Last week I wrote about the start of my search for a real medical diagnosis to my ongoing physical and mental burnout symptoms. After a visit to a clinician, I started taking supplements and waited patiently for positive signs that I was healing. I briefly mentioned why 'burnout' was a dead-end diagnosis. I think this deserves more inquiry. This week I want to explore the concept further and ask the question: is burnout even real?
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We've already been here
History is repeating itself. We've already seen a syndrome that's almost exactly like burnout appear and disappear in society. It's called neurasthenia. It appeared in the late 1800's and was popularized by neurologist George Miller Beard. He described it as "severe debilitating mental and physical fatigue arising after even minimal effort." The reason, he said, was due to the fast pace of change in modern society.
Beard thought our accelerated modern life and stressful jobs put excessive demands on peoples’ brains. This weakened and depleted their nervous system and caused exhaustion, anxiety, despair, insomnia, indigestion, palpitations, and migraines. He even wrote about the increasing use of clocks, timetables and how this created time pressure. In the good ol' days, he said, there was a wider margin of error to get to appointments. Now you had to be exactly on time, not a second late, which created more stress and "affected your pulse." If Beard were alive and working today, he'd hate it.
Like burnout, there was an entire self-help market for neurasthenia — from books, courses and people peddling the cure. There were even belts that would electrocute you, although I’m not sure how effective that was.
This was, for the most part, seen as a modern malady. It’s strikingly similar to burnout, which is often seen as the product of the social and cultural shift into a more service-oriented society (the first people to report burnout were physicians and nurses). Our more recent predicament — always-on, glued to your iPhone and being stuck indoors for two years during the pandemic — has exacerbated that trend. Now everyone seems to be burned out.
So, what happened to neurasthenia? Physicians agreed that modern society was causing all sorts of issues. But neurasthenia seemed to cover too many symptoms, and was really hard to test with any diagnostic tool. Neurasthenia eventually fell out of use because the definition was too vague. By the mid 1900's, the term had all but disappeared.
Could burnout have the same fate, or is it somehow different?
The burnout epidemic
When I first started my business, I was filled with enthusiasm. I would jump out of bed, brainstorm ideas with my co-founders and push our startup forward. But I was too ambitious, too involved, and too unable to set my own boundaries. Slogging away in increasing isolation brought me to my breaking point until I was overcome by total emotional and physical burnout. I was unable to work for weeks, and my path to recovery was a multi-year-long journey.
Today millions of people all around the world frequently overwork themselves to the point of exhaustion. According to a 2020 survey by FlexJobs, 75% of workers have experienced burnout at their jobs. One model says there are three types of burnout — frenetic, underchallenged, and worn-out. Burnout researcher Dr. Farber would label me and many others as a "frenetic" burnout type. They risk their physical health and "neglect their personal lives to maximize the probability of professional success." As you can imagine, the idealist, dreamer and people-pleaser is particularly susceptible.
Many others aren't overworked, but are underchallenged. They lack growth opportunities and are bored out of their minds. They have 'bullshit jobs', a term coined by author David Graeber. Bullshit jobs are "a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence." It's the receptionist who never gets any calls but has to sit there to make her boss look good. This type of soul-killing job can also lead to burnout.
Lastly, another form of burnout sits in between the first two: the worn-out type. Worn-out workers may be super busy, but instead of pushing harder, they just clock out. They accept neglecting their responsibilities as the only path forward. They completely detach. Most of the time, they're in situations that seem out of control, and they know that nothing they do will make a difference. One burned out high school teacher says, "I know I get back less by giving less, but I just can't give anymore. I don't give a damn."
But wait, can all of these things really be burnout? They all seem so different and span a range of symptoms from exhaustion, anxiety, boredom, and to hints of more serious depressive moods. Even within each type, there's such a wide spectrum. I've written about my burnout journey, describing the debilitating headaches, my inability to work for weeks and the subsequent months of therapy I needed. This is very different from my burned out friend who took a three-day break, went hiking, and was fine the next week. Clearly, we're talking about different things.
Herein lies the issue: After fifty years of studying burnout, scientists and researchers around the world still can't agree on what burnout is. We're all saying that we're burned out, dropping it casually or using it to take serious time off. It's the number one reason many people quit their jobs. So, why can't we agree on a definition? What's going on?
