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- Today we are diving into the science of burnout.
And what happens in our brain
and body when this is happening.
In order to make this happen,
I reached out to a colleague to better help us
understand all that can go on
when someone is experiencing burnout.
And as always, this video series
is an educational project sponsored by Google.
Now I personally think it helps to know
that there is an actual reason we feel the way we feel.
And in a way, it's validating.
Because if we know something is happening in our brain
to actually make our life harder, or maybe even easier,
it's obvious that we aren't making any of it up.
And either way that we feel,
we almost have like a real tangible reason for it.
Since I am no doctor or brain specialist,
I reached out to my friend and colleague,
doctor Barry Lieberman who if you remember
is a psychiatrist and medical doctor
and I am hoping that he can help us
better understand why it is burnout
makes us feel the way it does.
And I find it interesting that the symptoms of burnout
mirror many of the symptoms of depression.
So I'm curious if they both occur
in specific parts of the brain
or if you could be more predisposed to burnout,
you know, like we can for depression.
You know if someone in our family has it,
then we might be more likely to get it.
So many questions for Doctor Lieberman,
and also I just find it interesting
that anyone can get burned out just like with depression.
So I'm curious if burnout is really a real thing
or just another exciting buzzword
for a major depressive disorder.
So many questions, let's just get in there and find out.
Thanks for making time for us again, Barry.
Everybody's been missing you.
- My pleasure. - They really liked
our last hangout. - So did I.
- And so today, we're talking about burnout
and I think it's kinda like a catchphrase right now,
a lot of people talking about it.
Are you familiar with it or kinda what we're talking
about today I guess is more about what happens in our brain.
- Yes, of course, I'm familiar with it
because of course is very common.
It's a common social phenomenon
in addition to a specifically psychological
emotional reaction for people who have it.
Burnout, I don't know the percentages
but it's incredibly common and it has a lot to do
with why people get this illusion
and quit jobs or lose confidence in what they're doing,
there's even people who loved what they were doing
but they're maybe so overwhelmed by the specifics of it
that they get quote "burned out" and they lose heart.
- Yeah, have you ever felt that, though?
'Cause you worked in the ER for a while, didn't you?
- I did work in the ER for 17 years
and I loved it, there were three 12-hour shifts a week.
They did not burn me out because I guess
I didn't do it enough to get burned out by that.
But I alternated between that and being errancing patients.
And interestingly at least for me in my life,
the huge variation in what I did in the emergency room
where I could do things dramatically and effectively
deliver a baby in a car, or restart somebody's heart
or sew up some gushing laceration,
and quietly continuing to pay attention to somebody here
and actually sometimes listen.
- Imagine that.
- And always respond.
They were really different so the pacing,
I think if I had worked 80 hours a week as a psychiatrist,
I'm sure I'd be burned out
and if I did 80 hours a week as an ER.
I see ER people, I have an ER doc in my family
and in emergency rooms, many years ago, 20 or 30 years ago,
the ER physicians in this area
went on strike in order to limit the number of hours
that the city contract for emergency rooms
were expecting them to fulfill.
Because you do too much of anything for too many hours
that you get exhausted or drained, you get burned out.
- Of course, that's the thing, is it's so much effort.
And if the reward itself doesn't change.
- That's right. - You're gonna burnout.
- Yes, I mean, you even hear about surgeons
who love what they do but they spend so many hours
in the operating room, and they're extremely rewarded,
they almost always
make a lot of money. - They save lives, yeah.
- They save lives and stuff like that
but at some point, that balance.
I don't think human evolution prepared us
to put in the number of hours that we now can do,
the industrial revolution has allowed us
to put in huge amounts of time,
live longer, live healthier,
and be able to do things for many more years.
But I always jabber about the average
life expectancy in America,
100 years or so ago was 42 and 200 years ago was 36.
And now even though some people live beyond that,
they rarely lived as healthily as we do now.
- Yeah, and so when it comes to burnout,
what happens in our brain?
'Cause I always, the thing that I really geek out about
and enjoy is the fact that things do happen in our brain,
we almost have like proof that something's wrong,
it's not just a feeling.
- There's no question that when we see a physical correlate
like evidence of brain damage or changes,
it reassures us that it's real.
So we see the functions of our brain
in talking and feeling, experiencing the same,
all of us who have done meaningful amounts of drugs,
of course not you, you know.
- Never. - Know that major alterations
of the brain functioning just from a drug
especially things like psychedelics
or uppers or downers, you will see a complete change
in mental attitude, especially people
who are overly vulnerable to it
and people whose personalities change.
