burnout

Mental Health

[Part 1 of this post is here.]

I made the mistake of Googling “How to recover from burnout.”

Seriously, don’t do it. No, really, I —
Well, okay. Don’t say I didn’t warn you.

Now that you’ve done what I did and maybe scrolled through some of the amazing tripe that’s out there as advice, lemme tell you: ignore 98% of it.

One of the reasons I no longer practice something called “Solution-focused Brief Therapy” (SFBT) in spite of it being a highly-touted, evidence-based therapeutic intervention, is because it is at best a bandage solution, meant to deal quickly and (IMO) superficially with potentially significant client issues… all for the purpose of returning them to the workforce as Productive Members of Society as fast as possible, thus minimizing impact to the EMPLOYERS and their INSURERS. I’m not going to call it a scam outright, because it does provide some real, albeit temporary, relief to those who seek it. But it’s not an approach I respect for the simple reason that it’s predominantly used to tape up psychic injuries and send internally-wounded folks often right back into the very teeth of the stressors that are grinding them down in the first place.

And you know what that leads to? Burnout. Bandaids ain’t gonna hold jack-shit when we’re talking about the psychological equivalent of disembowelment. (Why yes, I *DO* have Very Strong Opinions on this topic, why do you ask??)

Workplace burnout is fast becoming the primary reason why employees take stress leave, even though what is likely covered by their insurance (assuming they have the luxury of coverage in the first place) is far below what’s actually required for recovery. From an American Institute of Stress 2022 study:

Workplace stress is one of the largest hurdles you can experience on the job. Stress at work comes in all shapes and sizes, across all types of industries and careers. After extensive research, our data analysis team concluded:

  • 83% of US workers suffer from work-related stress, with 25% saying their job is the number one stressor in their lives.
  • About one million Americans miss work each day because of stress.
  • 76% of US workers report that workplace stress affects their personal relationships.
  • Depression-induced absenteeism costs US businesses $51 billion a year, as well as an additional $26 billion in treatment costs.
  • Middle-aged participants had a 27% increase in the belief that their financial status would be affected by stress in the 2010s compared to the 1990s.
  • More than 50% of workers are not engaged at work as a result of stress, leading to a loss of productivity.
  • Companies spend around 75% of a worker’s annual salary to cover lost productivity or to replace workers.
  • The main causes of workplace stress are workload (39% of workers), interpersonal issues (31%), juggling work and personal life (19%), and job security (6%).

That’s a pretty bleak picture, and I suspect the Canadian numbers correlate relatively closely. Under Canadian employment law, “if you are a full-time employee with a work week of 37.5 hours, you earn sick leave at the rate of 9.375 hours each month for which you receive 75 hours pay. Sick leave is prorated if you are a part-time employee.” Under the Ontario Employment Standards Act, “Most employees have the right to take up to three days of unpaid job-protected leave each calendar year due to a personal illness, injury or medical emergency. This is known as sick leave.” Good to see in print that even our federal and provincial governance can’t agree on how to effectively manage sick leave, which is what employees are requesting when they are asking for stress leave. THREE DAYS??? Oy.

Unsurprisingly, many people start with the same assumptions about a stress leave that they might take into a vacation break: it’s time away from work, I’ll feel so invigorated, I’ll get so many non-work projects accomplished, I’ll make such great use of my now-free time! I’ll find a new job! But even a couple of weeks into a leave, they find they often Just Can’t Even, and that’s when they often wind up in my office, or offices like mine. They’re wondering where their motivation went, and why can’t they seem to feel any better even with the time they’ve already taken off.

