Fieldset
Tales of a burnt-out boy

At the start of a new assignment with MSF, Robert felt that something was wrong. He shares his personal account of what happened next…

Robert Malies working as a logistician for MSF

Finally letting go

Having spent the past four years working for Médecins Sans Frontières / Doctors Without Borders (MSF), I’d arrived in Geneva for my briefing ahead of a new assignment. I was due to travel to Cameroon for several months to help design and build a new hospital there.

I was feeling feverish and generally exhausted. This was on top of the nausea and dizziness which I’d been ignoring for a while as I ran around, high on productive adrenaline, doing courses, following up on my thesis research and preparing for my next posting.

This feeling was familiar. It had been there at the end of a long MSF assignment in Chad, and then again, a year later in the Central African Republic.

The HR officer sent me to a local doctor. After consultations and medical tests with no conclusive answers, I finally relented. I told MSF that I would not be going anywhere.

It was only at this point of finally letting go and accepting that something was seriously wrong that my adrenaline dropped and I started to be able to appreciate the damage that I had unwittingly inflicted on myself.

Pulling a muscle in my brain

Too much stress applied to a physical body part will eventually cause problems and, if the warning signs are ignored, long-lasting damage may well occur. If majorly injured, even very minor use of the injured part will cause discomfort and too much use will cause further damage and reverse healing.

This is very much how I felt.

I told my girlfriend that I felt that I'd "pulled a muscle in my brain".

Before all this, I had considered myself both physically and mentally a healthy person... And yet this did happen to me – throwing all of my preconceptions about health into question.

Reading, listening or talking about anything vaguely complex, and especially the use of screens (phones or computers) for even short periods all made my head spin.

If I read a book for 20 minutes I would feel so nauseated and dizzy that I would have to avoid any more mental input for the rest of the day while the symptoms slowly, slowly faded.

At its worst, muscle tension and fatigue meant that even physical activity, beyond very slow walking with very frequent breaks, became also difficult. I really felt disabled.

Before all this, I had considered myself both physically and mentally a healthy person. I had a good social life, practised daily meditation and took nice long breaks between my MSF assignments.

And yet this did happen to me – throwing all of my preconceptions about health into question.

Hidden anxiety

Eventually, I began to realise that a very subtle tension in my chest accompanied many of my symptoms.  The discovery of this almost-hidden feeling of anxiety led me to start approaching the whole thing differently.

The term “anxiety disorder” didn’t seem to quite fit, since my state of mind (at least on the surface) were pretty calm.

The physical symptoms, however, did sound a lot like those of someone experiencing a panic attack – dizzy, nausea, lack of appetite, hot, can’t think straight – except in my case they weren’t so acute and would linger around me, at various levels of intensity, all day, everyday.

img_20190508_133518.jpg

Robert had worked for MSF for four years before he "crashed"
Robert had worked for MSF for four years before he "crashed"

I had sought help from a vast array of health professionals. No indication of a mental health, nervous or burn-out type disorder was suggested – even after every test and scan known to humankind had come out as “normal”.

If I had been given some common examples of people working in the humanitarian sector who have had (for want of a better word) a “burnout” – I could have avoided many dead-ends.

What helped?

Once I stopped viewing my problems from a physical perspective, I began to follow a different route.

With the help of MSF UK’s Personnel Support Unit, I undertook some cognitive behavioural therapy (CBT) sessions.

The cognitive behavioural therapy followed a set structure over 6-10 sessions to improve how I was functioning, but without delving into the past. Although this helped on a somewhat superficial level, given that I had years of experience in mindfulness meditation there was nothing particularly new.

Unable to read the signs, a vicious cycle was established. I worked more and more, both fuelled by the anxious adrenalin, but also to distract myself from it.

Following the advice of a psychiatrist, I took an SSRI medication for nine months. Although providing a welcome reduction of symptoms, I felt that the deeper issues were not addressed with medication alone.

Finally, I also saw a psychotherapist, which opened up some interesting ideas, including root causes for what I was experiencing, linked to my childhood.

Psychotherapy, somewhat the opposite of the medication, addressed some very deep issues and allowed me to reset my priorities, mindset and approach to life. However, with the long timescales involved with psychotherapeutic approaches, it has been difficult to see any significant direct effect on my symptoms.

“The brain eating the body”

An approach that brought me a lot of relief was Tai Chi / Chi Gong (imagine old people waving their arms about very slowly in the park).

The Taoist school of thought, from which these practices originate, described my state of ill health as a ‘burned-out nervous system’. Looking back, this makes sense to me. I’d gone from MSF assignments to a Master’s in Public Health to an intense mountaineering trip and then back to preparing for my next posting with MSF.

Under Taoist thinking, too much energy is said to have got “stuck” in my head, and manic, anxious, adrenalin-filled states became habitual. I became increasingly sensitive to stress – like a thin electrical wire that will short-circuit if too much current is put through it.

We are all different, with different needs, triggers and levels or tolerance, but we all have our limits.

Unable to read the signs, a vicious cycle was established. I worked more and more, both fuelled by the anxious adrenalin, but also to distract myself from it. I exercised less due to tension and fatigue.

The damage continued to accrue until my system couldn’t take any more and the alarm bells went off. This whole process is often described as “the brain eating the body”.

The slow, repetitive Chi Gong exercises have helped me to feel like I am gradually releasing some of these accumulated deep tensions, both physically and mentally. By better connecting with my body and grounding me, they also helped “strengthen” my nervous system.

My self-awareness has improved – allowing me to better discern what activities or states are nourishing or harmful and to read signs of “going too far”. As everything has started to flow better, I find myself with more energy, clarity and, surprisingly, creativity.

Where am I now?

It has now been more than two years since my crash and I count myself very lucky that I have been able to take a slow route to recovery.

I have shifted from my work designing and building hospitals for MSF to a more manual version: carpentry. I work as much as feels good, doing something that I greatly enjoy.

I'd love to work with MSF again but I know that returning too soon would, sooner or later, not only bring back symptoms, but would reduce my chances of learning these deeper lessons.

Lessons learnt

During the past two years my progress has been slow but steady. The main changes I have made are:

  • Learning to listen to my body's signals => knowing when to stop and when to say no
  • Doing what feels right for me => not what I should do, not to achieve and not to impress
  • Working in a way that is enjoyable => not trying only to maximize output or efficiency
  • Sensing the right time to act => not forcing things

We are all different, with different needs, triggers and levels or tolerance, but we all have our limits. Organisations and managers need to be aware of warning signs - since someone in my situation is often unable to see that they’re running on a broken leg.

Looking back, the dizziness was not the only warning sign I received. A continuous painful cramp in my foot, knee pain, and general body tension were all present in the month leading up to my final "burnout". As my general state improved however, these all gradually disappeared. It continues to amaze me how mental-nervous states can be accompanied by such tangible and concrete physical indicators.

I hope that none of you ever experience what I have described. Please take just a little more time to listen to what your body tells you, bearing in mind what could happen if you ignore the small soft voice for too long.

--

If you think you may be experiencing symptoms related to your work with MSF, remember there is support available. Contact your human resources officer or the MSF UK staff health unit.