Эмоциональное выгорание: симптомы в теле и душе

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Когда стресс делает нас больными  

Стресс – главный недуг современного честолюбивого и успешного общества. Постепенно и незаметно проявляют себя его отрицательные последствия. В итоге – полный синдром эмоционального выгорания, который уже в течение долгого времени изнурял человека как особо тяжкий недуг. Он может в зависимости от тира личности, вывести из душевного равновесия (подавленое, безразличное настроение, отсутствие интереса, излишие раздумья и сомнения, чувство перенапряжения, раздражительность, агрессивность, нарушение сна, постоянная усталость,изнеможение и, как следствие, сомнения в себе самом, плохая концентрация и память,угрызения совести, мысли о самоубийстве или самоубийство),а также он может оказать своё негативное воздействие на физическое состояние человека (перенапряжения и боли в голове и спине,отсутствие аппетита,расстройство в пищеварении, слабость,плохое общее состояние).

 Понятие „эмоциональное выгорание“ (англ.: Burn-out) ввёл в 70-е годы американский психоаналитик Х.Фройденберг, который сам работал до 16 часов в сутки, часть своего времени во врачебной практике, другую часть посящая социальной сфере, а именно, маргинальным группам общества. После того, как изнуряющие перегрузки довели его собственное здоровье до полного изнеможения, написал он об этом научно-исследовательную работу. В ней проанализировал Х. Фройденберг на своём опыте феномен  „угасания“, „выгорания“.

Решающий вопрос заключается теперь в том, когда стресс начинает нам вредить и как установить границу между увлекательной, наполненной до краёв плодотворной работой, жизнью от чрезмерной активности и нагрузок, которые давно превысили допустиые пределы человеческих возможностей?

Речь идёт о двух разновидностях стресса: положительном и отрицательном. Положитель-ный стресс характеризует состояние, когда человек, положительно возбуждённый, через эффективные действия и поиски в своей жизни, активно и на высоком уровне продвигается и достигает поставленнных целей. При этом его индивидуальные внутренние запасы энергии соответствуют его возможностям, это значит, эти запасы должны быть так рассчитаны, чтобы затраченная энергия окупалась положительным, успешным результатом. В итоге человек получает желаемую, ожидаемую награду и признание со стороны окружающих и общества. Очень  важно остаться в этом равновесии между своей внутренней энергией, взглядами и убеждениями и - всем, что дорого в жизни.

Поступки и действия любого человека охватывают самые разнообразные сферы – профессию и семью, социальные контакты и увлечения и т. д. Всё это, с одной стороны, может быть очень многогранно, с другой стороны, ни в коем случае не должно быть чрезмерно. И если удаётся человеку найти и сохранить это внутреннее равновесие между вкладом и отдачей, если получает он за взложеный труд достаточную награду и признание, в состоянии он продуктивно, на высоком уровне и продолжительное время оставаться активным без того, чтобы через высокие нагрузки стать больным.

В случае, если не удаётся сохранить это важное равновсие, если инвестируемые энергия и время не окупаются  aдекватным успехом и признанием, грозит опасность его потерять. В этом случае говорят о так называемом  „отрицательном“ стрессе. Внутреннее равновесие нарушено, как правило, уже давно.Человек обессилен и обесценен в своих собственных глазах до такой степени, что ни о какой отдаче или признании со стороны окружающих не может быть и речи.

Часто служит толчком к смещению от стресса положительного к стрессу отрицательному в  неожиданный удар со стороны, например, заболевший партнер или начальник, субъективное оскорбление или несправедливое обхождение. В таких случаях переход от одного состояния в другое сравнительно быстрый. Прежде исполнял человек свои обязанности прекрасно и на высоком уровне. Теперь всё окружающее вызывает в нём антипатию, отвращение, даже ненависть – до агрессивного состояния. Если фаза негативного стресса затягивается на долгое время человек теряет своё внутреннее равновесие, мучается и страдает, образно говоря угасает, выгорает. Раньше или позже гарантирован переход такого состояния к синдрому эмоционального выгорания со всеми его симптомами. Их ни в коем случае нельзя неодоценивать, такой человек нуждается в серьёзном лечении.

