English Version | What to do when everything burns?

20 Jul 2022
By Ana Murcho

Burnout can kill. Now that we have the reader's attention, we will explain, in detail and with personal testimonies, how and why this illness that is increasingly present in society could be the pandemic of the future. It is not airborne, but the risk of contagion in today's fast-paced world is high.

Burnout can kill. Now that we have the reader's attention, we will explain, in detail and with personal testimonies, how and why this illness that is increasingly present in society could be the pandemic of the future. It is not airborne, but the risk of contagion in today's fast-paced world is high.

“If I didn't know you had taken the COVID-19 vaccine I would say that everything you are describing to me is symptoms of burnout. This way I think it must just be an adverse reaction.” In July 2021 I dragged myself to the Hospital da Luz (in the middle of working hours, accompanied by a colleague) because of a strange dizziness, which had started a few days after days after being vaccinated, but it wouldn't go away. I couldn't concentrate, I had a constant feeling of alienation, and I was permanently dizzy. The doctor who attended me was like an angel on earth - empathetic, calm, interested. She listened to me as if I were her most important patient, medicated me, and told me to "rest" and "take it easy." In less than a week I was "fine." Of course, when I left the ER, confident that this was just an "episode," I was in denial. The extreme fatigue of the past six months, where had I stuck it? The desire to sleep for hours on weekends, due to the lack of regular sleep on a daily basis, where had it gone? The feeling that I could "blow up" at any moment because I felt on edge - irritable, impatient, dissatisfied, unhappy - had it suddenly disappeared? It didn't take long to realize that, in fact, I wasn't "great." The penultimate week of August, on a morning that seemed like so many others, I sat down at the kitchen table with my computer to start a text, and nothing happened. Sometimes nothing happens for a minute or two because I get distracted by something, sometimes because I am picky and don't let my thoughts get to the "paper." That morning nothing happened because my brain didn't want it to, I suppose. I was fully aware that I would not be able to write a single line, something that in almost 20 years of my career had never happened to me. I panicked. I had always "commanded" my brain, always told it what to do, and it had always obeyed me. To realize that it refused to comply with my request was frightening. Anyone who works with words knows that there is nothing worse than running out of them as if the alphabet was suddenly stolen from us, as if all the basic teachings, from grammar to verb agreement, disappeared after the last final period. There was not going to be any text, because there were no words, just a gigantic gray knot that occupied the place from where, since childhood, the most bizarre and imaginative sentences always flowed. I cried a lot, more than I would have liked, and I found myself reduced to almost nothing. "I'm finished," I thought, "I won't be able to write again."

The term burnout emerged in the early 1970s by psychologist Herbert Freudenberger, who defined it as "a state of physical and mental exhaustion whose cause is closely linked to professional life." At first, burnout was usually associated with "helping" professions, such as doctors and nurses, but today the term applies to any profession, with a particular focus on those that carry a high degree of stress. Since 2019, the World Health Organization (WHO) has recognized burnout as a disease. For this entity, burnout can be a state of physical and mental exhaustion that is often felt during the practice of a professional activity or "a syndrome resulting from chronic stress at work that has not been successfully managed." One in four Portuguese had symptoms of burnout in 2020. Our country is the third worst in the EU in terms of reconciling personal and professional life. According to the Small Business Prices portal, which made the calculations based on the world happiness index of each country, the average annual salary, and weekly working hours, Portugal is the country (out of the 26 analyzed in the study) where more workers suffer or are at risk of suffering from burnout. Greece, Latvia and Hungary stand out in the next positions, with average wages and weekly working hours very close to those found in Portugal. But, in clinical terms, what is burnout? This is what we asked Filipa Jardim da Silva, clinical psychologist, coach and founder of Transformar Academy. Is there a simple way (a metaphor, for example) to explain it to those who are not familiar with the term? "Burnout is physical and mental exhaustion that is linked to the exercise of a profession in physical, emotional, cognitive and behavioral conditions that are stressful and above the person's capacity to deal with them. There is a link between burnout, stress, and psychosocial risks, which arise from deficiencies in the design, organization and management of work, as well as from a problematic social work context. Excessive workload, contradictory demands, poor organizational change management, lack of support from managers and colleagues, and psychological or sexual harassment are some examples of these risks. To describe burnout metaphorically we can think of a kettle, where we put water and heat it up. If at some point we never let the water cool down, never allow the kettle to pause in its heating function, and keep it on constantly before we know it, it will simply overheat and at some point, it will break down, and may simply stop, or even explode. That's how burnout is: we don't allow ourselves to take care [of ourselves] enough and balance it out on a day-to-day basis, demanding more and more of ourselves, which leads to an inhuman overload that one day causes us to break down."

