Burnout

Christina Maslach, who’s been researching burnout since the 70s tells a story about the burnout shops – the startups which advertised themselves as places where you could have worked yourself to (almost) death for a few years, but later you’d have profit from it enough to ditch the work. Only, what was supposed to be a short-term strategy became a long-term approach to working. The problem with it is that, as she says, humans are not able to run marathons with short-distance racing speed. It’s not sustainable. Nevertheless, this is what happened during the last 40 or so years.

The change in the working model also overlaps with the time of “the rapid and profound transformation from an industrial society into a service economy” (Schaufeli et al., 2009) We now live in completely different working conditions than our grandparents did, and change like that has its consequences. Apparently, one of them is burnout. 

Surprisingly though, this is not the first time in human work history we have seen burnout, only then it was called neurasthenia which meant weakness of the nervous system. This condition was first identified at the end of the nineteenth century when society shifted from an agricultural to an industrial way of working (Schaufeli et al., 2009). Interestingly, neurasthenia, much like burnout, first appeared among human services professionals and leading figures of the new industrial age, such as dynamic businessmen. According to George Beard, who introduced the term in 1869, neurasthenia was a result of rapid technological advancements, exemplified by inventions like the telegraph. Sounds familiar? It should. 

The confusion with the definition

Like with other psychological terms, there is no single definition of burnout. This could be one of the reasons why it’s so difficult to fight it, as we don’t really know what it is and how it happens. More than that, in ICD-10 an occupational phenomenon called burnout was included for the first time, but this is all there is – it’s a phenomenon, not an illness, or a disease. Burn-out is defined in ICD-11 (the current version) as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

• feelings of energy depletion or exhaustion;
• increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
• reduced professional efficacy.” (WHO Burn-out an ‘Occupational Phenomenon’, n.d.)

However, some countries (check Sweden and Netherlands) have extended the definition into a proper medical diagnosis which allows the medical and psychological workers to not only diagnose it but also treat it properly. But we are talking only 2 countries here. Given the prevalence of 10% of EU workers, 17% for non-EU we should definitely ask the question of why we have proper social programs for other mental problems and life situations – like homelessness – while it concerns fewer people than burnout does, and there is no such thing for burnout. 

The confusion about burnout not only concerns the definition but also the measures. There are at least 7 inventories and instruments to measure burnout. And the symptoms of burnout overlap heavily with depression and PTSD, which only makes it more problematic. Imagine you are a doctor who has to diagnose someone who comes in with signs of burnout. You not only need to choose a proper inventory, but you are only equipped with ICD (DSM does not list such a condition) to know what burnout is and when you finally manage to decide that your patient suffers from it, there is no program, no cure, and no prescription you can give them. In addition to all that, you are likely to suffer from burnout yourself, as a doctor, which doesn’t make things easier. 

It’s not just human services anymore

At the beginning of the burnout research in the 70s, it was deemed that burnout only concerned the workers who have direct contact with other (often suffering) humans – doctors, nurses, teachers, therapists… However, it was debunked in the 80s when the definition was extended from the intense requirements of client service to other work requiring creativity, problem-solving, or mentoring (Schaufeli et al., 2009). 

To me, however, this is still wrong. We all work with people, we all have clients – external, and internal, our managers, our colleagues. The people around us want and need something from us all the time, not always giving us anything back. It’s not what we do that determines whether we are prone to burnout but how we interact with others, what the working conditions are, and how resilient we are. This brings me to the long lists of reasons that you can find in research, and which try to explain why burnout happens.

Why we burn out

Let’s go back to Maslach’s three dimensions of burnout which are: fatigue, detachment (I hate to call it cynism, as cynism is a result of detachment and it does not satisfy the definition of “mental distance from one’s job”), and inefficacy. We will use it as the 3 areas to check how they interact with the lists we will analyse. And yes, there is more than one – depending on who you ask, you may get a completely different list of reasons for burnout. 

