Is Burnout a Medical Diagnosis? (Part I)
“According to Harvard Business Review, the psychological and physical problems of burned-out-employees cost an estimated $125 billion to $190 billion a year in healthcare spending in the U.S.,” (Garton, 2017).
| 7 minute read |
Is The Globalization of Burnout a Self-Imposed Threat?
The world’s sharpest minds continue to debate the medical conceptualization of burnout. Experts researched burnout openly since the 1970s as a global occupational phenomenon. Despite worldwide prevalence and urgency, contradicting research and data methods confuse the medicalization of burnout. Burnout impacts large portions of the world’s workforce: behavioral-mental health professionals, healthcare workers, law enforcement, and other public safety and service workers and yet, the controversy continues. Is burnout self-imposed or an elusive threat? Is burnout a personal or social-occupational issue? How does this inform our prevention of burnout in mental health fields? Does burnout meet the medical criteria to become a diagnosis, as established by the global powers at be? If we cannot define burnout, how can we expect to have a sustainable workforce of therapists, counselors, nurses, doctors, and law enforcement?
Burnout costs hundreds of billions of dollars annually in healthcare spending in the United States.
Burnout in the U.S. | The Impact of Burnout on Our Healthcare System
Remember, burnout is not an official medical diagnosis–just a social syndrome plaguing the workforce in global proportions. Although the World Health Organization (WHO) identifies burnout as a syndrome, the Diagnostic and Statistical Manual (DSM-5) does not follow suit. Burnout is not listed in one of the leading medical diagnostic tools in the United States. How can this be? Does burnout manifest differently among different cultures? Is the solution also cultural in nature? This burnout controversy is more expansive and less clear than I had originally thought.
“According to Harvard Business Review, the psychological and physical problems of burned-out-employees cost an estimated $125 billion to $190 billion a year in healthcare spending in the U.S.”
Overview
I first started researching burnout for my own catharsis and to encourage my fellow mental health professionals. I figured I would add a personal story, add a few quotes from people smarter than me, and then call it a day. But I really began questioning—is burnout a self-imposed issue or an elusive phenomenon?
But in my research, I opened up a can of worms–a truckload, really! Now, I’m hooked–a small fish in a very large ocean of learning more about the controversy of burnout. Call me naive, but I’m still surprised burnout is a medical controversy. So, a single blog post quickly expanded to three. Here’s a quick overview of my initial findings:
The world cannot agree on the medicalization, epidemiology, and treatment of burnout, despite the progress in the conceptualization of burnout by the World Health Organization (WHO), the American Medical Association (AMA), and Maslach (who created the Maslach Burnout Inventory or MBI).
The medicalization vs. over-medicalization debate is convoluted due to risks and opportunities in the areas of economic, political, cultural, and physiological. Bioethics and biopolitics identify pharmaceuticals and a negative workplace environment as having high stakes in the game.
There is global urgency to help support workers in the public service sector.
There are far more factors at play than meets the eye in determining the epidemiology of burnout
Burnout continues to be a medical-cultural controversy
How Do Epidemiologists Determine Diagnoses?
Epidemiologists determine the diagnosis or health event (what), person (who), place (where), time (when), and causes, risk factors, and modes of transmission (why/how). If we’re going to uncover the truth about burnout, we need to understand how epidemiologists think and gather data. Consider the question-prompts below and discover your own opinions. Is burnout a medical diagnosis?
WHAT
What is burnout? What is the source of burnout? What is the potential burnout will spread? What interventions will help prevent burnout? What causes burnout? What makes burnout reoccur? What are the effects of burnout on the body, mind, and soul?
WHO
Who is burnt out? Who is more susceptible to burnout?
WHERE
Where in the world are there patterns of burnout?
WHEN
When was the first documented account of burnout?
WHY
Why is burnout on the rise at this point in history? Why are some professions more likely to be burnt out than others? Why are some personalities more prone to burnout?
HOW
How does burnout differ from diagnosable diseases and conditions? How does someone heal from burnout? How long is the recovery process? How long has burnout been an issue?
Should burnout be diagnosable? YOU DECIDE.
Epidemiology is no longer confined to the study of communicable diseases, but was subsequently expanded to include, “anything that affects the wellbeing of a population,” such as natural disasters, terrorism, and occupational health, (Greenwood, 1935). The rise in global burnout only further solidifies a case for epidemiologists to increase their study of this occupational hazard.
