Burnout: How Can I Measure It?

At least half of ministers suffer from burnout sometime during their career. Burnout results primarily from two sources:

  1. First, some individuals work too long without a rest. Because many secular individuals work too long without a rest, they assume that overwork causes burnout among ministers. Although overwork characterizes many ministers, many other factors stimulate their burnout more than overwork.
  2. The second and most prevalent source of burout for ministers results from environmental stressors. These stressors remain mostly outside of their control, and therefore respond little to stress management skills. For instance, King David experienced intense outside stress when King Saul pursued him into the desert. The stress induced by King Saul remained totally outside of David’s control. And with those stressors totally outside his control, stress management principles could never help him. Like King David’s flight from King Saul, most stressors in ministry remain totally outside the minister’s control.
Burnout is a type of depression.

How can I assess burnout and depression?

Hundreds of events and conditions induce depression. Burnout serves as only one of many causes. However, the symptoms of depression remain the same regardless the source. According to the American Psychological Association, depression represents a depressed mood with four or more of the following (SPACEGIS) symptoms persisting for longer than two weeks:

  • S—sleep disturbance (insomnia or hypersomnia)
  • P—psychomotor retardation/agitation
  • A—appetite change or weight change
  • C—concentration difficulty, such as difficulty in making decisions
  • E—energy loss
  • G—guilt or excessive worthlessness
  • I—interest or pleasure in usual activities is lessened or lost
  • S—suicidal thoughts

Of all these symptoms, ministers seem particularly sensitive to guilt. Some ministers feel guilty for failing to win enough converts. Some missionaries in sensitive countries feel guilty for concealing their calling and restricting their evangelism, even while they feel guilty for risking expulsion whenever they engage in evangelism efforts. They feel guilty if they do, and guilty if they don’t. Thus, some ministers deal with chronic inappropriate guilt. If it were appropriate guilt, they would readily ask forgiveness and get on with their lives.

Exercise 2: Looking at the SPACEGIS symptoms for yourself, which symptoms surfaced over the past twelve months? For each symptom, in what way are you now different than the normal you?

According to the American Psychological Association, when an individual suffers from a depressed mood and experiences four or more of the above symptoms for more than two weeks, the individual is depressed.

The PHQ-9 represents one of the most widely used depression screening instruments. The PHQ-9 refines the SPACEGIS assessment by quantifying the symptom severity. The individual simply checks off the frequency of each symptom over the past two weeks and totals the score (score the “Not at all” category as 0 in the Subtotals column). For example:

PHQ-9 Symptom Checklist (Kroenke, et al.,   2001)
Over the last 2 weeks, how often have you been bothered by the following problems? Not at all Several days More than half the days Nearly every day
  •   Little interest or pleasure in doing things

  •   Feeling down, depressed, or hopeless

  •   Trouble falling or staying asleep, or sleeping   too much

  •   Feeling tired or having little energy

  •   Poor appetite or overeating

  •   Feeling bad about yourself, or that you are a   failure

  •   Trouble concentrating or things, such as   reading

  •   Moving or speaking  slowly

  •   Thoughts that you would be better off dead

Subtotals

3

4

9

TOTAL SCORE: 16

Typically, a total score under 5 is normal, the 5-9 range represents a minor depression, 10-14 represents a fairly mild to moderate range of major depression, 15-19 represents moderate to severe, and 20 and above represents a severe depression.

When left untreated, a mild depression (burnout) almost always progresses into a major depression.

However, three conditions can stimulate the same symptoms as depression: 1) bereavement (within two months of loss), 2) some specific medical conditions, 3) or drugs. Thus, depression is ruled out when any of these three conditions exist. Ilardi (2009) notes that some medical conditions can induce depression symptoms including:

  • Hypothyroidism
  • Anemia
  • Malnutrition
  • Hepatitis
  • Sleep Apnea
  • Diabetes
  • Reproductive hormone dysregulation
  • Stroke
  • Dementia
  • Heart Disease
  • Cancer

Some drugs that may induce depression symptoms include:

  • Beta-blockers
  • Benzodiazepines such as Ativan, Xanax, Klonopin
  • Alcohol
  • Narcotics
  • “The Pill” / HRT
  • Fluroquinolone antibiotics such as Cipro, Floxin
  • Anticonvulsants

Always consult a physician when you first notice the symptoms of depression. The physician will need to rule out these conditions before prescribing any medication.

