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What a Burnout Diagnosis Can and Can’t Do

Kelsey Tyler

A few years ago, when I worked in a TV network newsroom, our boss announced that the company would begin to offer meditation classes. The next day, a handful of us gathered in the lunchroom, where a serene woman with long, dark hair had arranged folding chairs in a semicircle. As she explained the concept of mindfulness and instructed us to focus on our breath, phones vibrated and people stealthily checked their emails. She closed her eyes and began to lead us in a short, guided meditation. By the time she opened them 10 minutes later, just about everyone had left the room and gone back to work.

We didn’t mean to be rude. The 20-minute class just wasn’t feasible with our workloads. We worked long hours and frequent overnight shifts, and faced constant pressure to hit tight deadlines. We were all tired, all the time. “I’m so burned out” was a common refrain around the office; we threw around the term casually, not thinking of burnout as a specific diagnosis. And at the time, it wasn’t. But earlier this year, the World Health Organization elevated burnout from an amorphous complaint to a more clearly defined — and diagnosable — “occupational phenomenon.”

This upgraded designation is an important step in clarifying what burnout is (and isn’t) and validating its impact on wellbeing. You might be tired or stressed from a new baby or the news cycle, but only work can burn you out, clinically speaking. And if your 9-5 life has you feeling drained and dejected, it’s a real problem and it’s not you — it’s your job. But there’s the Catch-22: While burnout isn’t your fault, it’s also not fully within your control to fix, and a diagnosis won’t change that. Burnout starts at work, and that’s where reform needs to happen. Experts hope the WHO classification will encourage employers to start taking burnout seriously.

The WHO lists every diagnosable disease in a periodically updated, comprehensive guide called the International Classification of Diseases, or ICD. In May, the WHO released the 11th edition of the ICD, which classifies burnout as a “syndrome conceptualized from resulting chronic workplace stress that has not been successfully managed.” The ICD-11 isn’t the first edition to mention burnout, but it is the first one to define it in detail with three specific diagnostic criteria: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; 3) reduced professional efficacy.

Even though burnout is now diagnosable — or will be in 2022, when the ICD-11 technically goes into effect — the WHO is careful to point out that it isn’t a medical condition, and never will be. Still, burnout’s elevated status is significant, and that’s partly because it took so long to happen. Burnout first entered the lexicon back in 1974, when the psychologist Herbert Freudenberger coined the term in his book Burnout: The High Cost of High Achievement. In his determination, burnout caused a number of different psychological and physical symptoms, including “the extinction of motivation or incentive,” fatigue, sleeplessness, headaches and gastrointestinal disturbances. As he explained in a 1981 radio interview, Freudenberger saw burnout as “a response to stress… to a demand that an individual may make upon themself in terms of a requirement for perfectionism or drive.”

“How do you distinguish between chronic stress and burnout if the two concepts overlap to a certain degree?”

Freudenberger’s book put burnout on experts’ radar. Psychologists and other researchers published hundreds of studies on the phenomenon in the following decades. But many efforts to document, understand and prescribe solutions for burnout ran into the same question: What is burnout? A mental illness? A chronic physiological condition? A societal epidemic? All of the above? Among other things standing in the way of definitional clarity , it wasn’t always easy to tell burnout apart from other conditions. 

“How do you distinguish between chronic stress and burnout if the two concepts overlap to a certain degree?” asks sociologist Torsten Voigt, professor at RWTH Aachen University in Germany, who published a review of existing studies on burnout in 2017. “Both the physical and psychological symptoms can certainly have long-term effects on the body. Stress and burnout are, for example, linked to higher degrees of stomach and bowel issues that can become chronic.”

Physical symptoms of burnout, such as trouble with sleep and weight fluctuations, also overlap with those of mental health conditions like anxiety and depression, says Elaine Cheung, research assistant professor of medical social sciences at Northwestern University. 

The WHO’s new diagnostic criteria for burnout attempt to resolve some of the confusion, but experts say they don’t quite succeed. “We need to better define the state of burnout,” says Voigt. “It is supposed to be different from mood disorders…but what are the criteria that justify diagnosing burnout instead of a different diagnosis? There needs to be more research on the concept itself.”

The concept of burnout might also be tailored to certain subsets of the workforce, experts say. Most of the research on burnout in the U.S. has focused on healthcare professionals, particularly physicians, and suggests that doctor burnout is a widespread scourge that can lead to medical errors and high turnover rates, and even play a role in suicidal behavior. It’s also expensive: By one recent estimate, burnout costs the healthcare system about $4.6 billion a year. 

But burnout isn’t confined to healthcare. By all indications, it infiltrates most industries. A 2018 Gallup poll found that nearly two-thirds of people surveyed said they experience burnout on the job. And according to one 2015 meta-study, burnout risk is especially high for minority workers with low levels of education, a population that few studies have focused on.

“We know very little about low socioeconomic status and burnout,” says Lily Brown, assistant professor of psychology in psychiatry at the University of Pennsylvania’s Center for the Treatment and Study of Anxiety. “No one deserves to feel burnout more than a person who’s making minimum wage and having to work multiple jobs to support themselves and by and large those are not the people who are represented in research.”

“Assertiveness is not going to fix all aspects of burnout, but it may help people to gain a sense of empowerment about their role in their job.”

Experts question whether the WHO’s definition of burnout accounts for the ways in which burnout might manifest differently in Silicon valley engineers vs. fast-food workers. “In a way, burnout is a ‘luxury,’” as it’s currently defined, says Voigt. As a prerequisite, the definition requires personal investment in your work. “Working three jobs to make ends meet, you may not have time or mental resources to feel burned out. All you do is rush to get things done.”

But whether we’re talking about ER nurses, attorneys or burger-flippers, burnout is, at its core, a problem rooted in workplace culture and labor policies that work against employee wellbeing. Making burnout diagnosable doesn’t change that.

“One of the challenges in pathologizing burnout is that the burden lies on the patient to fix their issue when the issue might be systemic to the organization,” says Brown. “When a patient comes in and describes a toxic work environment, the patient only has so many degrees of freedom in terms of what’s in their control.”

Still, there are strategies to take the edge off. In her lab, Cheung works with patients on a positive psychology intervention that teaches coping skills. “Learning positive reappraisal (focusing on the good), gratitude and self-compassion may be helpful for coping with stress in a toxic work environment,” she says.

Brown often works with patients to develop stronger boundary-setting at work, putting limits on hours, if possible, and saying no to tasks that don’t feel meaningful. “Assertiveness is not going to fix all aspects of burnout,” she says, “but it may help people to gain a sense of empowerment about their role in their job.”

There’s power in numbers, Cheung notes. “When you’re able to cope with your stress more effectively, taking action and trying to organize ways that you can round up the troops to talk to leadership and find ways to address the issues in your workplace can be useful for enacting real change over time.”  

But employees can’t win a fight against burnout on their own. Heavy job demands and inadequate resources are inherently part of the burnout equation. Research supports the need for employers to make structural, operational and even philosophical changes. Symbolic changes aren’t enough. Midday meditation classes, for example, might not do much good if taking a break only causes overextended employees more stress. By adding staff and helping employees find deeper meaning in their work, according to a 2017 report in JAMA, organizations can reduce burnout significantly. The problem is global, and in some countries, governments are getting involved, too. Japan, a nation with a notorious reputation for dangerously overworked employees, recently put a legal cap on overtime hours

In the case of my newsroom job, over several years, I noticed my own behavior and attitude change in ways that felt too big for a handful of meditation classes, or even an overdue vacation, to solve. I knew the workplace would never change, so I had to — by finding another job.

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