© 2016 The Wired Word
www.thewiredword.com
Burnout and depression are not the same thing.
Or are they?
According to recent research, the two diagnoses could be more closely related than has usually been assumed.
The study was published in the journal Personality and Individual Differences (see in link list below) in January, but wasn't widely seen until The Wall Street Journal and other mainstream media reported on the research earlier this month.
Psychologists typically connect burnout to one's job and thus sometimes call it "occupational" burnout, though it can apply to one's involvement in other endeavors as well. It's usually thought of as a state of physical and mental exhaustion (the word "exhaustion" comes from Latin, meaning "emptied out," denoting a lack of energy or vitality). In contrast, depression is considered a psychological problem characterized by chronic anxiety and feelings of sadness.
As one measure of how burnout and depression have usually been counted as separate problems, we note that neither of the two current standard medical classification lists, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10), lump burnout with depression. In fact, the DSM-V doesn't include burnout as a distinct disorder. The ICD-10 does, under the category "Problems related to life-management difficulty." Depression is listed in a different category.
What's more, psychotherapists typically think of burnout and depression as separate conditions. TWW team member Liz Antonson, who is a psychotherapist, explained, "Depression is a stand-alone psychological malady and often present without burnout factors," but she added that depression can be one consequence of burnout.
Leah Yau, a psychotherapist in New Jersey, said that in her practice, she's found that if people with a history of depression experience burnout and don't take care of themselves, they can slip into another depressive episode. Likewise, she said, people who are burning out often report some depression-type symptoms.
The study surveyed 1,386 teachers, about three-quarters of whom were women, from 18 U.S. states. Most were in their 40s and had taught an average of 14.4 years. The researchers determined that 10 percent of the women and 7 percent of the men were experiencing burnout, and that 10 percent of both sexes were suffering from depression.
Among those with burnout, 50 percent of the men and 38.2 percent of the women had severe depressive symptoms, 22.7 percent of the men and 36.3 percent of the women had moderately severe depressive symptoms and none of the subjects with burnout was free of some depressive symptoms.
The study's coauthors explained that redefining burnout to include depression could lead to more effective treatment for people who recognize they have burnout. Typically, such persons are less likely to seek help than those with depression. But if these sufferers can link burnout with depression, they may seek help and thus get better care from experts in depression.
More on this story can be found at these links:
Are Burnout and Depression the Same Thing? Wall Street Journal
You Call It Burnout. These Scientists Might Call It Depression. NYMag.com/Science of Us
Burnout Is Associated With a Depressive Cognitive Style. Personality and Individual Differences
You Call It Burnout. These Scientists Might Call It Depression. NYMag.com/Science of Us
Burnout Is Associated With a Depressive Cognitive Style. Personality and Individual Differences
Applying the News Story
Here at The Wired Word, we are not sure how much weight to give this study. The subjects involved were not assessed with clinical interviews, but instead self-reported their burnout and/or depression. And it is not known if any had a history of depression.
Additionally, there is a financial incentive in the counseling world to co-mingle the two diagnoses. When counseling clients, psychotherapists are only able to receive reimbursement from the clients' insurance companies if there is a defendable diagnosis from either the ICD-10 or the DSM-V. Since the latter does not include a burnout code, therapists who use that standard must state some other accepted diagnosis -- usually depression (if criteria are met) -- and list as contributing factors to the depression any features of burnout identified in the client. (We are not suggesting anything necessarily underhanded in this process. It is usually helpful to the client's well-being and recovery to arrange for his or her health insurance to pay for the counseling.)
Still, it seems clear to us whether or not burnout and depression are diagnostically related, both cause at least psychological discomfort and sometimes significant personal suffering. Thus, in this lesson, we will not attempt to separate the two, but will look at some questions and text that might speak to either condition.
The Big Questions
1. When you are feeling unusually "blue," "down" or tired for an extended time, does a diagnosis help you give yourself permission to get treatment? If not, what does? Where is the boundary between what people might call feeling blue and clinical depression? In what instances, if any, might labeling something "clinical depression" help or hinder a person's dealing with the situation?
