How Does Untreated “Burnout” Manifest?

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Wir wĂŒrden das al “Burnout” nennen, the woman told me.

Translation from German: We would call that “burnout.”

Different stages of burnt matches on yellow  background, flat layLast November, I was riding on a train from Basel, Switzerland, to Hanover, Germany. As the train left Basel, I settled into my window seat and enjoyed watching the countryside as the train rolled along. A couple hours into the trip, a woman boarded the train and asked me if the seat next to me was free. I nodded yes and adjusted the bag at my feet to make a little more room for her. As the train pulled away from the station, we began chatting in German, asking the typical questions such as where are you traveling to and where are you from.

“I am from the US. I was in Basel and am now heading to Berlin. Years ago, I lived in Basel for eight months while studying at the university,” I said. As we continued to chat, I told her that I get a lot of synchronicity and improbable connections that are often a lot of fun. I then told her how synchronicity is related to Basel. Swiss psychiatrist, Carl Jung, who coined the term synchronicity, grew up near Basel. In addition, he studied at the University of Basel and for a few years, he was a professor there. So even my relationship to Basel has a much deeper meaning and connection for me. As we continued chatting, I shared a few of my “goofy” synchronicity stories as I call them. She enjoyed them, and we laughed together.

At some point in the conversation, the woman asked me what I do for a living. I told her that I have worked as a statistician, a technical writer, a knowledge engineer, and as a software tester. I then said that I really want to get into writing and public speaking to help bring about change to the mental health system. I told her of the severe stress breakdown that I endured back in 1998 and how I was traumatized worse by the Employees Assistance Program at my former company and by the mental health system in general. I explained that at the time, I was told I was “seriously mentally ill” and there is no cure. I briefly described the dysfunction I had been crutching and how the experience overall was a breakout from that.

That’s when she said it. “Wir wĂŒrden das al “Burnout” nennen.”

“Burnout?” I asked. Then I thought about that term. In the years since 1998, I’ve used many different phrases to describe my experiences. “Burnout” wasn’t one of them. Over the next few hours, we continued chatting, often laughing together. We even took a selfie, which she messaged to her friend to tell her about me and the fun we were having. She encouraged me to get going on sharing my stories because she enjoyed them so much. She told me she was a fan and would look for my book in the future.  For someone who endured so much trauma in 1998, I enjoyed the grace of her enthusiasm. We exchanged contact information so that we can keep in touch.

In addition to my studies in Basel, I was also an exchange student in high school to Germany. A couple days after the burnout conversation on the train, I was visiting my host brother in Berlin, I told him about the conversation. He said, “Oh, yes, I know people who have had burnout. One woman I worked with went through that. She spent some time on a leave of absence. When she returned to work, she returned to a different position and started working part-time for a while and then increased to full-time.” He didn’t mention whether some kind of anti-depressant medication was involved. Most likely, he didn’t know the woman well enough to know something that specific.

As I continued my travels in Germany, I also stopped to visit another host brother and mentioned the conversation on the train about “burnout.” He also recognized the term and knew of someone who had experienced it. That person also had some time off work for rest, unwinding, and recovery before returning to work part-time as a transition to full-time employment after that.

I don’t remember just when I realized that the 1998 experience wasn’t the “burnout” as the woman on the train indicated. The “burnout” actually happened two years earlier.

In the summer of 1996, I first visited my medical doctor because I had short, periodic feelings of lethargy, which were uncharacteristic for me. I wasn’t “depressed” in mood or outlook in life, yet I knew there were aspects of my life that I didn’t like. I enjoyed my work, but I certainly didn’t appreciate the politics of it. Overall, I didn’t like being part of the “rat race” in a big city, which wore on me. The problem was I didn’t know where else to go.

I thought that perhaps something was wrong with my thyroid or some other physical condition. My doctor ran some tests and the results were fine. Some doctors might have just focused on the physical symptoms. Thankfully, she asked me what was going on in my life. I told her about my family history, including my middle brother who at that time had been out of touch with his family for more than six years. I also told of other stressful situations involving contentious divorces in my family and how I grieved for my nephews and nieces. I don’t remember if I told her of the stress at work specifically.

When she heard of what was going on in my life, my physician said, “You’re under a lot of stress. I don’t think you have bipolar or schizophrenia or anything like that, but you are under a lot of stress.” Unfortunately, she didn’t say, “You are burned out and something needs to change. You are heading right into some kind of breakdown.” If she had said, “You are burned out and should be on a medical leave for a time so that your system can balance better,” I would have heeded that caution. Since “burnout” and “breakdown” are not official diagnostic conditions, that wasn’t part of her diagnostic vocabulary. She did encourage me to seek counseling as a starting point to determine how to deal with the stress and alleviate it in some way.

