Put stress out before burnout gets you

Burn-out is a work-related, stress-induced emotional state which interferes with emotional, personal, interpersonal, and especially occupational functioning. The World Health Organization recently announced that it would include burn-out as a medical disorder in the International Classification of Diseases, 11th edition, which will come into force in 2022.

Fires should be prevented, not put out. This principle applies to burn-out, as well. Preventing burn-out, and dealing with the early signs and symptoms of burn-out, requires the use of principles of stress management. Here are a few guidelines which everybody should put into practice.

* Do not allow your professional life to become your whole life. Nourish a healthy social, family, and leisure life. This way, professional discouragements can be offset by rewards and successes on the personal front. Discover the richness and pleasures of life, and find meaning in life outside of the workplace.

* Develop hobbies and personal interests. Play games regularly. Outdoor games are better than indoor ones, and games that tire you physically are better than those that absorb you mentally. Playing is better than reading, and both are better than watching TV. If you must watch TV, watch family programmes along with your family; or watch only what you don't want to miss rather than because you have nothing else to do.

* Learn to indulge, reward or even spoil yourself regularly by going for picnics, cultural shows, movies, family outings, and other activities. Do you want something very much? Buy it, if you can afford it. Do you have a great liking for some particular food or beverage? Indulge yourself occasionally. Make life worth living. Have something to look forward to each day so that there is a reason to get out of bed in the morning. For every reason to groan that emerges from your workplace, there should be several reasons to smile in your family and leisure life.

* Do not neglect your social life. Keep the company of friends who make you feel good, and in whose company you can laugh and relax.

* Cultivate methods of relaxation: yoga, meditation, prayer.

* Slow down the pace of your life.

Consider the case of Dr Ramesh. He is a cancer specialist with 18 years of service. He has recently become disinterested in work. He comes in late, sees fewer patients personally, delegates responsibilities more often than not, is tardy with paperwork, loses his temper often, and has become indifferent to the anxieties of his patients. The changes occurred after a junior was promoted over him.

Dr Ramesh may be burning out. Burn-out is considered to be present if at least one criterion is present in emotional, occupational, personal, and interpersonal domains. Emotional symptoms include energy depletion and exhaustion; persistent anxiety or depression; boredom, disinterest or amotivation; and pessimism or cynicism.

Occupational symptoms include mental distance from one's job, decreased efficiency, procrastination, decreased commitment, working to rule, and a desire to quit.

Personal symptoms include a decrease in enthusiasm, originality, and creativity; unexplained or disproportionate fatigue; laziness, carelessness, or sloppiness; and use of alcohol to reduce stress or boredom.

Interpersonal symptoms include decreased concern or caring, frequent, unjustified irritability, family disharmony, and social withdrawal.

These symptoms should represent a change rather than a personal style of functioning. The symptoms should arise in the context of occupational life and not from a medical or psychiatric disorder. The number of symptoms present and the severity of these symptoms both indicate the severity of burn-out.

Burn-out is common in the helping professions. This is because emotional energy is expended in the process of caring and showing concern. Doctors, nurses, social workers, priests, counsellors, and therapists may be affected by the syndrome. Persons working in 'no-win' situations, or situations in which professional defeat is common, are especially vulnerable; these include doctors, such as Ramesh, who handle terminally ill patients, and marriage counsellors, who handle couples unwilling for reconciliation.

Burn-out also occurs in high-stress, high-demand, high-expectation professions, especially when the successes and rewards are insufficient to keep the individual fired-up with enthusiasm and interest.

Importantly, burn-out can also affect family members who care for bedridden or terminally ill patients.

Occupational behaviors and stresses that may cause burn-out are many; often, one stress or event acts as the last straw, triggering the onset of burn-out. Causes of burn-out include an initial overdrive, lack of success in work, lack of fulfillment, professional frustration, lack of scope to apply one's talents, lack of support, appreciation, or recognition at the workplace, lack of promotion or other material reward for one's efforts, presence of emotional stresses, such as working with people's problems or in demanding interpersonal situations etc., and presence of work-related stresses such as targets, deadlines, and overwork.

External stresses in domestic, financial, and other areas increase the risk of burn-out.

(Dr. Chittaranjan Andrade is Dean and Professor, Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore)