Eighteen months out of residency and into outpatient psychiatry private practice, for the first time since before medical school, I’m coming home actually feeling a surplus of energy to put into my life outside of clinical practice. Sure, I did my best to maintain my interests and relationships during my training, but doing so felt like trying to wring blood from a stone.

A slight sense of boredom in the evening, oddly enough, is a victory now. I mean this in the sense of enjoying the all-but-forgotten sensation of wanting for more to do vs. feeling too emotionally exhausted for anything but slumping into the couch with a glass of wine, engrossed in “peak TV.”

It dawned on me: I think this is what not feeling burned-out feels like!

The following are indicators of the changes I’ve made as I’ve transitioned to a sustainable life. They are outcomes, not catalysts, as we would often have people believe when we counsel them on “healthy lifestyle choices.”

In the past year, I no longer depend on caffeine in the morning to compensate for poor sleep habits, that glass of wine after work to unwind, and online shopping for mental relief. OK, I didn’t give up “peak TV” even though Game of Thrones is over, but I make mindful choices about when and how I enjoy it.

I’ve achieved the most consistent and effective sleep hygiene of my life and feel fully rested on 6.5 hours of sleep when I used to need 9 to feel OK. I wake up refreshed an extra hour early to start every weekday working on passion projects like writing and building my non-medical business. I walk 2 miles outdoors most days.

I no longer leave a signature trail of Diet Cherry Coke cans in my wake wherever I go and instead drink a lot more water. I eat my 5-a-day fruits and veggies and don’t consistently binge processed food in the evenings as I had for most of the past decade. I’m still working on a healthier relationship with food, but I generally don’t use it as a substance of abuse anymore.

Caffeine dependence, using alcohol to feel differently (even if used in moderation), compulsive online shopping, sleep deprivation alternating with oversleeping, consuming pseudo-foods in extreme quantity, passively flooding the senses with the experiential-equivalent of empty calories in the form of streaming video and social media are all maladaptive coping habits, self-medicating. While I found myself committing to working hard in order to change these habits throughout the year, I know I wouldn’t have succeeded or, frankly, even been sincerely motivated, if I hadn’t made other changes necessary for the sustainability of my emotional energy.

I’ve realized a lot of the advice we give in psychiatry, and other branches of medicine about giving up our vices, getting more active, improving our sleep, and eating healthier in order to feel better is actually backward. What has to happen first is identifying what in our lives isn’t sustainable.  The behaviors are the best way our psyches know to cope with life circumstances or mental frameworks that we couldn’t bear if we were to experience them without numbing ourselves. We, and our patients, have to identify what our self-medication is protecting us from and find new solutions despite the unconscious terror that such a cure is worse than the disease. Only then can we turn away from self-medicating our anxiety, disillusionment, and emotional exhaustion, let alone trauma, with maladaptive behaviors.

What has made my life abundant in the last year is owning my autonomy to cultivate my patient population and limit my work hours. Despite being fortunate enough to be employed in a very flexible organization, it took me six months of not exercising this freedom before I realized I was playing out moralized narratives of indentured servitude cultivated in residency and being complicit in perpetuating my own burnout.

At that point, I wrapped my head around what my future would look like if I went on taking every case that taxed my emotional reserves to the extreme and threw hand grenades into my clinic workflow on a daily basis, getting in the way of my capacity to help even the most straight-forward cases which could benefit tremendously from first-line interventions and a modicum of empathy. I accepted that I don’t have a moral imperative not to turn anyone away, that it is OK to make choices that let my practice be what I want it to be, whatever that looks like. That embracing psychiatry as a “lifestyle specialty” is not selling out, it is investing in myself, as well as allowing me to help more people in a more compassionate way in the long run.

So, a year ago, I discharged about a dozen patients that had been contributing most to my burn out. I’ve been implementing more screening methods, and been more selective since then about who I’m willing to see for follow-up after an initial assessment.  I set boundaries with patients in a way that makes my practice sustainable for me and accepted that it’s OK if my priorities don’t look the same as my colleagues’ and mentors’. We all had quirky attendings when we were in training. Now, I am letting myself have my quirks. I now block out 90 minutes at midday for admin time and at least 30 minutes away from my desk. Friday afternoons, I’m out of the office to work on things that make me feel whole.

I realize I’m fortunate to be able to make these changes within my current employment structure – I know not everyone can. Whatever autonomy you have, and it is likely that you have more than you let yourself believe, exercise it. If needed, accept that you’ll have to change your circumstances once you’ve changed your mindset. It is the path to truly enjoying your work and living life in a sustainable way.

Jamian Reed is a psychiatrist and founder, Life Psyence.

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