Burnout – it’s real and here’s what you can do

Burnout is not a medical condition or an illness, yet it affects a large number of people in workforce. It is not uncommon for women with a myriad of roles and responsibilities across professional and personal spheres, to not recognise the early signs of burnout. In fact, it may happen that one experiences unusual symptoms and soldiers on forcefully to deliver in career and at home only to progress slowly into full-blown burnout which in turn affects performance and the law of diminishing returns sets in, very unfortunately.

How Common is Burnout

In a 2019 Gallup study1, 28% of full-time employees reported feeling burnout at work ‘very often’ or ‘always’. Another 48% reported feeling burnout ‘sometimes’. This data shows that most full-time employees, as high as 8 out of 10, experience burnout on the job at least sometimes.

Burnout has become a phenomenon in modern times where multitude of complex and ever-increasing demands are the norm in most workplaces. When it comes to Women in STEMM, burnout perhaps has the potential to take dramatic turns in significant proportions given the career path itself poses substantial ongoing challenges to forge a steady path ahead, not to mention the socio-political issues that are highly prevalent for women in STEMM at each level. It is, indeed, a serious issue that can impact career aspirations and achievements and create a sense of inefficiency, self-doubt about one’s capacities and competence at professional and personal life.

What is Burnout Anyway

In May 2019, World Health Organisation2 confirmed the inclusion of burn-out in the International Classification of Diseases (ICD-11)3 as an occupational phenomenon and not classified as a medical condition. It is described in the chapter: ‘Factors influencing health status or contact with health services’ – which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.

Burn-out is defined in ICD-11 as:

“A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
  • reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

According to psychologist and prominent researcher Christine Maslach from University of California Berkeley, burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job4. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment4. She and her team devised Maslach Burnout Inventory™ (MBI) for objective assessment of the experiences, which has versions specific to medical personnel, health service workers, students, educators and for general use. MBI considered a gold standard for research in assessing burnout.

How to Recognize Burnout in Yourself

Maslach warns against the conventional wisdom that burnout is primarily a problem of the individual due to flaws in their character, behaviour or productivity and that the individual is the problem and the solutions lies in changing the person5. As WHO definition clearly linked burnout to occupation, one can appreciate that burnout experiences emerge as a consequence of one’s interactions within unhealthy working conditions and do not warrant categorisation of the sufferer as a sub-optimal worker.

In 1981, a 5-stage model for burnout developed by Veninga and Spradley6,7 showed five distinct stages:

  • Honeymoon stage: one experiences increased positive feelings such as excitement, enthusiasm perhaps in relation to a new job. The experience can lead to certain coping skills which eventually become dysfunctional and heralds the onset of depletion of energy.
  • Fuel shortage stage: one experiences fatigue, sleep problems, inefficiency and job dissatisfaction. There may be unhelpful coping mechanisms around eating and drinking habits.
  • Chronic symptom stage: one experiences more intense physiological responses and develop physical symptoms or illness and psychological symptoms such as anger, irritation and depression.
  • Crisis stage: without intervention, the previous stages go onto develop acute physical or somatic crisis such as peptic ulcer, tension headache, chronic backache, high blood pressure, sleep disturbance etc. There is also a tendency to withdraw, consider escape mechanism with increasing self-doubt and inability to feel hopeful about life.
  • Hitting the wall stage: this is a stage of complete maladaptation and failure of the person’s coping mechanisms to effectively manage the stress any longer.

The following questions are useful to ask yourself for informal self-assessment and contact a health professional if you answer yes to most of the questions. You can then formally use one of the established screening tools for burnout such as MBI.

  • Do you feel exhausted on a regular basis both physical and emotionally?
  • Do you feel easily stressed at work and unable to manage your work?
  • Do you feel you don’t really care about your work and clients?
  • Do you feel detached and cynical about your work and your role?
  • Are you unable to enjoy your life and usual things that made you happy?
  • Do you feel you are not contributing meaningfully to your work and career?
  • Do you feel you have no influence on your work?
  • Do you feel you don’t accomplish anything at work any more?

