Burnout: The Dangers of Acute and Chronic Secondary Stress

This essay was first presented to a group of social workers at a major medical center in northern New Jersey entitled, “Burnout: The Dangers of Acute and Chronic Secondary Stress.” (information presented in this article was taken from The Resilient Clinician by Robert J. Wicks and other clinical works). As we will see, burnout, as opposed to normal stress, can have major negative consequences to our health and well-being the longer it persists. I will outline how burnout develops, the physical and psychological signs to look for, the danger it presents to us, and ways to recognize and treat this debilitating condition.

The term burnout was first coined by psychologist Herbert Freudenberger in 1974 as “a depletion or exhaustion of a persons mental and physical resources attributed to his or her prolonged, yet unsuccessful striving toward unrealistic expectations, internally and externally derived.” And later, in 1980, psychologists Edelwich and Brodsky defined burnout as “a progressive loss of idealism, energy, and purpose experienced by people in the helping professions.” We can already begin to see from the quotes above that burnout is about “loss”, “depletion”, and “unrealistic expectations” of those who suffer from it.

What is the difference between stress and burnout? Stress is the response our bodies and minds have to the demands placed on them and the interpretations we assign to those demands. Stress involves too much: too many pressures that demand too much of one physically and emotionally. One may think, “I know I will feel better when the work is completed.” Burnout is a state of emotional and physical exhaustion caused by excessive and prolonged stress. Burnout is about not enough; being burned out means feeling empty, devoid of motivation, hopeless, and beyond caring. The thought may be, “I know it will never get better.” 

What are some causes of burnout? And how can we recognize it?

• Vague criteria for judging success and/or inadequate positive feedback on our work
• Guilt over perceived “failures”
• Using sick time or personal time to recharge ones “batteries”
• Unrealistic goals that are daunting rather than motivating
• Working with others who are also burned out
• Lack of appreciation by superiors, coworkers, patients and their families
• Trying to cope with our own issues while treating patients for the same problem
• Having a “savior complex” – an inability to recognize what we can and cannot do in helping others in need

The above list outlines some of the causes of burnout that we, along with others around us, can add to and perpetuate over time. As we learned

in the above paragraph, stress involves too much, but once we have completed the tasks that stressed us out we can begin to breathe a sigh of relief. Burnout is continual stress over long periods of time in which we can never get out from under the constant pressure to perform. And once we become burned out, it becomes like a “dark hole” we fall into without any break in sight.

Who are most vulnerable to Burnout? Those who:

• Work exclusively and intensely with distressed or demanding people
• Are charged with the responsibility for too many individuals
• “Personalize” their work
• Have an inordinate need to save people
• Are overly perfectionistic and idealistic
• Feel guilty about not attending to their own needs
• Like to fight for the underdogs
• Experience “vicarious” PTSD – being traumatized by the clients trauma

Concerning “Vicarious” PTSD (being traumatized by the patients trauma) some questions to ask are:

• Are you experiencing a blunting of affect, numbing, loss of feelings, or a tendency to avoid reminders of a past traumatic event?
• Do you have a heightened sense or exaggerated sense of being startled?
• Do you experience dramatic alterations in your outlook or world view?
• Have you begun to demonstrate signs of antisocial behavior that was not present before working with your patients trauma?
• Do you find that you are re-experiencing (your own) past traumatic events?
• Are your basic interpersonal relationships becoming dramatically affected?

The answers to the above questions can be helpful in gaining insight toward signs of burnout in ourselves that we are often not aware of but perhaps others can see. We will next take an in-depth look, through additional questions, at ways to begin to develop a self-care protocol. By answering the questions below honestly, we may prevent or gain the strength to get physically and emotionally stronger in order to manage our lives in a healthier way:

• How important and realistic is a self-care plan for you?
• How have your past experiences set habits in motion that make self-care a challenge?
• What is the ideal balance between work and leisure for you? Have you ever thought about this before?
• How much exercise do you get a week? How much sleep? And how are your nutritional practices?
• Do you use alcohol or drugs as a way to relax?
• How and with whom do you spend your leisure time?
• How much quiet time do you set aside for yourself each day?
• Do we follow our own advice we give to others? 

The answers to these questions can help bring awareness to what self-care aspects we may have forgotten or practices that may be detrimental to how we care for ourselves. We will now take a look at specific self-care behaviors that we may be lacking in our lives.