you that might be showing up in your physical body to get your attention.

Neha Sangwan, MD: [00:20:08] That’s the question I’d be asking. And I think we missed that. You wanted to know? How would we know? So I told you, you might be you might feel fatigued, right? These palpitations, muscle aches, headaches, insomnia, intestinal issues, you might be irritated. You might snap at people, you might feel overwhelmed. You might feel sad and be like, wow, I don’t know why I’m feeling this way. So you’re starting to not recognize yourself. You might miss deadlines. You might be forgetful, blame other people you know, stay late, come in late. Things that aren’t you. You might make mistakes. That’s like in the beginning where you’re starting to realize, like, I’m not me. As this goes on over time, you’ll literally in that chronic adaptation, when you’re using all these different strategies, you might start procrastinating, calling in sick, socially withdrawing that depersonalization that we spoke about cynicism. But here’s how I know you’re at the end of the chronic adaptation phase and getting in real trouble when you’re using more of your coping mechanism than you did before. Even if your coping mechanism is running or exercising. You used to be able to run a couple miles and everything was fine, but now you’re running five and ten miles just to get the same effect. So when you’re using any coping mechanism but you’re needing more of it and more of it, that is a subtle but important clue to pay attention to.

Neha Sangwan, MD: [00:21:31] And here’s how I know you’re almost at exhaustion and ineffectiveness when you start telling me things like, it doesn’t really matter. I can’t make a difference. It’s apathy. That’s when I know now that that cynicism has come in, and now you’re undermining your own efforts. And then exhaustion, the ineffectiveness, the last phase, a weekend, a week off. They’re not enough. They’re not enough anymore. You don’t recover, you’re not resetting. So you’re having this extreme fatigue, heaviness, lethargy. It’s not going away. You might have difficulty functioning. You might have depression. Now, burnout and depression are not the same thing, but sometimes they overlap. So you might have some depression. And at the very end, the most severe debilitating. You can’t function and you have hopelessness and suicidal ideation. But any time you’re you’re hitting this exhaustion phase where you start not being able to recover, that is when you most certainly need professional help. That’s not even a question you need. I would be writing you for time off, and you need to be seeing someone professionally to help you. But here’s my hope. I wrote a book on burnout. It’s called Powered by Me: From Burnout to Fully Charged at Work and in Life. I want exactly what you’re asking how do we move people up in this whole spectrum? So they’re picking this up early. They’re shifting much earlier. So we don’t have this crisis experience in the world.

Jonathan Fields: [00:22:58] And we’ll be right back after a word from our sponsors. I’m glad you brought up this contrast with depression also, because a lot of the things that you are talking about would be on the sort of the diagnostic checklist for depression as well. And I’ve had conversations with friends over the years, and I’ve probably wondered about myself, you know, like lifelong entrepreneur and also a very, very, very long time ago, past life as a big firm lawyer in New York City. And I worked that same way until I literally ended up in emergency surgery. My immune system shut down and had you ask me back then, you know, like, are you burned out? Are you depressed? I would have probably just nodded and said, I honestly can’t I just yes, maybe I can’t tell you, I literally can’t. I probably can’t even discern clearly what’s going on. I ended up leaving the law after that particular position, but it was interesting, at least in hindsight for me, is before I walked away from that entire career, I knew that I actually some a voice inside me said, you are not actually functioning at a level right now where you’re capable of making a good decision.

Jonathan Fields: [00:24:06] You need space. So before I actually quit, I took a leave of absence and I basically said, I need a month just to be just to recover, just to sleep, just to eat good food and start moving my body again. Because I don’t think I can make a good decision right now. And I think back in, in that season of my own experience and I sometimes I was absolutely burned out, you know, I was beyond the hours I was putting in the level of stress I was maintaining, the pace I was going and the lack of care I was giving to myself. But I also wonder, you know, like if there was an element of depression that was mixed in with it and, and and it it seems like if you’re experiencing this and this is a question for you, it’s almost like, how can you not at some point tip into some level of depressive experience along with this?