Maslach suggests that the main reasons are:

• Demand overload
• Lack of control
• Insufficient reward
• Absence of fairness
• Value conflicts

Here’s a list by Dr. Geri Puleo (‘About Dr. Geri Puleo’, 2018):

• Poor leadership
• Lack of organizational caring
• Negative co-workers
• Politics or sabotage
• Lack of resources
• Over-emphasis on ROI
• Work overload
• Poor communication
• Unethical or illegal requests
• No organizational vision or direction

The below list comes from (Edú-Valsania et al., 2022):

• Work Overload
• Emotional labour
• Lack of Autonomy and Influence at Work
• Ambiguity and Role Conflict
• Inadequate Supervision and Perception of Injustice
• Lack of Perceived Social Support
• Poor Working Hours

Cal Newport’s reasons (Huberman Lab Clips, 2024):

• The administrative overhead of the assignment (talking about it not doing it – meetings, emails
• Constant distraction (the spread of the administrative overhead)

They kind of overlap, don’t they… But let me show you how they really work together. 

Cognitive overload

Work overload or demand overload is not only about how much work there is for us to do. Maslach explains it using the “we have to do more with less” mantra, the thing we hear all the time inside companies, i.e. “We can’t hire more people, you have to deal with it”. And yes, it’s stressful. But the more stressful part of it is the constant cognitive (over)load this approach causes. When you have no resources (either no people to do the job, no data, no knowledge of the field, or poor communication that simply causes more confusion) you have to be creative. Creativity is a fantastic human skill, but it doesn’t like rush or stress. So balancing stress, speed, and creativity constantly overloads the system. 

On top of that comes the administrative overhead and constant distraction (check Newport’s work). There is a reason why we work better during a flow state, with no or limited distractions. It is because we can put all our internal cognitive resources into a single task. When switching constantly, we need to juggle the energy we have – and unlike training a muscle, exposing the brain to constant cognitive load doesn’t make it stronger. It depletes the energy and brainpower.

Role ambiguity, poor leadership and poor management also add more cognitive load to everyday life. By poor management, I mean lack of direction, lack of mentoring, and lack of proper prioritisation. A manager who is only able to say “move things forward” without defining where that “forward” is or what it takes to make a “move” demands a lot of brain power from their workers, which results in the overall higher cognitive load of the job. 

Additionally, we are very often appointed based on our “entrepreneurial” skills to do jobs under poor managers who are simply unable to define how to do the work, and what the goals are. The idea is that entrepreneurial skills can diminish the gap. Only that no entrepreneurial skills can make up for a lack of direction, and no definition of what is meaningful for the company we work for. 

What else is adding to the cognitive load? Too much autonomy. Personally, I’ve never suffered from a lack of autonomy, but from too much of it – I did. When you are responsible for defining your own job and role, building the job strategy, creating your own development plan, and listing all the resources you will ever need – this is yet another overload level. Especially when you have to do it with no knowledge of where the company wants to go and how it wants to get there (check Puleo’s point about No organizational vision or direction). 

Last but not least – emotional labour. It’s about hiding your true thoughts and feelings the whole day every day because showing those is not professional. Clients should not know what you really think about them and their ideas, right? You should stay calm when layoffs are announced. You should not be negative towards a single initiative. Hiding emotions like that, and acting opposite to the way you feel, all add to the cognitive load and make the “do more with less” even more difficult. But the real problem starts when there is nowhere to offload (see poor social circles below). 

What happens when the cognitive load is too high? We experience fatigue and exhaustion – the first and the most well-known burnout symptom. 

Lack of achievement

How many hours a week do you spend sending messages and attending meetings? I bet there are too many. The administrative overhead lowers your sense of achievement, doesn’t it. And you need it to feel good at the end of the day, otherwise the work seems pointless. 

The right amount of cognitive load, just like the right amount of stress can make us work more optimally and increase the sense of achievement. But any type of overload, lack of direction, poor goals, role ambiguity, internal politics and sabotage (see Puleo’s list) distances us from self-realisation and from making a difference, gradually taking away our sense of achievement.

What else adds to the lack of achievement? Extended bureaucracy and completing meaningless tasks. If you have to do taxes work all day long only because there is no one else to do it, while your main role is different – you will not feel that you’ve achieved anything that day. 

