World Mental Health Day 2017: Stress in the workplace

Psychologist David Vandenbosch co-founded the ULB stress management clinic in Braine L’Alleud, which is expanding to Montgomery in Brussels and La Louvière. He also trains therapists and individuals in mindfulness and acceptance and commitment therapy, and has worked as a business communication and recruitment consultant.

How would you define burnout?

Burnout is a consequence of chronic stress, the result of being in a permanent state of vigilance. When there’s a situation to resolve, the body mobilises; once it’s sorted, it calms down. With a constant work situation, the activity continues but is never resolved, so the nervous system and brain take over, putting in place a series of strategies that mean you ruminate and are continually agitated. The two systems are activated simultaneously as if you were braking and accelerating at the same time. They may help you keep it together but are intended for exceptional circumstances such as imminent danger. Your emotional system is much more reactive, leading to irritability, lack of sleep, concentration and memory. Despite physical fatigue, you remain in a state of alert and become progressively mentally worn out.

What effects does this have, mentally and physically?

In this state, three things happen: distancing from other people, increased irritability and a lack of motivation. It only takes something relatively minor to provoke a breakdown. Generally, a person will hit crisis point, break down in tears, suffer panic attacks or an outburst of anger accompanied by incomprehension about what is happening to them. They then find themselves signed off work. The physical effects of burnout are due to increased cortisol in the body and compromised immunity, which has an impact on every part of the body: muscles, digestion, hypertension, back pain, headaches, extreme fatigue and a multiplication of small illnesses, such as colds that last a month.

Why has burnout become so frequent in recent years?

Increased professional mobility is one reason. Not staying in the same job for the whole of your career can be a good thing, but even for people who welcome change, it’s stressful. New media and work practices based on being continually connected are another factor. Smartphones, laptops, the fact that we’re supposed to be reachable around the clock, they all mean our system can never switch off. We need to learn how to manage this.

Another reason is work assessments and evaluations, which have become long and complicated. There’s a first interview, followed by an assessment and then a second interview. This creates an enormous expectation of what a new job will involve; people think that if it’s that complicated, it’s going to be a fantastic job. They start work and then for many, it’s a complete let-down. Evaluations are often badly done, maintaining people in a permanent state of stress. There’s an increased mechanisation of the workplace. Employees are interchangeable and are required to follow a script. There’s automatically less space for initiative and this leads to less motivation and permanent emotional tension. Individualistic values such as making money can also be demotivating.

Are there some jobs at greater risk?

Historically, the health and social sector. Social workers can be caught between people’s demands on one hand and rigid rules on the other. This conflict can result in an emotional constraint which can lead to chronic stress. But nearly every sector is affected. I’m currently seeing a number of people from the pharmaceutical industry which has undergone many changes, resulting in an increase in workload and financial pressure.

How is burnout recognised by the medical profession and society?

A couple of years ago, people were diagnosed with depression because burnout wasn’t on the world classification list. Now it’s recognised and advice is much more current. But there remains an acceptance problem by people who have not experienced it or seen it in someone close to them. This is one reason why our clinic will be producing a brochure to explain to families what exactly burnout is. While in the past employers had been worried about taking on someone who had suffered it, the reverse is now happening. A person with experience of chronic stress is much more solid and can be a positive element in a team. They are more efficient and know for example about setting personal limits.

How do you work on resilience with businesses as well as individuals?

A new code concerning employee well-being was introduced in June, which provides psychosocial audits for those susceptible to stress in the workplace. If you ask people to work a lot, you need to give them the means to do so. Stress and burnout are a signal to companies that something doesn’t work in the system, so we try to make managers aware of not continually applying pressure on employees. It’s possible to do a psychosocial audit with the employer to find solutions that decrease pressure in the workplace, but the laws don’t go far enough.

An individual’s personality also plays a role, and burnout is often a result of self-pressure. We work on increasing coping strategies, such as reorienting your life, setting limits, being assertive, not falling back on negative thoughts, working on capacity building, not wasting energy on trying to change things that cannot be changed. This helps the person to work more efficiently and have more distance from work. But it requires effort. It can be a challenge for people who have this notion that they need to be strong and cannot show any weakness, which is common among self-made people.

