The big three: What is burnout?

How often do you wake up and actually feel excited about your day? That’s how mornings SHOULD be. With burnout, that’s rarely the case however.

Perhaps you’re one of those who say “It’s just a bit much right now”… and you’ve done that for a few years by now, or you’re one of those who say “But it’s SO FUN!” and LOVE everything –  but you’ve actually been home sick from stress BEFORE this, and you still don’t get it? You crash repeatedly and once you do it takes days to recover.

Let’s take a look at all of the big three I tend to – but start out with Burnout. That one, if it’s possible to isolate them, is what I tend to most with my clients, though as I’ve said, they’re rarely there in isolation. In one way or another we usually have to tend to all of them to some degree. So let’s start by getting a foundation about what they are and how they are usually treated before getting further.

The reaction is REALLY individual, both regarding what’s stressful and what happens once it gets stressful. Stress is such a subjective thing – and life is a big bunch of stuff, which is why it’s usually necessary to get an individualized approach to solve the problem. That’s where the coaching comes in really handy. It’s not as easily generalized as some other things.

I’ve touched the subject of those who are “school book examples” earlier; it seems as if stress related health issues are most common in women, 25-40 give or take a few years. They might work in the service industry, schools and healthcare, but also mid-level managers in private businesses. The same level of burden bother men and women equally. Then how come women suffer more… or at least search for help more? Could there be a good-girl syndrome that makes them suffer more since the same burden isn’t really the same? Do they just prefer to seek help, where men find it elsewhere, among friends or in a bottle? I don’t know. If you do, feel free to enlighten me.

It tends to start slowly anyhow… And then progress until you collapse unless you do something about it when the train is rolling. Hopefully you’ll do something about it earlier than at the end of the rope. It’s common to avoid, ignore, neglect or just not see the connection between stress and something else and seek medical attention for something else instead, but the stress is the perpetuating factor. Perhaps for anxiety, memory issues, chest pain, depression or trouble sleeping, headaches, some other sort of physical pain or gastrointestinal troubles. Some just go on and on until they’re done one day and don’t get out of bed. That’s likely the worst case.

Once bothered by this there is no quick-fix to the problem. I’ve noticed that the approach I use seems to be able to do quite remarkable progress for those who do it in just twelve weeks. If people do get far less symptoms and far higher quality of life as well as capacity to tend to life itself – that if anything ought to point to the fact that they might be heading in the right direction towards long term recovery. Some say that “we have no clue what makes these people better over time”. If that’s the case, but tending to life makes those who suffer from it suffer less, I’d say that’s a great treatment. Get going with the resources you’ve got, get a great start and really do make progress in twelve weeks while you learn how to take care of yourself – then you’ll be able to keep doing so from that point forward.

When I’ve spoken to people who’ve tried to get help from healthcare with this they’ve been told a variety of… interesting things, from “You’re not exhausted/burned out/whatever” – though it fits quite perfectly and most of their days are spent in bed, breaking down or just being confused and tired.

Some physicians say “there’s no evidence based treatment for exhaustion syndrome that have shown any better results than any other…” I’m not quite sure what to take from that. It’s irrelevant what you do, you won’t make any progress anyway? Which… I guess, means that there’s no point in trying. The end of the quote is “… More than adapting the workplace, such as having a employer who’s helping out with adjusting the workplace, say welcome back and support the employee. That could make the sick leave shorter. Everything we’ve tried to help patients with when they’ve suffered from exhaustion doesn’t affect the duration of sick leave.” The quote is from a Swedish TV-show mainly with investigative journalism.

I’m not quite sure I agree.

I’d say it requires change. Change and recovery. The lovely thing about biological parts and beings are that they can recover and heal. You likely got in the mess by doing what you “tend to do”. That’ll have to change or you’re in the same place again before you know it. If you tend to slit your wrists and you don’t stop doing that you won’t recover very nicely. Same thing here. Doing the right thing and changing the right things might shorten the rehab-process with several years and might minimize the risk of getting other long term consequences from the long term stress such as ME or fibromyalgia, which seems to be able to come from periods of long term stress.

Nope! We can’t have a stress response all day, no rest in between, repeat in infinity and expect to thrive. That’s modern life bonkers.Man with perspective.

Burnoutoccupational burnoutexhaustion disorder once in a while even chronic fatigue syndrome or exhaustion syndrome where the terms seem to be used quite interchangeably. It is an actual diagnosis in at least some countries where it’s got the code F 43.8A in the ICD-10, where ICD-10 is “The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating authority for health within the United Nations System. The ICD is originally designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases.”

