Why Success Can Hide Poor Health

We can be having the best year of our career and be in the worst condition health-wise we’ve ever experienced. Our promotion lands, the numbers grow, the work gets done in record time, and from an outside observer, everything seems fine. Inside though, sleep has gotten thin, the people closest to us are getting the husk version, and work that used to feel interesting now mostly feels like something to force our way through. Nothing is really broken though, so nothing needs to be fixed…

Output is one of the easiest things about us to see, which is why we tend to use it as the measure of how we're doing. It's pretty logical, at least some of the time, because sustained achievement must mean that we’re doing well all-around. We couldn’t achieve what we do if we weren’t doing ok, right? What we produce and how we perform, and the condition we're in while producing it are two different things, and they can drift apart for a long time before anyone notices poor health, including us.

Why Output Is the Last Thing to Fall

When our capacity starts to shrink, the visible work we do is usually the last thing to give. That's not an accident so much as a priority because most of us defend the thing that gets measured ferociously. The report still gets written, the meeting still gets run, the training still happens, and everything that’s unmeasured can slowly erode underneath. Sleep gets shortened first, then exercise, then how we act in conversations with a partner or a friend, then whatever curiosity we used to bring to the work itself.

Burnout research keeps highlighting that burnout was never defined as an inability to work. It's described as exhaustion paired with a growing distance from the job and a sense that we're no longer doing it well. That brutal combination can exist inside a perfectly functional career for years. We can be exhausted, half checked out of work we used to care about, and still be one of the more reliable people in the building. It’s a strange position to be in yet also a common one. Our output holds because we're holding it, and that's a completely different thing than being fine overall.

What Chronic Stress Does to Us

Running hot for long stretches changes our internal system doing the running. When something registers as demanding, our body sends a chain of signals that ends in a surge of cortisol. That surge plays a highly valuable role, but it’s meant to be temporary, spiking to meet a challenge and then switching off. Under repeated demand without much recovery in between, the switching off doesn’t happen, and our body starts accumulating the cost. This cost, or allostatic load, is the wear and tear that builds up from a stress response that keeps running when it should’ve finished.

The part of us that suffers first is the part we most want at work. The prefrontal cortex is unusually sensitive to stress exposure, and it’s also the part of the brain responsible for critical thinking. Even fairly mild stress we can't control causes a quick drop in what that region can do, and longer exposure changes the physical connections there. Initial phases of burnout rarely show up as a health problem though. The impacts start showing in subtle way, such as rereading the same paragraph, taking the familiar option because deciding between two new ones isn’t worth it, snapping at someone over something small, or finding that we've stopped having opinions about certain subjects we used to argue about happily.

Emotion goes flat when we start getting overloaded too, which is often the thing we notice last in ourselves but first in each other. The bandwidth that lets us be curious about another person, or patient with one, tends to suffer too because it draws energy from the same pool that’s already committed to handling our stress response. It's different for every person, but the pattern, at least in retrospect, tends to look like a gradual narrowing rather than a collapse.

How Poor Health Shows Up Before the Results Change

The gap between how we're overall health-wise (i.e. performance health) and how we're performing is measurable, and the medical field is one of the areas where it's been measured most carefully. A 2018 survey of practicing physicians in the U.S. found that 54 percent reported symptoms of burnout. It also found that more than one in ten reported making a major medical error in the previous three months, with the rate higher among those who had worse burnout symptoms. They were still showing up yet also carrying a full burden in their lives and were still producing outputs that looked like a functioning system, despite the occasional errors. As time goes on though without addressing the issues, the effects worsen.

Other studies show similar effects outside of medicine. Burnout predicts insomnia and depressive symptoms along with a raised risk of coronary heart disease, type 2 diabetes, and other chronic illnesses. When it comes to work, it predicts dissatisfaction and absence, along with presenteeism, meaning showing up to work but not getting much work done. Organizations feel the impacts downstream, with estimates putting the cost of turnover and reduced productivity attributable to burnout in the U.S. at tens of billions of dollars.

The habits that keep our output steady in the meantime are usually the ones that make the underlying picture harder to read. More caffeine, later nights, a drink to come down, weekends spent recovering rather than doing anything, and a slow narrowing of life down to work and the recovery from work. We get chipped away at despite completing the deliverables and still getting everything done.

The Difference Between Producing and Sustaining

Sustainable performance requires a different framing than point-in-time performance, and it comes down to whether today's output leaves us able to produce something similar next week, next month, or next year. That's where recovery research becomes hard to ignore because the thing that most reliably predicts strain isn't the size of the workload. It's whether we can mentally leave it in order to recover. Psychological detachment, meaning fully stepping away from job and task-related thoughts during time off rather than just stepping away physically, tends to erode exactly when demands are highest. We tend to lose it first when we're performing hardest and while everything still looks like it's going well. As soon as the ability to step away is lost, our stress response usually loses its ability to switch off.

This doesn’t mean achievement is suspect or that hard things are problems to be solved. Plenty of good work gets done under high demands, and coming out the other side of a demanding season is part of how we grow and how our capacity gets built in the first place. The distinction is between a season and a setting. A hard month that ends in recovery likely builds us up, while a hard year with no end point mostly drains our reserves until there’s nothing left.

What achievement tells us is what we produced. It says almost nothing about the shape we were in while we produced it or whether we’re performing on borrowed time versus whether we’re growing in a sustainable way.

References

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