In my early career I never thought about rest. As a student Occupational Therapist, I learnt to divide occupations, or activities of daily living (ADL’s) into four main domains; Domestic, Personal or self-care, Productive (mainly employed or paid roles) and Leisure. 

Now, I completed most of my practice placements in and around my home shire in the central belt of Scotland. Never once did Ina or John every understand what leisure was when a naive student occupational therapist asked how they occupy their time. Ina and John were more interested in how they were going to get to the Co-Op down the road for their morning paper and milk with their new zimmer frame; or protesting the idea of a handrail in their bathroom as another reminder of their advancing years and depleting capabilities. The system, and society fed into this perception of themselves too, though not so much back then as it does now. 

Permissions when considering those we are in service of.

If I had to ask Ina and John “how do you relax?” I guarantee they would firstly ask “what do you mean, relax?” After clarifying “doing nothing, switching off, resting” I am sure they would have said something like “Hen that’s all I do now!” As with most of my patients in elderly care, they would spend the day in front of a TV, never moving much from the chair; Ina and John would clock watch awaiting the next carer visit for much needed contact with a real person. The world no longer asks anything of them, something I am sure we have all wished for at points in our lives, and when it does give us a moments rest- its unfamiliar and uncomfortable. 

At what age or stage in life do we remove the Permission To Be Active from our patients, our parents, or even ourselves? Why do we only receive the Permission To Rest when we have passed through some invisible threshold, we have no idea we passed through until those around us start to treat us differently? Is it possible to give ourselves and others the Permission To Be Active and the Permission To Rest across the life span? Do we only get to trade one for the other? 

A little about the Permission Wheel

The Permission Wheel of Gysa Jaoui (1980) is a positive offering to counteract the limiting beliefs we have developed about ourselves, others and the world. The model has been further developed by a number of Transactional Analysts since the 80’s, most recently by Sean Henn (2022) who includes Permission To Be Nature. 

In the context of working within Health and Social care and academia for many years I am becoming aware of the Permission To Be Active and the Permission To Rest, with our capacity to access them being contextually bound (for the Transactional Analysts peeps out there- how these relate to the Permission Wheel from a theoretical perspective is for another day). I see Permission To Be Active and Permission To Rest as opposite ends of a continuum.  To only have Permission To Be Active leads to burn out, to only have Permission To Rest leads to stagnation – both having the potential to support health and to thrive in our roles and activities. They can also result in death if balance between them is not accounted for. Death of a role, an identity or life. Worst of all, like Ina and John- to be dehumanised- to only be seen as one dimensional, to not be seen - to be dead whilst still alive. 

Back to the story…

Permissions when considering ourselves

As practitioners working with Ina and John, we are also at risk of being perceived as, or perceiving ourselves as one dimensional. Do we have sufficient capacity To Trust in others and the world- that if we choose for a while, To Rest- we will not be forgotten about, we will not cease To Exist, that others will not cope without us?

For some of us the capacity To Rest may be related to how much permission we have To Be Important, To Succeed, To Exist or To Be Healthy. For others it might be a need for greater Permission To Feel your feelings of Anger, or Fear, Permission To Adapt. For me, after experiencing burnout, I knew I needed to work on Permission To Have Needs.

Just as we were emerging from the end of the Pandemic- in the final lockdown phase, my dad died after four years of living with Leukaemia. And he did live a full life until the very moment he closed his eyes at home, supported by a fantastic NHS service. From the phone call from my dad to tell me about his diagnosis, to the attempt at chemotherapy- the impact of which frightened my family watching him go through that, to sitting in the consultants room with my parents whilst we were told to focus on quality of life rather than years of life; I knew what was coming, I knew how he was going to look and feel and how the family was going to respond to this; I had been the NHS practitioner supporting families and their loved one through this many times. 

I stayed in my Occupational Therapy role, I clung to it until after the funeral was planned, after I gave a eulogy, after I had travelled the three-hour journey repeatedly from where I lived at the time to be with my mum, after a two week break from work, after going back into long hours of online university teaching and planning during the pandemic, until I broke. Autopilot no longer worked. 

I had discounted my own needs prioritising what (I thought) my family needed, what my students needed, and what my team needed. I didn’t stop for fear of what it might do to others. That my mum might feel she couldn’t lean on me if I was unable to keep going- to remain active, if I took time out- to rest, what would this do to my teammates who would have to pick up the extra work? In the end my body took over from my head.

I remember the moment, coming off a morning check in call with my very close teaching team led by a wonderful boss, I could not think. I couldn’t figure out what the next thing was I needed to do. I became aware of every atom of my being vibrating, unable to rest anymore I had to keep physically moving. In the first few weeks of sick leave, I couldn’t rest- I had to keep moving, keep walking, for miles and miles, until eventually my body figured out how to relax.

Burnout for me came months after my dad had died, it was laced with grief, it was triggered by grief, but it was not caused by grief. With the distance of time, I can confidently say this. At the time, it was easy to put it all down to grief, and it was safer too. It was safer to say it was all on me, that work expectations had nothing to do with it. 

As with everything, the circumstances leading up to and triggering burnout are complex. For me, I lacked the capacity to identify my own needs not only in grieving my dad, but in general; to account for my needs whilst also acknowledging the needs of others; and the system I worked within was floundering under very difficult circumstances during the pandemic to recognise and meet the needs of staff, uphold their usual high standards of educational delivery and care for students. 

Our health and care system and our educational institutions are predominantly staffed by women, Strong Women. Strong Women who have probably been surrounded by examples of Strong Women most of their lives. Strong Women who only know how to put the needs of others before their own- who even believe they must not have needs- or their children will come to harm, their patients or clients will get a less than perfect service, their colleagues will be burdened by an ineffective teammate. We may see ourselves as one dimensional- as someone who cares for others and not recognising that we are also someone to be cared for. 

Next Steps

To see yourself as a thinking, feeling, doing human being with needs I invite you to notice. 

Notice each time you are doing something for others, each time you are doing something for yourself. Notice when you are active (mentally, physically and emotionally) and notice when you are at rest- when you are not activated to be more than simply existing, simply taking up space in this world. 

Some questions to reflect on-

1. What permissions on the Permission Wheel (above) do you most recognise in yourself, and which are less accessible to you?
2. Where do you spend most of your time on the To Be Active – To Rest continuum (Above)?
3. How does your levels of permissions on the Permission Wheel relate to your capacity To Be Active in support of your health and wellbeing, and your capacity To Rest in support of your health and wellbeing?

To further understand what is impacting your own capacity To Be Active and To Rest explore the Personal World page for small group programmes where you can learn more. 

Posted 07.03.25