Recognize your burnout

Symptoms
You can think for yourself that (maybe) you've gotten burnout if you can perceive in your own functioning a.o. the following:

Exceeded self-criticism:
You think about yourself that you can't do no good anymore, everything goes wrong, whatever you do tomorrow will also be doubtful.

Inactivity:
You do far less then before, wherever before you would step forward you now prefer to stay in the background.

Withdrawal:
You always loved to move around the people and you had friends. These days you hardly see any people anymore and you don't look for your friends anymore.

Moodswings:
Everything looks bleak and you have no more fun. Sometimes, all of a sudden you feel sad.

Undecided:
You don't know where to go, in your idea you accomplish nothing anymore.

Not exactly a nice list.
If you overlook this, you would say there is a depression hanging on. And yes, rightly so, because being depressed and being burnout are often confused, just because the symptoms are so similar. There is a major difference though. Depression is an involuntarily condition, something which can just happen to anybody, often having to do with small biochemical flaws. Being burnout though comes direct from the life you led so far, you did it to yourself (not by purpose, of course). Knowing this gives an advantage: you can influence this back, you can arm yourself against it psychologically. The cognitive therapy, mentioned before, offers all the necessary tools.

Resuming:
Getting burnout: okay, this can happen to the best of man.. But: throwing your towel in the ring: no option, don't do it, the problem can surely be solved. Consult your medic, look for a proper therapist and start getting things back on the right track again.

Check if it's true

Everyone is entitled to a favorite mistake.
It just goes to say: everyone has his own special suppositions about the outside world. For many of these thoughts you may safely assume that they are somewhat true. "My mother loves me" for example is a very safe thought, it will always be true in one form or another. But your ideas about your social environment are not necessarily so true. For myself: I am married to a real black african woman. and in Holland I always suppose that nobody is bothered anyway with that. Comes a time, a couple of weeks ago that, after entering a lunchroom, we were very obviously neglected. After some 15 minutes we left the joint, slightly hungry but very indignified. You suppose racial discrimination is no more of your country just to discover that it is still there. The mistake in my thinking so was: with an african woman you can go everywhere in this country. If you find out it is not true, it hits you pretty hard.

Prove for yourself if it is true what you suppose
Now this is one of the major turning keys in the treatment of burnout. Take the liberty to check with your chief and your colleagues if they also find it as important and necessary that you put in two hours overtime every evening. You should realize that the answer might very well be reassuring. But, what you don't ask, will not be answered. If you are a married, working woman, is it still necessary that you serve dinner for your husband at exactly 18:00 or.... Well, I can go on much longer but I think you can see my point. We load our lives up with all kinds of habits that may trouble us sooner or later and which we then forget to check for their real necessity. Leave these patterns to grow and prosper, both at home and at your work and you make your life more difficult then necessasry, possibly funding a serious burnout. However, if you don't take all kinds of things for granted, you will see that inprovement of your life is easily obtainable.

What will people think?

Is somebody else's opinion worth much to you?
Now here is a well-known energy-consumer. You can consider getting burnout as having spent (too) much energy without getting anything back. Having yourself steered in all your actions by whatever you suppose others are thinking about you (don't be surprised, it all happens), now that consumes energy. My wife for example will always give the room a quick vacuum-job when we're expecting visitors, always out on making a good impression, even with the biggest barbarians. Now, this of course doesn't matter much, but when on the job you always act after (unproven) impressions of what you think your chief or colleagues think of your performance, than maybe the danger is there for you doing way too much. So think twice: is your energy then well spent or not?

Stand up for yourself!
It is still amazing to see how often people let themselves be guided by unproven assumptions and, even stranger, how they never ever come down to checking the reality of it. A proper self-investigation can lead to asking the right questions to yourself and your environment. Cognitive therapy is the instrument that can provoke getting these kind of questions on the table and getting them answered as well. No wonder that in almost every suggested treatment of burnout this is the leading technique.

Something for the boss

Mismatches
Last week I wrote that an effective treatment of burnout will always be multi-faceted, every angle should be approached. What we didn't consider then was that often there can be a serious mismatch between someone's personal style and job-expectations and the (implicit) expectations that the working environment has about the colleague/employee. If becomimg burnout has a relation with having to function in a large-scale organisation, then this also deserves attention in treatment.

