Burnout and emotional exhaustion

I work in a profession that has a serious problem – around one in fifty vets will commit suicide. Just think about that for a moment. Out of my class of 60 bright excited A-Level students, at least one will be so ground down by being a vet that they will kill themselves. In a great sit down with our nurses earlier this week (Youtube), the topic of burnout came up and with it being Mental Health Awareness week, it seems fitting to address this problem.

This disastrous statistic is down to many factors- access to means and a familiarity with putting animals to sleep on a daily basis are job specific, but there are other features of this job that everyone understands. Long hours, social isolation, impossible expectations, emotional demands all contribute to a toxic syndrome that is being talked about more and more- burnout aka. emotional exhaustion.

What is burnout?

Burnout isn’t absolutely defined, but it is generally held to be a response to severe stress resulting from high ideals and emotional pressure from the environment. Other stressors can include being permanently overworked or under-challenged, being under time pressure, or having conflicts with colleagues. It is thought the “helping” professions tend to suffer more as result of the vocational nature of their work, and also suffer from a similar problem called “compassion fatigue”- a self imposed kind of burnout.

Compassion fatigue occurs when people aren’t working in a resilient or sustainable way, are being overly empathetic and being drawn into the emotions of the situations they see and experience.
Carolyne Crowe MRCVS

Carers, doctors, nurses, vets, physios all tend to choose their careers as a result of a “calling”, and will often neglect themselves to answer that calling. Failing to live up to the high ideals imposed on oneself causes severe stress.

The end result of burnout is a person that is driven to the point that they feel exhausted, empty, and unable to cope.

The spectrum of burnout

We don’t just wake up one morning burnt out. It is a process that starts with an excited young person and gradually wears away at them. So what are the stages of burnout?

Stage 1- Stress arousal. You may be irritable or anxious, sleep may be affected and there may be periods of forgetfulness. Physical signs include palpitations and headaches

Stage 2- Energy conservation. At this point you may start becoming late for work, procrastinate, be persistently tired (need a 3 day weekend!) and socially withdrawn. Alcohol and caffeine consumption can increase, and you may develop a cynical or resentful attitude. You might have other escapist behaviour such as over eating (particularly carbohydrates)

Stage 3- Exhaustion. Chronic mental or physical fatigue, depression, bowel problems and headaches are common. Speech may be very “flat” and body language diminished. The desire to completely withdraw from social interaction and move away from family and friends can become overwhelming, and existing relationships are depersonalised- you may become very “cold”. Performance plummets and pleasure stops. Suicidal thoughts may occur.

A sufferer may experience only two or three of the signs in each stage. The progression can be stopped at any point, but it usually only gets acted on once stage 3 is reached. As the burnout progresses, so recovery takes exponentially longer.

Why do the caring professions suffer more?

It’s thought that doctors, nurses, vets etc. have four main principles drummed into them during training: service, excellence, curative competence, and compassion. The ability to change a person’s or loved pet’s health is enormously rewarding, yet this sense of service can easily become a sense of duty. If a doctor deprives themselves for the betterment of others, a sense of resentment can arise. Excellence is expected both by the individual, and by patients or clients. Zero tolerance for mistakes breeds perfectionism and ultimately either a feeling of failure or dangerous invincibility. Being a competent clinician solely responsible for patient outcomes can give rise to feelings of omnipotence and intolerance of challenge. Finally, compassion driven by service and sacrifice can result in the setting aside of emotions and a loss of empathy- emotional isolation is the result.

Positive Negative potential Burnout factor Potential intervention
Service Deprivation Compassion fatigue, entitlement Reframing, appreciation
Excellence Invincibility Emotional exhaustion Self compassion, inner critic awareness
Curative competence Omnipotence Ineffectiveness, cynicism Self-awareness, generous listening
Compassion Isolation Depersonalisation Connection, community, silence
Nedrow, Steckler, Hardman

What can we do to stop burnout?

It’s critical to identify the why. Why are you burning out? Is it the hours or is it the pressure from colleagues or clients? Part of this process is being absolutely honest with yourself about what it is that drains you. We all get pressure from other people to “enjoy” things; maybe you’re an introvert and honestly you hate parties but just get dragged along, or maybe you enjoy talking to people but are stuck in a solitary yet highly paid role. Stress diaries can help with this, but sometimes we need a little help to get the courage to take the steps that lead us to recovery.

We need to move towards the things that nourish us, and away from those that drain us. But what does this practically mean? Look at:

  • Lack of control- can you get a greater say in what you do at work?
  • Loss of control- is there any common factor at work that causes this?
  • Establish clear lines of authority- what exactly are you responsible for?
  • Dysfunctional workplace.- get the boss to stamp out bullying or negative interaction.
  • Is the job right? Does it fit your values? Does it fit your interests?
  • Is your job either continually monotonous or chaotic? Does its tempo vary?
  • Do you have the right social support?
  • Do you have the right work life balance?

Resist – build up your self defences

Restore – rebuild the energy that’s been drained

Reduce – lower the overall stress in your workplace

Reframe – alter the way you think about your job

Even in the perfect workplace burnout can still occur. As our nurses pointed in our video “A chat with the nurses” sometimes a job you love in a perfect environment can still cause burnout; the nature of the emotional toll can be high. In these cases, an antidote has to be found- either through support, an outlet such as sport or even professional therapy.

Emotional burnout is a risk for all of us- and we need to talk about it more.

Resources

http://www.carolynecrowe.co.uk/

http://twitter.com/hashtag/MentalHealthAwarenessWeek

https://www.vetlife.org.uk

https://www.vetmindmatters.org/

https://www.aafp.org/fpm/2013/0100/p25.pdf Physician Resilience and Burnout – AAFP