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12/11/2021

You've Burned Out. Now What?

https://www.hse.gov.uk/statistics/causdis/stress.pdf

In a healthy alternative universe your workplace protects against burnout by putting policies in place that people are expected to adhere to, things like not sending emails before 9 or after 6 and taking annual leave. It’s a measure of how unbalanced employment has become that the thought of limiting work to one time zone is considered unrealistic.

“Mental health” and “wellbeing” have become fashionable in many workplaces and more often than not serve solely to act as paper-based proof that an organisation is addressing the mental health of their staff. Making attendance of a mental health event compulsory is a huge red flag that your workplace is not interested in anyone's mental health, prioritising PR ahead of genuine attention to what harms or protects people. Careful management of workplace culture, building beyond blunt legal minimums, supporting meaningful activity, observing actual rather than performative productivity, keeping a benevolent rather than a suspicious eye on how many hours people are working is much harder than buying in an ‘expert’ for a few hours and ticking a box.

The number of people experiencing burn out is increasing and paradoxically knowing this you can take heart: it’s not you. It’s the zeitgeist. It’s the culture of work. It’s the culture of your workplace. We so often say “So and so’s burned out,” when it’s almost always more accurate to say “Their workplace burned them out.”

So here you are with a note from your GP and a couple of weeks off. Now what?

Understand that burnout is the equivalent of an RTA.
Your organs, including your brain, have been harmed.
Your immune system is compromised.
You’re very likely to be both anxious and depressed.
You’re very likely to experience physical problems - headache, stomach ache, muscle pains, blurred vision, palpitations, high blood pressure.
You’re very likely to be exhausted - not tired, exhausted - irritable, jumpy, fearful, tearful, angry, bewildered, resentful, feel guilty and shameful. (Guilt is about what you’ve done. Shame is about who you are.)
You can't make decisions, including what you want to eat or what film you want to watch.
And you don’t have a bruise or a lump to show for any of it.

This can be difficult for partners and friends as well as you to understand. In some senses it would be easier if you had been knocked over and had pins and plates in your leg from a severe break: people would send you grapes, not invite you out to dinner and not be surprised when you don’t return to normal after a week.

Rest
This is often easier said than done. Insomnia and restlessness are part of the adrenalin/cortisol response which become disordered under chronic stress and deranged in burnout. You may sleep for 16 hours or 2 and in the first few weeks even if you get enough sleep you may only be able to shower and brush your teeth before feeling exhausted. Slumping in front of the TV is ok, it’s what box sets are for. If you have children call in all the Covid-safe help you can get, don’t for one moment feel guilty about it.

Talk with your GP
Ask your GP for an MOT and ask how they feel about testing your thyroxine and blood sugar levels along with red and white blood cell counts - it’s only 1 needle. Low or high thyroxine levels, anaemia, incipient diabetes and underlying infections make everyone feel lousy and are easily treated. Women over the age of about 40 might want to talk about HRT - no blood test is yet sensitive enough to pick up on perimenopause but symptoms can be controlled safely.

Medication
I’m not a doctor, your GP is expert in the side effects and interactions of medication and how they may help or harm you as an individual.

If you had diabetes or dangerously high blood pressure you wouldn’t expect to tough it out, you’d take the meds because you don’t want to go blind, get your foot amputated or have a stroke, and you’d consider what changes you could make to help your condition. So it is with stress and burnout. Physiological changes from burnout can lead to heart attacks and strokes, weight gain with all that this can lead to, and hormonal changes. This is not all in your head, burnout is also very directly in your body.

Propranolol is a drug that is primarily used for heart problems but it works well for anxiety too. It’s been used by some Olympians to reduce unhelpful performance anxiety and is so effective that it’s been banned in sports. Propranolol reduces the impact of adrenaline, doesn’t make you feel strange, isn’t addictive and when you don’t need it any more there’s no withdrawal. It isn't an antidepressant. It helps stop anxiety from becoming a habit, and helps break that habit.

If you’re unable to be still or get any sleep, your GP might offer a very limited number of Diazepam tablets and a sleeping tablet called Zopiclone. Diazepam can offer extraordinary relief from severe anxiety, Zopiclone can help reset short term insomnia. Both drugs will cause dependency which is why GP’s prescribe so few of them. In the right circumstances they can offer real relief.

Many antidepressants also help with anxiety, some can be effective in helping you sleep. You’ll need to give them a couple of weeks to work properly and for your body to adjust: the right pill at the right dose for the right length of time can be a good support.

Take a good multivitamin, plus magnesium and vitamin D, every day. Give your body the support it needs.

