All In The Mind

00:00 ABC Listen. Podcasts, radio, news, music and more. 00:07 There are a lot of perfectly sensible reasons to start a war. Territory, resources, pigs. Wait, what? You've got to pay for that pig. Yes, a pig, a pastry shop, a football game, sometimes even birds. They don't seem to be easy to kill. History is filled with some stupid wars. On the No One Saw It Coming podcast, we are diving right into them. With me, Mark Finnell. 00:32 Search No One Saw It Coming podcast on ABC Listen or wherever you get your podcasts. 00:38 Just a quick heads up before we start. The second half of this episode includes a brief discussion of suicidal ideation. Take care while listening. And if that brings up any issues for you, you can always call Lifeline on 13 11 14. All right, let's get into the episode. 00:55 People talk about burnout as if it's a single construct. 00:59 I believe there are two phases. There's a phase of burning out and there's a phase of being burnt out. 01:07 There comes a time in many people's lives where you find yourself asking, am I burning out? Is this burnout or depression or just a bad patch or something else entirely? 01:19 Burnout has become a bit of a buzzword, but it's not made up and it is pretty common. The data is a bit scattered, but one representative survey of a thousand people from Beyond Blue in 2025 found one in two workers were facing burnout. with young people and parents most at risk. And it turns out there are certain professions and personality traits that put you at greatest risk as well. 01:45 Sociopaths never develop burnout. 01:48 And the reason is they're not reliable, they're not conscientious, and they're totally self-interested. 01:54 So today we're asking, what are the warning signs that you're burning out? 01:59 What makes it different to depression? I didn't want to get out of bed. I didn't want to go anywhere, do anything. I was sleeping a lot. I was crying all the time. And what does it take to recover? 02:10 I'm Sana Kadar from ABC Radio National. This is All in the Mind. 02:28 So my name is Sally Gould. I work as a paramedic. I've been a paramedic for 15 years now. I'm also a mum and an author. My book, Frog, The Secret Diary of a Paramedic, was released last year. 02:39 Paramedicine is a bit of a family business for Sally Gould. Her father was a paramedic and for a long time that put her off the profession. She thought she wanted to do something else entirely. I didn't want to do what he'd already done. 02:51 But by the time she was 15, she knew paramedicine was going to be her path as well. I hated the idea of being stuck in a building for my job. I just couldn't tolerate that. The idea that I got to see any type of patient, I never knew what was coming, just loved the thought of that. 03:06 And luckily, when she started training a few years later, shadowing more senior paramedics and going on call-outs, she loved the reality of it as well. 03:14 I do like creating order out of chaos. And that's what paramedicine is, because we have these patients for such a short time. We work really hard and then we drop them off and we're sort of done with them. 03:27 But as time went on, and you know there's a buck coming because this is a show about burnout, Sally was finding it harder to switch off after certain jobs. 03:37 and not the kind you might expect. I think the general population assumes that it's the traumatic jobs that are going to sit with you and wear you down. 03:47 But I was talking with a colleague earlier this week, and he likened it to being a Formula One driver. He loves analogies. And he said, you know, you're trained to drive under these incredible conditions and on racetracks at extreme speeds, but imagine that driver is doing the school drop-off around suburbia. 04:07 So we're trained to be in those time critical situations, but we spend a lot of our day doing really low acuity, what is sort of under stimulating work to us. So people with chronic health complaints, people who should have gone to their GP, people who don't treat us nicely. just ticking over on all of those, but also being on high alert that at any moment, the next job could be the worst one of our career and use all of our skills, you know, to the maximum of our ability. So it's this strange dichotomy of needing to be switched on and like a coiled spring at all times, but also being stuck in this sort of routine of the job because it does become routine. 04:49 Yeah. 04:49 And sometimes it's not even that the jobs are routine or mundane. They're truly time-wasting. Once Sally responded to a call from a young woman who'd said she was having an asthma attack. 05:01 But when I assessed her, she definitely wasn't. And, you know, we're kind of detectives and dig deeper and what's the reason behind this and are we missing something? And it turned out that she couldn't be bothered to fill her script and thought if we ran a nebuliser, it would prevent her from having an asthma attack overnight so she didn't have to go and get the puffer. And that's so far from the scope of what we're meant to be doing. And then for her to turn around and get annoyed at us because we weren't going to do what she wanted. Yeah. Frustrating. Yeah. She hurled abuse at you as you guys. 05:32 And tried to throw my equipment at me. 05:34 Oh, my God. Okay. So I can understand how things like that would really start to wear. 05:39 Yeah. There's times when that frustration can boil over because you might be sitting with someone who's got a tummy ache and on the radio there's a car saying, you know, we're at a pedestrian that's been struck and we need urgent backup and we're not available. And that tension of wanting to be in that other place is so hard to dig deep and show empathy to the patient that's in front of you because our brains work to want to help the sickest person first. 