Crisis, presuicidal syndrome, burnout Eszter Tisljár-Szabó eszter.szabo@sph.unideb.hu University of Debrecen Department of Behavioural Sciences Crisis definition What produces, or fuels a crisis is not simply defined by a particular situation but rather by the individual’s perception of the event and his/her ability (or inability) to effectively cope with that circumstances. Crisis definition • Homeostasis is disrupted: balance is thrown off and the individual is no longer able to cope with the situation effectively • Because of inability + there is no escape • „temporary state” – for most individuals • Symptoms can be – anxiety, – depression, – disorganization (cognitive, behavioral, emotional) Possibility for positive or negative consequences – Negative outcome: loss of self-esteem, loss of esteem of others – Positive outcome: opportunity for new experiences, starting over, gaining new skills, behaviors and even insights Suicidal behavior • For many, suicide seems to be the only solution in crisis situation • Is it only a „moment of madness”?? tendency to take a moralising approach trivialising suicide attempts no attempt to discover the background factors. Patients thus often leave hospital without receiving any real assistance Increased likelihood of repeated suicide attempts False belifs „People who talk about suicide are just threatening and will never carry it out” „People who take tablets are never making a serious suicide attempt, only blackmailing the people around them” „The suicide always wants to die” most suicides either talk about their intentions or signal them in some way before the act itself The suicide does not want to die, only live differently. In medical practice, every self-harming act must be taken seriously, because research has demonstrated that a prior suicide attempt is the greatest risk factor for subsequent suicidal mortality. Presuicidal syndrome (Ringel) • A psychopathological constellation • Features: 1. Dynamic constriction of cognitive functions, feelings behavior, and human relationships reduced possibility to resolve the situation or asking for external help 2. Inhibited aggression turned towards the self (causes:) – Frustration – Guilt for failure – self-punishment tendencies – ambivalence in human relationship – isolation 3. Suicidal phantasies: the constricted personality, turning away from the outside world, devotes all mental energies to the fantasy world: suicidal act firstly takes shape here joint presence indicates a state whose recognition is crucial if the suicidal act is to be prevented Opportunity for prevention • Most people who attempt suicide are in regular contact with their GP or other health professionals, and very frequently visit one of these shortly before the suicidal act. • Prior to suicidal act, nearly every person indicates an intention to commit suicide. Cry for help = an expression of the ambivalent state of mind experiences in the suicidal crisis From open request for help to a completely hidden, hardly perceptible signal not always easy to recognize the danger of suicide This communication phenomenon opens up an opportunity to provide help Discovery • Depression as a risk factor – Beck: cognitive triad: patient’s negative thoughts on the past, the future, and himself Questions about the patient’s immediate and future plans can be informative How are you going to spend the next few days? signs: uncertainties, ambivalence or complete absence of thoughts on the future. Mention of a death whish, suicidal intention; expressions implying termination or finishing, or analogues to these (going away, falling asleep) Watch for minor complaints To do Supportive behavior and empathic attitude to provide the patient with the chance to share his thoughts If the doctor notices messages alluding to a suicidal intention, it is vital to clarify these precisely. in medical practice, doctors often avoid the subject, fearing that mentioning suicide will „give the patient ideas” and increase the likelihood of them carrying it out. In fact, the situation reverse What to ask? „I see you are very dejected. Has it ever passed through your mind that it would be better if you were not alive?” „Have you ever thought, in this difficult situation, of getting out of it and putting an end to your life?” helps the patient in opening up, sharing the thoughts which are threatening him Who shows signs of intended suicide asking about specific suicide plans and preparation = it can provide key information about a psychological state that demands immediate intervention. Not to do Don’t ever trivialise or judge the patient’s feelings or the reasons leading to suicide. – it can cause the patient to lose trust and even break off relations with the doctor Cheering up or encouragement are unproductive („Pull