Burnout is a state that affects us on every level: physically, emotionally, mentally, and relationally. That means recovering from burnout needs targeted recovery processes (note the multiple there) aimed at each and every one of those aspects. And because burnout is often the product of long exposure to the stressORS that have ground us down to mush, it operates very much like a long-term illness. We’ve been “sick” for a very long time, even if we didn’t realize it until that sickness brought our functionality to a crashing, crushing halt. Ergo, we’re not going to “fix” it with a weekend of sleep, a two-week vacation, or even a two-month stress leave. We just can’t. THAT’S NOT HOW BURNOUT WORKS. (And yet, that’s what employers and insurers want us to believe because it benefits them, or they believe it does, to have their employees back in the trenches as fast as possible, recovered or not. They want the bandaids, because then they don’t have to fix their own destructive, systemic issues that create the stressors in the first place.)

So then, how DOES one recover from burnout, if at all??

The first step is recognizing the difference between the stressors, and the stress. Stress is what you experience as a result of a variety of factors (the stressors) having an ugly, corrosive impact on your quality of life.

“Stressors are what activate the stress response in your body. They can be anything you see, hear, smell, touch, taste, or imagine could do you harm. There are external stressors: work, money, family, time, cultural norms and expectations, experiences of discrimination, and so on. And there are less tangible, internal stressors: self-criticism, body image, identity, memories, and The Future. In different ways and to different degrees, all of these things may be interpreted by your body as potential threats.
Stress is the neurological and physiological shift that happens in your body when you encounter one of these threats. It’s an evolutionarily adaptive response that helps us cope with things […] [I]t activates a generic “stress response,” a cascade of neurological and hormonal activity that initiates physiological changes to help you survive[.] Your entire body and mind change in response to the perceived threat.” (Nagoski & Nagoski, “Burnout: The Secret to Unlocking the Stress Cycle,” Ballantine Books, 2019)

Burnout, therefore, is the result of living within the cascading effects of that threat-response pattern over the long term. And as a long-term issue, the recovery is also going to be a long-term process. How long? Well, that depends on too many factors to have a standard formula, but from my perspective, what I’m seeing is that the deeper the burnout, the longer the recovery will take.

I have come to liken what’s actually required for recovery as being akin to what happens when a serious athlete, like a marathon runner, breaks a leg.

At the point of the break, the marathoner does NOT think, “Hey! Now I can go and run all those OTHER races I’ve been meaning to get to for months/years!” No, the marathoner is going to be KEENLY aware of the damage and the pain… something burnout victims are notoriously bad at acknowledging (something, something, frogs in pots of slowly-heating water, something…). In a best-case scenario, the marathoner can get off the course and into help and safety immediately. Sometimes the break happens and the marathoner is going to have to continue on for a while before escape to treatment can happen, which means the pain will be inescapable once realized, and the damage might get worse before it has a chance to get better. Obviously, we want systems that support the former, but all too often we’re trapped in systems that enforce the latter.

Once the marathoner is off the course, then we’re into a healing process that looks a lot like this, and this model is what I’m now using with my burnout clients:

  1. First things first, the break needs a chance to actually heal: knitting bone and soft tissue back together, sometimes with professional intervention, but mostly just letting the brain and body do what they need to do to put broken pieces back together. THERE IS ABSOLUTELY ZERO LOAD-BEARING ACTIVITY AT THIS POINT. There can’t be; the broken bones won’t tolerate it. There’s a lot of rest. This stage usually takes several weeks for both bone breaks and for burnout.
  2. Then, once the bone has knit and the soft-tissue damage or inflammation has largely receded, THEN AND ONLY THEN will a doctor give the okay to start physiotherapy and rehabilitation. This is the stage in which the marathoner is trying to teach new tissue how to do basic things like move and flex, and integrate with the existing tissue. Agin, not a lot of load-bearing activity here. In burnout terms, this is the stage in which people start to do basic functions in their own lives, like tend to personal care or basic relational interactions. They might start THINKING about whether or not to update their resume, but they’re generally in no great energetic state to put their best selves forward in interviews. This stage can take literally MONTHS for both the marathoner and the burnout client.
  3. After that, and only once the medical and phsyio supports sign off, can the marathoner even THINK about starting to move like normal. They’re certainly not in a state to go back to running, but they might be able to take a walk to the end of the block and back. They’ll eventually work up to making it a sloppy shuffling runwalk, and be constantly monitoring the new tissue for pain or other signs of damage. THIS is also a stage that can take months to progress through, and this is the stage where both athletes and burnouts are likely to push too hard too fast, and experience inevitable setbacks when the recovery process proves unequal to the desire to just get on with things.
  4. When there’s a generally-consistent ABSENCE OF SYMPTOMS related the break/burnout for period of time approved by the support system (NOT the recovering individual), THEN AND ONLY THEN is the individual at the state where they can BEGIN to start retraining their body to work back up to a level of pre-break functional capacity. This is NOT the stage at which the marathoner goes and runs a 26-mile race. This is when they start actually running to see how far they can get, or they start for endurance but take it at a quarter-speed. This is when the burnout client MIGHT return to work one or two days a week on light duty.
  5. From there we collectively eyeball a “return to full-function” target but maintain a consistent and careful watch on how the recovering individual does with resumption of the load-bearing factors.

