Stressed, angry, on edge: why so many women feel burnt out
The Times
Mental Health
Anna Maxted
Gerry Gajadharsingh writes:
The following article gives great insight to a very common problem that we see frequently in clinical practice. It also gives some excellent practical suggestions and helps us understand not only what is happening physiologically but also why and what we might be able to do to help. The following is a powerful statement from the article:
“Burnout is a state that affects both high-earning women and those for whom an unexpected bill is devastating, because while the fears that keep them awake at night might be different, burnout ultimately results from self-neglect.”
Self-neglect – now that is a powerful but emotive description and, ultimately, a correct one.
Ironically, many women I talk to about the work life balance will tell me they love their job. It’s a bit like saying I can’t be stressed because I’m happy! Think about “stress” as overload – yes, there is good and bad stress but the body still recognises it as stress and our physiology responds to it accordingly, giving us symptoms which we may ignore, sometimes at our peril.
Research into the pressures on working women shows that four in ten of us believe we are on the brink of ‘burnout’
Do you sleep badly despite being exhausted? Do you often feel tearful and fearful but still manage to keep it all together? Then you’re part of a growing trend. Research into the pressures on British women has found that four in ten “are on the brink of burnout”. Nearly half of the 5,000 who took part felt “moderately or extremely stressed”.
In essence, our desire to do it all and never fail is wreaking emotional and physical havoc. “Women are more likely than men to suffer from anxiety and depression,” according to Daniel Freeman, professor of clinical psychology at the University of Oxford (and co-author of The Stressed Sex: Uncovering the Truth about Men, Women, and Mental Health, OUP). Though men were found to suffer higher rates of alcoholism, drug and anger issues, Freeman says: “Women experience something like 20 to 40 per cent more mental ill health than men.”
Most of us recognise the strain of modern life. What is alarming, though, is our belief that we must bear it — that running on empty is the norm. The new findings, by the beauty company Sanctuary Spa, are especially resonant following research published last month in Personality and Social Psychology Review, which suggests that the personality trait of perfectionism is toxic to health and happiness — sabotaging success, leading to “stress, burnout . . . and serious health problems, including depression, anxiety, eating disorders, fatigue and even early mortality”.
Of course, if we are the linchpin of the family and we are struggling to earn enough to support our existence (not always grand enough to be a “lifestyle”), we can’t simply step off the gas. But unless we want to ruin our health, we need to make urgent changes.
Consultant psychiatrist Dr Judith Mohring, of the Priory Wellbeing Centre in London, describes burnout as “a form of extreme stress which, in medical terms, is heading towards anxiety or depression”. Dr Nerina Ramlakhan, a consultant at the Nightingale Hospital in London, who specialises in sleep and energy, is seeing “a lot of burnout” at her clinic, and says women in their forties, “at a certain stage in life”, are particularly susceptible. She says: “Women are trying to forge ahead professionally, they have children, elderly parents, and they’re trying to hold it together in every area.”
When the American Psychological Association’s Stress In America survey looked at the difference between the sexes, in 2012, it discovered that women continued to report higher stress levels than men — on a ten-point scale (ten being very high stress), 23 per cent of women reported that their stress level was at eight, nine, or ten. And more women than men (43 per cent against 33 per cent) said they were more stressed than five years ago. Top sources of stress were money (72 per cent) and work (66 per cent).
Burnout is a consequence of increasingly frenetic lifestyles and high expectations, notably of oneself. The American psychologist, Sherrie Bourg Carter, author of High Octane Women: How Superachievers Can Avoid Burnout, says that women with an “I can do everything” mindset are usually oblivious to the damage they’re doing to themselves until they reach the brink of collapse. They regard perfectionism as an asset, not a flaw. In further research, Sanctuary Spa (which is launching a campaign this week to encourage women to “let go”) found that for 72 per cent of women the pressure to be “perfect” is self-imposed.