That's exactly what happened to me. My brain had never failed me before, it was just that I had apparently been failing it for too long. The diagnosis of burnout was first given to me by a psychologist, who advised me to "take a few days off" (in my case, this was important, the term "sick leave" scared me, and not having to take it as a necessity made me feel less pressured right away), and was later confirmed by a psychiatrist. Later I went to a functional medicine consultation, where I had a battery of tests and analyses, which allowed me to understand what was not working well - and there were many things. It was here that I was told that there was no certain time frame for getting back to normal. It could be a month, six months, a year. "What happened to you is that you ran out of battery," the doctor explained to me. "You know when our phones run out of battery and then need some charging time before they turn back on? That's the same thing. Now you're going to have to wait until you can 'make calls' again. And that means you have to listen to your body." Listening to my body. Here's something I've never done before. Work has always been my refuge, whatever the problem was. "Now your body has taken your work away from you, which was the one thing Ana wouldn't give up, so you would finally stop", I heard, perplexed - and embarrassed - at such a revelation. How had I never realized this before? The symptoms were (almost) all there. The word to Filipa Jardim da Silva: "Burnout has three dimensions. Emotional exhaustion, in which there's a lack of energy and a feeling of exhaustion at an emotional level, in which the person feels they've exhausted all the resources available to deal with daily situations and feels an incapacity to get involved in situations. There is also the loss of self-actualization, where one has feelings of failure, with a negative and exaggerated self-evaluation. Finally, there is cynicism, where there is cognitive detachment from others, including indifference and coldness, and even ruder attitudes, such as responding poorly. We can also highlight three levels of symptoms: physical symptoms: fatigue, headaches, high blood pressure, metabolic problems, thyroid problems, changes in sleep pattern and eating pattern (too much or too little sleep); psychological symptoms: irritability, depressed mood, lack of desire to be with others (desire to isolate), anxiety, feeling that no one supports you / that you can't count on anyone / that no one understands you; behavioral symptoms, ranging from changes in work performance to problems with colleagues and/or bosses, difficulty with punctuality, justified (with sick leave) or unjustified absenteeism, substance abuse (medication, alcohol, drugs, tobacco, and others), consequences of a depressed mood, and even suicidal ideation or suicide attempts."

Not all symptoms need to coexist, of course. I never felt particularly sad, for example, which is why it was so hard to accept the diagnosis. "I wonder if you have depression," my friends would ask me. It's a normal confusion. "Depression is usually one of the consequences and comorbidities of burnout, and if we don't verify a connection with the professional dimension, as mentioned before, then the depressive disorder is the main diagnosis. There are people who at certain stages of burnout identify more complaints of anxiety than of depressive mood, but with the failure to meet physical, nutritional and psychological needs, depressive mood tends to set in." Is there any way to avoid burnout? “The best way to avoid burnout is prevention, which is based on cross-cutting self-care strategies that promote psychological health in general. It is fundamental to guarantee a balance between our life dimensions, between productivity and leisure time. We are beings who need this physical, emotional, and behavioral balance to be well." Balance - this is the keyword. Because, in extreme cases, burnout can even kill, as Filipa Jardim da Silva explains. "Considering the physiological, behavioral, and neurological impact of burnout, there may be more or less lasting sequels, more or less impactful on the quality of life and functioning of each person. When we consider, for example, that a depressed mood is often associated with burnout, and that in cases of greater severity of this mood there is suicidal ideation, which can lead to suicide attempts, yes, burnout can kill. We can also think of the increased risk of cardiovascular accidents and strokes that exist in burnout, which also carries a risk to life. Finally, if we consider the changes in attention and sleep that occur in burnout, people are more prone to accidents in their daily routines, which also carries an additional risk to their physical integrity. There is no health without mental health. Burnout, being a mental illness just as depression or generalized anxiety is, for example, can lead to death." If all this still isn't enough to slow you down, read on.

