From Hyperfunctioning to Healing: A Guide to Personal and Organizational Change

“You said you were fine, but you don’t seem fine.”

The text came from a friend and coworker seated seven feet from me in the workroom. She’d just asked how I was doing, and I said, “fine.”

But she was right—I wasn’t fine. I was thinking of a patient case and feeling upset by what had happened. So why didn’t I simply tell my friend when she asked? Because of…

The culture of hyperfunctioning

Hyperfunctioning is when part of the body works harder than it should. It's like our minds are on overdrive as if our brains are computers with too many apps running simultaneously. This state involves a lot of thinking, planning, analyzing, and worrying. And when you’ve been hyperfunctioning for years, your nervous system gets so used to it that it’s difficult even to realize what’s happening—which is exactly what happened to me.

We all learn how to cope

I developed hyperfunctioning to navigate my childhood and, later, to deal with the stress of doctoring. My childhood convinced me that the best way to move through the world was to take care of everything myself. This is not a dig at my parents—they were loving and did their best, but no parents can shield their child entirely from stress and trauma.

Everyone develops coping mechanisms to get through life. Some serve us well, but others are maladaptive, causing long-term harm to our ability to thrive personally and professionally.

It’s up to each of us to address the maladaptive coping mechanisms we learned growing up, but they're not solely our responsibility—they can be fueled by teams and organizations (which is exactly what happened to me, again). My experiences through medical school, deployment, and my work as an emergency physician actually encouraged hyperfunctioning.

If you’ve never hyperfunctioned, you are 

1. A rare individual and 
2. I’m so glad for you! 

 Hyperfunctioning is no way to live. It’s depleting and isolating yet it’s common among individuals, on teams, and in organizations.

What’s the alternative? What can we do differently?

I share the single, double, and triple loop changes we can make to address hyperfunctioning, and the magic of small gestures like my friend’s text.

Single loop, double loop, and triple loop change

I think of change through the lens of single loop, double loop, and triple loop learning, an important framework adapted from Dr. Chris Argyris, who was a visionary on organizational change.

Single loop: Individual

We all want to work in great organizations, but it starts with our own healing—you really do have to first put on your own oxygen mask. This step is crucial, and it’s why I dedicated the first chapter of my book Revitalized: a Guidebook to Following Your Healing Heartline to how I healed my own hyperfunctioning. 

Reframe: from Independent to Interdependent. Spoiler alert: therapy was critical for me to recover from childhood traumas and let go of the hyperfunctioning I’d learned to cope with stress. I’m grateful the stigma around mental health is changing, but I know it still exists (it did for me). No matter what your previous experiences or assumptions about therapy are, I urge you to (re)consider it for your own healing journey. It’s priceless.

Double loop: Teams

Many teams run on a culture of competition and medicine is no exception. It’s common to hear one doctor share a story about a patient case, only to hear another doctor respond with, “you think that’s bad? I had a way worse one!” We get used to hearing stories as invitations to one-up each other, leading to a cycle of showing off …

Reframe: from Comparison-itis to Connection. What if your colleagues’ story is a bid to connect rather than show off? As described by the Gottmans, a bid is an action motivated by wanting to connect. While the Gottmans are primarily focused on romantic relationships, the “bid” concept applies to professional relationships too. When you hear, “I had a really tough patient/client/meeting today,” can you hear the desire to connect? When we listen to each other with empathy (and shelve our own tendency to follow up with an impressive story) we create space between us for trust and gratitude to grow. 

 Triple loop: Organizations

 There is no way you can work fifty, sixty, eighty hours a week without hyperfunctioning—yet eighty hours is the norm for medical residents. The number of patients doctors are expected to see practically demands it; in other industries deadlines, client demands, or endless meetings have the same effect.

Reframe: from Rewarding Hyperfunctioning to Responsible Rest

With projected staffing shortages across healthcare and an aging population with complex needs, the pressure for healthcare organizations to reward hyperfunctioning is immense. But this is a short-term strategy, and we know it has dire consequences from turnover to burnout. Courageous leadership will require smart decisions about priorities: what are the “glass balls” your organizations can’t drop, versus low-impact efforts that drain your workforce? Rest has long been (mis)understood as the individual’s to manage, and it’s time for organizations to encourage and expect staff to use vacation time, take parental leave, and more. Consider this: what if an employee taking a month off work was viewed as an investment in that individual? This perspective prioritizes the health of each employee, team and yes, the organization itself.

Small gestures have big impacts

When my friend asked how I was doing, we were near coworkers and I didn’t want to open up with an audience. Her follow-up text to check in was kind and caring, exactly the kind of small gesture that has a big impact, creating a sense of community, safety and camaraderie at work. 

Maybe you have good friends like mine at your job, or perhaps you’re surrounded by competitive coworkers, working in an organization that embraces hyperfunctioning. If that’s the case, it’s my hope that this story inspires you to do something a little differently—examine your own coping mechanisms when stress builds, reach out to a coworker who seems off, or advocate for rest-based leave policies at work. For further inspiration, my book Revitalized has you covered.

Follow Your Heartline,

Andrea