Often, those who reach crisis point have been under pressure for a long time, but they’ve been coping. Then, one event tips the scales: an unsympathetic new boss, marriage difficulties, a new baby, illness in the family. Those on the edge often experience warning signs, such as irritability and poor sleep — but they ignore them. A spiral of decreased energy follows, an indifference to activities you once loved, feelings of detachment and mood changes; increased anger, anxiety, sadness.
Dr Mohring says: “There are also biological symptoms — your sex drive goes, your appetite changes, your sleep is up the spout. You might suffer muscular pain, headaches, an irritable bowel.” Often, sufferers have difficulty concentrating and experience poor memory. Mohring says: “When you’re under extreme stress, there is disturbance in the neurotransmitters throughout the brain, and it feeds back into the body.”
It is a state that affects both high-earning women and those for whom an unexpected bill is devastating, because while the fears that keep them awake at night might be different, burnout ultimately results from self-neglect.
Dr Ramlakhan, the author of Tired But Wired, says: “Women have the opportunity to forge ahead that their grandmothers didn’t have, but it is at a personal cost. They put themselves under pressure to make everything perfect. Busyness is a badge of honour. Technology has played its part, but there’s a collective feeling of ‘we’ve got to justify our existence, we’ve got to get it right’.”
“We’re told as women that to think of yourself is selfish,” says Jenni Trent Hughes, a social psychologist. ‘That’s part of why we don’t ever want to do anything for ourselves.” She adds that the irony is that “if you ask your partner
Working long hours may be necessary to keep afloat, but ironing pants is never necessary. Yet, many women force themselves to do both — or some equally punishing variation. This refusal to self-nurture means that we realise we’re at crisis point only when we have a panic attack at work, suddenly can’t stop crying, or our partner begs us to seek help.
Dr Ramlakhan says, “In the early stages of burnout there are pervasive feelings of not being in control. You’re likely to wake up with anxiety in the pit of your stomach. Sometimes you’re not even sure of where the pressure’s coming from, but you can feel it.”
A prime candidate for burnout reaches for her phone upon waking, skips breakfast, drinks coffee, works on the commute. These habits, says Dr Ramlakhan, can prompt the body to run in overdrive: “The mind is racing, the sympathetic nervous system [which responds to stress by preparing the body for flight or fight] is activated; we’re running on survival mode — on adrenaline, and then we start producing cortisol, which is the longer-acting stress hormone.” Long-term, this depletes the body and leads to fatigue; it can result in chronic illness.
Meanwhile, at home, there’s no downtime, says Dr Mohring, as women are “doing the second shift of looking after the kids, making sure there’s food in the fridge, doing the laundry, making sure homework’s been done”.
We need to take an honest look at ourselves. For instance, there’s a difference between beneficial exercise and rising at 4.30 to squeeze in a visit to the gym. It’s probable that you’re grimly focused on goals, disengaged from your genuine emotions. “A lot of people who suffer burnout are copers. They don’t lean on other people very much,” says Dr Mohring. “They don’t enjoy being vulnerable. They see it as a weakness. I say that it takes enormous strength to say, ‘I need help, I’m not coping’ .”
How to reduce your load without everything falling apart? Dr Mohring suggests that people decide “which of their tasks would be important if they were to look back in a year’s time”. She asks her patients to list what they’d ideally focus on. “Often, people write, ‘I’d like to do less work, lose weight, quit smoking — and my son’s turning 12, I’d like to take him to a football match.’ Often, at the end of the list is the stuff that’s really important. And then, when we focus on the relationship, partner, children, friends — they realise, ‘That’s more important than I thought it was’ .”
The big claim by those of us teetering on the edge of mental and physical burnout is that we are doing this for our family. But Trent Hughes believes that women are being needless martyrs. “A lot of us are doing stuff for people that they don’t want,” she says. Essentially, this isn’t selflessness — it’s selfish.
“Your family would rather you were calm and happy,” she says. “Ask yourself if every chore is necessary.”
