Burnout, Chronic Stress, and Self Care
BY: T. Franklin Murphy | March 9, 2020 (edited July 13, 2021)
We can deplete energy through emotions, mental and physical exertions. When we push too hard, for too long, we burn out. Recovery requires a lifestyle change.
We get tired, I mean really tired. Not just I-couldn’t-sleep-last-night tired but exhausted physically, emotionally and mentally. Long days, accumulating responsibilities, and lack of recovery create a perpetual stress that invades and destroys well-being. For recovery, we need more than a couple lazy weekends. When over extended, the effects of burnout linger, disrupting essential rest and restorative enjoyments. Ultimately, a lasting recovery requires changing our lifestyles to shake off the physical and psychological damage of chronic stress.
Herbert Freudenberger (1926-1999) is a leading figure in Burnout Syndrome research and awareness. Physical and mental exhaustion existed long before Freudenberger coined the word burnout.
People have suffered exhaustion throughout recorded history. An illness that spread through middle-class, religious communities during the nineteenth century was labeled Neurasthenia. Neurasthenia was hardly ever fatal, but as destructive as infectious disease, leaving sufferers bedridden for weeks or even months. “Most sufferers . . . reported back problems, digestive ills, exhaustion, headaches, insomnia, and melancholy” (Ehrenreich, p. 80). Neurasthenia is the nineteenth century version of modern burnout.
Freudenberger was part of the counter-cultural movement of the 60’s and 70’s. He took a voluntary position at a free clinic in the San Francisco Haight-Asbury district. He acted as a surrogate parent to young clients. The work, however, was grueling. He routinely put in sixteen hour days, meeting one-on-one with clients and training volunteers. The clients were in perpetual crisis. Freudenberger routinely participated in all-night interventions, assisting clients through the constant traumas common to addiction and homelessness.
Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.
After a year at the clinic, Freudenberger had a complete breakdown. The demands of the free clinic were more than he physically could accomplish. Completely exhausted, he was forced to take a leave of absence. After his return, Freudenberger discovered that several other volunteers experienced similar exhaustion (Hoffarth, 2017). He blamed his break down on his overly dedicated attention to helping a population in extreme need “they continually take, suck, demand . . . requiring continuous giving on our part” (Freudenberger, 1975: 75).
"After a year at the clinic, Freudenberger had a complete breakdown. The demands of the free clinic were more than he physically could accomplish."
In 1974, Freudenberger described burnout in print. Burnout, he defined, was a work related syndrome with three main characteristics:
Another pioneer is Christina Maslach (social psychologist). According to Maslach, burnout is a stress state characterized by mental exhaustion, physical fatigue, detachment from work, and loss of energy (Traunmüller et al. 2018). She conducted research on a proposed remedy—detached-concern. Wellness providers and businesses often prescribed detached concern to caregivers as a way to moderate emotional arousal and prevent compassion fatigue. Maslach discovered that this approach often failed, leading to extremes of no-concern, and treating clients in detached or dehumanizing ways.
Detached concern is a natural protector, preventing emotional overwhelm. When physically, mentally or emotionally exhausted, we detach. Emotional detachment is a defensive response. Detachment has protective qualities but obstructs quality interaction. Current research supports the importance of the relationship in assisting populations in need. Carl Rogers’ unconditional positive regard and John Gottman’s emotional attunement are examples of this indispensable tool for assisting others with personality development. Emotional connection benefits both the professional and the client. However, these connection come at a cost.
Possible Contributors to Job Burnout:
Various factors contribute to work stress and eventual burnout. A few of these factors include:
Lack of control: When we lack authority to make basic decisions that affect our job — such as our schedule, assignments or workload — the lack of control often increases work stress, leading to job burnout.
Unclear Expectations: If we're unclear about the expectations and job duties, we constantly fret over our performance. The mental gyrations are exhausting. Expectation and feedback rejuvenate.
Dysfunctional workplace dynamics: toxic environments are draining. Bullies, micromanagement, external scrutiny add to stress.
Extremes of activity: When a job is monotonous or chaotic, we must exert constant energy to remain focused — which can lead to fatigue and job burnout.
Lack of social support: If we feel isolated at work and in our personal life, we might feel more stressed. Relationships lift and energize.
Work-life imbalance: If our work takes up too much time and energy, we neglect essential rejuvenating time with family and friends, this contributes to burn out quickly.
Burnout and Empathy
We each experience empathy differently. “Someone with very sensitive emotional antennae for his own feelings who observes the pain of another will feel that person’s anxiety or sadness in both mind and body—experiencing a surge of the stress hormone cortisol, for instance, as well as elevated heart rate and blood pressure. Such extreme sensitivity is likely a factor in the burnout that nurses, counselors, therapists, and social workers suffer.” (David, 2016, location 1158).
