Burnout” sounds like a dirty word. It evokes images of someone who is “fried,” depleted, drained, spent, crumbling, and virtually lifeless. These are indelicate ways that depict what is becoming an ever-increasing reality in the workforce. Work-life balance is a phrase almost synonymous with the burnout syndrome. The prestigious Mayo Clinic shows the following satisfaction with work-life balance statistics: 61.3% of the general population; and 36% of physicians. (1) Therefore, many people are dissatisfied with their place in the workforce.

Values, Frank John Ninivaggi MD
Source: Values, Frank John Ninivaggi MD

What Specifically Comprises the Burnout Syndrome?

The term has been used for the last 40 years and is gaining popularity because the reality of its impact on people is becoming more prevalent and devastating. Burnout is called occupation and job burnout. Several core features characterize it: physical and emotional exhaustion, lack of enthusiasm and motivation, and weak work performance. One feels a sense of inefficacy, loss of control, and helplessness.

What Causes Burnout?

Individuals experience burnout for several reasons. Many investigators emphasize today’s high-stress work environments where chaos elicits overwhelming emotional demands existing on a daily basis. All too often, we hear people describe demandingness, if not hostility, in their perceived work environments: too few resources, work overload, downsizing, leadership disconnect, lack of team support, perceived unfairness, inadequate compensation, fewer perks, incentives, and rewards, and fuzzy values statements. Emotional demands escalate to unbearable proportions.

An individual who either is overwhelmed or unequipped to modulate and cope faces this chaotic challenge. How one sees all this, assesses it, and handles it determines, in part, job success or eventual burnout. One’s personality, temperament, and disposition with its level of resilience play a significant role in the way stress is handled. The burnout syndrome escalates when one’s inner resources become depleted.

Physical and Emotional Exhaustion

The chaotic environments of today’s work conditions with their many demands and often unpredictable crises impinge on people’s ability to adapt and cope effectively. Anxiety arises and, in itself, clouds clear thinking and makes problem-solving more difficult. The stress reaction escalates and cortisol, known as emotional-hormonal “public health enemy number one,” rises, to hijack the body and the mind. People then operate on overdrive. This pressure exerts excessive force on the brain, heart, blood pressure, glucose regulating systems, and so forth. One's physical pace accelerates to accommodate to work demands to get things done. The result is exhaustion both to body and mind—emotions and thinking. Physical energy, appetite, sleep, and other activities of daily living dysregulate.

Lack of Enthusiasm and Motivation

When bodily functions suffer, energy levels drop. People who are trying to make sense of what is happening feel overwhelmed at coming to sensible conclusions because of the morass of events—not in their control. This helplessness results in lowered enthusiasm and motivation. These are forms of demoralization. Another word is dispiritedness. When negative emotions color this, cynicism emerges. Negative attitudes are deadly to well-being. At this point, workers start to detach from their work mission—tasks, clients, and patients. Psychological deterioration organizes and solidifies. People say: “Is all this worth it, anymore? True clinical depression may follow.

Ineffective Work Performance

Feeling exhausted and demoralized takes its toll on behavior.  Performance suffers. All activities of daily living slow down. Some tasks are left out—poorer hygiene, less exercise, poorer food choices, greater social isolation; some jobs become more “mindless”—mediocre or lax work performance; and poor choices creep in—work absences, malingering, turning to excessive alcohol or illicit substance use.

The Road to a Demoralized Workforce

Burnout detonates when both perception and real environmental conditions as mentioned earlier reach intolerable proportions.

Warning signs are people saying: "It's been a crazy day;" it's nuts around here;" I'm too busy right now;" and the feeling of "I'm always being interrupted; I can't get anything done."

At first, the best in people tries to mobilize greater motivation to work harder to meet demands. When this fails, these futile attempts turn into compulsive perseverance, fighting what feels like an uphill battle. Because so much effort is given to hold together this failing state of work affairs, self-care, family, friends and social life begin to deteriorate. The stress reaction becomes a chronic stress response that manifests as physical signs and symptoms.

If resilience is weak, and it is in those that succumb to burnout, the self-defense mechanism of emotional blunting occurs. One feels empty and deadened so that the pain of loss numbs. Greater social isolation occurs. Behavior is so altered that family and coworkers notice that something negative is happening. The emotional blunting turns into what is termed “depersonalization.” This emotional condition is a state of mind that temporarily dehumanizes a person into becoming a mechanical device, one just going through the motions to survive without any meaningful quality of life.