Neha Sangwan, MD: [00:24:55] Yeah. Well, I’ll give you my example because let’s let’s back up for a second where people are from burned out to fully charged because everybody’s somewhere on the spectrum. Always you’re from burned out to fully charged at work and in life. Well, you figure that out by figuring out where you have a net gain or a net drain of energy on a physical, mental, emotional, social and spiritual level. Right? Okay. So that’s the way that over these 20 years, I have now come to understand is the common, the commonality for these tens of thousands of people that I’ve worked with. Okay. So whether you’re doctors, whether you’re lawyers, whatever it is now, the important thing here is that people, when you’re overwhelmed like that, you don’t know what it is. It all just feels like a big drain. But when you think of burnout, burnout is not somebody who’s a drag on your team. It’s usually someone who’s pretty active type A going for it. They’re passionate. Why do entrepreneurs burn out so much? Because it’s the all-or-none lifestyle that they’re going for. There’s deadlines of funding and product and everything that they need to get over to keep this thing alive. So burnout is like you’re on fire for something. You’ve developed ways to live that allow you to do the extremes and make these achievements that no one else has ever made, whereas depression.

Neha Sangwan, MD: [00:26:23] So it’s a clinical diagnosis. You need to have somebody, you need the context, you need to understand what’s literally happening for them. But I’m telling you how I do it, which is depression is more of a stuckness. I would define it more of a sinking, a stuckness… Uh, depression doesn’t take a long time to happen. Sometimes a tragic event, uh, some sort of trauma being reactivated. It can happen just like this, a breakup, a something can happen, and it can tip you right into depression. And the the definition of depression is that you’ve been sad for, you know, six months or more. They want to make sure that it’s been going on for a certain amount of time. But the the energy of it is very different. So I’ll tell you that day that I burned out where I was in the hospital. Yeah. When the nurse said that to me, I literally was stunned. And I walked to the bathroom and took out my hospital phone and and called a colleague, a psychiatric colleague. And I said, when’s a good time for me to come see you? And he said, how about 5:00 tonight? It was like 11 in the morning. And I said, how about now? That’s like 911 from a doctor. We don’t do that. Right? And he said, oh my God, come over now.

Neha Sangwan, MD: [00:27:45] An hour later in his office, after he had asked me a bunch of questions. He gave me. What most doctors can give you is a prescription for time off. He had given me, I think, six weeks off and a prescription for Prozac. Now we have the power of the pen to give you paid time off. And the second thing we’re listening for is what is the context here? I have I have a cocktail of medications I can give you antidepressant, anti-anxiety, sleep medication, to name a few. What I’m doing in that moment is pulling you off the cliff and knocking you back into sleep rhythm. If you’re, uh, you know, if you’re depressed, I want to help lift your mood. If you’re anxious, I want to calm you down. Whatever I’m doing, I’m trying to get this bullet train from hitting a brick wall, okay? Or falling over a cliff. So I stop your world, give you paid time off so you can take care of yourself. And then I give you some cocktail of medications. Here’s the problem. Ten days a month, three months later, I send you back in the ring for round two without a single idea of how you got there or how to do it differently. And as human beings, we run patterns. We run behaviors.

Neha Sangwan, MD: [00:29:01] We have neuronal pathways in our brain and in our system that we are who we are. And if we don’t have any awareness or ability to have insights on that, how are we going to change what’s happening? And so thank God for me being a doctor and him being a psychiatrist who was quite aware 20 years ago of this chapter two of my book is the five sessions I had with him weekly, really getting me like behind the scenes of me saying, how do I not know? I give people time off and I could give them these prescriptions, but when I happen to me, I didn’t even know what was going on. Here’s the kicker I’m driving home and he tells me, like Neha, you can’t single-handedly change healthcare. You take every overnight shift when people call out sick. I don’t think you understand that this is a me/we world, that you’re in a system that makes its budget by understaffing. This game is not one you and your biology are going to win. And here I was a doctor. I had taken an oath to take care of patients. Only one person at night on call for 330 sick patients. I felt like it was my responsibility to volunteer with the oath I had taken to make sure they were going to be safe, but what I had forgotten about was the oath I needed to take for myself.