Ideally, if we are in a caregiver role, we emotionally attune to clients, feeling empathy and giving compassion, however, this shouldn’t be expected unconditionally. When emotional connection creates too great of a strain, burnout may fallow. Many programs are finding solutions to this well documented paradox. The ultimate success requires substantial efforts from both employees and employers.
Current studies on burnout don’t limit the syndrome to service workers. Burnout is now treated as a condition of chronic stress. These new definitions of burnout make it relevant to all careers, not just caregivers.
"Burnout can leave people feeling exhausted, empty, and unable to cope with the demands of life."
Elizabeth Scott | verywellmind
Maslach created a twenty-two item inventory (MBI) to measure three hypothesized aspects of burnout syndrome: (1) emotional exhaustion; (2) depersonalization; and (3) lack of personal accomplishment. Her inventory is still in use.
The MBI includes questions such as:
I feel emotionally drained by my work
I feel used up at the end of the workday
Working with people all day is really a drain on me
I feel very energetic
I feel frustrated by my job.
In my work, I deal with emotional problems very calmly
A recent Gallup poll reports that 23% of workers report feeling burned out very often or always. Another 44 % report feeling burned out some of the time (Employee Burnout, Part 1: The 5 Main Causes). Last year, WHO officially classified burnout as a syndrome. While burnout has widespread medical costs and negative impacts on production, the most devastation is felt by the individuals. Much like nineteenth century sufferers of Neurasthenia, victims of burnout are often questioned about the validity of their illness, accused of being weak or sneaky.
Impacts of Emotional Exhaustion
Emotional exhaustion impacts more than work efficiency. Exhaustion follows us home, robbing valuable enjoyments and interfering with healthy connections. Freudenberger experienced this, reporting he no longer enjoyed family vacations; his collapse soon followed. Constant stress becomes normal, relaxing feels wrong. Instead of recovering, a healthy break is wracked with guilt that ratchets stress back to accustomed levels.
When we habituate to chronic stress, our minds feel amiss when its gone. Rejuvenating escapes feel empty, prompting guilt for engaging in meaningless activities. Hans Selye, known for his research and writing on the stress response, observed that people become addicted to their own stress hormones, adrenaline and cortisol.
There is a trajectory between fatigue and burnout. Fatigue is a normal response. We feel fatigue after a grueling day. Normally, we feel rejuvenated with a good night’s rest. Survival activities demand energy, and depleted energy fatigues both body and mind. We recover from fatigue with rest, completing a recovery cycle. Fatigue is normal—a sign of healthy engagement.
Phillip Zimbardo, famous for his Stanford Prison Studies, emphasizes the importance of recovery. He wrote that when recovery cycles are not providing sufficient rest or relief from work to replenish energy that workers suffer from a condition of chronic weariness. (2008, loc. 7987)
"Possible causes include feeling either permanently overworked or under-challenged, being under time pressure, or having conflicts with colleagues."
National Center for Biotechnology Information
Burnout is perpetual fatigue. The mind and body never recover, eventually leading to exhaustion. The workplace demands haunt the mind and body away from the office. Never allowing the body to reestablish a homeostatic balance.
Burnout begins with physical exhaustion deepening into a sense of meaninglessness. What often begins with a deep desire to do a job well turns into numbness, resembling depression. Our bodies eventually put a foot down, “enough is enough,” withdrawing. We typically need employment, so we trudge through the motions but begin a protective disengagement. While we must continue to show up, we already have mentally and emotionally withdrawn.
We, the diligent workers that we are, try to fake it. Smile when we aren’t necessarily happy. The ‘fake it ‘til you make it’ adage isn’t always successful. Susan David, author of Emotional Agility, writes, “At work, though, the more you fake your emotions, or surface act, the worse off you’re likely to be. Too great an incongruity between how you really feel and how you pretend to be becomes such a chore that it leads to burnout and all sorts of related negative consequences at work, both for you and for your organization, in part because it’s just so friggin’ exhausting” (2016, loc. 2655).
When we invest cognitive, physical and emotional energy in a project, we are engaged. Engagement is the positive antipode of burnout. As burnout rises, engagement suffers dragging creative energy and productivity with it (Fragoso et al, 2016). Engagement is dedication, absorption and vigor that typically follows work that is intrinsically rewarding. However, burnout and engagement are not on opposite ends of the same pole. Freudenberg was certainly engaged in an intrinsically rewarding project. He just failed to properly off-set his work with necessary recovery. Unmediated engagement takes over our lives, chasing the important, sacrificing the essential.
"Engagement is dedication, absorption and vigor that typically follows work that is intrinsically rewarding."