2. If you are experiencing burnout or depression, how does that interact with your Christian faith? For example, if you hear a sermon on Christian joy or the gospel as good news, and joy and good news do not match how you are feeling psychologically, does that cause you think that something must be wrong with your commitment to Christ? Is that a realistic conclusion? Why or why not? On the other hand, if you are feeling well and well-adjusted and are listening to a sermon about depression or burnout, do you feel no connection?
3. If you have not experienced burnout or chronic depression, what helps you to empathize with those who have? Are there people who are depressed who, because of their proximity, have caused you to experience some of their symptoms?
4. If you have experienced either burnout or depression and feel comfortable talking about it, what did/do you find most debilitating about the condition? Did you or do you feel the congregation and pastors were able to minister to you? Did they even notice? Did you ever feel that some church members or pastors seem to believe that depression signifies a lack of faith, and blame you?
5. In what ways can your local church help its members who may be depressed, burned out, overwhelmed or otherwise disheartened?
Confronting the News With Scripture and Hope
Here are some Bible verses to guide your discussion:
Here are some Bible verses to guide your discussion:
1 Kings 19:4
But [Elijah] went a day's journey into the wilderness, and came and sat down under a solitary broom tree. He asked that he might die: "It is enough; now, O LORD, take away my life, for I am no better than my ancestors." (For context, read 19:1-15.)
But [Elijah] went a day's journey into the wilderness, and came and sat down under a solitary broom tree. He asked that he might die: "It is enough; now, O LORD, take away my life, for I am no better than my ancestors." (For context, read 19:1-15.)
In the scene pictured in this verse, the great prophet Elijah sounds overwhelmed. Ironically, he had just had a major success. In a confrontation with some 450 prophets of the god Baal and 400 prophets of the goddess Asherah, Elijah, alone representing Yahweh, proved that his God was the only one with power. (You can read the details of that encounter in 1 Kings 18.) But here in chapter 19, Elijah is anything but pumped up from his resounding triumph in the name of God. In fact, hearing that Israel's Queen Jezebel is after him because he trumped her prophets, Elijah hightails it out of the area. Then, when he is safely away, all his energy leaves him, and he begins to feel sorry for himself. He has had it with being a prophet and he wants to resign his commission. He is burned out.
That's not merely guessing at Elijah's state of mind. This is one case where the biblical author tells us what's up with the prophet using both metaphor and by quoting Elijah's own words. The metaphor is in the detail that Elijah, alone in the wilderness, "sat down under a solitary broom tree." That is a poetic way of conveying how Elijah felt -- all alone like that single tree. And then Elijah's words let us look into his mood: "It is enough; now, O LORD, take away my life, for I am no better than my ancestors."
What happens next, however, tells us that God is not about to let Elijah give up. The prophet goes to sleep, but God twice sends an angel to wake Elijah and give him food -- nourishment for what is to come. And then God directs Elijah to make a forced march to Mount Horeb, where instead of looking for a fresh vision or renewal, the prophet promptly takes refuge in a cave. That apparently was not what God had in mind, for God comes to Elijah in the cave and says, "What are you doing here, Elijah?"
The prophet's response is whiny and shows again how burned out he feels. "I have been very zealous for the LORD, the God of hosts; for the Israelites have forsaken your covenant, thrown down your altars, and killed your prophets with the sword. I alone am left, and they are seeking my life, to take it away." (Actually, that was quite an exaggeration. There were thousands in Israel who remained faithful to God, but when we are exhausted, we often fail to see the hopeful reality of a situation.)
God tells Elijah to go outside the cave and witness what God is about to show him, but Elijah won't go. So God sends first a great wind, and then an earthquake and then fire, but none of these things cause Elijah to budge from his hidey-hole. But after all the pyrotechnics of nature are over, there is nothing but the "sound of sheer silence," and it is that which finally lures Elijah to move to the mouth of the cave.
In the end, God gives Elijah more work to do: "Go, return on your way to the wilderness of Damascus ...." When he gets there, he is to anoint new kings for Aram and Israel, as well as begin schooling a new prophet who will eventually be Elijah's successor.
God doesn't seem very sympathetic. Here is poor Elijah, physically, mentally, emotionally and spiritually exhausted from his work as God's prophet, with people out to kill him, and God won't even let him rest -- won't even let him hunker down in this cave in peace. And when the weary prophet finally does stagger out of the cave, God adds new work to Elijah's to-do list!
