The dialogue surrounding mental health conditions has improved dramatically over the past decade and, for the most part, this has had positive effects, shedding the stigma attached to being ‘not okay’. Yet, with this open dialogue, certain phrases, such as feeling stressed, depressed or anxious, have become overused in the vernacular, which can diminish the severity of such conditions and their impact on individual sufferers. The same can be said for referring to being tired as feeling burned out, with few realising that burnout is a syndrome affecting an increasing number of people.
Defining burnout
The term burnout actually originated in the 1970s when the American psychologist Herbert Freudenberger first coined the phrase when diagnosing the crippling exhaustion felt by medical professionals. Usually resulting from pressures within the workplace, burnout is a feeling of extreme lassitude, caused by prolonged physical, emotional and mental stress that leaves the individual feeling detached, demoralised, hopeless and lacking in the motivation and energy needed to complete daily tasks. The term has evolved since the 1970s, as have the stresses, pressures and expectations of the modern age, so much so that burnout now refers to anyone experiencing severe exhaustion and an inability to cope with daily demands in and outside of the workplace. In 2019, the World Health Organization (WHO) officially recognised burnout as a syndrome due to its prevalence, as evidenced in a poll conducted by YouGov and Mental Health UK in 2021. This poll found that one in five workers in the UK felt unable to manage the stress and pressure of work, a figure that has risen dramatically since 2020 (Mental Health UK, 2021). Despite the evolution of the term, doctors and nurses remain prone to burnout, a susceptibility that the COVID-19 pandemic has only exacerbated in recent years. In any kind of medical profession, if the practitioner is feeling the effects of long-term stress and pressure, it could have an impact on the patients being treated and, ultimately, puts them at risk. Therefore, it is imperative to learn the signs of burnout, how to manage the symptoms and, most importantly, how to avoid it from happening in the first place.
Signs and symptoms
The overarching pressures of the working day have increased, in part due to technology and how accessible it has forced everyone to become. Emails and calls can be answered on the go and patients can be responded to out of hours, which blurs the boundaries separating work from home and on duty from off duty. Combined with the demands of a job treating and caring for others, a global pandemic and other life worries, it is not surprising that many medical professionals are experiencing or heading towards burnout. The human body can endure short bouts of stress, and it is where the ‘fight or flight’ response comes into action. Some individuals thrive in high-pressure situations; however, the human body is not equipped to handle prolonged exposure to stress without sufficient recovery. Everyone responds to stressful situations differently and, with burnout, additional symptoms vary from person to person. Other than demotivation and exhaustion, some may experience a weakened immune system, a vulnerability to infections, digestive problems (such as bloating or new food intolerances), headaches, joint and muscular pain, irregular menstruation, fertility problems and low libido. Naturally, these symptoms do not manifest quickly; they occur gradually as the body continues to react to extended periods of intense pressure, which indicates that a lot of health problems may stem from burnout.
Aside from the term now being used casually in conversations, another reason that burnout is becoming overlooked is that some of the symptoms presented are similar to other mental health concerns. Due to this, burnout often goes misdiagnosed or undiagnosed, which means that incorrect advice that will not resolve the causes of burnout could be prescribed. For example, the listlessness, detachment and lack of motivation experienced by those suffering from burnout could easily be mistaken for depression and vice versa. Yet, just as prescribing antidepressants to someone with burnout will do little to help them, recommending that someone with depression take time away from work could also worsen their condition. Misdiagnosis means that it is impossible to say how common burnout is. However, the recruitment site Indeed estimates that over 50% of employees are experiencing, or will experience, burnout this year (Kelly, 2021). Therefore, more awareness needs to be raised to help differentiate burnout from other mental health issues to help those who are experiencing it.
Recognition
As burnout occurs gradually and grows in severity over time, it can be recognised and resolved before it reaches a peak. According to Integris Health (2021), there are five phases of burnout described in relation to starting a new job, which demonstrates how progressively pressures can mount and lead to burnout. Recognising this slope could prevent some of the more serious symptoms associated with burnout from happening in the future. The phases are:
- Phase 1: with every new job or opportunity comes energy and enthusiasm for new tasks, learning new skills and meeting new people. Job satisfaction increases and leads to creativity and productivity. Stress levels are generally minimal, as optimism for the new supersedes any nervous anxiety.
- Phase 2: unfortunately, the aforementioned satisfaction can be short-lived, as the longer a position is held, though gradual, the more stress the employee is exposed to. Stress does not run the whole day at this stage, only certain aspects, but it is enough to tire the individual mentally and physically, deterring focus and reducing productivity.