6 different sources
Christina Maslach stated it quite right in het book "The truth about burnout". She describes a process as follows:
A high workload is almost always the starting point in getting burnout. Everybody is always busy and modern management, prompted by budget considerations, is always pressuring employees to do more in the same amount of hours.
This easily leads to a situation where emplyees come to think that they lost grip on their work. Next step may well be that you start to think that you are quite badly paid for all your efforts and the troubles your boss throws in with you for free. Once you are going down on this way of thinking you can easily jump to the conclusion that you are working in an extremely unfair system. Large-scale organisations are characterised by a fierce internal competition. You can easily feel all alone in a serious competition where your colleagues don't mean well with you at all. In the end you see ever more differences between what you stand for in your own work and what you perceive the organisation is targeting for.

Subjective? Objective? And what to do next?
Now the process, described as it unfolds, is of course a highly subjective one, it is all part of somebody's unique individual experience. Still, if emplyees go through such an intra-psychic process, there must be another, more objective and job-related reality behind it. A good therapist should always be alert on these phenomena and will have to find a way to exert some influence here. Usually this should be found by connecting with the human resources department of the company under consideration.

What would be an effective treatment?

A feassible approach
Now, is burnout something which is to be treated easily or not? At least a great number of approaches have been described so far. You can easily imagine that there will be a winning approach just for you. Just to name the most common: psycho-education, relaxation-training, stressmanagement, cognitive therapy, lifestyle-improvement, assertivity-training, social skills-training and selfhelp- or peergroups. Now these approaches are not all in the same line and are not readily to be compared to each other. If the original analysis is completed client and therapist together may decide which approach might be the most useful, given the particular situation. And then still: a skilled therapist will probably not want to work with just one approach, he will strive to offer a mixture to size. The most usual mix here will contain a cognitive approach (you examine together if everything you think about your situation, is realistic), there will be some attention for learning how to relax and the client's general lifestyle will be examined.

Effectivity
There is quite some research going on as to how effective all these various approaches are. Whereas burnout is such a young, but nevertheless very serious social and mental problem, we will not see the end of this research shortly. If you are a client yourself, you can easily check for yourself whether you are in good hands by looking at the chosen approach. If it is not one-sided but goes into several aspects of your problem, you can safely suppose that something good will come out of it.

A nice exercise

The miracle question
The here following small mental exercise is a good example of how you can actively handle your burnout.
Imagine a situation as follows. You are in bed, sound asleep. That night you are visited by an angel. The next morning you wake up and all your problems have disappeared. like snow melting in the sunlight. You feel fit and well-rested, life smiles at you and you feel like going back to work. The question you have to ask yourself then is: What exactly has been changed that makes things so much better and easier? If then you do correct thinking you will find a number of things that you will be doing different or that you approach from another angle. It is recommended to repeat this exercise a number of times, most probably you won't be completely aware of everything that counts the first time ever you make this "drill".

A fine example
In my practice of course I also sometimes use such techniques. One of my clients had become quite seriously burnout. In his case it wasn't particularly his workload but rather all the things he demanded of himself. I got to know him as a highly active man who could bring up a constant stream of new ideas and who also spent much time and effort in developing these ideas. Now of course not everything ended succesfull and coming a certain time, burnout hit him. After a couple of weeks of treatment and analyzing his situation thoroughly he was able to go to work with the miracle question.
Fortunately my client very quickly brought the insight that he should handle the products of his fertile mind in a different, less impulsive way. Stopping his flow of ideas wasn't necessary, but doing a quick check with colleagues and giving yourself another day to think things over, that was certainly possible. Acting after just this particular insight became an important factor in his recoveryprocess.

Burnout increasing

More professions affected
The last 15 years or so, we notice a shift in the prevalence of burnout. Whereas before they were the classic servicing professions that got affected, we now see in almost any major organisation that also staff with an administrative or technical job can become burnout. The question of course rises what would cause this?

