Dec 19

Burnout or Boreout – in the last issue of the ‘counseling Corner’ / this blog I have already mentioned that people being ‘bored out’ often show similar symptoms to people suffering from high amounts of work-related stress.
Interestingly, on a physiological level, the neurological and hormonal changes are quite similar between both of them, and their consequences are as well. Just as burnout, being ‘bored out’ is seen as a cause for diseases of the cardiovascular system (heart, veins and arteries), the digestional system, and it also might raise the risk for autoimmune diseases.

Here are 3 typical indicators for a burnout dynamic:

  • Physical, Mental and/or Emotional Exhaustion: Free time snaps away in a blink without any feeling of recovery or relief (burnout) or it seems to be never-ending with eating being one of the few highlights of the day (boreout).
  • Depersonalisation / Cynicism: Unfeeling and impersonal attitudes and reactions towards others, particularly with people you are dealing with on a regular basis. The goal of this behavior is seen as an effort to create distance between oneself and the ones who are causing discomfort.
  • Reduced Appraisal of Accomplishments: You might feel that you don’t achieve anything remarkable anymore, wasting your time. A feeling of failure and insufficiency is indicating an increasing loss of trust in our abilities.

The main problem in dealing with progressed forms of burnout is that we don’t have access to our usual resources of energy, creativity and a positive mindset anymore that could help to gain ground again. Instead, you as a ‘burned out’ person might make your situation even worse by trying harder to succeed or to gain control again.

Basically, every strategy to deal with the burnout process must relate to reducing the workload and to find balance again. But for that, quite dramatic turns might be required, like to take some time off or maybe even a ‘sabbatical’ leave.It might also turn out that organizational changes or adaptations to one’s self-management might be required in order to avoid ending up in the same situation again. Often enough, it doesn’t help to blame a company or a ‘situation’ for one’s burnout since to a very high extent, it is actually our own psyche that makes us vulnerable and causes us to have a tendency to drift towards boreout or burnout. It is also us who have to find means to find back to happiness again. From a professional standpoint, it is essential to do that as soon as possible (instead of waiting for irreversable damage to one’s health), and ideally, to get professional support for it as this can remarkably reduce the time required to regain stability and to find balance again.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011; Image credit:

Dec 19

“Burnout in Thailand? Impossible!”

That’s probably what most of us would think. But symptoms of ‘burnout‘ are not always linked to high workload alone, they can also have other causes. I have identified 3 groups of people that are vulnerable to symptoms of burnout, even in a sunny, tropical country like ‘mai bpen rai’ (‘everything up to you’) Thailand, but of course also other tropical countries abroad:

First, there are the foreigners who try to make a living here and who are employed by foreign or local companies. Often, they have to face high amounts of work-related pressure and stress right from the beginning of their assignments, while having arrived completely unprepared for the cultural changes they would have to face. Many are surprised and overwhelmed by how hard it can be to ‘juggle’ giving up the old life, finding and adapting to a new home, new colleagues and their work ethics, and learning how to get around and at the same time, to meet all the expectations they put on themselves.

Then, there are foreigners who try to start their own business in an Asian country like Thailand. These expat entrepreneurs are completely on their own, having thought that their experiences as tourists should have prepared them well enough. Soon, however, they face all kinds of obstacles in building up a successful business venture here as foreigners. Many things don’t work out as they would have back home with the same effort and money put into the project. Many little annoyances might gradually not only take the fun out of their dream of working in an Asian country, but lead to outright frustration and the feeling of never reaching a point where everything runs smoothly. And I haven’t even mentioned dealing with governmental institutions and paperwork.

Finally and probably surprisingly, even retiring in Thailand (but just as well in any other tropical country) can lead to ‘burnout’. I already mentioned the huge changes a migration to another country involves, and even if everything started happy and smoothly, after some time, the excitement might gradually fade away, perforated by disturbing or even annoying little experiences, social isolation or conflicts with other people. Also, many Westerners suffer from a lack of challenge and communication: they are bored out by the daily routine that kicks in after a while and feel stuck between meals, drinks and hanging around without any kind of challenge. Even finding someone to talk to at a certain nouveau level might prove difficult. But being ‘bored out’ has many physical similarities to burnout and might gradually make us just as sick and depressive. So it is important to take these signs seriously and fight them at an early stage before one gets overwhelmed by his or her own negativity.

In an followup entry of my blog, I will write a bit more about typical symptoms of burnout and boreout, and also outline strategies on how to deal with them.

