By Ms Farah Abdullah and Dr S. Mohamed

The pandemic has turned endemic and we have seen many individuals of different professions and academic backgrounds speak of resigning, giving up, ‘ending this pain’, et cetera. Some have even resorted to making negative decisions that may seem unruly to the norm.

Most individuals we come across in our practice ask ‘why don’t I feel happy working anymore’ or simply state ‘I don’t feel like my old self’; expressing overwhelming exhaustion, drained, self-doubt, general dissatisfaction, frustrations, and cynicism. If you feel the same, know that acknowledging this mental or emotional pain you are going through is commendable. Do not feel ashamed of addressing your well-being and getting the help you need.

People at risk for burnout are individuals who disproportionally provide high efforts in the manner of time, emotional involvement, and empathy with poor satisfaction. This is in addition to stressful and high demanding work or schooling conditions. These individuals at risk also lack adequate social support, have poor self-care, and take on more than they can handle at work, school, or interpersonally. Not to mention, bullying in schools and at work do contribute to feeling burnout.

However, it is important to understand the basis and difference between burnout and depression. Many use these terms interchangeably as it has been difficult to separate them. Simply put, one can lead to the other or may present together. Their symptoms do coincide but depression is a clinical diagnosis and both are managed differently. Furthermore, there are certain symptoms of depression that don’t present with burnout, such as low self-esteem, feeling of hopelessness, and suicidal thoughts to name a few. This is why important treatments like therapy or medications may be necessary in cases of clinical depression.

But could burnout be high functioning depression? In our practice, we’ve noted depression resulting in inhibition of desire for activity or action, but high-functioning depressed individuals forging ahead to succeed with goals while having symptoms of depression. Usually, these highly functioning individuals suffer invisibly and are not picked up by those in their surroundings. In short, high functioning depression is more than just burnout.

So what is burnout? Burnout is a phase of complete exhaustion due to prolonged constant stress (emotional, physical, and mental stress). It is a feeling that doesn’t dissipate with taking time off, vacation, an evening run, or soaking in a warm tub. It is progressive and lingers for months to years, differing in intensity from one person to another. It doesn’t go away on its own unless the root of the issue is dealt with.

Symptoms of burnout

Some symptoms of burnout are as follows:

1. Feeling emotionally exhausted.

2. Lack of motivation.

3. Lower productivity including lower stamina and energy.

4. Self-doubt and low self-esteem/imposter syndrome.

5. Feeling of loneliness and detachment or comfortable when isolated.

6. Prolonged stress presenting with the onset of physical symptoms like digestive complications, muscle tension, headaches and migraines, et cetera.

When not dealt with earlier, these symptoms worsen and may progress into depression. One person may present with burnout symptoms and severity differently from another. This is because it depends on one’s coping ability and the burnout stage.

Five burnout stages

With reference to the Veninga and Spradley Model of burnout, there are five distinct burnout stages:

1. The Honeymoon stage. A phase where one is enthusiastic about his or her job and appreciates healthy challenges and copes well healthily.

2. The Onset-of-Stress Stage. After some time in the honeymoon stage, he or she starts feeling an energy drag presenting with tiredness, disturbed sleep, and running at half tank. The coping mechanism at this stage turns unhealthy such as binge-watching, consuming excessive junk food, and many more. However, the job still gets done but with an awareness that there have been better days.

3. The Chronic Symptoms Stage. This is where he or she starts noting aggravated physiological symptoms such as physical illness, irritation, anger, and longer periods of feeling low moods.

4. The Crisis Stage. The term ‘crisis’ is self-explanatory. The previously physiological symptoms convert into psychosomatic conditions like a rise in blood pressure, poor immune system, reflux, and chronic headaches. Also, this stage is where emotional effects kick in such as self-doubt, overwhelming low moods, general frustrations, and more. The feeling of being stuck in a loop of negative emotions kicks in and the common coping mechanism here is escapism; a mental distraction from unpleasant situations (reality) like indulging in excessive video games or fantasising about moving to another country. This negative coping method can have adverse consequences when combined with substance use or other addictive activities.

5. The Habitual Burnout Stage. This is the total shutdown stage. Feeling numb, a complete maladaptation due to not dealing with the earlier stages of burnout healthily. Some personality changes may also be noted at this stage such as a previously jovial person now a party pooper. The pain at this stage is further enhanced when people in the surroundings start judging these individuals and place more pressure on their already burdened shoulders.

It is vital to note that there is no specific end period for each stage and you may go back and forth between stages. The main idea is to keep in mind that you cannot control your stressors, but you can control how you react to them. As the saying goes, ‘An entire sea of water can’t sink a ship, unless it gets inside the ship’.

Managing burnout symptoms

Here are some tips on what you can do to manage your burnout symptoms:

1. Acknowledge you are burnt out.

2. Identify your stressors and aim to avoid them where possible and face them only if required, when you are not running at a negative fuel capacity.

3. Learn stress management techniques like mindful breathing.

4. Seek professional help and understand that there is nothing to be ashamed of in getting the help you deserve. Many anonymous helplines are available.

5. Build a support network, where you can discuss your struggles openly in a safe environment without feeling judged. It doesn’t matter if these relationships are personal or professional.

6. Be on the move. Getting enough exercise or yoga can help relieve stress. These can also be done virtually so you don’t even need to leave your safe environment.

7. Speak up for yourself. Be honest about your situation with your superior. Delegate tasks.

8. Create a work-life balance to feel more functional like applying time-blocking.

9. Set boundaries. Do not allow the outside world to control your mental and emotional well-being.

10. Have a good night's rest with proper sleep hygiene.

11. Most importantly is to do things that you enjoy and remember to have fun.

Prevention better than cure

On a side note, prevention is better than cure. Since burnout is usually chronic, prevention strategies are the best way to approach addressing this burnout phenomenon. In our setting, we promote the 4 R’s Prevention Strategy – Reprioritise, Refresh, Remember, and Reach out.

1. Reprioritise your activities and your work objectives for the day. There is more to life than just work.

2. Refresh your skills or learn new ones.

3. Remember to take a break to help increase overall focus and productivity.

4. Reach out to others. Having a good support system is key.

All in all, we should address the feelings of burnout and the burnout phenomenon in workplaces and schools. Many positive actions can be implemented but it requires attention, empathy, and time from the superiors and policymakers. However, a positive ripple effect can start with you. Keep in mind that anyone can feel burnt out and deserves all the help they need. This person may be your colleague, classmate, spouse, sibling, child, or even you. Check-in on one another. Sometimes a simple hello can make a big change.

-- BERNAMA

Ms Farah Abdullah is an international medical volunteer, active writer, and a mental health advocate who has years of experience working with refugees and war victims.

Dr. S. Mohamed is an experienced senior doctor with the Ministry of Health Malaysia.