In North America, about 12%-14% of men and 22%-24% of women experience major depression at some time during their lifetimes. Of those who experience depression, about 80% will suffer from recurrent bouts over their career. For ministers, the rate seems about double the rate for secular individuals. For missionaries and pastors in countries outside North America, the rate seems higher yet. If Kroenke’s data is correct, a downcast spirit and depression will negatively impact any mission or church agency’s medical budget if not addressed with preventative care (i.e., preventative training in principles for resilience). More important than the medical expense, depression significantly reduces productivity of the average minister for at least two years when left untreated, causes conflict between coworkers, and negatively affects all team members including the entire church congregation.

What causes stress for ministers?

Holmes and Rahe (1967) published a well-known study on stress. They derived a stress scale (standardized from 1 to 100 with 100 representing the highest level of stress possible for any single event). By averaging perceptions between thousands of individuals, they found that the events of life commonly induce the following stress levels:

EVENT                                   Level

  •   Death of spouse                    100
  •   Divorce                                    73
  •   Marital separation                    65
  •   Jail                                           63
  •   Death of a family member       63
  •   Personal illness/injury             53
  •   Marriage                                  50
  •   Fired from work                       47
  •   Retirement                               45
  •   Family illness/injury                 44
  •   Pregnancy                               40
  •   Sexual problems                      39
  •   New family member                 39
  •   Business readjustment         39
  •   Change in financial state      38
  •   Death of a close friend            37
  • Change in spouse arguments   35
  • Mortgage > 2.5 X income          31
  • Foreclosure                               30
  • Change in work functions      29
  • Child leaving home                    29
  • In-law troubles                           29
  • Outstanding achievement       28
  • Starting/quitting school          26
  • Wife starting/quitting work     26
  • Changed living conditions     25
  • Revised personal habits         24
  • Troubles with boss                    23
  • Change in residence               20
  • Change in working hours       20
  • Change in schools                  20
  • Change in recreation habits  19
  • Change in church activities   19
  • Change in social activities     18

By summing the scores for each event that occurred during the past twelve months you can determine your approximate stress level. Some of the above stressors relate to traumatic events while others relate to lifestyle transitions. Please note that the events highlighted in bold represent stresses induced by transition to a new church assignment or into a status as a foreign missionary. By summing the events shown in bold, you will note that the average newly assigned minister or first-term missionary experiences about 326 units of stress due to transition to the field of his or her calling. After completing language school, missionaries usually transition to a new location and experience all these transition stressors for a second time within their first term. In contrast, the average North American lives year-to-year with a score of about 100 from all factors, combined.

Holmes and Rahe found the following in their research:

  • Those with a score between 150 to 199 have a 37 percent chance of minor illness in the next two years.
  • Those with a score between 200 to 299 have a 52 percent chance of minor illness in the next two years.
  • Those with a score over 300 have a 79 percent chance of major illness within the next two years.

Thus, transition to any new ministry assignment (and especially to an overseas assignment), may cause an unhealthy stress level. However, the Holmes and Rahe scale accounts only for events common in the everyday North American culture. It fails to account for environmental and cultural stressors common to ministry in many parts of the world. For instance, other highly stressful events (especially in less developed countries) that ministers sometimes face include:

  • A chronic lack of security
  • Driving hazards
  • Isolation
  • Culture shock
  • Assaults on self-esteem

Foreign missionaries also get to experience the stress of language school. Each of these six chronic environmental and cultural stressors is roughly equivalent to the 29 units of stress brought by a “change in work functions” shown in the above chart. Thus, the average minister arrives to his or her new assignment with approximately 326 units of stress from transition. In some cultures, the six unique environmental and cultural factors above can add another 174 units of stress for a combined total of 500 units of stress.

In addition to the transition stressors and environmental/cultural stressors, some ministers (especially missionaries and ministers in many third world countries) also experience crises that are unique but common to their culture. These crises include events such as:

  • Severe auto accidents¾now tied with armed robbery as the leading cause of death for missionaries worldwide
  • Armed robbery—especially common throughout Latin America, Africa, Eurasia, and Eastern Europe
  • Assault
  • Car-jacking—especially common throughout Latin America, Africa, Eurasia, and Eastern Europe
  • Kidnapping—common in Latin America and Africa
  • Civil war and insurrection—almost a norm in much of Africa
  • Natural disasters
  • Expulsion—always a problem in sensitive countries, but now common even in Western Europe

When any of these crises threaten personal death, it is roughly equivalent to the 53 units of stress brought by a “personal illness or injury.” When any of these crises threaten your spouse or children, it is roughly equivalent to the 44 units of stress brought by a “family illness or injury.” However, intentional man-made stressors confer the most damage. For a man-made crisis, jail time (at 63 units of stress) represents a more equivalent level of stress.

