Q: How can one assert that the partner, a relative or a friend suffers from burn-out if she/he doesn´t speak about? Are there indications in her/his attitude?
Photo: Sissi Furgler
A: First, and this is very odd – there is no accredited disease “burn-out”. This may be surprising, but one cannot find it in the ICD (International Classification of Diseases) code´s nomenclature including 78.000 diseases. The reason: you cannot characterize burn-out and there is no clinical picture to entry it in the ICD code. Maybe it was censored as there are too many authors suffering from it and they do not want to have their disease listed …☺- Back to the question: the related will not always recognize what is going on. This is very typical for many mental diseases, it is a very slow-going change in behaviour. First symptoms are very seldom recognized as symptoms of “pathologic mood” but much more as an act of insult.
The word “change” itself is the keyword: if a familiar person changes her/his character, usually it is noticed immediately. Very often one can hear: my husband/my wife/my father/my uncle etc has become a stranger to me, she/he is not more the woman/the man she/he was, we are not longer on speaking terms etc. As a doctor it is very difficult to help the family without talking to the patient herself/himself because there are a myriad of diseases that can cause this: life crisis (very typical midlife-crisis), problems in relationship, deficit in communication, depression, psychosis, side effects of medicaments, dementia, cerebral tumours or metastasis. A serious diagnosis is almost impossible without knowing the person related, without knowing if there are other, i.e. organic diseases.
There is a wide range of possibilities how a person suffering from burn-out changes her/his character, starting from being manic to being depressed, i.e. having bipolar disorders, addictions or dependences (belonging to the manic side of the bipolar disorder), such as shopping or internet addicts. The symptoms can be similar to those of anxiety neurosis or hypochondria. To make it a bit more simple – one can reduce to very typical changings that should attract the relatives´ attention: the person related retires from the world, she/he who was always full of energy is suddenly tired, doesn´t speak anymore about the problems in every day´s life, gives up social contacts, goes very early to bed but cannot sleep and has enormous problems getting up in the morning. As we see these are typical symptoms of a depression. It can also happen that the person related becomes aggressive, nervous and short-tempered, that she/he is impatient with the children, possibly gets even rough who was the nicest and kindest person before. “PLEASE leave me alone!” is what friends and partners get most of the time as an answer.
Another very typical aspect is that a former kind person can become cynical. Entrepreneurs always being content with their customers and always explaining everything with the patience of a saint start despising their customers, don´t answer questions, if the customer isn´t able to operate a machine he ridicules or abuses her/him, pupils who are not able to solve a problem are disabled by their teacher and so on … Exactly this mode of behaviour is very characteristic that everything turns into the opposite: those who had a great commitment become tired, excessive demand is being compensated by distancing oneself from the before flattered persons and disrespecting them now (be it employees, customers, pupils or patients). This is why burn-out often appears in professions where there are many interpersonal relationships (teachers, department managers, medical staff), yet scarcely anybody is immune from, neither the schoolmaster neither a housekeeping mother. This behaviour is extremely disturbing for the partner as the suffering person vents her/his spleen on her/his partner. The latter thinks, “this is not the person I married, this is not the one I loved before”. It´s a vicious circle. It feeds alienation of a relationship and the person concerned looses her/his last support. Separation, filing for divorce, a divorce battle can be too much and one teeters on the brink of disaster.
What my profession concerns: in the last 15 years four self-employed doctors who were working within a radius of about 30 km committed suicide. The suicide rate of doctors is fife times higher that that of the average Austrian (by the way, the Austrian average suicide rate is one of the highest in Europe). I sermonize to my students to see the red light and to react in good time, because one of 500 doctors will commit suicide during her/his working life. This is frighteningly – the more as these poor colleagues had often attended patients, only some hours before they committed suicide. One has to visualize this paradox!
To be continued … (beginning August)