As long as everyone knows what we’re talking about that’s just fine – and the point is that it’s caused by stress without sufficient recovery for a longer duration, generally months, and can make people extremely disabled and totally unrecognizable compared to how they used to be. It seems as if it’s almost exclusively a phenomena of society today – a consequence of the stress of modern life. Where stress have turned into one of the most common reasons for sick leave today with all its long term consequences. But are the usual treatment methods really effective? How are you cared for? Is it working?

If the stress is from work or private life is likely irrelevant, though it’s common to be a combination. It’s far from unheard of with situations where there is no private life and just plenty of work from getting up in the morning – to crashing in the evening. A common finding or risk is when it’s hard to let go of work when tending to private life; a high pressure and plenty of demands from work, along the same thing from yourself and a job where you’ll never really be able to “get completely done” are perfect conditions to get long term stress symptoms.

It might start with just nibbling on some sleep to get a bit more time in a day. Getting a bit forgetful and perhaps “sloppy”. Turns into a more noticeable feeling of being tired, irritated and you start to lack focus. You’ll perform worse. Things take more time and that’s annoying – you’re trying to perform. Sleep gets worse and things start to spiral downward as the symptoms increase…

It’s likely an issue mainly for those who’ve tried to achieve more than the capacity allows, when it’s done in that way. Which points to the fact that performance based self-esteem might be a big part of it. Trying to achieve, achieve, achieve, rather than accept the fact that rest is essential.

Some notice it really well when they first break down, when they do something completely crazy and end up at the wrong side of town when they’re going to work, have a panic attack or suddenly need to sleep for 16 hours straight.

The diagnosis was created to make it easier to classify all the patients who sought out medical attention for the symptoms from long term stress. It’s a diagnosis in Sweden since 2005 and will likely increase in numbers around large parts of the world.

Exhaustion and burn out in its real form will lead to plenty of issues. The ones below are some of the really common ones. Recognize any of them? They are at least some of the most debilitating.

Fatigue. Energy levels that once made you productive for eighteen hours a day are now depleting practically instantly when doing something – or more or less nothing – and they barely ever recharge.Not to mention the extreme lack of energy in the BODY – not just the MIND.

Physical pain – everywhere, or in places without any good reason what so ever. Except… there might be a reason here. Psychosomatic pain from a brain signalling for help and doing everything in its power to try to pull the emergency break for a chance to rest and recover. Some common examples are headaches, back pain and spasms, trouble with the forearms/legs and hands/feet, making the hands and feet mostly painful and dysfunctional, rather than lovely tools you’d like to use. Perhaps some chest pain?

Stress intolerance. Stress you earlier thought of as nothing suddenly seems like the whole world is coming down over you – and you break. You can’t take it. All this pressure!? Was it always like this?!

Worse memory, brain fog and actually feeling stupid because the brain simply won’t cooperate as it used to. Perhaps as a consequence from the long term stress, that gave plenty of cortisol, which practically acts like a toxin for the nerves and, according to some, could even produce brain damage.

Emotions. Did you always have all of those? Did you usually get annoyed and irritated by such minor things – or cry for such minor details?

Sleep, this once lovely thing – where are you now? Nowadays it’s exhausting even to sleep. Or try to anyway. If you get any at all, in between the episodes of sleeplessness. Do you sleep anything or are you rather just rolling around in bed all night?

Depression sneaks in; helplessness, general tragedy and misery starts to be the new common theme of life.

Anxiety might creep up on you in one way or another. A new, but kinda blurry, discomfort around doing a simple thing like shopping for groceries or walk through town. Perhaps you planned something fun like going to a restaurant, travel somewhere or just go to the movies – and suddenly you stumble upon your first panic attack?Does your heart usually race?

Symptoms of some sort from the heart seems to be quite common when you’ve been at it too hard for too long. The heart might race, skip a beat or add extra ones. Usually uncomfortable and most often harmless, but a symptom none the less. To make sure, asking a cardiologist to have a look at it might be a good idea. Long term stress really do put a strain on the cardio-vascular system so the heart attacks you’ve heard about from stressful events are not really just a made up thing. The heart is supposed to react to stress. To beat harder and faster is useful to get the blood flowing to get you going when you need to. But if that stress is at all times, when you’re at work, at home, when you can’t sleep and when you’ve got all that anxiety in general – that’s not functional. That’s not a good thing and useful, though it would explain why the heart rate might be elevated at practically all times. A resting heart rate shouldn’t be 90-110, but it might, if the physiology is really at it from the stress.

