Helpers Need Help in Avoiding Burnout

The helping professions, including those in the medical and educational fields to name only two, have been reluctant to recognize the symptoms of burnout, that point in a career where the work is too draining, too painful, too depressing.  Life takes on the aura of constantly being in the eye of a storm and happiness is an elusive quality that is always out of reach.

Now, a research review in the May 2006 issue of Psychological Bulletin (132:3) looked at studies of work-related burnout and found that there appears to be a strong association between burnout and cardiovascular disease.  One of the interesting and curious associations the reviewers found is between lower levels of cortisol in burnout sufferers.  Although cortisol is a stress hormone and would expect to be high in these individuals, Dr. Samuel Melamed, the lead author, believes that a deficit of this hormone may actually work to cause hyperactivity in an inflammatory process in the body.  Since inflammation has been thought to be involved in everything from Alzheimer's Disease to cardiovascular disease, diabetes and cancer, it provides interesting clues that need further study.  

It is Dr. Melamed's belief, in fact, that burnout may bring about physical changes which cause a worker to feel exhausted and weary.  These are not just psychological factors, as might have been thought previously.  The more effective means of treating burnout may not only be psychological but cover a wide range of other areas including the organization in which the person works, physiological factors and behavioral change.  

Related Topics: What Is Caregiver Burnout?, Workplace Stress and Your Health

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Anxiety and Its Economic Toll

The numbers of people with anxiety disorders and depression are substantial and one thing in favor of treatment for them is the economic factor. Once governments realize the true cost of not treating, it becomes a major impetus to institute change. This is the conclusion of a new report from The London School of Economics which was just published in June 2006.

The report, which is based on information from the UK, indicates that one in three people in all families suffers from either depression or chronic anxiety and only one-quarter are currently receiving treatment. The treatment, when given, the report continues, is usually medication without psychotherapy. It is here where the report makes its most interesting point.

The authors indicate that "modern evidenced-based psychological therapy is as effective as medication and is preferred by the majority of patients." While therapy is more desirable by patients, they must wait "over nine months" before therapy is available to them. The actual cost of therapy, they conclude, is of greater benefit to everyone since it "pays for itself in money saved on incapacity benefits and lost tax receipts."

The plan they suggest is to recruit 10,000 therapists and 250 local services with 40 new services opened yearly. They suggest that by the year 2013 there could be therapy services all over Great Britain and in this they have the support of the Royal College of General Practitioners.

Related Topics: Drug vs. Talk Therapy for Depression, SSRI Antidepressants Save Lives, Stress and Anxiety: How to Cope

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Teaching a Child Incompetence

I was walking on the beach this evening at a resort in the US when I stopped to walk around a young boy and his mother. The boy looked pretty forlorn as he stood on the edge of a large ocean pond that would have been, in my estimate, up to his chest if he were to walk into it.

His mother looked at me and said, "He won't go in and he won't even take off his sneakers because he doesn't like the feeling of sand on his feet." I think she expected me to laugh at his foolishness. I didn't.

Here was a six-year-old boy standing there and having his mother make fun of him in front of a stranger. I looked at him, leaned toward him and said, "It's really not a good idea to walk into any water where you can't see the bottom unless you're a really good swimmer, right?" He nodded his head in agreement while his mother just looked at me.

Sorry, but I don't think that we teach children to face the unknown by making fun of them. We understand their concerns or fears and we try to help them make good decisions. Walking into murky water and not knowing how deep it was would have been a bad decision on his part and his mother was trying to chide him into doing it. Wrong, ma'am, just wrong.

I'm passing this along to all of you so that you, too, will be able to help parents understand that ridicule isn't a good teaching method for life preparation. Neither is making a child feel foolish and failing to remember when you were little and afraid to do things.

So, no research on this one, just a life lesson I hope all of you will pass along.

Related Topics: Beach Safety, New Pool Safety Gadgets Help Prevent Drowning

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End of Life Decisions

An article I read recently in a newspaper's health section gave me pause, as I suppose it would anyone. The reason it had special meaning for me was that it dealt with the issue of dying with dignity and making one's wishes known.