Neha Sangwan, MD: [00:30:22] And so I’m driving home and he’s like, hey, I’m going to diagnose you with a severe case of people pleasing. And there I was. I went from running the hospital to standing in line for my own medication, for Prozac. And I’m driving home and I’m looking at the Prozac on my chair, the car seat next to me. And I’m thinking, I don’t know what’s going on with me, but I’m pretty sure it’s not a Prozac deficiency. I wasn’t depressed. I literally had pushed through my body in the name of a higher calling. And so I took that Prozac, I put it in the top drawer, and I thought, now this is where you never want your patient to be a doctor, because I start self-managing. And so I said, you know what, I’m going to talk to him weekly. I know the side effects of this. I’ve memorized them. I’m more afraid of those than I am of what’s going on. Maybe him and I together can figure this out. So five weeks go by and it’s the first time I started sleeping. It’s the first time the throat constriction in my throat started relaxing. And I could five weeks and I walk in and I say, oh my gosh, I wanted to tell you I slept last night.

Neha Sangwan, MD: [00:31:36] And he said, oh, that Prozac is kicking in right on time. Five weeks in. And I said, oh my gosh, I didn’t tell you. I didn’t take the Prozac. I wanted to see how our exchanges were going to go each week and see if I could figure it out. I’m sorry, I didn’t think to tell you. And he said to me, I can’t bill for a patient not on medication. Would you like to find a new provider or would you like to start taking the medication? Wow, that was my wake-up call. Yeah. You’re going to adjust to an insurances requirement. You’ve just given me months off. Paid. I’m getting better and we have to follow. You’re going to put me on medication with side effects so that we can match the billing? I was like, no. And that was the day I committed to documenting everything I learned in this process and filling that gap for people with, how did I get here? What are the underlying behaviors? Where do am I having a net gain or a net drain of energy? And what are the powerful practical tools to heal? So it’s my answer to that gap in medicine, uh, that I think we haven’t figured out. And I think it’s why the gap keeps widening in the world. We keep giving quick fixes rather than solutions.

Jonathan Fields: [00:32:57] Yeah. You also shared a little bit earlier, you know, when you sort of like take this meta look and say what’s really happening here and how can we do things differently? You know, it distills down to a bit of a framework, a more holistic approach with the five different things that really need to be factored in that you described earlier the physical, the mental, the emotional, the social and spiritual. Like how do we look at well-being from all of these different things and these different angles? I’d love to walk through sort of each one of those domains a little bit and understand better what you actually mean when we’re talking about it, and also how they work into this notion of being more okay in the context, especially of burnout, was I think it makes sense to start out with physical, because that’s probably the one that most of us. Well, actually, I was going to say it’s the one that most of us are aware of. But actually and this is what you write about, we think we are, but we really aren’t.

Neha Sangwan, MD: [00:33:52] Right. You’re right. So yes, let’s do this. Here’s another thing I’d love to give anyone listening their own burnout assessment that they can do for themselves, or to find out where they are from burnt out to to fully charged. I’ll give you the link for that. It’ll be free for them and it can be. If they’re doing really well, it can be for anyone they love and lead. Because I think this getting healthy is a team sport. Healing from burnout is a community experience. It doesn’t occur alone. And thank God for the nurse who said what she said to me. Thank God for the doctor who took me in immediately and diagnosed me with people pleasing and sent me on that leave because something much worse could have happened with me prescribing a wrong medication, me hurting a patient. I’m not sure I should have been driving myself home that day, but all in all, it ended well, right? Okay, I’d start with physical. So how do I take a look at this and then ask a few questions to give? Like a pulse check? Like do you have a net gain or a net drain physically? So the way I think about it is food, sleep, movement and energy. Okay. Food. How satisfied are you in, uh, with your own ability, like your own performance in each of these? On a scale of 1 to 10 food. Are you eating, you know, whole foods at regular intervals throughout the day? Like, how are you nourishing yourself? Not only how are you nourishing, but timing? Now some people are doing fasting and all these other things.

Neha Sangwan, MD: [00:35:25] That’s a different experience, right? But I’m just saying in general, how how is that happening and how satisfied are you with that? The second one is sleep. We have become a world that wakes up in the morning. And looks at a device to see what our readiness score is. We don’t ask our body if we’re well-rested. We don’t check inside. We are sourcing it from outside of us. That’s how little we’re connected to our own physical body. But I ask questions like, when you wake up, do you feel rested? Do you get 7 to 9 hours of quality sleep a night? Because there’s three really important things going on when you sleep. Number one, memory consolidation. You’re integrating everything you learned. Number two, physical repair. Whether you went to the gym and your muscles need to be repaired or your immune system needs to be strengthened, that’s all going on. The third one is so that’s physical repair, memory consolidation, physical repair. And the third one is emotional processing. If over time you start saying, I’ll sleep when I’m dead, I’ll sleep on the weekend and you start getting less and less sleep. Your body. Get ready for this prioritizes emotional processing over physical repair and immune function, and memory consolidation and integration of what you’ve learned. So then you fall sick after a little while. And what do you do? You get, you crawl in bed. So your body has this whole system. It knows how to do this. So when we think we’re smarter than the body, the body always wins.