Throughout this, the burnout client, like the marathoner, is hopefully working on adaptive skills to better balance the stressors that created the state of collapse in the first place. This may involve being honest with themselves about what they can and can’t handle; this may involve needing to do different work on managing stressful relationships. This may require changing jobs, or dealing differently with health issues. Some of these factors CANNOT be addressed by quick-fix bandaid solutions, and the entire recovery process is NOT a short-term affair. Burnout can literally take YEARS to recover fully; that part is defined mostly by the client’s ability to adopt and sustain more effective capacity-management strategies, not just “coping” strategies.

Clients don’t like hearing that they could be recovering from burnout for a long time; most people don’t like the notion of being compromised, because it will mean having to change how they live, how they behave, and how they view their own capability, differently for the duration. Employers don’t want to hear that they may be paying full or partial salaries for absent employees for months on end, and insurers put out so many hoops and challenges to those applying for stress leave that it makes it hard to onside medical and mental health professionals who are required to provide corroborating evidence of the client’s mental state for the duration.

I get it. It’s hard. So is being laid up with a broken leg when you’d rather be out running the Boston Marathon or through-hiking the Appalachian Trail. But the point at which you’re willing to acknowledge that something is broken is NOT the point to simply switch gears/stressors and keep applying load to something that has been broken down by bearing too MUCH load for too long.

Heal first. Then start to retrain or add adaptive skills. THEN start to work back up to load-bearing functionality. THEN re-assess that capacity, and make whatever changes will be necessary to maintain yourself at non-breaking levels.

It’s a slow process, but so far, it’s the only one I have seen work, and I’ve been looking at the issues of burnout for a really, really long time.

Mental Health, Uncategorized

In 2019 (when I started the original draft of this post), the World Health Organization released an updated classification for burnout as an “occupational phenomenon”:

28 MAY 2019 – Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition.

It is described in the chapter: ‘Factors influencing health status or contact with health services’ — which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.

Burn-out is defined in ICD-11 as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  • feelings of energy depletion or exhaustion;
  • increased mental distance from one?s job, or feelings of negativism or cynicism related to one’s job; and
  • reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

Burn-out was also included in ICD-10, in the same category as in ICD-11, but the definition is now more detailed.

The World Health Organization is about to embark on the development of evidence-based guidelines on mental well-being in the workplace.

This blog has looked at the issues of burnout many times before (here, here, here). On a personal as well as a professional level–across TWO career fields, no less–I am intimately familiar with what WHO somewhat blithely labels as “chronic workplace stress that has not been successfully managed”.

On one hand, I applaud WHO for putting their eyes on this issue as their attention can have repercussions on a global level. On the other hand, when North American culture seems hell-bent on stripping everyone but the richest of their rights, it means the workload of making things function as the entitled expect, continues to be the only kind of trickle-down effect to land on the common worker. And at the end of the day, people who fear for their jobs are increasingly UNLIKELY to raise concerns and issues about stressors in the workplace that affect their engagement and efficiency, as well as their overall mental health and safety.

