Richard dreaded waking up every morning. The first onerous thought in his head was that of facing work. He felt drained, depleted, and trapped. The temptation to stay in bed, to call in sick, was getting greater every day. But he also knew that if he didn't go, his workload would become more mountainous than ever, making things so much worse. Furthermore, he felt increasingly distant from his wife, Susan, and his two children. There were times he found himself uncharacteristically ill-tempered and emotionally distant from them. He couldn't help thinking they were avoiding him. To add to his misery, bills were getting mislaid, meetings missed, appointments scheduled for different days and times than he had in his PDA. Of course, these troubles were "likely the fault of people telling him the wrong information, messing up his desk, or making schedule changes without notifying him." Or so he thought.
Richard, like many individuals, is experiencing classic signs of "burnout." Burnout can be the result of an excessive workload, emotional strain, unrealistic expectations, or a combination of situations that can lead to self-negativism and feelings of isolation (real or imagined). But burnout is more than simply feeling overworked and in need of a vacation. It has a more insidious nature. Burnout can quickly and easily lead to one of a type of serious disorders known to mental health professionals as "mood disorders." Mood disorders include major depression, dysthymia and bipolar disorder (formerly known as manic-depressive disorder). Additionally, in an attempt to cope with the ever-increasing sense of being overwhelmed, many individuals turn to alcohol or drugs (prescription or illicit), further compounding their problems. If burnout has progressed to the point where depression or substance abuse may be occurring, professional mental health services need to be obtained. These services usually include some form of counseling or therapy, medication, or a combination of both.
In many professions, there is often an unwritten rule that the professional is the problem solver and should never need to have their problems solved by another. Facing the truth, that no one person can do all things all the time, and recognizing when it is time to get support and help, is crucial to surviving burnout. So how do you recognize depression in yourself? Often, a person's first indication is a tendency to lose interest in their appearance and their surroundings. Formerly neat, organized individuals become unkempt and disorganized, and often don't care that they are. Anger management problems may develop, tempers flare, and there is a feeling that everything is a crisis. Forgetfulness and distractibility may be present. Sleep may become fitful or disturbed. Using alcohol or drugs to "get through" the day may occur.
Unfortunately, there is, to some people, a stigma associated with mental health disorders. Unlike many physical disorders, psychological disorders often do not have symptoms obvious to others, giving the impression they are "not real disorders." Some people suffering from mental disorders may feel they will be stereotyped as "mentally ill" and worry about being ridiculed by family and friends. They may fear losing their jobs or promotions. Fortunately, recent medical science has progressed in knowledge and understanding of psychological disorders and, consequently, the embarrassment and shame previously associated with them is not as prevalent.
Major Depression
Major depression can include any or all of the following symptoms: a prolonged period of sadness, loss of interest or pleasure in things that previously were pleasurable, appetite and/or weight change, sleep difficulties, fatigue, difficulty concentrating, thoughts of suicide, or death. While major depression usually begins when a person is in his or her middle to late 20s, it can occur at any time of life, from childhood to old age. The onset of major depression may be sudden or gradual, with episodes lasting from a few weeks to many years.
Dysthymia
Individuals with dysthymia are chronically depressed. Although they have many of the same symptoms as those found in major depression, these symptoms are not usually disabling. Thoughts of suicide or death are not present, and there are no manic or hypomanic episodes, which are seen in bipolar disorder.
Bipolar Disorder
Bipolar disorder, previously known as manic-depression, is a mood disorder that includes at least one manic episode. Manic episodes are periods where a person manifests grandiosity or exaggerated self-esteem, a reduced need for sleep, increased talking, racing thoughts, distractibility, accelerated activity, and poor judgement. These symptoms are obvious and often outrageous (to others). A person with bipolar disorder often experiences a quality of mood that can be described as euphoric or expansive, though some individuals may only be irritable. A hypomanic episode comprises the same symptoms as a manic episode, but to a lesser degree.
To avoid the risk of family members and friends ostracizing them, some sufferers of a mood disorder attempt to medicate themselves via alcohol or drugs. Rather than improving the mood disorder, the individual invariably ends up with a dual diagnosis of substance abuse and a mood disorder. Alcohol itself is a depressant and does nothing but exacerbate the problem. Similarly, drugs further impair the individual, making a bad situation worse. Often the individual who is using alcohol and/or drugs to "self-medicate" develops even lower self-esteem, and exacerbates his/her feelings of shame, guilt and hopelessness.
What Can Be Done to Avoid or Relieve Burnout?
Burnout often starts with the feeling of being overwhelmed, as if there is not enough time in a day to get everything done. Attempts to make more time in a day seem impossible, futile or more trouble then they are worth. Identifying these feelings as burnout and then taking positive steps at this point is key to keeping the situation from becoming critical. The solution does not lie in trying to make a big block of time, but rather in making small changes throughout the day, removing the unnecessary, and making better use of your time. For example, lay your clothes out the night before so you save ten minutes the next morning. Also, prepare breakfast, lunch or dinner the night before to reduce preparation time the next day. Take less time showering in the morning, or shower the night before. Make sure briefcases are packed and prepared for work and you know where you keys are (preferably by the door), so you don't have to spend half the morning looking for them. Do you spend a lot of time on the phone? There are a number of things you can do while on the phone. Look over the table of contents of magazines you've been meaning to read this month. Tear out only the articles that interest you. File those articles and pitch the rest in the wastebasket. Remember, the wastebasket is an essential office item and can be very useful. It helps get rid of the clutter that can make you feel overwhelmed and disorganized. Chances are, if something has been sitting on your desk over a month, you probably don't need it anyway. Throw it out, especially if it is something that, in the unlikely even you do need it, you can get a copy from elsewhere. Little changes throughout the day make BIG results and give you a sense of control back in your life.