The world becomes smaller, the competion enlarges
With the rise of globalization and the explosive growth of informationtechnology, we see that companies find themselves surrounded by an ever growing competition. Many companies react with classic responses: they try to lower the costs and to increase the productivity rate of each staff member. Now especially here companies can go about quite bluntly. They demand more product, more results by the single employee, without investing much in additional methods, tools or systems that can actually help to make this possible at all. Almost every employee of a major company worldwide can tell the tale that more is expected of him than 20 years ago. To cut a long story short: the pressure of work has increased dramatically all over. That ever more employees lose track and become burnout is therefore no surprise at all.

A change of quality
Next to the rising pressure, we also see that interhuman relations and processes have gained in importance on the work floor. Many companies these days use the phrase "internal" client. This means actually that there is another department waiting for your results, to deliver themselves in time. If you define the internal relations in a company like that, you should realise in advance that you place your employees in a permanent process of negotiation. From there on we come back seamlessly to the beginning of the story: it is the relationship with others, next to a high workload, being both the causing and maintaining factor in burnout. Companies and institutions should have much more attention for these phenomena than is actually given these days.

Who is vulnerable?

Professionals & clients
Becoming burnout absolutely has a relation with having a personal contact with others. This personal contact will often involve a relationship of dependency. The "other" wants something from the "professional", whether this professional is a lawyer, a residential worker, a nurse or a social worker. The professional hears the call and goes to work to satisfy the "client". So far, so good, the laws of question & demand should do their work.

Making effort
Now the inter-human relations are not as simple as you might innocently think. Each client is different and should be treated accordingly and nobody can be neglected. And, don't forget, just the amount of effort you put in for your clients will show to yourself, to your colleagues, your client's family, the clients themselves and maybe your employer, just what an excellent ...(lawyer etc.) you are. The harder though you try under these perspectives, the bigger your emotional involvement. The client communicates a certain need or shortage and the professional responds. Whether he succeeds in answering the question or not, at the next appointment the professional will try his very best to show that he did everything possible. A vicious circle of unanswerable questions (client) and wasted energy (professional) can evolve very easily. We don't have to mention the eventual consequences for the psychic condition of the professional.

Vulnerable professions
Now this spending of mental energy and the communicative pattern behind it, of couse surfaces more in certain professions. Just to mention: nurses, residential workers, social workers, priests, lawyers, teachers and (sigh!) psychologists. Remarkably absent here are the medical doctors, in my experience they hardly ever become burnout. Their professional code forces them to always carry on and their training is apparently much better focused in evading the pitfall of a massive emotional involvement.

Maslach and more

MBI
Before I mentioned the MBI, the Maslach Burnout Inventory, the most generally recognized instrument to measure the prevalence of a state of burnout. Basically it is a list of not even 30 questions that point out three subjects or dimensions, together making up the burnout-syndrome.

Emotional exhaustion
This concerns the feeling of being completely empty because of working with others. Where we already saw that burnout is originally described as being related to the care-taking professions, this is still the most reputed part of being burnout.

Depersonalisation
You have developed a cynical and distant attitude towards the people you work for and with. Your belief in the other has gone out of the window and you don't expect it to come back soon.

Decreasing personal competency
You doubt your own competencies, you think you lost all of your original skills and you doubt if you can still face your patients etc. properly.

Engagement and more
Now the remarkable thing in this summing-up is that there is no more mention of engagement while originally that looked like the defining concept in the whole story. An overflow of engagement is considered the regular first cause of becoming burnout. Now this is mainly stuff for those scientific researchers who cook up all these psychological instruments in the first place, I won't go into further details here. It is also worth noting that the MBI is regarded as the best instrument but still these days there are researchers who point out that the essence of burnout is the particular combination of exhaustion and emotional distancing. Burnout so would not be composed of three, but only of two parts or dimensions. The essence of burnout then would be a lack of power to act, combined with a lack of motivation. We would be thinking then of an energetic and a motivational aspect, basically simplifying the idea of treatment.

Engagement, curse or blessing?

