Burnout: Do you have the grey dog?

26 minutes

Contributors

Gordon Parker

Professor,
University of New South Wales and Black Dog Institute

Emma Madsen

Founder,
The Carers Club

Episode Notes

Feeling burned out? It’s not surprising: experts say we all have a 30% chance of experiencing it. (Sorry to doctors, teachers and others in caring professions: your chances are way higher.) In this episode, the founder of the Black Dog Institute, Professor Gordon Parker, explains what burnout is, why it’s often misdiagnosed, and which personalities are most at risk of experiencing this syndrome which can impact our relationships, personality, and brain function.

Transcript

Ginger Gorman (00:00):

All right. So Emma, we are recording now. So if you just want to do a self-intro for me, that would be excellent.

Emma Madsen (00:06):

Hi, I’m Emma Madsen. I’m the founder of The Carers Club. I am a bereaved carer, I’m also a mama of three.

Ginger Gorman (00:16):

Emma sounds like a busy person, and right now she’s pretty on top of things, but that wasn’t always the case.

Emma Madsen (00:23):

Super forgetful, just forgetting simple things like, even just turning the oven on at the right time, or the back hose or whatever. And I would lose train of thought mid-sentence. Yeah. Just vague out a bit. I call it the zombie state where you just, I don’t know. You’re just not there sometimes.

Ginger Gorman (00:44):

Sound familiar?

Emma Madsen (00:45):

Getting home, driving from work or something home and then going, “Huh?” Forgetting the drive. You zonk out.

Ginger Gorman (00:53):

And also I find myself reading passages of text that I need to retain for work, and I just haven’t taken them in and I might read them three, four times. And then I think what’s wrong with me? It’s a similar kind of thing to driving somewhere and forgetting where you are or-

Emma Madsen (01:07):

Yeah. You’re on autopilot, but your brain’s got no room left to put anything else into it. Way more cranky, way more impatient. Snappy. That’s definitely what happened to me. And it actually resulted in me changing things with my workloads and things like that, because I recognized it in myself.

Ginger Gorman (01:27):

What Emma recognised in herself was burnout. It’s not the same as depression or anxiety, the mental illnesses that we are getting better at recognising and treating. But that doesn’t mean it’s not debilitating.

Emma Madsen (01:40):

I realised I needed more of a work-life balance. I realised I needed to not feel so guilty about having downtime during my day a bit more, because I am a bit of a perfectionist, which is another personality trait for this burnout stuff. And I just felt like I had to have the house, on top of the house. I felt like I had to be the perfect mother. I had to be the perfect colleague. And it just gets too much. And then I end up being not a very nice mom at times, and that’s… It’s opposite to what my value system is, where I want to be the best mom, but then I’m getting cranky at them because I’m so burnt out.

Professor Gordon Parker (02:15):

The principal symptom when somebody has a burnout syndrome is exhaustion.

Ginger Gorman (02:21):

Professor Gordon Parker is a professor of psychiatry at the University of New South Wales, and the founder of the Black Dog Institute. He’s also a fellow of the Academy of the Social Sciences in Australia.

Professor Gordon Parker (02:32):

What we find is that people with burnout will describe feeling mentally exhausted and physically exhausted. And even though they may have poor sleep, or they might even sleep excessively, they will still describe exhaustion. So that’s its central feature, but then there are a number of others.

Ginger Gorman (02:50):

Gordon’s research teams from the University of New South Wales and the Black Dog Institute have come up with the Sydney Burnout Measure. It’s in the book Burnout: A Guide to Identifying Burnout and the Pathways to Recovery, which Gordon co-wrote with Gabriela Tavella, and Kerrie Eyers. It’s a test that you can take to measure your own level of burnout. You might be feeling so burnt out that the idea of taking a test fills you with dread, but I gave it a go, and guess what?

Professor Gordon Parker (03:22):

That’s a fairly high score. But in our book, we suggest that in addition to completing a questionnaire, the individual needs to employ clinical reasoning. If you get a high score, you could have burnout, as I said. On the other hand, if you’re extremely depressed, or were having chemotherapy, or you were struck down with COVID, you would also probably get a high score.