(This short article is the blog-adapted version of an article dealing with psychological expat problems and general mental health issues that was published in various newspapers and magazines in Thailand, 2011; image credit: Shiho Fukada, NYT)

Oct 31

There is a weakness that is particularly frequent among people in service professions, causing burnout and depression rates in the service industry to be some of the highest.

The ‘Helper Syndrome‘ describes a strong drive to make other people feel better. In some cases it is done to ease or divert the helpers from their own pain. But by no means you have to be a ‘professional’ helper to behave this way, it can be a friend, neighbor, associate or yourself who is vulnerable to getting pulled into responsibilities and tasks that others wouldn’t even think about taking at the first place.

The Helper Syndrome can contribute to outright abusive forms of relationships: the ‘helper’ might increasingly experience signs of burnout or feel exploited, and their highest efforts might increasingly be taken as a matter of course with little gratitude for their support – no matter how much energy the helper invests, he might never get to a point where everyone is satisfied.

Another unhealthy aspect of the helper syndrome can be a lack of self-awareness and abuse of the responsibility a helper has towards the helped. This is because a helping relationship is typically unbalanced; people are not on equal footing. A good helper will be sensitive to the imbalance, while an abusive helper will ignore or even seek it. Instead of supporting the other in becoming stronger or looking for additional (often: professional) means of support, the helper tries to keep them dependent, and focuses on reaching their very own goals. To achieve their goals they might even abuse their power, or the trust of the recipient.

So whether the motives for such behavior are altruistic (‘I want to give something back‘, ‘I don’t want them to do the same mistakes I did‘, ‘I want to share‘, ‘I can do it!’) or driven by dubbing their own psychological issues, it is always a sign of emotional imbalance and exploitation, of oneself or others, if someone ignores their own limits and tries to ‘fix’ everything only by themselves.

Typical forms of ‘helper’ relationships are: long-term relationships of non-addicts with addicted, aggressive, selfish or controlling personalities or relationships defined by a strong imbalance (with one partner being the ‘teacher’, ‘the sugar-daddy’ or ‘the boss’). They are functional for both, but quite resistant (and vulnerable) to change, which prevents at least one of the partners from achieving greater self-esteem and realizing his or her full potentials. While professional helpers can use supervision to reflect their work, in our private lives we can just try to take care for ourselves to avoid getting entangled in dysfunctional helping ambitions.

(Picture credit:; This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 20

Myalgic Encephalomyelitis (ME) – besser bekannt als Chronic Fatigue Syndrome (CFS) – betrifft rund eine Million Menschen in den USA und noch mehr in Europa. Dennoch gibt es viel zu wenige intensive Forschungsinitiativen, kritisieren Experten in einer Aussendung. Die Zahl der Patienten steige an, aber das Wissen ĂŒber mögliche Behandlungsmethoden fehle.

Im Krankheitsverlauf zeigen sich meist neurologische, immunologische und endokrine AuffĂ€lligkeiten. Die Ursachen sind – trotz einer Vielzahl von Studien, die vor allem auf biologische und Umweltfaktoren abzielen – bis heute ungeklĂ€rt, es gibt nicht einmal laboratorische Tests oder Biomarker, die Hinweise auf bestimmte organische Komponenten geben könnten. Zu den hĂ€ufigsten Symptomen von CFS gehören Muskel-und Gelenkschmerzen, kognitive Schwierigkeiten, chronische geistige und körperliche Erschöpfung bei vorheriger Gesundheit und normaler AktivitĂ€t. ZusĂ€tzlich mögliche Symptome sind MuskelschwĂ€che, HypersensibilitĂ€t, Verdauungsstörungen, Depressionen, reduzierte Immunabwehr sowie Herz-und Atemwegserkrankungen – bemerkenswerterweise alles Symptome, die auch beim Burnout hĂ€ufig sind. Es ist jedoch unklar, ob diese Symptome einander gegenseitig verstĂ€rken oder nur das Ergebnis der “eigentlichen” CFS sind. Um die Diagnose CFS zu rechtfertigen, dĂŒrfen die Symptome nicht durch andere Erkrankungen verursacht werden.

Das Resultat der schlechten Forschungslage und Information ist wohl, dass die Krankheit oft jahrelang undiagnostiziert und unbehandelt bleibt. Das Vorkommen der Krankheit und ihr Einfluss auf das Gesundheitswesen sei höher als besser erforschte Krankheiten wie Multiple Sklerose oder HIV, so der belgische Forscher belgische Kenny De Meirleir. ME/CFS ist ihm zufolge eine chronische Krankheit, die die LebensqualitÀt der Betroffenen enorm einschrÀnke.

