Burnout as Trauma – Part 1

Several weeks earlier

My bike was safely stowed on my host’s back patio. Having showered off the dust from the Queensland roads and changed into my cleaner set of clothes, I emerged from my host’s spare bedroom and mentally braced myself for the ritual of socialising. I entered the small living room to find the house owner Mike sitting on a sofa, and a woman Mike introduced as his sister Beth sitting opposite him (names changed for privacy reasons). She was middle-aged with brown curly hair framing a kind face. I noticed how she sat timidly in the corner of her couch, with her feet together and hands in her lap. She gave me a shy smile and a greeting, her eyes bright.

I was somewhat surprised to see Beth here. Mike had let me know me before I arrived about his sister who lived in a granny flat out the back, saying she suffered from anxiety and was nervous around strangers. Perhaps he’d told her about my own anxiety challenges and this had drawn her out. Either way, I was genuinely delighted to meet this mysterious person. What was her story? How did she come to be here? I sat down at the other end of the sofa from her.

From the conversation that followed, I gleaned that she had been living in another city when a violent experience had left her with Post Traumatic Stress Disorder (PTSD). In addition to anxiety, she suffered from sleep trouble, chronic fatigue and physical illness. She became socially withdrawn and reclusive, to the point where her family grew extremely worried and invited her to come live with them. Sitting there on their couch, we discussed our symptoms together and I was fascinated by how much they overlapped. I asked her if she knew what ‘anhedonia’ was, to which she replied: ‘Yes! Story of my life!’

In truth, I wasn’t overly surprised. I’d talked to a few people on this bike journey with PTSD, each caused by something different: a car crash, childhood abuse, war, bushfire; and each time I’d been intrigued by the resemblance of our different health challenges. During my earlier ride across WA, I’d met a war veteran who lived a quiet life travelling alone about the countryside, much as I was. We spent some time together and I felt an inexplicable kinship with him. On my way through Sydney, I visited a friend who had developed PTSD after being in a train accident. She now lived a quiet, socially withdrawn life, struggling with anxiety, fatigue and chronic gut problems.

Why were we all so similar?

***

I had set off on this journey filled with questions, about preventing burnout and overcoming eco-distress, about finding purpose and balance while staying an active citizen. With the help of the people I’d met along the way, I felt I had come some way towards answering these.

But there was still one big question that remained: How do I get better? I wanted to know how to recover from burnout.

As I made my way up the Queensland coast, I knew of no experts whom I could visit. But my smartphone was a portal to a world of information, and I dived into the scientific research, poring over academic papers and literature reviews and phoning people with different perspectives. Slowly, I managed to piece together my own picture.

Our understanding of ‘burnout’ has evolved over the years. From 1974 when psychologist Herbert Freudenberger first coined the term, through to May 2019 (while I was part way along my bicycle journey) when the World Health Organisation finally recognised burnout officially as a workplace phenomenon in their International Classification of Diseases. In the intervening decades, burnout has become one of the most widely discussed mental health problems in today’s society, with the medical community still arguing about how to define it.

A 2016 paper by Christina Maslach and Michael Leiter, entitled ‘Understanding the burnout experience: recent research and its implications for psychiatry,’ looked at the developments in burnout research over the past few decades. It observed that a lot of research had been done on understanding the causes and consequences of burnout and on potential interventions to reduce burnout in the workplace, but there was a relative dearth of evaluative research on how to treat burnout.

How then do we treat burnout?

As an activist I remember once receiving a flyer about burnout that listed various ways to help prevent it, such as meditation, exercise, and better work-life balance. But there seemed little about what to do if you were already burnt out.

I’d seen numerous different doctors over the years, each of whom had treated my symptoms and tried various medications, including antidepressants, but ultimately hadn’t been able to help me.

I’d read a range of books on the topic, and I was frustrated with how fluffy some of their recommendations were. Maybe I just hadn’t been ready to accept their advice. I was a scientist at heart and I wanted some hard science to explain what had happened to me.

I thought back over the suggestions these books had given. Some were more spiritual in nature, around things like Acceptance, Self-compassion, Gratitude, and Positive affirmations. Others were a bit more practical, such as to Meditate, Take a long break, Slow life down, Listen to your body, Learn to let go, Breathe. I had tried to do many of these things, and they had been valuable. But I’d still grown sicker and lost weight until I ended up in hospital.

