Author: Woman, psychiatric nurse
The path into exhaustion
I am a psychiatric nurse. I worked at an open psychiatric day-care unit for adults when I became burnt out in November 2012. The reason I met the wall was probably a mix of extreme overload at work for a long period of time, combined with me being very sensitive and dutiful. I took on too many duties and was also given responsibilities that went beyond regular operations. I didn’t even understand I could have said no. And when it gradually dawned on me and I tried to put my foot down, my supervisor didn’t even understand that I meant what I said. Putting it simply; I burnt out in a job I loved.
Following several attempts to get back to work, first in my old position, but after a while via work trials at other companies, I eventually collapsed completely. A severe cold and throat infection depleted the last sources of energy I possessed. The burnout transitioned into extreme fatigue including oversensitivity to light and sound, pain, poor concentration, heart palpitations, etc.
A day in my fatigued state would look something like this: Get up. Have breakfast. Rest. Thinking I ought to get out. Pull on woollen underwear. Rest. Put on outer garments. Rest. Put my shoes on. Rest. Fill a thermos cup with tea and drive to the beach. Bring cushion and walk 50 metres out to the jetty. This distance was in fact a bit too far for me. I could sit there at the jetty for a long time, watching the tide come in. Eventually I would walk the seemingly endless stretch back to the car and drive home. More rest. Cook a simple dinner, which might involve frying fish cakes and preparing a vegetable mix as a side. Sometimes this would take up so much energy that I would need to rest again before I could eat. I would then need to reheat the food in a microwave. I sat up to eat but would have to lie down and rest several times throughout the meal. The food I ate had to be easy to chew.
My energy levels were so low that I had to choose between taking a shower or cooking a meal. If I made dinner, I might be laid down for days afterwards. I could not see any connection between my activities and the extreme fatigue that would overwhelm me afterwards, often accompanied with intensive bone aches. There were simply no logical explanations.
The process leading back to a healthy life
I received excellent help from a psychologist to deal with my depression that accompanied the fatigue. The depression lifted, but the intensive fatigue remained. After a while the psychologist had nothing more to offer, and I had nothing more to talk about.
She recommended that I was examined for ME. In that connection I completed an assessment at her offices. There were no specific findings, in other words: Nothing to report.
“Psychologically” I had been cleared, but “physically” I was stuck in an enduring and intensive exhaustion.
I was determined to not get an ME diagnosis before I went to the hospital for my examination. In hindsight I can see that I toned down symptoms, and as soon as I got there, I told them I did not suffer from ME. I also had my period and felt mentally stressed out, something which I omitted to tell them, as well.
The overall assessment concluded that I did not, at that point in time, meet the criteria for the diagnosis, and they considered my symptoms to be of a psychological nature. They did also say that I might have had ME before, and that there was no clear knowledge of what ME actually is. I was tremendously relieved to NOT get the diagnosis. In fact, I believe it aided my recovery.
All the same, the advice and guidance I received was as though I actually did have ME. I was told not to expend more than 70 % of my energy, etc. They took a dim view of the Lightening Process (LP) and warned me against overdoing things.
During this treatment I felt that was given help and support in accepting myself and my life. When friends and family asked me how things were, I could eventually say in all honesty that: “things are not so good, but I am good”. Despite the bad situation, I felt I was doing well.
As well as seeing a psychologist, I worked on my diet. I took some internet courses and learnt how to eat to stabilise my blood sugar and to reduce the symptoms of intestinal imbalance. Throughout my burnout period and the ensuing fatigue, I developed severe stomach problems. This course taught me how to improve my intestinal functioning and boosted my energy. Nevertheless, l had a long road ahead of me towards recovery.
I had my own flat, I did not have any children or other social commitments. I was financially secure, and I had good helpers around me. Despite all this, I was not able to get back on my feet, not until I attended the LP course. That was a gamechanger.
The road leading me to actually taking a course was a long one. I Googled and read about LP, I tried to figure out whether this might be helpful, but most hits seemed to focus on the negatives. I asked various health practitioners but nobody responded in a positive manner. I asked several people whether I could be ‘thinking myself sick’, but they all answered that I was not the type. However, after getting in touch with a person who had been diagnosed with the ME and who had become well again through the LP, I finally booked myself a place. I also found motivation and hope in reading the stories that were occasionally posted on the Recovery Norway website. I have often reflected on my process, and many times have I come back to these ‘well-again’ narratives.
