Working in aged care is, by its very nature, demanding.
But with the pandemic ongoing and the workforce crisis deepening, many workers may begin to feel that their experience of fatigue has developed into something more sustained and perhaps debilitating, such as burnout.
But what exactly is ‘burnout’, clinically, and how can one experiencing it recover?
These questions and more are addressed in a new book titled Burnout: A Guide to Identifying Burnout and Pathways to Recovery.
Co-authored by Professor Gordon Parker, Scientia Professor of Psychiatry at the University of NSW, Gabriela Tavella, a research officer at University of NSW and PhD candidate on burnout, and Kerrie Eyers, a psychologist and writer, the book advances upon existing literature, providing new insights into the condition and evidence-based pathways to recovery.
Parker, the founder and initial executive director of the Black Dog Institute, tells Aged Care News that healthcare workers and unpaid carers are prime candidates for developing the condition.
“What we’ve found in our studies is that people who are caring, reliable, diligent, conscientious, if not perfectionistic, are much more likely to develop burnout,” Parker says.
“They are dutiful, put in the longer hours, and just keep on keeping on, and that explains why much higher rates of burnout are found in doctors, nurses, teachers and veterinarians.”
While one would think working in a less meaningful, or less motivating, job might set a person on a path to burnout, Parker and co-authors find that, on the contrary, those working in jobs they are passionate about are actually at the highest risk.
“Those for whom work is their calling or passion tend to be constantly ‘giving’ and may be unable to stop…” they write.
“The positive feelings associated with giving, dubbed ‘helpers high’, may lock them in even further— but there is a cost.
“Burnout can reflect the dark side of self-sacrifice.”
A more sophisticated understanding of symptoms
As Parker explains, burnout has long been classified as a ‘triadic syndrome’, one comprising three key symptoms:
- Loss of empathy, also known as ‘compassion fatigue’
- Lowered work performance
Long classified as an occupational condition (most recently in the World Health Organisation’s ICD-11) Gordon and co-authors present the case for an expanded definition of burnout’s contributing factors and symptomatology.
“In our studies we have found that the symptoms are much more wide-ranging,” Parker says.
“We give a big tick to exhaustion: that is a central feature.
“We don’t feel entirely comfortable with loss of empathy.
“We see it as a much broader domain where there’s just a loss of feeling tone, so people tend to find that they’re not getting much pleasure out of anything, including mixing with other people — they may become insular and keep to themselves.
“Thirdly, there’s a very big symptom construct that’s been left out, and that’s cognitive impairment … sometimes known as ‘brain fog’.”
Parker notes that including cognitive impairment in the symptomatology is not a brand-new concept, but rather a restoration of an ancient, and somehow lost, understanding of the condition.
“If you go back to the ancient [Greek] descriptions of burnout, and these go back to the fourth century AD, it was one of the cardinal sins, called ‘acedia’.
“When the ancient monks developed acedia in those days, one of the key symptoms apart from feeling exhausted, feeling they’ve lost their faith in God and the sun was no longer shining, was they described cognitive impairment, that is a hugely important symptom domain.”
Distinguishing burnout from depression and anxiety
Parker notes that thankfully, the world has moved beyond the ancient Greek’s conception of mental illness as a moral failing, but some of the ancient ideas have maintained their influence on psychiatry, almost 2000 years later.
“In the sixth century Pope Gregory the Great recast the list [of the original eight deadly sins] and combined tristitia, which was another cardinal sin for depression, with acedia, a decision that impacts on our current diagnostic categories,” Parker says.
This leads to the next important aspect of the book, helping clinicians and patients distinguish between burnout and other psychological conditions, such as depression.
“There’s been a huge debate as to whether burnout is synonymous with depression,” Parker says.
“Separating the two is not easy … a very high percentage of people with burnout will develop secondary depression, and some people with depression will actually then be more likely to develop burnout.”
In developing the Sydney Burnout Measure, Parker and colleagues’ research indicates that depression and burnout are distinct, but often co-morbid, conditions.
“What we would argue is that depression can be a consequence of burnout, or concomitant.
“It’s not a defining feature, but it is very commonly experienced by people with burnout.
“Most people have burnout have a set of other symptoms such as depression or anxiety or insomnia.
“So, even though they’re exhausted, they will generally report very poor sleep.
“They wake up unrefreshed and they don’t sleep the number of hours they would like.”
Recognising ‘forgotten caregivers’
Unpaid carers are depicted in the book as a ‘neglected and overlooked category’, and the book serves to dispel myths that only corporate high flyers are susceptible to the condition.
“Burnout is not restricted to those who are working in a nine-to-five job in an office … it is becoming increasingly more prevalent in personal lives, especially for women who have secondary caring duties alongside work,” Parker says.
“We’ve looked at people who might be say, parents, particularly mothers, that are looking after kids who have great demands, or looking after elderly parents with dementure, or the sandwich generation looking after both.
“We find that the symptom complex, and the pattern of burnout, in those who are in informal caregiving or informal work situations, is exactly the same as those in formal work.”
The road to recovery
Most importantly, the book offers a guide for navigating one’s way out of burnout territory.
“The biological changes in burnout are pretty dramatic, but the key message is they are all reversible,” Parker says.
Containing new, evidence-based tools, the book enables readers to work out for themselves whether they have burnout and generate a plan for recovery based on their personal situation.
Firstly, the book helps readers foster a better understanding of their personality type, which has been an overlooked contributing factor to one’s likelihood of experiencing full-blown burnout.
“If you’ve got a personality style that is contributing to it at all, such as you being reliable or perfectionistic, you really need to change that if you’re going to get over burnout,” Parker says.
With this in mind, the book encourages a pluralistic treatment plan for the condition, addressing personality style, occupational factors, and other stressors.
“We have the burnout measure, which gives them a probability of the chance they currently have burnout.
“Then, we provide an appendix which lists the common burnout triggers — and they’re not just excessive hours, or being on your phone 24/7, but they’re ones like where your core values are at variance with your employer’s.
“So people can just go through and check everything that’s relevant to them, and that’s helpful because it gives them targets that need to be addressed.
“What we’re aiming to do in the chapters is to give a lot of what we would hope is common sense advice, and then, in those appendices, really focus on what the individual reader might want to check and tick off.”
To find out more about Burnout: a Guide to Identifying Burnout and Pathways to Recovery, follow this link.