Burning Out interview

An interview between director Jérôme le Maire and co-writer Pascal Chabot.

Pascal Chabot : Can you remind us the origin of this film ?

Jérôme le Maire : Arnauld de Battice, the producer of the film, is at the origin of the idea to have us both meet. Arnauld called me and told me there was a book I should read. Your book “Global Burn-Out”. It grabbed me right away because it spoke of a serious subject (which I felt was still going to increase in scale), and in a unique way. In your book, Pascal, you explain very well that burn-out is a disease that mirrors a disorder in our society. It is a civilization pathology, much like neurasthenia or spleen were at other times. I found this approach to burn-out innovative. It grabbed me because I love making movies that talk about man, society, about us!

PC: It is true that you always kept the notions of system, mirror of a society disorder, and civilization pathology in mind. In order to reconstruct the genesis of the project, we could ask ourselves what kind of approach you adopted, since there are a thousand ways to make a film about the issue. I believe that the option most in line with your work was direct cinema...

JLM: Yes. I made an assessment of what had already been done on the subject at the time, when we met in late 2012 early 2013, and found a lot of stories with people telling how they fell into burn-out, and sometimes how they got out of it... That is to say, many testimonies of people who spoke of the past. Yet, I wanted to see how burn-out happens in real time. Like in your book, you make us reflect on the present time: “What is happening in our society?” “How do we get out of the rut?”... I wanted to follow a burning-out process and be there when it happens. Hence the English title "Burning Out". This notion called for direct cinema. It also generated a lot of complications because it is very risky to film a place on fire!

PC: We met a lot of people, experts on the subject (those mentioned in the footnotes of the book), people from organizations and companies. From the start, the question was to know where it is possible to film, what to film, how to make visible what is difficult to see with the naked eye. Or, when it is made visible, if it is not too late.

And you chose the Saint-Louis hospital.

JLM: No, this choice imposed on us, I did not make the choice!

PC: It is true that somehow the hospital came to us since I was invited there to give a lecture on burn-out. I remember a very hot afternoon, a hundred or so health professionals, surgeons, anaesthesiologists, nurses, health-care workers, crowded into an overheated room... In this intense atmosphere, people in white and green coats came in and went out obeying the beeping sound of their pagers, and you were there.

JLM: I remember very well that I chose to stand where I would have placed the camera to film the scene. That is to say, I was in the middle: you were on my right and the doctors listening to you were on my left. And in fact, in front of me was a person who proved to be important for the film: Marie-Christine Becq, an anaesthetist around fifty years old. She invited you because she was impressed by the reading your book. She was really interested in getting you to the hospital to speak about the subject to her colleagues and to her hierarchy! She put herself in the same place as me, in front of me. We formed a square with four corners: the public and Pascal / Marie-Christine and me.

In all the pictures I took, Marie-Christine was present. Sometimes she looks at you, sometimes at me. She seems to be thinking: “I have to find someone to help us get out of the impasse we are in!” I immediately identified this person as a sort of whistle-blower. The characters that do this are beautiful because they give their all, take risks to save the system. I love the people who have this courage, and what’s more, they are very cinematic!

PC: From June 2013 to June 2016, for almost three years, you went to the hospital almost every week. But you did not film right away. We may wonder how you managed to penetrate this environment where few non-doctors get in, how did you talk about your project and got to be accepted?

