Burnout syndrome, or burnout syndrome, is a process that develops in some people who work long-term in a highly engaged and intensive way with people, most often in so-called helping professions. It manifests itself on physical, psychological and social levels. Its core characteristic is the complete exhaustion of a worker’s strength combined with emotional fatigue, feelings of hopelessness and loss of energy, irritability.
People suffering from burnout syndrome feel that for demanding work they are not sufficiently rewarded, not only financially – they lack personal appreciation. They are tired, may fall into anxious or depressive states, and feel they can no longer help others.
Paradoxically, burnout syndrome is not dependent on age, intelligence, education, length of practice, or how long the work has been performed. Even the assumption that burnout syndrome more often affects women has not been confirmed (Kupka, 2008). The latest perspectives also point out that burnout syndrome does not necessarily occur only in so-called helping professions but also in other employment categories (lawyers, civil servants, athletes, artists), and that it is even present in categories of unemployed people (Křivohlavý, 1998).
Causes
There are several causes of this process. External factors are usually cited—psychosocial stress, the high burden that the profession itself puts on the employee—and internal factors, the individual’s personality traits.
People are much more prone to burnout syndrome when they enter jobs that demand high quality, responsibility and work involvement while not providing enough autonomy in work activities. An employee who cannot decide the pace of their work and how to distribute it during the day is more at risk of burnout syndrome. A major external factor is also the quality of social support, that is, the amount and intensity of contacts a person creates themselves and contacts they receive from others.
Among the most important internal factors are personal prerequisites of the individual. As a risk factor, Type A behavior is considered, with emphasis on competitiveness and hostility, a high degree of empathy combined with a low ability for assertive behavior, high performance demands often connected with low self-esteem and self-concept, anxious, obsessive and perfectionist traits, a lonely life and others.
The risk of burnout syndrome is higher in some professions. These are primarily:
- physicians (especially in specialties such as oncology, surgery, LDN, ICU, psychiatry, gynecology, high-risk branches of pediatrics),
- nurses and other health professionals (care workers, medical laboratory technicians),
- psychologists and psychotherapists,
- social workers,
- teachers at all levels of school,
- police officers, especially in direct field service,
- postal workers, especially those at service counters, and couriers,
- dispatchers, air traffic controllers, telephone operators,
- lawyers, especially attorneys,
- prison employees – guards, but also other staff,
- professional officials – politicians, but also managers,
- under certain circumstances, members of the armed forces – mainly depending on the overall prestige of the state and the current international situation,
- clergy and religious sisters,
- non-employee categories of people in contact with others who depend on their evaluation and may therefore be exposed to the effects of chronic stress – artists,
- top athletes (Kebza, Šolcová, 1998).
Historical background
The term burnout syndrome (originally in the form “burn-out”) was first used in 1974 by H. Freudenberger in the journal Journal of Social Issues. He characterized it in a concept that has been essentially retained to this day: a psychological state of exhaustion expressed primarily as a reaction to chronic work stress (Kebza, Šolcová, 1998). The transition between the 1970s and 1980s was linked to extensive research in the field of burnout syndrome. Predictive factors affecting the development of burnout syndrome and the possibilities of secondary prevention were mainly examined. Today’s perspective on burnout syndrome is based on findings from past years. Greater emphasis is placed on primary prevention.
Acute burnout syndrome
Burnout syndrome may appear as an acute reaction to excessive workload, even at the beginning of a career. A typical example is an enthusiastic worker who is eager to help, wants to create new procedures, takes over even other people’s work, and is fully engaged. After a short time they realize that the work they do piles up, and due to illness or unwillingness of some colleagues they are working more than they should. Gradually they begin to feel severe physical and psychological fatigue, and tendencies toward depression may appear. The physical and psychological state of the organism deteriorates very quickly, the worker is no longer able to perform their work sufficiently to be beneficial to people, they begin to avoid contact with them, dehumanization appears in their approach to people, they are exhausted, may feel hopelessness and social alienation. Such acute “burnout” can happen over the course of a few months. The possibility of correction is higher than for chronic burnout syndrome; usually a longer rest, relaxation, and longer vacation is enough.