Chronic Stress and Burnout
Engagement is akin to Mihaly Csikszentmihalyi ’s flow. “This ability is related to interest by a feedback loop of mutual causation and reinforcement. If you are interested in something you will focus on it, and if you focus attention on anything, it is likely that you will become interested in it” (1998, p. 128). This feedback loop of attention is disrupted in burnout. We quit giving attention because we’re exhausted. Energy to attend is a limited resource. Once our reservoirs of energy are depleted, we have nothing left to give—to anything.
Chronic stress is closely associated with burnout. Stress or stressors are not the enemy by themselves. Stress is an essential part of living organisms, activating survival responses. Acute stress is a biological response to a threat. We perceive a threat, our body activates a response, and we act. Once the stress cycle is complete, we recover. Chronic stress activates stress mechanisms that we can’t complete, either because we don’t recognize the stress or we have no control over the stressors (Maté, 2011, location 684). A defined beginning and end to the stress cycle is ideal. We stress, we respond, we recover.
Chronic stress leads to serious illnesses such as cardiovascular disease, depression, anxiety, and drug and alcohol dependency. Stress activates the nervous system. Hormonal excretions signal to the body a need for additional energy. The normal functions of the body shifts, borrowing energy from immune protections, digestion, organs and other regulatory functions.
These energy shifts characterize the flight-or-fight reactions to combat immediate danger. Maté explains that, “these biological responses are adaptive in the emergencies for which nature designed them.” He continues, “But the same stress responses, triggered chronically and without resolution, produce harm and even permanent damage. Chronically high cortisol levels destroy tissue. Chronically elevated adrenalin levels raise the blood pressure and damage the heart” (location 686).
"Burnout can affect anyone, at any time in their lives. However, a recent study has shown that the average professional experiences burnout by the age of 32."
A chronically activated stress response means chronically increased blood pressure, placing a burdensome demand on blood vessels. Our bodies begin to wear down under the constant weight of stress, eventually collapsing. We must release pressure by recognizing the source and turning off the spigot.
Maté warns, “when we have been prevented from learning how to say no, our bodies say it for us.” In order to prevent burnout, we must see the incoming disaster and make significant change.
Impact of Chronic Stress
To better understand the impact of stress, we must examine stress in biological terms, not subjective feelings. Modern day demands create a perpetual stress. We are so accustomed to stress that we are oblivious to the happenings in our own bodies. Subjectively, we may believe we are fine. The stress response, however, still activates. Our biological system prepares for a life threatening attack, leaving our bodies in biological overdrive, waiting for a response.
The threat destabilizes homeostasis—the ideal biological state required for flourishing (and survival). We function best under certain conditions. When events destabilize, the experience of stress mobilizes forces to regain balance. Maté suggests that “we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat. We keep ourselves in physiologically stressful situations, with only a dim awareness of distress . . .” (Location 708).
Freudenberger made these points explicit in his book Burn-Out. He advised readers that the ‘single biggest gift’ we can give ourselves is a readily-available commodity known as self-awareness (Freudenberger and Richelson, 1980: 204). Self-awareness is commonly referred to as mindfulness.
Only when we are aware can we do something about it. We must develop a lifestyle that values recovery. We can say, ‘no’ to events or habits that have a negative impact on wellness. A critical element of this lifestyle change includes purposeful self-care. “The over-arching goal of self-care activities has been to maintain equilibrium or homeostasis within the system. . .” (Bressi & Vanden, 2016). For burnout, we’re talking about a mindfulness of stressful body states and the impact of external stressors on our being.
We ignore the internal stress, repress the signals, and therefore the stress remain invisible.
Three Components of Stress
The experience of stress has three components. First, there is an activating event—an emotional or physical event; then internal processing, interpreting the event as threatening. And finally, a physiological, psychological, and behavioral responses to resolve the perceived threat. Effective self-care addresses all three components of the stress experience. We limit stressful events, improve cognitive interpretations, and respond more effectively.
We think we are impervious to heavy demands. We are not. The greater the demand—emotional and physical—the thinner we spread finite resources. We fool ourselves, thinking we have infinite strength. We do not. Key to successful prevention is limiting stressful events, keeping them within our capability to process.
My personal financial collapse of 2008 prompted extra hours of work. My work week jumped from a healthy forty hours to a dangerous average of seventy hours. Physically the extra work was draining. However, my life seemed to be okay. From my subjective perspective, everything seemed under control. I was actually proud of working so many hours. We silently respect those willing to destroy their lives in pursuit of financial success.
The heavy workload paid financial dividends. I recovered financially. However, even though I engaged in many self-care practices, the heavy demands exceeded internal resources. I had an emotionally demanding job—a police officer in a large city. Injuries started lingering. I experienced new pains and discomforts—dizzy spells, deteriorating vision and a few unmentionables.
The physical cost was minor. The mental and emotional exhaustion extracted a higher cost. New emotional events cut much deeper. I would ruminate incessantly over emotionally demanding events. My mind couldn’t find closure. Before I could turn the page on one event, another trauma would intrude. The emotional events accumulated, lingered and began to haunt.