But here's the real surprise: That is what works. God tells Elijah to get back to work, and Elijah does it. He goes on to again work successfully for God right up through his final hours on earth.
Questions: To what extent does this get-back-to-work response seem like a "pull yourself up by your bootstraps" (or a "get back on the horse when thrown") approach to depression? Why might that approach work in some instances and not in others? When has re-emersion in your work or other responsibilities helped you get past burnout? When has re-emersion only made matters worse? What, if anything, did help? Is there a time you felt like giving up and then knew God was internally nudging you to keep going? If so, did you resent or welcome God?
Psalm 42:5-6
Why are you cast down, O my soul, and why are you disquieted within me? Hope in God; for I shall again praise him, my help and my God. (For context, read 42:1-11.)
Why are you cast down, O my soul, and why are you disquieted within me? Hope in God; for I shall again praise him, my help and my God. (For context, read 42:1-11.)
Clearly the psalmist is feeling down here -- whether depressed, burned out or otherwise despondent. And since he asks "Why?" it's apparent that he cannot tie his mood to a cause. What he feels is what he feels, whether he can identify a reason for those feelings or not.
But note that he's also giving himself a prescription: "Hope in God; for I shall again praise him, my help and my God." We take it that from past experience, he's recognizing a cyclical pattern in his feelings (or as the old song puts it, "Sometimes I'm up, sometimes I'm down.") So in hope he holds on to the belief that he will again feel able to praise God.
Note that the idea that God is a help to those who are dispirited is not confined to Psalm 42 alone, but appears in many places in the psalms. Consider these two examples:
• Psalm 94:19 -- "When the cares of my heart are many, your consolations cheer my soul."
• Psalm 34:18 -- "The LORD is near to the brokenhearted, and saves the crushed in spirit."
• Psalm 34:18 -- "The LORD is near to the brokenhearted, and saves the crushed in spirit."
Questions: Do you recognize some cyclical pattern in your feelings? What lessons, if any, do you draw from that? What about if you seem stuck for the long term in the bottom of such a cycle? How, if at all, does hope in God help then? Are feelings right, wrong or neutral? If you are able to recognize the signs that you are on the verge of a bout of the blues, or depression, do these signs allow you the emotional space to seek and find help, or are you too disheartened to reach out?
Exodus 18:17-18
Moses' father-in-law said to him, "What you are doing is not good. You will surely wear yourself out, both you and these people with you. For the task is too heavy for you; you cannot do it alone. (For context, read 18:13-26.)
Moses' father-in-law said to him, "What you are doing is not good. You will surely wear yourself out, both you and these people with you. For the task is too heavy for you; you cannot do it alone. (For context, read 18:13-26.)
When Moses' father-in-law Jethro visited the encampment of the Israelites in the wilderness, he observed that Moses was carrying the duties of leadership and judge all by himself. Jethro wisely told Moses that if he continued to do that he would "surely wear yourself out," and that "you cannot do it alone." Jethro advised Moses to delegate some of the work and keep for himself only the duties that he alone could do. "If you do this, and God so commands you," said Jethro, "then you will be able to endure, and all these people will go to their home in peace" (v. 23).
Moses took his father-in-law's advice, and delegated important work to others. Thus, he avoided the kind of exhaustion that can lead to burnout and was, as Jethro said, "able to endure."
Questions: When have you taken on so much work that you lost the joy of what you were trying to accomplish? What kept you from delegating some of the duties to others? When has delegation enabled you to endure? When has delegation been harmful -- and why?
Philippians 4:6-7
Do not worry about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. (For context, read 4:4-9.)
Do not worry about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus. (For context, read 4:4-9.)
Questions: How would you describe the "peace of God"? How is it related to matters of psychological discomfort? Is the peace of God dependent upon you transcending your depression? Can you be depressed or blue and still feel the peace of God?
Galatians 6:2
Bear one another's burdens, and in this way you will fulfill the law of Christ. (For context, read 6:1-8.)
Bear one another's burdens, and in this way you will fulfill the law of Christ. (For context, read 6:1-8.)
