Experiencing burnout? Remember: Drowning people are responsible for their rescue.

Burnout has become a fashionable word lately. The first time I heard it was in 2015 from one of the students in my graduate cohort during her thesis defense. At that time, I found the information interesting, although I could not fathom how being within the therapeutic space with a client could transform into a clinification of the population. Well, since then, my classmate founded the Self-Care Institute (https://www.selfcareinstitute.com), which became quite popular among clinicians from various disciplines, and I arrived at the point of necessity to take the class titled The Intersections of Burnout, Self-Care, and Social Justice. I highly recommend it to those who know they are in the process or already in the burnout state. The information in the class will validate your suspicions, alleviate the sense of guilt, and explain that continuous fatigue, emotional exhaustion, and depletion of vitality are indicators of broader and deeper personal, organizational, and systemic issues.

How do you know that you are one of those "drowning" that will get to the state of burnout? Every person's situation is different. However, you should start suspecting something if one or a few of the following happened to you:

• Your reaction to the frequent changes in policies, forms, rules, and productivity expectations at your work is more irritable and nihilistic than an enthusiastic display of curiosity and readiness to take on the challenge.

• You become painfully aware of the high turnover of clinicians after witnessing fourteen of your teammates leaving the place of work within the last three years, and you catch yourself thinking while mentoring the newly hired person, "How long will this one stay?"

• You sit and stare at a white wall for 10 minutes at the end of the day before you muster the energy to clean up the room after treating nine clients within the last eight hours and suddenly start sobbing in the car on your way home with no apparent reason.

• You noticed that all you had been doing within a few months was work and sleep. Weekends don't help --you still want to sleep. Oh, yes! You also need to finish the job that seems never to end. How did you again get behind?

Well, you certainly had "drowned" and should start some rescue activities when:

• you don't have the energy to contact your usual social network and realize that you have not talked to your close and loved people in a few months;

• you have problems with sleeping: you feel depressed and constantly sleepy, or you cannot sleep through the night, waking with anxious thoughts that don't stop;

• your appetite changed, and you noticed fluctuations in your weight;

• you get ill all the time: the body seems to be falling apart despite taking vitamins, making trips to the gym, getting massages, and visiting a chiropractor;

• you spend your paid time off (PTO) mainly to deal with more and more frequent calamities in your life, including another illness, instead of resting and recuperating;

• you dread mornings because you have to go to the place of your work;

• you lose the sense of competence and meaning in what you do at work, including the clinification of your patients; you feel ineffective, empty, and hopeless at work.

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The rescue activities are commensurate with the severity of the damage. I would say that taking any class at the Self-Care Institute (https://www.selfcareinstitute.com) will be beneficial because it explains what is happening to you and gives a strategic direction toward salvation. Yet, self-care requires time and effort, which are difficult to fetch for many people because everyone has different access to the resources for self-care. Time is one of them.

Besides, any additional task in the state of burnout feels like another thing that requires emotional labor and energy and becomes detrimental. Again, every reading you find will deliver that restoration failure of vitality over the weekend and short vacation is what differentiates burnout from regular tiredness. Here is the truth--realize that your lifetime does not belong to you if you have already "drowned." Some other entity owns it. Therefore, getting back at least some time to complete a work-in-progress inventory of your life is the first ethical imperative of self-care. Here, I have lessons learned from personal experience to add to the preventive self-care practices from the class.

See a therapist

It is beneficial to start seeing a therapist, preferably a licensed psychologist, who will help you with the spit-out of bottled emotions. After a couple of visits with verbal venting, you feel lighter and partially reclaim the ability for rational thinking. 

Talk with the direct supervisor at work

At this point, it is wise to discuss your condition and situation with the direct supervisor at work and let them know that you have entered therapy. Most likely, your supervisor is experienced enough to understand what you are going through, will consult with HR, and will direct you to the channel or the person to connect with for advice. 