JLM: Indeed, I spend a long time before taking out my camera. I like to know people well and also for them to know we well, because I often film their intimacy. It takes time to get into a close relationship with someone, especially when there is a camera between people. In addition, here, in surgery, there are a lot of people (about 250) and it is a very complex system. Location scouting therefore took a long time: more than a year, in fact. First of all, I spent time simply introducing myself personally to everyone. I started with the heads of department. Although the subject frightened them a little (“Suffering at work? Burn-out? Here?”), I think they did trust me because I was frank and direct. When I introduced myself, I gave the book “Global Burn-out” and my latest film “Tea or Electricity”. I said: “I want to make a film about this and this is the way I will do it.” They were reassured because I came on my own and told them I would film alone over a year. They understood that I was not there to shoot a TV report and leave. In France, people have respect for artists. When the heads of department opened their doors to me, I could go wherever I wanted. But it was complicated. There are a lot of rules, a lot of procedures. It was not easy to find my way around, and to find my right place. At first, I just took notes on a pad. Then I started taking still pictures. Then I recorded conversations with a Dictaphone. Often I asked a nurse, an executive or healthcare assistant: “Can I follow you for a while?” And I followed this person for an hour. Sometimes we talked, sometimes not. The idea was to have them get used to my presence, and for me to start knowing all the places and what happened there.

So I visited the surgery department regularly for over a year at a rate of three days a week. When I came back to Brussels, I put my papers in order, sorted out my pictures and noted my comments, transcribed my recordings for the purpose of writing the dossier. I also regularly went to consult Doctor Mesters, a psychiatrist who specializes in burn-out (and in the eradication of burn-out in pathogenic places). He helped me to reflect on what I was living and to analyse the situation. Finally, in the department, most people welcomed me wholeheartedly. They were clearly happy that someone was concerned with their problems!

PC: One may say that the Saint-Louis hospital management showed courage and boldness in giving the permission to film.

JLM: Indeed, it was quite audacious. And pretty amazing! Honestly, I was really afraid that we would never get the permits. Actually, it is very difficult for a company or an institution to let someone film the acute problems that the system encounters. In fact, no one wanted to take responsibility for allowing me or preventing me from making this film. So I was taken all around, from a manager to a director, from the hospital to the headquarters of the group (it is a huge company with 100,000 employees). But during this time, I continued scouting and grew closer to the staff. The management dithered. They wanted clarification, guarantees... To reassure them, I specified two things: I had no intention of filming the patients and I wanted to finish the film on a positive note. I sensed the hospital was reassured that I did not emphasize the link between the quality of work conditions and the quality of patient care. As for the positive outcome, the management thought it was a guarantee I was giving them, but in a way, it was a constraint I imposed on them. This forced them to make arrangements to change what was wrong! Incidentally, during the shooting, I went to see the management and said: “You have to do something, it’s not going any better!” So at one point, with my producers, we put the pressure and said: “Now, you have to give us an answer. Can we film or not?” And there, I wonder if they did not think it was too late to stop the project. Many people in the department were waiting to see how the management was going to respond to our authorization request. The management felt it. By accepting that we make a film about this issue, they sent a strong signal to the staff: they recognized that there was a problem, that something was wrong. By allowing the shooting, they accepted that “focus” be made on this existing situation. And that was really audacious! Still it was necessary to try to solve the problem... And that is the story told in the film!

PC: When you explain you made a film about the question of suffering and burn-out in a hospital, people think you filmed patients. But no, patients are absent from your film. It is a choice that must be made clear: you filmed doctors, nurses, surgeons at work... Was it not too difficult for you to get accustomed to this delicate profession, full of haemoglobin? 

JLM: It is true that when I tell the story of my film, people think it is about a hospital treating burn-out cases. And then when I say, “No, the doctors are the ones who are sick”, it casts a chill! I arrived in this hospital by accident, but finally, I think it is the perfect place to talk about these work-related illnesses. It’s really questioning to see a sick doctor. If the doctors are sick, who is going to cure them? Who is going to cure us?

And then it is true that the surgery department is a very special and very impressive environment. As a doctor pointed out to me, it is a violent place. There are people with scalpels, others with syringes filled with poison... In addition, the system in which I entered was also loaded with violence. There was a lot of tension, disputes, quarrels...

But surprisingly, you get accustomed. You get accustomed to the sight of blood, and you also get accustomed to a difficult environment. And this is the tragedy: the human being adapts. People no longer see the discomfort in which they are immersed daily. It is very tiring, and even leads to break down.

