Lloyd I. Sederer, MD

After 2-and-a-half years cursed by COVID-19, who doesn’t feel “burned out”?

What is burnout? Who is at greatest risk for its pathogenesis? We need only look in the mirror for an answer. And what else besides 

—first denoted a reduction of a fuel or substance from its ongoing use.

 It is no surprise the term has found fulsome application today in describing what so many of us feel as we march through the demands of our lives.

, especially in frontline doctors and nurses, has been amplified by the unending pandemic.

 describes a wide range of physical symptoms and common emotional problems listed in the 

Physical Symptoms and Common Emotional Problems Associated With Burnout

Burnout may occur in diverse settings (although here we consider health care settings). It is not a psychiatric illness and thus does not appear in the DSM-5. Burnout often resembles and can be misidentified as clinical depression. Although the symptoms of both overlap, burnout should not be confounded with depression. The fundamental difference is that burnout is a reaction to ongoing and significant 

 stress, from the conditions of work and/or the worksite. Burnout is different from depression (and other lookalike disorders) and calls for different means of remediation than those of depression.

For example, burnout among doctors and nurses in hospital and clinic settings is the product of long work hours (to cover shortages); isolation from colleagues and friends; an unending exposure to death and disability; a relentless burden from providing medical care during a massively disruptive pandemic; compromises to family life; and the high risk the coronavirus poses to doctors and nurses, their spouses, children, and other relatives.

These are extrinsically stressful conditions, with doctors and nurses especially (although not uniquely) riddled with burnout. Burnout in our colleagues and friends does not exempt anyone: We are them.

Inordinate and persistent degrees of stress keep pulling on the triggers that release cortisol and adrenalin—hormones that can ignite inflammation in many body organs including the brain, pancreas, heart and vessels, and joints. This covers just about everywhere important in our body.

Although acute inflammation can help heal wounds and prevent infectious diseases, chronic inflammation is implicated in many very common illnesses including diabetes, heart attack and stroke, osteoarthritis, depression, substance use disorders, Alzheimer disease, and even cancer. Chronic inflammation also shortens the caps (called telomeres) on the DNA in our cells, which keep the helix together. As the tips erode, the helix unravels, increasing the risk of cancerous mutations during cell division. All told, chronic inflammation is the enemy of our health and well-being.

, including mind-body interventions (eg, meditation, mindfulness, yoga, yogic breathing), as well as diet and exercise and the beneficial effects of trusting, enduring relationships.

 But these salutary activities, however important, yield limited protection from the ongoing stresses of a noxious environment. The sources of chronic stress and inflammation are what need to change, which means the toxic work setting needs to change. Wellness activities allow for tolerating stress, but they do not get to the heart of the trouble.

An individual caught in the crosshairs of worksite stress is not to blame or shame. After all, we are all human. How much can a person take?

The power to change arduous conditions at work or the exigencies of any moment (as in a deadly pandemic) is generally not within the power of the employee. Those in executive and management roles must not sidestep their responsibilities to do as much as possible to lessen stress and enable health care workers (in this instance) to take care of their patients, their families, and themselves.

What Is Within the Personal Control of Health Care Workers?

Workers are wise to demand free childcare, flexible shifts, supervisory and peer support, relief from educational loans or other indebtedness, personal/family housing support, meals, and the like. Nonetheless, we know how constrained hospital executives must be in times of financial freefall. This is not quite a “rock and a hard place,” because mindful organizational leaders recognize the need to attend to the well-being of their most precious assets, namely their doctors, nurses, and professional staff.

Taking care of ourselves is in no way contrary to assertively holding clinical organizations and their management responsible for providing less toxic and more supportive work settings. As workplace conditions improve, we still owe ourselves, our families, and our colleagues to do more of what we can to stay the course and continue to contribute. This is no easy task in the face of exhaustion and feeling helpless, yet personal control is a means of feeling less at the mercy of our environment while actually benefiting from our efforts.

There are, of course, the previously noted mind-body activities that can reduce your stress, including exercise, yoga, and meditation. These activities work and they are free. Some are regularly offered at workplaces. But you may ask:

™ to write specifically about burnout and

 (as one form of creativity). Mind-body activities can calm an overloaded mind and nourish wellness. The benefits of creativity, however, are different from the benefits of doing yoga and meditation.

