Burnout

The term burnout first appeared in 1960 in a novel by Graham Greene, “A Burn-Out Case”: the author describes the life of an extremely successful architect who, without warning, quits his job and flees to a village in the Congo, where he eventually dies. This sudden departure is very typical of burnout, especially if the person has ignored all the warning signs for months or even longer. A sudden nervous breakdown, insurmountable fatigue or exhaustion can also be clear signs of burnout.

Burnout is linked to the world of work

It was not until 1975 that the American psychiatrist Herbert Freudenberger and, in 1976, the social psychologist Christina Maslach (University of California) published the first studies on the burnout syndrome. They described it as a response to chronic stressors in the workplace. Historically, burnout was first discovered and observed in people who worked with patients (nurses, doctors, etc.). In her book The Truth about Burnout (1997), Maslach emphasizes that burnout is not a problem of an incompetent person, but of the workplace. Recent developments in the global economy have led to a great deal of insecurity for employees, a decline in group solidarity in the work team, and extreme austerity measures. The latter demand more and more from the employee for the same salary. Creative initiative is no longer encouraged. The pressure of competition (globalization) leads to more and more short-term thinking. Pointless decisions are often made amateurishly from the top without consulting the employees. They feel excluded, powerless and no longer taken seriously.

Symptoms of burnout

Maslach identifies three main symptoms:

1. Overwhelming exhaustion

2. Feelings of cynicism and detachment

3. Feelings of ineffectiveness (due to lack of resources) and reduced performance.

Burnout in ICD-11(WHO 2019 version)

Burnout appears in category Z73 (problems related to difficulties in coping with life) under Z73.0 as burnout (a state of total exhaustion) without comment. According to this classification, burnout is a framework or additional diagnosis, not a fully recognized diagnosis. In Switzerland, patients diagnosed with burnout are not entitled to a disability pension.

Differential diagnosis

A correct diagnosis is very important, on the one hand for dealing with the health insurance companies and on the other hand for determining the optimal therapy. It is necessary to distinguish burnout syndrome from other pathologies with similar symptoms. The following pathologies are possible:

• Depression: depressed patients regularly feel exhausted, slow, have no desire for anything, no appetite and poor sleep; they may withdraw and avoid contact. A painful sadness dominates, with possible suicidal thoughts. Burnout victims, on the other hand, tend to show a kind of indifference. They may also feel relatively relaxed outside the work environment if they don't think about work. Depression affects all areas of life.

• PTSD Post-Traumatic Stress Disorder: Dissociative symptoms such as detachment (depersonalization, derealization) are common. Depression, aggressiveness, and cynicism are also common. But the cause is usually clear: the previous trauma.

• Mobbing: This is also common in the workplace. As with PTSD, the cause is typically clear: interpersonal aggression designed to drive the opponent from the territory. The victim is supposed to quit. In stalking (rarely related to work), the victim (real or virtual) is stalked, hunted, and killed.

• Chronic Fatigue Syndrome, CFS: is a multicausal umbrella term without proper scientific recognition. If fatigue is the main symptom, the patient must be medically evaluated. What are the blood counts, iron, magnesium and thyroid levels? Is there a chronic infection/inflammation or tumor? Candida infections, gluten allergies, fibromyalgia, and even cervical problems can cause such fatigue.

• In her 2008 bestseller “Recovery from CFS: 50 Personal Stories,” British author Alexandra Barton describes fifty stories of patients who were cured of severe chronic fatigue through diet, prayer, thyroid extract, strict rest, etc. Fifteen percent were cured, and fifteen percent were cured within a few weeks by reverse therapy, a purely emotional therapy.

• CFS has very similar characteristics to burnout: it can also come on very suddenly after a long development, the mood is not as bad as in depression, people feel like doing something, but they lack the strength. With burnout, it is usually the work situation that makes you sick. Cynicism and aggression are often present. Ultimately, the person is blocked by others (inefficiency) and not by their own body, as with CFS patients.

Conclusion: This brief description should not give the impression that all these conditions occur in isolation. In practice, you may find an overworked secretary with an iron deficiency, a chronically depressed victim of bullying, or a burned-out trauma victim. Treating these complex cases may require several specific interventions, e.g., antidepressants + trauma therapy + iron infusions, etc.