Is Burnout A Personal Problem or a Work Problem?
There is a condemning question for those of us in professions with the highest risk of burnout–did we choose this? Is burnout our self-inflicted punishment for choosing a career wholeheartedly vulnerable to burnout? A lifestyle void of adequate rest? Unhealthy rhythms? Is it impulsive, compulsive, or intentional? Is our suffering self-imposed or is the solution slipping through our fingers? It’s frightening to measure your fatigue the moment you enter the office. How long can I keep doing this? How come no one else seems to be struggling? Productive people loathe the helplessness of brain fog. No amount of caffeine can awaken the senses, humanity, and hope. Blank stares at the computer screen. Lost time. Empty thoughts. Empty presence. Restrained tears. Clenched fists. Ready to quit. Overzealous one moment, underwhelmed the next. Surviving moment by moment. Dragging on. Shuffling. Staggering. Stumbling. Forgetting. Losing oneself. What’s the point?
Burnout isn’t an internal experience for long. It seeps from our pores and saturates the air around us, drowning life from relationships. It is the unwanted physiological droplets left as evidence all around us. Our health is depleting. As one person told me once, “What’s in you, comes out of you, and shapes the world around you.” Consider your clients, patients, colleagues, and supervisors. Reflect upon your friends and loved ones. You are a human being connected to a network. Whole communities of healthcare workers, behavioral health professionals, educators, pastors, and law enforcement–unsupported. Wiped out. Stuck. A fly caught in a tenacious web. But is burnout elusive? Or self-imposed? Don’t we see it coming? Why don’t we stop it? What is truly in our control?
Countless well-intended public service workers have run themselves ragged. Is burnout a medical crisis? Current epidemiology is impractical and inconclusive. Burnout remains prevalent, yet deceptive. How can this be? How can we induce greater consciousness of self-care among public service workers? What is the cost of holistic healing? Do we ever reach it? Do corporations, medical clinics, and mental health agencies have a handle on it? How can we better support those wrestling with burnout and compassion fatigue? Burnout is not rare. I’m convinced of it. Pay attention. It’s actually more common than we realize. It’s an unofficial epidemic, if you ask me. A gradual menace–a piecemeal tyrant.
“During intern year I thought that I was superhuman, that I had gained some mysterious capacity to plow through cases such as Mrs. L’s and not feel a thing. It took over a year after internship had ended for me to I realize that my humanity had in fact been diminished—both by the onslaught of suffering that I, like every doctor, had to confront during my initiation into the profession and by my response of “tuning out” all of those inconveniently human emotions I might have felt along the way.”
Burnout can actually make us numb to the pain of others and towards ourselves.
Check out our free resources to determine if you’re burnt out!
Christina Maslach and Susan E. Jackson, from the University of California, Berkeley, have been studying burnout for decades. Maslach was the main contributor to the creation of a burnout syndrome assessment tool, the Maslach Burnout Inventory (MBI). In their 1980 article, “The measurement of experienced burnout,” published in the Journal of Occupational Behavior, they introduced the 3 main subscales that most accurately describe burnout: emotional exhaustion, depersonalization, and personal accomplishment.
“The professional staff in human service institutions are often required to spend considerable time in intense involvement with other people. Frequently, the staff-client interaction is centered around the client’s current problems (psychological, social, and/or physical) and is therefore charged with feelings of anger, embarrassment, fear or despair. Solutions for these problems are not always obvious and easily obtained, thus adding ambiguity and frustration to the situation. For the helping professional who works continuously with people under such circumstances, the chronic stress can be emotionally draining and poses the risk of ‘burnout’.”
I don’t think we fully realize the societal and medical demand we put on certain fields. Who is at a higher risk of burnout? Medical, behavioral health staff; educators and principals, therapists, firefighters, and police officers. But how do we address this unseen threat? What are the symptoms of burnout and compassion fatigue? How can you tell if you’re experiencing secondary traumatic stress?
“An inability to empathize with others, or feeling numb, often happens as a result of one’s system being overwhelmed with incoming stimuli. Jon Conte, a professor of social work, clinicians, and one of the forefathers of trauma exposure theory, says it is as if you are a sponge that is completely saturated and has never been wrung out. One can only take in so much.”
