The Definition of Burnout
I think it makes a lot of sense to have a definition so that we’re all on the same page. I’ll try my best to give a definition, but then I’ll talk about the issues with it. Many people would describe burnout as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.
The major issue is that burnout isn’t a diagnosable condition, and it doesn’t have a formal definition that doctors and mental health professionals universally accept. As a result, there is no commonly accepted treatment protocol for burnout. There was a paper published in the Journal of the American Medical Association in 2019 that argued that burnout and depression are the same presentation because they have overlapping symptoms and clinical features such as fatigue/exhaustion, negativity, a loss of motivation and enjoyment in things, and a decline in work productivity. The paper took a stand that physicians often gravitate to the term burnout for themselves because of the stigma associated with a psychiatric condition like depression. Also, burnout seems to be more socially acceptable, almost like a badge of honour, because it means that you worked so hard or cared so much that you have no energy left in your battery to keep things going. However, for physicians that are attracted to labelling their condition as burnout, it can be potentially dangerous for themselves and the patients under their care because they misidentify burnout instead of depression and do not receive the appropriate treatment.
Whenever I receive a referral for a patient who self-identifies with burnout, I have consistently found that they meet the criteria for a mental health issue such as depression, anxiety, posttraumatic stress, or addiction. It is very common for them to experience more than one of these issues. However, it’s so hard for most people to see a psychologist or psychiatrist for the first time. They’re often scared and intimidated because of the stigma around mental illness. At the end of the day, the debate of whether burnout is its own clinical condition continues at the expense of the public because the lack of clarity leads to a lack of alignment over the proper conceptualization and treatment protocols. This prevents people from getting the help they need.
The Opposite of Burnout
I like to think of the opposite of burnout as what it looks like when people do not have any clinically significant symptoms of mental health problems like depression or anxiety. In this case, a person would be engaged with life, in a generally positive state of mind, and are functioning well in the major areas of life such as work, relationships, hobbies, self-care, and their home life. It doesn’t mean that people never experience stress, negative emotions, or issues in their lives. They do, but they are able to manage it and keep their lives moving forward.
Long-term Impacts of Burnout
This is a tough one because most cultures do not have a long history of mental health literacy. Our modern western conceptualization has mainly evolved over the past 100 years and much more so in the past 50 years. The old school mentality of “soldier on” and “grin and bear it” was often held by most cultures throughout history to keep people moving forward in order to survive. Sometimes we need this mentality to push through adversity, but sometimes it drives people further downwards.
For example, if you have a person who is generally conscientious in their life, this means that they are hardworking, driven to meet their goals, and like to be seen as competent by others. When their battery is charged, it’s much easier for them to take on stressors in life and work towards their goals. However, when they experience a lot of stress, adversity, and challenges, the level of energy in their battery starts to drain over months and years. In order to maintain their high standards at work or other areas of life, the person will likely push harder to keep up. This tendency to work harder becomes a pattern over time. This will burn more energy from their battery and will continue to drain it unless they find a way to change their patterns, alleviate those challenges in their life, and recharge their battery. As their battery levels run low, they will begin to experience soft symptoms of anxiety and depression such as irritability, fatigue, concentration problems, and muscle tension. If this pattern of pushing themselves and not recharging their battery continues, their battery will drain further, and they will experience more negative emotions of sadness, guilt, hopelessness, anger, and anxiety. They may also feel on edge, restless, have significant sleep problems, and either gain or lose a significant amount of weight. It also affects their ability to keep up with their work, maintain positive relationships, or take care of everything at home. When conscientious patients experience these patterns and agree that their battery has become depleted, they often describe it as burnout.
