Depressed, Stressed, & Burned Out: What is Going on in My Life?

Throughout the 30+ years of my vocational life, I have been blessed and benefited by the ministry of Dr. Archibald Hart, Dean Emeritus and Senior Professor of Psychology at Fuller Seminary’s School of Psychology. He is a friend, a mentor, a role model, and so much more. His contribution to understanding the unique challenges faced by those in the helping professions is incalculable. It’s my privilege to have him share a guest post this month on the all-important topic of stress and burnout. Thank you, Dr. Hart.

Depressed, Stressed, and Burned Out:
What’s Going on in My Life?

By Archibald D. Hart

Burnout! Burning out! Burned out! All perfectly legitimate images, but they barely describe the syndrome that inflicts people helpers. Burnout — the final penalty for those who care too much as a part of their job.

Burnout is a “syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do people work of some kind.” It is a response to the chronic, emotional strain of dealing extensively with people. If these people are troubled, then burnout can be particularly rapid and devastating.

The previous definition does not adequately capture the essence of burnout. Theorizing does not help us appreciate how destructive and debilitating caring for others can be. The pastor, who was once vibrant with power and enthusiasm, able to motivate others to service and godly living, and given to caring and concern, becomes reduced to useless ineffective rubble, emotionally exhausted, and deeply fearful. The spouse of the pastor, once the perfect hostess able to calm troubled waters and apply the soothing balm of comforting words and listening ears, becomes jittery when the telephone rings, panicked by any hint that the doorbell might clang and desperately wanting to be left alone. Or the pastor who once patiently and kindly plodded his way through the prejudice and projections of ignorant and insensitive parishioners becomes a lonely, isolated, deeply depressed recluse who cannot get out of bed in the morning and who conceals his secret siestas like a closet alcoholic.

A pattern of emotional overload with little reward or appreciation in the context of feelings of helplessness is at the heart of the burnout syndrome. Why are pastors particularly prone to burnout? Because they:

• have not been taught to care for others in the right way.
• care too much out of guilt.
• care too much and feel helpless about providing solutions.
• care too much all of the time.
• do not care enough about their own self-recovery.

Pastors tend to become overly involved emotionally, overextend themselves, and then feel overwhelmed by the emotional demands imposed by others. And the more people there are to feel responsible for, the greater the opportunity for burnout.

Once burnout sets in, pastors do not believe they are able to give of themselves to others. It is not that they do not want to help; they can’t. The gas is gone.

Burnout has also been called compassion fatigue. The muscle of a pastor’s loving heart goes weak and limp. No longer is it able to pump life-giving care and love to the rest of the needy body. Short bursts of compassion may be mustered in times of emergency, but it may suddenly and surprisingly cease at the most inopportune times. The love machine is powerless and eerily silent, waiting for a miracle to bring it to life again. For many the miracle never happens. It is then called burnout.

But is burnout for real? Could it be that our gullible Western minds have such a propensity for the faddish that we may be in danger of creating a monster simply by giving it a name? Will we not rush to excuse every moment of laziness or incompetence simply as a symptom of burnout? Will it not take away responsible behavior? Will burnout become a smoke screen for cop-out? Is burnout an excuse to leave the ministry, abandon a marriage, or give up on any activity that demands persistent, unrelenting dedication?

Discipleship is never easy. The servant of God must not be deterred by fake disasters, invented obstacles, or exaggerated weaknesses. But burnout is none of these for the majority of pastors. It is a real hazard, produced in well-meaning and dedicated people who care about others, whose motives are pure, and Holy Spirit-dependence sound. They simply discover that the human frame has its limits. When these limits are exceeded, the price is burnout.

The warning not to allow the idea of burnout to be an excuse for cop-out is well heeded. But on the other hand, prevention is better than cure. A thorough understanding of burnout can help pinpoint the pitfalls of this devastating and debilitating problem. My concern here is not so much that a discussion of the inevitable potential for burnout among pastors will provide a convenient cover-up for incompetence, but that a few readers will readily acknowledge the reality of the syndrome and the fact they are victims of it. It is much easier to understand that machines reach a stage of lifelessness and uselessness by being overworked than it is to convince so many well-meaning and dedicated ministers and people-helpers that this could happen to them.

