Burnout and Its Remedies


The sources of chronic stress and inflammation need to change, which means the toxic work environment needs to change.

Who isn’t feeling ‘burnt out’ after two and a half years cursed by COVID-19?

What is burnout? Who is at greatest risk for its pathogenesis? We only have to look in the mirror to get an answer. and what else Another Yoga class can reduce the severity and duration of burnout?

Define burnout

The term Burn out– a contraction of Burn out or burned out—initially denoted a reduction of a fuel or substance from its current use.1 It’s no surprise that the term has found widespread use today to describe how so many of us feel as we march through the demands of our lives.2 Workplace burnout, particularly among frontline doctors and nurses, has been exacerbated by the never-ending pandemic.3

The colloquial term Burn out describes a wide range of physical symptoms and common emotional problems listed in the table.

Burnout can occur in a variety of settings (although we’re looking at healthcare here). It is not a psychiatric illness and therefore does not appear in the DSM-5. Burnout often resembles clinical depression and can be misidentified as such. Although the symptoms of both overlap, burnout should not be confused with depression. The fundamental difference is that burnout is a response to persistent and significant extrinsic Stress, from the working conditions and/or the construction site. Burnout is different from depression (and other similar disorders) and requires different remedies than depression.4.5

For example, burnout among doctors and nurses in hospitals and clinics is the result of working long hours (to cover shortages); isolation from colleagues and friends; an endless exposure to death and disability; an unrelenting burden of providing medical care during a massively disruptive pandemic; compromises in family life; and the high risk that the coronavirus poses to doctors and nurses, their spouses, children and other relatives.

These are extrinsically distressing conditions in which physicians and nurses are particularly (though not exclusively) plagued by burnout. Burnout among our colleagues and friends does not set anyone free: we are them.

The stress response

Excessive and prolonged stress continues to pull on the triggers that release cortisol and adrenaline, hormones that can cause inflammation in many organs of the body, including the brain, pancreas, heart and vascular system, and joints. This includes important almost everywhere in our body.6

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Although acute inflammation can help heal wounds and prevent infectious diseases, chronic inflammation is implicated in many very common diseases, including diabetes, heart attack and stroke, osteoarthritis, depression, substance use disorders, Alzheimer’s disease, and even cancer. Chronic inflammation also shortens the caps (called telomeres) on the DNA in our cells that hold the helix together. As the tips erode, the helix unravels, increasing the risk of cancerous mutations during cell division. All in all, chronic inflammation is the enemy of our health and well-being.6.7

There are proven ways to reduce chronic inflammation, including mind-body interventions (e.g., meditation, mindfulness, yoga, yogic breathing) as well as diet and exercise, and the positive effects of trusting, lasting relationships.6 But these wholesome activities, important as they are, offer limited protection from the ongoing stresses of a harmful environment. The sources of chronic stress and inflammation need to change, which means the toxic work environment needs to change. Wellness activities enable stress tolerance, but do not get to the heart of the problem.

A person caught in the crosshairs of workplace stress bears no guilt or shame. After all, we are all human. How much can a person take?

The authority to change arduous working conditions or the exigencies of the moment (as in a deadly pandemic) is not generally within the power of the worker. Those in leadership and management roles must not shirk their responsibility to do as much as possible to reduce stress and enable healthcare workers (in this case) to look after their patients, their families and themselves.

What lies in the personal control of healthcare workers?

Workers would do well to demand free child care, flexible shifts, supervisor and peer support, exemption from educational loans or other debt, assistance with personal/family housing, meals, and the like. Yet we know how constrained hospital managers must be in times of financial free fall. This isn’t exactly a “rock and a hard place” as mindful business leaders recognize the need to look after the well-being of their most valuable assets, namely their doctors, nurses and professional staff.

Taking care of ourselves is in no way opposed to holding clinical organizations and their management firmly accountable for providing less toxic and more supportive work environments. Even as workplace conditions improve, we still owe it to ourselves, our families and our colleagues to do more to stay the course and continue to contribute. This is no easy task in the face of exhaustion and helplessness, but personal control is a means of making us feel less at the mercy of our environment and actually benefiting from our efforts.

