The big three: What is burnout?

What is burnout?

That question ought to be answered before going further with how to treat it.

How often do you wake up and feel excited about your day?

Excited, recharged, invigorated and ready to go are how mornings SHOULD be. That’s rarely the case with burnout, exhaustion disorder, or whatever you’d like to call it.

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. Or you’re one of those who say, “But it’s SO FUN!” and LOVE everything –  but you’ve been home, sick from stress, BEFORE this, and you still don’t get it? You crash repeatedly, and it takes days to recover once you do.

Let’s look at all of the big three I tend to, but start with Burnout. If it’s possible to isolate them, that one is what I help clients with most.

The reaction is REALLY individual, regarding what is stressful and what happens once it gets too 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 handy. To get the perspective to be able to solve the right issues.

I’ve touched on 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, healthcare, or be mid-level managers or owners of private businesses.

How come women suffer more… or at least search for help more?

Could there be a good-girl syndrome that makes them suffer more?

Could that same thing increase the stress levels or make them get into a more stressful situation?

Do they 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 crash unless you do something about it when the train is rolling. Hopefully, you’ll do something about it earlier than at the rope’s end. It’s common to avoid, ignore, neglect, or avoid seeing the connection between stress and something else and seek medical attention for something else instead, even though the stress is the perpetuating factor. Have you ever heard about anyone seeking medical attention for their heart when it’s a panic attack? Other reasons for people to seek medical attention could be anxiety, memory issues, chest pain, depression or trouble sleeping, headaches, gastrointestinal troubles, or other physical pain or discomfort. Some 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. I’ve noticed that the approach I use seems to make remarkable progress in just twelve weeks for those who do it well.

Those who really go for it seem to get far fewer symptoms and far higher quality of life and 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 physicians and healthcare workers say, “we have no clue what makes these people better over time”. If that’s the case, and tending to life and sorting things up makes those who suffer from it suffer less, I’d say that’s an excellent treatment.

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. One of those that isn’t even particularly uncommon is “You’re not ill/sick/exhausted/burned out/insert whatever”, even though it fits quite perfectly and most of their days are spent in bed, breaking down, or just being confused and tired. Completely ruined and incapable of living a decent life – but told they’re okay and just asked to leave.

Some physicians say, “there’s no evidence-based treatment for exhaustion syndrome that has shown any better results than any other…” I’m not quite sure what to take from that. Does that mean that it’s irrelevant what you do? That you won’t make any progress anyway? The only logical conclusion ought to be that there’s no point in trying anything. Ever. The end of that quote, coming from a highly regarded Swedish physician, is “… More than adapting the workplace, such as having an 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 working with investigative journalism.

I’m not quite sure I agree. Or rather, I’m sure I disagree.

You’ve done something and got the consequences from it.

We have a somewhat decent clue about what happens to people when they experience long-term stress.

I’d say it requires change.

If you’ve experienced stress for far too long, you’ll need a change to get rid of it – and recover. The lovely thing about biological parts and beings is that they can recover and heal. You likely got in the mess by doing what you “usually 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 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 by several years and minimize the risk of getting other long-term consequences from the long-term stress.

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

Man with perspective.

Burnout, occupational burnout, exhaustion disorder, chronic fatigue syndrome, or exhaustion syndrome seems to be used 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, what we call it is less relevant. The point is that it’s caused by stress without sufficient recovery for a longer duration, generally months, and can make people extraordinarily disabled and totally unrecognizable compared to how they used to be. It seems as if it’s almost exclusively a phenomenon of society today – a consequence of the stress of modern life. Stress has become one of the most common reasons for sick leave today, with its long-term consequences. But are the usual treatment methods really effective? How are you cared for? Is it working?

If the stress comes 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 personal 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 lot of pressure and demands from work and the same thing from yourself and a job where you’ll never really be able to “get completely done” are perfect conditions for long-term stress symptoms.

It might start with just nibbling on some sleep to get slightly more time in a day.

