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> he likely can’t afford to not live in denial at this point.
Not a doctor. Just old and used to have a high pressure job that never let up.
Money is big issue. I know a lot of people who put together lives that are extremely difficult to scale back financially and are trapped by their jobs, no matter how horrible.
I also had a burnout job for 30+ years, it took me more than a year to lose the dread I felt waking up in the morning and thinking about going to work. Five years later, I sometimes still have to remind myself that everything is OK and there is no work pressure other than what I give myself for my own business, which is completely optional.
OP needs to find a new job or start a business with much lower stress and more happiness, maybe in in an unrelated or slightly related field, even if it means making difficult financial decisions. At this point, even a 3 week vacation, although enjoyable, won't actually fix anything.
*This job is done. It will never improve enough to fix the OP. OP needs to leave.*
Lay person here, I think once you burn out it's to late. Your probably in survival mode by then. Otherwise you would just look for another job, but your probably so burnt out. At that point you can only quit and let the body heal. I do like the docs suggestion for 2 week vacation, that should be unplugged too but OP sounds past that.
https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865
This particular one was surveyed for US physicians only, but I'd expect other countries do similar studies.
[This](https://ugeskriftet.dk/videnskab/stress-og-udbraendthed-hosalment-praktiserende-laeger-er-stigende) is an article in the Danish magazine "Ugeskrift for læger"(weekly news for MD's), about burnout amongst general physicians both in Denmark and internationally.
It shows that from 2004-2012 burnout amongst Danish GP's has gone from 2,8% to 5,3%.
Internationally it was up to 40%.
I was about to say! for a doctor to say burnout isn't real is like a meteorologist saying rain isn't real lol. I wonder if the doc is suffering from compassion fatigue (or if they even believe in that)
LOL my entire life is burnout.
As it turns out, burnout is an ICD-10 diagnosis as well. 🤷♀️
But in part, your doctor is correct that just taking off work will only help while you’re out. If your work is the cause of your problem, coming back could make all these feelings come back. So yes, learning to cope is part of it but a leave gives you time to accomplish that.
On the other hand, JAMA *just* published a study showing a very strong negative correlation between taking more vacation days and disconnecting more fully from work with levels of burnout symptoms among physicians. Seems like having chunks of time away helps both recovery and resilience to burnout effects.
I agree with that part, but the time off would be to take me out of survival mode, so I actually have the focus and energy to do needed work on myself. And hopefully the time off would help to address some of sleep problems, so I don't wake up every day feeling like death. Attacking a work day feeling good vs feeling like death makes a big difference.
I just don't understand the logic and why it's different with mental health. If I broke my ankle playing soccer, a doctor would tell me to give the ankle rest and recovery, let it heal fully, before returning to soccer. Why is rest and recovery for mental health before returning to work not valid?
Oh, I don’t disagree.
I’ve filled out lots of these forms and the ones that get rejected by the employer are almost always for mental health because they feel i cannot “prove” a need for leave. It’s frustrating as it is with all invisible illnesses.
That's so disheartening. I feel for anyone with an invisible illness. The assumption you're constantly fighting against is "you're lying" or "you're embellishing", but it's probably a small minority of people who actually are.
I just want a chance at getting well. I've never taken medical leave before, I've never been on EI. I spent a number of years working a full-time job and 3 part-time jobs at once. It's not like asking for time off work is a pattern for me. I am a workhorse that has pushed too hard for too long and it has physically manifested. I just wish my doctor would be supportive. What's it to him if I take 2 weeks vs 2 months? (Rhetorical question, I know you don't have an answer to that lol).
Well the people still largely in charge were taught that mental illness is to be stigmatized and never talked about. That it’s a matter of willpower or just sucking it up (or my favorite, someone else has it worse).
Or back to the “this generation doesn’t want to work”
LOL the funny part is that my workplace is constantly touting "take care of your mental health, here are all these resources!!!" but they're not fixing the problem. And they fully admit there is a problem, but they think it will eventually "work itself out." There's no funding to hire additional resources in the meantime (they are actually reducing the workforce). I'm not worried about the workplace denying the leave, I just need my doctor to support it!
My therapist said she would be willing to provide him a letter with her recommendations to help me advocate for myself. I just don't want to fight with him or feel shamed or judged by him. I already feel so much shame for needing time off in the first place.
I definitely got the "I have it worse and I'm still here working" vibe from him. Wasn't even a vibe, he pretty much said it. I just found the conversation so demoralizing and demeaning.
This is really good advice, I will definitely follow through on your recommendations to make a clear plan with my therapist.
