Mark Gorkin, MSW, LICSW, "The Stress Doc" ™, a Licensed Clinical Social Worker, is an acclaimed keynote and kickoff speaker as well as "Motivational Humorist ...Read More
Here’s a story that speaks to the latent power of delayed grief; disruptive echoes from a seemingly distant past can still disorient and derail a life in the present. In the mid-1980s, I began working with a New Orleans businessman in his mid-30s on burnout issues he claimed were brought on by a demanding import-export business. His lack of focus and enthusiasm, along with decreasing productivity was evoking feelings of guilt, self-blame, and diminished self-esteem. Actually, he was confused by his state of exhaustion and ennui; normally he is quite decisive. And as his custom, he was mostly suffering in silence, until he heard a Stress Doc radio feature on burnout and called for an appointment.
In my office, the discrepancy between his words and emotional affect had me thinking a vital assessment piece was missing. And in fact, gathering some background history, our focus quickly shifted to another, more traumatic time. This client was also a former Israeli officer who had undergone truly harrowing encounters as a front-line Tank Commander in the 1973 Arab-Israeli War. His traumatic experiences included helping repulse a surprise tank attack by a numerically superior foe; many in his battalion lost their lives. And when finally returning from the battlefield in haste, in a state of exhaustion, he crashes his jeep killing two fellow passengers-soldiers. Necessary reports were filed; however, because he was an officer no psychological debriefing was required. In fact, he had never shared his harrowing experiences and guilt-laden emotions with family members. Now, in my office twelve years later, it was apparent how heavy still the military emotional burden and baggage, and how much it was adding fuel to his sense of shame and burnout fire. Actually, the present burnout smoke signals were more a smoking gun incriminating the long-standing smoldering PTSD within. I rerouted him back to Israel for that long overdue debriefing and encouraged him to begin sharing the suppressed experiences and emotions with his family. Fortified with proper support, he was ready to wrestle with his primal ghosts. I was confident that purpose and passion or even a new direction would rise from those post-traumatic-burnout ashes.
Clearly, this vignette shows how interconnected burnout and burn-in may be. With hindsight, I suspect the toll of loitering grief ghosts each year was getting progressively heavy; the burn-in finally reached a critical combustion point. It’s possible that for this ex-Israeli officer business burnout was a necessary, less conflicted and stigmatizing condition, one that provided a “pass in the impasse.” He could ask for help more readily around his business battle fatigue than for the warring ghosts within. (This is not an uncommon self-labeling ploy. For example, I’ve worked with many clients more willing to initially wear the badge of burnout than to acknowledge some form of clinical depression smoldering internally for months or years.)
Burnout: Definition, “Vital Lesson” Mindset, and “Eco”- and Ego-Driven Sources
With this example as a springboard, let’s explore burnout, from its foundation to its stages. Beginning with my classic definition, Burnout is a gradual process by which a person detaches from work and other significant roles and relationships in response to excessive and prolonged stress and mental, physical, and emotional strain. The result is lowered productivity, cynicism, and confusion – a feeling of being drained, having nothing more to give.
The classic or most familiar set-up for burnout is a professional or personal situation or environment that places high ongoing demands and responsibilities upon you while restricting your sense of control, autonomy, and/or authority, along with access to resources and support. However, look for two other volatile ingredients: inflexibly high expectations and elusive goals definitely add fuel to the fire. Consider my “Vital Lesson of the Four ‘R’s”: If, no matter what you do or how hard you try, Results, Rewards, Recognition and Relief are not forthcoming and you can’t say and mean “no” or won’t let go…because you’ve invested so much time, money, energy, and ego in that one right person, position, or only one right-possible-acceptable outcome…then trouble awaits. The groundwork is laid for apathy, callousness and despair.
But let’s expand from the psychological to the eco-logical and ego-logical. In a rapidly changing, uncertain, and 24/7 wired world, four major sources of burnout are posited – from “eco”-driven (as in organizational eco-system) to “ego”-driven (see the “Vital Lesson” above). A fifth source relates to preexisting “mind-body” conditions that may predispose an individual to burnout, e.g., early childhood losses, chronic illnesses or disabilities, traumatic experiences, and all manner of prematurely buried grief ghosts.
Consider these “Five Major Sources of Burnout”:
1. TNT World. In a 24/7, “TNT” – “Time, Numbers, & Technology” – driven and distracted world, the boundary between work and home is eroding; how does one truly relax when forever sneaking a peek at the latest text or Outlook message/calendar entry?; where’s that “Off-Duty” taxi sign when you need one?; there’s less recovery time and space with today’s exhausting and intrusive pace, especially for single parent or dual-income families; and to quote NY Times technology blogger, Nick Bilton, unlike the near universally fluent “Internet Natives” (born ABI – After the Birth of Internet”) many “Internet Immigrants” (born BBI – “Before the Birth of the Internet”) will always be challenged by the constant need for survival upgrading.
2. Out of Control World. Even more taxing than the pace of life, is a feeling that you no longer have control of its pace and priorities, especially you can’t influence the outcomes; your actions seem to have less and less consequence. People who have been downsized or anticipate being laid off, or have gone through a foreclosure, or are in an emotionally abusive relationship, or are caught in the always on, always anxious role of caretaker to an infirmed parent (especially when still parenting their kids) can start feeling like pawns – life’s forces and factors seem beyond their control.