Ginger Gorman (03:50):

This is Seriously Social, I’m Ginger Gorman, and I’ve had cancer treatment, I’ve been depressed, and would you believe I was just getting over COVID when I interviewed Gordon? Remotely, of course. So what exactly is burnout? How do you recognise the symptoms, and when you are so exhausted, how do you find the energy to overcome it?

Professor Gordon Parker (04:29):

Hundreds of years ago, actually in the fifth century AD, burnout was described as a cardinal sin, as afflicting the monks. So the monks would be working hard in the service of looking after people, and then wake up one day and say, “The sun is no longer shining. I’m exhausted, and I’ve lost faith in God. And I’ve lost compassion for other people.” And as a consequence of those latter two components, it was actually regarded as a Cardinal sin.

Ginger Gorman (05:00):

Well, that explains a lot about the guilt that comes of burnout. If you’ve been burned out, you know what I mean. Knowing on an intellectual level that others have it worse than you, believing you should be able to just enjoy the life you have, but also wanting to tell people, even your own kids, to suck it up when they come to you whinging about their problems. Sorry. They say empathy is impacted by burnout, and that was certainly Emma’s experience when she was enduring the toughest time in her life. I asked her to have a look at the Sydney Burnout Measure.

Emma Madsen (05:38):

It was really interesting reading also about how personality types tend to burn out a bit more than others. And so I’m quite an empath, always have been, take on a lot of other people’s concerns and those sorts of things. But when I was caring for my mom, she had brain cancer, a stage four GBM brain tumor. She was quite young, she was only 50, but then I cared for her up to her death. And during that time, burnout was really full on in my life. I had a one year old before she passed. I’d just given birth, we were in hospital at the same time, to my second child. So I had all that going on plus looking after her. And what I noticed was… and then had guilt afterwards I had to work through after she passed… was sometimes when in that burnout phase, you just get a bit less empathetic with the person that you’re looking after.

Emma Madsen (06:31):

So you end up getting frustrated with them more. You might be a bit more snappy. You get a bit more… Not as kind as you would like to be, a bit resentful. It can lead into a bit of resentment. And also you get less, maybe, have less empathy for people around you with maybe their own struggles, because even though you care for them, you’ve just got nothing else to give. It really impacts on your relationships and your grief process afterwards, because then you look back and go, “Oh, I was such a bitch,” or something, at the time. And I wish I would’ve been kinder in those moments to Mum, but I was just so burnt out, and so stressed.

Ginger Gorman (07:07):

Here’s Gordon again.

Professor Gordon Parker (07:08):

Lack of empathy has been long emphasised. It’s also been described as compassion fatigue, particularly in health practitioners, but there are a couple of problems with it. Firstly, some people experiencing burnout never experienced a psychological syndrome before in their life. Many doctors, for instance. And once they experience it, they actually will say, “Now I’ve got more empathy for people who have psychological symptoms.” People tend to become asocial. They keep to themselves. They turn down invitations to mix with others, and so on. So it’s this lack of feeling tone, a lack of vitality, a lack of gusto in life, that I think is a broader and better descriptor.

Ginger Gorman (07:53):

It certainly made me think about the feelings I have of burnout, and then also I will often at the same time be a much less empathetic mother. I’ll be much shorter with my children, much crankier when they hurt themselves, for instance.

Professor Gordon Parker (08:09):

Yeah. Some people, when they have burnout, get differing psychological concomitant symptoms. Irritability and anger are particularly common. They’re not central to the definition, but they’re very common, as are other features such as sleep disturbance, increased infections, inability to get out of bed being so profound that people might not be able to do it for days or even weeks.

Ginger Gorman (08:36):

As you heard earlier, Emma and I also had a shared experience of mental fatigue, a sort of cognitive impairment.

Professor Gordon Parker (08:44):

It’s rather like baby brain is experienced by many women. So they’ll say, “I can’t register information as clearly as I should. I forget things. I can’t focus as attentively as I would do generally.” And this reflects the impact of the cortisol, which is generally increased in acute burnout states, actually damaging parts of the brain where memory, and concentration, and attention are focused. So it’s a very significant and distinctive component of burnout. And I would say that it’s mandatory in the definition of burnout. If you are wondering whether you have burnout, then you must, in my view, have some level of cognitive impairment.