Chronic burnout syndrome
A larger problem is chronic burnout syndrome, which comes after a longer period of work in a helping profession, when the work has become routine. People affected by chronic burnout syndrome question the meaning of their work, compare the results of their efforts with the recognition they receive, and a sense of stereotype, hopelessness and frustration begins to dominate them (Baštecká, 2003). All this leads to acting irritably, feeling “drained,” and becoming insensitive to others. They do not feel joy in contact with people; even family and friends begin to be perceived as an additional burden.
Both acute and chronic burnout syndrome affect people much more often who are more engaged in their work, who want to help others at all costs, are very responsible, and are perfectionistic.
Stages of burnout syndrome
Burnout syndrome is not a fixed state; it is a continuously developing process that usually passes through these stages: 1. Stage 1 – initial enthusiasm and involvement, associated with long-term overloading; 2. Stage 2 – mental exhaustion begins to appear, partly also physical exhaustion; 3. Stage 3 – a dehumanized perception of the surroundings, which serves as a defense mechanism before further exhaustion; 4. Stage 4 – total exhaustion, negativism, disinterest in the surroundings and indifference.
A new profession is associated with expectations, often unrealistic. A person immerses themselves in work with willingness, and work can become the most important activity in life. But with prolonged strain, fatigue (psychological and physical) and irritability begin to appear. The transition from the first to the second stage is sometimes insidious; the person may not even realize they are performing work beyond their physical or psychological capacities. This is followed by a sobering-up stage. Through acquired experience, the person learns that they cannot help everyone and that they may hear thanks from one in ten. They feel that work makes life repetitive for them and begin to ask about its meaning. They start seeking more time for themselves, hobbies, and family. Sometimes they do not find meaning there either. They become allergic to the presence of other people, may lapse into apathy, have unpleasant feelings, and become critical of their work, clients and employer. Some workers change profession. In the worst case, they remain in their position for several more years, even though their work is no longer as beneficial to others or to themselves.
Primary and secondary prevention
Burnout syndrome can affect practically anyone who works with people. Primary prevention is therefore essential. Kupka (2008) lists these main prevention factors for burnout syndrome:
- finding meaningful work activity,
- obtaining and taking over professional autonomy and support,
- creating a natural relationship to work (recognizing the benefit that work brings to the person and the person brings to work) and to other life activities.
The primary preventive character is also Type B behavior, assertion skills in dealing with people, and the use of relaxation techniques. Good organization of one’s own time, variety and variability of work also act as protective factors. People who believe in their own abilities and self-actualization are less prone to burnout syndrome, just as people who are personally “indomitable” – characterized by a specific setting of strong resistance to stress. People with a high level of resilience perceive and evaluate themselves as more capable of handling daily demands, positively evaluating their physical and psychological strength. They evaluate situations positively and choose appropriate strategies to handle them (Kupka, 2008).
Primary prevention also includes seminars and lectures for employees in helping professions. The aim of these seminars is to properly educate workers.
A specific and rarely mentioned situation is when the employee themselves affected by burnout syndrome refuses to accept their burnout, does not try to seek help, or even belittles help. Then any psychological help makes no sense.
Secondary preventive programs are primarily directed at identifying employees with burnout syndrome and treating them. Help in severe burnout consists mainly of psychological support. The most effective option is changing profession. Often, however, the employees themselves reject this radical step for various reasons—they are used to the group, cannot do anything else and do not want to learn anything else. They also argue that the financial compensation of an experienced employee is different from that of a beginner.
Burnout syndrome can be overcome. Psychological professional help then primarily focuses on finding meaning in the employee’s life, adjusting the value hierarchy, and the proper alternation of work and rest.
PhDr. Kateřina Stibalová List of used literature: Baštecká, B. (2003). Clinical Psychology in Practice. Prague: Portál. Kebza, V., Šolcová, I. (1998). Burnout syndrome: theoretical premises, diagnostic and intervention possibilities. Československá psychologie, vol. XLII, no. 5, p. 427. Kebza, V., Šolcová, I. (1998). Burnout syndrome. Prague: Státní zdravotní ústav. Kupka, M. (2008). Palliative care and risk of burnout syndrome. E-psychologie. 2(1), [cit. 13. 8. 2010]. Available from WWW: . Křivohlavý, J. (1998). How Not to Lose Enthusiasm. Prague: Grada.
This article was published in the journal Social Services - October 2010. Issue theme, “Burnout Syndrome”