Neha Sangwan, MD: [00:37:03] So food, sleep. Do you have a joyful way to move your body multiple times a week. And energy, which is around cortisol and hormones? And do you feel even energy consistently throughout the day, or do you have in those dips? 2:00 energy dip 3:00 energy dip where you’re running to get a chocolate chip cookie and you know, something to boost you back up. So the other one is physical ailments, right? So do you. Does your body is there something that’s chronically, you know, really bothering you now once you answer these questions so you rate yourself on a scale of 1 to 10 food, energy, sleep, movement and physical symptoms, then this is the trick. That’s what your mind said. Now, what you got to do is you got to literally check into your own biology, your own physiology, and you have to check and see as you answered those questions, are you feeling a constriction, heaviness, tightness, net drain in your body, or are you feeling relaxed, open and and light? Net gain and your mind the answer to the questions along with your body have to be in harmony. If they are not in harmony, you have a net drain in the physical section because your body never lies. Our mind can say things like I’ll sleep when I’m dead, but your body is dragging. Your body feels heavy. And if your mind and your body aren’t in sync, the answer is net drain to each section that they’re not in sync.

Jonathan Fields: [00:38:29] Yeah, that makes so much sense. And that that has been my experience hands down. I’ve actually learned over the years that in a weird way, I’ve developed mindset self-care practices that allow me from a sort of a psychological standpoint, to be fairly at peace, to be fairly calm and balanced and steady in really high stakes, high uncertainty situations where and sometimes for long windows of time. But I’ve learned that my body actually doesn’t have the same capacity that my mind does to sustain myself in a healthy way in those scenarios. So my body always it’s like the canary in my internal coal mine, you know, it’s like like, dude, do you think you’ve got it dialed in? But I’m about to tell you, you don’t. And it does something to basically say you need to actually stop and make some changes. Yeah, it.

Neha Sangwan, MD: [00:39:21] Reminds me of that book. Right. The body keeps the score. It always does. Yeah, exactly. Even even in trauma, like things happen when we’re young and we we don’t know how to handle them. So we we move on and we adapt. And people say like, why would you ever go back to what ever happened a long time ago? But if something triggers that experience in your relationship 20 years later, it’s as if it was right there, right? We don’t it doesn’t feel like a long time ago. It feels like it’s right here, right now. Um, and so the body does keep the score. And that’s why even though I’m giving people a quick, you know, assessment and intake so they can figure out whether they’re having a net gain, net drain, the most important piece is that you also answer the questions, but pay attention to your body. So we’ll we’ll talk. Uh, the other ones are much quicker mental mental energy. So this is about how you form your thoughts. So you have you have really mastered this with this mindset experience. Right. That that you have figured out. But if something you know doesn’t go the way you planned, are you someone who makes it about you, personalizes it? I wonder what I did wrong? Are you someone who blames other people? You did something wrong? Or are you someone who says, oh gosh, I hope they aren’t stuck in traffic.

Neha Sangwan, MD: [00:40:33] I hope the plane landed, I hope and you pick something bigger than the two of you. Okay. Do you project, do you personalize, project or generalize? Generalize. So a lot of times people have patterns that they fall into that they’ve adapted to. And how you do this really matters because the truth is usually there’s something that’s your part of it. There’s something that someone else is part of it. And there’s something in the situation that’s the truth. And so there’s judgments and comparisons that we spend our lives judging ourselves against other people. If you do that, that’s going to be a net drain. There’s the thoughts on repeat in your head that you want to figure out, which is when you’re just showering, when you’re on the, you know, on a run, if you’re driving down the highway, whatever it is, what are the thoughts that you you have running on repeat? And are those net gains or net drains? They’re kind of in the background. You might not even notice them. So we have approximately 70,000 thoughts per day. 90 to 95% of them are the same as yesterday. That’s unbelievable. So this is why it’s a little hard to change our mind. And it’s also why crises, burnout, unexpected events jar us out of our patterns of thinking. So that’s why patients in the hospital were always open to hearing me talk about things like this, because they were in a setting they never expected to be in, you know? So, you know, paying attention to your thoughts, how you form them, all of that.