This isn’t an issue I know how to solve. Especially since I left IT, this is a discussion I have had with a very great many of my clients who work in IT specifically. This runs the gamut from trench-level workers in support call centres to the content developers (programmers/testers/designers/writers) to system architects, team leads, managers and corporate braintrust-level employees, to HR agents and executives, to C-Suite bosses. Burnout is pervasive in the high-tech industry at levels I have never seen from any other field, with the possible exception of teachers. Stress-induced sick leaves are rampant in IT, judging by my own clientele in two practices, and what I know of the types of clients coming to see many of my colleagues.

Burnout, as “chronic workplace stress that has not been successfully managed” means that several issues are coming to a head in the workplace:

  • unrealistic performance expectations (individual or across the corporate board)
  • demands and pressures that exceed regular working hours and bleed across employees’ private lives
  • artificial pressure to advance and/or transfer around the company for a breadth of experience or “to avoid stagnation” (Google in particular is notoriously heinous for this practice) regardless of the individual’s preference or capacity
  • lacking or insufficient support for employee mental health and balance with life outside of work
  • HR solutions and EAPS that are constrained to get employees back to work as quickly as possible, which always ends up working in favour of the corporations, not the employees
  • corporate practices that reward employees for making sacrifices that then normalize the culture of sacrifice

Organizations like WHO can legitimize the workplace effects of unmanaged stress, but this does nothing in truth to change the sales and management styles of businesses intent of maximizing a profit line no matter how badly they chew through human resources to do so. Looking at resources online dedicated to offering suggestions on retaining talent, I see some common themes:

1. Start with recruiting “the right people” who will “stay the course” (read: “people who won’t complain about getting hired for a 40hr work week who are then regularly asked to work 80+hr weeks).

2. Pay them well, offer bonuses and a good benefits package (read: if you give them enough money, they’ll theoretically never notice they’re missing their children’s childhoods, or their own romantic partnerships, or even sleep).

3. Offer them opportunities for advancement (read: because nothing makes people work harder than giving them goals that they can burn themselves out trying to achieve for the reward of yet more work and stress and burnout…).

4. Flexible work schedules, and a great corporate culture (read: give them all the comforts of home so they don’t miss actually going home quite so much). — edit to add: we did see an enormous shift downward in stress levels for much of the workforce who adapted to working from home during the pandemic, many of whom are not reacting well to corporate pressures to return to the office even part-time as of mid-to-late-2022.

5. Offer praise and affirmation (read: pleasant words on the way to self-sacrifice as a reward for setting oneself on fire make EVERYTHING SO MUCH BETTER, YO).

Okay, so I admit the bias here is exceptionally cynical, but I come by it honestly. These were cultures in which *I* came of age, and these are corporate practices I now watch consume my friends and clients and loved ones on a daily basis. But can anyone else spot what’s missing from these kinds of lists? When we talk about retaining good employees, can you see the glaring hole where the best answers of all should be?

Where in the conversation regarding burnout and retention are the discussions about governance responsibilities? Where is “more effective project/product management” that avoids the common practice of overselling features that cannot effectively be designed, developed, tested, documented, packaged and deployed in a realistic timeframe? Where is the discussion about mitigating the profit craving so that we reduce the factors that produce burnout in the first place, and avoid paying stress leave in favour of making it easier for employees to stay happily at their jobs? Where is the improvement in management that better controls customer-driven scope-creep under project deadlines?