Consult with HR

Suppose you work with a population requiring physical mobility, flexibility, and strength, as well as emotional stability and resilience. In that case, people in HR are well aware of the demands and high turnover of clinicians in the industry. They will advise you to get a paper from your mental health professional or any other doctor that you need a break from work. They will explain that you may be entitled to Family and Medical Leave of Absence (FMLA). Also, they will forward a form that your health professional needs to sign and the official work description that you do. 

Lesson #1--there is no such diagnosis as burnout

You give the form to your therapist and learn the most critical lesson #1. DSM-5 does not have such a Dx as burnout. There are no legitimate clinical documents in the US that recognize burnout as a reason for you to claim back your time from the entity that owns it. ICD-10 identified burnout as a legitimate medical disorder with the code Z73.0--Burnout state of vital exhaustion (read the article from the Association for Psychological Science here https://www.psychologicalscience.org/observer/burnout-and-the-brain). However, the World Health Organization (WHO) did not classify it as a "medical condition" (https://www.te-ar.com/post/burnout-a-medical-condition-or-not). WHO scaled it back strictly to the occupational context and classified it as a syndrome in ICD-11 with the code QD85--Burnout (https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f129180281). The rest will be between you and your psychologist. Mine refused to sign the paper given to me by HR because it required providing some assessment of my physical condition. My psychologist sent me to see other doctors. 

Lesson #2--MDs are the only real doctors

Suppose you broke your foot seven months ago and are still working on mending your body mobility while tackling a full-time physically and mentally demanding job and trying to complete your doctoral dissertation. As your psychologist suggested, you take the paper from HR to the offices of your physical therapist and chiropractor to learn lesson #2—those who have no letters MD after their names do not sign the paper HR gave. When you mention HR and work, they legally "stop" being doctors; titles DC and DPT don't count. They will send you to your primary care provider (PCP), the one that is MD.

Lesson #3--fight for your life and lifetime

It is difficult to get an appointment with a PCP when you have HMO. When you are in a rush, chances are you will not see your PCP, but you can talk with the nurse in the office. After a 25-minute conversation and explaining the situation, the nurse will direct you to see a psychologist or a work comp doctor if you have physical difficulties at work or, as she put it, "Your work hurt you." Lesson #3--you are more resilient than you think when you start fighting for your life or your lifetime. 

Lesson #4--educate yourself

Two things--make sure that you Cc your direct advisor on all the communication regarding your fight for your lifetime, and assume that you were ill-advised when you've reached the dead end. Where have you started? Oh, yes--HR! Lesson #4--educate yourself. You can find information about FMLA-protected leave of absence here (https://www.dol.gov/agencies/whd/fmla/employee-guide). It is prudent to find out about any other available options before you talk to HR again (look here https://leaveadvice.com/non-fmla-leave-of-absence/ and https://money.usnews.com/money/careers/company-culture/articles/how-to-ask-for-a-leave-of-absence). It makes sense to let them know you were unable to convince any medical professionals with authority to recognize your temporary difficulties and ask to advise further. 

Lesson #5--exhaust all options and possibilities

If you don't hear back from HR, write your resignation letter with a concise description of the situation, indicating that you have no other choice but to resign from your position and focus on your self-care. Ask for a meeting with your supervisor, explain the situation, and hand in the hard copy of the letter. Then email the attachment to your supervisor, to the supervisor of your supervisor, and to the HR person. Lesson #5--exhaust all options and possibilities before you cut the rope to free yourself from the anchor, and start swimming up to get some air. 

Swim free

If you never hear from HR again, drop all doubts and swim freestyle. If you hear from HR, get helpful advice from a knowledgeable professional, follow it, and enjoy your six weeks of unpaid personal leave to take the self-care class, do six hours of physical therapy a week, connect with people you love, do anything that brings you in back in touch with yourself. Most importantly, reflect on what you have been through within the last three years and think about what you want to do with the time of your life that you just got back in your possession. 

Hopefully, someone else had experienced a more compassionate learning space while reclaiming the time for self-care. Would you care to share in the forum?

I'm grateful for your attention, intelligence, and compassion.

Mtsyri