Questions: How can you help bear the burden of a Christian brother or sister suffering the pain of burnout and depression? How can you let fellow Christians help you to bear the burdens of burnout or sadness when they affect you?
2 Corinthians 12:7-9
Therefore, to keep me from being too elated, a thorn was given me in the flesh, a messenger of Satan to torment me, to keep me from being too elated. Three times I appealed to the Lord about this, that it would leave me, but he said to me, "My grace is sufficient for you, for power is made perfect in weakness." So, I will boast all the more gladly of my weaknesses, so that the power of Christ may dwell in me. (For context, read 12:2-10.)
Therefore, to keep me from being too elated, a thorn was given me in the flesh, a messenger of Satan to torment me, to keep me from being too elated. Three times I appealed to the Lord about this, that it would leave me, but he said to me, "My grace is sufficient for you, for power is made perfect in weakness." So, I will boast all the more gladly of my weaknesses, so that the power of Christ may dwell in me. (For context, read 12:2-10.)
We don't know what malady Paul was referring to as his "thorn" in the flesh. Bible scholars have speculated that it could have been anything from bad eyesight or bad hearing to malaria or epilepsy to headaches or recurrent depression. But for our purposes, its exact nature doesn't matter. The point is, Paul prayed three different times to God to have this ailment healed, and the only answer he got was "My grace is sufficient for you, for power is made perfect in weakness." Or, to paraphrase, "Live with it in my grace."
The answer Paul received from God does remind us that not all problems, psychological or otherwise, are altogether alleviated by treatment. There is a form of depression, for example, that is classed as "treatment resistant," and in such cases, it is valuable to look for the grace of God to help us bear what cannot be healed.
With all the medical, social and psychological help available these days, "Live with it," is never the right answer for real pain until all those avenues have been exhausted. But we recognize that each of those lines of help has its limits. God's sufficiency goes beyond that.
It's good for us to remember that in this world, there is no life without storms, no existence without dry seasons, no mortality without calamity. Life is complicated and sometimes beyond understanding. There will always be disturbing aspects and dark corners we can hardly bear to look at.
But we are not alone. God's grace is sufficient. His power is made perfect in our weakness. What that means will be different for each one of us, but the Bible reminds us that a life, a meaningful life, a worthwhile life, can be lived even in the depths of human pain.
Questions: Does this text feel like a band-aid that others apply to you so they don't have to deal with you when you are depressed? With what does God's statement, "My grace is sufficient for you, for power is made perfect in weakness," help you?
For Further Discussion
1. Regarding burnout, the following "suggestions" were once listed somewhere on the website of the Massachusetts Institute of Technology (MIT). Your class might get some insight from them as well as a laugh from the tongue-in-cheek counter-statements called the "MIT View" that someone added to them:
1) STOP DENYING. Listen to the wisdom of your body. Begin to freely admit the stresses and pressures which have manifested physically, mentally, or emotionally.
• MIT VIEW: Work until the physical pain forces you into unconsciousness.
2) AVOID ISOLATION. Don't do everything alone! Develop or renew intimacies with friends and loved ones. Closeness not only brings new insights, but also is anathema to agitation and depression.
• MIT VIEW: Shut your office door and lock it from the inside so no one will distract you. They're just trying to hurt your productivity.
3) CHANGE YOUR CIRCUMSTANCES. If your job, your relationship, a situation, or a person is dragging you under, try to alter your circumstance, or if necessary, leave.
• MIT VIEW: If you feel something is dragging you down, suppress these thoughts. This is a weakness. Drink more coffee.
4) DIMINISH INTENSITY IN YOUR LIFE. Pinpoint those areas or aspects which summon up the most concentrated intensity and work toward alleviating that pressure.
• MIT VIEW: Increase intensity. Maximum intensity = maximum productivity. If you find yourself relaxed and with your mind wandering, you are probably having a detrimental effect on the recovery rate.
5) STOP OVER-NURTURING. If you routinely take on other people's problems and responsibilities, learn to gracefully disengage. Try to get some nurturing for yourself.
• MIT VIEW: Always attempt to do everything. You ARE responsible for it all. Perhaps you haven't thoroughly read your job description.