Of course, this century we in the US have been confronted by a staggering “out of control” event – September 11th. As previously noted in an article written shortly after the terrorist attack a natural result of trauma and crisis is that past and, even, deep-seated memories or associations of previous threats, losses, tragedies or abuses may be stirred up. Initially, the disconcerting association may not be to a specific past event but more to a general feeling, such as being trapped, and feeling out of sorts or not oneself, etc.
As an example, a week after 9/11, a friend and an “S & L” Vice-President and Technology Officer shared how he was still feeling a sense of dis-ease that eluded his understanding. He saw the parallel with his previous combat experience, connecting the devastating rubble and gray ash around the fallen World Trade Center to the bombed out fields in Vietnam. But J. had emotionally grappled with his service experience, including near death encounters as an artillery officer. So the ongoing disorientation was perplexing. I asked J. if it was possible that the subconscious memory being stirred was less war-related and more connected to the tragic death of his first wife; she had been trapped in a roaring home fire. J. attempted a rescue that was unsuccessful. With a surprised and pensive look on his face, J. said, “I hadn’t thought of that.” He now recognized that the fiery ball and flames from the Twin Towers had also blown open personal black box holding memories of traumatic loss and a profound experience of helplessness.
3. Elusive or Egoal-Driven World. When ideals, high expectations, and critical or especially, pride-driven goals prove elusive or are continuously thwarted despite significant investment of time, energy, money, and self-identity, and one can’t step back or “let go,” an individual’s motivational fire will likely become exhausted if not extinguished; in the short-term, before the erosive spiral hits bottom, ambitious, outrageous or self-inflated egoals may be on display; alas, such objectives, whether genuinely daring or delusional, are often the product of deep-seated insecurity, critical ghosts, and magical thinking; by achieving something truly innovative or uncommon, “I’ll show all those doubters and naysayers once and for all!” (See Part IV for my personal burnout vignette.) Alas, if only it were that easy.
4. Niche to Ditch World. When a once successful person simply rests on his or her laurels, tries to cruise to retirement, resists new learning curves, or just habitually performs a repetitive job or starts sleepwalking through the work day or a career path then such a person is susceptible to what I call the “Bjorn Bored Syndrome” (BBS); one’s niche of success has devolved into the ditch of excess; see below.
5. Smoldering-Shaming-Post-Traumatic Ghosts, Depression and Disability Demons, and Disruptive Early Childhood Separations. To the degree a person carries around heavy bio-psycho-social weights (seemingly invisible to the bearer as well as to observers until it’s too late) this individual is germinating grief ghosts and is susceptible to “burn-in induced burnout.” That is, a) lingering life cycle losses insufficiently mourned, b) traumatic experiences denied or pushed aside by false pride or shame, c) the poignant pain of early childhood separations and abandonments on both individuals and members of the family system; (e.g., research shows those with major early loss issues when exposed to hazardous situations as adults are more susceptible to post-traumatic effects), d) childhood abuse or bullying; of course, the latter is not confined to the schoolyard – domestic abuse is in the bedroom and worksite bullying is found in the boardroom and on the work floor: the issue of workplace bullying is beginning to share the spotlight with sexual harassment; both may leave indelible scars; or e) a genetic-family predisposition for depression or other mind-body disabilities, along with the stigmatizing societal labels attached by self and others, all may fuel a smoldering, if not burning fire that consumes self-esteem; such mind-body states and traits also intensify the challenge of understanding/managing one’s emotions and developing work performance competency as well as emotionally intelligent relationship skills. These hazardous conditions and predispositions often set the stage for eventual burnout implosion or explosion.
However, with sufficient support from an eco-system along with the motivation and skills to recall, wrestle with, and transform past psychological “echo-system static,” this primal pain may be harnessed as passionate, purposeful, and exploratory energy and ideas for creative adaptation. As I once penned:
For the Phoenix to rise from the ashes
One must know the pain
To transform the fire to burning desire!
So let’s get to know better the pain, despite Carly Simon’s soulful declarations to the contrary.
The Four Stages of Burnout
Whatever the forces and factors of this “erosive spiral,” how can you recognize signs and symptoms? To reiterate, here’s the definition: Burnout is a gradual process by which a person detaches from work and other significant roles and relationships in response to excessive and prolonged stress and mental, physical, and emotional strain. The result is lowered productivity, cynicism, and confusion, a feeling of being drained, having nothing more to give. Doesn’t sound like fun.
Now let’s flesh out “The Four Stages”:
1. Physical, Mental, and Emotional Exhaustion. Do you recognize this sequence? Maybe you’re holding it together at work, but as soon as you get home, right for the fridge, get out the chocolate ice cream or the lite-beer, put on the tube, hit the sofa…and you are comatose for the rest of the evening, or wish you could be! (Of course, I frequently hear, “Doc, you mean there’s something wrong with that!”) Normally you pride yourself on doing a thorough job. Now budget cuts have you looking for shortcuts, if not cutting corners, and this gnaws at your self-esteem. Consistently doing more with less not only can induce a case of the brain strain accompanied by an energy shortage and feelings of exhaustion, but people often start becoming “lean-and-MEAN.”