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There are of course the aforementioned mind and body activities that can reduce your stress, including exercise, yoga and meditation. These activities work and are free. Some are regularly offered at workplaces. But you can ask: And that’s it?

burnout and creativity

I was invited by Psychiatric Times™ to write specifically about burnout and Write (as a form of creativity). Mind-body activities can calm an overworked mind and promote well-being. However, the benefits of creativity are different from the benefits of yoga and meditation. Creativity lights up our mind. It invigorates, clarifies and expresses what counts in our lives. As Andrew Solomon, a lighthouse in the nonfiction writing world, observed, “The opposite of depression isn’t happiness, it’s vitality.”8th The opposite of burnout is no different.

It serves you to write with your “voice”, which comes from the richness of what you feel and think. It can be your oxygen. You know you’re in this zone when fatigue goes away, as does aches and pains. Time can be fluid, with few boundaries. Writing is exercise for our mind; maybe it’s the antidote to a runner’s high. Writing is my oxygen – not just a scratch.

Writing about your work and life

We don’t have to have a god-given talent to write. writing is a craft9-12 no foundation – an outstanding award because writing is for everyone. But like any craft, putting words to paper requires learning and practice. Writing is hard work, but the kind that leaves you with a sense of mastery and the joy of a job well done.

My greatest (and only) writing coach was the late Bill Zinsser.9 For example, he compared the craft of writing to the craft of plumbing. A plumber gets up and goes to work. You don’t feel like fixing a leaky sink or a broken toilet. Like plumbing, the craft of writing is mastered through learning and practice.

When writers write for themselves, it is their passion that grips the reader, regardless of the subject: fly fishing, music, film, books, family, climate, crime, race, the joys and sorrows of everyday life, work, the game, baseball, and other sports, disasters and joy, animals and plants, the Rubik’s Cube of human nature, and so on. Write about what is happening in your life. Who has time to research other topics?

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Although there are many ways to write nonfiction, including blogs, commentaries, reviews, letters (remember?), and books, it’s your passion, not the form, that engages readers.

If you can think clearly, you can write clearly.13 Your expertise and experience count – use them. Write with your readers in mind. Imagine what you write is no different than conversing with a reader over a cup of coffee at their kitchen table. Also remember that brevity is a blessing: stay away from polysyllabic words and keep your sentences and paragraphs short.

end up

This essay packed a lot of information into less than 1700 words. Thank you for finishing it. However, as Winston Churchill said, “This is not the beginning of the end, but the end of the beginning.”

Enjoy your writing, and your readers will too.

Mr. Sederer is a psychiatrist, public health physician, and non-fiction author. To learn more, visit www.askdrlloyd.com.

references

1. Burnout. Merriam-Webster. Retrieved July 1, 2022. https://www.merriam-webster.com/dictionary/burnout

2. Depression: what is burnout? National Library of Medicine. Updated June 18, 2020. Accessed July 1, 2022. https://www.ncbi.nlm.nih.gov/books/NBK279286/

3. Physician burnout. Health Research and Quality Agency. July 2017. Accessed 1 July 2022. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

4. Burnout: symptoms and signs. WebMD. December 3, 2020. Accessed July 1, 2022. https://www.webmd.com/mental-health/burnout-symptoms-signs

5. Ninivaggi FJ. depression and burnout. psychology today. November 7, 2019. Accessed July 1, 2022. https://www.psychologytoday.com/us/blog/envy/201911/depression-and-burnout

6. SedererLI. Improving Mental Health: Four Secrets at First Sight. 1st Ed. American Psychiatric Association Publishing; 2016

7. Blackburn E, Epel E. The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier and Longer. Great central publishing; 2017

8. Solomon A. The Noon Demon: An Atlas of Depression. scribe; 2015

9. Zinsser W. Of Good Writing. HarperCollins Publishers; 1976

10. Zinsser W. Writing About Your Life: A Journey Into The Past. Da Capo Press; 2005

11. King S About Writing: A Reminder of the Craft. scribe; 2000

12. Lamott A. Bird by Bird: Some Instructions for Writing and Living. Pantheon Books; 1994

13. SedererLI. Eight enemies of good writing for the lay reader. Psychiatric Times. January 25, 2017. https://www.psychiatrictimes.com/view/eight-enemies-good-writing-lay-reader



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