There is something strangely paradoxical about believing you are a servant of God and acknowledging that you are on the road to burnout. Too many see it as a sign of failure rather than as a warning signal from an over-extended physique or psyche.

Is burned-outness the inevitable price one must pay for caring too much? Is it the ultimate penalty for being a channel of God’s grace? Must it inexorably and unrelentingly take its toll when the motive for service is so pure and the purpose so transcending of worldly considerations? Absolutely not. There is a vast difference between wasting out (in which one careens headlong into a meaningless and wasteful use of energy), and controlled burning out where you deliberately and by design give of yourself to the maximum of your ability so when your life is over you have a sense of having given all you can give. The first is self-destructive. The second is Christ-glorifying.

Our commitment to Christian ministry and service is to be a model to others, no matter what their calling. The true servant of God does not have to be prematurely destroyed by ignorance of the basic principles that govern the physiological and spiritual aspects of our existence, nor by unsanctified motives and guilt. We can effectively care for people without burning out if we heed some fundamental principles.

UNDERSTANDING THE DIFFERENCES BETWEEN STRESS, DEPRESSION, AND BURNOUT

When we hear or read a discussion about burnout, it soon becomes obvious that there is, in the minds of many, confusion between what constitutes burnout and what constitutes stress — or rather distress — which is the damaging consequence of stress. There are some similarities between burnout and stress. There are also many differences. A few similarities are legitimate and real. Many are erroneous.

Why should we differentiate between burnout and stress? For three important reasons:

1. The causes of burnout are quite different from those of stress.
2. The cures for burnout are significantly different from those for stress.
3. The acceptance of the essential differences between burnout and stress can help delineate more effective preventive mechanisms.

Not only is it common to confuse stress problems with those of burnout, but many also confuse problems of depression with burnout. Pastors who are experiencing a simple (though quite painful) depression could be inappropriately seeing it as burnout. This tends to complicate the problem unnecessarily since the blame is placed on the wrong cause. Many who should be seeking treatment for depression are left bewildered and confused by esoteric and confusing rationalizations concerning their alleged burnout. If the problem is depression, the cure lies clearly in seeking treatment for the depression. But if the problem is burnout, the cure may require much more complex and significant life changes. If the problem is depression, particularly of the endogenous type, effective relief may be only weeks away through appropriate medication. (See Different Categories of Depression) Burnout may require many months or even years of adjustment for effective recovery.

To assist the reader in developing a clearer understanding of the differences between stress, depression, and burnout let me describe the essential features of each.

Stress
Hans Selye, the father of stress research, defines stress as “the nonspecific response of the body to any demand.” He emphasized that the body can respond in the same manner to many types of pressure, both good and bad. The excitement of preaching a good sermon or watching your football team play a winning game can be as stress-producing as facing an angry member of your church board after a meeting. Although the one causes good stress (eustress) and the other bad stress (distress), both make the same demand on certain parts of your body system and move you away from your normal resting equilibrium. Too much of either type can work havoc in your body.

The most devastating form of stress is stress caused by the fight-or-flight response. This is the body’s emergency response system. This system prepares you to deal with any physical or psychological threat. When you become angry, you trigger this response. When you become afraid, you trigger it. Complex changes within the body prepare you to either fight (including many variations of the anger response) or flee.

When the system is constantly subjected to this emergency response and when there is nothing to fight or flee from, the body adapts to this state by producing complex stress hormones from the adrenal glands that cause an increased state of wear and tear in the body.

Unfortunately, this state of distress can be stimulating for many pastors. They become addicted to the high level of adrenaline in their bloodstream and even find it stimulating and pleasurable. For them stress is the road to excitement. It is also the road to self-destruction.