I had just helped a relative complete an advanced care directive in which she specified what she did and did not want and I vowed to keep my part of the agreement. Her husband would not participate in this and I knew why; he didn't want to think about death and dying.

None of us want to think about this and yet all of us must. It can be very stressful for many and I can remember when I sat in my attorney's office making out my will and, suddenly, I realized that I was making plans for the day when I would no longer be here. It was a surreal moment, but I knew it had to be done.

I've had patients who have come after the death of a parent and part of their grief and the stress they've experienced has been related to their not having had the power to step in and stop the medical care. Legal suits have led to ever-increasing paperwork in the pursuit of managing one's healthcare when speech may not be possible, or wishes will be ignored. As a psychologist, I know that this only increases the stress and the physical pain of the patient as it does for those who love this person.

My family went through a very similar situation when our mother died many years ago but we were fortunate to have had caring, empathic physicians, nurses and social workers because we were in a hospice program. In fact, it was one of the very first programs in the New York City area and we were incredibly thankful for what it provided in those painful months.

Pain relief was our primary concern and it was one of the stumbling blocks with which hospice helped us. My mother's doctor was afraid that, if he gave her pain medication, she would become addicted. Looking back, I find this an incredible statement since my mother was dying and addiction wasn't even on the list of priorities. Hospice saved the day and our sanity.

Now I'm reminded of the words of FDR in a different battle, saying, "The only thing we have to fear is fear itself." Meet it head-on and you'll have won an important battle.

Related Topics: Coping With Impending Death, Funeral Planning

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Cocaine: Deadly "Snow"

Vacations can be wonderful things. In addition to taking you away from your "must do" tasks of life, you get a chance to observe things you may not have noticed before. I had one of those "ah, ha!" moments several years ago in Europe, but it wasn't so "ah, ha!" at the time. It was more like, "I wonder why..."

Walking down one of the main streets in Dublin, Ireland near the large park in town, I noted in the crowds of people passing by a number of young men and women who appeared to have had strokes. Some of them were in wheelchairs and others walked with canes or crutches. None of them could have been older than 23 or so. It was curious that so many young people seem to have suffered from this condition. Granted, I may have misperceived and jumped to a conclusion that wasn't warranted, but it just looked like stroke to me.

Back home, I began to continue to wonder what could have caused so many strokes in young people and my search led me to something I had seen years before. I had gone to a professional seminar where the topic was cocaine and whether or not it was addictive. Now that question sounds so pedestrian I can't even imagine we ever wondered if it weren't. Some people, however, still cling to the hope that it's not and point to its positive qualities.

Let me go back in history to the early 20th Century, a time when cocaine was considered not only good, but provided a beneficial push to one's energy and motivation to succeed in their careers. Freud found it incredibly useful in making him more productive. He even wrote an entire book on it (The Cocaine Papers). That is until one of his closest associates died from an overdose of this wondrous elixir.

It was commonly used as a means of helping patients recover from their addiction to morphine and opera singers used it prior to performances. How could this be bad for you? Didn't they put it in over-the-counter medications, soda and cigarettes? Hadn't Sir Arthur Conan Doyle, or so the story goes, use it as one of his characters most useful preparations? The character in question is Sherlock Holmes.

I began to speak to colleagues about the seminar at that time and they told me about their perceptions of cocaine. They'd seen young people brought into ERs with cocaine overdose symptoms and, in fact, one colleague had seen twin brothers die there. Heart failure and stroke were among the most prevalent problems of this "wonder" drug.

So, what would make anyone want to use it? How, with all the knowledge could anyone still use it as a "recreational" or stimulant drug for massive work output? Did these young people in Ireland suffer from the effects of too many Saturday nights with this new-found "snow?" I don't know the answer to the latter question and I still don't know if there's a greater number of young people in Dublin with stroke, but I did see an awful lot of them walking on that street that day.

Cocaine remains one of those substances that promise relief from the cares of the world, but weaves a web that strangles those who use it. I've seen it bring careers to a halt and police blotters begin to fill up with those who have tried to obtain it. One young man who had a major career in TV in his future saw it all end with a purchase just a few blocks from the studio.

Is it worth it? I don't think so.