Prior to attending the course, I tried to inform myself about what the LP is and found some echoes of the treatments carried out at the psychiatric ward that I used to work at, but all the same, I had no clear idea of what the LP actually was. It seemed incomprehensible that one training course could cure all my physical symptoms, but I noticed that my first conversation with the practitioner made me feel optimistic. I did believe that I could recover, although I had no idea how this might in fact come about.
What happened at the LP course?
I attended the course together with my sister in December 2017. At the course I learnt about the brain, the nerves, and the body’s stress response. I had several Eureka! moments related to things I knew from the psychiatry, especially concerning triggers and how they can reawaken memories and induce symptoms.
I was taught how the language we use will impact our sensory ailments. I remember not fully understanding it and getting a little upset. All the same, I decided to take it onboard and found that it gave me hope and a feeling of freedom. “What if I actually can do something about these symptoms myself?”
The ability to separate facts from assumptions was another theme. What is true and what is a conviction? I had had many convictions related to my health, for example that I was unable to concentrate for more than 30 minutes tops. At the course I discovered that I was in fact able to focus and stay concentrated for four hours, three days running, with only short breaks. I remember being surprised that it was actually doable.
In conclusion, the practitioner urged us to reflect on our relationships. We were encouraged to socialise with those that support and cheer us on in the demanding process that this rehabilitation process will be. It is now, after the course, that the real work begins.
The time after the LP course; rehabilitation and work practice
Pretty soon after the course, in January 2018, I got a reference from NAV (the Norwegian Labour and Welfare Administration) to a company that helps people get back to work. I was given a dedicated supervisor who I worked with for about a year and a half. For the first six months following the LP course, I was often ill. I suffered frequently from a sore throat, and often had to end the meetings with my supervisor because I couldn’t speak. I was often hoarse, with flu-like symptom and had to work really hard to stop myself falling back into the pattern of fatigue that I had been in. I was often unable to distinguish between a real cold and ‘fatigue symptoms’ as these were completely identical.
One of the instructors was a personal trainer and I was given a lot of follow-up by him, too. I was given the opportunity to train strength, balance, and coordination, and he was also helping me sort out which of the symptoms I had. My sickness history had left me rather confused with respect to the signals from my body so that I was struggling to interpret my exhaustion, whether to relax or to train harder. They helped me with this. I had lost contact with myself and experienced all symptoms alike. Just regaining my physical strength and gradually understanding my own physical signals better, gave me the self-confidence and courage to continue the rehabilitation process.
I also made a major, important discovery when it came to training, which was that I developed fatigue symptoms from taking a gentle stroll in places where I had walked a lot when I was sick. There were so many times I had tried to build up my physical strength by going for walks, and sometimes getting so exhausted that I could not understand how I would be able to get back home again. There were times when I could not walk more than hundred metres before I had to turn around and go home. These areas brought back such bad memories that I had to find another way to exercise. Lifting heavy weights was better than taking light strolls in the neighbourhood, because the latter triggered reactions such as pain and exhaustion. This to me was a clear example of how triggers can cause reactions and symptoms, just as we learnt at the LP course and the same as I have been taught in trauma theory.
I also made a major, important discovery when it came to training, which was that I developed fatigue symptoms from taking a gentle stroll in places where I had walked a lot when I was sick
I tried to get back to my old job but discovered that it didn’t work. There were too many triggers in that workplace. I therefore started doing work practice in a second-hand shop which is run by the sheltered workshop where I had my follow-up. I was in training for a few hours three days a week. Now the challenge was how to relate to colleagues, work hours and rules. I quickly found my place in a corner inside the storehouse, sorting out second-hand curtains and tablecloths that were handed in.
While training my work capacity, I also had to work hard with all the feelings that arose along the way. The stark contrast, from being a competent nurse at a psychiatric ward, to doing work practice in a sheltered workshop, was glaring. Standing in my corner at the storehouse made me think; here I am, a trained specialist nurse and all that I am capable of is sorting out curtains and tablecloths. I had to stop, take it in, and accept it. This way I embraced and befriended defeat before I was able to turn it into capability.
Whilst working at the psychiatric ward I was often told how good and skilful I was, and simultaneously given extra duties. This meant that the word ‘good’ became stressful to me, even many years later. During work practice I discovered that I could not cope with praise because this would trigger my sense of duty and thus also the associated flu symptoms. This made me stop and reflect about what was going on. I discussed it with my supervisor who wisely allowed me to work myself stronger at my own pace and without too much feedback.
