Stress & Burnout - a presentation for clergy
Personal story
Just under 15 years ago I was on my short drive into work and the tears started welling up. I pulled into my carpark and walked past my office door and across to the door of my own GP, a friend and colleague and said “sorry Sue, I just can’t cope today - you and the boys will need to see my patients” and I had a cry on her shoulder and turned around and went home. Home was the problem - my 15 year old son was going through a psychotic breakdown. That was hands-down the most awful time in my life.
I’m sharing this story not looking for sympathy but as an example to discuss. This was not an experience of burnout but an acute stress reaction. As I lived through this there were times when work was a balm - time out to stop my mind going around in crazy anxious circles. There were other times not many, when I was too overwhelmed to work. Some of the things that helped me get through this were the supportive work environment I was fortunate to have. My colleagues stumped up and saw patients for me on those days I couldn’t work. My family wrapped me around with love and support. My church did likewise. My prayer life sometimes consisted of O God O God O God, help me help me help me, but even as I wasn’t articulate I knew that God and my church community held me. I did not need or seek medication but a different person with less support may well have done and indeed I have prescribed for people going through an acute stress reaction.
March 2020 was stressful for some of us. As it became apparent that this pandemic was here we were getting bombarded with information on the news, on social media, multiple work updates for both medicine and church, family discussions, anxious family members … I was on a cycle where I couldn’t stop checking the information and had what I described as “covid brain” - my brain was so stuffed full of covid it was hard to make room for anything else. It was all day, every day & into the evenings. Information and definitions were changing rapidly, we suddenly had to find new ways to work and worship. I was also doing theological study and contemplated dropping out as I couldn’t see how I could possibly get my first essay done in time. This time both work and church were part of the stress. Fortunately the time of excessive stress was limited and things eased as we came to know the “new normal”.
•Definitions of stress and burnout
•Physical and mental manifestations
•Recognising & Preventing burnout
•Developing resilience/optimising health
•Useful resources
About me - I was born and grew up in the Waikato. My late father was a dairy farmer of English extraction who came out to NZ after the war. Mum was a secondary teacher. I was born and brought up Anglican - I wandered off to the Baptist church for about 20 years and returned to the fold in my mid-30s. I went from school to medical school and graduated in 1982. After a break of 2 years attending Bible college I returned to medicine in 1987 and have been working in general practice since then. I was ordained priest last November and am serving as non-stipendiary priest assistant at St John’s Otumoetai while continuing to work part-time in general practice. My marriage ended in 1999 and I was then a solo parent to my 2 sons. My elderly mother now lives in a flat downstairs in our house and my eldest son returned to live with me a few years ago, he suffers from anxiety and depression and is on a sickness benefit. Today I am mostly wearing my other professional “GP hat” but my life experience also contribute to this presentation.
There are some terms we use in a particular way in medicine.
what do you understand by the word acute?
what do you understand by the word chronic?
Acute: Of abrupt onset, in reference to a disease. Acute often also connotes an illness that is of short duration, rapidly progressive, and in need of urgent care.
Chronic: a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months.
One of the common questions I am asked is “could this be stress doc?” and almost always the answer to that question is “yes”. Stress can cause almost any symptom you name.
Stress, in psychology and biology, any environmental or physical pressure that elicits a response from an organism. In most cases, stress promotes survival because it forces organisms to adapt to rapidly changing environmental conditions. Stress is your body's response to anything that requires attention or action. Everyone experiences stress to some degree. The way you respond to stress, however, makes a big difference to your overall well-being.
Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the "fight or flight" response, in preparation for violent muscular action. Effects include the following: Acceleration of heart and lung action, paling or flushing, or alternating between both, inhibition of stomach and upper-intestinal action to the point where digestion slows down or stops, the general effect on the sphincters of the body, constriction of blood vessels in many parts of the body, liberation of nutrients (particularly fat and glucose) for muscular action, dilation of blood vessels for muscles, inhibition of the lacrimal gland (responsible for tear production) and salivation, dilation of pupil (mydriasis), relaxation of bladder, inhibition of erection, auditory exclusion (loss of hearing), & tunnel vision (loss of peripheral vision),
If we look at the various bodily systems - we can see that every one of these can feel the impact of stress.
This could be summarised simply as head, heart and hands.
How does stress relate to burnout?
Burnout is a relatively recent concept - I found a paper published in June last year discussing the definition of burnout because there was NO exisiting consensus!
Burnout appeared in the ICD 10 (1990) but with no definition - a somewhat arbitrary definition appeared in the ICD-11 (ICD-11 adopted in 2019 & comes into effect in 2022).
“Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
This paper reviewed research over many years and several sources of definition and ran this through a panel of experts.
final definition
"In a worker, occupational burnout or occupational physical
AND emotional exhaustion state is an exhaustion due
to prolonged exposure to work-related problems”.
Although exhaustion constitutes the core component of occupational burnout, as highlighted in our definition, no fewer than 132 other possible symptoms (affective, cognitive, physical, behavioural, and motivational) have been mentioned in past literature reviews”
It was also noted that there can be a burnout–depression overlap.
“What is burnout?
Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. As the stress continues, you begin to lose the interest and motivation that led you to take on a certain role in the first place.
Burnout reduces productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give.”
“Burnout is a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.”