Of all the time I spent in the surgery department, I have no bad or horrific memories of operations, and yet, some were pretty terrible. On the other hand, I still feel the discomfort and tension that reigned there. 

PC: You told me that when you were young, you wanted to be a surgeon. It might not be a coincidence that you entered a surgical ward.

JLM: Yes, psychoanalytically it is interesting… Each film unveils hidden subjects for the director. No doubt I was coming to terms with my childhood desires or ambitions.

It is true that when I began scouting at the Saint-Louis hospital, I went out of curiosity more than anything else (do not tell my producer!) That’s what I love in my job: I can go wherever I want and observe anyone, anywhere, because I always have this wonderful excuse that I am doing research on a film! And for sure, I was fascinated by life in the surgical ward. I could not believe I was able to go to the hospital, put on pyjamas, consult the operating room schedule, and go see the operation that interested me. I was fulfilling a childhood dream! On the other hand, I was very touched when I saw surgeons (those whom I had “wanted to be”) bend their back and say that they no longer liked their profession. I was chilled to hear that. It was a shock!

PC: It is a film about suffering at work but above all, it is a film about dignity at work. And it has often been said that burn-out occurs only when there is a great investment, only when there is passion, desire to surpass oneself, perfection, excellence.

What is striking in what you have seen and shown is the love of work that comes through for each of the characters.

JLM: Yes, it’s very strong. What is extremely poignant is to see these people coming to lose the love of their work. When some characters tell me that they no longer want to work, it is downright surprising. We really do not expect a doctor to say that. A surgeon! Because a hospital, a surgical ward, is a place that in essence must (or should?) reflect the love of work, the love of serving people. They are not talking about saving people, but about serving people.

Can we imagine what it means having doctors not wanting to help people? Some of these doctors and nurses cannot take it anymore. They have no more fuel to drive their engines. They are empty because this system in which they evolve no longer gives them anything. In our society, hospital has become pathogenic. It’s catastrophic.

“Burning out” is a film about the love of work but sadly too, about the loss of that love.

PC: You were fortunate to arrive at a time when management commissioned an audit on the quality of life at work and quality of work. This audit is important in the film and at the same time, without revealing everything, it is clear that this audit is not in itself a solution, since it contains no major proposals for the future. What did you think of this audit?

JLM: First, I’m not sure it was a coincidence. It did not come out of the blue and arrive anywhere. The art of direct cinema is choosing to be where something is going to happen. It requires patience, qualities of observation, but also a bit of persuasiveness. To put it clearly, it so happens that the management commissioned the audit at the same time as it granted me the authorization to film. For me, it is beyond doubt that management has killed two birds with one stone. I do not say this as a reproach or to be cynical. The management figured: “We have a double problem: First, the surgery department caught on fire; and, second, a director wants to film there. What to we do in these circumstances?” Of course, they could have said: “There is no fire, and you're going to film somewhere else!” But that would not have been very clever. They chose to say: “Let’s fix the problem, move forward a step. Ok, you make a film, and we commission an audit on the issue.”

In itself, this manoeuvre suited everyone. They solved two problems at once, because the people in the department were happy that the problem was finally acknowledged, and I had a beautiful scenario in perspective: will the audit improve the quality of life at work?

The problem with this kind of audit is that since it is expensive (around 100,000 euros), results are required. And, I believe that reflecting on the quality of work is not an exact science. It does not give tangible, concrete results. So the specialists fall back on what they know best: figures, graphs, tables. We therefore return inexorably to productivity, performance, optimization...

Actually, before the audit started, I met the head of the auditor’s office who expressed his concerns of appearing in the film as the bad guy. I told him I did not understand his fear because the call for tenders mentioned “quality of life at work” which would make him look rather as a hero. He answered that this was written on all missions. It’s like “green-washing”: it all comes down to the quality of life at work. But he knew his real (tangible) goals were performance and optimization. How to practice more operations per day? How to reduce the time between patients? How to increase the usage rate of operation rooms?...

