An epidemic of Burnout recognized by the World Health Organization

The following post was inspired by this article:

https://edition.cnn.com/2019/05/27/health/who-burnout-disease-trnd/index.html


Archaeologists have found evidence of farming that dates as far back as 9500 BCE.  Since that time,  humans have been toiling and to ensure that they could feed themselves and care for their families.  The Industrial Revolution saw a shift whereby workers largely moved from agriculture jobs located in the country and in villages to manufacturing jobs located in the city.  The ability to measure time, according to some historians, led to the modern work day.  I wonder if early workers gave a thought to how hard they worked.  Did they complain about it or was it was simply a fact of life?  Did they suffer, and if so, how was the suffering experienced and lived?

Fast forward to 2019.  Enter quality of life and privilege.  No longer do we measure health by our ability to provide the basic necessities.  Psychologists and other disciplines currently measure health and wellness by examining factors such as engagement, connection, and overall happiness.  In the romantic relationship realm, standards for a good life have also changed;  People marry for love rather than to combine property or increase the size of their army.  Humans in developed societies have constructed a world where they have the mental energy to wax philosophical about existence and ponder the meaning and value of life.  Concerns about survival have perhaps been replaced by  'higher order'  affairs.

In line with this progression is overall satisfaction with one's work. It is no longer a given that work will be hard.

This blog is about burnout and stress leave from work.  I want to add here that when I was practicing in the US, I only once heard of someone going on stress leave from work.  Sure, people around me were stressed.  Many people I knew worked long hours.  I worked long hours during parts of my career.  I experienced stress but would have never given myself an actual clinical label.  My father's father worked during the Great Depression and ethic of hard work somehow passed down through the generations and lodged firmly into my psyche.  Work is supposed to be hard.

When I first moved to Denmark and started practicing, I started seeing my first cases of work related stress and burnout.  From my capitalist point of view, it was discombobulating.  I reasoned that work stress was more of a cultural phenomenon rather than an objective fact.  I remained open but was skeptical.

Two things happened that influenced my thinking but were in contradiction to one another.  The first is that I saw many advantages to the Danish lifestyle.  Danish people just seem more relaxed and they have won 'the happiest people' in the world award more than once.  I also started to relax and found myself sauntering, instead of rushing to work.  There just always seems to be more time this country.  In retrospect, USA work standards now seem malignant to me.  I personally know people who struggle to get to work on time, due to car troubles, and who have unforgiving bosses.  Most people I know work 40+ hours per week and don't get nearly the vacation we get here in Denmark.  But the other thing that happened that affected my thinking.was the refugee crisis and the proliferation of the term 'white privilege'.  For those of us who work in the Western world and have 'stressful' jobs, I am sure there are many refugees who would love to take our place.  Though I have embraced the philosophy of work/life balance as an ideal, it's still hard for me, as a privileged white person, to grasp that it's an 'illness' to have stress at work. 

The collective body of the World Health Organization has however, deemed that burnout is real and even gets the claim of being named an actual disorder.  In the realm of diagnosis, we must take everything with a grain of salt.  While it's important to take the suffering of others seriously, the  labeling of disorders is a social phenomenon shaped by cultural values and the times.  But in my current state of mind, I am glad that this international health institution has made this shift.  I hope it extends beyond developed societies and everyone, the world round, reflects about when work is too much.

I welcome your comments.

Debbie Quackenbush, Ph.D. is a Clinical Psychologist who has been practicing for thirty years in both the USA and Denmark.  You can find out more about her at her website, here:   debbiequackenbush.com.

Mindfulness in Frederiksberg

Mindfulness and mindfulness meditation are concepts that have been well integrated into our modern day psychology vocabulary.  Blame the Buddhists or blame Marsha Lenihan, but mindfulness is here to stay at it seems to be a modern-day cure all-- an elixer for all of your emotional woes.  In my experience however, some of the people who need these techniques have the most difficulty utilizing them.   For the most agitated of people, it can feel like utter hell to sit still and breathe for just ten minutes.  Perhaps it's not unlike what happens when someone who is tremendously out of physical shape tries to get fit;  those first attempts at fitness and exercise are not only tortuous, but also not immediately beneficial.  The benefits are instead reaped over time and with practice.

There are many activities that can, I believe, mimic the mindful focus on the 'here and now'.  Even the most banal of tasks-- for example, sweeping the floor or washing dishes, can transcend the humdrum and become a pathway to calm, silence and simple purpose.

My first creations-- I am a bit proud of them!

A few weeks ago I was walking through Frederiksberg when I ran across this place:   Restart ('Rest-Art').  It's next-door to an art  gallery and the view from the window was just one of workspaces and art supplies.  I had to go inside and see what it was all about.  I did this and met the owner, Marianne.  She explained the concept to me and her belief that engaging in creative endeavors can help one to de-stress.  She gave me a small tour and explained some of the paints and supplies around the shop.  There were so many different media that I had no idea what to do initially (I am definitely not an artist) so I looked to her for guidance.  She offered suggestions and ideas about techniques-- enough to get a non-artist started. Since then, I have been back a few times and made some small, usable things.  In my opinion, it was a great way to slow down and unwind a bit.  I think these kinds of active endeavors (as opposed to more passive ones such as closing one's eyes and focusing on one's breath) are a bit better suited for people who struggle with meditation.   Of course, the point is not what you create (though it can be a fun by-product) but the process of being present in the task.