06:02 Mm-hmm. 06:04 And then to top it all off, at a certain point, Sally was partnered with a senior who was quite bullying. 06:10 His approach to teaching was not teaching. It was just to belittle me, correct me, make fun of me. It hammered her self-confidence. part of me thinking, is he right? Am I not cut out for this? Am I not good enough? And she needed this man sign off to finish her training. Ended up just dreading going to work, crying on the way home every day. Add to that night shifts and extremely long hours. Our shifts are rostered to be about 12 hours, but we're always going over time because you can't just say, oh, sorry, hop out at the side of the ambulance. 06:42 I need to go home now. You have to see that patient through. It was all a perfect storm for burnout. 06:50 So the common work triggers would be excessive work hours. And of course, one of the reasons why we're seeing this epidemic of burnout in the last few decades is this increasing pressure for us to be on the whole time. So that's a very common trigger for burnout. 07:08 This is Gordon Parker. He's an emeritus professor of psychiatry at the University of New South Wales, and he spent decades researching burnout. 07:17 But it can be other obvious factors, such as the workplace being incredibly demanding or very noisy or overly lit. 07:25 Or it can be having a really mean, terrible, high-pressure boss. 07:29 It can also be a lack of any stimulus at work, which is quite surprising, but that sometimes occurs. And other nuanced burnout triggers include where you feel conflicted that your value system is being compromised by maybe an employer who wants you to do certain things that are against your values. 07:50 Burnout is very often linked to a workplace, but not exclusively. There's been a lot more written in recent years about carer burnout or parental burnout. 08:00 So there's now greater recognition that burnout can affect people who are formerly unemployed, but who have demanding family and other responsibilities. And I think that's a very important move from where burnout was considered and conceptualized in the 80s. 08:19 You might be surprised to hear that burnout has been on the radar of researchers since as early as the 1980s. 08:24 For the ones that are in the organization, A, it's burnout, B, it's long hours. You become very narrow, very besotted. 08:31 It can sound like a really contemporary buzzword, a bit of therapy speak that's busted through thanks to the algorithm. But as Gordon says, there is decades of research behind it. 08:41 Again in the 80s, we had our first measure of burnout developed. 08:46 This was by an American psychologist named Christina Maslick. 08:50 And the Maslick Burnout Inventory or MBI has been used in over 80% of studies in the last few decades. 08:58 The Maslow Burnout Inventory basically assesses three elements. Exhaustion, compassion fatigue, and decreased performance. It is the most commonly used measure, but others have been developed, including one by Gordon and his colleagues, which is based on a series of studies that they conducted. 09:16 And out of that, we developed a measure that has six key constructs. So we define burnout firstly by exhaustion, that is its cardinal feature. Secondly, there is cognitive impairment, which is not captured in the Maslick burnout inventory. And that's important because people with burnout almost universally report they've got foggy concentration. Thirdly, many measures of burnout have a scale called capturing lack of empathy or compassion fatigue. 09:50 Now, in real life, it's a broader construct than that. What people generally feel is a lack of feeling tone. They don't get much of a buzz out of anything. 10:00 Then there's insularity. 10:01 People tend to just keep on their own. So at lunchtime, they don't go off and eat with their mates. They'll keep to themselves. 10:08 And then finally, there's a range of physical and psychological symptoms that can pop up. Things like headaches, trouble sleeping, anxiety, depression. 10:17 Sometimes in profound cases, people falling to the ground, compromised immune functioning, which means they get more infections and so on and so forth. So our scale has six constructs that have broadened the definition of burnout from the simple three-factor MBI. 10:35 And so these are the red flags that can tell you you're burning out or burnt out. Professor Gordon Parker says that is an important distinction to make. 10:46 People talk about burnout as if it's a single construct. I believe there are two phases. There's a phase of burning out and there's a phase of being burnt out. And there are multiple analogies, but one I would use would be of a candle. Let's say a candle is being under pressure from some wind and it's flickering, such as an individual might be under stress. The candle is still alight, but it's not in good shape. And then you can have the situation where the wind is so strong that it actually blows the candle out. 11:21 Now, to get the candle going again, if you're in a burning out stage, there are certain strategies that might simply be employed, such as de-stressing. But when somebody is burnt out, that is a much more finite stage. And I think that concept of there being two phases has been essentially ignored in the literature. But I think it's very important because the management of burnout actually, in my mind, depends very much as to whether you're in a burning out phase or in a burnt out phase. 