He bought the Lalu Prasad Shaw three years ago. Since then it has been hanging in his study, facing the plush wine-coloured reading couch lit up by a Solveig floor lamp, where he would laze with a glass of red and a book after a long day in the consulting room and doing his rounds in the wards. Often he would close the book and pause just to look at the serene eyes in the inscrutable face of an unknown subject regarding him from its frame with a mellow gaze. Now, after nearly two years of horror, death, despair that face him constantly in the super-speciality hospital where he works in Internal Medicine, he senses futility in all he does. The painting does not give him pleasure anymore. In fact, by the time he gets back home from work, his wife would already be asleep, and he would flop down beside her and drift off to exhausted sleep. His wife, who owns a small art gallery, is now home all the time, trying to negotiate online sales through auction houses. In spite of her best efforts to cheer her husband up, he is no longer the man he was—the streaks of grey on his hair seem thicker, the lines on his face deeper and the bags under his sharp observant eyes now dull and tired.
The doctor, who does not wish to be named, can no longer be the physician who can heal himself. He knows too well that he is suffering from classic pandemic burnout. In the car on the way to hospital, in the consulting room and during his rounds, the tiresome thoughts play in his head like a stuck gramophone record.
‘I’m no longer a good doctor.’
‘What is the point of treating patients? They die anyway. Or they are ungrateful so and so-s.’
‘I can’t do this anymore.’
The World Health
Organisation (WHO) regards physician burnout a syndrome rather than a disease. The chronic distress that goes with being a doctor is what mainly leads to it. There are three signs that indicate burnout among medical professionals. They are: 1. Deep emotional exhaustion that turns into irritation or feeling downbeat. 2. Empathy diminishes and is replaced by cynicism, negativity, and emotional numbness. Psychiatrists call this state depersonalisation. 3. The doctor feels he is not professionally useful. But by the time the second phase of the Covid-19 wave peaked, burnout affected not just physicians but also a wide spectrum of professionals, such as CEOs, academics, businesspeople, government officers, administrators, policemen and journalists, and also homemakers. Never before have the lives of ordinary men and women, mothers and fathers, bosses and employees, friends and lovers been tested as they are now. People are forced to stretch themselves after the lines between home and work blurred, and multitasking and stress became familiar vectors of life.
Take Shreya Bhaskar (name changed), a school teacher in Lucknow. She loved her students, and loved teaching and the pride her work gave in watching children grow intellectually. When classes moved online last year, she began to witness a change in her work and herself. Bhaskar was expected to perform her level best in a state of limbo, as salaries were delayed, students became difficult to communicate with, the parents less accommodating and organisation was thrown to the wind. Her daily routine that she had once looked forward to every day vanished. Before she knew it, she had begun disliking everything to do with school. Her psychotherapist recognised her symptoms of dullness and indifference as classic signs of professional burnout, and recommended time off to recuperate.
What is burnout?
The term was coined in the 1970s by American psychologist Herbert Freudenberger, who used it to describe the consequences of severe stress for individuals working in human service sectors and the medical profession. Initially, the fallout of excessive and arduous work was noticed among doctors and nurses, who were most prone to exhaustion, listlessness, and inability to cope. The WHO lists burnout as an ‘occupational phenomenon’, in its 11th Revision of the International Classification of Diseases, and not as a medical condition. It is defined as “a syndrome resulting from chronic workplace stress that has not been successfully managed”. It is characterised by “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.” This definition also dissociates professional burnout from general anxiety disorders by proclaiming, “burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
What leads to burnout
When long-term, unresolved stress negatively affects your work and your life. Online searches for ‘signs of burnout’ show a 24 percent increase throughout 2020 compared to the previous year. By limiting the definition of burnout, the WHO has narrowed the scope of a serious global problem. Dr Amrita Basu, an ENT and Head-Neck Surgeon who practices in Malda and Kolkata, is used to treating severe neck pain, headache, foreign body sensation of throat, chronic reflux, and other outwardly physical symptoms. She puts down a lot of such symptoms to work-related stress. “When one’s health in all its spheres is out of balance due to excessive chronic stress, burnout can occur. If not taken care of, various physical and mental health issues crop up,” she says.