While pastors cannot completely eliminate stress, every effective leader needs to know how to recognize overstress; that is, when his physiology is unable to recover quickly from the over-demand. The symptoms of distress are designed to warn him of the excessive wear and tear, and they provide complex self-regulating checks and balances to restore optimum functioning. These symptoms include headaches, teeth grinding, insomnia, muscle tension, gastric disturbances, high blood pressure, and rapid heart beat. Many pastors see these symptoms as obstacles to performance or success that need to be overcome rather than as signals to be heeded. Pastors merely want to get rid of these obstacles. They either ignore them or obliterate them with medication. These actions may relieve the symptoms, but they don’t stop the excessive wear and tear on the body.

While prolonged distress can lead to burnout, stress is essentially different from burnout in that its symptoms are the consequence of overuse of the body. These symptoms are caused by the overproduction of adrenaline and the repeated triggering of the fight-or-flight response. Stress could just as easily be called hurry sickness. Seldom does the disease of over-stress in and of itself slow the victim down — not until the final blow is struck and the ulcer, stroke, or heart attack has occurred.

Burnout is qualitatively different. It is much more protective than destructive. It may intervene when you are on the road to stressful destruction and take you out of the stressful environment. When it does it is often a blessing. It instantly slows you down and produces a state of lethargy and disengagement. In this sense it may even be functional. The system gives out before it blows up.

Depression
Depression is the most complicated of all our emotions, and, yet, one of the most common psychological problems a person can experience. Someone has called it the “common cold” of the emotions.

It’s a feeling of gloom or sadness that is usually accompanied by a slowing down of the body, not just in the mind. (See below “Common Symptoms of Depression.”)

Common Symptoms Of Depression

• persistent sadness, anxiety, or an empty mood.
• feelings of hopelessness and pessimism.
• feelings of guilt, worthlessness, and helplessness. (Depressed people may burst out crying for the slightest reason.)
• loss of interest or pleasure in ordinary activities, including sex.
• sleep disturbances such as insomnia, early morning waking, or oversleeping.
• eating disturbances (either loss of weight or gain in appetite and weight).
• decreased energy, fatigue, and being slowed down.
• thoughts of death or suicide, and even suicide attempts.
• restlessness and irritability.
• difficulty concentrating and remembering, and in making decisions.
• physical symptoms such as headaches, digestive disorders, and chronic pain that do not respond to treatment.

We are all designed to experience depression. At some time in their lives, probably one of every five people will experience depression seriously enough to hinder their normal way of life.

Depression is nearly always present in burnout. It may only be present in some stress disorders. When it is present in burnout, it is a symptom of the disorder and not necessarily a problem in and of itself.

The depression of stress is always the consequence of adrenal exhaustion. The body produces a state of depression in which the low mood, disinterest in regular activities, and physical fatigue is designed to pull the victim out of the rat race and produce a state of lethargy. The lethargy, in turn, allows the body to rest and recover from the over-stress.
Depression can be a reaction to what is going on in life — to significant losses one experiences. This is known as reactive depression. Most people contend with this type of depression in their daily lives. If we are emotionally healthy, we deal with those losses promptly, and the depression is short-lived. If we are not, the depression lingers and may even get worse or chronic.

For instance, many people experience the “Monday morning blues” as they prepare to meet the demands of the week. For some, the blues are the low periods in their cycle of emotions that normally follow high periods of excitement. Those cycles are quite normal and are determined by our individual physiology, by the weather to some extent, by infections, and by many other circumstances. They are the body’s way of regulating immune function and forcing us to rest. The blues should not alarm us. If we cooperate with them, we’ll improve our overall state of body and mind.

Sometimes stress will bring out an underlying endogenous depression. This depression is produced by complex disturbances within the body’s chemistry that are in some way (which is not yet clearly understood) related to some weakness or defect in the neurotransmitters of the nervous system. When subjected to prolonged stress, depression of the biochemical sort may set in. Much depression seen in high-pressured, over-worked, and ambitious people (including ministers) may be of this sort. It may be a precursor to burnout and may even hasten the final giving up that characterizes burnout. But it can also be free standing and independent, never producing the burnout syndrome.