2. Shame and Doubt, maybe Lashing and Tuning Out. When someone asks you to take on a new project, despite wanting to help does a voice inside scream, “Who are you kidding!” Will supervisors, colleagues, friends and family members sense there’s something wrong? You’re feeling shaky in the present and losing confidence about managing the future – you can even start discounting past accomplishments. You worry that others will detect your compromised state. Or, you begin to project your self-doubt, now impatiently criticizing others or even lashing out.
However, being overloaded, grappling with too many demands along with inadequate controls, authority, and accountability is not the only formula for burnout. The erosive spiral also viciously cycles when lacking sufficient mental stimulation, feeling underutilized, or worn down by numbing repetition. I call it the “Bjorn Bored Syndrome,” named after the late-’70-80s Swedish tennis great, Bjorn Borg. Despite winning four consecutive French and Wimbledon tennis titles, Borg burnt out on the circuit well before he was thirty. (Was the thrill gone?) He had great success, celebrity status, the travel around the world life style…but he also had the drudgery of the all too familiar mind, body, and spirit numbing hours and hours of practice. (And maybe there was an ego issue: he also was losing consistently to John McEnroe at the US Open.) Perhaps his one-time niche of success was turning into the ditch of excess…for Borg it truly was a critical crossroad; he dropped out of the fast-lane. The Bjorn Bored Syndrome: When Mastery times Monotony provides an index of Misery!
Remember, this is not a logical process but a psychological one. Are dark clouds of uncertainty and self-doubt following you? If uncontrollable heavy, labored breathing and exhaling, moaning and groaning are punctuating your day…are you ready to enlist in the Stress Doc’s “Frequent Sigher’s Club?” I’m confident this is one group that will really take off!
3. Cynicism and Callousness. Eventually, some folks have enough of feeling anxious and vulnerable. They start putting on the heavy armor: “Look out for #1,” “Cover your derriere,” “Get out of my way,” or “I could care less,” as well as that instant crowd pleaser, “Whatever,” dripping with scarcasm. And ironically, sensitive or overly accommodating individuals are prone to this personality transformation, eventually developing calloused skin for “self-protection.” Remember, burnout is less a sign of failure and more a sign that you gave yourself away. Not surprisingly, you can become resentful and feel that people are taking advantage of you. In the short run there may be some payoff – you become abrasive enough or give people the darkly silent evil eye long enough and people start avoiding you. In the long term, not only are you projecting a dysfunctional image, but you are bottling up or covering up all this fear, frustration, and sense of failure. When you put on your heavy armor, you may believe “Nobody’s getting to me.” But more likely, “Nothing’s get out.” All that tension and turmoil is bubbling and boiling inside. And the risk is not only a hardening of the psyche; you may be encouraging a hardening of the arteries – high blood pressure and premature heart attacks or brain attacks, i.e., strokes – as well. As I like to say, strong silent types – you Rambos and Rambettes know who you are – usually get a lot more ulcers than Oscars! Which is why it may be better to move into the fourth stage; sometimes folks have to hit bottom before they will admit needing help.
4. Failure, Helplessness, and Crisis. Being caught in a career or relationship catch-22 often signals the final stage: one may feel, “Damned if I do, damned if I don’t; damned if I stay, damned if I leave.” Your coping strategy is coming unglued. In this vulnerable state, you may be especially sensitive to criticism and feel paralyzed, or being impulsive and acting out. Over time, prolonged stress can inhibit the functioning of brain neurotransmitters such as serotonin and dopamine, biochemicals instrumental in mood state, especially feelings of calm, happiness, and joy. And when a person has a genetic tendency or family history of mood instability, has experienced early childhood loss (e.g., the death or chronic illness of a parent) or unresolved trauma (e.g., being raised in a substance abusing family dynamic or, for example, having post-traumatic military stress), then such biochemical predisposition or disruption combined with prolonged stress may even foster clinical depression.
Burnout is like trying to run a marathon at full speed. Without pacing or meaningful stimulation, the mind-body parts wear out, and the mental and psycho-motor apparatus breaks down. In fact, one reason the fourth stage is so disorienting psychologically is that there are cracks in your defensive armor. Emotional memories, those lingering and loitering ghosts, are now floating up to the surface of consciousness. Not only are you dealing with demands in the present but now you are weeping over once significant people you haven’t really thought deeply about in years. You are confused, perhaps fearful over these out of your control memories and mournful sighs. Remember, by the fourth stage, burnout is no longer a logical process but a psychological one. (Do you recall the vignette of the New Orleans businessman/Israeli soldier? And while “Stage Four” sounds terrible, consider this: hitting bottom means there’s no more downward spiral. And if you can reach out, there’s nowhere to go but up. Fourth-stage burnout is the crisis point. Are you ready to reach out for the help and resources you need? Are you willing to connect burnout and burn-in; are you prepared to explore, engage, and embrace your grief ghosts? Are you ready to…Practice Safe Stress?