What are the symptoms?
By the definition of American psychotherapist Rachel Naomi Remen who specialised in treating terminally ill persons, handling their family members, and burned-out professional caregivers, “burnout is the loss of meaning in one’s work.” Inspired by the US-based Winona State University’s burnout study, the UK-based mental health and well-being training organisation Calmer has added its own psychological research to identify five stages of burnout and how to prevent it from immobilising you. In its first stage itself, positive coping measures have to be immediately put in place.
Stage One is the Honeymoon Phase. A new job, project or location kicks off excessively high levels of responses. Your energy levels are stratospheric. Your commitment to tasks is intense. Your creativity and optimism are in full flow. You jump up to accept responsibility. You want to prove yourself. And your productivity booms. Now comes Stage Two. The predictable-related stressors rear their head. Suddenly some days are difficult. You don’t feel as optimistic as before. Your focus begins to wane. Insomnia is becoming a habit. You feel irritable and exhausted. Appetite is less, so is sleep. And when you sleep you grind your teeth. The job is no longer fun. Your BP is up and the heart rhythm is erratic. You are getting headaches. You begin to neglect personal needs and care.
If you don’t stop Stage Two from turning Three, you are headed for Chronic Stress. Motivation is all but gone. You get up tired every morning. You delay decisions both at work and home. Your boss calls you a regular latecomer. You have become resentful, withdrawn, angry, cynical, insecure and indecisive. Quick to anger, you slip into a state of denial and chronic exhaustion. Your sex drive is zero. You are drinking more, both alcohol and caffeine. Stage Four is Burnout. By now you cannot function as normal anymore. All symptoms, physical and psychological, of the previous stages intensify plus a few dismal additions. Self-doubt is a constant now. The headaches are accompanied by chronic stomach problems.
Medical intervention is crucial at this juncture before you reach Stage Five—Habitual Burnout. The symptoms have become so entrenched that the mental, physical and emotional problems are continuous. A New Delhi-based dermatologist recalls treating a patient, Pooja Chawla (name changed), who developed painful psoriasis on her ankle. Chawla was shocked by her doctor’s diagnosis that her condition was a physical manifestation of prolonged pandemic stress, brought on by balancing childcare, domestic duties and her career as a freelance all-hours content writer. Chronic mental and physical fatigue, sadness and depression are clear symptoms of the final burnout stage.
“When a person is unable to manage or cope with chronic workplace stress, burnout is inevitable. Though it was traditionally restricted to occupational stress, burnout is now happening in other areas of life, having gotten worse during the pandemic,” shares Dr Shailaja Shastri, Dean of Faculty of Liberal Arts and Humanities, Jagran Lakecity University, Bhopal. She has been an advocate of mental health awareness for 30 years. People with city jobs are finding ways to combat burnout. Chirag Aga, who works in a big corporate firm in Mumbai, has noticed a rising trend among his peers to move out of town. In recent months, the anxiety of the second wave combined with existing WFH woes prompted many people to relocate to the more peaceful environment in the hills or to Goa. Preferring to slow down rather than quit their jobs, such urban nomads are taking time off to reorient themselves and return to work virtually from their new abodes, fully recharged.
The Pandemic Effect
Covid-19 has upended work-life balance. A lack of empathy from senior management, and the inability to enjoy time off while cloistered in shared spaces with family members have become stressors. Shaifila Ladhani, a New Delhi-based psychotherapist, observes that more than 80 percent of her current roster of clients have signs of burnout across genders, occupations and age brackets. “There has been little mention of burnout in India, but the way Indians work, it has been an epidemic in the making for a very long time. If one person is expected to do many things at the same time without any systemic support, they will certainly experience burnout. It stems from increased responsibilities at work and home, lack of proper pay structure, saturated incomes, and little or no support from co-workers,” she asserts.