Emotionally demanding work
A well-known factor in the building-up towards a burnout. Some professions, like teaching or nursing, apparently demand a more than average engagement with the pupils, patients etc. But we can also postulate that those professions even provoke that engagement. Within the occupational group the story goes that without just that engagement you can never qualify as a "good" teacher, nurse etc. The social perspectives under which you function then are very present, very implicit, very un-outspoken and even dressed up with a certain morality. Young professionals will easily follow this implicit ideal. When you are young, you can live up to it for some time. But, just face it: giving, giving, giving without ever getting something back, how do you make it?

The so-called professional attitude
So you can get stuck in your work. To make matters worse, the last 10 or 20 years we are bullshitted into believing that we should behave like a "real" professional. Now this "real" professional is just as fake as the mandatory engagement that you have to show on order. The implicit assumption behind this professional is that you are able to completely exhaust yourself day in day out for your pupils, patients etc. After preferably putting in some overtime you close the door behind you and are able to throw away all your worries, mixed emotions and concerns instantly.

Dilemmas
Unfortunately, there is no school or education in this world that teaches us how to do it, this closing off your emotions at will. So if you keep on doing what you always did, without ever getting aware of those implicit paradoxes, you can easily get burnout, simply because you can't distinguish a way out.

How do we solve this riddle?
What of course should happen is that you get aware of the position you are in. If you can tell yourself that you are guided by implicit and unlabeled assumptions, instead of the clauses from your labor-contract, you have already come a long way. You will probably not be able to do this on your own, it needs a lot of talking to your colleagues going through the same processes. It is also the moment that some counseling could be of help. It is by now a well-known fact that it is quite difficult to learn to perceive those implicit laws and to understand how far-reaching these influences can be.

A little bit of history

A young syndrome
The burnout syndrome is quite young for a recognised psychic disease and as yet doesn’t even figure in the DSM-IV, the most official catalogue of mental illness worldwide. Before World War 2 it is not mentioned at all. Then all of a sudden Graham Greene publishes his novel “A Burnt Out Case”, featuring a main character who is completely disillusioned and cynical and ties up his western existence by going into a self-chosen exile.

Freudenberger
In 1969 Freudenberger, a New York psychologist, first tosses the term burnout. He goes on to describe how social workers in the drug-scene deteriorate in no-time from idealist to distant and cynical officials. More than average these officials were plagued by all kinds of minor complaints: headaches, infections, ulcers, sleep disturbances etc. Worth noting is that when he first used the phrase burnout, he got an immediate and strong response. The word was easily recognised for the mental state it described. Freudenberger himself went on to describe a great many cases, always emphasizing here were always strongly committed individuals who had given the best of themselves to their demanding job. Getting a burnout meant at least that you had done your very best and so could even be used as a kind of excuse.

Maslach
Another famous name in the research Christina Maslach, an american psychologist who has devoted much work to measuring and gaining deeper insight the burnout phenomenon. To attain this she developed the Maslach Burnout Inventory, a questionnaire that international now is considered the leading instrument.

Learned helplessness

Animal experiments
In the 70’s, when the idea of burnout first was described, there was an american psychologist, Seligman, who did some experiments with animals, that would be strongly condemned today from an ethical viewpoint. The results did contribute in time a lot to the theory building about the possible cognitive background of burnout. In summary, those experiments went like this:

Learned helplessness
Dogs were locked in a cage and were exposed, in an unpredictable rhytm, to mild electric shocks. Of course they tried escaping frantically but as soon as they learnt the inescapable nature of their situation, their behavior adapted to it. They got apathic, laid themselves on the ground and started moaning. They deteriorated to a condition that we could call acquiescing, apathic, hopeless or even depressive. In a later stage, they did get options to escape by simply jumping a fence, which they never did anymore. Apparently they had learned very thoroughly that, whatever they did, it wouldn’t be of any use. Seligman called this condition “learned helplessness.

Optimistic dogs
Another group of dogs had also been exposed to the shock treatment but had the escaping option right from the beginning. Now these dogs managed to find escapes, all the time they received shocks. Apparently they had learned that initiatives will be rewarded and kept up, so to say, an optimistic attitude.

A clear parallel with burnout
The parallel with becoming burnout won’t escape you. People can, especially in their professional lives, live through a number of situations in which they find, however hard they try, that they cannot improve their situation. Depending on their fixed income they think that they are completely running out of options to organise things differently

Personality?