As time went by my job duties grew, always in agreement with my supervisor.
I went through periods of relapse, in which my body switched back into stress mode. Had I followed my old reactions, I would have taken a few days sick-leave and stayed at home to rest. However, the knowledge I had gained from the LP course, along with my experiences from the psych ward, meant I had to take a different tack. I spoke to my supervisor and we agreed that we would INCREASE my working hours with an extra day. The reason being that I had too many triggers in the pattern I had created for myself in my own flat. I needed help to break with these. So, while increasing my work hours, my supervisor agreed that I should work slowly, with many short breaks. This way I was able to counteract my stress response and thus also the flu symptoms.
NAV had allocated me a year of follow-up from my supervisor and I had been led to understand that there would be an extra year if the process was good. In the autumn of 2018, we had scheduled a joint meeting with my doctor, supervisor, and my case handler at NAV. To my surprise NAV sent a totally new case handler, whom I had never met before. She informed me that the NAV office had decided that I should be classified as fit for work as of January 2019 and that I would be given six months to find a job. In the blink of an eye, my situation had been turned upside down; from having plenty of time, to suddenly just having a couple of months.
This was the biggest stress test I had ever faced. The symptoms of fatigue rolled in, and I found it extremely unpleasant to be given this message from a total stranger. However, I mobilised strength through reflecting on everything I had managed to do over the past year. I made my mind up to that I would handle this, although I had no idea how.
Over the next weeks I received close follow-up by my supervisor. I was forced to go through the mental process of looking for a suitable job. I was terribly despondent. All I wanted was to stay in my safe surroundings in the sheltered workplace, but I had to break up. During this process, I came across a job advert for a substitute nurse in community care. Feeling very uncertain that I would ever be able to work in health care again, I nonetheless decided to call the manager. My story did not seem to frighten her off, on the contrary she invited me in for a chat. I was given the opportunity to get work practice there before going into temporary position of 60%. I gradually increased my workload to 70, 80 and currently 90% working day. What helped me feel that I could cope was the excellent follow-up I had from the manager. I have had some adjustment during periods when I’ve been overwhelmed by stress. The dialogue I’ve had with my manager has made me feel secure that I am allowed to stay in my own process in a stressful working day. Without this dialogue and facilitation, I might easily have had to drop out again. Understanding and support is extremely important in working life and I am surprised as well as grateful that my manager would give me a permanent position, despite knowing all about my past history and my vulnerability in stressful conditions. She trusted me and chose to make it possible for me to regain my strength and my confidence in my job as a nurse.
Now I am fully fit again and I am employed in a 90% position as a nurse in a hectic and often unpredictable job. I cope well with the stress and I have the energy for after-work activities. If I want to, I can do extra substitute duties when needed. The flexibility feels good.
From the day that I collapsed with burnout and until I recovered my health, almost seven years went by. They were seven long years that taught me a lot and provided me with a profound insight into the interaction between our psyche, body and not least, our environment.
Reflections
When I was doing my specialisation, I wrote a thesis about trauma. The knowledge gained from that, as well as my work experience from working in psychiatry, has come in very handy in my own rehabilitation process.
Here is an excerpt of something I wrote at my final exam. I feel it is still valid and has gained a much stronger personal relevance.
”As an introduction to trauma theory, I would like to present a philosophy which is often used where trauma is concerned. This is Maurice Merleau-Ponty’s philosophy. He claims that the world is only accessible through our senses but joined with a cognitive awareness, the senses gain importance in the way of self-experienced action and self-reflecting experience. Put together these make up a very special lived meaning (Kirkengen 2009).
His starting point is our existence as a body and Merleau-Ponty underlined that it is as bodies that the human being appears to the outer world and how it understands and seeks meaning. The body is by nature an experienced body, and one means that perception is a pre-condition for our being in the world (Gretland A 2007). I understand this to mean that one experiences being through our senses, and through our senses we form a picture which is then taken in as perception, i.e. the way sensory impressions are understood.