Related Topics: Fewer Teens Report Risky Behavior, Herb Use Linked to Drug Abuse


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Self-harm and College Students

I've often talked to patients in community mental health centers and psychiatric hospitals who were what we call "delicate self-cutters" or SIB patients (self-injurious behavior). The reason for the self-harm has varied little and patients told me they had a sense of relief afterward. But until now professionals may not have known how prevalent this behavior might be.

A recent study which appears in the June 2006 issue of Pediatrics (117, pp. 1939-1948) looked at a sample of 2,875 students in two universities in the Northeastern United States. The universities are not named for reasons of confidentiality, which is the usual procedure in this type of research.

Originally, 8,300 students were picked at random and asked to participate. Of that number, 3000 students did take the survey but, also as is usual, incomplete questionnaires were not included in the calculations. The results, however, are of interest.

Seventeen percent of the students admitted to deliberately harming themselves and of that number, 75 per cent had harmed themselves more than once. For self-harmers, therefore, it is usually not an isolated incident.

The researchers also found that self-harmers were experiencing higher levels of distress, had signs of eating disorders and a history of three types of abuse: physical, sexual or emotional. The forms of self-harm included cutting, pinching, scratching, burning themselves, ripping or pulling their hair or skin. I have seen young female patients engaged in extraordinary forms of self-harm which ran from breaking their arms in doors to cutting their arms with razor blades and burning themselves with hair dryers. These patients, however, were in psychiatric hospitals, not college.

A secret form of self-abuse, respondents who had told someone about the abuse usually told mental health professionals rather than their medical doctors or other medical workers. The researchers indicated that, just as is done in the case of alcohol abuse, physicians and healthcare professionals need to begin asking about self-harm if something seems to indicate it.

Related Topics: WebMD Video: The Teen Brain, When Scab-Picking, Cutting Becomes Addictive

Technorati Tags: Eating Disorders, self harm

The Best

Remember when "the best" meant something special, really great and nothing else was better? Remember when you had a "best friend"? Best was a word reserved for only that very special few who met your high standards and they would be with you no matter what happened.

Recently I had a talk with a colleague, an MD, who believes as I do that "the best" deserves to be tacked on to something that is earned, not bought, something that signifies accomplishment without coercion or puffery. It's something for which we all continue to strive and yet, as a wise statistics professor once told me, "is always beyond our reach so we are ever trying to grasp it."

He was talking about a concept of higher statistics called multiple regression analysis and, in my estimation and to those who had had the great good fortune to be his students, he was "the best." Never had I had fellow students eagerly tell me, "you've got to take his course because he may be retiring and you have to have him as a professor." I had to have this man as a professor? Weren't there other professors who could do as good a job? Quite simply, no. I found that out from the moment I stepped into his packed lecture hall and he began by very simply telling us what we could expect from him.

"If you are my student," he began, "you will always be my student and, if you need help with your research or your statistics, you will come to my home and my wife will make us bagels and cream cheese and we'll talk about statistics until you understand. If the weather is good, we'll go for a walk. You will always be welcome. Remember, there are no stupid questions, if you don't understand something, so don't let that stop you from calling."

I remembered him fondly and I still do and, occasionally, I wonder how he's doing in Florida. I'd love to sit in his lectures again and, if the opportunity ever presented itself, I'd be on a plane tomorrow. He is that most special of individuals who is simply among "the best."

I bring this subject up because I am finding there are too many "bests" being thrown around today. There are also too many people who claim to have all kinds of accreditation from any number of organizations. This is how the MD and I began talking about the subject. He said it wasn't hard to get whatever letters you wanted. If you just sent in your check, you would receive your "diplomate" or whatever it was that you were buying.

A listserv of which I am a member mentioned the same topic of purported credentials that would seem to place these individuals among "the best" in their field. The MD posting it remarked that everyone should remember it's still "let the buyer beware" time when looking for any services whether medical or other.

So, let's remember that "the best" can be used until it no longer has any meaning and I, for one, intend to keep my standards high and my critical analytic ability sharp in order to weed out those who would pretend to be among "the best."

Related Topics: Best Depression Treatment: The One You Want, Medical Specialists

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