I should note that the prices were quite reasonable.   Depending on the media you use, the experience can cost less than going to a movie.  Coffee and juice are of course, extra and can make the experience more expensive.  I left feeling excited and inspired in an American way that probably made the Danish owner slightly uncomfortable.  I want to recommend this place as a little oasis where one can retreat from life's hustle and bustle and get in touch with their creative side.

On the perils of rumination

Since ancient Greece have humans valued our ability to manipulate concepts in our mind.  Numerous courses exist these days that teach people how to think logically and ethically.  However, thinking is not always a helpful endeavor.  Sometimes it can even lead to pain and suffering.  Excessive thinking about a worrisome topic can create anger and depression.  This kind of thinking has been labelled 'rumination' by psychologists.  Many people who ruminate do so obsessively with the hope that the thinking will eventually lead to some sort of solution.  'If only I can think my way through this' the ruminator believes, 'I will solve my problem and feel better.'  This belief is fundamentally incorrect.  Our brains routinely make logical errors and thus. thinking is not the path to truth.   Practitioners of meditation know are well aware of this. 

Descartes reified thinking

I came across this article and thought it expressed this sentiment better than I could:

https://medium.com/thrive-global/how-psychologists-treat-the-kind-of-thinking-that-leads-to-depression-a690a0cebade

To assimilate or not to assimilate-- a psychologist's thoughts about acculturation

Donald Winnicott

Donald Winnicott stipulated the presence of a 'true self'.  Our true selves are, according to Winnicott, the most spontaneous and authentic parts of who we are.   His idea was not a new one, and it even dates back to the Danish philosopher, Kierkegaard who referenced 'the self which truly is'.  If there is a 'true self', then how does this concept fit in with the process of acculturation and assimilation?  For those of us who are immigrants to another country, is it possible to try and fit in, while maintaining a semblance of authenticity?

To begin this exploration, I will share a personal failure:  After six years of living in Denmark jeg er stadig ikke flyende på dansk.  I chalk this up to a few things including age, perfectionism, and also the fact that most of my workdays are conducted in English.  When I moved to Denmark, I had high aspirations about mastering a second language.  Like most immigrants to Denmark, I enrolled in the free Danish classes and set myself to the task of learning how to pronounce vowels whose sounds I could not discriminate.  I failed miserably and even four years into my relocation to Denmark, could barely understand anyone who spoke to me.    Eventually, after a lot of hard work, I could understand people speaking to me but I still have to be able to hear them perfectly and see their lips move.  Danish, as a language, has humbled me.

Learning Danish is just one of the most obvious and noticeable ways one can try to assimilate.  Of course there are others-- I know people in my position who quickly switched to neutral tones in their attire.  Others learned how to make a flæske steg.  My opinion about how much effort one should put into integration has changed over the years.


I have seen people who were very good assimilators and others who weren't so good and I am not convinced it is necessarily the healthier thing to do, always, to 'fit in'.   If there truly is such a notion as Donald Winnicott's 'true self', then it makes some sense that parts of any given culture would resound with any given individual and other parts would not.  By extension, I think that means that there are also parts of the culture into which you were born that both would and would not ring true to your identity.  I have come around to the belief, however that, psychologically speaking, there is something sturdy and resilient about holding onto parts of yourself despite enormous pressure to do otherwise.

Anecdotally, in my practice, I have seen some people really try and fit in who became resentful and depressed.    On the other hand, you might ask, isn’t integration the respectful thing to try and do?

If I back up from Psychology and think about integration and assimilation from a more sociopolitical perspective, aren’t the nationalists of every country waging a losing battle?  We live in a global economy.  With the internet and inexpensive transportation, doesn’t our future hold more people in mixed cultural marriages and children who come from more than one culture?  Does it make logical sense, or is it just a romantic fancy to try and hold onto specific customs and traditions?  To be clear, I am equally skeptical about traditionalists from my own country as I am about the nationalists in Denmark.  It just seems to me that humans of the world could use a good lesson in embracing diversity if we are to co-inhabit a peaceful future world.  I am heartened that a certain percentage of the expat and immigrant community has started calling themselves 'world citizens', highlighting their loyalty first to the world, and second to the nation into which they were born.

My decidedly un-Danish sock drawer

Refocusing on the individual, of course., there is no ‘right answer’ in terms of how much one should try to integrate.  I can only share with you the conclusions I have come to which is that I have decided to continue working on my Danish pronunciation and comprehension.   But in the meantime, I’m just going continue the lifelong quest to be, in the words of Donald Winnicott, my 'true self'.  In my case, that is someone who is a mix of Latina-US, Germanic-US, and now Danish cultures.  