Professor Luc Montagnier – NobelpreistrĂ€ger 2009 fĂŒr Medizin – meint, dass das Wissen, das ĂŒber das Syndrom bereits existiert, medizinisches Personal aber entweder nicht erreicht oder es zu wenig ernst genommen wird. Montagnier, einer der Mitendecker des HI-Virus, unterstĂŒtzt einen neu gegrĂŒndeten Think Tank zur Erforschung und Bewusstmachung der Krankheit. Die mit diesem verbundene Organisation “European Society for ME” (ESME) hat das Ziel, das Bewusstsein und die Forschung fĂŒr die ernst zu nehmende Erkrankung interdisziplinĂ€r zu schĂ€rfen.

(Quelle: European Society for ME)

Jan 20

Nach einer Analyse der Daten von 2.755 mĂ€nnlichen Angestellten, welche zu Beginn einer kĂŒrzlich abgeschlossenen Studie des Stressforskningsinstitutet der UniversitĂ€t Stockholm noch keinen Herzanfall erlitten hatten, zeigte sich zumindest fĂŒr MĂ€nner eine Assoziation zwischen “unterdrĂŒckter BewĂ€ltigung” infolge einer unfair gefĂŒhlten Behandlung und gesteigertem kardialem Risiko.

FĂŒr die Untersuchung wurden die verschiedenen Strategien, Dinge fĂŒr sich zu behalten, als unterdrĂŒckte BewĂ€ltigung definiert. Die Teilnehmer wurden gefragt, welche Strategien sie anwendeten: Ereignisse vorbeigehen zu lassen ohne etwas zu sagen, aus einem Konflikt einfach auszusteigen, Symptome wie Kopf- oder Magenschmerzen zu haben oder zu Hause schlechter Laune zu sein. Faktoren wie Rauchen, Alkohol, körperliche AktivitĂ€t, Bildung, Diabetes, Anforderungen im Beruf und Entscheidungsfreiheit wurden berĂŒcksichtigt, Blutdruck, BMI und Cholesterinwerte gemessen. Die MĂ€nner waren zu Beginn der Studie in den Jahren 1992 bis 1995 durchschnittlich 41 Jahre alt. Informationen ĂŒber einen Myokardinfarkt oder Tod aufgrund eines Herzanfalls bis zum Jahr 2003 wurden aus den nationalen Datenbanken zu Krankenhausaufenthalten und TodesfĂ€llen entnommen.

Bis 2003 hatten 47 der 2.755 MĂ€nner einen Myokardinfarkt oder starben an einer Herzerkrankung. Jene, die hĂ€ufig oder oft einfach einem Konflikt auswichen oder nichts sagten, verfĂŒgten ĂŒber ein doppelt so hohes Herzrisiko als jene MĂ€nner, die sich unangenehmen Situationen stellen und versuchten sie zu lösen (2,29 [95% CI 1,00-5,29]). Kopf- und Magenschmerzen oder schlechte Laune zu Hause erhöhten das Risiko nicht.

(Quellen: J Epidemiol Community Health; 2009, Nov 24; MedAustria)

Jul 22

At a conference organized by the Health Promotion Fund for a Healthy Austria, experts recently lectured on approaches to resolve critical future scenarios. One of the core points was the question of the affordability of health care.

Obesity is one of the most pressing health problems and is consistent across all age and social groups. One in five pupils between six and 15 years has an excessively high body weight, eight percent of them are actually obese. Of the adults between 18 and 65 years, almost half are overweight or obese. “One consequence of these developments is an increasing wave of disease and therefore costs to the health care system, because being overweight is a major risk factor for cardiovascular disease, type 2 diabetes and certain cancers,” said Ch. Hörhan, head of the funds.

Stress, on the other hand, is an indirect co-causing factor for cardiovascular diseases and mental disorders – albeit indirect and thus often underestimated by health policies. According to surveys, the percentage of Europeans feeling stressed out has raised significantly over the last 10 years. The number of prescribed psychotropic drugs has also increased, as has the number of sick days due to mental problems according to one of the contributors. Among the reasons for invalidity pensions, mental illnesses is already in second place with 29 percent.

Stress can not only be caused by heavy workload, but also by financial problems, difficulties within the social environment or worries about the future. In the past few years, the influence of social, economic and social factors on the health of the population has become clearer – but still with only little consequence on health policies.

Sidenote by R.L.Fellner: according to latest research, apart from other hormonal changes involved by stress, cortisol distribution increases – under certain conditions, this can be a contributing cause for obesity (Cushing’s Syndrome / Hypercortisolism [more]).