Neha Sangwan, MD: [00:41:59] And then at the end, you got to also align. As you’re answering this, you have to align your body with these experiences. Emotional energy. This is an easy one, right, to assess. We’re talking here about tears, anger, anxiety. How well do you handle them in yourself and others. Um, trauma, grief, loss, apologies, forgiveness. How good are you? Not just with others, but at forgiving and apologizing to yourself? And how well do you infuse joy and play and into your days? And so emotional energy can be assessed pretty simply by asking, tell me where in your life you are avoiding challenging conversations or difficult emotions? Is it personally? Is it professionally? Is it financially? Is it you know, where where is this? Because if you can check that off, you know exactly where you’re having a net drain of emotional energy. Flipside what areas are bringing you joy and play and, you know, pleasure and enjoyment here. Right. And so that’s a quick one. Or you can just look at it and then you check in with your body and you know whether you have a net gain or drain of energy, emotionally, social energy. We’re at the last two now. Social energy. This is a quick one, but let me let me tell you what it entails.

Neha Sangwan, MD: [00:43:18] Power and hierarchy. Whether it’s in the boardroom of the bedroom, we’re all doing it. We’re navigating. Right. What’s happening? Agreements, setting expectations, making clear agreements, and drawing healthy boundaries. How good are you at that socially? So it’s knowing what you need in the face of another. How well do you navigate that healthy conflict? When when there’s conflict do you express it? Do you hold it in? Do you explode? What happens there? That? And when you’re upset or disappointed with someone else, do you talk about them or do you talk to them? That’s the drama triangle. So there’s all these ways that we look at how are you navigating your social energy? Well, how do I ask it in the burnout assessment? Pretty easy. Write down for me. The top five people or groups of people you spend the most time with online or in person. And once you do, pay attention to your body as you’re writing them in. Is it constricted? Tight? Heavy? Is it open, relaxed and light? Now, I understand that people can be a mix of things, like you can get joy from someone who makes you crazy, right? Family? Oh my God. And there is a net gain or a net drain that goes on here. And so you just want to allow your body to help you where your mind is getting confused. You just always check in with your body. Uh, and then lastly is spiritual.

Neha Sangwan, MD: [00:44:48] So spiritual energy, this is about what you value. And people said to me, why on earth did you make spiritual energy part of a business book? Well, because I think it’s the most important energy there is. It’s about our highest values. It’s about what matters to us. It’s about why we get up every day and do the thing that we’re doing. Why do we put all this energy forth? What’s the difference we want to make in the world? Once you know what you value? Here’s the kicker you can make quick and effective decisions in a world moving fast with a lot of unknowns, because now you have data from inside you that helps you say, well, I really value health over finances, so I’m going to invest the money because it has to do with my health, even if I don’t know what it’s going to be right. So it helps you make quick and effective decisions. The other thing, spiritually, that’s really important in a world moving as fast as ours is, I think the people that are going to do the best from here on out, the companies, the societies that are going to do the best are going to be the ones who have the highest levels of self-trust and agility and self-trust, meaning the question I’m going to ask you around that is, tell me where you’ll take risks and tell me where you won’t, because that’ll tell me where you trust yourself and where you don’t.

Neha Sangwan, MD: [00:46:08] And for me, I’d say I take risks mentally, emotionally, socially, spiritually Entrepreneurially financially. But in my life I have not taken risks physically and romantically. And so right away, when when I answer those questions, you should be able to know immediately where I trust myself and where I don’t. So I’m not the one bungee jumping or skydiving right out of a plane. Those physical risks aren’t aren’t the ones that I take. And romantically, I mean, now I have a boyfriend of five years, but before that I was pretty averse to all of it. And so I think there’s it will give you a lot of information about your own levels of self-trust. Then there’s reconnecting to purpose and meaning and feeling valued both at work and at home. And so the spiritual aspect of it is really about how do we navigate the unknown and mystery. And, and when all else fails, we have a pandemic when the world is not as we expected. You have a heart attack, a stroke and pneumonia. What do you have faith in? Is it science? Is it humanity? Is it the next generation? Is it your religion? Is it your faith like I – Whatever it is, you need to know what it is that you draw upon when the world is not what you think it is.