And do we want this to be the model for our daughters? The attitudes that contribute to burnout are being passed on. Sanctuary Spa’s research shows that, compared with other age groups, 18 to 24-year-olds are feeling enormous pressure in every area — from having to be funny, fashionable, interesting, sexy, to being the perfect daughter and having the perfect body. Trent Hughes says the idea that this generation is liberated “is the biggest load of codswallop. They are far more stressed out than we were — they have many more pressures, the standards of perfection are much higher. It’s heartbreaking. There are many more boxes that society wants them to tick. You don’t have to have the perfect hair, body, job. There are schools in my area that have eating-disorder counsellors on the staff.”
Dr Ramlakhan agrees. “We feel we have to micromanage our children’s diaries and it’s breeding a generation that can’t sit still, can’t handle boredom, who can’t create and manage their own time, who constantly feel that they have to be doing something — we’ve lost the ability to daydream,” she says. “When we stop being able to do nothing, we can’t relax. We can’t even watch Bake Off without doing the Ocado shop, or Amazon, or checking emails.”
There are lifestyle changes we can make to pull back from the brink and remain effective. Dr Mohring says: “Reducing alcohol is important; it has a massive effect on mood. Try to have three or four nights a week booze-free. Exercise is important. Getting outside is very important. We talk about connecting with your passions. Commit to one day a month where you do something for yourself.”
Dr Ramlakhan has several “non-negotiable” rules for patients on the brink. The first is to eat a breakfast, containing protein, within half an hour of waking. “It stabilises the blood sugar, and we start to run on the body’s fat stores, the body’s natural metabolism, as opposed to the survival metabolism, the adrenaline. We need to tell our body that we’re not living in crisis and famine, that we’re safe and there’s an adequate supply of food.” This will help us feel calm, produce helpful hormones and promote better sleep.
On which note, tough as it sounds, she also insists that sufferers get to bed before midnight, ideally at 10.30, four nights a week. “That 90-minute phase before midnight is incredibly healing. When I’m working with patients with chronic fatigue, thyroid problems and adrenal exhaustion, that’s the phase of sleep we work on. They often resist it because that’s the time, after the children have gone to sleep, that they catch up on emails, ironing, box sets. Even if you’re not asleep by that time, you’d ideally be in bed and resting.”
If this feels impossible, start with small adjustments: half an hour earlier to bed, one less cup of coffee. It makes a difference.
Trent Hughes says that if you ask women what they want, it’s often about their kids, partner, house, elderly parents, making ends meet. “It’s never, ‘I’m trying to feel fulfilled.’ Meanwhile, their family say, ‘I wish you laughed more. I wish you had more time to spend with me.’ That’s important for women to understand,” she says. “They have to put themselves on the list. Taking care of yourself is a necessity, it’s not a luxury. We’re burning out because we don’t understand that.”
Are you at risk?
- You wake up feeling exhausted and remain tired all day
- You feel detached, cynical, uninterested, as though you’re on autopilot
- A sense of dread is frequent and you often feel overwhelmed
- No matter how much you do, you feel as though you’re underachieving
- Your “Achilles heel” issue — irritable bowel, headaches, eczema — is playing up, and you’re frequently ill
- You suffer from insomnia
- You can’t focus or remember things. Your lack of concentration can feel like a hazard
- Your mood is low; irritable, edgy. You feel anxious, angry, hopeless, unbearably sad
- You have lost your appetite
- You feel panicky, even suffering panic attacks
How to help yourself
- Plan a treat — a way of reconnecting, removing your thoughts from the present. It’s a mental zone of safety you can head to. It can be as simple as seeing a friend
- Give to others — even doing a small kindness lifts mood. You might volunteer to read at a primary school
- Learn a new skill. Learning French, or how to knit, perhaps on your commute if you’re short of time, is therapeutic
- Drink two litres of water a day. The body and brain work better if they’re well hydrated
- Cut down on caffeine — it’s an artificial form of adrenaline, it mimics the effects of stress
- Turn off the iPad. Step back from technology in the evenings and shut it off an hour before bed
- Exercise for 20 minutes every day, but not excessively. A walk is great
- Get to bed before midnight four nights a week. This is the “warm-up phase” and encourages good sleep patterns