11:52 And in the book that we wrote, we described a professional woman who worked extraordinary hours, couldn't get out of bed in this severe burnt out stage. When she was taken to hospital, nobody in the ED could work out what was going on. But her blood pressure was 60 over 40 compared to the normal 120 over 80. 12:13 Her pulse rate was 170, which was very, very fast, and she had no cortisol levels, and she just couldn't get out of bed. So in that burnt out state, there are far more distinct markers of, in a sense, an irreversible syndrome until strategies are put in place, adjusting a work-life balance. 12:41 From ABC Radio National, this is All In The Mind. I'm Sana Kadar. Today, burnout. The warning signs, how it feels, and how to make your way out to the other side. 12:54 Now, burnout isn't included in the DSM, the bible for psychiatric disorders, but it is listed as an occupational phenomenon in the International Classification of Diseases, the ICD-11, which is another major publication. 13:08 And for paramedic Sally Gould, there were plenty of warning signs that burnout was creeping up, but she didn't necessarily notice all of them at the time. 13:17 It's hard to know when it actually started because it was a very slow sort of sinister beginning that didn't, you know, look obvious to me at the start. So I don't know when it started, but I became a little bit jaded about work. I became cynical. I became frustrated with people. I didn't have the empathy that I needed in that sort of role. And that was me at work. And then me on my days off at home became completely non-functional. So I didn't want to get out of bed. I didn't want to go anywhere, do anything. 13:48 I didn't want to connect with people socially. I struggled to do things like grocery shopping, showering, getting dressed. I was sleeping a lot. I was crying all the time. It just wasn't a version of me that I recognised at all. 14:03 Was this about two years into working? About that, yeah. One thing we haven't mentioned but you write about in the book is kind of you have a lot of, you notice this in yourself, perfectionistic tendencies. 14:14 How much do you think that played into the experience of burnout you were having at this point? I think it definitely played a part in the situation because I could see how far away I was from the person that I wanted to be in that job and the way I dreamt that career looked for me. But also in my life, I wasn't nailing anything. So I was falling so short of doing anything, let alone work. being perfect or being successful or nailing my life. I guess that all played in, especially when I realised I had a problem, but I didn't know what the problem was and I didn't know how to solve it. 14:52 So I didn't even want to admit there was a problem. There's that shame, I think, but also that fear that I didn't understand what that whole trajectory would look like. So I didn't even want to take the first step. In terms of recovery? Yes. 15:08 What Sally is describing about herself isn't unusual for people at risk of burnout. 15:13 What we've identified as the most important predisposing factor is personality style. 15:19 This is emeritus professor of psychiatry Gordon Parker again. 15:23 And people who are reliable, dutiful, diligent, if not perfectionistic, are much more likely to get burnout. 15:32 And why? Fairly obvious reasons. They're the people who work the hardest. They're the ones who will stay on longer to ensure that they do a good job and are dutiful. So if we accept that model, not only does that have management implications, that you don't just manage the stress, but it means you should do something about the predisposing personality. 15:55 Okay, as someone who cares a lot about their work and who I'd like to think is pretty reliable and diligent, I'm talking about myself here, this is very hard to hear, that the very things that make you good at your job can be your downfall when it comes to burnout. And Gordon says these personality traits also account for why certain professions have higher rates of burnout. 16:20 To practice medicine, you have to be diligent, if not perfectionistic, even more so for lawyers. Any profession that demands that people are reliable and conscientious is going to be overrepresented. And that's why we see it in the health professions. We see it in teachers and we see it in lawyers. 16:42 But the most distinct group that Gordon says is overrepresented when it comes to burnout, you'll never guess it. But try anyways. 16:50 Oh, which profession? 16:54 From my observations? 16:57 Journos. 17:00 I feel the journos one. Not journos. Try again. Psychologists? 17:05 Psychologists. 17:07 because I feel like people are always unloading their problems onto them. 17:11 All good guesses, but none of them accurate. It's clergy. 