yourself together”) Problems when treating patients who have attempted suicide • Serious failing: if treatment of patients’ somatic conditions is not followed up by psychological help • Such people are at heightened risk of repeating their self-destructive behavior, often in a more serious form. Suicide in doctors FEMALE • The suicide rate in female doctors was higher compared to the general population, (Hawton et al., 2001), and compared to other academics as well (Arnetz, 1987) MALE • Suicide rate in male doctors was less than that of the general population (Hawton et al., 2001), • male doctors exhibit an elevated suicide rate only when compared to other academics (Arnetz, 1987) Burnout (Maslach ) „a psychological syndrome in response to chronic interpersonal stressors on the job’’ (Maslach et al., 2001). Burnout Inventory 22 statements Depersonalization Emotional Exhaustion Personal Accomplishment Burnout Three Types of Burnout You Can Experience Emotional Exhaustion • how draining your job is • how used up you feel after work. • This can feel like apathy, lethargy, low energy, depression… • lessening of your motivation and a lack of desire to do things. • This results from supporting too many projects, tasks or people Three Types of Burnout You Can Experience Depersonalization • • • • • how you deal with people turning people into objects an unfeeling, impersonal response towards patients you just keep them as a nameless, faceless being cynicism • It is about how you are pulling back your caring about others because it’s too intense. • This is a method of getting space from others. Three Types of Burnout You Can Experience Personal Accomplishment • your sense of achievement, • the feeling that you are accomplishing things that are worthwhile. • This often results from how good you feel about what you do. • efficacy • When your values and the organizations values and goals are aligned, there is a sense of success about what you are doing. • When burning out in this area, one feels like they are not doing something that makes a difference. You don’t feel like a problem solver, and motivation diminishes. Promoters of Burnout Involvement with People • Chronic issues or pressures—when there’s little chance of change or improvement • Others time demands on you • High supporter for the needs of others • Receiving a lack of positive feedback • Negative coworkers • Carrying another’s load Promoters of Burnout The Job Setting • Stressful environment: tensions, upset people, working conditions, lack of needed supplies or tools, etc. • Lack of control of your destiny from rigid controls, rules or leadership style • If you have to do the dirty work • Team doesn’t collaborate • Few celebrations of progress or achievements non-stressed doctors also describe similar working conditions. very poor, almost non-existent correlation between working hours, patient load and other variables describing working conditions, with stress levels or with burnout not workload per se which is stressful: imbalance between effort and reward: hard work for little reward, financial, psychological, social or professional, is stressful and results in burnout. Promoters of Burnout Personal Characteristics • If you are a loner and don’t have a support system, both personal and professional • Not having clearly defined goals and mission, personal and professional • Lack of self-confidence or self-esteem • Needing to be liked or approved of continuously • Negative self-talk • Rigid or inflexible Depression • Pervades every aspects of life Burnout • Job related • Situation specific • Absence of sense of meaningfulness • Correlates with a lack of perceived job significance Stress • Related to workload Approaches to Avoiding or Overcoming Burnout Personal • • • • • • Maintain good nutrition Take intermittent breaks, walk away for a bit Learn to overcome irritation, frustration and anger Don’t take things too personally Choose to focus your thoughts positively Learn relaxation techniques specifically for calming and relaxing • Get exercise regularly Approaches to Avoiding or Overcoming Burnout Social and Organizational • Learn how to say “no” tactfully • Avoid off-time spillover into your personal life • Develop effective interpersonal and communication skills • Have someone you can confide in • Give time or energy to something worthwhile • Find humor regularly • Be assertive for what you value Literature • Csabai & Molnár (2000) Health, Illness and Care. Budapest, Springer. • Pilling et al. (2008) Medical communication • McManus (2007) Stress in health professionals. In Ayers, S. (Ed.), Baum, A., McManus, I. C., Newman, S., Wallston, K., Weinman, J. et al., Cambridge Handbook of Psychology, Health and Medicine (2nd ed.). Cambridge: Cambridge University Press
© Copyright 2024