It’s difficult to prescribe an antidote when we continue to struggle to conceptualize burnout. In 2016, Michael P. Leiter and Christina Maslach published their updated research from their work in the 1970s and 1980s, to identify five different profiles on the continuum between Burnout (the most negative experience) to Engagement (the most positive). The three intermediate profiles were Disengaged (characterized by high cynicism only), Overextended (high exhaustion only), and Ineffective (high inefficacy only), (Leiter, Maslach 2016).
One antidote is rest. We have made burnout recovery sorely oversimplified, subjective, and unpragmatic. How can we truly measure holistic rest? How long is the recovery process? Are some more at risk of burnout and compassion fatigue than others? This attacker, burnout, is a phantom. Or is the culprit something else? (Hmm.) The conceptualization of burnout continues to divide scientists and medical health professionals across the globe. Simultaneously, other similar medical diagnoses are intersecting with burnout, causing further confusion regarding conceptualization of burnout.
“Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression,” (Cocker, Joss, 2016).
Interesting. Compassion fatigue, Secondary Traumatic Stress and burnout correlate enough to challenge our current understanding of burnout. Does one cause the other? Or are these terms synonymous? Or merely cousins in the medical field?
What we can agree on, is the importance of protecting our mental health professionals (and others), as well as our clients and patients. We don’t want to harm our clients and patients, so we support, validate, and partner with them in their holistic healing. So, why don’t we offer that same sacred protection to ourselves? Addressing our compassion fatigue serves better client health outcomes.
(If you’re asking, What is burnout, compassion fatigue, and depression? What is secondary traumatic stress? And how does it relate to trauma? Check out these terms in my last blog post. Although these terms are not synonymous, they interconnect. For all intents and purposes, I may use burnout (BO) and compassion fatigue (CF) interchangeably. Check out the References section at the end of this blog post. Look for Middleton or check out Cocker and Joss’ work, if you’d like to know more.)
“Although trauma and burnout are different issues, some of their symptoms overlap, and the experience of trauma may contribute to and exacerbate the feelings of burnout. Trauma can also lead to depression and suicide—the two other mental health–related occupational hazards of our profession that we most frequently discuss—as well as substance abuse, complex grief reactions, “overdedication” to our work at the expense of self-care, and other mental health concerns,” (Vance, 2019, p. 868-871).
Medical professionals are at heightened risk for burnout.
“To our knowledge, this is the first review to attempt to evaluate the evidence of the effectiveness of CF interventions in at-risk health, emergency and social care professions. Results revealed that, despite an awareness of the prevalence of CF in these at-risk workers, there is a lack of information and evidence about effective workplace based strategies to reduce CF in these occupational groups via modifying its recognised individual and organisational risk factors. Therefore, we recommend more research to determine how best to protect vulnerable workers in order to prevent CF, as well as the potentially more significant health and economic consequences related to the subsequent physical and mental health outcomes,” (Cocker, Joss, 2016), emphasis added.
Essentially, compassion Fatigue—like burnout—remains elusive. Lurking... Waiting... With no forewarning.
Burnout is not new. Since the 2019 WHO’s (World Health Organization) public declaration, more and more researchers are jumping on board to discover the symptoms, causes, and effects of burnout. What’s the first challenge point? According to WHO, burnout is an occupational phenomenon and they do not classify it as a medical condition. Hmm. I’m on the fence about that. I think there’s an argument either way.
Even though burnout does not have a medical diagnosis, fatigue does! Fatigue is a common yet rather puzzling symptom associated with depression and anxiety, which are also medical conditions. What gives? Why is burnout conceptualized in such an unclear manner? Is burnout really that unexplainable and ubiquitous? (Like… a phantom or something? It’s there, but it’s not?)
Dr. Mary C. Vance comments on the importance of conceptualization and terminology related to burnout in her article, Recognizing Trauma In The Healer: “Yet we in the healing professions, who may experience many such events in our line of work, can’t seem to call trauma what it is. That collective silence saps our resilience and impedes our healing. We can’t solve a problem we haven’t named,” (Vance, 2019, p. 868-871). She continues saying, “Names matter. The words we use to describe our pain set the tone for how we experience it, relate to it, and heal from it.” The conceptualization of burnout is not only a matter of personal healing, but of medical and universal importance, as well.
“Until we call trauma by its name, we cannot come to terms with its full impact on us. Until we recognize that we can experience traumatic injury in the line of duty, just as soldiers, police officers, or first responders do, we are perpetuating the myth of the superhuman healer who can see ever more patients, write ever more notes, work ever longer hours, and absorb ever more pain, and still somehow keep going.”