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Stress vs. Burnout |
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Stress |
Burnout |
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Characterized by over-engagement. |
Characterized by disengagement. |
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Emotions are overreactive. |
Emotions are blunted. |
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Produces urgency and hyperactivity. |
Produces helplessness and hopelessness. |
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Loss of energy. |
Loss of motivation, ideals, and hope. |
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Leads to anxiety disorders. |
Leads to detachment and depression. |
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Primary damage is physical. |
Primary damage is emotional. |
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May kill you prematurely. |
May make life seem not worth living. |
CAUSES OF BURNOUT:
“Job burnout can result from various factors, including:
- Lack of control. An inability to influence decisions that affect your job — such as your schedule, assignments or workload — could lead to job burnout. So could a lack of the resources you need to do your work.
- Unclear job expectations. If you're unclear about the degree of authority you have or what your supervisor or others expect from you, you're not likely to feel comfortable at work.
- Dysfunctional workplace dynamics. Perhaps you work with an office bully, or you feel undermined by colleagues or your boss micromanages your work. This can contribute to job stress.
- Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and job burnout.
- Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed.
- Work-life imbalance. If your work takes up so much of your time and effort that you don't have the energy to spend time with your family and friends, you might burn out quickly.”
As a GP I sometimes feel a lack of control over my schedule & find myself running chronically late.
There are conflicting job expectations, my own, my managers, the patients, the PHO, the DHB, hospital doctors, health department. which can lead to a lack of clarity.
Workplace dynamics have varied over the years in addition to bullying from within the workplace we are subject to bullying by our patients.
In a people-facing occupation there is a constant need to be focussed on my patients. If they deem a lack of interest or lagging in attention they can be quick to criticise. The kind of problem I face is constantly changing - it may be that I had to break a diagnosis of cancer or alzheimers to the previous patient but the next patient in front of me demands 100%.
The need to keep patient confidentiality can lead to feelings of isolation.
Work life balance - anyone tried being on-call? Most of my colleagues do unpaid work from home logging in to work on the never-ending inbox.
This is not to say I am currently suffering from burnout but my occupation puts me at risk and there is a high rate of it in my profession.
Where do you see the risks in the life of vicars/priests-in-charge?
Job description for vicars
who is your boss?
Are you on the road to burnout?
You may be on the road to burnout if:
- Every day is a bad day.
- Caring about your work or home life seems like a total waste of energy.
- You’re exhausted all the time.
- The majority of your day is spent on tasks you find either mind-numbingly dull or overwhelming.
- You feel like nothing you do makes a difference or is appreciated.
Effects of burnout
Mayo clinic
“Consequences of job burnout
Ignored or unaddressed job burnout can have significant consequences, including:
- Excessive stress
- Fatigue
- Insomnia
- Sadness, anger or irritability
- Alcohol or substance misuse
- Heart disease
- High blood pressure
- Type 2 diabetes
- Vulnerability to illnesses”
From helpguide.org
“Physical signs and symptoms of burnout
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Emotional signs and symptoms of burnout
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Behavioural signs and symptoms of burnout
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When I posted to an online group of GPs that I was doing a presentation on burnout some of the responses were negative towards the term “burnout”. One stated that there is a lot of victim-blaming calling it burnout and he preferred the term “moral injury”. another agreed saying “simply not having the time, resources and energy to do the job you know you should be doing but are not allowed to” … “burnout remedies always imply the victim is doing something wrong and if you simply did yoga/mindfulness/exercise etc you will magically manage better…
Principles of resilience from Psychology today
Principle 1: Cultivate a Belief in Your Ability to Cope
Principle 2: Stay Connected With Sources of Support
Principle 3: Talk About What You’re Going Through
Principle 4: Be Helpful to Others
Principle 5: Activate Positive Emotion
Principle 6: Cultivate an Attitude of Survivorship
Principle 7: Seek Meaning
article from Psychology today - but many of these principles are the things that lead us to burnout. - So - let’s try for -
Optimising wellness:
Sleep - probably number 1,2 & 3!
Nutrition & exercise - Greger's daily dozen
“Stress and the gut-brain axis” - a significant amount of our brain is found in our gut. the function of the “gut brain” - these neurones that are in our gut linings are profoundly influenced by the bacteria in our gut. The bacteria produce large amounts of neurotransmitters like serotonin and its precursors. If you transfer the bacteria from anxious mice into the guts of germ-free mice you will make them anxious. You’ve heard of probiotics? - There is currently a lot of interest in “psychobiotics” - a new field of research.
Fiber-fueled on how to optimise your gut microbiome. - eating the right foods and doing your exercise outside where possible. - microbiome from the trees.
Relaxation / Meditation
6 relaxation techniques
Gratitude practice
Recreation & renewal - finding beauty
A Sabbath for joy and play
Supervision & Spiritual direction
an empathic encounter with your 7 selves - see applied empathy book
The 4 C’s
Control
Connection
Commitment to being present
an attitude that life is positively Challenging
If we are going to consider a systems approach rather than focussing on individual reslience there was a paper published in 2013 looking at clergy burnout & resilience which made the following 7 recommendations. (slide)
A few useful resources
Finally the wisdom of Leunig - a herbal remedy for life-ache.
Stress and burnout pdf slideshow
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