. It energizes, clarifies, and gives expression to what counts in our lives. As Andrew Solomon, a beacon in the world of nonfiction writing, remarked, “The opposite of depression is not happiness, it is vitality.”

 The opposite of burnout is no different.

Writing in your “voice,” drawn from the bounty of what you feel and think, serves you. It can be your oxygen. You know you are in that zone when fatigue disappears, as do aches and pains. Time may be fluid, with few boundaries. Writing is exercise for our mind; perhaps it is the counterpart to a runner’s high. Writing is my oxygen—not only an itch to scratch.

We need not have God-given talent to write. 

 not an endowment—a salient distinction because writing is there for everyone. But like any craft, putting words on paper takes learning and practice. Writing is hard work, but the kind that leaves you with a sense of mastery and the pleasure of work well done.

My greatest (and only) writing coach was the late Bill Zinsser.

 He likened the craft of writing to the craft of, say, plumbing. A plumber gets up and goes to work. There is no mood for fixing a leaky sink or a broken toilet. Like plumbing, the craft of writing is mastered by learning and practice.

When writers write for themselves, it is their passion that grabs the reader, regardless of the subject: fly fishing, music, film, books, family, climate, crime, race, the pleasures and pains of everyday life, work, play, baseball and other sports, catastrophe and joy, animals and plants, the Rubik’s Cube of human nature, and so on. Write about what is happening in your life. Who has time to research other subjects?

Although there are many nonfiction writing forms, including blogs, op-eds, reviews, letters (remember those?), and books, it is your passion, not the form, that speaks to readers.

 Your professional expertise and experience count—use them. Write with your readers in mind. Envision what you write to be no different from talking with a reader over a cup of coffee at their kitchen table. Also remember that brevity is a kindness: Stay away from polysyllabic words and make your sentences and paragraphs short.

This essay has packed a lot of information into fewer than 1700 words. Thank you for making it to its end. However, as Winston Churchill said, “This is not the beginning of the end, but the end of the beginning.”

Enjoy your writing, and your readers will enjoy it too.

 is a psychiatrist, public health doctor, and nonfiction writer. To learn more, visit 

1. Burnout. Merriam-Webster. Accessed July 1, 2022. 

https://www.merriam-webster.com/dictionary/burnout

2. Depression: what is burnout? National Library of Medicine. Updated June 18, 2020. Accessed July 1, 2022. 

https://www.ncbi.nlm.nih.gov/books/NBK279286/

3. Physician burnout. Agency for Healthcare Research and Quality. July 2017. Accessed July 1, 2022. 

https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

4. Burnout: symptoms and signs. WebMD. December 3, 2020. Accessed July 1, 2022. 

https://www.webmd.com/mental-health/burnout-symptoms-signs

5. Ninivaggi FJ. Depression and burnout. 

. November 7, 2019. Accessed July 1, 2022. 

https://www.psychologytoday.com/us/blog/envy/201911/depression-and-burnout

Improving Mental Health: Four Secrets in Plain Sight

. 1st ed. American Psychiatric Association Publishing; 2016.

The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer

The Noonday Demon: An Atlas of Depression

Writing About Your Life: A Journey Into the Past

Bird By Bird: Some Instructions on Writing and Life

13. Sederer LI. Eight enemies of good writing for the lay reader. 

https://www.psychiatrictimes.com/view/eight-enemies-good-writing-lay-reader

Articles

The sources of chronic stress and inflammation need to change, which means the toxic work setting needs to change.

Burnout and Its Remedies

Alex Harz approaching the south summit of Mt. Everest. Copyright: Alex Harz

40 degrees. You are breathing thin air with one-fourth the sea level of oxygen. You haven’t slept for 2 days. Every step forward feels like your legs are encased in concrete. One hundred-meter crevasses flank you, left and right.

Is this some form of torture invented by the Taliban? Maybe the photo above is of a climber frozen in place since 1962? Or might this be payment due for buying all that non-returnable gear at EMS? Or might it be a Himalayan scene from a forthcoming 

It’s worse. Because it’s no joke to climb to Everest Base Camp (el. 17,500) after flying in to the remote Lukla airport (el. 9400) on what looks like an old toy plane. Then there is the climb to camps 1,2,3, and 4 (the last at el. 23,000)—the way stations for the few whose minds are set on ascending to the summit (el. 29,032).