Try to establish small routines
Sleeping and waking
Aim to be in bed and to get up at set times. Our bodies are very like the bodies of other animals, so just as your dog learns through repetition when it’s time to be walked, to be fed, to play, to go to sleep, so do we. A sleep routine might be: 6pm have supper (go to bed on an empty stomach) 7pm wash up, 7.30 watch a film, 9.30 read, lights out at 10. A waking routine might be: get up when your partner does, wash, get dressed, have breakfast, wave the kids off to school, clear up, rest.

Food and water
Aim to eat 3 nutritious meals a day - if you can afford it consider buying in meal kits where ingredients are weighed out and good quality and recipes are simple. Drink a little water every hour, drink more water than coffee or tea, and more tea than coffee - set an alarm to remind you, don’t put it off. Your brain and the rest of your body need water.

Exercise
Don’t worry about exercise to begin with.
We’re so immersed in the idea that every waking hour must be used to improve our defective selves that the idea of not doing purposeful exercise can seem counterintuitive. But your brain and body are worn out. Just as you wouldn’t consider going for a run on a broken leg, so you are now allowed not to use every waking hour to prove how productive and driven you are.

Don’t stay in bed but do learn the joy of pottering. Clean the bath. Write a letter. Put the dishes away. Polish some shoes. Do some laundry. Sit in the garden. Mend something. Play with the dog. Read the kids a story, have a conversation with them that doesn’t involve education or self improvement. Have a conversation with your partner that doesn’t involve planning for the future - plants, elephants, Bolivia, anything that’s interesting but not necessarily preparing for some kind of task.

Try to get out once a day, buy a paper, sit in a cafe or post a letter, mainly to breathe deeper and get some daylight, even on a rainy, cold day. Walk the dog, take the kids to the park and keep the rest of your diary free.

You’re aiming for a small sense of satisfaction at the end of the day.

Give yourself time
Two weeks seems like a massive indulgence but burnout can take months to recover from. GP’s know how impactful burnout is and will happily sign you off work. In my experience it’s the person who’s burned out who is anxious to prove they’re not slacking that puts pressure on themselves. HR understand the reputational damage to an organisation that burns people out which is intensified if they pressure people back to work.

Expect very little from yourself but allow each day to pass knowing that you’re soothing your nervous system, resting your overstimulated brain, glands, heart and other organs, allowing them to return to normal function as they will over time. In 4 weeks you’ll see a noticeable difference which you can trust your body and mind to build on. Don’t set goals: if you fail you’ll become anxious and disappointed. Healing is not an exam-tested subject, this is an opportunity to watch your body and mind find their own way.

Money
If you’re employed you are legally protected from returning to work before you are well enough. This legislation exists because untold numbers of people have been severely harmed by terrible employment practices. Take the legislation seriously. In a couple of weeks talk with HR who will have all the details including how much pay you are entitled to while ill. HR exists to protect the employer from legal liabilities - they will not want to be taken to court - and they will be clear on next steps. Many organisations also have occupational health staff who can help an employer understand what individual people need, and if your organisation has one, use them.

If you are self-employed you are still entitled to financial support, and don’t hesitate to claim it. A benefits system is a measure of a civilised society. The forms are notorious, you're not stupid if you can't fill them in, they're designed to prevent people from claiming, so ask for help from one of a number of agencies.

Therapy
In therapy, which people often come to in the first weeks of burnout, we talk about how they’re feeling, keep an eye on things like sleep and how relationships with partners and children might be, see how things are ticking over. Over time we begin to look at where their concepts of work, worth, status, identity might have been built, where they absorbed ideas and ideals from, how they came to understand different things to be more or less important. In time we take a long overview of how parts of the past may have led to this place, what may need to be tweaked to make the future more balanced, and begin to experiment with how it is to start doing that. It can feel like a conversation, it’s absolutely not any kind of test or education, and people consistently find that they know what they want and need from their future, rediscovering innate skills to slightly alter how they approach parts of their life. A one degree change in trajectory results in a very different direction.

Rest. Let things evolve. Take help where it’s available. You’ll get through this.

5/11/2021

Burnout In People Who Are Not White, Well-Off Men.

A great deal of the literature on burnout is written about white, middle class men. The explosive anger, irritability, cynicism, becoming distant with partners, friends and children that the literature describes are all real and all much more likely to manifest in people where these behaviours are accepted.

Imagine a woman, whether in the boardroom or anywhere else, standing up so quickly she pushes the chair over and storming out of a meeting. Becoming explosively furious about little things. Shouting at people who work with her. Bingeing on alcohol or drugs. Spending all night on a video game. Punching a hole in her office wall.

Imagine a person of colour doing that.

Imagine what would be said about that woman, especially a black woman.

Compare it with what is said when white men do exactly these things.