Insight and evidence is growing that certain personality-traits somehow come together with a heightened risk for burnout.

Perfectionism
is one of them. Just imagine that you think of yourself that you have to be perfect in all your acts and performances for some 110%. Then live up to it. Relalize what is happening to you. Your free time will decline and you will be often disappointed in yourself. Chances are that no-one around you will notice your intentions and efforts. Then imagine that you handle your business like that for twenty years on end. Realize the energy it took from you and think what is has brought back to you (probably hardly anything). Do you feel exhaustion coming up? When in my consulting-room I push this subject a bit further, it often appears there is a different motivation behind it all. Those perfectionists often are very sensitive to

Social perspectives.
Expensive word? Oh yes. I usually explain it by asking: "Would you often look at youtself through the eyes of another?" Or, are you continuously thinking: "What would such and such say of me now?" If indeed that gives a strong motive for your acts, if really your behavior is steered by such considerations, then of course chances are that you go against your own ideas. Chances are also that you are spending your energy not too well. Not to worry for the single occasion, we all do it sometimes. If this however comes down to a lifelong exhausting pattern of behavior, of course it can cost you dearly in the end.

Recognize your burnout!

Of course it helps if you can spot for yourself that you're heading downwards in a way that can eventually lead to a complete burnout. In this process you can go through seven several stages, starting from slight excitement to total desperation. To get a better view, here they come:

1) Symptoms of warning. You couple a great feeling of engagement in your work with the idea that time and again you're not finishing your things proper. You start to notice that you are losing energy or constantly lack sleep.

2) Diminishing engagement, withdrawal. You are getting cynical and less positive, a certain reluctancy creeps in. Your coffeebreaks are getting longer, you start to treasure your weekends ever better. Your idealism is declining.

3) Emotional reactions, others are to blame. Depressive symptoms appear: you lose your sense of humor and pity yourself and you have moodswings. You can get agressive outbursts, others get the blame easily, conflicts prevail.

4) Weakening. Concentration and memory diminish, you lose initiative and creativity and your perceptions get ever more one-sided.

5) Waning. You get ever more indifferent and you avoid social contacts. You give up your hobbies.

6) Psychosomatic reactions. Sleepdisturbances, tense muscles, head- and backaches, nausea, problems with heart or intestines, impotency, more coffee, alcohol, tobacco or drugs etc. etc.

7) Desperation. A completely negative view on life, strong feelings of hopelessness and senselessness, thoughts of suicide.

The message will be clear: don't let it come this far. From experience I found that people either react rather early in the process (stage 1/3) or far too late (stage 6 has commenced). Do you recognize with your self that you may be are living through such a process, don't hesitate and consult your doctor or a social worker.

Keep in touch with the boss!

There you are, sitting at home, feeling bad as you never felt bad before. You feel downright shitty and thinking of your job is just repulsive. Then, next thing you know, you are talking to your medical doctor and he will simply advise you to just pop-in with the company for a small chat and a cup of coffee. You don't even think about it and turn the advice down. A couple of days later, your chief gives you a call and basically repeats the same invitation. Having heard this advice twice you reconsider. Later on in the week you get in the car, drive down your familiar road and find it amazingly empty, outside the rush-hour. You go in and ... well, it doesn't get so bad, though you are happy to leave the building after half an hour, some small talk and two coffees.

Has this recently happened to you? If so, then this is all part of a modern strategy to keep burnout-patients more involved with the job. Evidence is showing that staying somewhat loosely connected with the job during your recoveryproces makes it easier to comeback. The aversive emotional over-reaction that can form itself so easily if you withhold yourself from your working-spot for a longer period time is so easily to avoid.

Stress?

Stress and burnout are two concepts that hold a strong relationship. Anybody who has become seriously burnout will surely have experienced serious and long-term stress in the working environment. The enormous weariness that people sometimes demonstrate during a consult is easily explained as a result of a long-lasting over-effort. But how is it really? Professional cyclists can make fantastic efforts day in, day out and seem to recover amazingly fast all the time. So, men has the ability to recuperate all the time. Then, how come, all of a sudden there is a day that you just can't pull yourself together anymore. Though we know not everything yet, many things have been discovered in recent years.