Nevertheless, there is a more important aspect of the lack of achievement than just silly things to do. And it’s Sisyphean work. It’s what’s hidden within the points such as Lack of control and Lack of influence at work, which are often explained as having no influence over how the work is done.

Some say that being involved in organising the company’s work processes can help with that. But to me, this is much more than just being involved in the company’s decision-making. This is about making a difference in the world. It’s about changing what you think needs to be changed. This is why, in my opinion, human services were the first discovered to be sensitive to burnout. When you are a nurse, you can’t stop accidents from happening, when you are a doctor you can’t make a disease disappear, and when you are a therapist, you can’t change all the workplaces in such a way that people won’t suffer from burnout. This is idealism, the so-called personality type A characteristic which when nurtured can change the world and when frustrated can lead to burnout. And this personality type is more prone to it. It’s not always that easy to just focus on what is in our control, especially when we are expected to do more with less all the time. 

What happens when we experience a lack of achievement? We see it as a huge lack of efficacy and personal failure.

Lack of reciprocity

There has been extensive research on the social exchange theory and its links to burnout (Schaufeli, 2006). Emotional exhaustion is related to a lack of reciprocity which seems obvious, doesn’t it.

Let’s go back to the emotional labour and hiding our feelings from others as part of a social contract. Imagine your role is to teach a bunch of students a subject. Not only, you will be asked some silly questions (over and over again the same questions year after year), you will experience laziness, trickery, and cheating, but you will not be allowed to say what you really think about it. After all, your role is not to moralise, but to teach.  In the end, not a single student will thank you for your patience and guidance, but they all will take it for granted. It’s exaggerated, of course, but I want you to see it clearly and I bet you can translate it to other jobs. 

The problem with such a situation is that the people who received your time and patience, are often not the ones who appreciate your effort. It gets worse when there is no one else to do it for you. It’s not possible to keep giving while not getting anything back. And a paycheck is not reciprocity. Not the one humans expect. 

“(…) burnout occurs when the worker perceives a lack of equity between the efforts and contributions made and the results obtained in their work. This lack of reciprocity, which can occur with service users, colleagues, supervisors, and organizations, consumes the emotional resources of professionals, generating an emotional exhaustion that becomes chronic. From this approach, burnout can be triggered by the significant interpersonal demands involved in dealing with clients/users that become emotionally consuming. Thus, to avoid contact with the original source of discomfort, depersonalization or cynicism is used as a stress coping strategy, which ultimately leads to low personal fulfillment” (Edú-Valsania et al., 2022) 

The notion of “equity between the efforts and contributions made and the results obtained” is crucial here. There are two aspects to it.

The first one is fairness. There is however more to it than just rewarding those who deserve it. It’s also about noticing and not allowing low performance to manifest. This is what fairness is. Otherwise, we have a system which, although slightly promotes high efforts, demotivates everyone by silently allowing low-performance behaviours to pass by unnoticed, showing that the organisation does not really care what happens inside of it (see Inadequate Supervision and Perception of Injustice). 

The second aspect of equity is a bit more complex. We live in an economy where we not only have to earn a living but also want to buy a house and have a family which, from the financial side of things, is much more unrealistic than it was for the boomers (DW Documentary, 2024). By giving all to the company, employees hope that the paycheck will allow them to fulfil their dreams of having a place to live and to be able to feed their families. When it doesn’t happen, they may experience a lack of reciprocity and burnout as a result of it (see Lack of organizational caring). After all, this is what we are told – this is why we work, to be able to afford our dreams. And if the company doesn’t care – why should we? So we detach, distance ourselves, and become cynical. 

Poor social circles

We all know that social support and communities are important aspects of our lives. They are very likely the most important factor in getting mentally healthy. Yet, when it comes to workplaces – we kind of forget about it. As if workplaces were areas which, when entering, can strip us of all emotions, personal goals, and the social needs that make us humans.