We ask people to fill in questionnaires about various aspects of their life: work, hobbies, family, friends, health. Usually, each area is impacted by stress and they report a low satisfaction level for each area, leading to apathy that spreads to all aspects of life. As the brain is in danger mode, anything not related to work is relegated to a non-priority. While in therapy, the patient will be asked to list the things they used to like such as doing sport or seeing friends. We encourage them to restart these activities and aim for a better work-life balance. Three things are important: recharging the batteries by resting, picking up activities again, and living in the present.

How do you help people recover?

We work towards coherent long-term goals. In the initial tumultuous period, it’s important to offer clear explanations for the breakdown. These are concrete things, not psychoanalysis. We work on exercises that relieve the brain, so little by little, you are less influenced by these thoughts that lead to stress. It’s important to respect the exercises, and it’s necessary to cut links with the office and invest in leisure time. Once recuperated, we’ll work on the process of stress and then start reintroducing activities. But if you go back and nothing changes in your work patterns, you will relapse.

What’s your advice for avoiding chronic stress?

A good way of detecting stress is to ask yourself if you can spend 30 minutes a day on anything you like. If that’s not possible, you have a problem. You may think fitting in a massage will help, but the importance is in identifying the stress and putting in place a strategy. Consider changing your relationship with your smartphone; switching it off at night and not replying at any time of the day. Restart extra-curricular activities if you have dropped them. During busy moments, stop and check your mood; switching off automatic pilot can be helpful. Spend more time with family and friends. If the problem persists, speak to a medical professional or your manager. An increase in alcohol, nicotine or other addictive substances is another warning sign. People who are susceptible to burnout are those who think their achievements are due to their personal capacity; they are frequently perfectionists, very involved in their work and highly competent in what they do.

Is burnout better recognised now by both the public and the medical profession?

A couple of years ago, people were diagnosed with depression as burnout it wasn’t on the world classification list. Now at least it’s recognised and advice is much more current. But there remains a problem of acceptance for those who have not experienced it or seen it in someone close to them. This is one reason why our clinic will be producing a brochure to explain to families what exactly burnout is. While in the past employers had been worried about taking on someone who had suffered it, the reverse is happening as the person is much more solid and can be a positive element in the team. They are more efficient and know for example about setting personal limits.

Are expats at greater risk?

Moving to another country is always stressful, even for people who are adaptable. Stress can be a motivator, but when this stress doesn’t end, then it can have a negative impact. With expats in my practice, depending on how far away their country of origin is, we develop a series of strategies to maintain roots, including keeping in contact with home. Generally, a social network is recreated here in Belgium, which is a prime factor for well-being. From the moment you arrive, you create a social entourage among colleagues and friends whom you can confide in to create an environment in which you feel good and safe.

Stress check-list

• Take 30 minutes out every day
• Switch off your smartphone at night and don’t reply to mails all day
• Keep up extra-curricular activities
• During moments of stress, stop and assess your mood
• Spend time with family and friends
• Seek help if increase in alcohol or drug consumption

Agnès Simon, burnout survivor and mental health campaigner

“When someone is suffering from a burnout, it’s as if they’re halfway up the stairs and they stop, physically unable to go any higher. I like to describe our brains as a computer that makes everything work. If this computer has a bug, your body does not work anymore,” says Agnès Simon. The human resources professional experienced burnout in her job at the Belgian Post 10 years ago. “I didn’t have children; I concentrated on my work and I had a job that I was passionate about. I was hospitalised after a period of chronic stress,” she says. The breakdown triggered psychosis. I was probably susceptible as there were cases of mental health issues in my family. My treatment consisted of a long period of recovery, including therapy and learning to manage my stress. It’s a long process that varies according to the individual and often requires making changes in your life.”

Doubly qualified in psychology and business, Simon was unable to return to her original post, preferring to dedicate herself to the mental health sector. As she meets more and more people declared unfit to work, she is adamant that there needs to be a rethink of the workplace. “We live in a society that has intellectualised work, yet the work space is often noisy and lacks privacy, combined with increased connectivity and unrealistic performance targets,” she says. There’s a need to look for the reasons behind burnout, and a need for collaboration between employer and employee. “There’s a co-responsibility, and workers need to be able to act when confronted with stress.”

Burning Out: the film

The 2016 documentary Burning Out by Belgian Jérôme le Maire is an illustration of management-induced breakdown. Set in a Paris hospital, it follows the lives of medical staff in a surgical unit as they battle constant stress, lack of staff and stringent budget cuts.