But first, let’s start in the capital city of Nepal, Kathmandu (el. 4600, pop. 846,000, without its “urban” sprawl)—as did the climbers in 

(Gravitas Ventures). Tourism dominates your first day as your local guide, fluent in English, herds you to a gargantuan market of narrow, serpentine streets, encroached upon by every stripe of merchant. Hindu and Buddhist shrines are features of the tour, some restored or under reconstruction from the major earthquake (7.8) in 2015. Never sidestepped on the itinerary is the crematory, open 24 hours/day, where Hindus burn their dead and sweep their remains into a tributary of the Ganges River.

This film beautifully uses Kathmandu to mentally transport you, like the climbers, to the journey ahead. You mix with its people, pay respect to its historic shrines, witness its dead being cremated in the open air, and realize that you are 

I was in Kathmandu in 1995, beginning a trek to the base camp of Annapurna (el. 13,550), the tenth-highest mountain in the region (el. 29,545), which is as deadly as Everest to those who seek its summit (not me). The people of Nepal radiate a warmth and welcoming that is now so uncommon to find. This immersion into Kathmandu will be the most significant Nepalese experience that most tourists—and they are legion—will have. 

 portrays a tender and detailed account of the city—a gift, and no less so than the icy sites ahead.

The Everest quest then moves on to Lukla.

concentrates its cameras on people, especially Ryan Waters (the American lead climber), and touching lightly on his climbing team, the Nepalese Sherpas, and the guides. Waters is tall, fair, lean, and collegiate looking, effusing keen interest and humanity; only later will you see his unwavering grit, when the going gets impossible by most human standards. It is hard to read him—to appreciate what has driven him to this over-the-top and potentially fatal adventure. Three-hundred climbers have died on Everest; we see the cairns marking their burial sites along the ascent.

There is not much technical in the film’s portrayals (not that I wanted it). We see the extraordinary mountaineering equipment and the massive support staff, but they do not reach center stage. I had a group of 10 assisting my 4-person, nontechnical climb. There is not a word about funding 

, which surely was a bargain considering the cost of an Elon Musk SpaceX rocket into to the earth’s stratosphere.

We march the white mountain from one harrowing place to another, as if beside Mr Waters and his team. This is as close a perspective possible of the mountain and him. Watching Mr Waters persevere with a smile begs the question: 

would an individual subject himself to what otherwise appears enormously punishing

Metaphor and simile are useful in considering this question.

Everest is a massive mountain scraping the sky, cold and unforgiving, lording its dominance over the likes of us. Climbing it would be like a heavyweight boxing championship: Glory to the winner of the battle, although the mountain itself will not feel the punches—just you. Climbing the mountain must also be an exercise in seeking to dominate your less-than-invincible self.

The amygdala is an almond-shaped nerve bundle, barely an inch long, in the forefront of our brain’s temporal lobes. It is the origin of our fears (from “fight or flight” to intimacy). The mountain challenges the amygdala, as the amygdala challenges the mountain. Talk about David and Goliath!

A quotidian life could be transformed by the majesty of the summit. There would be pain to suffer, but not the variety that debilitates—rather, a pain that runs from head to toe and shouts that you are truly alive. No doubt about it.

The loneliness that pervades our lives, which is as much a health risk as 15 cigarettes a day, would evaporate—diffuse into the clouds. Because in extreme climbing, the climber has 2 intimate and ardent bonds. One is to the fearsome giant, the mountain to be tamed, the yin to your yang, and the source—ironically—of the juice in your blood. The other is to the extraordinary attachment to your teammates, leaning into danger as you are—the eyes, ears, and desire beyond your own. It is this type of attachment the military trains into soldiers so “no one is left behind.” You are bathed, if you will, in closeness otherwise almost unimaginable.

 summit seems anticlimactic, but it is a rare moment.

The film ends in triumph, richly deserved. Yet, it is still less than we can comprehend. If you ever meet a mountaineer, offer him or her a drink in exchange for a glimpse into their soul.

 is a psychiatrist, public health doctor, and non-fiction writer.

“A quotidian life could be transformed by the majesty of the summit. There would be pain to suffer, but not the variety that debilitates—rather, a pain that runs from head to toe and shouts that you are truly alive.”

A Transformative Journey in THE QUEST: Nepal

“Reacher” season 1 is now available to stream on Amazon Prime.

When Reacher (Jack, no middle name) is in peril, which happens frequently in the Reacher books, 2 Tom Cruise films, and throughout this long-awaited series, you can rest assured: “Don’t worry about him.”