Or you'll see somebody come in
and they'll say, I know he's 50 years old,
he's suddenly become a different person
and we don't know why he's not doing drugs
and I might start looking for a brain tumor,
or an abnormal blood vessel formation in their head.
And MRIs now allow us to see that too.
But taking it back to something more complex
as you're asking about burnout,
there's actually observable changes in areas of the brain,
especially in emotional centers of the brain,
usually called the limbic system
but includes things like amygdala, and cingulate gyrus,
and interior frontal cortex and whatever,
all these parts of the brain,
you can actually see changes in them using functional MRIs
under certain kinds of experimental stresses.
And we translate from that,
obviously people who experience burnout
which are millions of people,
you don't trip them all through an MRI lab,
but what you do is you judge
by the observable clinical and usually self-reported,
people say, I don't know, I just don't care anymore,
or I just don't have the same motivation
and it's been reported a lot,
you'd even may reference before we talked
about the overlap between this and depression.
- Yeah 'cause it sounds similar in some ways, you know?
- It is, it is.
I mean, to me it is and to me it may not even be different.
It may be just a very specific kind of depression
rather than an externally relatively,
externally caused depression.
You know, things like,
we usually talk about major depressive disorder,
we used to call them endogenous depressions,
they just came from inside.
And a lot of people are vulnerable to depression
so you see people who should be happy as pigs in poop
who in fact are not. - Yeah.
- But burnout, we presume is much more
like it can happen in people
who are not particularly vulnerable to depression
but are under extreme stress circumstances.
- Yeah, and if there are changes in the brain,
like you're saying then that would of course,
it lends itself to a different experience.
- Yeah, the similarities between depression
and burnout symptoms are so dramatic,
expect of course people who are feeling burned out
usually know it's related to what they're doing.
- Yeah, 'cause it's occupational, right?
So it's whatever you're doing,
even if you're a stay at home mom,
it's the work that you're doing everyday
is burning you out versus I feel depression
is more over arch, almost like a cloud has come over
whereas burnout I feel like it's specific to,
even though I know it can evade other parts of your life,
it feels much more specific to your occupation.
- [Barry] Yes.
- So if people feel like they are maybe struggling
with burnout or they're kind of concerned,
what advice do you have to them?
Do you think seeing a professional such as yourself
or myself is the best first step?
- Well yes.
The reason I hesitate and actually
you might also say quit your fucking job.
- Fair, fair.
- Because many times you have to,
if people can change the circumstances
or rearrange it, my brain automatically starts to fill
with many stories which I'll hold back
of people who've just changed their situation.
You know a good example of burnout
is people in bad relationships.
We think of it as occupational
but I would certainly say that maybe more of what I see
is people who are in, where they've come
to really be unhappy with their relationship
or more so than jobs.
But in all cases, yes, of course
if somebody going to a therapist, you or me,
to sort out what's going on
and to see if there are workable changes
or rearrangements because it may not be a bad thing,
maybe they are burned out on a job they're doing
but they love the job but hate what's happening to them
and they really need to change their hours
or do something different, if they can.
- Yeah, of course, yeah, that's a great point
that it doesn't just, it can be relationship,
it doesn't just have to be work.
I think we can be burned out
in a lot of aspects of our life.
And the sooner we recognize it the better.
- Yes, yes, so seeing a therapist is certainly one way
to be able to talk openly about maybe feelings
that are hard to share with other people
or certainly in a relationship where that's often the case.
But even with jobs, people think,
sometimes they're embarrassed,
gee I'm doing this great work and everybody is envious of me
that I'm doing this
and I'm thinking I'm sick to death of this.
- I think there's a lot of, I don't know if you agree,
but I always think that people have a lot of,
I don't know if it's really guilt
or like guilt associated with expectation,
like oh I'm doing this great thing,
I should be happy. - Yes.
- Everybody is so excited for me, I should feel good.
And in a way it's almost like we're invalidating ourselves.
- Your own feelings, that's right.
Because we feel guilty about these negative feelings,
about this positive thing.
Again, job or relationships, or both sometimes.
And then the question, as you know
when we talk about depression, we almost always are talking
about anti-depression medications
or augmentation with other kinds of medications
but whether a therapist refers that person
or in the case if they're coming to me,
I can jump to that a little bit more quickly.
But those are things that make the fact that we know
that there are observable measurable brain changes going on
even more valid.