Why Burnout Occurs

A range of organizational risk factors across many occupations in various countries have been identified with six domains being particularly noteworthy: workload, control, reward, community, fairness, and values4,8-10.

High amount of work volume causes burnout by depleting the capacity to perform at high levels despite skillset. A clear link has also been found between a lack of control and burnout whereby perceiving a capacity to influence decisions and exercise a degree of autonomy can cause job satisfaction and lessen the risks of burnout. Reward of various kinds (praise, promotion, recognition etc) can potentiate and promote positive behaviours and consistent functioning. Sustained supportive workplace relationships minimizes conflicts and in turn risks of burnout. It is also noted from literature that equity and social justice are intrinsic expected standards that facilitate engagement, sense of respect and trust and prevent risks of burnout in employees. Values are also critical as a conflict between individual and organisational values can cause lasting impact on one’s sense of allegiance to the mission of the organisation and contribute to burnout and demoralization. In a 2018 cross-sectional study of 2026 workers from 63 workplaces from the province of Québec, Canada, it was shown that gender distinctively shaped environmental and individual pathways to burnout11,12. It is understood that women may have a lesser degree of autonomy and decision-making capacities in certain roles which colour their perception of job satisfaction and career growth potentials.

What Can You Do

  1. Self-awareness and identify warning signs early:

Women can engage high level of inner critical voice telling them that they need to work hard if some of the early signs of burnout is experienced. We have the tendency to ignore the problems in sleep, anger, mood and push harder to meet the deadlines and also not recognise the impact on personal lives.

  1. Establish if burnout is happening:

This is a critical step. We may need to speak with a trusted peer, a mentor, a good friend, a loved one, a doctor or counsellor to share what is being experienced and cross-check the physical and psychological symptoms. It is possible the burnout can create challenges in decision making about job, one may even think of changing or quitting job, walk-out on relationships or move cities in this intense state where nothing feels right but the desire to keep going forward is still bothering inside.

  1. Seek appropriate support:

Learning to ask for help from family, friends, trusted colleagues, mentors, coaches, mental health professionals may not come easy for many women, who have been managing career trajectories with aplomb and may feel it’s a step backwards to ask for help or even develop burnout. Recognising with proper support, where necessary changes are warranted for e.g., boundaries at work, prioritising tasks at home and work, upgrading self-care and the need for social connections.

If you respond “yes” to all or most of the questions, the alarm bells should be going off. It’s time to schedule an appointment with your internist, mental health professional, or a coach. These questions — especially the last two — take the concept of normal “stress” to the next level, in terms of how it has impacted your overall mindset.

  1. Learning to never compromise on health and well-being:

Simple steady path on self-care and well-being journey aids us to appreciate our abilities, limitations and areas where we need to improve at home and work. This does not mean we are deficient, it means we are still learning and growing. Basic steps of sleep, diet, exercise are always the foundational aspect to look after. Modern technology creates a unique situation where access to work is a click away! One can bring mindfulness to this and draw boundary and expectations around work. Taking vacation, short breaks, time-off, long-weekend go a long way to help one recover from burnout. One may even take a step further and invest time and mental energy in a new hobby! Creative pursuits can be healing. Women can give permission to self to enjoy life in all its dimensions within and beyond work. Learning and practising mindfulness and self-compassion can assist in this process.

  1. Evaluate your work and make choices:

We can engage in this final step only with clear mind, restful awareness of the whole situation and good physical health. Burnout is progressive and each stage can continue for a while and wrong decisions made along the way. Hence, once recovery journey is initiated, one can reflect the areas at work that need attention. Is it time to let go of certain aspects how we have been operating, is it time to have the tough conversation with the boss, or is it time for a long break or a change of scene. All options can be on the cards and the expanded awareness of the freedom one can experience in each of the choice can arm one with a capacity to make choices without fear or favour.