Reacher does not seek trouble—trouble finds him. When it does, mercy on the evildoer behaving badly.

There are 25 Reacher books, all with the same protagonist—a run matched only by Nancy Drew—created by Lee Child, a successful, but laid-off British TV director. He came to the States at 39 and began writing a book a year. His first Reacher book, 

bestseller list, as has every one since—quite a few have been #1. A Reacher book sells every 9 seconds around the globe.

The Reacher streaming series, based on Lee Child’s books, with 8 parts at ~50 minutes each, is a treat and a relief. Reacher has not disappeared from the screen—only Tom Cruise, who played him in 2 full-length films. The credible Reacher we have been waiting to see is played by Alan Ritchson, with keen understatement and as much deadliness. Credit for the series is given to 

, but the story, events, and characters are drawn from a number of Child’s books.

Reacher gets off a bus in a Southern town. He wants to learn more about Blind Blake (1895-1934), a blues artist who potentially died there. The town is prospering after hard times. A businessman, Kliner (Currie Graham), came to town 5 years earlier, built a lucrative company (ostensibly legally), and then rained money to rebuild a broke down town. He buys off some cops, and the mayor, so it looks like crime will pay.

Not so: When the threat of exposure of Kliner Industries is at risk, Kliner and his psychopath son (Chris Webster) get dead serious about keeping the lid on Kliner’s operations. You know—only dead men don’t talk. His company’s customer is a band of merciless South Americans, and unless Kliner keeps delivering his product, he will be toast—and not the kind served with breakfast.

Soon after getting off the bus, trying to have a piece of Georgia’s famed peach pie, Reacher is arrested for murder. This is not the best way to befriend the town’s chief detective, Oscar Finley (Malcolm Goodwin), or a home-grown, tougher-than-nails female police officer, Roscoe Conklin (Willa Fitzgerald), but it will do. A killing, exacted in a distinctly “Venezuelan way,” has marred the bucolic town, and there are far more gruesome murders to come. Jail alone has not left Reacher in a very bad mood, because of what happened to his older and taller brother. There is no stopping Reacher, Finley, and Roscoe from hunting down—with intent to kill—the individuals responsible for spilling blood and stoking fear. Suspense and danger mount and gallop (like a Reacher novel) to a fiery end. Don’t worry: Remember, Reacher is there.

Reacher shines as a character when working with smart women, built to repel trouble and usually in uniform. In this case, there are two. The town cop, Roscoe, and Reacher’s former military sergeant, Neagley (Maria Sten), who is called in from the “private sector” to add more firepower to the action. With Reacher paired with Detective Finley, a tweedy Harvard obsessional running from his life in Boston, we have a bit of a reprise of the “Odd Couple,” like Felix and Oscar did for a long time on network TV. Reacher’s older brother, Joe, and parents appear in carefully staged flashbacks, giving Reacher’s character more depth and texture. The ensemble plays like a finely tuned orchestra, but with guns, not violins.

 The first is his size, weight, and strength. At 6’5,” 250 pounds, Reacher metes out justice no matter what the enemy strength may be. As a former major in the Army’s military police (MP), Reacher is used to rounding up criminals—those that are trained to kill.

 The second is Reacher’s brain. With an eidetic memory, the sleuthing powers of Sherlock Holmes, and a singular focus on getting the job done. He also can think like his foes—which helps a lot in finding and outwitting them.

 The third is Reacher’s character. Vigilante justice allows him to break a lot of rules. He cannot abide with losing. He is an itinerant—here one day, gone the next. After a score of years in the Army, going where ordered, he is now a free man. As a minimalist, Reacher does not need much, materially or emotionally. He carries only a folding toothbrush, his passport, and some retirement cash wired to Western Union. Clothes? He tosses those after 3 days and gets a new, inexpensive outfit.

A great deal of truth is written into the Reacher fiction oeuvre. I have read it all. Child is a wise man and a gifted storyteller. As Philip Roth said, if you want the truth, read fiction.

is a psychiatrist, public health doctor, and nonfiction writer.

Reacher: a wicked action-packed new show. 