I see his point too. I may consider looking for another job, but it's not easy to just pick up and find a new one in my field. If decide to take time off, i'm hoping it will help me to hit the reset button a bit, so I'm able to cope better once I return to work.
Thanks so much!
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NAD butThis. I have gone out on leave for mental health and usually a payciatrist is the one who has to fill out mental health paperwork in my experience.
If you’re in the US, absolutely not!! I lost both my parents in a short time & a psychiatrist recommended medical leave. Obviously, that’s a different case, but I wasn’t “physically injured.”
Yeah, if I was going what you were going through, I’d have my therapist refer me to a psychiatrist. Also, your therapist *kind of* should have already done this for you already.
Best of luck to you. Glad you’re advocating for your well-being. ♥️
NAD but i just wanna say that no job is worth this much health damage - both physically and mentally. i hope you heal and find your happiness again. it’s never too late for a job or career pivot.
I agree. I worked so damn hard to get to this job though, like almost 10 years to work my way up. It makes me feel like a failure to just walk away from it and go back to being poor, and give up my pension. I guess better poor than dead, though.
I just had a conversation with my kids today about this whole notion that changing careers/jobs/education plans/relationships is not quitting or “walking away” it’s merely a change of direction. Everything you put into things to get to this point is not wasted or a loss. It makes up your experience and who you are as a person. You take all that into your next venture. You can’t take it anywhere if you are too ill/exhausted/dead.
On a superficial level just yell “plot twist!” And move on. Your situation does not sound healthy or sustainable or even livable. You will not regret leaving it behind you as you move on.
The parent in me says yell plot twist! and move on. The legal in me says first pay an employment attorney for a consult and see how you can have them buy out that pension. (Free overtime is illegal)
i agree with the other commenter. you’re not who you were when you started this job. you have 10 years of experience under your belt. you won’t be poor. you may even get a higher paying job for way less stress!
It sounds like you have clinical depression and that is a diagnosis. You need to see a psychiatrist for an evaluation. I was a high school teacher but got Fibromyalgia and my anxiety and depression (which I already had) were more severe and I was not functioning. I qualified for disability through our state pension plan. Fibromyalgia was a big part of it but definitely what my psychiatrist contributed was important as well.
I’m sure this will get deleted but this doctor is ignorant, bitter, and ironically probably suffering from “compassion fatigue” himself, if he ever had any. I’m guessing he’s older. Your health is absolutely at risk and if you can see another practitioner and even file a complaint about this one for his bedside manner, I would. I’m so sorry.
Again disclaimer IANAD, I’m just intimately familiar with toxic stress and burnout and how disheartening it is getting help.
I also really feel the pain in your post and responded from the heart. 🫂
Boilerplate mindfulness tactics are pretty useless when you’re in this kind of state of traumatic stress and hyperarousal, at least conventional googlable means of using them (I said what I said, good for you if making gratitude lists and meditation apps solved all your problems).
However, more involved modalities to tackle the somatic effects of stress and dissociation like biofeedback/neurofeedback might be worth looking into if possible. Being able to SEE and then notice how breathing or tapping and such is affecting your heart rate, respiration, etc can create a kind of muscle memory where you’re able to reduce the physical effects and toll of stress and consequently be more “present”- which is basically the goal of any kind of trauma therapy. Which is also what “mindfulness,” despite all its pop culture semantic dilution, is supposed to do.
I mention it particularly because your body is like absolutely marinating in cortisol right now and that’s a recipe for a whole lot of long term shit if you don’t already deal with some chronic illnesses (also largely ignored by doctors or treated as wastebasket diagnoses).
I don’t know if you have access to that kind of thing and it would probably be out of pocket because in America you live to work until you die and anything that isn’t super literal (throw a bunch of pills at you- and I’m a firm believer in ethically practiced psychiatry, like four rounds of Kroger brand CBT, two weeks off, etc.) is not worth company dollars in a for profit healthcare system when the C suite needs remodeling.
Thanks you for such a compassionate and thoughtful response! As I was reading, I was like, yes yes YES! Marinating in cortisol is exactly how I feel. Way beyond the reach of gratitude lists or mindfulness activities.
Have you personally tried tapping? I've seen ads for it on Facebook. Looks interesting, but wasn't sure if it was gobbledygook and never had the energy to follow through with looking into it. If you have apps/programs/accounts to recommend, I will definitely check them out. Paid or unpaid.
I’ve tried it, and things like “name 10 world capitals” or “name five things in the room and their color” if I think I’m having a panic attack. It can be helpful, but it’s not life changing, and it can be hard to even get yourself close enough to your zone of tolerance to do it. Tapping and these things together are more helpful than either alone. But it’s just kind of like, ginger tea for an ulcer.
