Crisis, presuicidal syndrome,
burnout
Eszter Tisljár-Szabó
[email protected]
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