Jonathan Fields: [00:47:28] And we’ll be right back after a word from our sponsors. I’m fascinated by just naming convention in linguistics. You know, we have a different company that goes into that in a lot of different ways. But it’s interesting to me that you chose the word spiritual for that. The fifth energy. Um, because as you described, you know, a lot of the work that you do actually is in the domain of organization. And oftentimes you walk in the door and that word can raise eyebrows or even repel people. But then when you the way that you describe spiritual energy is actually in a very practical way, like it’s like you’re now you’re using language to say, oh, wait a minute. Okay, so, so values and purpose and okay, these are things that we can connect to. But also I wonder if a lot of people don’t when they first hear the phrase think of spiritual energy in that way. It’s almost like you’re reclaiming it and saying, this is what I mean when I say this. And let me give you the practical nuggets, the ingredients of this spiritual energy, the way that I’m talking about it. The other thing that that I’m really curious about is so when as you’re going through each one of these five different energies and, you know, sort of like starting out as well, let’s use this as a diagnostic framework, but also let’s use it as a therapeutic framework. You know, we can talk about all. And if you see, you know, I’m low on this or I’m high on this, you know, like it’s it’s a net drain or a net positive.

Jonathan Fields: [00:48:51] That’s a sign a that I want to focus on that and the each of the individual components that you mentioned under them are also they point you in the direction of what to do in order to feel better. And you know, in your book you list just a ton of different exercises and strategies and tools to actually get into. But what was interesting to me also is that, okay, so you have a whole bunch of questions to ask yourself, but at the end of the day, like your ultimate question is, let me tap back into my body and sense like I need to just sense, is this a net positive or net negative? Is it giving me energy or taking energy? So you’re pulling it away from the cognitive part of the exploration and saying, I need to feel that so many people do not feel their bodies anymore, like we live from the head up. So I imagine you must come across this on a pretty regular basis when people are like, I can’t really tell you, you know, like you’re asking me to actually kind of like feel this thing and like, energetically is a net positive or net negative, like, I don’t know. I would imagine that comes up in different language in different ways fairly often. Like how might you guide somebody to reconnect with that sense so they can get the wisdom of that sensation?

Neha Sangwan, MD: [00:50:06] Yeah, it’s a great question. And I begin by saying, congratulations, you are a master of the external world, because that means they have successfully tuned out like I had done, and they were in full service to what our society teaches us to do. And then what I do is if that’s where they’re focused, my job I this is like a little lipstick case. It’s like its own thing. But I use like an AirPod case. Anything, a smooth stone, anything in the world that fits comfortably in your hand. And I asked them during meetings, during an experience to please hold on to this. And then when something shifts, something unexpected happens. If I were to be asking you, how do you feel that in your body? And you would say, I don’t know. What I asked them to do is to tell me that they can feel this in their hand. Once they do this 4 or 5 times, all of a sudden they’ll say, oh my gosh, my back is really tight. Oh my God, I have this thing at the base of my head like I have a headache. And so what I do is I use the outside world that they’re so tuned into to bring it in and have them literally have something concrete to hold on to.

Neha Sangwan, MD: [00:51:27] And, you know, of all the different industries and, you know, people that I’ve worked with, the most tuned out that I have found has been oncologists, literally cancer doctors who have to meet every patient with the possibility that they might die and their need to just get out of themselves and focus on this human being in front of them without needing to feel. And I don’t know what chapter it’s in, maybe 12, 13, 14, something like that. I literally take you through this with an oncology group where I have to help. And the reason I knew this person was experiencing something was because he would flush and turn red. And then I’d say, what just happened? And he’d say nothing and I’d say, no, no, no, no, no. Clearly something is happening. Nope. Nothing. And it must have been, I don’t know, almost 20 years ago that I came up with this. Okay, hold on a minute. I need you to hold on to something. And if you’re going to tell me nothing, I need you to feel this. And that’s how I started to understand that sometimes I need to bring the external world to your body.