In terms of the impact of telling someone to “soldier on”, it generally makes things worse. If you think of it from the conscientious person’s point of view, they feel that they are willing to work to overcome adversity or challenges. They always have worked hard and generally, it’s always been effective. It’s a lifelong pattern that has helped them achieve their goals, such as getting a degree, getting a promotion, or making the team. But this time, something is different. They’ve been pushing as much, if not more than they have in the past to work through the bumps, and it’s getting harder over months or years. It’s more exhausting. They notice that they can’t bounce back as quickly as usual, and they can’t stay as resilient in the face of change or challenges. They don’t know how much longer they can keep it up. This often makes them feel confused because their lifelong pattern of soldiering on isn’t working this time. They often feel frustrated over not being able to figure out how to get things on track despite all of the work they’ve put into keeping things going. They often question and blame themselves for not finding a solution. Therefore, telling them to “soldier on” will likely be twice as damaging to the person because it is instructing them to keep up exactly the same patterns that are driving their life downwards. Secondly, to a conscientious person who prides themselves on their work ethic, it often makes them feel judged for not doing the main thing that they’ve always done throughout their life: work harder and soldier on. It sends a message that makes them feel unintelligent because the answer is as simple as “soldiering on” so why haven’t they figured that out or done it enough?
The patterns that keep the person’s battery drained are the ones that need to be identified and changed. For example, a common strategy in Cognitive Behaviour Therapy is to have the person track their moods throughout the week in a systematic way. This helps them become more aware of what causes their moods to spike, such as an overwhelming thought or anxiety over facing something they’ve been avoiding. Over time, the tracking helps them see a predictable pattern in their moods throughout the week. For example, people may experience similar moods when they wake up, interact with certain people, or think about the stressful issues in their lives. One of the reasons why Cognitive Behaviour Therapy works so well is because it has an approach to teach these skills to people so that they can learn to be more self-aware of the patterns they need to break.
I have found that Cognitive Behaviour Therapy works particularly well for conscientious people because, when they are struggling and their battery is drained, they are desperately looking for a plan and proactive things to break those patterns that are driving their mental health downwards. These are the people I’ve always worked well within my clinical practice. They are on disability leave and the most common diagnoses I give are depression and generalized anxiety (technically, they are diagnosed as Major Depressive Disorder and Generalized Anxiety Disorder but I have a profound disdain for labelling them as a disorder). Again, some arrive and believe that burnout is the primary issue. The diagnoses are important because there are specific Cognitive Behaviour Therapy treatment approaches for depression and generalized anxiety. For the patients on disability that I treat for burnout, I consistently find that successfully treating depression and anxiety (occasionally with posttraumatic stress or other diagnoses) leads to them feeling better and getting their lives back on track.
As a doctor, my dad often talked about treating his patients’ physical illnesses but how “nothing was worse than emotional pain.” The reason why treatment is so important is because living with chronic mental illness is hard emotionally, and it takes a toll on the body. If people believe that they are experiencing burnout but do not get the help they need, they can be living with depression or other mental health issues for prolonged periods. There was a paper published in Nature in 2019 that stated unequivocally that we know that depression causes patients to die faster. People with mental health issues need help and treatment because it erodes their quality of life and shortens their life.
The Main Causes of Burnout
People often report experiencing burnout when their battery is drained over time, and negative patterns are created in their daily lives that keep them low and unable to recharge. There are many factors that can lead to this, but there are common patterns. They experience a lot more personal and/or work-related issues that cause a lot of stress. For example, a toxic work culture, interpersonal conflict, unclear roles/expectations, or unrealistic workloads can drain a battery over time. In people’s personal lives, relationship problems, family or personal health problems, or financial stress are all stressors that can deplete our energy levels. The exact variables are different for everyone but the pattern of them taking a toll on their battery for a long time is very common for many people who report experiencing burnout. Another common issue is that they struggle to change the patterns that contributed to draining their battery on their own.