Reacher: Don’t Worry About Him

 reported that those identified as “vaccine hesitant” are “all-in” for taking medication (if ill, of course) for the treatment of COVID-19.

 from COVID-19 with a highly effective (if not lasting) vaccine that has been given safely to millions are ready for COVID-19 

 with pills. Standing tall for pills—but 

 the vaccine—is Florida Governor Ron DeSantis, an anti-vax champion who has erroneously claimed that vaccines cause sterility.

, instead of taking a vaccine given safely to many people. In the United States alone, more than 200 million doses of the Moderna vaccine have been administered since its United States Food and Drug Administration (FDA) approval in December 2020.

Yet, 200 million doses are not enough evidence to sway many a vaccine refuser, including the Florida governor. Instead, tens of millions of 

Americans—not strangers, but family, friends, and coworkers—are becoming ill. When will a brilliantly lit fire under resistance be ignited? Stoked because resisters are significantly sicker with COVID-19 than those who were vaccinated (and boosted). Their illness is much more likely to require hospital care and disproportionably fill the hospital morgue. These are our relatives, friends, and coworkers—not strangers—who are overloading our hospitals and overwhelming our doctors and nurses. Yet they will be eligible to receive COVID-19 treatment medication: “all in” to receive a largely unproven, perhaps unsafe, vial of tablets or capsules.

 moment in the COVID-19 vaccination siege (see Brad Pitt’s film credits; otherwise see Homer, then Virgil) where COVID-19 treatment serves as a Trojan Horse that can enter the heretofore unassailable, closed doors (and minds) of the vaccine hesitant? The timing may be right: Might COVID-19’s protracted impact, now more than 2 years of raining economic misery and killing over 800,00 Americans,

 unlatch the doors now closed to vaccination? Soften calcified opinions?

We know that people change their minds (and behaviors) 

—about what to wear, what to eat, close relationships, where to go or live, cigarette smoking, and dying by suicide. Every person has the 

to change their mind, with time and when circumstances change. Change is the rule more than the exception.

Estimates are that 2.4 billion pills are ingested every year in the United States.

 Americans love pills! A handy fact, as COVID-19 continues to destroy.

I do not imagine a drift to prevention will engage many of those prone to storm US government institutions, or the rioters in the known to be civil country of Canada. Baked-in mis- and disinformation and a “live free or die” ideology generate stubbornly held convictions. These are high walls to scale, which make the United States a poor performer on the world stage of citizens vaccinated. Recall, however, that minds—and habits—were changed about tobacco when disinformation was replaced with the truth that smoking kills. 

We do not need to bat 1000, nor could we. But what about a US vaccination batting average of 800 (80% who get 2 shots, plus booster). Might that goal be oiled by unanimity of mind for treatment? Not so big a step from prevention.

How many lives would be saved? Family health and financial suffering diminished? Business recovery made possible, all by prevention—before illness? Being able to keep open our favorite local restaurants, bodegas, cleaners, and car washes, and restoring zest to the entertainment industry?

 say caregivers—everywhere, every day. But not shots? The Trojan Horse, with its army of influencers, is about to broach the gates of the fortress that heretofore has said, “no” to COVID-19 vaccination. People do change their minds. A lot has happened in these past 2 years to kindle change. Will treatment strike the match that will kindle the fires of prevention? As has been said by many a foe to our country, “Americans may be stubborn, but they are not stupid.”

I learned in medical school to meet individuals where they are and help them go where they fear going. Bring on the pills! Let’s see how far pills might change public opinion—especially about the COVID-19 shots.

 is a psychiatrist, public health doctor, and nonfiction writer.

1. Facher L. Some Americans are hesitant about Covid vaccines. But they’re all-in on unproven treatments. 

. January 27, 2022. Accessed January 31, 2022. 

https://www.statnews.com/2022/01/27/some-americans-are-hesitant-about-covid-vaccines-but-theyre-all-in-on-unproven-treatments/

2. Jeong A. DeSantis suggests vaccines hurt fertility. A study indicates otherwise—but says catching coronavirus might. 

. January 21, 2022. Accessed January 31, 2022. 

https://www.washingtonpost.com/health/2022/01/21/covid-vaccine-infertility-pregnancy-desantis/

3. Perrone M. US gives full approval to Moderna’s COVID-19 vaccine. 

. January 31, 2022. Accessed January 31, 2022. 

https://apnews.com/article/coronavirus-pandemic-moderna-vaccine-approved-dc6f5ac9eeb31667d5a28f0954335b65

4. Adam D. The pandemic’s true death toll: millions more than official counts. Nature. January 18, 2022. Accessed January 31, 2022. 

https://www.nature.com/articles/d41586-022-00104-8

5. Preidt R. Americans taking more prescription drugs than ever. 

. August 3, 2017. Accessed January 31, 2022. 