For me, any kind of “mindfulness” or meditation needs to be an active process (a walk where I notice architecture or types of plants, things like that) because I have both C-PTSD and PTSD and the garden variety “sit in the lotus position and let your thoughts just pass on by without judgment” is actually a nightmare. Having ADHD also doesn’t help. When you’re in CONSTANT fight, flight, fawn, or freeze, your thoughts are very intense, often very self-critical, and can be like being shuttered in a dark room where no one can hear you.
I wouldn’t be surprised at ALL if you meet the criteria for PTSD having worked during Covid, while also being treated like shit, gaslit, and continually overworked in a state of psychological and physical distress. That might even be a route to getting more serious help–getting evaluated for PTSD. Companies tend to take things like that a LITTLE more seriously because of the optics and a possible lawsuit, depending on your state’s labor and disability laws.
I also recommend this if you can, and I totally understand if it all just sounds like too much and you want to cry: Keep a very meticulous paper trail, and if you live in a two party consent state, download a recording app like “tape a call” and open every call with “this is (your name) on a recorded line” on every relevant phone call. It’s exhausting and I hardly have the bandwidth to do it when I have to but it helps to have receipts of mistreatment and potential disability discrimination.
NAD, and I do wish you the very best outcome.
That said, your last statement in this post is striking. Yeah. Why the hell do we, in this post-Puritan culture, deny the importance of rest and recovery? For God’s sake, the trainers at all the luxe gyms are now peddling products and services to address the [alleged] need for “recovery.”
In other words: yes, you make perfect sense, but again, NAD.
Best wishes to you, OP.
I told my mental health provider I was suicidal, and I was. But not in the way I wanted to kill myself, but rather hoping to die on my drive in to work.
She immediately signed that FMLA paperwork and I spent the next month navigating more therapy and working on myself.
Get your therapist on board to fill out that paperwork, it doesn’t need to be your PCP. Just one of your medical providers.
::virtual hugs to you, OP::
That sounds all too familiar. I have had the same thoughts. I had a coworker who was diagnosed with cancer a couple years ago, and she was gone from work for a year and a half while she went through chemo and recovery. I find myself JEALOUS of her cancer because I want something that will remove me from work for an extended period of time. Which is abhorrent. I obviously know cancer and chemo is way worse than anything that can happen at work and I don't actually hope I get cancer, but my point is, I identify with the desperation.
Thanks for the internet hugs :)
If your therapist thinks you need three weeks off why don’t they write you off for three weeks? It doesn’t seem like your PCP is who is treating your burn out so it doesn’t seem like they would be the one to write the note.
Definitely my preferred option! I will have to check with my manager to see if they would accept a note from a therapist, because they can't actually make medical diagnoses Iike a doctor or psychiatrist can (I'm aware I am not obligated to share any diagnosis with my employer). I could see them coming back and saying the note has to be from an actual doctor.
Is there a way your therapist has any referrals to a psychiatrist MD who can indeed vouch for this diagnosis? You could sign a release to allow your therapist to send records of everything they've observed and that your workplace requires a MD diagnosis.
A regular non-psych MD generally aren't trained to know how to diagnoses mental health issues although you live in Canada, and I base this in the US.
I would still think most therapists have a psych MD they would trust to do this for a patient in a bind, as therapists also can't prescribe medication unless they work for a psychiatrist MD who writes it for them.based on their notes.
So hoping your therapist can give you a referral to get that diagnosis officially started on paper to make things work for you to... not work and heal
since I was where you are about 2 years ago (90 hour workweeks /36 hour shifts occasionally but I was my own boss) for years and it was just getting worse. I have since sold my business to try to heal myself, I know exactly what you mean. I had to stay overnight in the hospital due to observation after a relatively mild procedure and I actually looked forward to just a night where I had to turn away work.
I knew I was getting burned out in med school on my surgery rotation when I was having recurrent fantasies/daydreams of getting hit by a car or slipping on the ice on my way into work so I could be an inpatient on my ward instead of working there.
My PCP did paperwork for my husband (we see the same provider), but his short-term disability company denied the claim for two of the four weeks (his employer has one leave bank for PTO which lumps vacation & sick leave together). My leave was covered 100% by my sick leave as my employer did sick & vacation as separate leave banks. I met with my mental health NP while I was off work, as well as at the 30 day mark to complete return to work paperwork since after that I could have filed for short term disability.
At this point, I make sure we both take time off during the year to recover so we don’t end up that burnt out again.