PC: So you decided to play the card of a suggestion box, a metaphor for participatory democracy, against an external audit with patented methods. This box is really central and represents a place where social links are rebuilt, right?

JLM: I did not invent the box! Let’s say I saw it and focused on it. You know, I was in the department for two years already. Almost a year filming, and people were not getting by. I had filmed the lassitude, the exhaustion, the quarrels, then the arrival of the audit, and finally the disappointment that the audit neglected the quality of life at work... At that time, I was in the process of looking for an ending. Because, ultimately, I am telling a story. It has always been clear to me I wanted to end the film with hope. Not a happy ending, but an opening, a prospect, if only to make these people I filmed - who had become friends for some - feel better! Well, truly, I hoped that the problem would be solved, or at least in the process of being solved. But that really was not the case. And worse, there was a movement of discouragement, of letting things go. I was a little depressed, too. And then one day, while I was filming an umpteenth meeting where everyone was repeating the same things, I heard this idea of a suggestion box. I felt something could come out of this. I said to myself: “Well, that's interesting. A movement, life. A simple, but human thing!”

So I focused on that box because I felt people were connecting. And that was new. And then, another novelty, the staff was reinvesting the workplace! I thought it was a strong sign.

Of course, the box will not save the hospital, the hospital group, the public service, the city of Paris or Europe... I think it is simply a symbol, a metaphor of participatory democracy that is very much in the spirit of the times. A few hundred meters from the place I was filming, Place de la République, began the movement of the Nuits Debouts (Nights Standing). I think it pertains to the same thing. Reclaim the public space (or workplace) and connect with others. Because burn-out, let’s not forget, is a relational disease!

 

PC: For three years, you followed closely the organization of work. If you had to give advice to a management to avoid this kind of problem, what idea would you come up with?

JLM: It’s funny, the new director of the Saint-Louis hospital asked me the same question a few days ago in his office! Well, I’m not a specialist, but it’s true that when you look at a phenomenon carefully for a while, some things become obvious. The first advice I would give is to work on the follow-up process. You know, over the time I stayed to make my film, I saw a high rate of turnover in the management and in all the administrative positions, which seemed to me a little worrying. To give you an idea, I arrived at the hospital before the group’s CEO took office, and for several months, there has been a rumour that she should leave soon. This means I would have stayed longer than her! I imagine the transition will be ensured, but even so, each change is a disruption. Today, short-term vision has become the norm. To give an example, in the film, the director describes the 6 months long audit as “medium-term”. If the medium term is six months, the short term is what? One week? And the long term is one year and a half?

In my opinion, the kind of problem the hospital was facing concerning the quality of life at work (curing systemic burn-out), could take years to be solved.

PC: I would like to raise one point: your presence as a director greatly influences the processes that take place before your eyes. There is one part of the interaction between you and the reality you film you might control, and another that you probably do not control entirely. How do you experience this interaction?

JLM: I prepare this interaction long ahead. When I arrived at the Saint-Louis hospital, I was really well informed. You summarized for me many books you read to write “Global Burn-out” and you made me read others. You enabled me to meet people who made me meet other people. For example, I followed Professor Mesters, a Belgian psychiatrist and the founder of the European Institute of Intervention and Research on burn-out. This man is kind of a “burn-out buster”, who goes into big corporations and tries to eradicate burn-out from systems. I followed his work with his team for over six months. They trusted me, let me into their operations, let me understand how they worked, see their tools and experience them. Professor Mesters gave me a private course on systems engineering and made me do exercises. Moreover, during the shooting, I consulted him regularly to have him help me decipher what was happening and what I was living, but also to understand what was my position in the events that were playing out.

I also attended management courses at the Solvay Business School, other courses on stress at the faculty of psychology. I attended symposiums on suffering at work, on management difficulties... I also followed for six months a person suffering from burn-out. We met once a week and she told me what she had experienced, how she felt, how she looked to the future.