A survey titled ‘People at Work 2021: A Global Workforce View’, recently published by ADP Research, declares that 70 percent of Indians experienced stress at least once during the work week, on a regular basis. Working from home is also a burnout motivator. The survey observes that the amount of extra time spent on the job for no additional pay had increased in comparison to the previous year. Workers in India now average over 11 hours per week of unpaid overtime. This can only be ascribed to the lines blurring between personal and professional hours as people work from home. Moreover, almost four in 10 Indians either lost their jobs during the pandemic, or were temporarily laid off by their employer, or had to take a pay cut. Many of them were also forced to take on additional responsibilities or see a change in their roles. These measures forced workers to make difficult personal choices and compromises, such as putting work over health and family.
With a complete shift in ‘normal’ human activities, the onset of emotional exhaustion is to be expected. Along with social distancing, individuals have begun to emotionally distance themselves from others, further contributing to stress build-up and burnout. Most affected are health workers, police personnel and other frontline warriors. Vaishnavi R Kanzal, Clinical Psychologist at Aster CMI Hospital, Bengaluru, refers to a meta-analysis conducted in 2020 and published in the Indian Journal of Psychological Medicine, which indicated that 1/4th healthcare professionals in India suffered from burnout. “The pandemic drastically increased their workload and work timings without allowing them adequate rest. They also experienced pandemic distress, compassion fatigue and secondary trauma. Most of the emotional turmoil and psychological distress was neglected initially, leading to burnout,” she says.
Be on guard
Psychologists across the board agree that Type-A personalities, typically signified as ‘over-achievers’, are most prone to burnout. Dr Manish Kumar Verma, Associate Professor of Psychology at Lovely Professional University, Jalandhar, says, “It is the desire for perfectionism that pushes people to experience burnout. This is also applicable to people who work too much, without putting aside enough time for socialising and relaxation.” Even those who work closely with Type-A personalities are considered at risk of developing chronic stress.
A 2015 study on the subject of Personality, Coping and Burnout in Online Doctoral Psychology Students, conducted by Walden University, Minnesota, USA, determined that certain personality traits such as neuroticism and emotion-oriented coping indicate higher chances of burnout. On the other hand, those who are extroverts, with open and agreeable personalities, have fewer chances of experiencing it.
Apart from inducing chronic stress, an overt sense of competition has other harmful effects—it prevents people from accepting their mental health issues. The ADP Research ‘People at Work 2021’ survey shows that in India, though flexibility of work timings is encouraged by many employers, people feel judged by their co-workers for utilising that flexibility. Akshat Srivastava, who works with a multinational firm in Bengaluru, blames peoples’ competitive spirit for this. “It feels strange to say, but people in my organisation would rather take two weeks off for being completely asymptomatic with Covid-19 than admit to taking time off due to burnout! They’re worried it will impact their growth when they return,” he shares candidly.
This is unfortunately most applicable to millennials. A life dependent on screens and constant social media exposure creates unrealistic expectations. Arjun Banerjee, Director of creative communication agency Grasshoppers India, claims this is due to the tremendous pressure of image building that social media enforces on the younger generation. The urge to achieve more in a short time is unfortunately linked to self-validation. This is further aggravated by excessive digital use, leaving no time for work, friends or play, ultimately resulting in feelings of anger, stress, physical and emotional fatigue.
The WHO estimates that poor mental health costs the global economy $1 trillion annually in lost productivity. A recent analysis by Deloitte on the stock performance of the S&P 500 Index companies found that the companies that scored high on health and wellness, appreciated 135 percent more than other companies. Corporate organisations are increasingly becoming aware of the need for safeguarding their employees’ mental health needs. However, for significant change to take place, it has to begin at the management level, so it trickles down to employees. Hospitality brand OYO has introduced a four-day workweek with Wednesdays off to let employees have a midweek break and unlimited paid leaves to unwind and care for their mental health. The Bengaluru-based multinational company that Akshat Srivastava works for, has made the second half of Wednesdays ‘Zoom-free’ zones, shunning virtual meetings, and as far as possible encouraging phone meetings for quicker and less stressful engagement through the rest of the week.