Burnout
Stress and depression are different from burnout. While these maladies may finally converge on the burnout road they could just as easily be taking different routes entirely. A body system exhausted by overwork, pushed beyond reasonable endurance, and depleted of resources could become burned out. But burnout can also be reached by roads quite different from those of stress and depression. (See below Differences Between Burnout and Stress.)

Differences Between Burnout And Stress

• Burnout is a defense characterized by disengagement.
• Stress is characterized by over-engagement.
• In burnout, emotions become blunted.
• In stress, emotions become over-reactive.
• In burnout, emotional damage is primary.
• In stress, physical damage is primary.
• The exhaustion of burnout affects motivation and drive.
• The exhaustion of stress affects physical energy.
• Burnout produces demoralization.
• Stress produces disintegration.
• Burnout can best be understood as a loss of ideals and hope.
• Stress can best be understood as a loss of fuel and energy.
• The depression of burnout is caused by grief engendered by the loss of ideals and hope.
• The depression of stress is produced by the body’s need to protect itself and conserve energy.
• Burnout produces a sense of helplessness and hopelessness.
• Stress produces a sense of urgency and hyperactivity.
• Burnout produces paranoia, depersonalization, and detachment.
• Stress produces panic, phobic, and anxiety-type disorders.
• Burnout may never kill you, but your long life may not seem worth living.
• Stress may kill you prematurely, and you will not have enough time to finish what you started.

In essence, extreme states of burnout will comprise most, if not all of the following:

• demoralization — the belief you are no longer effective as a pastor.
• depersonalization — treating yourself and others in an impersonal way.
• detachment — a withdrawing from all responsibilities.
• distancing — an avoidance of social and interpersonal contacts.
• defeatism — a feeling of being beaten and a giving up of any hope of being able to avoid defeat.

WHO SUFFERS FROM BURNOUT?

Burnout tends to occur more frequently in those vocations that involve helping people. Pastors are particularly vulnerable to burnout because they experience the greatest exposure to the needs of people and, from a human standpoint, often have the least resources to offer.

The emotional antecedents of burnout in the people-helping professions include situations in which emotional demands are made over long periods of time. The helper usually holds high ideals, along with an excessive personal expectation that cannot tolerate failure. There is also a lack of adequate social support to aid the helper to accept the limitations of resources — both personal and organizational.

Almost every minister could be rated as very high on every one of these antecedents. If it were not for the resources of the gospel, the task of ministry would be impossible. It is not a reflection on the ineffectiveness of the gospel when a pastor succumbs to burnout. It is merely an acknowledgement that the glory of the gospel is contained in earthen vessels. Don’t be surprised if now and again they tend to show the signs of weakness.

RECOVERING FROM BURNOUT

As in the treatment of all diseases, the cure begins with acknowledging the problem. Burnout should never be seen as a sign of failure. Sometimes burnout is God’s plan for your life. It is the only way He can get your attention.

Burnout is an important protective system — a warning signal telling us that we have lost control of our lives. Do not fear the cure for burnout. If anything, give yourself permission to experience it — recognizing that it is protecting you from a far worse fate.

Pray for the wisdom and courage to align your life with God’s purpose and plan. Heeding the warning signals of your system’s disintegration is only the first step. Determinately following the remedy will require much patience and perseverance.

The cost of burnout can be high for both the pastor and church. Recovery is not without its price. All those involved in the life of the pastor — family, parishioner, and friends — will be affected by his or her burnout. Sadly, many burnout victims go unrecognized and, therefore, unhelped. This often leads to drug or alcohol abuse (often secretive), or to isolation depression that will eat into the psyche of the sufferer like a cancer. The Spirit of God may not find an eager and effective response from the hearts of these burnout victims. Prayer will seem like a nightmare; the Scriptures will sound hollow and even the thought of fellowship will evoke feelings of panic. What is even more unfortunate is that many will not even acknowledge they could have such a problem. They will deny it, refuse to accept it, even blame others or circumstances for it, but not take the first step toward being honest with themselves and admitting they are in a state of burnout.