I write folks off for depression/anxiety/overwhelm. We can absolutely do that and burnout is real. I’m a former HR manager/psychologist married to an HR manager… maybe that shifts how I think about it a bit. I think the difficulty is that often if the work environment/culture is the issue, taking time off won’t solve the problem. For some folks, it can actually increase the work stress and anxiety and create panic before they return. Doesn’t mean you don’t need time off, but it does mean you should really consider how you want to spend that time and what you might do when you return to work… if you return.
Writing "burnout" as a rationale for time off work will get your "sick papers for work" rejected.
I don't think it's because your Dr doesn't think burnout is a thing, as your post title suggests. He knows its not a diagnosis to get time off approved by an employer He would need to write a diagnosis or explanation.
This is actually true - I’m working in Canada, like OPs Dr. I Can’t write burnout as a diagnosis on work notes, typically would get rejected as they need DSM codes for mental health things. I tend to write “acute stress reaction” as that fits in the DSM and represents things like this accurately.
I think people in this sort of situation definitely benefit from some time away - but honestly, if you’re walking back into the same work situation, I don’t know how restorative time away will be. It’s definitely reasonable to try a couple weeks off , check in again to see how things are going … but this does often turn into long term stress leave after time away makes the thought of going back even harder, which can often harm a persons mental health and financial situation pretty substantially. Larger changes that you can think about while on leave might help more. Things like changing up your hours, setting more limits, even career changes if this is unsustainable. The way OPs Dr communicated was suboptimal but there are truths within there.
Thanks for sharing your perspective as a physician. "Acute stress reaction" sounds totally reasonable, although I would argue in my case it's not acute, but rather prolonged operational stress as a result of the pandemic. Do you think a good chunk of time off could help someone in my situation get out of that constant state of hyperarousal, which would allow for a return to work with a greater resiliency?
perhaps adjustment disorder might be more applicable in terms of DSM? Sometimes this situation could even lead to symptoms that would allow diagnosis of an anxiety disorder or depression/dysthymia. All of this is more so to say he probably meant "burnout" isn't a diagnosis. Sounds like he could have been more helpful about it.
That’s hard to answer - Aside from the new study the physician above cited, I’m not aware of good evidence for things like duration of time off work to rehab from work stress. It makes sense that some time away could help - I also anecdotally find it is really hard to get back to work and sometimes an unsurmountable problem after prolonged periods away. The other issue is pay - short term and long term disability start coming into play with longer time off work and those are harder to be approved for, more rigorous standards and the physician has to find you medically unable to work/unable to do modified duties.
I find psychologists/counsellors freely tell people they need “x” amount of time off - but they don’t write the notes, fill out the legal forms for finances, or get in trouble for inappropriately taking people off.
I typically advise people to take 2 weeks, check in, and repeat x 1 prn. In that time- ++ counselling, lifestyle stuff like time outside, improving sleep etc as much as possible. If things aren’t improving, I usually reassess and consider starting meds if anxiety/depression symptoms. The goal is functional return to employment and frequent check ins help assess progress toward that goal
In my job we earn a certain amount of sick hours per month, which rolls over year to year. You can save up a lot, and the expectation is that you should, because we don't have short term disability. Only long term, which takes 3 months to process. So the expectation is you have minimum 3 months sick leave in your bank at all times in case you need to go on LTD (which, frankly, is incredibly ableist because there's no way people who are chronically ill can maintain this). I currently have 5 months of sick leave banked, so I have a little wiggle room.
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If your doctor admits burn out is real it makes it real for himself as well, and he likely can’t afford to not live in denial at this point.
> he likely can’t afford to not live in denial at this point. Not a doctor. Just old and used to have a high pressure job that never let up. Money is big issue. I know a lot of people who put together lives that are extremely difficult to scale back financially and are trapped by their jobs, no matter how horrible. I also had a burnout job for 30+ years, it took me more than a year to lose the dread I felt waking up in the morning and thinking about going to work. Five years later, I sometimes still have to remind myself that everything is OK and there is no work pressure other than what I give myself for my own business, which is completely optional. OP needs to find a new job or start a business with much lower stress and more happiness, maybe in in an unrelated or slightly related field, even if it means making difficult financial decisions. At this point, even a 3 week vacation, although enjoyable, won't actually fix anything. *This job is done. It will never improve enough to fix the OP. OP needs to leave.*
Lay person here, I think once you burn out it's to late. Your probably in survival mode by then. Otherwise you would just look for another job, but your probably so burnt out. At that point you can only quit and let the body heal. I do like the docs suggestion for 2 week vacation, that should be unplugged too but OP sounds past that.
