Depression, Exhaustion and Burnout

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Published February 2, 2020. 

Dr. Sylvester Ikhisemojie

In discussing matters of health concern, it is often common these days to find people who habitually complain of being tired. Some admit to feeling so exhausted that they do feel that they can barely cope with the routine work schedule in the office. For many young people these days, this seems to be the pattern and just over a fortnight ago yours truly was in the position to advise a young mother of two who was recovering from illness to take a couple of days off work. The answer was that she was a contract staff and would not be permitted to do so. That was a response which was shocking to say the least.

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There was no amount of admonition to the effect that only people who were well could actually work would change her mind. Work continued and barely a week later came the sad news: she had gone to bed the previous night like everyone else in her family but had failed to wake up in the morning. She had died suddenly during the night.

In the days since that tragic news broke, nearly everyone who knew her has suddenly realised that the pressure of the workplace, the attendant stress it brings about and monotony associated with a regimented office routine can often become an incendiary mixture which make people overly anxious, unable to sleep properly and less effective at work. Some people describe experiencing feelings of helplessness, apathy and even frustration. Others say they feel hopeless, especially in sectors of the economy where wages are being owed sometimes over many months, while some others say they feel exhausted. It is a challenge though to differentiate between burnout, fatigue and depression but it is noteworthy that the World Health Organisation, has brought about some clarity to the matter by listing burnout in the International Classification of Diseases (ICD-11). It did not call this condition a disease in that classification but it called it a “syndrome conceptualised as resulting from workplace stress that has not been successfully managed”.

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Burnout is thus a workplace problem whereby a combination of unrealistic expectations from employers and poor organisational management, do not sufficiently support people or their aspirations. In such situations, their hopes crumble as they begin to feel undervalued, overworked, underpaid and unappreciated. In many sectors of our lives today within the working population, the above conditions hold true and the employee is the worse for it. And although this word has been in use for many years, it is only recently that it has crept into use in the hospital setting and it is beginning to look now like it could be an epidemic. Just while typing this essay, somebody I have advised over several months said bluntly that she was resigning next Monday. There is no other job on the horizon, she said but she had had enough. That said, it is equally important especially for the purposes of treatment to distinguish this condition from depression and chronic fatigue.

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In the main, while burnout can be managed effectively by changing the situational and operative circumstances of the workplace, the other conditions tend to be unaffected by similar changes. Burnout can therefore be divided into three parts according to Professor Michael Leiter of Deakin University in Australia. The first part is said to be characterised by exhaustion which is easily recognisable enough due to the fact that people are often too tired even before the working day has begun. More to the point, people are exhausted even before getting to the office. They would have spent between three and five hours in Lagos morning traffic to get to work, would have slept for perhaps four or five hours the previous night and not had any breakfast. Worse, the hassles they undergo to get to the office are seldom reckoned with in the overall appreciation of the work output. The above situation is the perfect description for the largest cities in Nigeria today.

The second part is the feeling of disengagement from a particular job you once cared about very much. Over time, one feels a lack of motivation to even appear at the office and develops a penchant for quarreling over minor issues not to mention having a disdain for the management. There are no further challenges to be had and no real targets to excite one like they used to. In the end, a certain attitude of cynicism develops around the entire establishment and you allow your colleagues know it. When the situation has reached a head like this kind of scenario, it is often helpful to have a useful audience with the boss and make an effort to secure some quality time away from work to rest and reposition oneself mentally. Once more, this approach may be self-defeating in Nigeria where most workers are not willing to go on vacation for various reasons.

Finally, the third part of the tripod is when a person begins to lose efficacy at work. This effectively means that one develops a certain level of apathy to the work as a whole and there is no further motivation towards self-improvement. Such an individual then starts to lose self-confidence to the extent that the importance of the work as a whole is no longer appreciated. With the passage of time, such a person even loses the capacity to learn and to thrive. When the summation of these three stages of burnout is compared to clinical conditions such as chronic fatigue and depression, it is seen that burnout is not an illness at all. Rather, it can be labelled a precondition that might leave someone vulnerable to developing a depressive illness.

Another key difference between the three conditions stems from several observable situations. If one changes some important parts of the work place there may be no impact on someone who is described as suffering from a depressive illness. This is because depression is most commonly a reaction to some inner turmoil. In cases of burnout, however, when the volume of work done by an individual is altered and the schedule of work is changed, huge differences might be made in improving the overall condition of the person. However, there are those who prefer to use this term than depression because it is not a term associated with any form of stigmatisation.

It is regarded as a step away from depressive illness which is universally acknowledged as a mental health problem. The other difference is that people who are described as suffering from burnout often return from any vacation refreshed and energetic whereas people with depression remain unchanged whether they remain at work or go away for some time on holiday. In the end, many will appreciate that there is a massive difference between someone who feels exhausted even before normal work commences on any working day and one who is exhausted at the end of a normal day’s work. The latter is a normal response to stress: the former is a prelude to illness.

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