Conclusion

Ely and Padavic13 in their article titled ‘What Holds Back Women’ writes that the challenge women face at work is not of balancing work demands and family but rather a general problem of overwork that prevails in contemporary corporate culture. Similar situation is also prevalent in academia and STEMM and generating the same or even greater amount of output with same or limiting resources is not sustainable in the long run.  Each woman then is placed in a position to create opportunities constructive  communications to engaging leaders and executives to review their work culture, the environment, staff support structure and enable the possibility of a healthier, nurturing culture where one can thrive and not burnout. In fact, it is a responsibility that lies with each woman as only then, a culture of support, respect and growth is possible to welcome newer generations to join the workforce with confidence.

About the author

Dr Linda Kader is a psychiatrist, psychotherapist and mindfulness meditation teacher based in Melbourne. She currently works at The Royal Melbourne and The Royal Children’s Hospitals. Her areas of expertise include Early Intervention in Youth and Adult Psychiatry. Linda is committed to bring psychotherapeutic theories to understand the struggles of human minds in a deeper humanistic manner alongside evidence-based biological models of illnesses. She is trained both in Psychodynamic and Contemplative (Buddhism-based) Psychotherapy to assist her patients, when appropriate, with their difficulties. She worked at Orygen Youth Health for over a decade and conducted clinical research in psychosis and remains passionate about research & innovation in Psychiatry and also served as Acting Medical Director for a period. Linda is a Senior Fellow at the Department of Psychiatry, University of Melbourne and has maintained long-standing interest in teaching. She served as the Deputy Dean at Northern Clinical School in the Faculty of Medicine Dentistry & Health Sciences, University of Melbourne. Linda has an interest and intellectual curiosity to understand the mechanisms and usefulness of psychedelics in Psychiatry. She is a passionate advocate for refugee health. She is committed to promoting diversity, gender equity and mindful leadership Healthcare settings. She gives her time and skills in advocacy towards safety and mental health well-being for healthcare workers in COVID-19 pandemic. Linda is a long-time meditator in Insight Meditation Tradition. She is a cinephile, thrives on nature, arts, literature and good conversations.

References

  1. Gallup’s burnout-related data in this report came from Gallup Panel TM studies conducted in 2016, 2018 and 2019.
  2. World Health Organization. 2019. Burn-out an “occupational phenomenon”: International classification of diseases.
  3. ICD-11: International classification of diseases 11th 2018. World Health Organization.
  4. Maslach C, Peiter MP. 2016. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry. Jun; 15(2): 103–111.
  5. Blogpost on https://www.mindgarden.com/blog/post/44-a-message-from-the-maslach-burnout-inventory-authors
  6. Veninga, RL, Spradley, JP (1981). The work stress connection: How to cope with the burnout? Boston: LittleBrown and Company.
  7. Sharma RR. Indian model of executive burnout. 2007. Vikalpa. 32:2, 23-38.
  8. Maslach C, Schaufeli WB, Leiter MP. 2001. Job burnout. Ann Rev Psychol. 52:397‐422.
  9. Schaufeli WB, Enzmann D. (1998). The burnout companion to study and practice: a critical analysis. London: Taylor & Francis.
  10. Karasek R, Theorell T. 1993. Healthy Work. Stress, productivity, and the reconstruction of working life. New York: Basic Books.
  11. Beauregard N., Marchand A., Bilodeau J. et al. 2018. Gendered Pathways to Burnout: Results from the SALVEO Study. Ann Work Expo Health. May; 62(4): 426–437.
  12. Byrne EK. 2020. 5 Steps for Women to Combat Burnout. Harvard Business Review. May.
  13. Ely RJ, Padavic I. (2020). What’s really holding women back? Harvard Business Review. March-April. Issue 14.

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