In FantasyLand, for the most part. That’s where. And more and more people are “coming down with” symptoms of stress, fatigue, anhedonia; comorbid diagnoses of depression and anxiety increase exponentially in my clientele every year, even before the pandemic sent those numbers spiralling out into chaos. People take insufficient downtime through the work weeks because they feel they can’t repent of their busy-ness, and when they do take time off as vacation or stress leave, they rarely do what’s needed to recover (more on that in Part 2). Part of recovering from burnout across the board is going to require the corporate culture that engenders the stress to begin with, to take a long, hard look at its own culpability, and step up to change expectations and management styles. That isn’t going to happen in my lifetime, I suspect; stress is built into the very nature of a build-and-deploy, feast-or-famine cycle of software development.

So if we cannot remove or significantly redesign the stressORS, how then do we begin to reframe our understanding of healing from the stress itself? For that, we go to Part 2 of this discussion. Please stand by! 🙂

Emotional Intelligence, Mental Health, Self-care, Uncategorized

[This week’s post is by request. Yes, we take requests! Honestly, anything that gives me some direction more than fifteen seconds before I sit down at the keyboards with the first coffee of the creative day is welcome. Assuming it’s something I actually know something about, of course.]

When I talk about making starting the career change from Hired Pen in IT to Personal Improvement Sherpa, I often use the term, “I hit the wall” as part of the formal narrative explaining what happened. For me, there was probably a large chunk of undiagnosed and probably-not-even-recognized depression already in play, but the biggest factor behind the need to change course lay in a persistent and burgeoning case of burnout. The friend who requested some exploration of this topic is also grappling with something that feels like burnout but with the more pervasive sense that most would more likely associate with depression, in a “absolutely anti-motivated to do anything that is not absolutely mandatory” kind of way; they describe themselves as feeling neither sadness nor despair, nor are they unable to get out of bed. But they do feel “frozen”. There is still a sense of connection to joy and lightness in other aspects of life, but there is no energy to connect with the actions most commonly associated with creating joy and mirth.

Working with as many clients, and still having an exceptionally large number of friends working in IT, I can verify that there is a LOT of comorbidity between the symptoms of depression, burnout, and fatigue. It’s one of the major reasons why, when clients come in with a self-diagnosis of depression, I want to explore more of a general context for what’s happening in their lives to see if there are any systemic factors that might suggest more clearly the predominance of any one of these states.

“Depression is one of the most common mental illnesses, and it can be mild, moderate or serious. There are several different types of depression that can be recognised by different signs. Which symptoms of depression occur and how strong and frequent they are vary from person to person. People in any social or age group can be affected, both women and men. If someone has had at least two of the following symptoms for longer than two weeks, it might mean that they are depressed: deep sadness; listlessness; loss of interest in the things they usually care about.” – US National Library of Medicine

“Exhaustion is a normal reaction to stress, and not a sign of disease. So does burnout describe a set of symptoms that is more than a “normal” reaction to stress? And how is it different from other mental health problems?

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no such diagnosis as ?burnout.? This is unlike having ?depression? diagnosed, for example, which is a widely accepted and well-studied condition. That is not the case with burnout. Some experts think that other conditions are behind being ?burned out? ? such as depression or an anxiety disorder. Physical illnesses may also cause burnout-like symptoms. Being diagnosed with ?burnout? too soon might then mean that the real problems aren’t identified and treated appropriately.” — US National Library of Medicine

Fatigue as a general symptom runs through a lot of these kinds of conditions, running the gamut from “I’m a little tired today but I can push through it” to “it’s a Blanket Forts Against the World kind of day”. Fatigue’s commonality is also one of the factors that makes it more difficult to differentiate between situational burnout and deeper depression, because fatigue is a profound thief. So when we’re talking in session about what’s going on, we explore the presence and perceived impacts of fatigue: how long has it been going on, how often does it impact functionality, what else is occurring in the subject’s life that contributes to exorbitant and draining stress? What aspects of their lives DON’T currently feel like a drain on their personal energy resources? What restores them?

