In May 2019, the World Health Organisation (WHO) included 'Burn Out' in its 11th Revision of the International Classification of Diseases (ICD-11), classifying it as an occupational phenomenon (but not a medical condition) “resulting from chronic workplace stress that has not been successfully managed.” [1] Burn Out is a stress syndrome where the body’s capacity is at, or has exceeded, limits. The three main symptoms in the WHO criteria are: exhaustion; distance from or negative feelings towards the individual’s job or career and reduced professional productivity even if the person is working flat out. The individual may be experiencing heightened stress presenting as low mood, poor appetite or overeating, restless sleep or insomnia, tearfulness, irritability, forgetfulness, impaired ability to concentrate and brain fog. In time, anxiety, withdrawal and a sense of failure take over such that a diagnosis of depression is made, not least because the symptoms overlap. Physical problems present when increased stress and anxiety lead to increased adrenaline, decreased sleep, gastric and cardiac symptoms. In time, Burn Out can lead to break down, which can take months to recover from. 
 
So why does Burn Out occur? Burn Out often occurs as a result of enduring excessive workloads, meeting high expectations and repeated exposure to tough or traumatic situations. It’s not surprising therefore that Burn Out occurs frequently across the corporate and healthcare world and amongst first responders. It is especially likely if there is an absence of sufficient support systems in the workplace and / or an absence of balance and respite in the individual’s 'off duty' time. Lack of opportunity to 'de stress' means that we remain in chronic activation mode. Couple this to chronic stress in one’s personal life and that person eventually finds themselves unable to cope. Of course, there are individual factors in our personalities that can contribute to Burn Out: an inability to say 'no'; a fear of letting others down or not putting our own needs first, all of which mean we inevitably take on too much. We want to please, feel in control, feel we are trustworthy, responsible and reliable. We are unable to delegate as we cannot trust others will do the job to the same standard as we would. As we grow older, we find it difficult to accept that we can no longer take on as much as before or that we may be replaceable. In an era of staff shortages, we may simply have no one to share responsibilities with. Then there is that much cited word called resilience that we are all expected to show even though the definition of resilience may differ, depending on who is citing it. But that is a subject for another article! Suffice it to say that in my opinion, resilience is the ability to recognise when we are at limits and not crossing that line. That means being sufficiently in touch with our bodies, minds or emotions to recognise this. Recognising when we are in conflict or when our values, morals and personal ethos are being compromised, insulted and injured. Recognising when our coping mechanisms are failing and we resort to other measures such as excessive alcohol consumption. Other signs include: devising coping formulas to get ourselves into work and through the day; really dreading going to work, noting this dread setting in earlier and earlier over a weekend; noting the feeling on being 'on fumes'; noting feelings of disillusionment – “ this is not the job it used to be”, “ this is not what I signed up for”, “ “there is no sign or hope of things getting any better”; noting a feeling that “I would give this job up in the morning only for the money/mortgage/pension or “there is nothing else I can do or would be employed for”; noting not having the motivation, energy or courage to do anything else or even to look at options. 
 
This all describes the burning up phase, where we have some chance of intervention. But what if we have already passed that mark and have already burned out? Well, by then, we probably have been to the doctor at least once and ignored their medical advice regarding taking it easy, addressing lifestyle issues and other self care recommendations. At Burn Out, we will be back to the doctor with more advanced symptoms often in the cardiac area - palpitations, tachycardia (increased heart rate) and so on. Realistically, a significant period of rest is now needed, a minimum of three weeks but likely longer. This is primarily to allow meaningful rest – to allow space and time to simply be while allowing symptoms to settle. Taking time to rest and recover can be difficult, as we feel guilty for resting and not being at work. After all, we are not really sick are we or at least that is what we feel others will think. Not being at work is only emphasising that things are not 'normal,' that we are not 'normal.' Recognise this as the internalised voices of other people who are not experiencing what we are experiencing. Allow time to cry, which may not have been possible to do in the effort of keeping going. Crying activates our parasympathetic nervous system and brings calmness. It is a natural completion of the stress cycle. 
 
During this time of recovery, we limit our contact with people that drain our energy and spend time with people that are gains in our life, bringing energy and positivity, making us laugh and forget. To help figure out who these people might be, try this exercise here . Make gentle exercise a priority, starting with a ten minute walk per day, ideally in nature, working up thirty minutes or more per day as energy returns. Even a ten minute walk can noticeably improve mood. Taking in more Omega-3 fatty acids in our diet (salmon, herring, mackerel, anchovies, sardines seaweed, flaxseed, walnuts) boosts mood. Reducing sugary foods and carbs can also improve mood and reduce energy crashes. It is a good idea to reduce caffeine and drink alcohol only if it can be done in moderation. While alcohol can be relaxing, too much can cause anxiety as the affect wears off. Drinking lots of water maintains hydration and flushes out toxins. 
Consider meditation to help relaxation. There are many apps available online or try our 'Mind Down' session which will be available as a podcast from this website in the coming weeks. Engage in creative activities - baking, making, painting, gardening. As well as a source of distraction, being creative helps reduce that feeling of emptiness and helps build our confidence and self esteem. See more on creativity here
 
In time, when the emotions have calmed and we are better able to appraise rationally, it is useful to review and reassess our values in life. Is that job, salary or pension so good we have to risk our health? Have we become disillusioned with the role? Is it fulfilling? What are our expectations and how do we manage them? What are our options or alternatives? Creating options is important so that we do not feel stuck. Are there opportunities in those options, including the prospect of a better life style even if at a reduced salary? Remember, jobs often come with many expenses: childcare; motor costs; public transport costs; meals; clothes… 
 
Seeking the support of a therapist can help appraise what has happened, help explore options and change behaviours that do not serve us well. Returning to the same role will require a new approach so that this does not happen again. It can be a long road back from Burn Out and recovery means having a deeper understanding of our limits and what renews and replenishes us. Taking care of ourselves and making our own needs a priority is not an easy lesson to learn but it is a critical one. 
 
If you need some help with anything mentioned in this article, get in touch here
 
References 
1. https://www.who.int/mental_health/evidence/burn-out/en/  
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