Meanderings about telepsychology-- Two things I have learned

I started doing telepsychology several years ago, before most people were using teleconferencing or other forms of online psychotherapy.  I am a devout technophile and admittedly like to incorporate technology into my life in whatever ways I can.  I have also had the opportunity to conduct some research online that examined virtual reality therapy and also the way people form relationships online.  I am a virtual positivist and have high hopes that technology, for all of its downfalls, will ultimately continue to advance the human race.   I thus projected that, a virtual means of therapy provision would become quite popular in my practice, if I offered it.  I assumed that, for people who sought out therapy, many individuals are busy and would like to avoid transit time to and from a therapist's office.

I began offering online therapy-- more specifically, therapy via videoconferencing, when I opened my practice in Copenhagen in 2014.  To my surprise, almost no one seemed interested.  The only clients who were keen about distance therapy were those who were moving away and who wished to maintain a therapeutic relationship via videoconferencing.  Even my busiest clients-- high achieving professionals who worked long days and weekends, still preferred to come into the office.  I would offer the option, but nearly everyone turned it down.  Interestingly, when clients have moved away and we have continued our work together, virtually, most of the time they said the sessions were 'fine' and didn't complain about the quality compared to our in-person previous sessions.  However, they still preferred the in person sessions.

Another thing I found surprising is how dissatisfied I was with videoconferencing.  I'm a long time user, as I said above, of technology.  I have sustained long-term relations for years nearly only with Skype and related services.  But still, following every provision of online service, I felt 'skeptical' that it was helpful and oddly less gratified than usual.  It has surprised me that I also prefer in person counseling to videoconferencing.

The data supporting the use of videoconferencing and other forms of virtual psychotherapy continues to look promising.  There is quite a bit of research, these days, about the effectiveness of distance therapy.  Most supports teletherapy as being as effective as in-person therapy.  This is good news for many reasons;  Telepsychology allows people in rural communities to receive proper psychological care, for example.  However, it seems, from the research and from my observations, that while telepsychology is effective, it probably is not going to replace in-person sessions anytime soon, simply because people seem to prefer the precence of a real-life office and psychologist.

What are your thoughts about online versus offline therapy?  Do you know what you would/do prefer and why?

Psychological scientists could be their own worst enemies

Stanley Milgram's famous obedience study has been recently found to have had serious flaws

Some political pundits have noted that we now live in a 'post fact' society where the brash assertions of politicians are given the same weight as scientifically backed facts.  Kellyanne Conway, advisor to US president Donald Trump famously referred to the phenomenon of an 'alternative fact'.  Also famously, despite the fact that most scientists argue that climate change is real, there exists a vocal number of politicians who deny it is so.

This is why it is particularly disheartening when science fails us.  Scientists who fabricate data, and journals who only publish 'positive' results.  Like everything, science has been compromised by the capitalism of rewarding the results that have the highest consumer demand.  New review processes need to emerge that reward the rigor with which the study was conducted regardless of the results.  New processes also need to emerge that retain professors to universities also based on scientific rigor rather than number of publication notches they can carve on their belts.  We, as Psychologists, need to hold ourselves accountable for the data we present to the public.  They should expect no less.

Post- Postmodernism and Psychology

I teach two college classes every semester.  My students are typically bright, curious, and motivated.  In a weekly assignment associated with the course materials,  I have them provide an analysis and critique of the assigned readings. They are brilliant at this.   They seem to be well trained, by their home universities, in the criticism and deconstruction of other peoples' works. 

Often times the critiques are the predictable and uninspired:  Freud was misogynistic and only relied on case studies.  The researchers relied too heavily on college students as subjects.  While these appraisals are valid, I worry that modern day students are being taught more about what not to believe than what to believe in.  More personally, I have misgivings that I contribute to an academic culture that glorifies tearing down at all costs, with little to no emphasis on creation and inspiration.  At the risk of politicizing this blog post, there are some people who will admit that they elected the US president simply because he promised to destroy existing systems.  I think this is attitude is corrosive to society.

How does this relate to clinical psychology, you ask?  For one, I think that the deconstruction that academics teach, on a micro level, is all too often turned inward on oneself.  Other- criticism becomes self-criticism and self-criticism  can morph into anxiety and depression.  We have become a culture of doubters and naysayers with lessened capacity to dream and believe.

As an example or societal pessimism, we mock parents who teach their children that they are 'special'  It is not possible for all children to be special, realists and scientists argue.  Not everyone deserves a reward for playing soccer.  Some of the kids truly were better than others.   However, in the context of one's close relationships, is genuinely not possible to be special, unique and extraordinary?  I think so.

Finally, therapeutic psychology is about hope-- a term that is exceedingly optimistic.  Hope is the belief that things will get better. I believe part of my job is to peddle hope.  I have seen people with your particular problem get better.  A good amount of research has been done about the contribution of hope to therapy outcomes.  Hope has even been implicated by researchers as one of the three factors that make most psychotherapies equally effective.

In sum, I hope we are all special to at least one person in the world, and I hope that we spend equal times standing up for our beliefs, as we do poking holes in other peoples' beliefs.