From there we look for burnout symptoms: what are the high-demand attention drains currently (or recently) impacting the subject’s life and energy levels? Where is the balance with self-care and/or external support? How much of their day is being dedicated to these high-demand pursuits, and over what length of time? What other aspects of their lives still provoke joy, delight, mirth, wonder, passion, even if at lowered levels than constitute their normal baselines? The likelihood of burnout being the dominant effect rather than depression is often tied to these discernible draining factors over an undefined-but-probably-extensive-or-ongoing period of time. Without such key indicators as work stress, family stress, personal health stress, etc., we consider the scales tipping more in favour of depression. We also look at bigger systemic factors including family histories around mental health issues/Family of Origin relational modeling/parental alcohol or drug abuse, etc. when looking for indicators of depression.

And finally, we ask the question, “As difficult as it might be to imagine right now, if we took away the fatigue, what kinds of feelings would be left?” Self-reporting clients have, at least in my experience, been clear to indicate whether they expect themselves to “bounce back” and be right as rain again, or whether the nihilistic disengagement from the world would still be a part of the picture. (Self-reporting measures are generally problematic at best, but lacking a verifiable clinical diagnosis for depression, as counsellors and psychotherapists, we operate largely at the mercy of what our clients tell us.) The clients’ own hopefulness about their potential future state provides at least some degree of useful information, and can often gives us a platform (however small) on which to start building that sense of hope into some sustainable, hopefully realistic faith in change and progress. Clients stuck in depression often cannot connect with hope; hopelessness is one of the most common lies depression tells us. But burnout, while it may not allow for significant enthusiasm about the future, doesn’t completeley dismiss it so much as waves a hand at anything hopeful and begs, “Come back later, please”.

Typically, burnout is the result of specific and identifiable stressors like occupational burnout, persistent relationships stresses, or ongoing/long-term care practices for ailing or high-demand family members, for example. When facing burnout we look at rebalancing self-care practices in the short term, sometimes involving very deep conversations about the willing (often repetitive) sacrifice of self-care in pursuit of project deadlines or the drive to care-take others. We discuss the values keeping clients potentially stuck in these kinds of patterns, a conversation that comes up a LOT with driven professionals. Often we have to normalize the fact that corporate mindsets and project management pay a degree of lip service to the nebulous “work/life balance”, then expect the superhuman in terms of commitment to near-impossible project deliverable dates. And in the case of those who persist in “taking on too much” and deliberately, repeatedly pushing themselves into burnout states, we have some conversations around what’s their return on investment that makes doing this to themselves over and over, worth the costs of the pattern?

With depression, the work is more complicated, and may often necessitate conversations about clinical diagnostics (that psychotherapists are, unfortunately, not trained to do) and/or medications to help level out the worst of the symptoms. Because the depression may not be cognitive, it’s harder to shape a therapeutic conversation around motivations, and we may have to work more fundamentally with the bodily experience of depression, up to and including normalizing it as a chronic persistent or recurrent medical condition like diabetes, arthritis, MS, and others. We change how we consciously relate to the presence and impact of the illness when we can’t shift the illness itself in significant ways.

We can do the same with burnout, but burnout needn’t be a persistent issue for people so it’s sometimes less effective to treat it as a persisting condition (though it can be argued that project cycles increase the likelihood of it being recurrent). When burnout becomes a cyclical factor in someone’s life especially, we could really use some increased self-observation to watch for markers of this state sliding into depression. A pervasive sense of inescapability can shift a mindset from the hopeful, “light at the end of the tunnel” coping mechanism to a fatalistic sense that “it will never be any different or any better than this, so why bother?” Losing hope is fundamentally damaging to our mental health:

?Life is never made unbearable by circumstances, but only by lack of meaning and purpose.? ? Viktor E. Frankl

Burnout can leave us with purpose but no energy to engage without a period of recovery and restoration; depression leaves us feeling devoid of meaning or purpose. And fatigue is the river that runs through both states. How we treat any of this depends on our abilities to differentiate between these conditions, and how willingly our subjects can still feel any connection, however tenuous, to hope.