There is a lot on the lists that fall into this category. The obvious parts are negative co-workers and a lack of perceived social support at work. This means that the way we feel with other people at work makes a huge difference. Conflicts and animosities add to the cognitive load and drain us emotionally (actually, cognitive load and emotional capacity are not separate (Fraser et al., 2012; Plass & Kalyuga, 2019)). Also, when we cannot be ourselves at work, we need to hide our thoughts and feelings all the time (not only in front of customers or patients but also our managers and coworkers), and we experience a lack of social support.  Over-emphasis on ROI (see Puelo’s list) is yet another factor that adds to it. It strips the company from the human factor, making everyone inside of it a replaceable resource to increase ROI. 

The other element of it consists of everything that prevents us from building a proper social support circle outside of work. Poor Working Hours, overtime, working shifts, unrealistic schedules, and… constant availability via phone, chat, or email. They all impact our social life outside of the workplace and harm our support system which can save us from burnout (Wekenborg et al., 2022). 

What happens when we cannot count on other people? We become depressed. Depression also shows up as fatigue and detachment… 

Conflicting values

I agree with Maslach to list values separately, as in my opinion, they are the most important element of the whole picture, given that they impact all the other areas. 

When we work against our own values (or have to fulfil unethical or illegal requests), it adds to our cognitive load by generating an internal conflict between what we think and feel and how we act. Such conflicts are draining. They can impact our self-concept and significantly impair the way we perceive ourselves. 

When we comply and act against our own values, we also impair the perception of our own efficacy (think along the lines of: “Can I be capable if I’m not even able to say No to something like that?”) and impact our sense of achievement. Even if we achieve something significant, when it’s not in line with our values, it does not add to our internal list of achievements. So despite the efforts we put into completing a task we disagree with, we get no return from it. 

When we act against our values, we sacrifice a lot and inadvertently expect a lot back. The problem is that if it’s part of our roles, it may go unnoticed and is definitely not viewed as a sacrifice. When our efforts are not valued, when they are ignored, it only adds to the already long list of issues noted in the category of lack of reciprocity. 

Finally, when our values are not in tune with the company values, it’s very likely that the people who surround us are not the people who understand us or who support us – so our workplace social circle is very much impaired. 

Hence, values incompatibility impacts all three dimensions – fatigue, detachment, and inefficacy. 

What to do

Before we go into how to help oneself, we should go a bit deeper into why so little is done about it. And the problem that I see with it is that… this approach works from an economic point of view. Why take care of employees when we can replace them with the new people coming in? Despite what we’d like to believe, it’s not that expensive to train new employees, provided that you don’t require a very high level of service – and this is the current trend. If you don’t believe me, ask yourself how many times this year have you been surprised by services which did not require you, as the client, to oversee, correct, or complain about. Average is the new norm. And when the average is good enough, it’s much cheaper to fire burned-out employees and hire new ones, instead of offering them proper prevention and healing programs. Especially since overcoming burnout may take years. 

“The recovery of clinical burnout, however, may take more than one year. Some studies show that even after 2 to 4 years, a substantial part (25– 50%) of the patients with clinical burnout is not fully recovered.” (van Dam, 2021)

I’m writing it to set up expectations properly, not to judge the current trends. It’s going to be very hard to find a workplace which will care. It may take time and will require proper research. And if you’re already suffering from burnout, you need to make it your priority, especially since the majority of the work needs to be done by the organisation, and not you as an employee. 

The below table comes from Edú-Valsania et al., 2022 and shows the proportion of the activities that should be performed by the employer. The proportion speaks for itself.

If you are going to find the right place for yourself, the list above may serve as a list of criteria to look for. I would especially focus on burnout monitoring and tailor-made plans. If it’s implemented (and it’s done well), you can kind of expect that someone inside cares about long-term employment and not only ROI. 

Second, to prevent burnout you need to focus on your overall stress levels, start checking the levels of cognitive load and reciprocity daily and manage them yourself (no matter how good a workplace is, in the end, you know what you are capable of and how much you can take). Take care of the social support you have or build one, as it will lower your overall stress levels.