Burnout is brutal whomever it happens to and it manifests and is treated differently depending on who expresses the accumulated angst of a particular workplace. A number of studies suggest that burnout impacts more women than men and that the pressure on black women means that they are "paid less and have to work twice as hard to be noticed or gain the same opportunities as peers."

Covid definitely has had a different impact on women than on men. It’s quite straightforward that on average mothers do more housework, childcare and caretaking in general than fathers, and covid added full time teaching to the mix.

Women are more likely to feel frustrated at work because on average we’re more likely to be in positions with less authority, earn less than the equivalent man and therefore have less power to create changes to faulty processes. Our ideas are less likely to even be heard, let alone acted on. This is compounded for black women where “higher effort/reward imbalance, greater job demand, and lower control over work were all associated with work stress.”

It’s quite clear that sex, ethnicity and income have definite impacts on wellbeing in any context, but how might it manifest in people who are not well paid white men?

I’d propose that the main difference is that anger is stifled. People who are used to having to shut their mouths to avoid punishment learn to swallow their anger and are much more likely to turn that exasperation, overwhelm, shock, awareness of inequity, impatience, and discomfort on themselves than people who are used to being listened to and taken seriously.

In general, women have learned to ‘tend and befriend’ in stressful situations while men are more likely to respond with ‘fight or flight’. It takes a lot longer and a lot more energy to build and cultivate relationships than it does to blow them off.

A vital difference is the exhaustion that different groups can bear: women expect to do most of the thinking and planning as well as most of the work around relationship building, housework and childcare while being employed. The energy it takes to simply not be a well-off white man - absorbing everyday insults, both unconscious and conscious, and the monstrous impact of knowing that if you're murdered it's no big deal, or that you can be more qualified than your boss and still not be taken seriously, of not having the financial ballast to take a taxi rather than the bus at the end of a crazy day, to have breaks or treats or to eat well, to not have food just appear - can’t be overstated.

Endurance becomes a muscle that is necessary to over-develop so please lets never speak of 'resilience' ever again. McKinsey addresses this head on, it’s easier for many people to look at these issues as a matter of productivity and reduced liability than of simple, appalling facts.

So while white, well-off men will also work harder in an attempt to do better, people who are not them are working very hard as a baseline. While the pain and frustration of a job that has lost meaning is awful for anyone who experiences it, people with less power have less opportunity to do anything about it and are often much less tolerated if they express that pain. While the environment around white, well-off men bolster them against the problems of a workplace and of the world in general, the environments around people who are not white, well-off men compound those peoples problems.

It’s a cliché that in similar situations men get angry and women cry - god help the man who cries or the woman who gets angry - but when women and people of colour internalise all this it can manifest as depression, anxiety, brain fog, headaches, muscle pain, coughs and colds, binge eating or reduced appetite, digestive problems, things that take them to their GP who will give them meds to deal with symptoms. Whereas when white, well-off men burn out they are much more likely to quite rightly take time off work to recover.

No matter who experiences it, burnout is not weakness, it’s a symptom of inefficiencies that disproportionately impact engaged, intelligent people who do more than just follow orders. When it manifests dramatically in people who are allowed to be dramatic it's taken seriously: it’s so much easier to ignore its clear manifestation in people who have been taught to keep their heads down.

There are still a great many organisations where open sexism and racism are everyday realities, where people in power push the boundaries of illegal behaviours because they know no one will stop them. If this is your workplace, get out. Respectfully acknowledge the internalised voices of friends and family who told you to grit your teeth and take it, and then put them to one side: all you need to take is your self-respect, your entitlement to sick leave and the time to apply for new jobs in a market that has suddenly opened right up.

You absolutely do not have to fight this fight for anyone else. Why would you turn to face an enemy when you have so few resources? Recover first. Rediscover the strengths of community, mutual support, right relationships, being able to ask for and accept genuine support and re-member who you are.

Therapy can be a useful adjunct to this process, many workplaces offer it as a benefit. Black and Brown clients who may not resonate with any therapist offered by an EAP might also want to take a look at Black, African and Asian Therapy Network, Aashna Counselling and Psychotherapy, Nafsiyat, or the Muslim Counselling and Psychotherapy Network.

4/11/2021

Burnout

“Burnout” has become a bit of a buzzword, being used to describe feeling exhausted and stressed. Exhaustion and stress are real, but burnout is another level of collapse.

I’ve seen more cases of impending or actual burnout in the last 6 months than I have in 17 years. Covid has meant that workplaces and people have had to turn on a sixpence but this doesn’t seem to be a foundational problem for people experiencing burnout.

If there’s one defining issue, it’s loss of meaning.