The conscience that I am going to modify the system in which I enter with my camera obliges me to know precisely where I go and what I do. The days are over when anthropologists made themselves very small and pretended to observe a reality without changing the environment. It’s the same when you make a movie. How could we pretend that we do not influence the people we film? For me, it’s obvious. And it would be dangerous or irresponsible to believe this. So, as a director, I accept that I will change things by filming them. And I go even further in this film since the influence that everyone can have on a system is in fact the subject of the film. “Burning Out, At the Heart of the Hospital” is a film about participatory democracy. If we hope that the system will move on its own, that politicians or leaders will change things, we can wait a long time. If we believe that because we vote once every 4 or 5 years, our leaders will get us out of the rut, we are naive! On the other hand, we need to regain confidence in our ability to change the system ourselves. If we want to see change, we must look within our reach. If I make a change, the whole system moves a bit. This means that I have decided to do this rather than that, and my action can be taken as an example!

This is what happened during the shooting: since I wanted a change to occur, and believe me, I wanted these people to regain their splendour and love for their beautiful craft, I felt I had my card to play too. I could influence things in my own way. I had a role in this story, and I played it.

PC: This interaction with a subject that takes place in a closed environment is obviously a guiding principle in your approach. You shoot in a single location where you intervene by asking questions that already influence the answers you will receive. At times, you are even quite interventionist in your research.

JLM: Yes, it is a leitmotiv in my films. It is probably also a question of temperament. I feel good behind closed doors because I sense I have better control over things. I do not want to make things move without knowing where there are going. In a closed environment, I know the situation perfectly and the people who are part of it know me very well. I realize that I often take great risks when I film people because I know I will have an influence on them, on their lives. It is a responsibility to draw a portrait of someone or someplace when crucial things are happening. I do not take this lightly. In my film “Where is love in the palm grove?”, I know that I pushed Mansour towards marriage. I tickled him with his love stories. In “Tea or Electricity”, I stirred up the village’s claims against the commune. And in this film, I realize that I prodded Marie-Christine into action. She felt she had to take action and that I was waiting for something to happen. And I know that consequently she took more risks. So, from the moment we are in a closed environment where I play a part, I have legitimacy. I am with them inside; I do not film through the window, but I belong to the group. When you are part of it, you can control your influence better.

PC: And regarding your approach as director, would you see yourself, in the future, return to places like this? Or even in fifteen years?

JLM: No way, I will never again be locked up in a place on fire (laughter). No, but seriously, the making of this film was really difficult... It was distressing.

PC: Painful?

JLM: Very painful. I really had to dig deep. As a matter of fact, it is probably not a coincidence that my next film will happen between the mountain and the desert! I believe that after this intense experience in the surgery department, I need to take off. There was a time when I was even scared for myself. It is no coincidence that one speaks of epidemic as burn-out is concerned. It is true that stress is something very contagious. When making this film, I learned about vicarious trauma. It is when you find yourself in the aura of someone who suffers and are touched by his suffering, by his pain. This is what police officers, social workers, and doctors experience! As I read in an article: “Listening always has an impact on the listener”. But what was my position? All day long, for months, I had people confiding in me, telling me that they could no longer cope, sharing with me their exhaustion, confessing their doubts and their anxieties. I was clearly in the aura of pain and I felt it. Fortunately, I had people around supporting me: Professor Mesters who helped me analyse my position in the system, my shrink (whom I do not only see for this film, but go to regularly, as you would bring your car to the garage for minor repairs), and of course my family. And you, Pascal, looking over my shoulder, and our producers, Arnaud de Battice and Isabelle Truc. It was really important to have people I could see to talk about what I was going through.

PC: OK, so, all the best to “Burning out, In the Heart of the Hospital” and let’s hope, above all, that the film will have a positive impact and raise awareness of the vital importance of human ties that make the nobility of work and without which management is pointless.

