wtf is this "burnout" thing i keep referring to?

I've been talking a lot about burnout lately, on the blog, on twitter, and in my personal relationships offline. It has occurred to me lately that "burnout" is one of those words that has been adopted by a lot of people, which may or may not be used correctly. "Stress" and "depression" (and maybe "anxiety") are similar words that get adopted outside of the worlds they are originally defined by and used somewhat easily to describe lots of various states. Just like sadness isn't clinical depression, or feeling anxious isn't panic, stress isn't necessarily burnout.

I have been working on a post about burnout and starting to attempt to "dig out of my burnout hole" when it occurred to me I am probably contributing to this problem by not really taking the time to talk about what burnout is. Given that I'm a psychologist with both a personal and professional interest in burnout, it seemed like a good opportunity to take a time out from talking about me, and talk about what this frame of mind looks like. In clinical psychology, the phrases burnout, vicarious traumatization, and compassion fatigue can be (mistakenly) used interchangeably. Francoise Mathieu, who is a well known in the area of compassion fatigue for practitioners, has a great recent article here that defines all of them. (This will download a PDF)

(Disclaimer: Because I'm a blogger, and because I'm lazy and refuse to allow the blog to become too much like work, I don't have cited resources here. If anyone wants some, I'm happy to pass them along if you email me or tweet me).

Burnout is not stress, but a state of being that can come from prolonged stress. While some of the consequences of stress and burnout can look the same (e.g., insomnia, increased use of drugs and alcohol, relationship problems, low productivity, irritability, fatigue, concentration problems - incidentally many of these are also symptoms of depression, to further complicate the picture), there are some features of burnout that really set it apart from stress. The big ones that personally come to mind are these:

1. Depersonalization - people who are burnt out can experience a sense of depersonalization and detachment. You might feel disconnected from your life, or as if you're watching your life happen without you, or that you aren't very present within your own life. For me this often manifests as a feeling of not really having been home for days or weeks on end, despite the fact that I have been. Or I sometimes will have a sense of missing seasons, or losing track of what time of the year it is (A few weeks ago I briefly couldn't remember if it was the Fall or Spring semester). I'm not sure that diagnostically the experiences I put in this category would hold up, but for me they highlight a general sense of not being present.

2. Cynicism - individuals who are burnt out are also deeply cynical. These are the colleagues who seem angry at everything, who are very bitter, and who might display a sense of humor that seems questionable. Burnout and resulting cynicism is pretty common in academia - especially in situations where we feel powerless against a job structure or system that seems dysfunctional or we have little control over our work or work environment. Because my personality errs on the side of cynicism (although that's not the way I'd describe it internally, I know it can look this way externally), I don't have a good personal radar for when I'm becoming overly cynical. The only checks I have are these: First, when I'm angry all of the time about the same things and/or the same things are getting too much "air time" in my conversations with ECB, for example. Second, when I realize people are trying to problem solve something that for me just felt like an observation. That is, the situation seems completely unsolvable to me, but not to others. Of all the things that happen to me when I'm burnt out, this is the one I hate the most -because it can potentially damage my interpersonal relationships or it can give a really, really negative (and incorrect) impression on people who don't know me very well.

3. Lack of Empathy or Ability to Connect with Others - for practitioners in the health or mental health care fields, this is particularly of concern. When people are burnt out they lose their empathy for other people. Clearly if you're responsible for the care of others, this isn't a great setup. For some people I know this is an early warning sign of impending burnout. For me, it's a late sign. Because I tend to pick up on people's moods and emotions easily - and feel other people's emotions easily - this is a very, very, very bad sign for me. When someone is crying in my office and I'm irritated, or when someone wants to tell me a story and I want to punch them in the face because I have "better things to do," it's a sign things are pretty bad. In the past six months I've made some new interpersonal connections that make me feel happy - and I'm holding on to that reaction tightly, because it makes me feel like I can bounce back if I give my mental health some more attention.