When a person’s battery has drained, the patterns in place are often associated with different types of mental health issues. For example, people experiencing depression have a pattern of feeling like they don’t have any control to change things, they tend to think in all-or-nothing ways, and they struggle to set goals in a systematic way to move things forward. People with anxiety have patterns of struggling with uncertainty and experiencing a lot of worry that constantly drains their battery. People with post-traumatic stress can be so deeply affected by their trauma that their bodies are in a constant state of fight-or-flight because they have developed a pattern of experiencing the world as an extremely dangerous place. For some people who struggle with managing their alcohol consumption, the one thing that helps them feel anything other than the stress and fear they had all day at work is a drink when they get home. If they have tried everything else, and that is the only thing they’ve found to alleviate their pain, there are patterns where it becomes more frequent over time, and one drink becomes many. When people report burnout, they often experience one or more of these patterns that keep their battery drained but do not understand or see it as a mental health issue.
How to Address Burnout
I like to think of mojo as confidence so getting your mojo back is a big part of reversing burnout. This fits with my experiences treating depression and anxiety, which are often the main presentations of burnout and conditions where people have lost their confidence. For example, I have never seen a patient with depression whose overall level of confidence was high because depression is often accompanied by a perception of hopelessness and a lack of control over making any changes. Also, a lot of negative self-talk further erodes confidence over time. To reverse these patterns, so the person feels hopeful, they should focus on the smallest areas of life that they can control and keep building on overtime. They should also talk to themselves like how a good coach would motivate their athletes. Both of these led to a different set of patterns that would alleviate depression and rebuild their confidence. Similarly, patients with anxiety tend to overestimate the amount of danger in their lives and underestimate their ability to cope. As a result, they frequently worry and question themselves in ways that further chip away at their confidence. Reversing these anxiety patterns by helping the person re-calibrate their perception of danger, assertively manage their worrisome thoughts, and train themselves to face situations that reinforce their ability to cope and perform in different situations are all ways to rebuild confidence and reverse the patterns that lead to burnout.
Based on the idea that we need to help people experiencing burnout to recharge their battery and increase their confidence, here are 5 Things You Should Do:
Step 1: Meet yourself where you are at. This is a critical step that requires a certain level of self-awareness and acceptance. For example, suppose you are a conscientious person experiencing burnout and setting goals and expectations based on your perception of having a relatively charged battery. In that case, you will likely struggle because in reality, your battery level is so low that your goals are too lofty or difficult to sustain. This will result in you not succeeding and feeling confused and upset with yourself because you’ve had success pushing forward in the past. Also, this makes it hard for you to see that you need to set a series of smaller goals that lead to consistent success, build positive momentum, and begin breaking your old patterns. That’s why at this stage, you need to evaluate the level of energy in your battery and accept that there are a number of patterns that need to be identified and changed.
Step 2: Identify the stressors and patterns that are contributing to depleting your battery. This also requires you to have sufficient self-awareness skills to see the patterns and figure out what needs to change.
Step 3: Make enough changes to cause a shift in the patterns that drain your battery. You need to break those old patterns and build new ones because, at the end of the day, it comes back to the old saying, “Insanity is doing the same thing over and over and expecting different results.”
Step 4: Ensure that your new set of patterns is putting you on a better trajectory. This means that the old patterns that were depleting your battery levels have changed or diminished so that you can start to recharge. As your battery recharges to higher levels, you should feel an increased sense of confidence, assertiveness, and decisiveness.
Step 5: Ask for help if needed. This can be really difficult for conscientious people because they generally like to be regarded by others as highly capable and competent. It’s a hard pill to swallow to admit to themselves or others that they are actually struggling. When they reach out to people, it’s critical to identify the right people because a negative interaction can make them feel worse and retreat into themselves. They will likely continue with the patterns that keep their battery low. Sometimes a mental health professional such as a psychologist is needed but it’s like finding the right doctor, hairdresser, or mechanic in the sense that you need to find the right fit for you. One of the main reasons why they’re needed is because managing your mental health is a skill just like reading, gardening, or throwing a ball. We all learn various skills in school and in life but we rarely learn how to improve the skills needed to take care of our mental health. These professionals are trained to help you learn those skills.
