006 Emotional Burnout & Support

Mary Kuentz and Laura Wade explore their journeys through emotional burnout, some of the research about burnout symptoms.

  • Definition of Burnout
    • Mechanical – When there’s nothing left to combust, no more energy in the system
    • Emotional “burnout” was coined in the 1970s by the American psychologist Herbert Freudenberger. Emotional burnout describes the consequences of severe stress and high ideals in “helping” professions. Doctors, therapists, coaches, and other healers, who sacrifice themselves for others, would often end up being “burned out” – exhausted, listless, and unable to cope. It’s the shadow side of self-sacrifice. We will be looking at how to support without sacrificing and what to do when you’re already sacrificing.
  • Mary and I are passionate about taking Holistic views, so we will be discussing how issues affect us on an emotional, mental, physical, and spiritual levels.
  • Today we will be looking at the Emotional side of Burnout, and including how to know when you’ve entered the spectrum of burnout and what to do about it.
  • Emotional Signs of Burnout
    • Reduced Performance (difficulties in maintaining boundaries)
    • Emotional Protection/Isolation – Flat Affect Feels, nothing to look forward to, joyful things from the past no longer seem joyful in the present
    • Hopelessness about the state of the world and being unable to affect the issues of the world. Suffering is still happening in the world. What’s the use?
  • Practices to Heal Emotional Burnout: 3 practices, 2 and 1 of micro and large
  • Self-Empathy – begin to practice self empathy that you would give a friend client or loved one
    • Journaling – stream of conscious writing, to give it a place to vent
    • Take a Break, a day, a week – Emotional Well-being Day
      • May be different from a SPA DAY!
  • What’s the one shift, easy and doable, that would make the biggest difference?
  • How can you begin integrating that shift into your life, even in a small way?
  • Stop Blaming yourself for feeling burnt out
    • Many people keep pushing, internally and externally to overcome burnout in the early stages, i.e., “If I can just finish this project…” “If I can just get to Friday…” “If I can just push through this pain…”
      • Pushing to keep up
      • Punishing themselves to be who they have been in the past
  • Informed Health Online [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: What is burnout? 2012 Dec 5 [Updated 2017 Jan 12].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279286/
    • Listed 3 main symptoms of Emotional Burnout:
      • Exhaustion: People affected feel drained and emotionally exhausted, unable to cope, tired and down, and do not have enough energy. Physical symptoms include things like pain and stomach or bowel problems.
      • Alienation from (work-related) activities: People who have burnout find their jobs increasingly stressful and frustrating. They may start being cynical about their working conditions and their colleagues. At the same time, they may increasingly distance themselves emotionally, and start feeling numb about their work.
      • Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout are very negative about their tasks, find it hard to concentrate, are listless and lack creativity.

Finding Compassion for a Broken Man

He didn’t imagine this for my life. He’s in his 40’s and walking back to his halfway house, after working a long day of construction framing. His body aches and his mind is screaming at him. He uses alcohol and drugs when he can, it quiets his mind. Yet he knows he will likely be drug tested tomorrow, so he walks past the liquor store with what little strength he has left. He gets back to his dingy room, the cockroaches hiding from the light. He swallows a couple sleeping pills and waits for sleep to come. Sleep has always been hard for him. It’s been 40 years and he still hasn’t figured out how to sleep, what type of man can’t fall asleep.

He’s being hard on himself again, that’s really the only way he knows how to speak to himself. While he remembers his past, he isn’t yet able to offer himself any compassion or forgiveness about why he can’t sleep now. When he was a toddler, the youngest of the bunch, he wasn’t able to protect his older sisters. He laid in bed hearing the repeated sound of a belt as it hit his sister’s flesh. His oldest sister would bawl so loudly, yet that seemed to end her punishments sooner. Then his mother would begin to belt the younger sister, and she never made a noise. Her beltings would last the longest. He would finally wet the bed and cry out. His mother would leave his sisters alone, now he was the one to face her pain.

Towards the end of her life, he would get to know his mother. She was a depression child, the middle of seven. After her father left the family, her mother had to try to keep seven children feed, which seemed like an impossible task. She gave her middle child away, to be a maid, for a household that had plenty of food. Over her entire life, she would only share one story of her time in that household, so what happened there would mainly be a mystery. Yet it’s evident to see, she carried a lot of pain, and it would leak out and effect those she loved the most.

Back to him though, he’s lying in bed with his noisy brain. Even in prison, he had better access to alcohol to calm his brain. Within a year in prison, he was a bootlegger, sneaking juices from the cafeteria and fermenting them in his cell. He was able to trade his moonshine for a little more safety in prison, and the alcohol allowed him to get some rest. Rest might be an overstatement, it allowed him to black out, more of a respite from his mind and his physical cell. He didn’t have alcohol in this moment, so all the memories of how he messed up everything in his life flooded his mind. How he and his wife were both been sent to prison for being marijuana farmers. His kids were in their early teens and drifted among family members, each suffering from their own trauma and not being able to provide his kids a home. By the time he got out of prison, his kids were adults, thus no longer needed and no longer spoke to him.