A single act of expulsion (either expulsion as a missionary from a country or expulsion as a pastor from a church) usually produces enormous stress. Initially, it seems equivalent to being fired from work (47 units). Unlike a secular individual who loses his or her job, however, an evicted missionary or minister also experiences all the transition stressors (another 174 units of stress) upon expulsion. Missionaries and pastors who change fields or churches involuntarily attest to the devastating effect of that event. Expulsion due to political decisions within a country confers a severe effect—about 221 units of stress (174+47). However, expulsion due to decisions by agency or local church leadership confers an even more devastating effect. Since this rejection occurs “within the family,” it seems more similar to a divorce than the loss of a job. Sometimes, an expulsion offers the best choice for everyone. Unfortunately, expulsion usually occurs at the end of a long history of escalating stressors (stressors similar in effect to in-law troubles and trouble with one’s boss) that along with expulsion and transition can easily put the minister within reach of a major illness. When a minister needs to change fields due to disagreements with co-workers, we recommend rest and recuperation along with relationship skill training (see Transforming Conflict: Relationship Skills for Ministers, by Nathan and Beth Davis).

With any decline in the economy, most ministers face a daunting financial crisis. And this crisis remains mostly outside of their control. Many ministers find that their financial support drops 25 to 50 percent during a recession. When a North American church member loses his or her job, they can file for unemployment and receive up to 24 months of government aid for retraining. When a minister or missionary loses monthly support, few options remain. Some ministers get secular jobs, and some missionaries give up their career status for an associate status or forgo major portions of their normal budget. Regardless, the financial stress affects self-esteem and sometimes translates into chronic stress.

However, the most common source of minister stress remains the least recognized—vicarious exposure to others in crisis including poverty, death, and illness. Simply witnessing church members and others in crisis stimulates large amounts of unrecognized stress that can, by itself, induce burnout and depression. In North America, the average secular individual may witness one or two incidences of severe crisis, death, or life-threatening illness during a lifetime. In most churches and in some third-world cultures, crises, poverty, death, and life-threatening illness seems like a daily obstacle course. Each instance of vicarious stress brought by church and community members adds 29-39 units of stress, depending on the depth of the minister’s friendship and intervention. The cumulative effect of living as a pastor to those in chronic crises, poverty, death, or life-threatening illness often induces severe helplessness related stress. However, most ministers cannot remain as voyeurs of those in their community or congregation. Like Jesus, they get personally involved with those in crisis. Thus in any single year, many ministers experience 200-300 units of stress from this source alone. And this source of stress remains chronic year after year, and remains almost totally unmanageable. That is, no minister can prevent a crisis in the family of his or her parishioners. For most ministers, a call into pastoral care inherently represents a call into chronically high levels of mostly unmanageable stress.

When discussing units of stress in the range of 500-600 units, the exact level of stress seems relatively unimportant—anything over 300 remains extremely unhealthy.

Some insights about ministerial stress come to mind:

  • Almost all the stress discussed above remains outside the control of the minister. That is, ministerial life inherently includes the transitions shown in bold as well as the environmental stressors unique to each culture and ministry. These remain mostly unavoidable occupational hazards.
  • A normal minister lifestyle sometimes includes inherently unhealthy levels of stress.
  • Recovery from stress levels over 300 units of stress (transition and environmental stressors) usually takes at least two years. By this time, a host of new stressors may have appeared.

Exercise 1: Look at the events in your life over the past twelve months.

  • Compile your stress score from the Holmes-Rahe chart listed above.
  • Add the additional stress from any of the applicable environmental and culture factors listed above.
  • Add the additional stress from your exposure to crises in your adopted culture.
  • Add the additional stress from exposure to individuals in crisis, including poverty, death, and illness.
  • What is the sum of all your stresses?

Note that the higher the dose (the number of exposures to crisis), the more damaging the effect. Consider the following:

  1. As a general rule, by the third crisis, an individual grows four times more susceptible to burnout or depression.
  2. At any point in time, about 40 percent of North Americans need only one additional crisis to induce burnout.

For ministers who departed from their previous assignment due to a church or personal crisis, they will almost certainly arrive at their new assignment with minimal margin against burnout. Some ministers arrive on a new assignment with two or three crises in their recent past (such as conflict with a prior church board or staff). As they experience the additional transition stressors, environmental stressors, and crises common to their new culture, the symptoms of burnout or depression seem inevitable. Their colleagues sometimes wonder why a minister burns out so quickly, when in fact he arrived at his assignment with minimal margin (resilience) against stress.