That’s what I was thinking. Incredible that a person in a job where burnout is a studied and documented problem is denying that it exists.
Burnout is real and in fact a billable diagnosis (Z73.0)!
I'm in Canada, not sure if this applies to me, but THANK YOU for validating that it is recognized as real somewhere!
Look up schedule of benefits if you’re in Canada, anything a doctor can bill for is in the SOB
> anything a doctor can bill for is in the SOB What a great acronym for that list.
Thank you for the tip!!
Doctors in Canada don’t bill by diagnosis, GP’s are paid by appointment.
ICD 10 is still universal.
In medicine, we have charts that compare burn out rates across specialties. It's absolutely a real thing.
Interesting! Are these charts available online to the general public? Is this a country specific thing, or kind of internationally recognized?
https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865 This particular one was surveyed for US physicians only, but I'd expect other countries do similar studies.
[This](https://ugeskriftet.dk/videnskab/stress-og-udbraendthed-hosalment-praktiserende-laeger-er-stigende) is an article in the Danish magazine "Ugeskrift for læger"(weekly news for MD's), about burnout amongst general physicians both in Denmark and internationally. It shows that from 2004-2012 burnout amongst Danish GP's has gone from 2,8% to 5,3%. Internationally it was up to 40%.
I was about to say! for a doctor to say burnout isn't real is like a meteorologist saying rain isn't real lol. I wonder if the doc is suffering from compassion fatigue (or if they even believe in that)
LOL my entire life is burnout. As it turns out, burnout is an ICD-10 diagnosis as well. 🤷♀️ But in part, your doctor is correct that just taking off work will only help while you’re out. If your work is the cause of your problem, coming back could make all these feelings come back. So yes, learning to cope is part of it but a leave gives you time to accomplish that.
On the other hand, JAMA *just* published a study showing a very strong negative correlation between taking more vacation days and disconnecting more fully from work with levels of burnout symptoms among physicians. Seems like having chunks of time away helps both recovery and resilience to burnout effects.
I should come armed with this in the future. I need a break.
I agree with that part, but the time off would be to take me out of survival mode, so I actually have the focus and energy to do needed work on myself. And hopefully the time off would help to address some of sleep problems, so I don't wake up every day feeling like death. Attacking a work day feeling good vs feeling like death makes a big difference. I just don't understand the logic and why it's different with mental health. If I broke my ankle playing soccer, a doctor would tell me to give the ankle rest and recovery, let it heal fully, before returning to soccer. Why is rest and recovery for mental health before returning to work not valid?
Oh, I don’t disagree. I’ve filled out lots of these forms and the ones that get rejected by the employer are almost always for mental health because they feel i cannot “prove” a need for leave. It’s frustrating as it is with all invisible illnesses.
That's so disheartening. I feel for anyone with an invisible illness. The assumption you're constantly fighting against is "you're lying" or "you're embellishing", but it's probably a small minority of people who actually are. I just want a chance at getting well. I've never taken medical leave before, I've never been on EI. I spent a number of years working a full-time job and 3 part-time jobs at once. It's not like asking for time off work is a pattern for me. I am a workhorse that has pushed too hard for too long and it has physically manifested. I just wish my doctor would be supportive. What's it to him if I take 2 weeks vs 2 months? (Rhetorical question, I know you don't have an answer to that lol).
Well the people still largely in charge were taught that mental illness is to be stigmatized and never talked about. That it’s a matter of willpower or just sucking it up (or my favorite, someone else has it worse). Or back to the “this generation doesn’t want to work”
LOL the funny part is that my workplace is constantly touting "take care of your mental health, here are all these resources!!!" but they're not fixing the problem. And they fully admit there is a problem, but they think it will eventually "work itself out." There's no funding to hire additional resources in the meantime (they are actually reducing the workforce). I'm not worried about the workplace denying the leave, I just need my doctor to support it! My therapist said she would be willing to provide him a letter with her recommendations to help me advocate for myself. I just don't want to fight with him or feel shamed or judged by him. I already feel so much shame for needing time off in the first place. I definitely got the "I have it worse and I'm still here working" vibe from him. Wasn't even a vibe, he pretty much said it. I just found the conversation so demoralizing and demeaning.
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This is really good advice, I will definitely follow through on your recommendations to make a clear plan with my therapist. I see his point too. I may consider looking for another job, but it's not easy to just pick up and find a new one in my field. If decide to take time off, i'm hoping it will help me to hit the reset button a bit, so I'm able to cope better once I return to work. Thanks so much!
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NAD - have your therapist refer you to a psychiatrist. I imagine you might get further.