Больной находится теперь в фазе, когда проявляются самые разнообразные нарушения в психике и в различных органах. Человек встаёт и идёт на работу неохотно, против воли, вечером с трудом засыпает, часто просыпается в поте и стрвхе, сон сопровождается кошмарами. Человек погружается в чрезмерные размышления,раздумья, замыкается в себе, недоверяет другим, избегает общество. Он замечает, как снижаюся его собственные способности, умение концентрироваться и запоминать вещи, где раньше не было проблем. Через это часто возникают всё новые и новые проблемы на работе.

В процессе такого саморазрушения проявляются всё сильнее страхи с чем-то не справиться; сомнения в самом себе и в своих собственных силах могут в некоторых случаях привести к самоубийству.

Человек и физически чувствует себя плохо. Часто именно это является поводом для обращения к врачу. Пациент жалуется на отсутствие аппетита, потерю веса, нарушения в желудочно-кишечном тракте, снижение жизненной энергии, общее сильное изнеможение, когда и хороший сон уже не приносит облегчение. Типичны мускульные перенапряжения и боли, часто в области шейного и поясничного позвоночника с иррадиацией в руки и ноги; через стресс возникающие головные боли, мигрень, чувство стеснённости и тяжести в грудной клетке и в брюшной полости.

С одной стороны, эти неудачи могут быть обусловлены нарушениями в психике, т. е. иметь чисто функтиональное происхождение как результат чрезмерного раздражения нервной системы. В этом случае, как правило, не наблюдается изменения в органах человека, недуги исчезают, как только устранено кризисное психическое состояние. А может случится так, что через отрицательную стрессово-гормональную нагрузку функции в определённых органах действительно нарушены, что подтверждается и медицинским обследованием. Речь о таких симптомах, как например, повышенная желудочная кислотность, способная вызвать гастрит или язву желудка; повышенное кровяное давление  с возможными осложнениями в области сердца и мозга; мускульные напряжения  и перенапряжения, провоцирующие иногда выпадение межпозвоночных дисков.

В завершение ещё один очень важный, пожалуй, центральный вопрос. Как лечить эту, такую многостороннюю болезнь? Наблюдения показывают, что сначала больные, как правило, обращаются к общему лечащему врачу, а не к психиатру, потому что налицо нарушения в функциях тех или других органов. Очень важно здесь понять, что человек нуждается в помощи действительно с двух сторон: необходимо как тщательное обследование органов, так и компетентное психиатрическое лечение.

Что касается первой стороны: при соответствующих жалобах и симптомах  надо выяснить их причины. При болях  в области спины и головы необходимы обследования у невропотолога и радиолога. Хорошие результаты даёт к примеру, ЯМР-томография, она даёт возможность исключить опухоли, сужения или выпадение межпозвоночных дисков. Также необходимо обследовать сердечно-сосудистую систему, чтобы исключить недуги в этой области.

После  того, как проделана вся эта работа, выходит на передний план квалифицированное психиатрическое и психотерапевтическое лечение. Для этого есть многочисленные возможности, которые способны лечить синдром эмоционального выгорания со всеми его симптомами (аналогично тому, как проводится лечение депрессивных заболеваний). Это

антидепрессанты из группы подавителя повторного  восстановления серотонина в сочетании с соответствующими психотерапевтихескими мероприятиями.

Цель психотерапии -  разработать совместно с пациентом для его жизни „Coping“ -механизмы и новую стратегию в преодолении стресса. Возможно, стоит в целом по-новому продумать и определить подходящие жизненные цели, пересмотреть до этого действующие правила и категории.

Бета-клиника в Бонне, специализирующаяся на лечении недугов, причины которых кроются в области головы и позвоночника, предлагают широкий выбор методов лечения таких болезней, как синдром эмоционального выгорания. Коллектив, состоящий из опытных неврологов, нейрорадиологов, нейрохирургов и психиатров, снабжённых новейшими приборами, проводит в одном месте как необходимую диагностику, так и психиатрическое и психотерапевтическое лечение – амбулаторно и стационарно.

Синдром эмоционального выгорания – серьёзное заболевание, поэтому чрезвычайно важно заметить его у семя самого и начать лечеие у соответствующух компетентных врачей, не давая болезни перейти в рязряд хронических, чтобы, например, своевремянно предотвратить самоубийство,чтобы избежать любой другой трагический исход, к которому может привести  синдром  эмоционального выгорания.

 

Барбара  Гавеллек, доктор медицинских наук, врач-специалист по психиатрии и психотерапии 

Foto: SidewaysSarah, flickr, Shed the Negative



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