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The Royal Society of Medicine in London are set to host a conference in July relating to the convergence of symptoms between Covid-19, hypermobility syndromes and neurodivergence. A diverse range of specialisms (immunology, rheumatology, psychiatry, cardiology) are coming together to discuss the extent of overlap in these patients. It is increasingly recognised that many neurodivergent people are experiencing greater levels of chronic illness, which may have been exacerbated by / precipitated by the Covid-19 outbreak.
The organisers state: "post-COVID, we can still see the ongoing 'fall out' of hypermobile and neurodivergent patients. Particularly young, working-age people are rendered disabled, and more women are affected than men." This is incredibly damaging to career prospects and, given how little knowledge exists in mainstream medical and occupational health circles, can feel confusing and frightening for those who don't know where to turn for advice. Many are struggling to stay in work, or on course. Burnout is real - defined as an occupational condition, where chronic stress has not been managed and leads to exhaustion, apathy and reduced productivity - and, the organisers suggest, much more common in people with this overlap in symptom and diagnoses.
Whilst we wait for further research and development, and seek first line support from medical practitioners, it's good to remind ourselves of how we can self-help in burnout: boundaries, rest, self-care.
Many ambitious, career-driven people struggle with the concept of rest. We plough on until we fall over, thinking of rest as a reward for our hard work. You need to flip this narrative and rest in order to do your best work instead. But before you can focus on making time for rest, you need to reset your boundaries. You will be required to say no and "let people down." You will have to do this with friends and family as well as colleagues. If you are a people-pleaser and your identity is tied up with being useful, this will be difficult.
Two things to remember: (1) you can't be helpful to anyone if you "crash out" and (2) you are a human being not a human doing. Not everyone will respond positively if you stop doing what you usually do. Some people may want you to continue exhausting yourself to make their lives easier. Considering who those people may be in your life is actually quite helpful long term, so consider this a cleansing moment rather than an abdication of your responsibilities.
This is an area where a professional could add value. For example, coaching is very effective for workplace burnout, counselling can help you process your dynamics in personal social groups or choose clinical therapy if you need to work on deep seated family relationships and trauma.
You are not the only person in burnout right now, you can find support and validation in online groups or with peers who have experienced the same. Groups where the facilitation is professional and trained are recommended. For example, Project 507 CIC have a range of options from a free newsletter to a Book Club right up to monthly supervision groups and formal training. These are particularly targeted for professionals working in social justice and caring professions.
Seeking peer support is one thing but long term, the goal is for you to have an internal reference for your own limits and to feel comfortable knowing when you have had enough, given too much and redrawing the boundary. You don't need permission from anyone to know your own capacity.
"I know I'm in burnout, but I don't know where to start." This comment, overheard recently, reminded me of the "brain fog" that comes with some health conditions, where your cognitive processing speed has been compromised, leading to feeling overwhelmed and not knowing where to even start. You start, by stopping. Review your diary for the next month. Cancel all non-essential plans and obligations. Delay and defer anything you can. People will understand: "I'm terribly sorry, I need to address some urgent priorities, and I won't be able to complete the project against the current deadlines. I could deliver by X / I recommend (insert alternative colleague or provider)." No need to over explain. The urgent priority, by the way, is YOU.
Give your permission to slow down the cardio if you need to and seek medical advice on what might be better for you. Lots of career driven people are exercise junkies, but with hypermobility syndromes exercise needs careful planning and professional guidance. Rest and recovery is as important as exercise in a sustainable health routine. Further, if you are suffering from chronic fatigue, exercise has been found to exacerbate symptoms and can be totally counter-productive until you have recovered. Sleep, watch TV, read a book, avoid scrolling your phone - this is not restful. Buy a basic phone if you have to or take breaks with no phone.
After rest comes the self-care, which could include diet, therapies, recreation.
It can be very difficult to plan a healthy diet when you are overwhelmed and in brain fog, so you need some "go-to" short cuts, like a list of simple food that you can easily action over a weekend to give your body a break. You might have some frozen meal portions that you can eat instead of a takeaway, if you also eat differently from the family. Parents might need different food to growing kids, but cooking separately is yet another thing on the to do list, so instead of worrying about solving the problem permanently, plan yourself a one meal or one weekend alternative just to feel like you are investing in yourself. Nutrition is key to chronic fatigue but you can't solve this yourself, in one go. Start with what you can manage and seek help with nutrition. It may be important to check for deficiencies like Iron, B12 and vitamin D and have your Thyroid function checked. Always seek medical advice if you are concerned.
Therapies like massage and yoga cost time and money. Often people in burnout can't handle even one more thing to plan! What is the easiest, quickest most relaxing thing you can do for yourself? Sitting in the garden with your morning tea or even five minutes of deep breathing could be the place to start. Just the very act of doing something for yourself, just for you, not because you must or because someone else needs it can be the start of a mental reframe.
When you are in burnout, motivation for recreation can be hard. The planning and logistics might take so much effort that the actual fun or social interaction is not worth it. So again, the advice is to start with something small, just opening the door and letting a tiny crack of light in! This could be as small as a WhatsApp exchange with someone who makes you feel energised not depleted, or watching a film you've not had time for yet.
Professor Emeritus Amanda Kirby is a neurodiversity expert who has been writing about this for many years. She notes the need for resources to address the challenges of burnout associated with Covid, hypermobility syndromes and neurodivergence:
"I think adversity is a key component for secondary challenges impacting on health and wellbeing post Covid - there is greater inequity in society and who gets help and support."
Professor Kirby points out the link between adversity and chronic health conditions over a lifespan and the limits of "siloed provision despite co-occurrence being the rule rather than the exception". Having first published on the link between neurodivergent conditions like Dyspraxia (Developmental Coordination Disorder) and hypermobility in 2005, Professor Kirby welcomes the increasing attention these issues are getting in the post-Covid crisis of work absence.