Emotional Intelligence, Mental Health, Self-care, Uncategorized

The Interconnectedness of Depression, Burnout, and Fatigue

[This week’s post is by request. Yes, we take requests! Honestly, anything that gives me some direction more than fifteen seconds before I sit down at the keyboards with the first coffee of the creative day is welcome. Assuming it’s something I actually know something about, of course.]

When I talk about making starting the career change from Hired Pen in IT to Personal Improvement Sherpa, I often use the term, “I hit the wall” as part of the formal narrative explaining what happened. For me, there was probably a large chunk of undiagnosed and probably-not-even-recognized depression already in play, but the biggest factor behind the need to change course lay in a persistent and burgeoning case of burnout. The friend who requested some exploration of this topic is also grappling with something that feels like burnout but with the more pervasive sense that most would more likely associate with depression, in a “absolutely anti-motivated to do anything that is not absolutely mandatory” kind of way; they describe themselves as feeling neither sadness nor despair, nor are they unable to get out of bed. But they do feel “frozen”. There is still a sense of connection to joy and lightness in other aspects of life, but there is no energy to connect with the actions most commonly associated with creating joy and mirth.

Working with as many clients, and still having an exceptionally large number of friends working in IT, I can verify that there is a LOT of comorbidity between the symptoms of depression, burnout, and fatigue. It’s one of the major reasons why, when clients come in with a self-diagnosis of depression, I want to explore more of a general context for what’s happening in their lives to see if there are any systemic factors that might suggest more clearly the predominance of any one of these states.

“Depression is one of the most common mental illnesses, and it can be mild, moderate or serious. There are several different types of depression that can be recognised by different signs. Which symptoms of depression occur and how strong and frequent they are vary from person to person. People in any social or age group can be affected, both women and men. If someone has had at least two of the following symptoms for longer than two weeks, it might mean that they are depressed: deep sadness; listlessness; loss of interest in the things they usually care about.” – US National Library of Medicine

“Exhaustion is a normal reaction to stress, and not a sign of disease. So does burnout describe a set of symptoms that is more than a “normal” reaction to stress? And how is it different from other mental health problems?

Experts have not yet agreed on how to define burnout. And strictly speaking, there is no such diagnosis as “burnout.” This is unlike having “depression” diagnosed, for example, which is a widely accepted and well-studied condition. That is not the case with burnout. Some experts think that other conditions are behind being “burned out” – such as depression or an anxiety disorder. Physical illnesses may also cause burnout-like symptoms. Being diagnosed with “burnout” too soon might then mean that the real problems aren’t identified and treated appropriately.” — US National Library of Medicine

Fatigue as a general symptom runs through a lot of these kinds of conditions, running the gamut from “I’m a little tired today but I can push through it” to “it’s a Blanket Forts Against the World kind of day”. Fatigue’s commonality is also one of the factors that makes it more difficult to differentiate between situational burnout and deeper depression, because fatigue is a profound thief. So when we’re talking in session about what’s going on, we explore the presence and perceived impacts of fatigue: how long has it been going on, how often does it impact functionality, what else is occurring in the subject’s life that contributes to exorbitant and draining stress? What aspects of their lives DON’T currently feel like a drain on their personal energy resources? What restores them?

From there we look for burnout symptoms: what are the high-demand attention drains currently (or recently) impacting the subject’s life and energy levels? Where is the balance with self-care and/or external support? How much of their day is being dedicated to these high-demand pursuits, and over what length of time? What other aspects of their lives still provoke joy, delight, mirth, wonder, passion, even if at lowered levels than constitute their normal baselines? The likelihood of burnout being the dominant effect rather than depression is often tied to these discernible draining factors over an undefined-but-probably-extensive-or-ongoing period of time. Without such key indicators as work stress, family stress, personal health stress, etc., we consider the scales tipping more in favour of depression. We also look at bigger systemic factors including family histories around mental health issues/Family of Origin relational modeling/parental alcohol or drug abuse, etc. when looking for indicators of depression.

And finally, we ask the question, “As difficult as it might be to imagine right now, if we took away the fatigue, what kinds of feelings would be left?” Self-reporting clients have, at least in my experience, been clear to indicate whether they expect themselves to “bounce back” and be right as rain again, or whether the nihilistic disengagement from the world would still be a part of the picture. (Self-reporting measures are generally problematic at best, but lacking a verifiable clinical diagnosis for depression, as counsellors and psychotherapists, we operate largely at the mercy of what our clients tell us.) The clients’ own hopefulness about their potential future state provides at least some degree of useful information, and can often gives us a platform (however small) on which to start building that sense of hope into some sustainable, hopefully realistic faith in change and progress. Clients stuck in depression often cannot connect with hope; hopelessness is one of the most common lies depression tells us. But burnout, while it may not allow for significant enthusiasm about the future, doesn’t completeley dismiss it so much as waves a hand at anything hopeful and begs, “Come back later, please”.

Typically, burnout is the result of specific and identifiable stressors like occupational burnout, persistent relationships stresses, or ongoing/long-term care practices for ailing or high-demand family members, for example. When facing burnout we look at rebalancing self-care practices in the short term, sometimes involving very deep conversations about the willing (often repetitive) sacrifice of self-care in pursuit of project deadlines or the drive to care-take others. We discuss the values keeping clients potentially stuck in these kinds of patterns, a conversation that comes up a LOT with driven professionals. Often we have to normalize the fact that corporate mindsets and project management pay a degree of lip service to the nebulous “work/life balance”, then expect the superhuman in terms of commitment to near-impossible project deliverable dates. And in the case of those who persist in “taking on too much” and deliberately, repeatedly pushing themselves into burnout states, we have some conversations around what’s their return on investment that makes doing this to themselves over and over, worth the costs of the pattern?

With depression, the work is more complicated, and may often necessitate conversations about clinical diagnostics (that psychotherapists are, unfortunately, not trained to do) and/or medications to help level out the worst of the symptoms. Because the depression may not be cognitive, it’s harder to shape a therapeutic conversation around motivations, and we may have to work more fundamentally with the bodily experience of depression, up to and including normalizing it as a chronic persistent or recurrent medical condition like diabetes, arthritis, MS, and others. We change how we consciously relate to the presence and impact of the illness when we can’t shift the illness itself in significant ways.

We can do the same with burnout, but burnout needn’t be a persistent issue for people so it’s sometimes less effective to treat it as a persisting condition (though it can be argued that project cycles increase the likelihood of it being recurrent). When burnout becomes a cyclical factor in someone’s life especially, we could really use some increased self-observation to watch for markers of this state sliding into depression. A pervasive sense of inescapability can shift a mindset from the hopeful, “light at the end of the tunnel” coping mechanism to a fatalistic sense that “it will never be any different or any better than this, so why bother?” Losing hope is fundamentally damaging to our mental health:

“Life is never made unbearable by circumstances, but only by lack of meaning and purpose.” ― Viktor E. Frankl

Burnout can leave us with purpose but no energy to engage without a period of recovery and restoration; depression leaves us feeling devoid of meaning or purpose. And fatigue is the river that runs through both states. How we treat any of this depends on our abilities to differentiate between these conditions, and how willingly our subjects can still feel any connection, however tenuous, to hope.

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