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiU84Oxrvr1AhVfjokEHeZdCRUQFnoECAIQAQ&url=https%3A%2F%2Fwww.webmd.com%2Fdrug-medication%2Fnews%2F20170803%2Famericans-taking-more-prescription-drugs-than-ever-survey&usg=AOvVaw1ET-1IJzYVG9YJ2Yr5JinK

Millions of unvaccinated Americans are becoming ill. How will a brilliantly lit fire under resistance be ignited?

The Trojan Horse and Breaching the Fortress of Vaccine Refusers

Your space capsule has just landed after 4 years of hurtling about in the galaxy. All radio communication was lost some years earlier when your ship was hit by a movie camera from a Brad Pitt film. You cannot sue since 

 has yet to open an intergalactic court. You are oblivious to how you immediately will be thrown into the game. Perhaps by the rescue folks in the helicopter—why are they wearing masks instead of helmets? Unbeknownst, you now have been tagged to play COVID Dodgeball. Funny, NASA thought you might bring back some horrific infectious disease from exposure to a contagious asteroid growth. Is the space program out to lunch, or do they need better funding?

COVID Dodgeball is a new game going “viral” across the United States, definitely surpassing “Minecraft” in followers. It is called 

.* Do not be fooled: You may think you are not playing, but you are. It is inescapable, unless you are living alone in the Arctic Circle (pets do not count).

COVID Dodgeball can be played in any and all settings, and by persons of any age, gender, race, or ethnicity: in supermarkets, at concerts, at parades, at home, in cars and subways, in nursing homes, in movie theatres—you name it. It can even be played at the DMV (as I discovered—but too late).

Billions of Earth’s inhabitants are tossing the dodgeball at subsonic speeds without regard for who it hits, or how badly. The legions of sick, those getting sick, and those not evidently sick are sources of the dodgeball, which is why COVID Dodgeball is really hard to win. It is everywhere, but not in your dog, cat, or goldfish. A dust mite is 2000 times the size of the spherical COVID critters, caked with really tiny spikes that know how to get into your RNA.

Put your ripe space suit back on, get a big oxygen tank, and go on an unplanned crash diet. There are not many others with your dodgeball defenses since the space program has withered in recent decades. You are the lucky one, assuming you do not want to get sick and maybe die.

The rest of Earth’s inhabitants, being much larger than dust mites, are easy prey to the invisible, evil dodgeball—except 

 those who are wearing face masks. Once the ball has hit the defenseless others, its primary goal—and the purpose of the game—is to replicate better and faster than mice or rabbits, trying to forestall future human efforts to win the game. Were you thinking of a moral defense? Think again. The dodgeball has no conscience, being raised without parents; it does not fuss over stopping your breathing. Have mercy on those without space suits; some may be family.

What about the children, you may ask? They are smaller targets and mostly have intact inner defenses against the dodgeball. But they nevertheless are participants in the game because they can and will hurl the ball right at you, while feeling pretty fine themselves—most of them, most of the time, so far.

Multinational pundits declare that zombies do not play dodgeball. These 

 tiny creatures have their own, apparently satisfying, ways of pummeling you.

But all heretofore said must be just about

 to many of our bodily organs if we fail to dodge the errant ball. But the dodgeball is a 2-headed devil.

 side of the dodgeball is studded with different also very tiny, but precise and misery-making spikes. These prey on 

. Are you drinking too much? Taking grammy’s oxycontin? Predicting your early demise? No appetite, or too much appetite. Forget about sleep. Dodgeball hits do cause a lot of mental distress, including anxiety, depression, alcohol and drug abuse, and posttraumatic stress disorder. That is the other side of the dodgeball—and reason enough to dodge as best you can. Plus, there is the mysterious long (course) spike that lingers for months, messing with thinking, word finding, and auditory nerve functioning, while inducing major-league exhaustion, as if you had run a marathon even though you are just trying to get out of bed.

These COVID Dodgeball-generated feelings and thought problems do not appear to be transmissible, even to those yet to be born. But their psychic pain can run deep and stay too long (I can say, as a fully trained psychiatrist). The psychic spikes of the dodgeball are also invisible to the naked eye, yet they produce torment not to be sneezed at—to those tagged by the dodgeball, and to those who care about them.

