Spring 1982 - Athletic Training History

discharge of many other emotions. He further felt that werely to a great extent on work as a source of selfevaluationand as a basis on which to pattern modes ofadaptive behavior. 2Calvin summed up in his protestant work ethic that onelak°red earnestly without complaint and withdiligence, was doing God's work on earth. Voltaire in hisCandide expressed, "Work keeps at bay the great evils:Boredom, vice, and need." 2"No one ever died of overwork" is often quoted, but theindividual does cease to operate effectively. Some peoplelack the inner governor, and for various reasons ignoremany of the commonplace signs and symptoms signalingthe need for rest and recreation. Many articles fill theliterature with the inability or unwillingness to work, butfew deal with the problems of overwork. Overwork mayrepresent an effort to maintain a clear conscience bysaying to the world, "See, I am blameless. I have done allthat I could, even working to the edge of totalexhaustion." 2No one needs a definition of the Burnout Syndrome; thename is too descriptive, the pictures it brings to mind aretoo vivid, the effects it produces are too real. Itsprevalence seems to be widespread; it respects nosocioeconomic or cultural group; it may be found amongall age groups; and it may be found in both men andwomen. It strikes all professions, including athletictrainers who actually may be at a higher risk owing tosome of their unique vulnerabilities. The purposes of thispaper are to identify some of the early warning signs andsymptoms of Burnout, examine a cross-section of itspervasive effects in several occupations, and to suggestsome prevention measures, and finally, to prescribetreatment.Case HistoriesTom, a 43-year-old dentist suffers from dysphoria: "Ijust don't feel good and I can't remember how long it hasbeen since I felt relaxed." He is married, has threechildren, his practice is active, he has no majorindebtedness — but he is often tired. He cannot seem wellwithout medication and he is seriously considering"quitting" or "just walking out of my office and nevercoming back." All his life he wanted to be a dentist but hedoesn't enjoy it much anymore. "I find that little thingsirritate me and when a new patient comes to my office, Ifind myself more nervous than the patient. I've done thesame examination a thousand times; I don't know why I'mnervous." It has been a long time — years — since he tooka vacation: "I don't feel good when I take time off — Ican't relax." Even though he feels bad generally, he feelsbest at work. He feels guilty when he takes time off:"When I go home early on Friday afternoon, I stay by thephone in case someone needs me." He feels exhausted.Psychiatric treatment for depression produced marginal,temporary improvement, even with antidepressantmedication. He was impatient with free time in his officeand impatient with his children at home. "No problemwith the wife." Pathetically, he said, "I've got what mostother people want: a good home, a family, and a goodjob....but I'm not happy." In his most telling statement (anescape fantasy) he said, I feel like I would like a pipe and acouple of pounds of tobacco and to be left alone byeverybody."Diagnosis: The Burnout Syndrome.Premorbid Condition: passive dependent person.Contributing Factors: overworked, overstressed,failure to relax.Possible Complications: suicide.Treatment: Reduce office hours to four days per week;take off one week every three months.Ann, a 30-year-old nursing supervisor, reports that hernurse employees are insubordinate. She feels they don'tlike her. She is overly conscientious at work, conies backafter her regularly scheduled hours and feels incompetentwhen she compares herself to the younger, lessexperienced women at work. She can't relax. At home hertime is devoted to work projects — "I like to make thingsas gifts for my daughters and husband." She also findstimes to go back to the hospital at night to visit a sick"friend." The impression she makes is one ofsuperficiality: she has a cliche for most things, a shallowreply to direct questions. Her marriage is on the rocks.Twice she has impulsively and abruptly asked herhusband to leave. The first time he complied with herrequest. On the second occasion he said, "This is it! If youmake me leave now then I'm not coming back." Her lastvacation? An obligation visit to her mother with whom shehas a strained relationship. She feels bad most of the time,but at work she seems able to psychologically manage alittle better.Diagnosis: Burnout Syndrome.Premorbid Personality: First husband was killed inVietnam. She "handled" her grief by throwing herself intoher work.Contributing Factors: She is the boss at work, but sheworks harder there than any of the younger nurses.Possible Complications: divorce.Treatment: Work eight hour shift only. Stay away fromthe hospital when off duty. Take up exercise to relieveanger and anxiety.Gene, a 40-year-old university athletic trainer; married;two children; financial stability; nationally ranked athleticteams. Chief complaint: "I'm exhausted; I wake up in themorning and I dread the day. I don't look forward tothings; I dread things — even vacations. I fear I may fallapart. Things I've automatically done for years I now getup-tight about. Team trips — I hate them. I also wish we'dlose, but the strain is just as great. I'm the first personthere at work and the last person to leave. I've forgottenhow to relax. I find myself hanging around the treatmentroom even when we are closed. It's no better at home:Everything is a hassle. Occasionally, I get a tip and make agood business investment — something that used to exciteme — but now it means nothing. I used to enjoy thetelevision and newspaper coverage but now it all seemssilly.Diagnosis: Burnout Syndrome.Premorbid Personality: frustrated athlete or coach.Contributing Factors: His work has been so highlysuccessful it has come to be expected; not muchrecognition now — no time really away from work.Treatment: Take a sabbatical — at least one semesteroff, perhaps pursuing travel or hobby.What is now recognized as the Burnout Syndrome isbasically a maladaptive form of coping with stressthrough excessive "devotion" to work: work loses itscharm and challenge and the victim of the BurnoutSyndrome becomes enslaved to work as a form ofdrudgery.Clinically, the Burnout Syndrome presents as a form ofdepression; however, it does not respond to the usualtreatment of depressives and it is an atypical form ofdepression, not the usual triad of hopelessness,helplessness, and haplessness. The most telling symptomwhich patients with the Burnout Syndrome complain of isworking longer hours and enjoying work less withintolerances for time away from their job.StressThe physical aspects of work often produce a pleasantfatigue. However, the stresses and anxieties of the job, incombination with the physical fatigue may lead toburnout. Stress in itself is not bad. Positive effects ofstress can increase alertness and efficiency. Without somechallenge of stress, a task soon becomes boring as seen inAthletic Training • Spring 1982 37