Burnout ~ comments and links

At a basic level burnout could be described as a combination of severe exhaustion, distress, dis-empowerment and depression.  When we keep going and our inner self has been saying "Stop!" unheeded for too long burnout may result.  In severe cases continuing in the old way is then impossible.  Recovery requires time, lifestyle changes and clarification of personal issues and values.

This article in Wikipedia provides a good overview which is just as well as I found no mention of it on either the BBC or the New York Times health guide sites.  I know that burnout doesn't have medical status in New Zealand or in the U.S. and from its omission from the BBC site I presume it isn't recognised as such in the U.K. either.

The medical profession's refusal to recognise the condition is puzzling as any web search immediately throws up masses of articles about the degree to which those in the medical profession suffer from it.  Here is an example in the New Zealand Medical Journal.
Some years ago I read a book which discussed the legalities involved with this in America, but unfortunately have no record of the title.  Those researchers were well aware that this lack of recognition meant that doctors and patients had to find another way of placing it. Chronic Fatigue Syndrome, otherwise referred to as M.E., is one of them, and as this condition is often accompanied by depression it would appear to fit it quite well.  My personal view is that it is a distinct condition and I hope that one day it will be recognised as such.

Burnout certainly does have strong psychological components.  With CFS, on the other hand, depression is considered to be a separate issue.  Those who claim that burnout and CFS are related are unlikely to have formal research or health authorities supporting their views.  Such claims can at the best be considered as conjecture.

So how then do doctors end up making this compromise?  I don't know, but I suppose that if burnout isn't acknowledged as a medical condition it isn't seen as a compromise at all, and if CFS-like symptoms continue for an unexpectedly long time it's not a surprising conclusion.  Alternatively, maybe the physical and emotional trauma of burnout makes one vulnerable to developing the more serious and long term condition of CFS.  Clearly more research is needed.

I do highly recommend Dina Glouberman's book  "The Joy of Burnout" which I found very helpful indeed.  The author describes the condition with the conviction that arises from her own experience.  Dina is a psychotherapist so this is her angle on profiling  it, relating different cases, and offering suggestions about managing recovery.  It's very easy to read and her crisp identification of what's distinctive and important kept me turning the pages.
Here are:
And also:

Dina makes the important point that burnout isn't caused by overwork, but by overwork in situations in which we repeatedly over-ride our own judgement, ethics and natural limitations - often in order to please others.  Those with an over-active sense of duty and obligation please step forward! 

If this is you, I suggest you urgently reassess your situation and scale your efforts back to what fits you better.  It's not worth repeatedly going that extra mile for others, believe me.  You might consider bringing that fine quality of duty to bear on your own well-being. 

It may be helpful to remember the instructions of what to do if you are on an aeroplane and the oxygen masks drop down: you put on your own mask first before attempting to help others.  If you pass out before doing so, you are of no use to anybody - rather the reverse.  Our own well-being really is our first responsibility!  This may seem obvious or selfish depending on your point of view, but it's true nonetheless and very easy to lose track of when we are closely involved with those who are dependent and / or demanding.

My only disappointment with Dina's book is that there is no discussion at all of the physiological effects of burnout.  It certainly is frustrating that so little research seems to have been done, and what I have been able to find focuses on the adrenal function rather than neurological factors.  Severe burnout isn't marked only by what feels like near-death fatigue and emotional malaise, but also by what feels like a neurological disaster: blinding headaches, cognitive incompetence, super-hyper-sensitivity to absolutely everything and chaotic nightmares - all, in my opinion, obvious signs of a brain in melt-down.

While it's important to address the mindset and behaviours that landed us in this degree of physical crisis, recovery isn't going to be achieved purely by changing our priorities and improving our outlook.  Much more is needed, but what?

I have come across one doctor who responded affirmatively when I asked him about burnout.  I needed medical attention for quite a different matter, but asked this question in addition.  Yes, he said quite matter-of-fact, it was a condition in its own right and distinct from Chronic Fatigue Syndrome.  He went on to say that once one loses the degree of function that I had it wasn't possible to fully regain it.  His acknowledgement of burnout as a condition was heartening but his prognosis sobering.  I wanted to talk more, to find out more, but greatly to my disappointment he was 'only a duty doctor' at a twenty four hour health practice so I was unable to consult him again.

I do hope you have better luck.  I'm sure that most people would understand that doctors need properly researched and accepted studies before making their own pronouncements.  We expect that.  If doctors are taking their present stance due to these and legal constraints it would be helpful if they could at least say so.

Footnote, 29th August 2011: 
I've added a passage about medications I've tried in relation to this, to my article Treatment ~ it's about looking after you.

Book shop link for interested NZ readers:

Fishpond.co.nz - sorry, no image of cover available.

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