17:16 Gordon says there are a number of reasons for this. The need to always be on call, the constant exposure to tragedy, the lack of tangible results and unclear measures of achievement. 17:26 And interesting finding that in this country, over 90% of people who start training to take up a role in the clergy leave before they actually finish their course. And it's often because they're picking up on the factors that are going to drive burnout. 17:44 So I think that helps explain why we see certain professions overrepresented. The converse is rather ironic. Sociopaths never develop burnout. 17:57 And the reason is they're not reliable, they're not conscientious, and they're totally self-interested. 18:04 And so their capacity to care for others just isn't there, and therefore it can't be run down. 18:11 You know, I can't help but think that the message here is be more sociopathic and care less about work. But I'm not sure that's quite right either. Obviously, there's a balance to be achieved in how you approach work. And for Sally, it was a long time before she realized what she needed to change in her life. 18:30 I was at a point where I was non-functioning in my days off and barely able to get the uniform on and perform that role. I was wearing the uniform as sort of a sense of, you know, armour that it protected me, but I was just empty within it. So a combination now that I couldn't enjoy my job, I wasn't enjoying my personal life, I was just existing. So it was my husband who said, hey, this isn't working, and he suggested a GP visit. which seems so small a step, but to me at the time just felt huge. 19:01 I just want to backtrack before you get to the GP. 19:03 One thing we haven't mentioned with your experience of burnout was like the suicidal ideation that you were starting to experience. 19:08 So tell me when that started to come on and how long that was going on for. The thoughts were there for months, I would say, and they probably started quite small. And towards the end, before I got help, it was the majority of what I would think about on a daily basis. 19:25 I would just go round and round in my head. The only time I wasn't sort of thinking about it was when I was sleeping. 19:31 I was just thinking how nice it would be to not be there anymore. And I was starting to think in quite a lot of detail about how I would go about carrying that out. That's really scary. 19:43 If your husband hadn't said, it's time to go see a GP, do you feel like you were close to taking action or how do you feel about when he swept in? 19:51 I do think I was getting closer and closer to taking action. I do feel like it was becoming to feel like the only option. 20:01 At the recommendation of her GP, Sally went and saw a psychologist, but they didn't click. 20:08 She kept sort of circling about work and I kept getting really frustrated and she just wasn't going about it in the right way, trying to tell me that I'd done... 20:16 some sort of traumatic job at work that was making me like this. And I just kept thinking, no, I love my job. My job is the only thing that I actually have a tiny bit of care for. 20:28 And so we sort of just got into this standoff, I guess, where she thought I was holding off on her and lying to her about not disclosing some sort of traumatic experience. But I was being very honest that I didn't have one traumatic job that I thought had put me in that space and So the psychologist appointments felt to me like a waste of time, but it obviously was enough just to give me a little hope and a want to be better. 20:53 And to be clear, Sally isn't anti-psychology. She just had a bad experience in this instance. 21:00 And when I sort of thought, what can I do? What can I change in my life to get better? The first thing I did was just get rid of the contraceptive pill, get rid of the alcohol and start doing some exercise. Nothing hectic, like not glamorous, like walking around the block in my thongs. The clearing of my mind from getting rid of those chemicals that were affecting the way my brain was working was enough to go, okay, this feels a bit better. Okay, I can maybe get out the door to do a five minute walk. 21:28 And then unfortunately, it's all the things that we know are good for us. You know, eating well, sleeping well, exercising, they do work. But it was not a smooth recovery. It wasn't quick. It wasn't always linear. And it was probably years until I was quite well. And I've had periods in my life where I've been down again. So it sounds like... a lot of your recovery was self-directed then. Yes. That's incredible that you were able to pull yourself out without the help of a professional who was kind of getting at the actual cause of the problem. 21:58 Maybe it wasn't the best way to go about it and I'm not recommending it. I probably should have found a psychologist that I clicked with and we could have together come up with a more effective plan. But you got there in the end. I got there. Thank goodness. Thank goodness. 