Burnout—An Exhaustive Pursuit

After completing a lengthy medical and specialty training process, I suddenly felt like I had caught a second wind and was feeling enthusiastic and energetic. As a young physician starting to practice in the Rio Grande Valley during those years, I considered the extensive needs and gaps in services in this area as well as the opportunity to pursue diverse professional interests. From the beginning, I took on three jobs that required at least eighty hours a week of commitment and an intense work schedule. Although I felt I was able to keep this pace for the next 15 years, I started to feel exhausted and at times emotionally depleted. Eventually my body sounded the alarm, which required major changes in my work schedule and redefining a new path forward.

Despite considering the possibility of burnout at that time, I ruled it out, because I felt that I loved my work and was not exhibiting cynicism towards my obligations. I attributed these concerns to physical fatigue related to my busy schedule. Yet, in hindsight, I now consider that my condition at that time indicated that I was running on empty.

I have always enjoyed running. A couple of years ago I decided to run the Chicago marathon and qualified through my support of a foundation focused on suicide prevention. I initially thought that I would make it to through the half marathon mark. But once I got into a steady pace, I decided that I could go a bit further.  Suddenly, at around 22 miles my legs and body experienced a shock, and I struggled to go forward, my mind went through a dark mood but, despite these experiences, I pushed forward. I had heard many runners describe this as “hitting the wall”. Fortunately, I eventually saw and crossed the finish line. I share these personal experiences to highlight that despite having enthusiasm and commitment, an individual might reach an impasse or a barrier that pushes back on our positive intentions.

 I will now review some aspects found in the literature regarding burnout, which has not been adopted by American Psychiatry as a diagnosis in the DSM- 5, yet the World Health Organization’s ICD-10 does place it as a disorder. This syndrome was first coined in 1974 by the psychoanalyst, Dr. Herbert Freudenberger, who had gone through his own experience with burnout after working 12 hours shifts in his clinical practice, then volunteered in the evenings treating people suffering drug addictions in New York City.

It is difficult to define burnout, but it can be understood by its three dimensions: emotional exhaustion, depersonalization/cynicism and diminished sense of personal accomplishment. There are also personal and organizational factors that contribute to burnout. Although most believe that external or organizational factors are more prominent factors, individual characteristics can play a role, including motivation, self-esteem and control issues and frustrated idealism, amongst others. External or organizational factors may include work overload, no control over decision making, insufficient recognition or rewards, disconnection in the workplace, absence of fairness and conflicting values.

Serious outcomes can often occur in those individuals that are experiencing burnout, including physical symptoms like sleep problems, exhaustion, weight loss/gain, drug or alcohol use, headaches or stomach aches, increase in blood pressure and cholesterol.  Burnout can also manifest through psychological symptoms which could include emotional detachment, cynicism, boredom, irritability, impatience, mistrust and excessive worry. Some have described different burnout stages, where initial fatigue can easily be reversed, up to a more severe stage known as “hitting the wall”, where dysfunction can be more unmanageable and detrimental to a person’s health.

It is important to take into consideration interventions to provide relief but, more importantly, to keep in mind preventive measures for burnout. The key components of burnout include emotional exhaustion, depersonalization /cynicism and feelings of diminished personal accomplishment, which gradually can affect self-competency and self-esteem, doubting and lead to being critical of oneself. The antidote to these burnout manifestations is to prevent and repair.

Recently, a 10-year boy with mild autistic spectrum disorder and ADHD who was suffering from chronic stress at school told me when I asked, “What helps you cope?” He surprised me with his answer: “Mindfulness”, which in fact is an antidote for burnout. Mindfulness means being in the moment, being present and engaged in whatever we are doing, as opposed to multitasking.

Dealing with physical and mental exhaustion requires restorative rest, adequate sleep hygiene, putting aside our digital technology and balancing our schedule with physical exercise preferably outdoors in nature. Increasing exposure to ‘“greenery” has been shown to positively enhance a sense of wellbeing. Other helpful strategies include healthy eating and diminishing the level of consumption of caffeine and alcohol.

Addressing a diminished sense of accomplishment might require re-booting; that is redefining what is important to us. What this means is that focusing on what gives us purpose in school, work and relationships can improve personal satisfaction and bring joy to our lives.