Heed a spouse’s or friend’s advice
Sometimes it may be necessary for a spouse or friend to confront the victim with honest feedback. In fact, I have not encountered many pastors or missionaries who have taken the initiative in seeking help for their burnout problem. Invariably, it is in response to another’s caring concern that they have taken action. During the first visit the pastor will say, “My spouse is worried about me. I don’t think the problem is that serious, but to please her, I’m here.” Bravo. Doing it for a spouse is better than not doing it at all.

Realize burnout is not a sign of failure
Since most burnout situations are more the product of bad circumstances than of bad people, the pastor needs to be reassured his burnout is not necessarily a sign of personal failure. Unfortunately, given the sensitive nature of the guilt mechanisms most people are heir to, pastors are more likely to attribute burnout to defects in them than to the circumstances of their work. This can lead to a sense of personal loss and a deep depression. In such a depression, the pastor is unlikely to seek help without persistent prodding by a caring spouse or friend. Reassurance that there is a way out of the abyss, without provoking further guilt feelings, can open the door for further help.

Seek professional help
Severe cases of burnout — where the pastor is in a state of emotional turmoil, extreme fatigue, is negative and depressed, and withdrawn — should be treated by a professional. Burnout can be the cause or consequence of so many other problems that self-help in severe cases will only aggravate, not help.

For most, though, burnout will be a less serious problem. Attention to some basic principles can prevent it from worsening and can bring about relief and restoration of a vital, spontaneous, and dynamic personal, spiritual, and professional life. Since no two burnout situations are identical, coping needs to be tailor-made and is most effective when it occurs at several levels. Attention must be given not only to personal aspects of the burnout, but also to the social and institutional aspects as well.

Learn coping skills
It is important to realize that burnout begins slowly. This is good news and bad news. The good news is that pastors have plenty of time to take preventive steps. The bad news is that it can creep up so slowly many pastors will not recognize it. Burnout is an insidious disease. It does not strike like a bolt of lightning out of the sky — it creeps up on you like a snake in the grass. If the problem does develop quickly, say over a few days, it is more likely to be an endogenous depression rather than burnout.

Since burnout begins slowly, steps to effective prevention can be taken early in the process. Prevention is effected by implementing the techniques of coping at an earlier stage in the burnout process.

Coping refers to efforts to master the conditions causing the burnout when automatic responses are not readily available. Coping, in itself, does not demand success — just that you put out the effort. What always surprises me is how effective it is just to make some effort to change the circumstances of the burnout. This can dramatically restore a sense of hope, even when the effort is not altogether successful. Helplessness seems to vanish when the smallest of attempts is made to control the cause.

Richard Lazarus, a prominent stress researcher, has suggested two general types of coping that can be applied to the problem of burnout:

1. Direct action.
2. Palliation or indirect action.

In direct action, the person actively tries to change the source of the problem by confronting it and finding positive solutions. When the source of the problem is ignored or avoided, the likelihood of burnout is increased.

In indirect action, the person tries to understand the source of the problem by talking about it, adapting to the source by making adjustments to it, and diverting attention from it by getting involved in other activities.

Neither of the above coping strategies is better than the other. Both are necessary for successful prevention or recovery from burnout. All coping is carried out in a spirit of dependence on the source of all our strength. God alone knows the depth of our despair, and He can give us the power to rise from it if we will trust Him.

PREVENTING BURNOUT

From my experience in working with pastors, I have found that particular attention should be given to three important areas of personal functioning if one is going to prevent burnout: assertiveness, role conflicts, and the pitfalls of sympathy.

Assertiveness
Much stress and burnout found in pastors is caused by a misunderstanding of how to be assertive, and, yet, have a Christlike spirit. Consequently, many pastors have difficulty dealing with interpersonal conflicts, manipulative people, bossy or demanding superiors, or powerful authority figures. They cannot say no to the many demands made of them, and often feel abused, hounded, ridiculed, criticized, and humiliated, but do not know how to handle either their feelings or the abusive situation. As a result, suppressed anger and passive-aggressive behaviors emerge as a lifestyle that can predispose the pastor to burnout. The antidote is clear: learn how to be assertive in a manner consistent with your Christian spirit.