In her book ‘In the Tiger’s Mouth’, activist and educator Katrina Shields wrote that ‘Some people may experience burnout as a temporary malaise, make appropriate adjustments and continue on. But for others, burning out means a stress-related disease producing major life crises from which they may never fully recover.’ It was a daunting thought.

How then should I understand these lingering after-effects of burnout? Would I ever be well again?

A clue was offered to me halfway up the Queensland coast when I came across the work of researchers who believed that burnout is in fact a form of Post Traumatic Stress Disorder (PTSD).

One of these was Dr Geri Puleo, an American university professor specialising in organisational change management. As part of her PhD dissertation Dr Puleo interviewed a large number of workers who had been through burnout. Based on these interviews, she was able to map out a typical trajectory of what these workers went through.

She found that people descended into burnout relatively quickly, often in as little as six months, though typically slower for people in positions of leadership and greater autonomy. Employees went from a place of ‘hope’, through stages of ‘frustration’, followed by ‘anger’, then ‘apathy’, and finally into burnout.

In contrast, recovery was painfully slow, some taking two years or longer, and requiring a fundamental shift in the worker’s attitude towards work. Many workers spent a lot of time in denial, and accepting they were burnt out was one of the most difficult first steps. They then needed to remove themself from the stressful work situation, either physically or psychologically. Most ended up leaving their jobs, and some left their previous field of work altogether.

The next step was developing greater self-knowledge and awareness, understanding and accepting what they were going through. Finally, a revised psychological contract with their work needed to be established. The old relationship with their work had been broken, along with the hopes, perspectives and motivations for that work. It was also easier for the employee to be re-triggered into burnout, further delaying their recovery.

I thought about where I sat along this recovery pathway. How far along had I come in developing greater self-knowledge and awareness? I’d learnt so much about myself on this journey, but was it enough? Had I really changed, or was I fooling myself and just playing out the same patterns of behaviour as had led to me burning out? How deep did I really need to go?

Much deeper, it would seem.

During her interviews with burnt out workers, Dr Puleo was struck by the similarities between burnout and PTSD, both of which were characterised by symptoms of anxiety, disturbed sleep, depression, social withdrawal, avoidance behaviours, irritability and mood changes. She told the story of one executive director of a non-profit organisation who, twenty months after her burnout, still found herself breaking down in tears and uncontrollable shaking. Dr Puleo raised the question: what if burnout is in fact a form of PTSD?

So, was this what I was grappling with? Did I need to start thinking of myself as dealing with some kind of Post Traumatic Stress Disorder?

Trauma is an emotional response to a highly distressing event. Under normal conditions, people react to a threat with a temporary increase in their stress hormones, then when the threat is over the body quickly returns to normal. But if a person becomes frozen in a state of intense stress, then they are experiencing a trauma — even though they may not be consciously aware of the level of distress they are experiencing. Trauma that is not released can turn into PTSD.

The human body is regulated by the autonomic nervous system, which controls unconscious functions like breathing, digestion and heartbeat. It has two branches: the sympathetic nervous system, which acts as the body’s accelerator; and the parasympathetic nervous system, which acts as its brake. When we experience a stressful event, our sympathetic nervous system kicks into gear, releasing stress hormones, boosting the body’s alertness and increasing blood flow. We refer to the activation of the sympathetic nervous system as ‘arousal’, the so-called fight-or-flight response.

Normally our nervous system should provide a lightning fast response to a threat but then quickly return us to equilibrium. The bodies of PTSD patients, however, fail at this balancing act. Their nervous systems have become dysregulated by their trauma. Fight-or-flight signals continue long after a threat has passed and do not return to normal. Their body remains in a state of ‘hyperarousal’, and the continued secretion of stress hormones is expressed as agitation and anxiety, and in the long term wreaks havoc on their health. Common symptoms include chronic pain, chronic fatigue, fibromyalgia, migraines and digestive problems.

In the book ‘The Body Keeps the Score’, renowned trauma expert Dr Bessel van der Kolk explains how traumatic stress literally rearranges the brain’s wiring. He writes that trauma is not just an event that took place in the past. It is also the imprint left by that experience on mind, brain and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.

Dr van der Kolk describes how many traumatised individuals are too hypervigilant to enjoy the ordinary pleasures that life has to offer, while others are too numb to absorb new experiences. Many trauma patients seek out thrilling activities, as it at least makes them feel energised and fully alive instead of numb.

He describes them becoming socially withdrawn, explaining that trauma scrambles the part of the brain that specialises in attuning to and synchronising with other people. Being stuck in a state of hypervigilance also makes it difficult for them to connect with people, since closeness often triggers a sense of danger.