“from a biological point of view, it does not matter whether the chronic stress is caused by working conditions or private circumstances or both. It is about the consequences of (chronic) stress for the functioning of the biological processes in the organism that also affect psychological processes and social behaviour.” (van Dam, 2021)

https://7thlife.org/alternative-causes-of-depression-not-just-the-chemical-imbalance/There is a reason why it’s so difficult to differentiate chronic stress-related diseases and burnout is one of them (although not officially recognised… yet). And in the end, it really doesn’t matter, in my opinion, if your problem is classified by the doctor as complex PTSD originating from work stress, depression, or burnout as the solutions are similar (apart from medicating those which I’m not fond of). If you’re still not sure these 3 overlap, check the table below coming from van Dam, 2021.

So what to do if you already suffer from burnout? Nothing! I don’t mean sit and wait for someone else to deal with it for you, but to literally do nothing. If you can afford it (or if you’re lucky enough to find a doctor who can offer a long-term sick leave) stop working. Get rid of all social responsibilities, and household chores, stop excessive exercising, and don’t even do psychotherapy (other than some mild form of crisis counselling, but nothing draining or deep).

“First, it is inadvisable to start psychotherapy. Psychotherapy may be emotionally demanding and stressful and therefore hinders recovery from chronic stress”(van Dam, 2021)

Only when your body and mind are rested, you can gradually resume the responsibilities. If you want to know more about the burnout healing phases, check the van Dam, 2021 work for more instructions. 

Don’t be afraid to get a low-demand job. It’s not admitting to a failure, it takes a lot of courage. And if you’re afraid that you may never be able to go back – don’t be. If your resume looks good, a career break doesn’t cross you out. Companies will still want to appoint you to your previous roles when you are ready. Unless you enjoy your new life too much to want to go back. 

If the burnout is a result of a job change, don’t be afraid to admit that the career move was not for you. It’s not a failure, it’s an attempt, a try. If we don’t try – we never find out what is right for us and what is not. So if the role you went for is not the one for you – just go back. It may actually solve the problem. 

Don’t be afraid to admit that the place you work in is not right for you. If your values or your company values have changed, if you now disagree on what is important or ethical – just find a place that works in line with your values, so you don’t have to bend yourself to the requirements. Find a place which can help you heal, and which offers proper burnout programs and monitoring. 

Get your social support in order, make sure your friends and family support you, that you can count on them, and that they know what’s going on with you. If your workplace is emotionally draining, there is a lot of conflict or competition to deal with – you may want to look for a different company. If not, make sure that you have a proper social circle supporting you inside as well as outside. 

Last but not least, you should be aware of what is called residual burnout (TEDx Talks, 2014). This is the part of it that is close to PTSD. What happens is that a situation similar to the one that caused burnout can trigger the burnout response in you again, even at a different workplace. So it may be that you find yourself fatigued and detached again, after a meeting that was similar to the meetings you were in before, despite the fact that your new employer really cares about your wellbeing. Understanding what triggers you is the work that you need to do yourself, as you can’t expect the world around you to change completely. Work with a therapist, friend, or someone smart you trust to see and recognise the patterns in what triggers you and then work out new ways of thinking and behaving in similar situations. Although I’m not a fan of therapy, group therapy may be beneficial for you. Seeing other people, suffering from the same condition, and realising that you’re not the only one may help a lot. 

When you successfully overcome burnout, you may experience a shift in the way you look at life. Don’t be surprised if you don’t want to go back, start value and prioritise different things, and see the world differently. It’s normal. This is yet another overlap between PTSD, trauma, and burnout.

“A successful treatment of burnout may move into a fourth phase. There is a body of literature suggesting that people exposed to even the most traumatic events may perceive at least some good emerging from their struggle with tragedies. This is called posttraumatic growth” (van Dam, 2021)

So if you’re struggling now, I wish you to experience the growth eventually. 

This article is based on the research I’ve done and the resources I came by. Despite my every effort, inaccuracies may occur. Please do not treat this article as medical advice but as a guideline and a baseline for your own research. 