Ginger Gorman (09:38):

Before Gordon and his colleagues developed the Sydney Burnout Measure, the dominant assessment for burnout was the Maslach Burnout Inventory.

Professor Gordon Parker (09:46):

So if we compare our measure to the MBI, yes, we both share exhaustion. Yes, they have lack of empathy. But we tweak that a bit to say a lack of feeling tone. We both include impairment in work performance. We, by comparison, also have this withdrawal/insularity dimension, where people just tend to keep to themselves, stay alone. We have the cognitive component that I’ve emphasised. And we also add the unsettled mood, the anxiety, the irritability and depression.

Ginger Gorman (10:24):

Gordon’s interest in developing a more comprehensive burnout test came from personal experience.

Professor Gordon Parker (10:30):

A few years ago, I developed a few symptoms and I wasn’t sure quite what they were. And I wondered whether this was just a predictable old age cognitive decline, whether in fact, I might have a level of depression. And so, I did some reading on burnout, and realised that I had fairly classical symptoms, although they were relatively mild. And once I realised that this was the likely diagnosis, I chirped up immediately, and decided, as I have historically over the decades, if there’s a construct or a psychiatric label that’s in existence, can its definition be improved? Can it be reshaped? And so the interesting consequence of developing some mild burnout symptoms was it drove me to research the domain.

Ginger Gorman (11:24):

What were you noticing in yourself?

Professor Gordon Parker (11:26):

I noticed that I would just tend to be quite content to go off and have lunch by myself. And while my socialising within the family wasn’t affected, and still obtained great pleasure from my wife and children, and the grandchildren, I was tending to turn down a number of social invitations. So I was just becoming a bit more insular.

Ginger Gorman (11:52):

So who’s most at risk of burnout?

Professor Gordon Parker (11:55):

Those in the caring professions are much more likely to have burnout, and they have higher prevalence rates than those in the general population. The general population rate’s probably around about 30%.

Ginger Gorman (12:09):

Wow.

Professor Gordon Parker (12:10):

But at any one stage, doctors will have a prevalence rate of about 30%, and a lifetime chance of about 60%. And so we go across all of the health practitioners, we get high rates, we go across teachers, we get high rates. Clergymen have particularly high rates, and that sort of makes sense. So the caring professions are overrepresented, but in addition, lawyers have very high rates of burnout. Burnout is overrepresented in people who are dutiful, reliable, caring, and perfectionistic. And I think that’s the best explanation for why there are so high rates in those in the caring professions, and those in lawyers, because if you are not reliable and dutiful and perfectionistic, then in fact, you’re not going to handle your position well, and you run certain risks. So the sad aspect about all of this is that burnout is much more likely to be experienced by kind and caring people. And I was chatting on this topic to somebody when I was playing golf a while back, and he just turned to me and he said, “Gordon,” he said, “I now understand why sociopaths never develop burnout.”

Ginger Gorman (13:26):

Well, that’s true though, isn’t it? They don’t fit into these categories.

Professor Gordon Parker (13:30):

They don’t care for other people.

Ginger Gorman (13:32):

That’s fascinating to me Gordon, because we’ve never, in literature about this until now, seen that personality is a factor that feeds into this issue.

Professor Gordon Parker (13:43):

That’s right. It’s been left out of the equation, or minimised, or when examined, people have said it’s not existent. But probably a few other personality styles that are overrepresented. For instance, type-A people, people that are constantly on the go, they work 80 hours a week, and they have great difficulty when they retire, and they’re impatient, and they dominate conversation. They’re a bit more likely to develop burnout. But the key personality style is being dutiful, and reliable, and conscientious. And that’s why there’s another component to the whole literature. It’s largely focused on people in formal employment, and of course it’s commonly reported by people who are in caring positions at home, and obviously more likely to be women rather than men who are caring for children, particularly children with disabilities or frailties. And/or parents who might be dementing and have high demands, or the so-called sandwich generation, where looking after both children and parents with demands. So, we’ve also seen burnout in those who are not formally employed, and that’s also been minimised in the literature.