It all sounded uncannily familiar.

So then, what about burnout? What about people who, rather than a one-off distressing event, experience chronic stress to the point of exhaustion and beyond?

With the relatively recent discovery of neuroplasticity, it’s been found that our brain retains the ability to change and reorganise throughout our life. The more we use certain neural networks, the stronger and more dominant they become. That is, our brain and body are shaped by the things we repeatedly do. When a neural circuit fires repeatedly, it can become a default setting — the response most likely to occur.

Could it be that chronic stress keeps the nervous system in a state of high arousal, to the point where it becomes dysregulated, similar to PTSD patients? Had burnout rewired my brain and body, leaving it stuck in a state of tension? Was it hyperarousal that was undermining my sleep and digestion, and keeping my body fatigued?

When talking on the phone with Bronwyn Gresham, a clinical psychologist on the board of the organisation ‘Psychology for a Safe Climate’, she asked if I had heard of the concepts of ‘big T’ and ‘little t’ traumas.

Big ‘T’ traumas are the life- or body-threatening events most commonly associated with PTSD, such as war, a car accident, or a sexual assault. Little ‘t’ traumas are smaller than big ‘T’ traumas, but are still highly distressing on a personal level, such as a relationship breakup, emotional abuse, bullying or harassment, which can be extremely upsetting and cause significant emotional damage. Whilst one little ‘t’ trauma may not meet the criteria for a PTSD diagnosis, the emotional harm caused by little ‘t’ traumas has a cumulative effect, and repeated exposure to little ‘t’ traumas can cause more emotional harm than exposure to a single big ‘T’ traumatic event.

I considered how this might apply to my experience. I recalled the periods of overwhelming pressure working on certain projects or campaigns, the occasional devastation when a high-stakes campaign lost or a hard-worked project fell short, and the infrequent, but profoundly distressing, moments of interpersonal conflict with colleagues as stress and passion collided. Each time I had failed to seek help to process any emotional anguish I’d felt; instead I’d avoided it, suppressed it, bottled it up, and just got on with things; because that’s what I’d been taught strength was. I now knew differently.

There were other views on whether burnout was a form of PTSD.

I made a call to Dr Richard Yin, the WA chair of the organisation Doctors for the Environment Australia. Over the phone he told me about his own burnout journey, and described the steps he went through to recover. He recommended: 1. Stop doing what’s burning you out, 2. Top yourself up by doing what nourishes you, and 3. Learn to constantly re-orient yourself to doing what nourishes you, as it’s easy to re-burn-out.

‘What nourishes me?’ I wondered. I wasn’t sure I knew anymore.

Dr Yin added his perspective that not all psychological distress from activism was ‘burnout’, that there are other trauma-related conditions that activists can experience, such as ‘vicarious trauma’, when we’re constantly exposed to distressing news about the environment. Chronic stress can also trigger clinical symptoms of depression, anxiety and PTSD, in addition to burnout. That is, it’s not ‘just’ burnout that we experience, it can be things like trauma and PTSD as well.

I’d heard of vicarious trauma before, and what I read taught me more. Often used interchangeably with ‘secondary trauma’ or ‘compassion fatigue’, the term was coined to describe the experience of therapists working with trauma patients. Its application had later been expanded to other professions, including people working on environmental issues. Symptoms included intrusive thoughts, avoidance behaviours, hyperarousal, and others similar to PTSD. I thought about my own avoidance of negative environmental news.

I came across one study that noted clear signs of traumatic symptoms amongst environmental researchers, pointing to vicarious trauma as a probable cause (Pihkala, 2019). Another study described secondary trauma as a syndrome of symptoms nearly identical to PTSD (Figley, 1995). Yet another study found that the concepts of burnout, vicarious trauma and secondary trauma overlapped to such a degree that they were predominantly measuring the same phenomenon: burnout (Devilly et al, 2009).

All these different terms, all pointing to pretty much the same thing.

Different conceptual models, each leading to the same phenomenological outcome. Whether burnout was a type of trauma or PTSD, or whether it occurred alongside trauma and PTSD, either way it gave me a new perspective on my health challenges. It was helpful for normalising my experience and for putting the pieces together; to understand what was really going on and work out the best strategy for moving forwards.

But where did this leave me? If I was to think of burnout as a form of PTSD, what could I do about it? Was there a way to retrain my brain, to recalibrate my nervous system and reconnect with my body, my world, and the people around me? I still had more answers to find.