Presented at the CCIH Annual Conference
May 29, 2006 by Ron Mataya, MD, Chair,
Department of Global Health
Loma Linda University School of Public
The Syndrome
• Emotional Exhaustion
• Depersonalization
• Reduced personal accomplishment
– occurs among individuals who do “people
work” of some kind (Burnout: The Cost of
Caring by Christina Maslach)
• A type of job stress
– arising from the social interaction between
helper and recipient
• Emotional overload
• Subsequent emotional exhaustion
– people feel drained and used up
– emotional resources are depleted and
there is no source of replenishment
– people no longer able to give of
themselves to others
• Depersonalization
– detached, callous and even dehumanized
response signals
– developing a poor opinion of people
– expecting the worst from them
– even actively disliking them
• “I began to despise everyone and could
not conceal my contempt. I find myself
caring less and possessing an
extremely negative attitude.”
• Provider may:
– derogate other people and put them down
– refuse to be civil and courteous to them
– ignore their pleas and demands
– fail to provide the appropriate care or help
• Reduced personal accomplishment
– results from being down on others and
eventually on oneself
– feelings of guilt about the way they have
treated others
– gnawing sense of inadequacy about their
ability to relate to recipients
– resulting in a self-imposed verdict of
• “It’s painful to say it, but maybe I ‘m
just not cut out for this kind of work. I
thought of myself as a sensitive and
caring person, but often I’m not
sensitive and caring when I’m with
clients – so I’m really deluding myself
about the real me.”
• Crumbling of self esteem results in
– depression in some people
– seeking for counseling or therapy
– change jobs
• By abandoning any kind of work that brings
them into stressful contact with people
Real Life Situations
• Teacher of a class of 30 students
– must deal with their personal and social
– discipline, influence, shape, manage and
direct their behavior
– face possible friction and hostility from
– uncertainty of layoffs from administrators
– ever-present budget cutoffs
A Mother:
• must care for several young children at home
• without help or support from others
• with no opportunity for a work break
A Minister:
• A source of refuge and support for anyone
seeking help any time
• Has no one to turn to when personal
problems arise
A Police Officer
• deals continuously with seamy side of
• with lawbreakers and victims of crime
• with violence and potential danger
lurking in every encounter with a
A Physician
• Wades in an unending stream of
patients who are sick, upset, angry and
frightened by their illness or its
• The “Who?” question results in:
– Blaming people
provider of care
recipient of care
or both
including self
The “What?” question
• Points us to the situation that is
causing the burn out
– What kind of tasks are they expected to do
and why?
– What settings do these activities take
– What limitations or constraints exist for
them because of protocol, rules, standard
operating procedures?
• “Although personality does play some
part in burnout, the bulk of evidence I
have examined is consistent with the
view that burnout is best understood
(and modified) in terms of situational
sources of job-related, interpersonal
stress.” Burnout – The Cost of Caring
– by Christina Maslach, p. 14
How to handle burnout personal approaches
• Working smarter instead of harder
setting realistic goals
doing the same thing differently
breaking away
taking things less personally
• Caring for Oneself as well as for Others
accentuating the positive
know thyself
rest and relaxation
making the transition
a life of one’s own
Social & Organizational
• Social support
– the companionship of colleagues
– help
– comfort
– insight
– comparison
– rewards
– humor
– escape
Improvements in the Work Place
• Getting more resources
• Doing it better
– dividing up the work
– changing the contact with clients
– limiting job spillovers
– taking time off
– getting help
The Serenity Prayer
“God, grant me the serenity to accept the
things I cannot change, courage to
change the things I can, and wisdom to
know the difference”.