As you surely have concluded, COVID Dodgeball must be a big seller. How? Ask your broker or watch an evening business show—there are many of them. But, unlike Pfizer, Moderna, and Johnson & Johnson, there is no stock to be had for COVID Dodgeball, although this spares investors from the tumult of market “corrections,” especially while we are contending with COVID.

There are tens of millions—more—of individuals in the United States 

 carrying the wicked dodgeball, with its 2-sided protrusions designed to whack you. There are winners and losers. Winners are those who played the game artfully. Losers are those who are older, ill with other illnesses, or immunocompromised, and those who did not put on their spacesuits.

My great thanks to Heidi Anne Duerr, associate editorial director at 

We’re all playing the “viral” game—but how do we win?

COVID Dodgeball

When I left New York City in the summer of 2020, as did many others (especially those like me who are at high risk for COVID-19), I left the "Writing  for the Lay Public" workshop that I cofounded with Deborah Cabaniss, MD. That moment meant losing the ongoing, exceptional personal and professional privilege the workshop afforded me. No more thinking and writing with some of the most generous, thoughtful, and dedicated people I have known. No more of the heartening feeling (in short supply nowadays) I took from witnessing the trust and support the group members gave one another. And no one to teach me!

Once a month, repeating each academic semester, those who had signed up to attend gathered for 90 minutes. We were all there to listen and respond to a fellow workshop member’s draft—an approximately 800-word article written for the workshop and read aloud there. Because this workshop was hosted by the Department of Psychiatry at Columbia Medical School, attendance was limited to members of the department, including residents, fellows, graduate students in psychology, junior and senior faculty, and members of the neuroscience community. The department chair came for 1 meeting to read and hear comments on an essay he wanted to publish—a kind endorsement of the workshop.

As I recall, there were 10 participants 9 years ago, and 30 at the end of the 9-year run. Workshop members’ nonfiction commentaries and essays found their ways into dozens of online publications, including 

Some workshop members came for 1 semester; others for a few sequential semesters. Some left and returned, and a handful of die-hards have participated for about all of the 18 semesters.

I co-led the workshop with a senior faculty member in the Psychiatry Department’s Resident and Fellow Training Division. As a psychoanalyst and writer of professional books, she was a great complement to what I had to offer—which, I think, was mostly a faith in those seeking to give voice to their professional (and personal) experiences, latent without a medium for expression.

This was not a didactic course. There was no homework, either (except for writing). Collectively, participants and coleaders created a safe and supportive environment for all who wanted to build on the craft of nonfiction writing. The workshop members were the best teachers: They listened and commented 

, as might the intended audience for the article. The discussion often considered who the audience was for the written piece. We frequently asked, what is your message or point of view?

Clarity of writing, not literary or grammatical skill, carried the day. Essay beginnings and endings, brevity, and a steady, narrative line that carried the reader from the first to the last paragraph were stressed—humor and levity, as well, to help the “medicine” go down. All of this was done virtually once COVID-19 emerged.

The topics were as varied as the participants. Though, to my mind, they all sought to make sense of being human and our so very transitory lives. The writings were about loss; wonder; transitions; setbacks and successes; love and attachment; mental and addictive disorders; our brains and bodies, inseparable; trying to comprehend a paradoxical and ironical world; those individuals and communities who seemed to have lost their moral mooring; those who have abandoned the common good; professional experiences that taught or transformed; change or the impediments to change; and more. In other words, whatever the author set out to portray. Inescapably, the last few semesters had many essays about life surrounded and invaded by the viral demon, COVID-19, including virtually practicing the art of psychiatry and psychotherapy.

At times, I also provided the writing workshop (or a variant of it) at the New York Academy of Medicine; at professional meetings; and at workshop lunches with residents, fellows, and psychology trainees after a Grand Rounds. These workshops were remarkable in their energy, creativity, participation, and wise consideration of grave (and humorous) happenings. What was missing from these one-time events, however, was the power of a group that had come together, built trust over time, and sought to learn how to write well by encouraging and teaching one another.

I write this remembrance on the eve of starting again—as the only remedy I could divine was starting again, somewhere else, with a different community of participants.

Here’s how a writing workshop encouraged this doctor’s enthusiasm. 