I thought I’d be sitting down to write an article about something light and fun, like the healing potential of intentional cultural and music events. (If that intrigues, it will be the subject of a conversation between Steve Heilig and myself during Commonweal’s open house this weekend.) But much more present in my heart is what it takes to have a foot in a system that needs to change—in my case, the health care system—while simultaneously supporting that which is emergent—in my world, healing that is allied with the natural world and harms no one, including the healer. This bridging work is increasingly important as we remake a regenerative society, and it is worth contemplating how to do so without burning out or becoming a martyr.
Capitalistic values such as speed, efficiency, productivity, throughput, transactional encounters, profit margins and value assigned principally to efforts based on reimbursement are unnatural constructs. They deplete and degrade us, denying us the depth of experience and fullness of life allowed through presence, spaciousness and relational ways of being. Do you, like me, find yourself contorted into ways of being that are antithetical to your very humanity? I feel it in my bones as I sit in front of a screen long after patients have gone home, responding to messages in the “portal,” following up on labs and imaging studies I ordered, coordinating care for patients, brokering deals between the pharmaceutical industry and the insurance companies in prior authorization forms. In other words, doing the work of being a doctor that falls outside of the 15-minute visit that the system does not give us time to do, expecting us to do it after-hours, knowing we are too dedicated not to. I pay a steep price to be in my integrity as a healer in a system that encourages rushed encounters biased toward prescribing, not healing. I’m thinking of time with my children, personal time, time in nature, physical fitness and mental wellbeing.
I know many of you can relate to the escalating pace and pressures the system imposes seemingly without regard for workers’ wellbeing, not to mention the wanton ecological recklessness it exacts upon our planet. Many of you feel the call to change that which can be changed, even while suffering inside the system. Wherever you find yourself on this spectrum, it is helpful to name the discomfort you feel and make some decisions about what to do about it.
In grappling with this uncomfortable tension between what is and what could be, I’ve encountered a useful frame that helps orient me to the dynamic place of having one foot in a broken system and another in that which is emergent. Inspired by cycles of change within living systems, Margaret Wheatley and Debra Frieze of the Berkana Institute first described a “two loop” model of social change. It describes the way in which, in organizations and systems, as in nature, a dominant system peaks and then, due to various dysfunctions, begins to decline. That is the first loop. From the period of challenge and decline comes a generative potential for innovation. Thus begins the second loop, in which emergent solutions and paradigms are born and, over time and with coalescing energies, become the new system. Those of us with a foot in the old and new can navigate better by recognizing the nonlinear nature of change. We can recognize the need for compassionate midwifing of both that which is dying and that which is being born (which helps us empathize with the administrator who is just doing her job in upholding the structure she finds herself in). We can rest knowing that sustainable change happens by building networks and communities of practice, and that no one person should feel the weight of saving the world.
So here we are in 2022, with a foot in the old and fervent hopes for a regenerative new. In conversations with others working for change, be it for the environment, social justice, regenerative living or medicine, I’ve heard a similar theme—the risk of burning out is high. An essential question for change-makers is: How are you taking care of yourself? This is a question that could drive someone laboring in our broken system bonkers. It is essential to examine the structural cause of the burnout we are experiencing, but being encouraged to meditate more while the exhausting structure stands is maddening. Yet self-care is critical capacity-building for those working for change. Without it, we risk going down with the ship. Rabbi Hillel, the Jewish spiritual leader, summed it up: “If I am not for myself, who will be for me? If I am only for myself, who am I? If not now, when?” Self-care is inextricably linked to our ability to serve community and engage with emergent paradigms. The means of effecting change must be consistent with the end we wish to achieve.
Perhaps what we need is a “community of practice” of self-care, in which we become emboldened to set effective boundaries and are liberated from feelings of guilt when we say no to some invitation, task or project in order to care for self. The world’s needs are endless. Our finite, precious, ensouled and embodied beings’ needs must be at least as compelling as that of everyone else’s, and sometimes it takes social support to create new patterns. I, for one, am increasingly drawn to caring for patients and community in a way that does not ask me to choose between myself and others. As committed as I am to my first-loop engagement, I cannot let it drain me of the life energy needed for the essential second loop. Do you have a pattern of engaging with service that could be elevated into one that prioritizes your needs?
I have a request. Could we all support each other in taking care of ourselves, and encouraging boundary-setting with grace and compassion? Could we look at what we might be unwittingly perpetuating in our self-abnegation, or through our expectations of instant gratification? As we mutually support each other to slow ourselves down, step back when we need to and lean into new, regenerative structures aligned to the life-affirming rhythms of nature (light and dark, work and rest), we can compassionately care for all members of community, and for life itself. Re-weaving societal structures is hard, good work. Doing this good work in equal measure to good play (and restorative self-care) is the only sustainable path to the future we wish to inhabit.
Anna O’Malley is a family and community medicine physician at the Coastal Health Alliance, where she explores community-level healing work in addition to integrative primary care. She founded and directs Natura Institute for Ecology and Medicine in the Commonweal Garden.