n the past five years or so, ‘burnt out’ pops up more and more in my consulting room, especially when – and since – Covid 19 merged our working and home lives into one relentless chore. Less efficient versions of this popular term could be, ‘I’ve nothing left to give’, ‘there’s no fuel in the tank’, or even the ‘hospital fantasy’ some (working mothers) describe, where they are admitted to a private room in a comfortable well-run hospital, with a painless condition that involves bed rest, good food brought on a tray, plenty of nourishing sleep, and compassionate medical staff attending to their needs (fantasies can be fantastical after all).
However, ‘burnout’ in the sense that it first emerged as a psychological issue is rooted to a particular context: the workplace. Strictly speaking, this means that you can’t suffer burnout from partying too hard or renovating your house or looking after children – unless you are a professional party-goer (yet to meet one), renovating your house as a service to someone else, or you are a teacher or nanny. Many women spoke of ‘burnout’ during the pandemic because they were working three jobs simultaneously: the one that earned them money, the one that educated their children, and the one that cared for the home.
Although the symptoms of ‘burnout syndrome’ or ‘occupational burnout’ or, simply put, ‘burnout’ can resemble those of depression, the experience is distinct because it refers to someone’s response to chronic work stress that, by definition, develops over time. You may reach the end of your tether after a stressful meeting or spat with your boss, but if you can shake it off by the next day, you aren’t burned out. Another way of looking at it is that you can’t recover from burnout by taking time out of work and then returning to the same workplace situation.
The writer Jonathan Malesic wrote The End of Burnout (2022), after experiencing a dreadful episode during his academic job at a university. I will come onto how the ‘syndrome’ has been quantified by researchers and clinicians, but his description of burnout as ‘an ailment of the soul’ captures the deep anguish it can cause. He suggests that burnout occurs ‘not because we are exhausted but because our hearts are broken. Our love for work went unrequited – it did not love us back. And nor did it bring us the dignity, purpose and recognition for which we hoped.’
Malesic sees burnout as a cultural problem for the millions of us working in the neoliberal economies of the West which prize productivity and consumption above the values that most employees I know care more about – such as being treated with fairness and dignity, having concern for the environment and future generations, as well as nurturing a sense of purpose and autonomy each day at work. If burnout is, as Malesic describes, the ‘chronic experience of being stretched between ideals for work and the reality of your job’, it remains an inevitable fall-out or our workplace culture today.
Most of us work because we need to earn money, but also, if all goes well, we try to choose a role that fulfils something else that matters to us. We may want to prove ourselves to be competent, or to show our family and friends or community that we are useful or helpful or accomplished. We may also view work as an extension of our values, which is immediately obvious for those on the frontline of humanitarian work, or maybe we want to be fulfilled on a deeper spiritual level, such as becoming a yoga teacher or rabbi – or psychotherapist.
A cynical view of burnout sees it as a convenient label to encourage, to sustain the very system that creates it. In other words, if we are at risk of ‘burning out’, which arguably any of us who work too hard without enough pay or respect or leave or parental cover could be, we need to think about fending it off. The logic goes that this risk keeps some businesses going: yoga retreats, meditation apps, self-help books, dietary supplements and wearable health devices. (I return to this in another post on ‘self-care’).
Malesic also wonders if we may be unrealistically pouring too many of our abstract ideals into jobs that no longer care about us, which only sets us up for disappointment. My son’s experience in the gig economy as a delivery courier was, luckily for him brief, but enough to feel the inklings of an unrequited love. He loves to ride his bike, enjoys the puzzle of route-making and was seduced by a friendly ‘onboarding’ and ‘free’ branded merch – as well as the promise of earning enough to buy a (worryingly cheap) car. The reality was starkly different, and each shift even more demoralising than the previous one: his employer didn’t care about him or his fellow riders in the slightest.
Burnout can involve dreadful, and unmanageable symptoms that ultimately cause many people to become very unwell, and to leave work. Before and during the pandemic, it became a serious issue amongst our healthcare workers, and in a 2021 report, the cross-party Health and Social Care Committee in the UK warned that workforce burnout across NHS and care systems had reached ‘emergency level’, which was risking the future functioning of services.