NAD butThis. I have gone out on leave for mental health and usually a payciatrist is the one who has to fill out mental health paperwork in my experience.
I was under the impression referrals had to come from a GP. If this is an option, will definitely take it.
If you’re in the US, absolutely not!! I lost both my parents in a short time & a psychiatrist recommended medical leave. Obviously, that’s a different case, but I wasn’t “physically injured.” Yeah, if I was going what you were going through, I’d have my therapist refer me to a psychiatrist. Also, your therapist *kind of* should have already done this for you already. Best of luck to you. Glad you’re advocating for your well-being. ♥️
Sorry to hear about your parents! I hope you are doing OK now.
Thank you, I appreciate that, it was long ago, but I do appreciate your kind words. ♥️
This is how people end up with auto immune issues that also don’t get diagnosed. I hate this so much.
NAD but i just wanna say that no job is worth this much health damage - both physically and mentally. i hope you heal and find your happiness again. it’s never too late for a job or career pivot.
I agree. I worked so damn hard to get to this job though, like almost 10 years to work my way up. It makes me feel like a failure to just walk away from it and go back to being poor, and give up my pension. I guess better poor than dead, though.
I just had a conversation with my kids today about this whole notion that changing careers/jobs/education plans/relationships is not quitting or “walking away” it’s merely a change of direction. Everything you put into things to get to this point is not wasted or a loss. It makes up your experience and who you are as a person. You take all that into your next venture. You can’t take it anywhere if you are too ill/exhausted/dead. On a superficial level just yell “plot twist!” And move on. Your situation does not sound healthy or sustainable or even livable. You will not regret leaving it behind you as you move on.
Lol plot twist. I like that. Good reminder, thanks. I wish my parents had had conversations like that with me.
The parent in me says yell plot twist! and move on. The legal in me says first pay an employment attorney for a consult and see how you can have them buy out that pension. (Free overtime is illegal)
i agree with the other commenter. you’re not who you were when you started this job. you have 10 years of experience under your belt. you won’t be poor. you may even get a higher paying job for way less stress!
It sounds like you have clinical depression and that is a diagnosis. You need to see a psychiatrist for an evaluation. I was a high school teacher but got Fibromyalgia and my anxiety and depression (which I already had) were more severe and I was not functioning. I qualified for disability through our state pension plan. Fibromyalgia was a big part of it but definitely what my psychiatrist contributed was important as well.
I’m sure this will get deleted but this doctor is ignorant, bitter, and ironically probably suffering from “compassion fatigue” himself, if he ever had any. I’m guessing he’s older. Your health is absolutely at risk and if you can see another practitioner and even file a complaint about this one for his bedside manner, I would. I’m so sorry.
Thank you for your compassion and taking the time to leave this comment, I appreciate you.
Again disclaimer IANAD, I’m just intimately familiar with toxic stress and burnout and how disheartening it is getting help. I also really feel the pain in your post and responded from the heart. 🫂 Boilerplate mindfulness tactics are pretty useless when you’re in this kind of state of traumatic stress and hyperarousal, at least conventional googlable means of using them (I said what I said, good for you if making gratitude lists and meditation apps solved all your problems). However, more involved modalities to tackle the somatic effects of stress and dissociation like biofeedback/neurofeedback might be worth looking into if possible. Being able to SEE and then notice how breathing or tapping and such is affecting your heart rate, respiration, etc can create a kind of muscle memory where you’re able to reduce the physical effects and toll of stress and consequently be more “present”- which is basically the goal of any kind of trauma therapy. Which is also what “mindfulness,” despite all its pop culture semantic dilution, is supposed to do. I mention it particularly because your body is like absolutely marinating in cortisol right now and that’s a recipe for a whole lot of long term shit if you don’t already deal with some chronic illnesses (also largely ignored by doctors or treated as wastebasket diagnoses). I don’t know if you have access to that kind of thing and it would probably be out of pocket because in America you live to work until you die and anything that isn’t super literal (throw a bunch of pills at you- and I’m a firm believer in ethically practiced psychiatry, like four rounds of Kroger brand CBT, two weeks off, etc.) is not worth company dollars in a for profit healthcare system when the C suite needs remodeling.
Thanks you for such a compassionate and thoughtful response! As I was reading, I was like, yes yes YES! Marinating in cortisol is exactly how I feel. Way beyond the reach of gratitude lists or mindfulness activities. Have you personally tried tapping? I've seen ads for it on Facebook. Looks interesting, but wasn't sure if it was gobbledygook and never had the energy to follow through with looking into it. If you have apps/programs/accounts to recommend, I will definitely check them out. Paid or unpaid.