References

About Dr. Geri Puleo. (2018, March 31). ChangeWithoutBurnout. https://changewithoutburnout.com/about-dr-geri-puleo/

Burn-out an ‘occupational phenomenon’: International Classification of Diseases. (n.d.). Retrieved 17 July 2024, from https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

Demerouti, E., Bakker, A. B., Peeters, M. C. W., & Breevaart, K. (2021). New directions in burnout research. European Journal of Work and Organizational Psychology, 30(5), 686–691. https://doi.org/10.1080/1359432X.2021.1979962

DW Documentary (Director). (2024, April 27). Burnout – When does work start feeling pointless? | DW Documentary [Video recording]. https://www.youtube.com/watch?v=raVms8w61No

Edú-Valsania, S., Laguía, A., & Moriano, J. A. (2022). Burnout: A Review of Theory and Measurement. International Journal of Environmental Research and Public Health, 19(3), Article 3. https://doi.org/10.3390/ijerph19031780

Fraser, K., Ma, I., Teteris, E., Baxter, H., Wright, B., & McLaughlin, K. (2012). Emotion, cognitive load and learning outcomes during simulation training. Medical Education, 46(11), 1055–1062. https://doi.org/10.1111/j.1365-2923.2012.04355.x

Gabriel, K. P., & Aguinis, H. (2022). How to prevent and combat employee burnout and create healthier workplaces during crises and beyond. Business Horizons, 65(2), 183–192. https://doi.org/10.1016/j.bushor.2021.02.037

Huberman Lab Clips (Director). (2024, April 17). How to Avoid Burnout | Dr. Cal Newport & Dr. Andrew Huberman [Video recording]. https://www.youtube.com/watch?v=smjGAcyqDnk

WHO Hypertension. (n.d.). Retrieved 17 July 2024, from https://www.who.int/news-room/fact-sheets/detail/hypertension

IT Revolution (Director). (2019, July 1). Understanding Job Burnout—Dr. Christina Maslach [Video recording]. https://www.youtube.com/watch?v=SVlL9TnvphA

Major Depression—National Institute of Mental Health (NIMH). (n.d.). Retrieved 17 July 2024, from https://www.nimh.nih.gov/health/statistics/major-depression

Mäkikangas, A., Leiter, M. P., Kinnunen, U., & Feldt, T. (2021). Profiling development of burnout over eight years: Relation with job demands and resources. European Journal of Work and Organizational Psychology, 30(5), 720–731. https://doi.org/10.1080/1359432X.2020.1790651

Maslach, C., & Leiter, M. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15, 103–111. https://doi.org/10.1002/wps.20311

Plass, J. L., & Kalyuga, S. (2019). Four Ways of Considering Emotion in Cognitive Load Theory. Educational Psychology Review, 31(2), 339–359. https://doi.org/10.1007/s10648-019-09473-5

Schaufeli, W. (2006). The balance of give and take: Toward a social exchange model of burnout. Revue Internationale de Psychologie Sociale, 19. https://doi.org/10.1016/j.jsp.2005.11.001

Schaufeli, W., Leiter, M., & Maslach, C. (2009). Burnout: 35 Years of research and practice. Career Development International, 14. https://doi.org/10.1108/13620430910966406

TEDx Talks (Director). (2014, March 19). Burnout and post-traumatic stress disorder: Dr. Geri Puleo at TEDxSetonHillUniversity [Video recording]. https://www.youtube.com/watch?v=hFkI69zJzLI

van Dam, A. (2021). A clinical perspective on burnout: Diagnosis, classification, and treatment of clinical burnout. European Journal of Work and Organizational Psychology, 30(5), 732–741. https://doi.org/10.1080/1359432X.2021.1948400

Wekenborg, M. K., Hill, L. K., Grabbe, P., Thayer, J. F., Kirschbaum, C., Lindenlaub, S., Arne Wittling, R., & von Dawans, B. (2022). Associations between burnout symptoms and social behaviour: Exploring the role of acute stress and vagal function. BMC Public Health, 22(1), 892. https://doi.org/10.1186/s12889-022-13333-3