Role conflicts
I doubt if any other vocation has as many diverse roles attached to it as ministry. The pastor is expected to be a good preacher, teacher, counselor, administrator, business manager, and friend. A multitude of expectations are imposed on the average pastor. Many of these can cause conflict and stress that can be debilitating. Research in industrial settings has repeatedly demonstrated that role conflict leads to stress and burnout. This is also true of ministry. The following steps can be helpful in preventing role conflict:

• Know what your goals are for your ministry. Clarify your internal expectations by talking them over with a trusted confidant. You will experience enough ambiguity from others as to what you should be doing, so at least ensure that you are clear about your own goals.
• Clarify the expectations others have of you and decide which of these are consistent with your calling. Be assertive and ask: “What do you expect of me?” Then, be assertive in accepting or rejecting those and negotiate changes in these expectations to fulfill your calling.
• Focus your roles. Scattered goals produce scattered people. Identify your strengths and the talents God has given you, and, then, concentrate on these. Since you must give an account to God of your own ministry and not to your congregation or any other institution, make sure you are free to exercise that ministry.
• Educate your congregation in the complex issues of being a minister, the diversity of roles you must play, and the possible debilitating effects they can have. If they know what you experience, they will be much more understanding and less demanding than if they did not know.

Pitfalls of sympathy
Burnout can result from an inability to keep personal emotions sufficiently detached to avoid over-involvement in the pain of others. How much can a pastor take of the emotional or spiritual pain of others before it starts to burn him out?

The Christian minister or missionary is particularly vulnerable here. He is called to be all things to all people. He is supposed to “bear one another’s burdens” and “weep with those who weep” (Galatians 6:2, NASB; Romans 12:15, NASB).4 But how much contact with troubled people can be tolerated if one must become emotionally involved with all of them? While not becoming indifferent to the pain of others, it is necessary for pastors to develop an appropriate degree of self-protection so they do not become emotionally destroyed.

There are many reasons why ministers are overly affected by the pain of others. They may be guilt prone and use their own weeping over the pain of another as a way of alleviating their guilt feelings. Paradoxical, isn’t it? Especially since they preach a gospel that offers forgiveness. Or they may become overly involved with the pain of another to satisfy some deep personal need (conscious or unconscious). It can also be an excessive need for attention, recognition, or appreciation. In some strange way the vicarious pain helps to alleviate these needs and may even boost their self-esteem.

Perhaps the most important reason pastors are affected by the pain of others is they are not taught to differentiate sympathy from empathy. They erroneously believe that they are required to feel sympathy for all who hurt. Psychologists prefer the concept of empathy as a special form of sympathy because it describes a way of relating to another that shows care and love, but does not produce a reciprocal pain.

Clinical research has shown that empathy is much more helpful and comforting than sympathy. Hurting people only hurt more if they see that their hurt causes others to hurt also. Hurting people are healed by understanding, not by someone else becoming emotionally affected by their hurt.

Pastors need to work out a theology of compassion before becoming involved with a hurting world. On one hand, pastors must be ready to “weep with those who weep” (Romans 12:15, NASB), but on the other hand, “We who are strong ought to bear with the failings of the weak and not to please ourselves” (Romans 15:1). Pastors need to know when they are being motivated by neurotic needs to feel the pain of others and be willing to surrender their neuroticism to the cross of healing so that we can be “blameless and harmless, the sons (and daughters) of God” (Philippians 2:15). We are hardly “harmless” as ministers when we operate out of a neurotic need to sympathetically feel the pain of others. Not only do we destroy ourselves, we rob those who are hurting of the respect due to them in their suffering.

CONCLUSION

Although burnout can be a traumatic, devastating, depressing, and even a life-threatening experience, it can also be the beginning of true maturity and the discovery of what God wants to do in your life.