The authors routinely talk to individuals who feel as if they can barely survive as a minister after spending several years with a Holmes-Rahe score over 500. No wonder they feel burned out.

Some church pastors experience a crisis every week through the experiences of their church members. Since the higher the dose, the more damaging the effect, many ministers and missionaries successfully survive the stressors over the first three to five years only to exceed their stress margin and finally succumb to stress during the next few years. Suffering from depression (a downcast spirit), their productivity falters, their relationships blow up, or they quit altogether.

A downcast spirit rarely results as a failure of the minister—it usually results as a normal by-product of the minister’s stressful environment and occupation.

Reflect on the number of your coworkers who burned out over the past ten years. For some, their burnout follows as a normal result of their stressful environment, regardless of their workload or stress management skills. Contemplate for a moment, will it help these ministers to hear: “Suck it up,” or “Manage your stress better,” or “Go to the hardware store, buy a ladder, and get over it?”

Ministers sometimes feel abnormal due to burnout. However, the stressors remain abnormal, not the minister. That is, a downcast spirit occurs as normal result for anyone living with more than 300 units of stress. The stressors inherent to ministerial life remain mostly uncontrollable. Because of environmentally induced stressors, ministers rarely need stress management skills—they primarily need skills to build more resilience.

However, God continually calls ministers to serve fundtional and dysfunctional people. The call into ministry leads almost every minister into harm’s way.

Brian (not his real name) seemed perplexed when he sent me an email about feeling depressed, especially since he had written his master’s degree thesis on stress management. He carefully analyzed each new task to lighten his workload. Now, his workload seemed unrealistically light—he even felt guilty for delegating almost everything to a local colleague. With so little work, what kept stimulating his downcast spirit? Regardless how much he tried to reduce his workload and responsibilities, his spirit felt chronically downcast. He entered a deep depression in which he received an ultimatum: resign from his ministry agency or get terminated. He resigned.

Hearing a friend say, “Suck it up” failed to help him. Hearing someone else blame him for burnout and say, “Manage your stress better” also failed to help. He prayed every day for help. However, Brian is merely human, and so his body still responds to stress just as God designed it to respond. That is, when the stress persists for more than about 30 days, his brain reduces serotonin production, and he grows depressed.

Almost all of Brian’s stressors, like the stressors common to most ministers and missionaries, remained totally outside of his control. Initially, Brian found that God’s call includes great joy. He also found that “the call” frequently includes great suffering, as described in the book of Job. When his friend said, “Suck it up,” he implied that Brian failed to control his own feelings and that the solution remained totally within his own grasp. That is, his friend implied that if we feel bad, instead of turning to the Comforter, we can cope by simply telling ourselves to “Suck it up.” This type of advice seems reminiscent of Job’s friends who suggested that Job’s plight resulted from his own sin.

Job’s friends also told him to repent. Telling a minister or missionary to better manage his or her stress implies that he or she needs to repent of a stressful lifestyle. Similarly, telling a minister to pray harder seems similar to telling him or her that they have failed to pray hard enough. Reflect for a moment: How would Job feel if you told him to, “Suck it up,” or “Manage your stress better” or “Pray harder”? How would these statements help Job?

Job’s friends failed to realize that he lived in the middle of a struggle between God and Satan, and Job retained no control over God or Satan. Likewise, most ministers retain little or no control over their environment. Their stress often results from the sinful ways of a godless society and a fallen world. Like Job, ministers and missionaries sometimes suffer from the invading Sabeans (see Job 1:15) or Chaldeans (see Job 1:17) who steal and kill.

A healthy environment excludes assault, robbery, murder, kidnapping, man-made crises, and natural disasters. Sometimes we acculturate ourselves to a godless environment so thoroughly that we begin to see these sins as normal and our response as abnormal. However, Job’s feelings and responses remained normal. His environment was abnormal. Likewise, the minister’s response of burnout is usually normal, and his or her environment remains sinful and therefore abnormal.

In contrast to Job’s (and Brian’s) friends, Jesus says, “Blessed are the poor in spirit, for theirs is the kingdom of heaven (Matthew 5:3).”  “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls” (Matthew 11:28-30, NIV). Jesus never claims to prevent us from feeling “weary and burdened.” He simply invites the weary and burdened to find rest in Him.

To learn how to prevent burnout, please read How can I prevent and recover from it?

© 2013 Nathan Davis

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