I’m no epidemiologist, but we all can notice how diseases and their definitions change over time. Once AIDS was a checklist of various abnormalities that clustered together, then we discovered the HIV virus and eventually treated even those who didn’t yet fit that definition. There are diseases we know the cause of, can diagnose with reasonable accuracy, and can make predictions about outcomes even if there is no cure, what one might call authentic diseases. And then there’s some that are mere associations of symptoms and signs that are harder to define in a way that doesn’t change with the times and our culture, of which we might never find a unifying cause or be able to predict outcomes or treat. Some of these lose the disease status and become considered part of normality, like the effect on woman of being treated as mere property, formerly called hysteria.
So what is burnout? Apparently the modern use of the term has been around for decades, even back when I thought it only meant someone who smoked too much dope. We didn’t learn it in med school in the old days at least, but the triad definition was already in use: emotional exhaustion, depersonalization, and decreased feelings of accomplishment. It doesn’t have a page in UTD, but ICD 11 has now included it, subtracting the word “feelings”, ie actual decreased accomplishment, and adding that it must be from employment. If it is an illness, is it a mental illness?
And what of the outcomes? Can errors, suicide, or quitting be considered deleterious outcomes of a real disease? Errors can more intuitively be explained by not having time to think, but that’s more likely to be caused by your work environment than by how you feel about it. Suicide is more likely caused by major depression, which may have overlap with burnout but is certainly not the same thing. Quitting would just be a reasonable response, not pathologic.
And if it’s a disease, what is the cause? The treatments usually offered as well as the admonitions to “seek help” seem to point to the idea that we should see it as a either a mental illness or lack of resilience. But we are as a group amazingly resilient, just look what we put up with in our twenties! Pamela Wible defines it as the normal response to abuse. ZDogg among others define it as the response to moral injury. And a recent survey discussed in my previous post shows doctors and nurses think it’s related to too much work to do in the EHR. Cause matters, because eliminating the cause makes more sense than any other treatment, and I tend to agree with all three. Making intelligent and knowledgeable people who have so much to offer humanity pretend they are happy with idiot bosses having them do idiotic things while blocking their ability to do what they know will help is really all three.
There’s a newly named workplace syndrome or diagnosis that seems to also tie all three together, and it’s called bullshit.
So BS is a form of torture. Many tolerate it for 40 hours a week, but they are usually in jobs where they have time to do other things at work, or at least relax, and they were probably never idealistic enough to give up their youth and go into serious debt to have a satisfying career. Maybe burnout is just BS combined with having too much of it to do, or the effect of all that on people who once were idealists?