Do you often feel exhausted at work or feel so tired that you are unable to keep going at your job. Do you think it is possible that you may be experiencing “Burnt Out”? It’s not so ridiculous a suggestion as it might first seem. Many people in stressful forms of employment are at risk of this experience and it is important that this is recognised. There is much at stake for everyone in the work environment when it comes to “Burn Out”. 

Burnout is often mistakenly dismissed as an evasion of hard work, or as a handy excuse for laziness, or an explanation for a change of employment or a code-work for mental health breakdown. It is none of these things.  Burnout needs to be recognised and understood for what it really is: a health risk for the employee, a health hazard for the employer, and a potentially serious jeopardy for service users. That is why everyone has a stake in the issue of burnout.

Burnout has been described as a triad of experiences commonly occurring in the context of excessive amounts of stressful work.
These three features are:

  1. extreme levels of exhaustion,
  2. reduced levels of performance and crucially
  3. a loss of concern for/or recognition of the value of the work itself leading to cynicism or depression.

    Long hours without sleep or extreme demands of stressful employment are commonly recognised precipitants of Burnout. Take the example of the long distance lorry driver. Over much time if the driver were allowed to drive day and night without rest or proper breaks or refreshments alarming consequences would arise. After a time the driver exhausted behind the wheel of this vehicle would be unable to drive with sufficient care and worst of all would very likely become unconcerned about the hazards of the driving task. Obviously fire personal, police and first responders of all kinds are at risk and this may be amplified by acute stress reactions associated with exposure to extreme events. Typical burnout is more insidious. It can be seen as an over-use injury that is damaging to brain behaviour and occupational function. 

Junior Doctors are a good example and their experience of Burn Out has been recognised. Now modern legislation is in place mandating that excessive hours should be a thing of the past. The European Work Time Directive is a legislative stop-watch protecting clinicians and patients from the consequences of Burnout caused by excessive time worked by hospital staff. 

All this makes sense and yet the factors precipitating Burn Out are not just about long hours and extreme demands. The triad of exhaustion, diminished performance and cynicism which characterises Burn Out is much more prevalent than that. So what are the other factors that precipitate this transformation of previously energetic, motivated and productive workers into those currently experiencing Burnout? 

In addition to excessive work load and poor remuneration four commonly recognised factors contribute to Burn Out. These are

  1. Lack of Control
  2. Conflict of values
  3. Unfairness and
  4. Breakdown in community.

    Lack of Control

    High demands in themselves may be stressful but when these high demands are combined with a lack of control over the work process the effect can be especially toxic. Much research corroborates this fact and the result is a recognition that increased rates of depression and heart attacks are associated with occupational stress especially where the employee has little say over the time or direction of his or her efforts. 

Conflict of values 

Conflict of values refers to a disconnect between the core values which originally led the employee into the occupation and the perceived values of the employing organisation. This form of burnout is most common amongst vocational employees for whom a sense of values is  just as important as monetary rewards or promotion. Teachers and Nurses frequently experience this kind of stress and burnout. A values driven employee cares about the meaning and purpose of their work. These values probably propelled them through training and sustained them through much stressful experience. Once this employee discovers that their values are not shared by the organisation, then there is a risk that a burnout narrative will emerge. This disconnect of values leads to frustration, cynicism and ultimately depression. 

Unfairness stifles ambition and initiative and this leads to burnout. Where an organisation is seen to have favourites, to behave arbitrarily or even to tolerate bullying, the result will be destructive not just for the employees but also for the organisation. The best modern companies particularly those engaged in the knowledge based or service-led industries recognise the damage unfairness does to the bottom line and so these companies prioritise the welfare of their staff by looking at the fairness of their industrial processes. 

Breakdown in community

Breakdown in community refers to the community of the workforce. This is something that is often missed, but in life we spend enormous amounts of our time at work.  Think of the amount of time spent by nearly 90% of the workforce in their daily labour. The majority of this time is spent at work, relating to colleagues or working with others. Our investment in terms of time in these relationships may be very large especially when compared with the time given to family and friends. In time this investment becomes too much and when this imbalance becomes critical a burnout becomes a big risk. We may be able to distance ourselves from friends and family. We may even separate or change partners in our personal relationships but relationships at work can be very difficult to break or to remove ourselves from. When interpersonal conflict is at the heart of our work environment stress then burnout is a common outcome. In these circumstances there tend to be few winners.

So what can we do to mitigate the risks of Burn Out?

Firstly we could examine our priorities. We might start by looking at our diet and exercise, our use of alcohol and other substances, our sleep and our play, and when we consider these genuinely we would probably find ways to improve our mental health. Suppose we went further. Suppose we chose to prioritise our mental health when it comes to considering our occupation. Maybe then we could promote a shared consciousness at our work place of the values of mental health and maybe then we could speak up for an end the stigma that surrounds these issues in the work place. One practical move would be to promote the development of a mindful workplace by encouraging colleagues to form a mindfulness group at work. Training in mindfulness based stress reduction (MBSR) is available in many settings and a group trained in this could be established in any office or factory at very little cost. 

These are very small suggestions and yet on a grander scale it is surely urgent that we make progress to restore our lives. If we were prepared to examined the balance of our lives and look closely at the gap between the values we once had and the commitments we have now made we might find a very different vista opens up. Once we discover these priorities are in conflict with each other we might be prepared to look at personal practical solutions. What we might call this “practical mindfulness of everyday life” is not for the faint hearted but it could be worthwhile. It could save our lives, and even if we become depressed or overwhelmed we would readily look for help without fear or shame. This too is something that employers and organisations could help with with. In every sense mental health is a matter for us all. 

Most important of all is the understanding that recovery from these issues is the norm. These stresses can be overcome with support and enlightened change. Blame is of no value and shame is destructive of wellbeing. This work place injury “Burn Out” is like any other. It is important that we take it seriously.

By Prof. Jim Lucey MD PhD, Clinical Professor of Psychiatry at TCD and Medical Director at St. Patricks Mental Health Services

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