What if I'm Beyond Just Burnout?
If the steps listed above seem "off the mark," then what you're feeling goes beyond this initial phase of burnout into a deeper sense of isolation and depression. The first step is to identify and acknowledge you are feeling depressed. Realize that feeling depressed is just that -a feeling- not evidence that you (or anything else) are actually bad. Once you realize that feeling bad about yourself is not the same as actually being bad or "screwed up" you might have more power to deal with the "blues." Although our society seems to tell us we have to always be "up," occasional "down" times are just normal. Depression, however, is more than just a normal low period, and shouldn't be minimized.
After identifying that you are depressed, don't dwell on analyzing why you may be depressed. Not only does this keep you focused on feeling bad, but also, if you are depressed, you are probably not in the best frame of mind at the time to be doing self-analysis. When you're depressed, what starts out as constructive introspection can easily turn to harsh self-incrimination and degradation.
The helplessness that ensues depression can be a learned response. Years ago, a study was done using dogs and placing them in cages where they would receive a mild electric shock through the cage floor. They were permitted to jump to the other side of the cage where there was no shock, and initially the dogs responded to the shocks by jumping to safety. Next, the entire cage was electrified in such a way so as to afford no escape. Try as much as the could, the dogs could not escape the shock. After realizing there was no way to avoid the shocks, the animals appeared to resign themselves to their fate and made no attempt to avoid further electrical shocks. The cage was returned to original configuration, again allowing a place of safety and escape from the shocks. However, this time, after receiving the electrical shock, the dogs made no attempt to escape-thus the term learned helplessness. Even after being shown they could escape, the dogs still seemed resigned to their fate. At one point the experimenter attached a harness and dragged the dogs across to safety, and eventually they relearned to avoid the electrical current. So what does all this have to do with feeling depressed? Hopelessness can be unlearned and hope can be relearned. If you have the inner resources and strength to attack this without professional help, take it easy on yourself and don't expect overnight changes. Congratulate yourself for small steps and remember you are doing this for yourself, not for others.
It is important to note that depression is not a definitive term, but rather a continuum of feelings encompassing normal ups and downs, the "blues," situational depression, and chronic depression. Self-help can work well at the lower end of this continuum, but a person may need the help of a mental health professional should these feelings progress beyond that point.
Treatment
Untreated depression can last from six months to several years. With treatments available today, there is no sound reason for a person to suffer needlessly from depression. Seeking professional help is an indication of strength of character and true desire to feel better. Most mental health professionals will take a multi-disciplinary or holistic approach in treating depression and mood disorders. This approach includes therapy, medication, and if necessary, substance abuse counseling and treatment.
Cognitive-behavioral therapy can be useful in identifying ineffective coping behaviors and negative emotions. This therapy can help with changing how an individual thinks about loss, helplessness, failure, and isolation. Interpersonal therapy focuses on interpersonal problems a person experiences when interacting with others. New social skills, as well as emotional expression, are encouraged and developed. Group therapy provides the opportunity to openly discuss problems with others who are having similar experiences. This form of therapy helps with the expression of one's feelings and assists in better understanding and coping with the day-to-day issues of life. Regardless of the particular orientation of the therapist, talking about your feelings in a supportive environment can greatly reduce the stress and isolation of trying to handle it alone. For most people, scheduling the first appointment is the most difficult (and most important) hurdle to jump.
Depression often has physiological effects causing biochemical changes within the body. Individuals with depression tend to have abnormally low levels of certain neurotransmitters, such as seratonin. Antidepressant medications can be used to treat these low levels. There are a number of medications used to treat depression, including Effexor, Serzone, Prozac, Zoloft, Paxil, Wellbutrin, and Elavil. Bipolar disorder is often treated with mood stabilizers, such as lithium derivatives. Of course, if you have any history of alcohol or drug problems, inform your physician, as the use of drugs and alcohol can have a very serious effect when combined with these medications.
If present, substance abuse needs to be treated along with the depression. While the issue of abuse will likely be addresses in therapy, attendance in Alcoholics Anonymous, or a similar support group, is usually a part of treatment.
Could I Be Depressed?
Take this brief questionnaire to find if you are experiencing signs of burnout and depression.
No=0 A Little=1 Sometimes=2 A Lot=3
_________________________________________________________________
Have you been feeling sad, blue,
and downhearted? 0 1 2 3
_________________________________________________________________
Have you been having crying spells
or felt like crying? 0 1 2 3
_________________________________________________________________
Have you been having trouble sleeping
or sleeping too much? 0 1 2 3
_________________________________________________________________
Have you noticed a change (up or down)
in appetite or weight? 0 1 2 3
_________________________________________________________________
Have you been having difficulty
making decisions? 0 1 2 3
_________________________________________________________________
Are you more irritable
or easily annoyed lately? 0 1 2 3
_________________________________________________________________
Have you been tired, fatigued,
or lack energy? 0 1 2 3
_________________________________________________________________
Have you been feeling worthless,
guilty, or hopeless? 0 1 2 3
_________________________________________________________________
Have you lost interest in work,
hobbies or other things? 0 1 2 3
_________________________________________________________________
Have you felt suicidal or that others would be
better off if you were dead? 0 1 2 3
Add your score. Twelve points or higher indicates you may be depressed. It would be advisable to contact a mental health provider to further assess your risk for depression. Even if your score is below 12 points, you may still be at risk. If you suspect you may be suffering from depression or burnouut, contact a mental health provider for more information.