My understanding of this is that the body is senses, and the senses are body. By this I mean that we can see, hear, smell, feel and taste and everything this does to our physical bodies. But the different sensory perceptions take on different meanings, depending on our previous experience. I could illustrate this with the smell of a fire. Two people smell fire, one of them has a lot of experience with pleasant outdoor hikes and consequently associates bonfires with good memories. This person finds it pleasant and calming. Person number two, however, has experienced being trapped in a burning house, and the smell of a bonfire is perceived as a stinking, dangerous smell. The person is reminded of pain and fear. Both these people had the same sensory stimulation but interpret these impressions differently and thus their perceptions are different. Our lived lives have given meaning to our sensations and the body is lived with its experiences.
It follows that man’s basic and common condition of life is that we exist as bodies. There is no body-less thought, nor is there any body-less feelings (Kirkengen 2009). Because we know that both joy and sadness fill our bodies until we feel like we are overflowing, or we are about to go under. Our experiences are bodily and therefore a traumatic experience will not impact solely on our thoughts but the body as a whole. This does something to the complete ‘experiencing’ human being.”
These were ideas I could relate to at the course and something I kept coming back to during my rehabilitation process. To understand how memories are stored has been essential for me in managing to break free from all debilitating symptoms.
It is often said that during the LP people learn to ‘think themselves’ well again, but actually it is not a matter of ‘thinking themselves well’ but rather ‘understanding themselves well’. The LP is well aligned with trauma treatment in the recognition of triggers, identification of symptoms and stopping them. Falling seriously ill is a traumatic event.
It is not a matter of ‘thinking themselves well’ but rather ‘understanding themselves well’
I believe chronic fatigue patients develop a separation between the emotional part of their personality and a ‘normally functioning’ part, just like trauma patients do.
For a severely traumatized person to be able to be well-functioning in their daily lives, it is necessary to split away painful memories. Many seem to cope well in their daily lives, as long as they are not exposed to triggers and bad memories. But as soon as the triggers are raised, daily functionality is impaired and anxiety and depression occur. Experiencing triggers along with the associated reactions will often lead to avoidance, which tends to expand.
ME patients, as well as burnout patients and people suffering from chronic fatigue, have found that certain activities will lead to symptoms, so that they simply try to avert these more and more. These patients are positive, they try and they try, often putting more pressure on themselves than they can bear, making them ill. Some people say they felt ‘more ill’ after an LP course, because they were told to ignore symptoms and keep going. Based on the understanding I have, I would believe they keep going, whilst still maintaining a separation between feelings and functions in their daily lives. It is like putting on blinkers, without relating to the ensuing emotions. And this is not what we learn at the LP.
When I was trying to work again after the LP course, I defined myself as well towards the outer world. I was not well, but it was important to create a new label. Simultaneously I removed the protection I had in being sick/exhausted. I had to face life and stress without that comfort and that thought alone was sufficient to bring about symptoms.
As mentioned above, I was able, when I was still very sick, to sincerely say that ‘things aren’t too good, but I am good’. I believe I was able to do so because I had constructed a sort of defensive wall internally, against the grief of being ill, the expectations from myself and others. This gave me a sort of acceptance which was a vital survival strategy which helped me to cope with the massive despair and sorrow I felt. I see it as a kind of avoidance which also aligns with the avoidance developed by trauma patients. The difficult emotions must be kept at arm’s length for me to even pick up the courage to go back into society and meetup with friends and acquaintances.
Working as a psychiatric nurse means I have worked a lot on teaching patients to act to the opposite of emotions. I used this actively on myself when I felt my body was screaming for rest. I had to stop, take my feelings seriously, and place these symptoms where they belonged. Gradually I had to integrate these feelings into my everyday life, step by step. I am now referring to my feelings of shame, the expectations I had, the expectations others held, the sense of duty and responsibility, the feeling of loneliness in my situation. I had to relate to all these issues, while slowly working myself onto a healthier level. I am grateful I was allowed to do this in a safe environment, in a sheltered workplace with a good supervisor.
I feel lucky to be surrounded by good helpers. I have a leader I can talk to if I feel stress building up and who will adjust my workload for a while if needed. This gives me a sense of safety and trust that I will be looked after if I need it. I can now face the world, be naked and vulnerable, but without the fear of being overcome by emotions. I have been able to integrate difficult feelings inside me and no longer feel a fear of for example being confronted with having been outside working life. The shame I felt over this is now gone.
The way I see it, both the LP and trauma treatment teaches you to integrate your feelings into everyday life. It is like a zipper which you slowly, tooth by tooth, join up to become a whole person once more. This is a process which must be learnt and done as one proceeds. New experiences and accomplishments must be created. It is not about thinking yourself well, but about understanding yourself well again.
