PSYCHOTHERAPY - Psychoanalysis - Systemics - Pnl - EMDR

Burning out in childhood, silly and vinegar

Emotional exhaustion, depersonalization and lack of personal accomplishment at work; here we have the three classical axes when depicting burnout. The professional worker of health, education or social services comes to feel that he has no affection and energy left, finds himself  indulging more and more often in cynical attitudes and remarks about the clients or patients, his  tasks  give him no more professional challenges, pleasures and responsibilities. At home after work he only wishes to go into a coma before the TV. And this is no caricature.

Magic is over, work has no longer fun, his former hope to learn and improve things has disappeared, and clients look increasingly like bad people deserving everything that happens to them. And to boot he feels guilty and ashamed for having these thoughts regarding those previously considered ill or victims, for trying not to be assigned this newly arrived case, conceals his feelings when facing colleagues and seeking a bit of solace compares himself with Donald Sutherland and Elliot Gould in MASH or regrets not having written The House of God before Samuel Shem did.

More than an ending state, burnout is considered as an adaptive process to chronic job stress, through which the professional burns just to continue working, either because he can’t stand the idea of having lost his ideals or simply because he cannot quit. There burn those who are ashamed, those who have shame. Properly speaking, burning out at work is the polar opposite of malingering, that faked or self inflicted damage by which the rogue aims at getting a leave, a very dangerous game, by the way, because our mind purports to turn true our lying, and to many workers an actual condition  has turned up to remember him of his lost dignity.

According to the particular point they stress, descriptive and explanatory models of burnout include factors pertaining to the organization, the relationship with the client, the relationship within teams and finally the psychology of the worker. Obviously, though the reasons for stress may come from everywhere they will burst in the professional. The main variable will always be me in front of myself.  Any professional will immediately identify some of these stressors in his daily work context, but now I want to move from this general level to discuss one specific factor susceptible of generating burnout among those who work with abused children.

I mean the default credulity or incredulity.

When we interview families whose children have been tutored by the authorities out of being abused by their grownups, in order to assess their chances of retrieving them, many times we feel compelled to believe they can change. We need to see signs of smoothing and changing on their anxieties, or even of negotiation and resolution of their conflicts. We have already exposed the relational abusing game, we had explored it, we have introduced the crisis in their family dynamics, and they have answered to our remarks and challenges changing their attitudes and behaviour. Sure it may not be enough or these changes may not keep over time, but anyway they are moving on. Besides, it might also be just lip service, trying to seduce us into proposing the administration to give back the children to them, but even so we increase our mental martingales to justify their cunning, worst would be they didn’t have it, and although our ears squeak on hearing how they mouth words not minutes ago we have proffered out, we end up admiring their flexibility, if they can be that flexible this may prove they can truly change, and so on.
We trust by default, that is, we end up (or had begun?) by the possibility that they will no longer abuse their son, and as at any rate the child will continue tutored and followed up by the territorial services… alright, let’s hope that ultimately we won’t end up with a silly face.

At the opposite pole, having undergone several slaps, or depending on whom, not having received any, we take the opposite attitude and cultivate a reconcentrated disbelief. As a colleague once said “biological parents do not change”, so we’d better not waste time going into methods for verifying the accuracy of changes, just keep distance and let us not into the temptation of any therapeutic pride. If they had to mistreat their child to solve their malignant triangulations or neglect him to obey their genealogical tree, then they cannot really change. And if it looks like changing, that is surely a lie, and if it was true… well, we’ll see it in a long, long time. Those who take this attitude, mistrusting by default, hope that in the end their faces won’t become vinegary ones.

Of course I’m drawing here two extreme cartoons; nobody fits entirely into any of them. In addition, there are fortunately a lot of cases in which we face not this crossroad. There are family dynamics so chronically perverted and negligent that nobody will aim at ambitious structural changes, or new narratives of the family history. We seek a better future for the child and that’s all we can do. There are also families already in crisis, within the couple or with their families of origin, in which a child neglected or abused has been an unfortunate side effect. We’ll keep company to the unspoken separation of Mom and Dad along a number of interviews and we’ll worry about coming to an agreement on child custody, visiting and contacts with grandparents and significant relatives.

In the middle remains almost everything else, and in this universe of uncertain cases some professionals will tend to trust their clinical eye on family dynamics and unhappy parents and others would prefer not to see and much less smell the sticky stench of anxiety. Some will run the risk of being fools and others vinegary.

To believe is not to know, we already knew this, as we also know there are a lot of underground movements in these families, of which what we ignore is much greater than what we can prove. We can sustain ignorance as a stage of knowledge, as worthy as any other or we can settle it by a belief. What we can also do is to formulate a hypothesis, which is fine as long as we don’t forget that it is just that, a hypothesis, because such oblivion invariably gets it morphed into a dogma.

Asked about his inclinations, any professional will state categorically that he prefers to sustain ignorance in its dignity and formulate hypotheses to guide observation instead of castling within a belief, but I’m very much afraid that is not what usually happens. The system of children protection is pre-emptively precautionary in front of any risk of abuse. Upon detection of an abuse, the system’s nature will make you react as if its reiteration were a fact, not just an assumption to prove before taking any decision. And this stance has its rationale, which in a very short time becomes obvious to those working in this field; you better act just in case than regret afterwards the damage happened to a child. We live in an atmosphere full of secrets, where what is hidden is hidden because somebody is hiding it.

That’s why we understand perfectly the refuge in unbelief, an attitude we may cultivate to protect us from deception. What is the risk of this strategy? Clearly to get hardened, lose sensitivity, become mechanical enforcers of a manual that will always be incomplete because it does not describe appliances: with no verbally explicit recognition and responsibility of the damage and empathizing with the child for the inflicted pain, we have no positive prognosis to give back the son, without submission to individual or couples therapy we will never take seriously an improvement in family circumstances, and so on. The risk is finally coming to regard ourselves above good and evil, judging people as not even God would do and putting conditions, namely improvement plans, which no family could meet and that if fulfilled too well we’d be left under the appalling suspicion of having been again deceived.

We also understand those whose sin is credulity, those who need to trust in the capacity of changing in order to work with these families. I do not mean that naïf devotee of empathy, straining to wear the shirt of the other guy, an impossible undertaking which if successful may leave the partner shirtless. I mean the therapist who becomes “one of the family”, who digs out and candidly puts his finger on conflicts like a relative who returning home from a long journey finds out how much his family has changed. The one who cordially drops some salt in the wounds, keeping at the same time a sense of humour that even though can be a bit harsh makes all grownups look at  themselves in another perspective within the game they have been playing in. Obviously, the risk is to get trapped, not now in empathy but bogged in sympathy and fascination, even with the horror and crime. Like all those who dive into mysterious territories, if our eyes get used we risk to end up considering appalling phenomena as normal.

We may all incur in both positions, either one or another according to our impulses and we agree that evil lies not in feeling sometimes gullible and sometimes unhappy but that our face is becoming rigidly silly or vinegary.

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