Founded on shaky ground
German-American psychologist Dr. Herbert Freudenberger popularized the word burnout in the 1970s. He saw that many of the volunteers at the addiction clinic where he worked were feeling exhausted, frustrated, and disillusioned. He himself was getting pretty drained with the late-night shifts. Dr. Herbert described burnout as "the extinction of motivation or incentive, especially where one's devotion to a cause or relationship fails to produce the desired results." This experience inspired him to publish a book that got him on Oprah and went on to be a best-seller, "Burn-Out: The High Cost of High Achievement."
The problem is, Dr. Herbert never ran a study on burnout. He came up with a definition based on a few anecdotes. He never measured it in any way. In his book he used words like "speed freaks," a lot of counterculture lingo and fused it with psychoanalytical talk. It was totally unscientific. He listed symptoms ranging from shakiness, fatigue, crying, paranoia, cynicism, exhaustion, stomach issues, headaches, just to name a few. It was vague and lengthy. In other words, burnout could be anything and everything.
Around the same time, Christina Maslach was a psychologist that was starting to look into burnout. She came up with a survey called the Maslach Burnout Inventory (MBI), a list of 21 questions to assess burnout. You can take it for free here. Maslach didn't provide a systematic study of burnout, but simply came up with the criteria based on her assumptions. She even admitted herself that it wasn't rigorous. The questionnaire hasn't changed in over 40 years and while there are other tools, it's still the main survey used today.
In a meta-analysis of over 1,225 articles about burnout, researchers concluded that, "No consistent valid definition exists. Burnout seems to be more or less a fuzzy set of many definitions. In the literature, a multitude of burnout symptoms and theories and explanatory models can be found." In fact, very few studies even tried to develop a diagnostic criteria and define burnout properly. Instead, they measure burnout and ideas on how to treat it. But how can you measure or treat something that isn't properly defined? You can't. It's like everyone jumped on the burnout bandwagon, but we have no idea where it's going. This puts the whole idea of burnout into question.
So if we can't define burnout, what is it?
This wouldn't be the first time in history when we've used an umbrella term to label a set of symptoms we didn't really understand. For example, "hysteria" was commonly diagnosed in the 19th and 20th century, mostly amongst women. The word comes from the Greek "hystera," which means "uterus." It was a gendered word from the start (and still is — think, 'she's hysterical!'). It was an ill-defined term for a host of symptoms like anxiety, depression, emotional issues, paralysis and unidentified pain.
Freud believed that hysteria occurred because "women had lost their metaphorical penis." Thankfully, more rigorous tests for mental health became available. People realized women's experiences were being stigmatized and hysteria was debunked as cultural and gender stereotyping.1 These were people suffering with real issues, like dissociative disorder, sexual abuse, and trauma. Hysteria was a socially constructed idea and a lazy way to put these patients together into one group.
There are other examples of syndromes that were once named but disappeared after their true colors were revealed. Gulf War Syndrome was given to veterans and included symptoms like fatigue, joint pain, and memory loss. It was later discovered to be the side effects of inhaling toxic sarin gas in Iraq. I'm not saying burnout patients are tripping on contaminated water (although it's not that far-fetched), but it begs the question, is burnout really caused by workout stress? Perhaps it's been misdiagnosed for something completely different.
Or take Homosexuality, which was considered a mental disorder until 1973. Once we learned better it was officially removed in 1986. Could burnout take the opposite direction — from not being a diagnosis to being taken more seriously by the medical community? Other disorders that are currently medically recognized, like Multiple Personality Disorder, are hotly debated. Is split-personality disorder really a separate disorder, or is it really just a type of dissociative disorder? Similarly, is burnout really it's own thing, or is it just on the spectrum of anxiety or depression? These are questions open to debate.
Well, damn. What are we talking about then? Could it be something else?
Imagine if burnout syndrome had three unique symptoms: toothaches, hallucinations, and a tendency to sweat profusely (like my last shroom trip). It would be straightforward to classify burnout into its own little bucket. However, the opposite is the case. Burnout shares symptoms with several disorders. This makes it even trickier to define.
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