JLM: I just wanted to add one small thing. When you were talking about the advice I would give the management… The film is an invitation to listen to people who are specialists in their field of work, and are also specialists when it comes to their problems. This is really important because we are in a society where we do not listen anymore. All day long, we exchange emails that we hardly read anymore. We do not listen to questions anymore; our answers miss the point. There is a huge communication problem even though we are at the beginning of the digital age. Listening to people is the basis. It is fundamental.

PC: There is much to learn from the people who have endured these ordeals. In terms of advice, they can provide a wealth of information. Perhaps, one should propose that, for a while the suffering workers take fictitiously leadership, to see what solutions they would have to propose if they were part of the management. It is a double reality test, for them and for the organization. The workers realize that some things are difficult to change; the organization realizes that it has not made all the possible changes.

JLM: I have a question for you, Pascal. How do you feel when you see, after all this time, your book changed and transformed to become a film? We have, on one side, a succession of pages, on the other a succession of images. How does it make you feel?

PC: I am quite happy to see that the book did not go unheeded and that it had this kind of destiny. I am delighted that you took hold of it. As for this transformation, it is challenging and rather intriguing. We go from one order to another: in philosophy, we are in the order of conceptual analysis, which tries to report on the causes of the problem by way of language and which ultimately cannot help being somewhat prescriptive in relation to the behaviours to be avoided; in the cinema, we are in the order of the image whose logic is very different.

You show, without necessarily analysing, but by putting action, affect and emotion at the centre. Things become sensitive. You master the strength of cinematic language very well. You wanted this language of the image to remain pure, in the sense that the image was never to be the commentary of a thought, but had to be self-sufficient and exude thought without being illustrative. The documentary genre, when successful, allows this. There has been much discussion, sometimes tension in trying to make these two orders meet. But we got there, I think.

I never wanted to be interventionist in this process. Right from the start, I chose a biological metaphor (already!) comparing our project to a cell. This cell was first a book cell. It was dedifferentiated. It became totipotent, that is to say it could follow a new destiny in all sorts of different contexts. You chose to redifferentiate it in the heart of the hospital... From then on, the logic of a new creative process had to take precedence over my initial intentions in the book. And that is what happened. Films that only seek to clone a book are neither good movies, nor “former good books”.

But what amazed me most is that cinema actually depends on a lot of discussions, piles of dossiers, negotiations about changes in the film that commissions and broadcasters sometimes ask for, and also largely finance... The producers were great, we owe them a lot. But without financing, it is very difficult. Compared to all this machinery, writing is a much more relaxed work. Almost ultra simple. It is true that the author is more alone, but he goes where he wants, and for little money.

As I see it, I think our two approaches are complementary, while being very distinctive. What matters in the end is that we fight for the same things. 

JLM: Another question. If I am not mistaken you wrote this book in 2012. 

PC: Yes.

JLM: This film was finished in 2016, or even 2017 since we are almost there. Do you think the word burn-out and the concept of burn-out have changed between the time you wrote the book and the moment we talk about it today? 

PC: It is true that the media coverage of the term has had an impact, which is not a bad thing because in many organizations there was almost a code of silence about people who felt bad at work or isolated in their confrontation with a management, at times violent. This media coverage has shed some light on the problem. The questions have therefore also evolved. We went from the question “what is burn-out” to the current questions: “how to get out of it?” “What can be done to, not only fight, but move this system towards something more viable?” And this is a question we keep asking in our present day world. Just as we discover human exhaustion in this civilization pathology, we witness on our planet the exhaustion of biodiversity, resources and solidarities. Here too, we try to invent viable futures. Personally I turned to the idea of transition after the burn-out issue because I think this is where the invention of the future happens today. In any case, it is necessary to rethink the relation of the individual to the system, so that they both benefit from their interactions.


Interview taken from official Burning Out website.

 

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Burning Out - Moving Docs

Burning Out is literally a drama about life and death. For two years, the Belgian director Jérôme le Maire followed the members of a surgical unit in one of the biggest hospitals in Paris.