Emma Madsen (15:03):

I can tell from my own personal experience, being at work all day’s a lot easier than being a caregiver. It’s a different kind of stress, but it’s not the same emotional, and physical, and mental load. I think that happens more in the caring roles.

Ginger Gorman (15:18):

Emma also learned that she wasn’t alone in feeling burned out as a mom.

Emma Madsen (15:23):

It was interesting. A therapist told me, and a GP backed it up, that they say they met [inaudible 00:15:29] women burnt out either six months post-birth, or when their youngest child is about around four and a half, when they’re about to go to full time school. And it’s almost like our bodies or our minds or something go through survival mode, boom, boom, boom. Just getting through it, getting through it. And then we have a moment of breath, and then we feel burnout. It’s like we have a big sigh, and our bodies are so tired we have sleeping problems, and we are like, we’re happy. We’re happy. We love our kids. We love our partners. We love what’s going on in our life, but I’m just exhausted, and I don’t know what’s wrong with me. And I think that’s where the burnout’s coming out.

Ginger Gorman (16:07):

There’s no formal diagnosis for burnout. It’s not in the DSM-V, which is that diagnostic manual for mental illness. So it’s often misdiagnosed as a number of different ailments.

Professor Gordon Parker (16:21):

The most common one is depression, and in fact, there are many authors in the field who argue that burnout is just a synonym for depression. The two are the same. We don’t buy that, and our analyses don’t support it. Quite a while ago, I saw a woman who had two children who were born with intellectual disabilities, and from the moment of birth, they cried 20 to 22 hours a day, seven days a week. Her husband left her, and she was on an isolated country property, and she only got family support about three hours a month. She was referred to me for treatment for clinical depression.

Professor Gordon Parker (17:03):

When I saw her in those days, I knew she didn’t have depression because she was very reactive in her mood, she had good light in her eyes. She could be cheered up, and she was in the zone that she was in with me, showing no symptoms of depression, and not actually experiencing depression. So taken out of the stressful situation, there was no depression. So, the risk is if we fail to recognise that burnout can exist in people with demanding domestic responsibilities, then the real consequence is they may miss the diagnosis, but even worse, they may get a false diagnosis of depression, where I ran that risk, and put on antidepressant tablets, or given some other intervention that is quite inappropriate and irrelevant.

Ginger Gorman (17:54):

But burnout and depression aren’t mutually exclusive.

Professor Gordon Parker (17:56):

The problem emerges is that a significant percentage of people with burnout will develop a depressed mood, and other depressed symptoms. But that is a consequence, and that does not mean that the two are synonymous. And the treatments for burnout and depression should differ distinctly, and that’s why it’s important to distinguish.

Ginger Gorman (18:16):

As the founder of the Black Dog Institute, Gordon refers to burnout as the grey dog.

Professor Gordon Parker (18:22):

People with burnout say that the sun is no longer shining, and the sky is no longer blue, and life looks grey. So it’s somewhere akin to depression, but able to be distinguished.

Ginger Gorman (18:36):

And it’s a phenomenon he wants people in his own profession to give much more attention to. Why do we need to change it so that someone like myself might turn up to the doctor with these symptoms, and get a burnout diagnosis and not a depression diagnosis?

Professor Gordon Parker (18:53):

If I just mention my history, as a medical student, as a young doctor, as a psychiatrist in training, as a psychiatrist over many, many decades, I have never received a lecture on burnout. I have never received any educational input on the topic, and I think that goes for most health practitioners. It’s gone under the radar. So the importance of defining it properly, and positioning it as a clinical syndrome, is to ensure that when people do have a burnout syndrome, they actually get that as the right and the valid diagnosis, and they do not get an inappropriate diagnosis and inappropriate treatment. And so therefore we need richer definitions of burnout, recognition that it occurs, is overrepresented in people with dutiful personality styles. Recognition that it can be differentiated from depression, and maybe medical states causing fatigue. And so despite burnout having existed for nearly 2000 years, and its formal naming for over 40 years, medical practitioners are very much in the dark in terms of its diagnosis and management.

