Burning Out On The Job

It was not the first time I had spoken with this attractive, fifty-ish woman.  The first time this co-worker had come into my office at the clinic where we both worked “to say hello.”  She occasionally stopped by to report to me one of her great successes with a patient.  Often she would also tell me how wonderful I was.  But this time, her pleasant visit ended with a real break-down, reducing this lady to teary exclamations about how horrible her job was.  The tears and complaints spilled out so fast that she soon was complaining about how rotten her entire life was.

I knew this person was a cracker-jack therapist — one of the best I had known, ever.  Until then, I didn’t know she was also miserable, with the worst and loneliest professional life I had heard of in a while — divorce and abandonment from men who sounded as if they had not been as resourceful and energetic and smart as she was.

It was a clear – and severe – case of professional burnout.  Of course, that’s not a real psychiatric diagnosis. She may have needed something for depression or anxiety or both, but there was no way — none at all — I would ever consider thinking in those terms about a coworker, no matter how much I liked her.

I did not want to tell her the things I would tell a patient.  And to be honest having her dump on me upset me.  After all, I was at work and I had “real” patients to talk to, and I did not want to expend my precious energy putting her together. My calendar told me to expect to be put at least six other people together – “real” patients — before I got to close the door of the clinic behind me for the day and get back to my “real” life.  In other words, do the important things  that keep ME stable —  such as dinner with my precious husband, and my class in improvisational theater or dance.

But, of course, she was a friend and she was hurting.

“Work is not who you are.  It is what you do.”

Trying to talk more as a friend than as a shrink, I sat there and reminded her of her children and their families and how much she loved singing and (surprise-surprise) she had “forgotten” to try out for that chorus she wanted to join.

These things were important and had flown from her consciousness as she grew more perfectionistic about her own work.  She would rehash cases with me where she had done excellent work, but still would agonize trying to figure out what she could do better.

I was scared — really scared — that she could lose her edge as a therapist if she continued “stuck” in this rut.  After all, an assembly line worker can probably manage to function pretty well even after burn-out.  I imagine one can yell or curse or act weird as long as the widgets get assembled in time.  But in psychiatry, or psychology or therapy or anywhere you have the intension of helping another person with his or her life, you are the treatment.  It is simply less good to go into the room with a patient when you feel rotten and wish you were somewhere else, doing something else.

Even physicians in other specialties can be accused of nothing worse than having a “bad bedside manner” when they are in bad moods.  I have heard that one plenty, about other doctors, when they are gruff but get the job done.  You can write the right prescription, read the EKG correctly, interpret the lab reports flawlessly or even amputate the correct limb.

I told my friend that I did not think any less of her for feeling as she did, but she needed to do something.  Close the door on the clinic when she left.  Do something in the evening that involved “connecting” with other folks.  Sing, preferably with a group.  Do Something.  No, not everything I suggested would work, but something would.  And it was very important.

If she could not do these things, she was on her own, to find a doctor or therapist.  She wanted to do it herself.  I told her such programs could be treacherous, but she was on her own here.

Yes, it could be physiological.  The job of caring for the mentally ill is stressful.  Chronic stress can lead to multiple physiological conditions.  This is why it makes sense to start with a physical exam and screening blood work.  Folks who worry about other people are notorious for not worrying enough about themselves.

Some effects of chronic stress on the body may be a bit too subtle for your standard physical.  They may involve subtle — “subclinical” — signs, or even laboratory values that are close enough to normal that some doctors would treat and others would not.

One such condition is “Adrenal burnout.”  Stress means your body is secreting corticosteroids in response to stress.  This response was very helpful for Fred Flintstone, when he was confronted by a saber-toothed tiger and had to either kill it or buck and run.  But if you are a mental health worker, your “fight or flight” instinct might be triggered several times a day, even if there are no saber tooth tigers anywhere near, this can be a problem.

There are some good guides on the ‘net that are general, concerning burnout, which can happen to anybody who is exposed to chronic stress conditions over time, whether or not they are work related.

There are also some good links on the ‘net for people who are in the mental health professions.
The bottom line is that people need to learn to be themselves.

We spend our whole lives somehow navigating between animal urges and the ideals of society.  If this sounds like Freud, that’s exactly what it is.  An ego stuck between id and superego.

What we feel like doing (the friend in my office wanted to clobber at least one coworker) and what we must do (see patients to get a paycheck).

The answer is to remain real, true to yourself, linked to the society around you, but linked also to your own needs.

“Work is what you do.  It is not who you are.”