Like many of my colleagues during the pandemic, I volunteered to offer free therapy sessions to NHS workers. Over the course of six months, I spoke online most weeks to a nurse, V, who was, without doubt, by the end, burnt-out (to be clear, V is a composite of many clients I spoke with and her words are not hers). When we said goodbye, she had resigned from her post with a plan to ‘do nothing’ for the three months she could just about afford to take, while she contemplated setting up a business on her own. She was heartbroken to leave a job she had loved for over fifteen years, but felt she had no option. ‘My goodwill has run out, and I have nothing left for anything or anyone, which is a big worry to me. I need to take stock and find something that gives me more back than I’ve been getting’.
V used to love her job as an A&E nurse. She enjoyed the fast pace, the teamwork and the challenge of having to quickly respond to all sorts of people and problems. ‘It was far from perfect, and none of us are paid nearly enough, but I had great colleagues, learnt a lot and most days I felt valued.’ But when the pandemic hit hard in March 2020, her good feelings soon evaporated. She spoke of the chaos of changing protocols, the lack of protective PPE and preparedness, the terror of catching the virus, and the shame of it when she inevitably did (as this meant time off work, and more pressure on her colleagues who were all buckling under the weight of it all).
V also spoke of how her levels of care were corroded by the the unprecedented number of patients she had to deal with each shift. ‘I hate the idea that I ended up not caring about my patients in the way that I used to. I can get over the exhaustion, but I can’t forgive myself for losing compassion.’ She also had to make decisions that she didn’t want to make – such as having to choose which patient to prioritise, because of lack of equipment or staff. V couldn’t offer enough emotional support to her patients either, which was especially dreadful when their lives were precarious, and she had to forbid their loved ones from seeing them. ‘Every bit of my body felt it was cruel and wrong. I couldn’t walk away or complain or break the rules. We were all in the same boat, watching each other in agony.’
V’s experiences of having to act against her values can also be described by the relatively new terms of ‘moral distress’ or ‘moral injury’. These also describe forms of work-related anguish that are related to, or often a part of, burnout. Some academics use the terms interchangeably, but the British Medical Association discern a difference, with ‘moral distress’ described as: ‘… the feeling of unease stemming from situations where institutionally required behaviour does not align with moral principles’, while moral injury, ‘can arise where sustained moral distress leads to impaired function or longer-term psychological harm.’
While we tend to use the term ‘burnout’ loosely, there’s no unified definition in the research, or clinical literature either. The World Health Organisation does not view it as a ‘medical condition’ as such but defines it in their 2019 ICD-11 as an ‘occupational phenomenon that results from chronic workplace stress has not been successfully managed’. Some countries – such as Denmark, Estonia, France, Hungary, Latvia, Netherlands, Portugal, Slovakia and Sweden – accept that ‘burnout syndrome’ could amount to an occupational disease though, deserving of compensation to those suffering it.
Graham Greene’s 1960 novel A Burnt-Out Case is often suggested to be the first popular depiction of the experience, telling the story of an architect who no longer found any meaning in his work, nor any joy in his life. However, it emerged as a mental health concern in 1974, when the psychologist Herbert Freudenberger wrote about the burnout he witnessed amongst colleagues working in a free clinic for drug addicts. He described states of exhaustion, fatigue, and frustration that looked like depression, but were intrinsically linked to the stresses of the job, and he made a link with those in the helping professions.
Two years later, the American psychologist Christina Maslach’s work with social care professionals put burnout on the psychological map as a gradual process of fatigue, cynicism, and reduced commitment. She joined forces with a colleague Susan Jackson and their research led, in 1981, to a reformulated idea of a syndrome, using the Maslach Burnout Inventory (MBI) to quantify it (which is now reflected in the ICD-11 criteria).
The MBI assesses three dimensions, that were familiar to me from my work with V: emotional exhaustion (which is of a chronic sort, not mended by sleep), a sense of ‘depersonalisation’ (a type of cynicism that can tip into a lack of feelings or empathy for others, or even a disengagement or indifference), and ‘reduced personal accomplishment’ (feeling ineffective). Later versions were adapted to their context, such as for teachers and students and medical professionals, although it is accepted that burnout can debilitate workers in almost any field – business, law, technology and closer to my home, mental health practitioners…..