The main point is that there are a lot of ups and downs in life and it’s hard for anyone to manage it all on their own all of the time. There is help out there and everyone can learn about mental health and things they can do to improve it.
How Friends, Colleagues, and Partners can Help
Many conscientious people isolate themselves when they are struggling because they are embarrassed and self-conscious. So, it’s important for friends, colleagues, and life partners to reach out and stay connected and supportive. Once you’ve reached out, it’s important to listen to understand and not listen to solve their problems. Listening with a lot of empathy and really trying to see things from their point of view is absolutely critical. Some people struggle with this because they literally put themselves in the other person’s shoes instead of considering the makeup of the other person and how they are reacting to their experiences. Most people have a good heart and offer potential solutions because they are trying to help. However, this can come across as judgemental or condescending. For example, telling a person experiencing depression to think more positively or advising someone experiencing anxiety to stop worrying are useless and potentially damaging. Most people are smart and resourceful enough that they would have done those things a long time ago if the answer was that simple. There is never an easy solution or magic bullet.
How Employers can help with Burnout
In order to reverse burnout, you have to understand it. This means employers need to recognize their role in both contributing to burnout and reversing it. For employees, I’ve tried to emphasize that work life, personal life, and people’s pattern of coping are the major factors that contribute to burnout. When an employee goes on disability leave due to burnout, there is a combination of patterns from each of these factors in place. For example, working every day with a manager that has constantly undermined your work and trust for the past two years, while at the same time managing your partner who is at their wit’s end because your newborn baby hasn’t slept in 8 months, and your personal tendency to bury all of your problems and soldier on are all problems to be solved in order to recharge your battery. If your employer has a strong understanding of burnout and learns to identify the patterns that lead to it from their side (i.e. the dynamic between you and your manager), they could help by making changes so that historical patterns that led to your burnout does not repeat itself when you return to work.
Strategies to Raise Awareness on Burnout
Over the years, I’ve learned that it is critical to get alignment and buy-in from all of the leaders. More specifically, the CEO and executive team of an organization need to set the tone and messaging. If they do not endorse it or believe in it, any initiatives around mental wellness will likely die on the vine because the messaging will ring hollow to the employees. Also, the leaders need to be crystal clear on the current status of their culture and where it is at in terms of mental health literacy and understanding. For example, if the leaders do not see the brutal truth that their workplace has a toxic or indifferent culture, they will likely implement a variety of different strategies that are destined to fail. Meeting yourself where you are at is a key first step for workers experiencing burnout, and it is also the first step for organizations to take successful steps to support employees’ mental wellness.
In addition, the strategies to raise awareness must help the employees gain a clear understanding of burnout, how to identify it in themselves and colleagues, the steps they need to take to reverse it, and how the organization will support them. There is a lot of literature that proves an ounce of prevention is worth a pound of intervention. If your people are the most important asset of your organization, it is essential to help them maintain their physical and mental wellness so that they can remain healthy, engaged, and productive.
Most Common Mistakes when Addressing Burnout
The most common mistake I see people making for themselves is soldiering on with the same patterns that continue to drain their battery. They feel worse over time and usually isolate themselves due to feelings of embarrassment, guilt, or shame. They have difficulties reaching out for help, seeing their negative patterns, and finding ways to break those patterns.
In terms of mistakes that people make when reaching out to people experiencing burnout, I see a lot of well-intentioned people trying to help. However, they rarely listen with empathy to understand what the individual is experiencing. Instead, they listen but offer a series of suggestions and potential solutions. This becomes a worse interaction if the person reaching out does not understand burnout or has misconceived attitudes about it or mental health in general.
There aren’t easy solutions for everyone that work all of the time. The main takeaway for the person experiencing burnout, is that they need to reach out for help. For the person who is extending a helping hand, they need to provide an empathetic ear to listen and understand rather than listen to problem-solve.
This article is an interview transcript with Dr. Andrew Miki conducted by ThriveGlobal and Authority Magazine.