22:13 Now, a question you might be wondering at this point is, how do you tell if what you're experiencing is burnout or depression? After all, Sally had suicidal ideation. She couldn't get out of bed. She didn't want to socialize. People with depression can experience all of these. And this is actually a debate that's been running through burnout and depression research for decades, as Professor Gordon Parker tells it. 22:39 The researchers in this field are almost equally divided into those who say that burnout is just another name for depression and those who say they're strikingly different. I belong to the second group and that's not just opinion based. We did a big study where we had 140 symptoms given to a group of people with burnout and in that list we had over 30 depression items And then when we undertook statistical analysis to identify the burnout symptoms, out came the sort of constructs that I've discussed before. 23:17 But depression did not emerge as a constituent factor and therefore part of the burnout description. 23:25 So that and several other related studies argue strongly to us that depression and burnout are not synonymous. 23:33 That said, plenty of people who develop burnout also develop depression at the same time. 23:39 So if you have a boss who is demanding and setting impossible outputs for you to be reaching, then you may develop burnout. But if he also demeans and diminishes you, you're also likely to get depressed. What I found most useful as a clinician in terms of differentiating the two is to ask the patient, what is the driver? And if it's depression, the patient will almost invariably report some factor, some trigger that compromised their self-esteem, made them feel worthless, and dropped their self-worth, self-esteem to the floor. 24:17 Somebody experiencing a burnout syndrome will more describe the stress factors going along with their work. So in addition to looking at the basic constructs for people who have depression and those who have burnout, looking at the precipitating factor is often the best way of identifying whether it's depression or whether it's burnout. 24:39 That has implications for treatment as well. A depression treatment could be medication or talking therapy, like cognitive behavioural therapy. 24:48 Whereas for burnout, the model is quite clearly different. You need to identify and address the triggering factors. Then you need to get the person doing de-stressing strategies. And what we found, again, when we asked people what they found most helpful... 25:05 The number one was having time off work. Secondly was exercise, particularly strenuous exercise, talking to somebody else. And then after that came what we would have thought would have been higher up the list, strategies like mindfulness and meditation and so on and so forth. In addition, in our model, we would say that if you want to address burnout, you need to do all of those. But if there is a predisposing personality style, such as being perfectionistic, then that needs to be addressed. 25:37 And in that case, you'd probably require a skilled psychologist to apply a cognitive behaviour therapy approach. 25:46 That is exactly what paramedic Sally Gould has been working on with her psychologist. A new one, one she clicks with a lot better now. And there's a few other strategies she's put in place to deal with the fact that her job does expose her to traumatic experiences. 26:01 then the risk of compassion fatigue and moral injury is ongoing. Well, firstly, I think I redeveloped my idea of what resilience means. You know, back when I started the job, I thought resilience was not letting anything affect me and pushing down all the emotions. Now I realise it's about acknowledging that the things I've seen are going to cause an emotional response, giving space to those feelings, and then utilising my toolkit to process what I've seen to get back to a healthy place. I'm also very rigid with... 26:32 My sleep. Sleep is so important to me, as is exercise, eating well and social connection. And there are only a handful of jobs that stick with me as, you know, truly traumatic. And they're ones that I've worked through with my psychologist and spoken to with trusted colleagues. to sort of process the specifics of a couple of really traumatic jobs for the most part. I do still lean on that dark humour and the way we debrief with colleagues, but nurturing myself in my days off is just non-negotiable now. 27:03 And so to conclude, I kind of want to get a picture of how you would describe yourself over these three kind of phases of your career, like the early ingenue paramedic. 27:13 And then during the burnout phase and now. So if you had three words you could pick to describe yourself in the early phase, burnout and now, what would that be for each of them? In the early stage, I was – one word is hard. No, you can have three words. Oh, three for each. Excellent. 27:29 I would say green, optimistic and naive. In that middle stage, dissociated, depressed, lost perhaps. Yeah. And now I would say thriving, enthusiastic and content. That's a beautiful journey. I'm so glad things have turned around for you. 27:52 Thank you so much. 27:57 That is Sally Gould, intensive care paramedic and author of the memoir Frog, The Secret Diary of a Paramedic. 28:05 You also heard from Emeritus Professor of Psychiatry at the University of New South Wales, Gordon Parker. He's the co-author of a book called Burnout, a guide to identifying burnout and pathways to recovery. 28:20 And that is it for All in the Mind this week. Thanks to producer Rose Kerr, senior producer James Bullen, and sound engineer Tegan Nichols. 28:29 I'm Sana Khadar. Thanks for listening. I'll catch you next time. 28:51 Bye. 29:27 You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio and exclusives on the ABC Listen app.