Neha Sangwan, MD: [00:52:44] Have you feel gravity pulling your bottom down on the chair, the chair supporting you, your feet on the floor. Because when someone’s in their body, they can’t be spiraling out in the future. And anxiety. Anxiety is a failed attempt to control the future. So what you do is you bring everything back. Because when you right now, I’d ask everybody listening. If you take a nice slow, deep breath and you become really aware of your rib cage expanding and contracting with your next breath. You can’t be anywhere but here in this moment right now, because you’re in your body. And so the secret is our mind can go to the past and regret. It can go to the future and keep us up at night. It can run in loops and do all these things. But the way you get out of that loop is by getting in your body. Your body not only keeps the score, it’s your connection to intuition. It is your connection to inner knowing. It is your way to be present in the world right here, right now. We have all these escapes. But the secret, the secret is the body.

Jonathan Fields: [00:53:52] Hmm. No, that resonates so deeply. And for me, that practice for years has been mindfulness and breathing. Um, you know, breathing is, for me, a short-term intervention that takes me from my head, like, dropped me right back down into the physical part of it very quickly and can also like pretty rapidly downregulate my nervous system if needed. And then the mindfulness practice is sort of like the more long-term intervention. Like this is not something that works overnight, but over a period of months or a years or decades, you know it. It teaches you how to constantly check in, notice where you are, and then come back to where you want to orient your attention and your attentiveness. But I love this sort of like the idea of you taking a physical object, placing it in somebody’s hand, and using that as sort of like a mechanism for somebody to reconnect to their physicality using an external object. And that over time, when you repeatedly do that, it starts to just ripple through their body. It’s like, oh, I’m holding this thing in my hand. But I notice this thing over here that I didn’t really notice before. It’s fascinating. I love sort of like the idea of using that mechanism because it’s so accessible.

Jonathan Fields: [00:55:02] Also, you know, it’s something anyone can do it and they can feel it relatively quickly. So it’s not not saying, hey, do this practice which you know, like you’re going to struggle with probably shame and blame yourself with for like months, if not years. And then eventually you might feel something. No, no, no, which was my journey with mindfulness. Like it didn’t come easily. So yeah, I love the workaround. Yeah, yeah yeah, it feels like a good place for us to come full circle in this conversation as well. You know, I think, um, you’ve given us a really good framework to really understand this experience that so many of us have and will certainly we’ll drop a link to the quiz so that people can actually go through this and do it yourself and actually figure out, like, you know, what’s really going on, and for sure, great tools and strategies in the book as well. If we zoom the lens out in this conversation, you know, in the context of Good Life Project., if I offer out the phrase to live a good life, what comes up?

Neha Sangwan, MD: [00:55:53] I’d say you’d want to lead from the inside out. You’d want to be aligned. Meaning you know what you value and what you think and how you feel. And the action and conversation you create in the world is aligned from that true place. And probably the ultimate answer to living a good life to me, is that the word sacred exchange is coming to me, that I feel like I just had a sacred exchange with you, um, that there’s that alignment that that we talk about what matters to us, that we trust ourselves enough to tread closely to our hearts, and that every exchange we have, uh, is meaningful to ourselves and to each other, and that the ones that don’t go the way that we want them to go, their lessons in life, school, and we’re going to use them and we’re going to do better next time. So it’s about grace and compassion, but really alignment and sacred exchanges.

Jonathan Fields: [00:56:53] Hmm. Thank you so much.

Neha Sangwan, MD: [00:56:55] You are so welcome. It’s been such an honor to be with you.

Jonathan Fields: [00:56:59] Hey, before you leave, if you love this episode safe bet, you’ll also love the conversation we had with Yvonne Ator on our sister podcast, SPARKED about ways to reframe burnout. You’ll find a link to Yvonne’s episode in the show notes. This episode of Good Life Project was produced by executive producers Lindsey Fox and me, Jonathan Fields. Editing help by Alejandro Ramirez. Kristoffer Carter crafted our theme music and special thanks to Shelley Adelle for her research on this episode. And of course, if you haven’t already done so, please go ahead and follow Good Life Project. in your favorite listening app. And if you found this conversation interesting or inspiring or valuable, and chances are you did. Since you’re still listening here, would you do me a personal favor, a seven-second favor, and share it? Maybe on social or by text or by email? Even just with one person? Just copy the link from the app you’re using and tell those you know, those you love, those you want to help navigate this thing called life a little better so we can all do it better together with more ease and more joy. Tell them to listen, then even invite them to talk about what you’ve both discovered. Because when podcasts become conversations and conversations become action, that’s how we all come alive together. Until next time, I’m Jonathan Fields signing off for Good Life Project.