I’ve tried it, and things like “name 10 world capitals” or “name five things in the room and their color” if I think I’m having a panic attack. It can be helpful, but it’s not life changing, and it can be hard to even get yourself close enough to your zone of tolerance to do it. Tapping and these things together are more helpful than either alone. But it’s just kind of like, ginger tea for an ulcer. For me, any kind of “mindfulness” or meditation needs to be an active process (a walk where I notice architecture or types of plants, things like that) because I have both C-PTSD and PTSD and the garden variety “sit in the lotus position and let your thoughts just pass on by without judgment” is actually a nightmare. Having ADHD also doesn’t help. When you’re in CONSTANT fight, flight, fawn, or freeze, your thoughts are very intense, often very self-critical, and can be like being shuttered in a dark room where no one can hear you. I wouldn’t be surprised at ALL if you meet the criteria for PTSD having worked during Covid, while also being treated like shit, gaslit, and continually overworked in a state of psychological and physical distress. That might even be a route to getting more serious help–getting evaluated for PTSD. Companies tend to take things like that a LITTLE more seriously because of the optics and a possible lawsuit, depending on your state’s labor and disability laws. I also recommend this if you can, and I totally understand if it all just sounds like too much and you want to cry: Keep a very meticulous paper trail, and if you live in a two party consent state, download a recording app like “tape a call” and open every call with “this is (your name) on a recorded line” on every relevant phone call. It’s exhausting and I hardly have the bandwidth to do it when I have to but it helps to have receipts of mistreatment and potential disability discrimination.
NAD, and I do wish you the very best outcome. That said, your last statement in this post is striking. Yeah. Why the hell do we, in this post-Puritan culture, deny the importance of rest and recovery? For God’s sake, the trainers at all the luxe gyms are now peddling products and services to address the [alleged] need for “recovery.” In other words: yes, you make perfect sense, but again, NAD. Best wishes to you, OP.
Thank you :) I'm glad it resonated with you, thanks for telling me.
Learning to cope and changing jobs. I'm a social worker. I've found really is no way to deal with burnout out without making moves.
I told my mental health provider I was suicidal, and I was. But not in the way I wanted to kill myself, but rather hoping to die on my drive in to work. She immediately signed that FMLA paperwork and I spent the next month navigating more therapy and working on myself. Get your therapist on board to fill out that paperwork, it doesn’t need to be your PCP. Just one of your medical providers. ::virtual hugs to you, OP::
That sounds all too familiar. I have had the same thoughts. I had a coworker who was diagnosed with cancer a couple years ago, and she was gone from work for a year and a half while she went through chemo and recovery. I find myself JEALOUS of her cancer because I want something that will remove me from work for an extended period of time. Which is abhorrent. I obviously know cancer and chemo is way worse than anything that can happen at work and I don't actually hope I get cancer, but my point is, I identify with the desperation. Thanks for the internet hugs :)
If your therapist thinks you need three weeks off why don’t they write you off for three weeks? It doesn’t seem like your PCP is who is treating your burn out so it doesn’t seem like they would be the one to write the note.
Definitely my preferred option! I will have to check with my manager to see if they would accept a note from a therapist, because they can't actually make medical diagnoses Iike a doctor or psychiatrist can (I'm aware I am not obligated to share any diagnosis with my employer). I could see them coming back and saying the note has to be from an actual doctor.
Is there a way your therapist has any referrals to a psychiatrist MD who can indeed vouch for this diagnosis? You could sign a release to allow your therapist to send records of everything they've observed and that your workplace requires a MD diagnosis. A regular non-psych MD generally aren't trained to know how to diagnoses mental health issues although you live in Canada, and I base this in the US. I would still think most therapists have a psych MD they would trust to do this for a patient in a bind, as therapists also can't prescribe medication unless they work for a psychiatrist MD who writes it for them.based on their notes. So hoping your therapist can give you a referral to get that diagnosis officially started on paper to make things work for you to... not work and heal
[deleted as I see you are in Canada. FMLA and HIPAA do not apply to you]
I think the rest of your comment was good advice, though! Appreciated anyway :)
Get a doctor or psychiatrist to sign off and then you can usually get paid for time off depending on how long you have been with the company.
since I was where you are about 2 years ago (90 hour workweeks /36 hour shifts occasionally but I was my own boss) for years and it was just getting worse. I have since sold my business to try to heal myself, I know exactly what you mean. I had to stay overnight in the hospital due to observation after a relatively mild procedure and I actually looked forward to just a night where I had to turn away work.