4. Feeling Emotionally Numb - feeling emotionally numb means not having much reaction to anything, positive or negative. It's feeling monochromatic in your emotions, rather than having a healthy range of them. And it feels different than an appropriate level of acceptance. For example, sometimes if a bad thing happens (some type of stressor) we might not get upset and that's healthy. However, sometimes we might not get upset because it's burnout. Feeling emotionally numb isn't something I recognize very easily, but rather something my friends will reflect back to me - for example, ECB will often tell me I don't seem appropriately angry over something that has happened. Or I might describe something with a bizarre amount of positive affect, as if I'm merely amused, when in fact I should be really upset.

I chose my burnout, and I chose to own the consequences, when I chose to prioritize getting tenure over the rest of my life. At this moment, I'm glad I made that choice - attempting to be amazing at too many things (a tenure track professor, a homeowner, a daughter, a friend, a potential date, a human being outside of psychology) was causing me a paralyzing amount of anxiety. However, it hasn't been a good choice (for me) for a number of reasons:

1. I'm not sure how I can turn it back - I have been promising myself I will slow down since the start of May. In case you're not looking at the calendar, that was almost 2 months ago now. Every time I try to slow down and stop working, I feel anxiety. Allow me to state the obvious: This isn't good. I'm at the point where I am seriously considering imposing a vacation upon myself so I can get out of this mindset. That's kind of fucked up. At the larger level, I worry that being burnt out for so long has fundamentally changed parts of my personality, my work as a psychologist, and my relationship with work. I feel a bit of fear that I won't be able to "return" to the person I was before.

2. Burnt out people make questionable ethical choices - this is a particular problem when you're providing care for other people. For example in a study of clinical psychologists, Pope and colleagues found that almost 60% of psychologists reported working with clients when they were likely too distressed to be helpful. As a professor, I am responsible for other people and I do have to make ethical choices. But burnout clouds our judgment and can make decisions that would otherwise look incredibly problematic to us seem not that wrong. Particularly when we need to take careful time to make decisions but we feel pressured to make them quickly and get back to our own things, when we are burnt out and have a severe sense of time urgency.

3. Burnout impairs relationships - I don't even have the energy to explain this. I hope it seems self-explanatory why being depersonalized, cynical, numb, and having no empathy isn't really the best way to connect with others. Maybe it's really for the best I haven't been dating on purpose.

4. Burnout makes me look nothing like what I am "really" like  - a few weeks ago I tweeted part of a conversation with a friend where I said that now that I've achieved my tenure requirements I was looking forward to becoming a person I actually like again. This wasn't necessarily a joke. I have become (in part) a person I don't really like that much. I can't see past my own stress, I can't filter that stress with others. I am exhausted all of the time. I can't concentrate - and the worst thing is I am fucking up all over the place because I can't remember things. I used to be an organized person who never forgot anything. Do you know how unsettling it is to have no recollection whatsoever of an experience you had or something you said to someone or a task you said you'd do? I can't shake how awful that feels. I'm an emotionally sensitive person who is usually there to support my friends - it's like it's been turned off. I hope anyone I've met in the past 2 years can take this as some sort of disclaimer - I'm so much more awesome than I seemed, I promise. If you can hang in there, it will pay off. (Unless you like cynical bitch Psyc Girl and then we probably won't be friends long term because I'd like to retire her).

5. I've learned that I can hit rock bottom... and then keep going - I've learned a really dysfunctional lesson in the past 2 years, in particular. I'm like a car that runs out of gas... and then keeps going. I have accomplished major lines on my CV in a state of burnout and exhaustion that I never would have thought possible. In fact, the past 2 years I've been exhausted (and physically ill for most of them), but they have probably been my most productive 2 years yet. This is not a good lesson to learn. I have no radar for when I need to slow down, no ability to touch base with my body to know when I'm past my limit - apparently I don't have a limit when it comes to work. Instead the limit is personal and interpersonal. I'm grateful for the things I've learned and accomplished, but in a lot of ways I would prefer to know where my professional limit lies. Now I need to learn it from scratch.