I believe that empathy—the capacity for emotional awareness and literacy in oneself and perspective taking toward others—goes to sleep.

Here, the burnout syndrome has organized to become an actual problem. While not a psychiatric disorder, the International Classification of Diseases (ICD-10) does list it as a problem condition (Z-73) under life-management difficulty.

Hospitals and physicians are acutely aware of real adverse harm both physical and psychological on multiple levels in the health care provider environment. They actively study and intervene assiduously and continuously. When an adverse event occurs, health care systems recognize three “victims:” 1.) the patient as the first victim, 2.) the health care professional (e.g., the doctor as the “second victim”), and 3.) the health care organization. Current health care systems recognize this and educate for both patient safety, physician welfare, and organizational high-reliability to avoid errors. All these innovations optimize the health care environment of optimal patient safety and reduce future risk of unintended error.

Treatment

All treatment first begins with recognition and prevention. Identifying the problem, recognizing its signs and symptoms, and spotting it in oneself and others is crucial to prevention and remediation.

When burnout is present at any stage, two levels of intervention work best: individual and organizational. The entire challenge of “burnout syndrome” is complex. The following suggestions merely outline and hint at a few relevant strategies needed for effectiveness in addressing this contemporary problem.

I think that a fundamental difficulty is impaired emotional awareness. My current research is developing a practical “emotional literacy” model and will be available in the near future.

The Individual Level of Treatment

SLOW DOWN!

It's in your power---right now---to start to heal by slowing down thinking and behavior. One of the most frequently used words I use in the few books I've written about health and well-being from the Eastern and Western perspectives is "pause."

In many ways, the rest is commentary, but important to fill in the gaps.

Basic stress management interventions target exhaustion, cynicism, and inefficacy. Stress management techniques vary and are accessible in books, the media, the Internet, and through professional guidance. Stress management, in fact, has been shown unquestionably to optimize health and well-being. Experts in burnout research say that exhaustion is easily treatable with stress management techniques. Cynicism and inefficacy are harder to tackle and modify. Work engagement is most effective in helping cynicism and inefficacy to ease. Issues needing attention are self-perceptions, self-efficacy, problem-solving skills, self-esteem, and learned helpfulness skills, to name just a few.

The Organizational Level of Intervention

Organization needs to acknowledge the problem in workers and on every level of management. The buzz word is “engagement.” This term means that the entire team in the workforce must be cognizant of its values, vision, and mission statements. Abstractions are best avoided. Real-time, concrete material examples are the best words and images used to give everyone a clear-cut idea of what is at stake and needs to be done. Introducing reasonable choice, flexibility, and meaningfulness make all this "humane" and real to people. Remembering that the “work” is a team project and that the team is a collection of human individuals who must bear in mind their humanity is essential to success. Collective effort is common observation and communication.

Ongoing measurement is needed.  Continuing positive feedback and education for all is also primary. A safe work setting where values of authenticity are aspirational endorses this. Real-time, timely follow-through and the living example of leadership demonstrate authenticity.

Wellness committees are an excellent idea to solidify primary (before), secondary (at), and tertiary (rehabilitative) preventions. I believe effective engagement must be respectful involvement. This professional feedback means authentic interpersonal interest, caring, and helping. It means allocating and authorizing control to team members to perform flexibly using individualized---safe, efficient, and effective---personal and group methods.  And lastly, the emotional climate to counter the burnout syndrome is one of agreeableness, cooperation, active listening, and compassionate humor.

Prevention and intervention robustly address health outcomes and general well-being. Effective work engagement strategies bolster morale and positive motivational outcomes. (2)

My forthcoming book addresses a self-activism and self-entrepreneurship model that empowers emotional awareness and resiliency in the face of life's amazing challenges.

1. Tait, D. et al., “Changes in Burnout and Satisfaction with Work-life Balance in Physicians and the General US Working Population between 2001 and 2014, Proceedings of the Mayo Clinic 90, no 12 (2015):1613.

2. Bakker, Arnold B. et al., “Burnout and Work Engagement: The JD-R Approach,” Annual review of Organizational Psychology and Organizational Behavior 1, (2014): 389-411.

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