Tight chest, pressure in your chest or a hard time breathing though nothing’s really wrong is likely similar to the hearth-thing, as long as nothing else is wrong. To make sure about that someone who usually look at hearts might have to take a look. It might as well be from tense muscles around ribs and the chest area, that refer pain and restrict movement.

Gastrointestinal issues you’ve never had before suddenly start showing up?

Sensitive to stimuli like sound and lights?

Dizziness for no apparent reason along side a bunch of the other symptoms?

Treatment as soon as possible seems to be beneficial. Long term stress is practically toxic and getting out of it as quickly as possible ought to shorten the time it takes to recover. It usually leads to a vicious cycle of helpless- and purposelessness which needs to be tended to as well. It’s important to manage energy and tend to all the symptoms that bother to get back to life in a decent way, instead of just staying there, helpless. When panic attacks, anxiety, pain, depression, sleep issues, avoidance and passivity is all there is to life, that’s nothing that’ll just “pass” from waiting. That’s won’t “heal” by just sitting idly. You’ll need to act and get a grip of the situation. Preferably as soon as possible.

The exhaustion syndrome, which is a diagnosis in some countries, come with certain criteria.

  • Physical and psychological symptoms of exhaustion under at least 14 days as a consequence of one or several identifiable stress factors which have been there for at least six months.
  • Notably declined mental energy dominates the picture. Less productive, less stamina or longer recovery time after mental work.

At least four of the following have been present practically daily for the 14 days:

  • Hard to focus [suddenly incapable of doing more than one thing at at time, keeping track of a conversation] or remember [names, places, dates, where you put things, parked car, find words]
  • Notably harder to handle stress and pressure, such as doing something timed. Intolerance to stress; trying gives anxiety, and increase the dysfunction of focus and memory.
  • More emotional, unstable and irritable. Bad mood, easily provoked.
  • Physical fatigue and weakness.
  • Physical symptoms such as pain, heart racing, upset stomach, dizziness or sensitivity to stimuli.
  • Sleep disruption, sleeping more or less than before.

For a diagnosis the patient “should suffer from the problem” or have a decreased function in social- or work related situations where it can’t be as a result from drugs, medication or other illness such as depression, panic syndrome or GAD.

It usually consists of a few phases, where it’s a long process to get it. It won’t happen over night – and if you’ve worked hard to get it there’s usually some work to get back.

Build up

– Work consists of handling stress, challenges and demands. Speed, perhaps an unsafe environment and things are unfair. Conflicts and you lack control.
– At home there’s something else, if you do have any free time to spend at home. Perhaps people to take care of, illness, conflict or bothering economics? Once one do crash and burn the situation often get obvious. You’ve been way too busy and it just went over your head for months, years or perhaps even “practically always”. But you kept going bravely. Ambitious and thorough, that’s who you are – and perform – that’s what you do! You’re a doer, you help and you achieve. At any cost. You rest and sleep less, ruminations and brooding start, cognitive symptoms appear or perhaps it starts with weird pains and aches.

Acute phase

Sudden and often something you really notice. Practically a break down of some sort, so it’s common to really know when and where. Some break down in the office and cry under their desk, some drive to their old work place they haven’t been at for years – and once there they have no idea how to get in “because the key doesn’t work?!” – and once they get what they’re doing they have no idea how they got there or why. Some just don’t get out of bed one day. They can’t. The body just won’t do it. There’s nothing you can do about it.The cognitive symptoms and fatigue suddenly hits. You might get some sort of black out, confusion, or disorientation.

Recovery

Symptoms regress and capacity increase. But if it’s done without decent control and competence it’s often confusing, irregular, slow and sometimes completely incomprehensible without any pattern what so ever. Unless there’s a dramatic change in relation to what you did in the build up-phase, this might take years (if it ever gets done – there are those who’ve kept going for 15+ years and don’t have the capacity to work to this day).

People often hope for a week off – and then they’re back at it, but the going back is never sudden. If you got here you worked hard to get here. It wasn’t achieved easily and there’s a journey back. You can’t force getting better, but you can create the conditions necessary for recovery.

Memory, concentration, stress intolerance and a hard time with pressure are usually the most persistent symptoms. If you really did do something about it early enough the recovery time might be weeks, if you didn’t – years. So take care of this early enough. Act as soon as things don’t really seem to be okay anymore. If the situation isn’t acceptable – do something about it. Ask someone or do it yourself. As long as it gets better…

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