I started to jabber before about,
I used to do that thing called
the dexamethasone suppression test.
I wanted to just say you used to give a person,
you can measure a person's production of cortisol
when people are stressed especially in anxious depression,
their cortisol levels are up
and normally with a person who isn't,
you give them dexamethasone the night before
and it suppresses their production of cortisol the next day.
That's normal, that's a normal test.
The abnormal test is the next day
when you do a repeat blood test,
the cortisol is still elevated
because they're still messed up.
You don't do that anymore, only because one, it's expensive,
two, I hate to order blood tests
'cause I hate to have my blood drawn too.
- I know, it's such a pain in the ass.
- Well, no, they take it from a vein.
(laughing)
But that's--
- I guess I'm going to the wrong place.
- Well you may have have gone to somebody
who really didn't like it or really liked you,
it depends on who drew the blood.
But in any case, you don't really need to do anything more
because you don't have to convince people as much
that there is a chemistry of an emotional state.
And in these tests that we're referencing today
that there is actually morphologic IE observable
anatomical changes that parts of the brain
may shrink or expand
and that's what some of these studies have been showing.
So people who are especially studying brain science now
are very, very much tuned it to that.
We know that we know that emotions and thoughts
are a function of the brain
but we didn't really think of our brain
as changing and yet it does.
- Yeah, and I think that's like I said so validating.
And it also just tells us more about what's going on
and why the symptoms we're experiencing are happening
because if our amygdala, I always call it the fire alarm,
it's the thing that sounds when kids throw tantrums,
or when we cuss somebody when they cut us off on the street
when we're driving and whatever,
if we're really irritable and quick to get angry,
I feel like that's our amygdala firing.
You know it's like our fight or flight,
and so if that's being affected,
if it's getting enlarged because of the burnout,
that makes sense and sometimes I like
when things logically make sense
'cause a lot of emotional stuff feel like well,
I don't know, the chemicals of this can be shifting,
you know but this is like tangible.
- Yeah, I'm sorry, I keep smiling
because I'm remembering a 12-year-old boy
I knew once who would say when he looked at pictures
in Playboy, it made his weeny tingle.
(laughing)
- That was a direct correlation.
- And I'm sure he later had an experience
of even more bodily changes in that regard.
And those we don't doubt,
and we don't doubt when we're angry,
our face gets red, our heart rate goes up,
our pulse rate goes up, our breathing
and everything like that.
We've always known that but we don't really think
until lately, gee, if I'm almost
always angry or stressed or upset,
not only am I gonna be probably having
a much more frequently elevated heart rate or whatever,
but these things are also going on in the brain.
- Yeah, agreed.
- Yeah, and burnout because it isn't,
we don't normally think of it as a,
don't usually think of it as a
oh it's a psychological problem but it is.
It has a psychological effect
even if it's externally caused.
- Totally, yeah.
- And, and, and, of course,
in addition to the possibles therapeutic reevaluations
of who am I and why am I doing this
and should I be doing this and do I want to
or how can I do it differently?
All of which are therapeutic explorations and interventions
and there's also of course the possibility of medications
easing the symptomatology.
- So thank you for taking the time, it was really helpful.
It just validates what I thought was already happening
and gives us a reason,
kind of an explanation to what we may be feeling.
- And that's the only reason I'm talking to you,
it's to validate you.
(laughing)
- Thank you, thank you, Barry.
- Otherwise you'll get burned out doing this.
- Preventing burnout one day at a time.
- Yeah.
- A huge thank you to doctor Lieberman for his time.
And I think it's so interesting to know
that research shows us that burnout
can affect an entire system of our brain
making our amygdala larger and affecting
how our prefrontal cortex operates, so fascinating.
Although I am sure some people would view this
as maybe a bad thing, well, I guess at the beginning,
I think that this is really validating.
It means that there's really something
happening in our brain
to make us feel the way that we feel.
Now for this week's homework,
since doctor Lieberman talked a lot
about how we should make positive change
in order to help ourselves feel better more quickly,
what's something that you could do this week
to better manage any possible symptoms
of burnout you might be experiencing?
And also let's get that comment section going,
let's start a conversation.
If you do or even don't think burnout
is something affecting you,
what was the most interesting or shocking thing
you learned in this episode?
For me, it was the fact that the amygdala gets larger,
that like blew my mind, phew.
So let me know what you think and I'll see you next week.
- And then a family member got ill
and it was then when I guess with the other things
that were going on, this particular event
just like tipped me over the edge, I guess you could say.
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