Ginger Gorman (20:10):

It’s seen more as if something you say casually, rather than a formal diagnosis.

Professor Gordon Parker (20:16):

Yes. And there’s a problem with that, in that it’s not uncommon for people to, let’s say they’ve done a 24-hour shift. Maybe in some service industry, maybe in a hospital. And as they’re walking out, they’ll say to a colleague, “I’m actually absolutely burnt out today.” So that’s its popularisation, where it can risk being minimised and seen as trite. But it’s a false application of the term burnout.

Ginger Gorman (20:46):

So, what can we do to pull ourselves out of this grey dog?

Professor Gordon Parker (20:49):

There are so many books on burnout that you’d be burnt out reading them all, but when you do read individual books, most people are coming up with a one size fits all model. We offer a pluralistic model, and by that, I mean we suggest that there are differing components that need to be focused on. So the first component is to identify what are the work stresses that are pressing your buttons. And so we actually have an appendix for people to complete, and they’re not just variables such as excessive work hours. They can be the environmental factors, very noisy, too much light. It can also be conflict with core values, of the particularly employing organisation, a whole series of work stresses. So people can check that and identify which ones are salient to them, to then fashion a strategy to improve things. Secondly, we review the literature on de-stressing strategies and we look at what the sample of 1200 people told us.

Professor Gordon Parker (21:52):

And we melded the two, and the most important de-stressing strategies appear to be exercise, and it’s better if it’s strenuous exercise, obviously having a holiday. Then after that comes mindfulness and meditation. And then after that come a whole series of predictable, also de-stressing strategies, be it yoga or whatever. And they’re important to employ and to keep on employing. And then the third component, which as I’ve already alluded to is almost never picked up, is to do something about one’s personality style if that’s making a contribution. So if you are highly perfectionistic, and whether you’re a boss or an employee, and you have to check everything, then in fact, not only does it drive you into burnout, but unless you modify that behavior, then in fact you can stay stuck in burnout. And one of the most common clinical scenarios I see are public servants, and also those in the healing professions, who are doing a great job and have done a great job for an extended period of time, but there’s something going dreadfully wrong in the workplace.

Professor Gordon Parker (23:08):

They’ve either got a tyrannical boss, or they’re being bullied, or the environment is toxic. And what they should do is cut their losses and get out. But because they’re dutiful and reliable, that’s not in their nature. And so they stay on and they get stuck. And that’s where, as a clinician, I often have to really heavy them to argue that it’s a no-win situation. So doing something about the personality component, if relevant, is extremely salient. So it’s a, if you like, a triadic model, identifying stresses, de-stressing, and addressing personality drivers, rather than just a single model. And then in addition, we also have a whole series of resources that people can turn to.

Ginger Gorman (23:58):

Exercise, downtime, mindfulness, and try to reduce those perfectionists or dutiful tendencies. The challenge, of course, is not feeling like your burnout recovery strategy is just adding to your overwhelming to-do list. Maybe employers can take this on board as well. If you know that you have a staff member who is always reliable, and even a little bit of a perfectionist, don’t take that for granted. Aside from their wellbeing, research confirms burnout costs organisations a lot in absenteeism, that’s being away sick, and presenteeism, which is turning up, but not being able to fire up. So if you are looking for solutions, the Black Dog Institute is probably a good place to go for some ideas. Then of course, there’s Beyond Blue, and if you’re a burnt-out carer Emma’s Carers Club is a great support network. We put links to all of them in our show notes.

Ginger Gorman (24:57):

And if that burnout is manifesting in depression, and you need urgent support, remember Lifeline is there for you 24/7. The number is 131114. Thanks for listening to Seriously Social, I’m Ginger Gorman. And if you’re enjoying the podcast, one of the best ways to support us is to subscribe, and if you listen through Apple podcasts, drop a review in there for us as well. We love reading them, and it helps other people find us. Seriously Social is produced by Kim Lester, engineered by Mark Gageldonk, AKA Baldy, and executive produced by Sue White and Bonnie Johnson. It’s an initiative of the Academy of the Social Sciences in Australia. See you next time.

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