Now imagine a workforce filled with clinicians, doctors, nurses, law enforcement officers in this position. (Uh oh.) Uh oh is right. The conceptualization of burnout, compassion fatigue, and STS is a global affair. But will the medical world recognize it as such?
If you fear you may be burnt out from work-related pressures, magnified by personal stress, then take this brief 10 Question Quiz or better yet, sign up here to receive updates on our upcoming digital bundle, packaged with TONS of helpful information and tools to help you combat burnout in helping professions. It’s time to take your life back. It’s time to confront burnout.
So what are we doing to address the deteriorating health of healthcare workers? If you fear you may be at risk of burnout from work-related pressures and personal stress, then take this brief 10 Question Quiz. Or better yet, sign up here to receive updates on our upcoming bundle, packaged with TONS of helpful information and tools to help you combat burnout in helping professions. It’s time to take your life back.
If you had all the answers, you wouldn’t be here reading this, would you? (Nope.) And what you’ve tried hasn’t worked? (Nope.) Join the club. (Try this, instead!) So, are you willing to make changes? Are you prepared to achieve success in both your personal and professional life? Are you prepared to confront any push-back or disparaging comments about your work ethic? Perhaps you’ll be a rebel against the status quo. Or Maybe misunderstood as a modern-day martyr. Yet you know the truth: you will no longer allow your job or anything else to steal your health, rest, time with loved ones, or sanity.
If you are in any of these helping professions, do you feel the effects of burnout? Have you noticed colleagues or loved ones suffering through compassion fatigue? What about secondary traumatic stress? What will you do? Seize the day! Your health and the health of others, depends on it.
In our ongoing series, we’re going to continue this conversation of self-care and self-compassion within careers riddled with burnout and in a culture tormented by the ideal of productivity. Why wait to change? Do you believe anyone else can decide for you? (Nope.)
It’s time for a shift. Transformation. I know I need a win. It’s time to counter burnout and poor self-care. Take a step. For you, that might mean rest. For others, advocacy. It is likely drawing boundaries and saying no to some people. It might mean using your paid time off or taking an extended weekend to get out of town. Read a book. Get to the gym. Change any unhealthy rhythms. Soon you’ll experience strength and hope to allow you to tackle the issue on the front lines—in the workplace.
If you fear you may be burnt out from work-related pressures, magnified by personal stress, then take this brief 10 Question Quiz or better yet, sign up here to receive updates on our upcoming digital bundle, packaged with TONS of helpful information and tools to help you combat burnout in helping professions. It’s time to take your life back.
References
American Psychiatric Association. (2015). DSM-5 classification (5th ed.). American Psychiatric Publishing.
Barron, C., Ring, D., & McGlone, M. (2017, May 9). Is there a better term for ‘Burnout’? Dell Medical School. https://dellmed.utexas.edu/blog/is-there-a-better-term-for-burnout
Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International journal of environmental research and public health, 13(6), 618. https://doi.org/10.3390/ijerph13060618
Garton, E. (2017, April 6). Employee burnout is a problem with the company, not the person. Harvard Business Review. https://hbr.org/2017/04/employee-burnout-is-a-problem-with-the-company-not-the-person
Greenwood M.Epidemics and crowd-diseases: an introduction to the study of epidemiology, Oxford University Press; 1935.
Leiter, M. P., & Maslach, C. (2016). Latent burnout profiles: A new approach to understanding the burnout experience. Burnout Research, 3(4), 89-100. https://doi.org/10.1016/j.burn.2016.09.001
Lipsky, L. V., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. National Geographic Books.
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99-113. https://doi.org/10.1002/job.4030020205
Middleton J. Addressing secondary trauma and compassion fatigue in work with older veterans: An ethical imperative. Aging Life Care J. 2015; 5:1–8.
M.P. Leiter, C. Maslach. Areas of worklife scale manual (5th ed.), Mind Garden Publishing, Palo Alto, CA (2011).
Parens, Erik. (2013). On Good and Bad Forms of Medicalization. Bioethics 27 (1): 28–35.
Vance, M. C. (2019). Recognizing trauma in the healer. Health Affairs, 38(5), 868-871. https://doi.org/10.1377/hlthaff.2018.05061
World Health Organization (WHO). (2022, February 11). ICD-11 2022 release. https://www.who.int/news/item/11-02-2022-icd-11-2022-release