There will be a number of reasons for this, but since I have no control over how businesses operate it's probably not useful to go into them here.

People can work extraordinarily long hours and not burn out because they’re gaining some reward. Money helps but this is seldom the problem. When you can see no end to pointless or even counterproductive activity it’s utterly demoralising. Your team's goals are X, you have particular skills and experience in X and your organisation is doing Y even while it’s saying it’s committed to X. You’ve spoken with whomever you need to, used all your interpersonal and managerial skills, and you become aware that nothing is going to change. But you can’t quite believe that superbly qualified people in a high status organisation are going down this route, you just haven’t communicated with them properly, so you work harder, learn more and chillingly, come to the same conclusion.

One of the signs of burnout is the belief that if you just work harder things will improve. From the hamster turning the wheel the wheel begins to turn the hamster. Sometimes this results in the hamster being thrown from the wheel - people having accidents that force them to take time off work - the midwife who falls and breaks both wrists, the producer who takes their first break in months who breaks a leg while skiing - fateful escapes that force them to realise that the world did not come to an end when they did not go in to work. People who aren’t thrown off the wheel can work harder and start achieving less, adding to their confusion and misery.

It’s worth looking at these two pages that describe burnout, one from the NHS, one a classic 1996 Harvard Review of Books essay.

The NHS page talks about “Individuals who are not emotionally self-sufficient” who “engage in avoidance coping strategies such as denial, disengagement, or substance misuse” or who “react negatively to situations not meeting their high standards” who don’t have “the ability to reinterpret or reframe a challenging situation optimistically.”

The NHS, while superb at diagnoses, has ancient history of blaming people for their own suffering, something that many workplaces replicate.

The HRB is much more nuanced while being just as straightforward about “ (1) chronic fatigue; (2) anger at those making demands; (3) self-criticism for putting up with the demands; (4) cynicism, negativity, and irritability; (5) a sense of being besieged; and (6) hair-trigger display of emotions.” as well as being “indifferent to friendships and often hostile. They had become rigid, had short fuses, and were distant from their children.”

but adds: “Understandably, managers tend to rely on their best people; but the best people are more vulnerable to becoming burned-out people. The overconscientious, in particular, need to take time off from the demands of their role and to spend that time in refreshing recreation. The military has learned this lesson, but management has not.”

Britain is well know for our lousy management skills and I don’t want to get into why that may be here. But creating scapegoats is a tried and tested way of turning the truth-teller into a sacrifice that makes everyone else feel temporarily good about themselves. Get rid of the troublemaker and the office can get back to normal. But now there is no truth-teller and so truths begin to be felt by everyone once more and the cycle continues.

If you’re seeing signs of burnout in yourself, think very hard about what you’re doing. Know that it can take many months, sometimes years, to recover and not infrequently that means not being able to physically do anything other than sleep and watch TV for weeks.

If you suspect you may be beginning to burn out and are in a role with decent sick leave and pay - most managerial and all executive roles do - take it now. If you’re stuck with statutory sick pay, don’t bother putting the extra hours in: do your job, go home at the end of your hours, look for ways to get a job where you’re treated with a little respect or at least earn enough to create savings to see you through a decent break.

If you’re not yet at that point, how would it be to tell your manager that you won’t be looking at emails before and after set times? If you’re afraid of doing this, this is information: why would an adult be fearful of putting entirely reasonable limits around their workload? Globalisation is real and so is the need for R&R. UK productivity compares poorly with France who instituted the right to disconnect in 2016.

Bullying is everywhere, especially in those professions that are linked with caring. Corporate and commercial organisations have learned that a culture of genuinely addressing abuses of power is linked to greater productivity and a better reputation. Even so, standing up to bullying often takes more energy than it’s worth. Consider if discretion might be the better part of valour: seeking a new role before your confidence is eroded may be the best choice.

If you find yourself asking why you’re trying to save an organisation that seems intent on wasting time, money and resources TAKE NOTE. Test the waters, ask for guidance and clarity and if, having received it, you still believe your employer or department is actually working against itself, think very hard about getting out. It doesn’t matter if you’re right or wrong, if you simply do not believe in what you’re doing but remain, you are very likely to burn out.

Don’t wait until you hate your manager and divide your colleagues into enemies and allies, don’t wait until your manager asks to have an informal word with you about your attitude or productivity, don’t wait until your partner, children and friends get tired of your inability to be with them or of your irritability and ranting when you are.

Therapy can help you stand back, take stock, strategise on how to improve your life and gain some understanding of how you got here. Burnout can be devastating. Don’t wait for it to savage you before you acknowledge it.

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You've Burned Out. Now What?

Burnout In People Who Are Not White, Well-Off Men.

Burnout

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