6) LEARN TO SAY "NO." You'll help diminish intensity by speaking up for yourself. This means refusing additional requests or demands on your time or emotions.
• MIT VIEW: Never say no to anything. It shows weakness, and lowers the research volume. Never put off until tomorrow what you can do at midnight.
7) BEGIN TO BACK OFF AND DETACH. Learn to delegate, not only at work, but also at home and with friends. In this case, detachment means rescuing yourself for yourself.
• MIT VIEW: Delegating is a sign of weakness. If you want it done right, do it yourself (see #5).
8) REASSESS YOUR VALUES. Try to sort out the meaningful values from the temporary and fleeting, the essential from the nonessential. You'll conserve energy and time, and begin to feel more centered.
• MIT VIEW: Stop thinking about your own problems. This is selfish. If your values change, we will make an announcement at the Corporation meeting. Until then, if someone calls you and questions your priorities, tell them that you are unable to comment on this and give them the number for Community and Government Relations. It will be taken care of.
9) LEARN TO PACE YOURSELF. Try to take life in moderation. You only have so much energy available. Ascertain what is wanted and needed in your life, then begin to balance work with love, pleasure and relaxation.
• MIT VIEW: A balanced life is a myth perpetuated by liberal arts schools. Don't be a fool; the only thing that matters is work and productivity.
10) TAKE CARE OF YOUR BODY. Don't skip meals, abuse yourself with rigid diets, disregard your need for sleep, or break the doctor appointments. Take care of yourself nutritionally.
• MIT VIEW: Your body serves your mind, your mind serves the Institute. Push the mind and the body will follow. Drink Mountain Dew.
11) DIMINISH WORRY AND ANXIETY. Try to keep superstitious worrying to a minimum -- it changes nothing. You'll have a better grip on your situation if you spend less time worrying and more time taking care of your real needs.
• MIT VIEW: If you're not worrying about work, you must not be very committed to it. We'll find someone who is.
12) KEEP YOUR SENSE OF HUMOR. Begin to bring joy and happy moments into your life. Very few people suffer burnout when they're having fun.
• MIT VIEW: So, you think your work is funny? We'll discuss this with your director on Friday, at7:00 P.M.!
• MIT VIEW: Work until the physical pain forces you into unconsciousness.
2) AVOID ISOLATION. Don't do everything alone! Develop or renew intimacies with friends and loved ones. Closeness not only brings new insights, but also is anathema to agitation and depression.
• MIT VIEW: Shut your office door and lock it from the inside so no one will distract you. They're just trying to hurt your productivity.
3) CHANGE YOUR CIRCUMSTANCES. If your job, your relationship, a situation, or a person is dragging you under, try to alter your circumstance, or if necessary, leave.
• MIT VIEW: If you feel something is dragging you down, suppress these thoughts. This is a weakness. Drink more coffee.
4) DIMINISH INTENSITY IN YOUR LIFE. Pinpoint those areas or aspects which summon up the most concentrated intensity and work toward alleviating that pressure.
• MIT VIEW: Increase intensity. Maximum intensity = maximum productivity. If you find yourself relaxed and with your mind wandering, you are probably having a detrimental effect on the recovery rate.
5) STOP OVER-NURTURING. If you routinely take on other people's problems and responsibilities, learn to gracefully disengage. Try to get some nurturing for yourself.
• MIT VIEW: Always attempt to do everything. You ARE responsible for it all. Perhaps you haven't thoroughly read your job description.
6) LEARN TO SAY "NO." You'll help diminish intensity by speaking up for yourself. This means refusing additional requests or demands on your time or emotions.
• MIT VIEW: Never say no to anything. It shows weakness, and lowers the research volume. Never put off until tomorrow what you can do at midnight.
7) BEGIN TO BACK OFF AND DETACH. Learn to delegate, not only at work, but also at home and with friends. In this case, detachment means rescuing yourself for yourself.
• MIT VIEW: Delegating is a sign of weakness. If you want it done right, do it yourself (see #5).
8) REASSESS YOUR VALUES. Try to sort out the meaningful values from the temporary and fleeting, the essential from the nonessential. You'll conserve energy and time, and begin to feel more centered.