He had a temper, he knew that, he was far from the perfect man. When he was born, the trauma of his mother, already impacted his epigenetics. His DNA was methylated, which is actually a protective factor, if a human was born into a warring tribe, it was safer for us to think less and react more, this piece played into his temper. He spent his entire life reacting, no one had showed him a different way. The traumas of his prison life added on to the traumas of childhood meant he had a highly activated amygdala. His amygdala would take input anyone else would sense as beneigning and send him into fight of flight. What happens in fight or flight, is blood flow to the prefrontal cortex almost stops, this prevents the ability to empathize with another or even yourself (another reason he frequently speaks so harshly to himself) and shuts down logical thinking. It floods his body with stress hormones, so he’s ready to take out the threat in front of him, even when the threat is someone he loves. He has no way of sensing this, he’s flooded with cortisol and lacks blood flow to his prefrontal cortex. While it’s possible to demethylate his DNA, he didn’t know to search out for this, he keeps blaming, ridiculing, and torturing himself for not being able to act differently.

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This is my portrayal of a small part of my uncle’s story. A few months after this point, I’m 19 and visiting my grandmother and see him viciously lashing out at my grandmother. She got down on her hands and knees crying. He began yelling racial epithets, I never knew existed, at two of my friends. I held a bitterness and fear towards him for this event.

My uncle’s story does change. After his third DUI, his life begins to change with the support of his mandated counselor. He praises her frequently for altering the course of his life. He becomes the only family member of that generation who encourages me to take care of myself. He appears to release the manipulative traits he picked up as a child to obtain safety. He rebuilds the relationships with both of his sons. He’s in intense, chronic pain. He chooses to spend his money on their college education, instead of obtaining medical insurance and addressing his needs. They both get their associate’s degree and walk for their graduation on the same day. He then allows his son and myself to help him get insurance and begin to have doctor’s visits. They discover he’s already stage four cancer. He’s surrounded by his sons, nephews, and niece during the last year of his life. He’s healed many of his wounds, and supported us in beginning to do our own healing. I believe he became the man he wanted to be.


What’s the cause?

Recently on these two podcasts, Found My Fitness and The Drive, medical professionals discuss their new understanding of Alzheimer’s. My simplified summary of these podcasts is that we are now seeing that there are several subtypes of Alzheimer’s. These subtypes are actually unique diseases that all have similar effects, yet a unique cause. The scientific community seems to be aware of the following subtypes: the first is characterized by systemic inflammation, the second type shows reduction in support for synaptogenesis, and the third type characterized by environmental toxin exposure from molds or heavy metals. They even named another type 1.5, as it seems to be a mix of the first and second types. When medical providers thought it was only one disease, then the cures that were being applied were probably unlikely to apply to all types of the disease, as they had different causes. If someone’s Alzheimer’s is related to mold exposure from their homes, then reducing systemic inflammation via dietary intervention may have little impact. I’m wondering if we will see similar discoveries in mental health.

I think it’s likely that we will discover multiple subtypes of depression, anxiety, and other mental health concerns. I think it’s likely there will be overlaps between the subtypes, such as the type 1.5 for Alzheimer’s. When I review studies on the treatment of depression (broccoli sprouts to support neuroimmune system, curcumin, transcranial magnetic stimulation) so many of treatments provide improvement for a portion of the people in the study, yet not one treatment provides benefit for all the people. Is it possible that the reason for this partial effectiveness is that there are many subtypes of depression?

What could be the causes of some of the subtypes of depression? My guesses are:

  • Distressing Beliefs
  • Childhood Trauma
  • Behavioral Patterns
  • Rigid Neuropathways/Default Network
  • Overactivity of Immune System/Inflammation
  • Poor Nutrition
  • Poor Gut Health
  • Sedentary Lifestyle
  • Poor Sleep
  • Social Stress

When counselors are lucky, we see clients that are only suffering from depression that is connected to beliefs, emotions, stress, and traumas. We have the tool set to support clients in these cases. What happens when the client is suffering from multiple subtypes or a subtype that is outside of our professional lane? What if we started with interventions with the highest benefit and least risk, and find ways to keep these affordable for our clients? Could we partner with professionals in other fields and find ways to offer group consultations to keep costs low? A childhood obesity clinic offered parents group informative sessions by a nutritionist on dietary advice for their children. All the parents had a similar concern and they all needed similar support from the nutritionist, and the group information sessions made them more affordable.

As mental health counselors, can we build a network of providers that can affordably support our clients? Maybe a nutritionist, you partner with, offers a monthly class on nutritional recommendations for depression and you offer a class on distress tolerance skills or something else that would be supportive to her clients. These classes can have a fee and be a referral source. We could each have a network of many other providers from different fields.

When we have clients that aren’t responding to our tools, maybe it’s not because they are resistant, maybe it’s because their depression has a different cause.