Though the bigger firms can afford to give time off to their employees over mental health concerns, it is tougher for smaller organisations to do the same. Pune-based Richa Singh, Co-Founder and CEO of Blogchatter, a prominent blogging community platform, explains, “As the leader of a small team, I have learnt to catch the early signs of stress, so I can encourage that person to take time off.” Work suffers if one person takes prolonged leave, so stress build-up has to be battled in unique ways. Their weekly online meetings incorporate banter and chit-chat before sitting down to business. “Keeping the conversation light makes our team comfortable and judgement-free. We openly talk about our own bad mental health days, and that encourages our team members to speak up too,” she says.
Boosting employee morale in difficult times is tremendously important. Manas Mehrotra, Founder, 315Work Avenue, a coworking space in Bengaluru, organises daily calls with team heads to stay connected. His company has also tied up with a third-party team of mental health experts to ensure their employees stay motivated, happy and productive. At A.O. Smith India, virtual talent shows, contests and quizzes are organised regularly. “Finding joy in the small things can give team members a sense of belonging during these tough times. In fact, in this difficult year, our employees voted us as a ‘Great Place to Work,’ which I consider one of our biggest achievements,” shares Parag Kulkarni, Managing Director of the firm.
Rachel Goenka, CEO of The Chocolate Spoon Company, which runs multiple chains of restaurants, has mandated regular meditation sessions for the entire company. Founder of Epistle Communications Consultancy, Tanya Khanna, realised that team support and empathy were essential for alleviating symptoms of burnout, so she instituted weekly team interactions and periodic personal interactions too. Hyderabad-based ekincare is an integrated health benefits platform that helps companies manage their employees’ health and wellness. Founder Kiran Kalakuntla says their services became increasingly popular in the last year as many corporate firms looked to outsource the mental health needs of their employees.
With the right mindset, it is possible to reverse burnout and recover from it completely. Ambika Srikrishnan, Counselling Psychologist from Medall Mind and Blume, puts it succinctly, “Ultimately, the way out of the abyss of burnout is to be compassionate towards one’s own mental health needs and reach out for help when needed. Do whatever it takes to calm your mind amidst the chaos, but above all, continue to believe that this too shall pass.”
Practical advice to overcome burnout
• Examine your thoughts and the messages that you are feeding your mind. The world is not perfect, so do not expect perfection.
• Keep a gratitude journal of what you have accomplished and write in it every day. If you’re struggling to find things to write, expand your thoughts to include things that make you thankful.
• Limit your screen time
• Set boundaries for your time and desires
• Practice meditation, get enough sleep, eat a balanced diet and ensure you get enough quality time with friends and family Dr Manish Kumar Verma, Associate Professor (Psychology), Lovely Professional University, Jalandhar
• Walk barefoot in a park. The negatively charged ions in the body will be converted to positive ones and help people with hypertension, stress, fatigue, and anxiety.
• Add Ashwagandha or Withania somnifera to your diet. This herb combats stress and provides increased strength and stamina to the body, especially to people fighting depression and anxiety.
Sonali Bansal, Health Coach and Nutrition Therapist
•Apply Brahmi and Bhringraj oil to your scalp for a calming effect on your mind and body
•Include Ashwagandha and Jatamansi in your diet to promote sound sleep and reduce stress and anxiety, while strengthening your nervous system
Sheetal Bhatt, Director, Harrit Health Care, and Proprietor, Harrit Farms and GOD Café
•Follow a clear strategy of stress management
•Eat balanced nutritious meals, get exercise, and create healthier sleep patterns
•Divide responsibilities equally in the household
•Create a self-care plan for yourself, which includes taking a break from work and/or a digital detox
Shaifila Ladhani, Psychotherapist
•Focus on progressive muscle relaxation (PMR) to reclaim the sense of control
•Download health-tech apps to help with a healthy regime
•Change lifestyle habits rather than opting for medications Rohan Verma, Co-founder and CEO, Breathe Well-being
Questions to ask your doctor
What are the symptoms of burnout?
If I am diagnosed with burnout syndrome, what are the measures I should take to deal with its aftermath?
Is it treatable? What are the treatments involved here?
What is the financial investment required for the treatment?
Am I suffering from clinical depression or burnout?
How do I know if I am suffering from burnout?
What are the possible factors causing it?
How do I manage burnout on my own?