Initially getting a bit forgetful and perhaps “sloppy” turns into a more noticeable feeling of being tired and irritated and lacking focus. You’ll perform worse. Things take more time, and that’s annoying because you’re trying to achieve something here. Sleep worsens, and things spiral downward as the symptoms increase…

This is generally an issue for those who’ve tried to achieve more than the capacity allows them to, which points to the fact that performance-based self-esteem might be a big part of it. At least for some. Trying to achieve and achieve without accepting that rest is essential.

Some notice it well when they first break down, when they do something completely crazy or dangerous – or perhaps end up on the wrong side of town when they’re going to work because the brain just blacked out and worked on some old autopilot. Others get an eye-opener when they have their first 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 medical attention for long-term stress symptoms. It’s a diagnosis in Sweden since 2005 and will likely increase in numbers around large parts of the world.

Exhaustion, burnout, or whatever we want to call it will lead to many issues and symptoms. Here are some of the 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 whatsoever. Except… there might be a reason here. Psychosomatic pain from a brain signaling for help and doing everything to try to pull the emergency brake 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. The 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 feeling stupid because the brain simply won’t cooperate as it used to. Perhaps due to 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. You’re lucky 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 become the new common theme of life.

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

Symptoms from the heart seem 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 nonetheless. To make sure, asking a cardiologist to look at it might be a good idea. Long-term stress really does strain the cardiovascular system, so the heart attacks you’ve heard about from stressful events are not just a made-up thing. The heart is supposed to react to stress. To beat harder and faster is helpful 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 wrong is likely similar to the hearth-thing, as long as nothing else is wrong. To ensure that, someone with the right equipment and who usually look at hearts might want to take a look. It’s more common to find out that there’s nothing wrong, but you don’t want to ignore it and be a part of the minority. It might be from tense muscles around the ribs and the chest area, which refer to pain and restrict movement, but then again, it might be something else.

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

Sensitivity to stimuli like sound, smell, touch, or lights.

Dizziness for “no apparent reason”.

Treatment as soon as possible seems to be beneficial. Long-term stress is practically toxic and getting out of it as quickly as possible should shorten the time it takes to recover. It usually leads to a vicious cycle of helplessness and purposelessness that needs to be tended to. 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 are all there is to life, that won’t just “pass” from waiting. That won’t “heal” by just sitting idly. You’ll need to act and get a grip on the situation. Preferably as soon as possible.

The exhaustion syndrome, a diagnosis in some countries, comes with certain criteria.

• Physical and psychological symptoms of exhaustion under at least 14 days due to one or several identifiable stress factors thatch 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 increases 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 a result of drugs, medication, or other illnesses such as depression, panic syndrome, or GAD.

It usually consists of a few phases, where it’s a decently long process to get it. It won’t happen overnight.

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 does crash and burn, the situation often gets obvious. You’ve been too busy, and it just went over your head for months, years, or perhaps”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. It’s practically a breakdown of some sort, so it’s common to know when and where it happened. Some break down in the office and cry under their desk, some drive to their old workplace they haven’t been to 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 don’t get out of bed one day. They can’t. The body won’t do it. There’s nothing you can do about it. The cognitive symptoms and fatigue suddenly hit. You might get some sort of blackout, confusion, or disorientation.

Recovery

Symptoms regress, and capacity increases. But if it’s done without decent control and competence, it’s often confusing, irregular, slow, and sometimes utterly incomprehensible without any pattern. 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 can’t 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 difficulty 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.

If you’re curious and would like some further reading about this, the book covers more and is found at www.mbdolor.com/book. There, you’ll find a couple of chapters like “consequences of stress” and “What is stress?” to cover the theoretical part. The whole point of the book is to teach you to treat yourself. But to get you going in the right direction, just reading the book won’t be enough. You’ll have to take action.

Full series:
The Big Three: What Is Burnout?
Why Do We Get Burnout?
Treating Burnout