We must manage workloads, keeping energy available for unplanned surprises. If we continuously push, the body borrows from other essential functions, and soon physical and mental wellness deteriorate.
Interpretation of Events
The second component is internal interpretations of events. We interpret both cognitively and implicitly. Our perceptions increase or reduce stress. Our interpretations flow from our beliefs. One harmful belief is an expectation of perfection. Albert Ellis quipped, “stop shoulding on yourself.” We create impossible demands, setting up failure. We condemn our actions, peppering our self-esteem with harsh judgments, “I should have done this,” or “I should have done that,” creating unnecessary stress. We need to stop “musterbating” (another Ellis word) and accept imperfection. We improve harmful, stress-inducing interpretations with kinder cognitive reappraisals. Self-compassionate appraisals go a long way.
Susan David suggests that “self-compassion actually sharpens your edge. After all, it’s associated with health behaviors such as eating right, exercising, sleeping well, and managing stress during tough times, which is when you need to care for yourself the most. It even strengthens your immune system, helping to ward off illness, while encouraging social connection and positive emotion” (2016, Location 937). I believe this is true. Self-compassion provides significant stress relief by removing the constant aggravation of a mean inner critic.
Response to Stress
The last component of the stress experience and self-care is the response. A healthy response brings closure. We may acknowledge stress but fail to respond effectively. We defer stressful action, buy time, but allow unfinished projects to linger in our minds. We need effective, organized responses. We perceive a need, our body activates, and we respond, the stress-response cycle is complete. Effective action crosses projects off the to-do list by focusing attention and concentrating efforts.
However, our response to chronic stress needs more than a pragmatic organized doing. We need to address the illness as a whole, as a consequence of an imbalanced life. A primary objective of self-care is recovery. An essential response to chronic stress is structuring our life to include rest and recovery.
Sarah Wilson wrote, “Many of us with anxiety don’t look like we’ve got a problem because outwardly we function ludicrously well. . . Our anxiety sees us make industrious lists and plans. . . We are a picture of efficiency and energy, always on the move, always doing. . . The more anxious we are, the more high-functioning we will make ourselves appear, which just encourages the world to lean on us more.” (2018, location 451-459).
The more organized and efficient we are, the more likely we will be given more responsibilities. The pile of work is constantly fed, no matter how fast and efficient we prove to be. We must set the pace within our capabilities.
In self-care, the basics are the best place to start—sleep, healthy diet, and exercising. When work intrudes on these primary areas, a red warning flag must be waived. Increasing stress and decreasing homeostatic activities is akin to desiring to lose weight while increasing calories and decreasing movement. The math doesn’t add up. The cost is a perpetual deficit where our must bodies decide how to pay the debt—PTSD, devastating illness, mental breakdown.
Lisa Barrett wrote that, “the science is crystal clear on healthful food, regular exercise, and sleep as prerequisites for a balanced body budget and a healthy emotional life. A chronically taxed body budget increases your chances of developing a host of different illnesses. . .” (2018, p. 178). Daniel Amen pinpoints burn out disruptions to the deep limbic system. He also prescribes rest, exercise and a nutritious diet (2015).
David Reynolds in his enjoyable book Constructive Living commented, “Eating, exercise, and sleeping are basic anchor points of living. . . A lot of moodiness, depression, nervousness, and even craziness improve when these simple needs are met in regular fashion. Erratic uncontrolled lifestyles produce erratic uncontrolled people” (1984).
Paradoxically, the activities that balance our mind and bodies are typically the first sacrificed when time and energy are limited. We borrow energy by eliminating balance.
Many ignorantly follow the same path, fail to limit stressors, abandon healthy basics and then look for something to add to their overflowing plate to give them more energy. Instead of managing stress, we want ways to cope with those insane stressors. Give me another pill, doctor. We hold a flippant attitude; we believe we can cheat biological certainties by relieving the onslaught of stress with a few mental gymnastics and two pills to calm our nerves. It doesn’t work.
Effective coping has an important role. However, coping skills can’t perform magic by creating an inexhaustible source of energy. Effective coping skills mediate the weightiness of stress, limiting the drain on resources. Coping works in conjunction with lifestyle management. When we sprain an ankle, we ice, take anti-inflammatory and . . . STOP RUNNING. Treating chronic stress needs the same intelligent response.
Here are a few activities, skills and practices that improve coping:
Effective self-care is a re-balancing of life, cutting back on insane workloads, focusing on the basics and adding rejuvenating activities. If we don’t, we may find our bodies adjusting for us. We must be honest and open, examining the happenings underneath our skin. Our exhaustion is telling a story of a life out of balance, slow down, make the change and discover recovery.
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