- Phase 3: if nothing changes, this stress becomes more intense and persistent. Aspects of the job role will be affected by this increased pressure, for example, running late for patients, making mistakes and lapses in paperwork. Relationships between colleagues could be affected, as well as those of friends and family, as the individual reacts to stress and the effect it is having on all aspects of their life.
- Phase 4: this is where limits are reached. Stress and problems at work consume the individual as they obsess over them. Self-doubt creeps in, along with other physical symptoms (as listed above). At this stage, others will be able to notice a significant difference in behaviour. This is burnout.
- Phase 5: if left untreated, burnout becomes a part of the individual, affecting multiple aspects of their life. Burnout now inhibits their capacity to perform at their job, which not only puts patients at risk but also the individual's job security.
The stress that presents itself in phase 2 is where individuals need to take stock and evaluate how they respond to stress and how these pressured situations can be made more manageable, so the stress does not take over and result in burnout. Due to the widespread accessibility and visibility on social media, people appear to compete with one another over who can be the busiest and the most stressed, but burnout and the other symptoms it presents should not be considered the norm and life should not continue like this. Job satisfaction, productivity, success and optimum physical and mental health come from knowing individual limits and enforcing boundaries.
Preventing burnout
If the symptoms and issues raised in this article sound familiar, ultimately, medical intervention should be sought in the first instance. Additionally, the following may help to alleviate the symptoms a little.
Be honest and selfish
As burnout is primarily associated with pressures within the workplace, this is perhaps the best area to first address. If possible, speak with a line manager or HR personnel and alert them to the aspects of work that are causing or contributing to the pressure, as, naturally, it is in their best interest to help and support their employees. However, not all workplaces have a mental health program in place, despite the rise in mental health conditions. According to the latest YouGov poll, only 23% of UK employees knew about their employer's plans to spot and alleviate signs of chronic stress and burnout in their employees, a figure that is, worryingly, the same as the poll conducted the year prior (Mental Health UK, 2021). For the 77% of workplaces without a wellbeing plan in place, sadly, it is down to the individual to alert senior management to the pressures that make the role challenging. Additionally, employees also must discern when enough is enough and, if changes are not made, when to leave and look for alternative employment elsewhere.
Set boundaries
Setting new boundaries or re-establishing the old is important in aiding recovery. In regard to work, once the areas causing stress have been identified, plans need to be implemented to resolve/alleviate these issues. Whether it is more time to see each patient or fill out paperwork, reviewing the hours of the working day and sticking to them or restricting contact out of office hours, when boundaries are consistently enforced, it becomes harder for others to cross and abuse them. The same can occur outside of work if boundaries are put in place, and discussing with family and loved ones what is needed to feel better is equally important. Whether it is more time alone, sharing household chores or even the conversation about changing jobs and the financial implications, all will contribute to recovery.
» … missing meals or eating foods that are rich in sugar result in a hypoglycaemic state that affects cortisol levels and the body's stress response, thus making the individual feel worse «
Nutrition
Immense stress and pressure can lead to some destructive and unhealthy habits, such as binge drinking, eating or smoking, which will only exacerbate symptoms of burnout. Identifying and eliminating those unhealthy crutches will support the body's return to health. Therefore, nutrition is very important, as is understanding what foods will help ease and magnify symptoms. For example, missing meals or eating foods that are rich in sugar result in a hypoglycaemic state that affects cortisol levels and the body's stress response, thus making the individual feel worse. It is advisable to fill up on vegetables, lean proteins (such as chicken and fish), omega-rich fats (such as avocados and nuts) and fibre-rich carbohydrates (such as oats and brown rice. Additionally, although it is a stimulant, caffeine participates in burnout, as it mimics the body's stress response, so limiting coffee intake by drinking decaf or swapping it for green tea would avoid this.
Exercise
Moving the body through exercise can be a great stress reliever for some, but certain types of exercise can actually exacerbate symptoms of burnout, so exercise should be approached mindfully and with caution. As burnout is an extreme form of exhaustion, regular exercise for extended periods of time will be detrimental to the body's ability to recover, with individuals experiencing muscular aches and pain for longer, along with more fatigue. Lower intensity exercise is best, such as walking, cycling or swimming, but, ultimately, a sport or exercise that is found to be enjoyable will help improve mood and mental wellbeing.
Conclusions
Burnout does not occur quickly, and neither does recovery; however, it will not get better on its own unless changes are implemented. Recovery or alleviated symptoms do not mean that burnout will not occur again, but seeking help, identifying triggers and re-establishing boundaries is certainly an important step. Feelings of burnout are not normal and should not be considered just part of working in the modern post-pandemic age.
Useful resources
- For urgent mental health support: https://mentalhealth-uk.org/help-and-information/get-urgent-help
- To find a mental health counsellor in your area: www.counselling-directory.org.uk