• MIT VIEW: Stop thinking about your own problems. This is selfish. If your values change, we will make an announcement at the Corporation meeting. Until then, if someone calls you and questions your priorities, tell them that you are unable to comment on this and give them the number for Community and Government Relations. It will be taken care of.
9) LEARN TO PACE YOURSELF. Try to take life in moderation. You only have so much energy available. Ascertain what is wanted and needed in your life, then begin to balance work with love, pleasure and relaxation.
• MIT VIEW: A balanced life is a myth perpetuated by liberal arts schools. Don't be a fool; the only thing that matters is work and productivity.
10) TAKE CARE OF YOUR BODY. Don't skip meals, abuse yourself with rigid diets, disregard your need for sleep, or break the doctor appointments. Take care of yourself nutritionally.
• MIT VIEW: Your body serves your mind, your mind serves the Institute. Push the mind and the body will follow. Drink Mountain Dew.
11) DIMINISH WORRY AND ANXIETY. Try to keep superstitious worrying to a minimum -- it changes nothing. You'll have a better grip on your situation if you spend less time worrying and more time taking care of your real needs.
• MIT VIEW: If you're not worrying about work, you must not be very committed to it. We'll find someone who is.
12) KEEP YOUR SENSE OF HUMOR. Begin to bring joy and happy moments into your life. Very few people suffer burnout when they're having fun.
• MIT VIEW: So, you think your work is funny? We'll discuss this with your director on Friday, at7:00 P.M.!
2. Respond this this, from TWW team member Liz Antonson, who is a psychotherapist: "When I was in practice, 'problems in life' were categorized but not reimbursable. That is why many providers looked for a clinical code that could justify treatment with reimbursement.
"It was never a stretch for me to bill out on the clinical code for depression as inevitably the burnout feature could easily be described in the depression profile. I could do what I wanted in my private practice but the rub came in the mental health outpatient clinic I worked for. Often the presenting problem was a stand-alone problem in life on which the label burnout could be affixed but did not meet the criteria for clinical depression. My clinic director was offended when I would not fudge my clinical judgment to comply with the need to be paid for services. The update of the ICD-10 accommodates that dilemma."
"It was never a stretch for me to bill out on the clinical code for depression as inevitably the burnout feature could easily be described in the depression profile. I could do what I wanted in my private practice but the rub came in the mental health outpatient clinic I worked for. Often the presenting problem was a stand-alone problem in life on which the label burnout could be affixed but did not meet the criteria for clinical depression. My clinic director was offended when I would not fudge my clinical judgment to comply with the need to be paid for services. The update of the ICD-10 accommodates that dilemma."
3. Comment on the following, from TWW team member Mary Sells: "All of us have experienced some deep depression at some point in our lives -- of that I am convinced. When I had my turn with it, I turned to my faith and to a great psychotherapist and got all the tools I needed from both. Faith is the enduring medicine for it gives us a view outside of ourselves that manifests in hope and trust in the Lord."
4. Discuss this, from TWW team member Frank Ramirez: "One of my favorite books is Lincoln's Melancholy by Joshua Wolfe Shenk. The author set out to explore Lincoln's depression. He wanted to find out how Lincoln conquered depression to go on to become one of our greatest presidents. What he discovered is that Lincoln never conquered his depression, but he still went on to become one of our greatest presidents. In part, this was because society recognized (while not fully understanding depression) that some people had 'melancholy.' It was part of who they were. Such people were not automatically disqualified from positions of responsibility. The book discusses some of Lincoln's coping strategies, since he recognized the signs that a bout was coming on better than anyone, and he had as much reason to be depressed (the death of his children, a war that threatened to dissolve the nation, generals who seemed incapable of fighting) as anyone. In some ways, I see Lincoln doing as Elijah did -- rushing back into the fray."
Responding to the News
If you recognize ongoing psychological discomfort, this may be a good time to seek some professional help to deal with and hopefully alleviate it.
Closing Prayer
Help us, O Lord, as we follow Jesus to the best of our ability, to know your peace in all aspects of our lives, whether we are strong or weak, well or ill, happy or sad, upbeat or cast down. In Jesus' name. Amen.
No comments:
Post a Comment