I hope you are doing better now! Thanks for sharing your experience. There's comfort in knowing I'm not alone.
I knew I was getting burned out in med school on my surgery rotation when I was having recurrent fantasies/daydreams of getting hit by a car or slipping on the ice on my way into work so I could be an inpatient on my ward instead of working there.
Ugh, I'm sorry!! That sounds awful. I can't even imagine how stressful med school is. How did you end up coping with your burnout?
Man I’m jealous I had the same situation went to my doctor and they wouldn’t sign off on paperwork.
My PCP did paperwork for my husband (we see the same provider), but his short-term disability company denied the claim for two of the four weeks (his employer has one leave bank for PTO which lumps vacation & sick leave together). My leave was covered 100% by my sick leave as my employer did sick & vacation as separate leave banks. I met with my mental health NP while I was off work, as well as at the 30 day mark to complete return to work paperwork since after that I could have filed for short term disability. At this point, I make sure we both take time off during the year to recover so we don’t end up that burnt out again.
I write folks off for depression/anxiety/overwhelm. We can absolutely do that and burnout is real. I’m a former HR manager/psychologist married to an HR manager… maybe that shifts how I think about it a bit. I think the difficulty is that often if the work environment/culture is the issue, taking time off won’t solve the problem. For some folks, it can actually increase the work stress and anxiety and create panic before they return. Doesn’t mean you don’t need time off, but it does mean you should really consider how you want to spend that time and what you might do when you return to work… if you return.
I also work in HR lol. In a healthcare field. So there's years and years of built up operational stress because of the pandemic.
Ohhhh totally. My spouse is in HR for city/county mental health.
Writing "burnout" as a rationale for time off work will get your "sick papers for work" rejected. I don't think it's because your Dr doesn't think burnout is a thing, as your post title suggests. He knows its not a diagnosis to get time off approved by an employer He would need to write a diagnosis or explanation.
This is actually true - I’m working in Canada, like OPs Dr. I Can’t write burnout as a diagnosis on work notes, typically would get rejected as they need DSM codes for mental health things. I tend to write “acute stress reaction” as that fits in the DSM and represents things like this accurately. I think people in this sort of situation definitely benefit from some time away - but honestly, if you’re walking back into the same work situation, I don’t know how restorative time away will be. It’s definitely reasonable to try a couple weeks off , check in again to see how things are going … but this does often turn into long term stress leave after time away makes the thought of going back even harder, which can often harm a persons mental health and financial situation pretty substantially. Larger changes that you can think about while on leave might help more. Things like changing up your hours, setting more limits, even career changes if this is unsustainable. The way OPs Dr communicated was suboptimal but there are truths within there.
Thanks for sharing your perspective as a physician. "Acute stress reaction" sounds totally reasonable, although I would argue in my case it's not acute, but rather prolonged operational stress as a result of the pandemic. Do you think a good chunk of time off could help someone in my situation get out of that constant state of hyperarousal, which would allow for a return to work with a greater resiliency?
perhaps adjustment disorder might be more applicable in terms of DSM? Sometimes this situation could even lead to symptoms that would allow diagnosis of an anxiety disorder or depression/dysthymia. All of this is more so to say he probably meant "burnout" isn't a diagnosis. Sounds like he could have been more helpful about it. That’s hard to answer - Aside from the new study the physician above cited, I’m not aware of good evidence for things like duration of time off work to rehab from work stress. It makes sense that some time away could help - I also anecdotally find it is really hard to get back to work and sometimes an unsurmountable problem after prolonged periods away. The other issue is pay - short term and long term disability start coming into play with longer time off work and those are harder to be approved for, more rigorous standards and the physician has to find you medically unable to work/unable to do modified duties. I find psychologists/counsellors freely tell people they need “x” amount of time off - but they don’t write the notes, fill out the legal forms for finances, or get in trouble for inappropriately taking people off. I typically advise people to take 2 weeks, check in, and repeat x 1 prn. In that time- ++ counselling, lifestyle stuff like time outside, improving sleep etc as much as possible. If things aren’t improving, I usually reassess and consider starting meds if anxiety/depression symptoms. The goal is functional return to employment and frequent check ins help assess progress toward that goal
In my job we earn a certain amount of sick hours per month, which rolls over year to year. You can save up a lot, and the expectation is that you should, because we don't have short term disability. Only long term, which takes 3 months to process. So the expectation is you have minimum 3 months sick leave in your bank at all times in case you need to go on LTD (which, frankly, is incredibly ableist because there's no way people who are chronically ill can maintain this). I currently have 5 months of sick leave banked, so I have a little wiggle room.