Le Maire, who has made a number of feature-length documentaries, was first inspired to make the film after reading the bestseller Global burn-out by French researcher Pascal Chabot. He attended a conference by Chabot on the burnout syndrome at Saint-Louis Hospital in Paris. Le Maire was shocked to discover that the conference was for doctors at the hospital rather than patients.

For two years, Le Maire followed a surgical team at Saint-Louis. With a camera on his shoulder, he filmed surgeons and anesthetists performing operation after operation, always under pressure, resulting in a catastrophic breakdown of professional relationships. “The micro-society of the surgical unit with its complexity, its class system and its extremely elaborated work organisation is a perfect metaphor for larger society and for the issue I desired to examine,” he says.

The film was released in 2017 and has been screened in festivals as well as cinemas. Says le Maire “After each screening of the film I’m meeting people who tells me that this is exactly what is going on in their company and that they recognise it all from their own lives. Unfortunately it seems like this situation at the French hospital is more the rule rather than exception. Our modern world has transformed hospitals into health factories and patients into objects.

This feature appears in The Bulletin Autumn 2017. Pick up a copy in newsagents now, browse the magazine here or subscribe today…  Photo caption: Burning Out, documentary by Jérôme le Maire © AT-Doc

Is work too important in your life? Lise Skinnebach, Clinical Psychologist & Helpline Supervisor at the Community Help Service (CHS) in Brussels, looks into mental health in the workplace

Mental health in the workplace is the theme for mental health day 2017. But what is mental health in the workplace about? We know that much more could be done to improve mental health by management. They should appreciate the limitations of their staff, understand the importance of a work/life balance, regularly express recognition and acknowledgement, invest in structures to improve adequate support, prevent bullying, etc, etc. But what about the employee? What can he do to improve his own mental well-being at the workplace?

We work about eight hours a day, which comes close to a staggering one-third of our lives. Work looms large; nothing preoccupies our lives more, so people take it seriously, and for a good reason. We spend more hours working than we spend with our families or sleeping. The hours of dedication and sacrifices that demands the majority of our awaken life have to be meaningful to us and hence job titles have come to define who we are. Work is no longer just something we do to maintain our lives and put bread on the table. It can’t be easily separated from the rest of our life. Our personal identities have to a large extent become defined by our careers.

The demands and challenges of work are never ending. It can be intriguing and exhausting. There is competition and the reality is that only a few people will keep advancing. Then there is failure or – fear of failure. What do you do if that sense of inadequacy sneaks in? Devote more time to work, or find meaning and pleasure elsewhere?

The majority of people do have a broad identity consisting of various elements like: mother, runner, wife, political activist, singer, etc. But an increasing number only have one identity: their profession. It often starts out passionately and rewarding, but there is a risk that work develops into a compulsion that eventually takes hold of our lives.

When your job defines you, your world becomes narrow. When your job defines who you are, everything that happens at work becomes personal. The more we define ourselves through our work and derive our identity from it, the higher the risk of mental health problems, when work falls short of our own expectations.

When we can distinguish who we are from what we do, we become less vulnerable. If a colleague or a customer is unhappy with our performance at work, we should be aware that he is questioning our work role rather than us as people, which then makes it easier for us to handle the situation in a professional way.

A healthy work-life balance is possible when we recognise and address our compulsion and understand that we exist in a larger context. Think about how you want to be remembered when you’re no longer here? By your resumé or by the strong and meaningful relations you developed by spending time with people, who mattered to you? Meaningful relationships and engaging activities are important. Redefining achievements and accomplishments can be necessary.

It is therefore of utmost importance that we know who we are outside work and that we derive pride and pleasure from that. The more we are aware of the fact that we are not our job, the lower is our potential for stress and our risk for burnout; the more enjoyable is our collaboration with others, and not only does our life improve, but so does our performance at work. In brief: while managers are still accountable for mental health in the workplace, employees may equally contribute to their own mental health by not placing too much importance on work!

Community Help Service (CHS) offers a crucial service to the English-speaking community in Belgium. Trained volunteers who have been carefully chosen for their empathetic and listening skills are operating an anonymous and confidential Helpline. They listen without judgement, which can be useful when going through a process of understanding and defining who you are – not just what you do – and helping you to survive the ups and downs of working life.

CHS Helpline: 02 648 4014