To really understand what is going on here, we have to travel back in time, to the good old days when our forebears started walking around on two legs on the East-African plains. Not having any instruments yet for either transportation or defence, he had to rely on the own body. At the threat of danger or the necessity for action (a hunt) he must be able to use that body to the full. In professional jargon we call this the so-called fight-or-flight reaction. More precisely stated: the body prepares itself for intense and explosive action. We breathe faster, the heart starts pumping, we start to sweat to cool our body more rapidly. We show all the signs of what we still recognize today as serious excitement. All these fysical reactions are provoked because we start producing in a rapid pace certain hormones, adrenalin and noradrenalin. In East-Africa matters were probably settled promptly and man could switch back to first gear. In our modern society though we have taken to organize matters such that we think our business is stressfull very often, very fast and always longlasting. Whereas we have named the professional situation as vital in our existence, we come upon the "fight-or-flight" reaction there quite easily and quite continuously. Recent research has also shown that an affluent ration of stress-hormones in the body can harm our immunity system. Longlasting stress so leads to a whole array of different minor complaints.

And this now is what I see in my consulting room: People come in with a wide range of different complaints, from headaches and insomnia to ulcers and impotency. By the way, as clients gain insight in the process they're going through and find ways to relax, many of these symptoms disappear gradually in the first one or two months of treatment.

Self-observation

It all matters how you can look at yourself. To overcome a situation of complete burnout it is very necessary to start looking at your own person and all your very own peculiarities. To achieve this, I often encourage my clients to start writing about their condition. My experience has taught me that everybody can perceive and narrate a lot just about him/herself. Whatever you know about yourself is never meaningless, it will always point out something. Now of course you can just start a diary in the blind but it just helps to give it some aim and direction. I often request my clients at the outset of the treatment to write about their energysystem, where is energy spoiled and where is it gained. So, think for yourself where you spoil your power and efforts (probably without getting back any incentive) and where you gain your energy (these will usually be the things that work well with you and that you enjoy.)

For clients who are still working but feel a burnout approaching it is often useful to start keeping a so-called stress-diary. When, where and how did I feel stress coming up, how was I able to react and what did that respons bring me? What did I feel throughout the whole situation? Next step then is, if you have a number of notes like that, to link them together and see if you can make out any meaningful pattern. If so, well, then you know where to start.

And talking about helping yourself: take this to heart, we all know how to write, don't we?

Do you want to overcome your burnout?

Allright, allright, everybody is busy, very busy these days. The days go ever faster, the schedules grow ever fuller and every day you drive home with the idea that your work is even less finished than the day before. To solve this problem you decide to throw in a little overtime. It solves nothing and you start working later and later. The heaps of paper on your desk don't diminish and you find it a good idea to rise early, avoid the morning-traffic and put in extra time in the early hours. Your sleeping gets ever worse, you develop a quick temper and you forget even the simplest things. And then one morning you stop functioning. You can't get out of bed, you feel tired, tired and then again tired and you call the boss, notifying him that you need a break, just to rest. Burnout, overworked, just name it.

A terrible gap!
No end to be seen!
You never felt so bad before!

Your neighbours don't understand what you are doing around the house all of a sudden.
Your chief just wants you back.
Your doctor pulls his most concerned face and advises you to keep in touch with your company.

Have you come to this situation?
Don't you know how to continue?
Do you desperately want a solution?

Well, that solution is there. Just take the time and the rest you need to recover but... use that time and that rest also to fully realize for yourself what you have been doing to yourself and where you have to change as to never reach such a condition again.

Would that be possible?

Why, sure that is possible. Whoever learns the right lessons will pass through a recoveryprocess that in the end will prove to be much more than that. You will find yourself in a process of serious improvement. Overcoming your burnout will eventually bring you to leading a life much more rewarding than before. So it is not only recovery, but there will be a total improvement and readjustment. People who managed to fully overcome their burnout appear to be able to enjoy life better, make better decisions and can generally lead a more relaxed lifestyle