In fact, I only realized I was having burnout when I was really at my limit. After two years of working from home, without schedules and with a very heavy workload, in February I had the confirmation that I couldn't take it anymore. It was on an afternoon when I went to the office and met with my colleagues, and specifically with a colleague who had been through the same thing, that I realized that I realized that I was not well and that I needed help. Two days later I was sitting in an appointment with a psychiatrist and went on sick leave. It was a shock, I really enjoyed my job and thought I was just in need of a vacation. Christmas and the beginning of the year are heavy times in my profession [communications and public relations] and I never thought this build-up would have worn me down to this point. It was actually not only a shock for me but also for the company I was working for." The testimony is from Constança Firmino, 31 years old, content creator and founder of the jewelry brand ERELISBON. What is the reaction of someone so young when they receive such a diagnosis? "I think that nowadays, since telecommuting, workers are expected to accumulate several functions and the workload increases, but mental health is not taken into account." In a video posted on Instagram, back in April, Constança assumed she had not heard the signs. At this distance can you identify what was wrong? "Now, after almost six months and after a lot of therapy, I can identify all the signs and what led me to them. I was working long hours with great responsibility and very tight timings to achieve almost impossible goals. In the end, I ended up feeling incompetent and always afraid of being fired, I had no chance to say no to the imposed timings and hear that I didn't meet them because I wasn't organized. Unfortunately, in Portugal, there is still the perception that we are only good at our job if we are able to perform miracles and it seems that it is a pride to work overtime without compensation." Sadly it’s true. The pressure to succeed, to be the best, leaves no room for mental health care, which is (very) neglected. How was the recovery process? "I am still being treated for burnout because unfortunately there is no time frame for healing, many of the effects live on in us for several years. I go to therapy every two weeks, which helps me learn coping mechanisms to deal with burnout. In the early days, I had to switch off completely and stay on the couch and do nothing, which was quite hard for me to accept because I am a person who doesn't like to stop. Over time I learned to listen to my body and switch off whenever it asks me to. I have recently become more active again (after four months) but as I learned in therapy, very slowly and without pushing my mind and body to the limit. Another thing that helps me a lot is physical exercise because it's liberating."

In recent years burnout has become a regular topic, both in the media and in café conversations - the ones where we just want to talk about light, good things. Is this happening more because the work context is worse or just because people are more aware of the subject? Filipa Jardim da Silva's opinion: "Talking is important, but at this stage, it's not enough. Burnout is more talked about because of its increased incidence, moreover, the overall incidence of psychological illness, and consequently its impact has become more visible. Psychologists, either individually or through the Portuguese Psychologists' Association, have also been doing important and relevant work, in various sectors, to promote emotional literacy and greater knowledge about mental health. However, in Portugal, we have an educational, social, and organizational system that promotes diseases. Unlimited dedication is valued, confusing passion with exhaustion. We design curricula and work schedules that make it difficult to respect the various areas of life and, as a result, generate imbalance and lack of satisfaction with physiological and emotional needs. [...] We don't need more time in the day, we need to prioritize what is really important. And as long as school and work schedules, the agendas of teachers and CEOs, and our own expectations are built without taking into consideration a balanced body and mind, we will hardly improve our current reality." Constança Firmino agrees: "About burnout, I think that in Portugal there's still the prevalent idea that the more hours you work, the more successful you are, so when someone says they're suffering from burnout it's because they're weak, they're not good at work, or they don't want to work. Until this idea changes and people start to realize that you need a balance between work and personal life it will be difficult to change these prejudices. Regarding mental health, I think that the self-love movement has helped to break some stigmas like going to a psychologist or psychiatrist, although I feel that medication in the mental field is still frowned upon. You have to understand that we are talking about chemicals in our brain that just sometimes are not working well and need a boost and medication is for that, it can't be seen as a big deal. Mental health is health and we need to educate the population on how important it is." There is a silver lining in everything, and in my case, the full-blown brake marked a kind of before and after. Nowadays I don't do anything without first asking myself if I am capable - if I have the strength. My body gives me all the signals I need (it sounds like one of those Shanti mantras, but it's true). I have learned to stop without being ashamed to do so, I have learned to say no, I have learned to rest without feeling guilty about it. Nothing is as urgent as we have been taught to believe. Surviving burnout is seeing the world with new eyes, as Constança Firmino explains: "The biggest lesson I take away is to learn to listen to my body and mind, not to accept a job where they don't respect my limits and my mental health. Lastly, not to let work overlap with personal life, for months I didn't see family and friends because I was working too hard, I don't want that to happen again."

Translated from the original on The Sunny Vibes Issue, from Vogue Portugal, published July 2022.Full stories and credits on the print issue.

Ana Murcho By Ana Murcho

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