Over the next 20 months, I pursued several things, including counseling, reading numerous books suggested by the counselor, taking stress management classes at work, and even switching jobs to another division in another part of the company. I continued to consult with my medical doctor. Nowhere in that time did the concept of “burnout” come into play, nor any suggestion of taking some kind of medical leave with some assistance to later return to a work environment. On an interesting note, my plan prior to the 1998 breakdown was to take a personal leave of absence for a few months through the summer of 1998. As I look back, I instinctively knew that I needed some type of “break” from my life. That came a few months early in a very different way than I was planning.

My efforts from 1996 to 1998 did relieve some stress and processed some grief. However, that relief was minor and short-lived. The counseling and stress training didn’t address enough of the underlying issues causing the buildup of stress. I continued to carry a significant amount of stress and remained unaware (unconscious) as to how unhealthy my work and social environment was.

It was only during the breakdown that I embraced the analogy of the frog in a pot of water. In that metaphor, a frog is in a pot of lukewarm water and conditioned to the initial temperature of the water. If heat (stress) is added to the pot slowly, the frog adapts and conditions itself to the rising temperature of the water and fails to try to jump out of the pot. From 1996 to 1998, the stress and even toxicity in my life continued to build, and I continued to try to adapt. I didn’t know how to jump out. I also didn’t know in which direction to jump.

A few months after the conversation in the train, as I reviewed the progression from 1996 to 1998 as it relates to the concept of “burnout,” I recognized not only my struggle in those two years of worsening conditions, but also my strength. In 1996, my functionality was already compromised with what could have been called “burnout.” For two years, I continued to function and tried to work to a solution even when the mental health and medical systems didn’t assess the full scope of what was happening and how those factors continued to increase.

Ultimately, that breakdown was very much a “breakout.” Even as I experienced it, I knew that the breakdown / breakout, would be a temporary condition. Surreal? Yes. Permanent? No. My experience was a culmination of factors. It was not an “illness” or “disorder.” Any “disorder” I had was in the two years prior while continuing to crutch the unhealthy, even toxic, environment and systems I had become enmeshed in.

When I realized that the “burnout” happened two years before the severe stress breakdown in 1998, I then wondered how things might have unfolded differently had there been a recognition of “burnout” in 1996. Most likely, I would have gone on a medical leave for a couple months or more. In that time, I could have not only rejuvenated, but also possibly learned useful tools to recognize my role in my environment around me and to learn how to stand up for myself as to what I need to become and stay “healthy”—even if the environment isn’t. Or I would have realized that I did need to leave that environment entirely.

Had that worked, I likely wouldn’t have endured the breakdown and breakout of 1998. The breakdown would have been avoided, saving me from intense pain and trauma. Yet paradoxically, I also wouldn’t have had the incredible learning experiences that I had in 1998. Through the intense process, I learned so much more from the non-ordinary states of consciousness that I reached than I could have otherwise.

In looking at the relationship of when the “burnout” actually happened, I realized there is a pretty important question to be asked.

How many people who have had experiences similar to my 1998 journey exhibited signs of significant “burnout” prior to their experiences? In addition, how long prior to those experiences did the person experience some type of “burnout?” What factors were causing and contributing to that “burnout?”

Or to use words and phrasing that I am not wild about: How many people who have experiences that get labeled “psychotic,” “bipolar,” “schizoaffective” or even “schizophrenic” are people whose burnout has gone untreated for an extended period of time?

One ironic aspect of this comes from a slogan that was used frequently in my work environment. I worked in Quality Assurance with regard to reducing variation in processes and hardware as a way of saving costs and reducing or eliminating defective product that would either need to be reworked or scrapped. One of the slogans that pounded in my mind in 1998 was “defect prevention, not defect detection.” When I was in Banff, Alberta, in the initial phase of the breakout, I recognized that I was the “defect” that wasn’t prevented.

I showed signs of significant stress for years. I actively sought help for almost two years. I tried everything suggested to me. Yet my mind still exploded and imploded. In that state, I was the “defect” in the sense that I couldn’t work and ultimately ended up losing that job, despite meeting the company’s medical leave requirements not once, but twice.  Ultimately, though, despite the pain, it was the best thing that could have happened to me.

After my visit to Germany last November, I visited a friend in Liechtenstein. She invited me to attend a holiday dinner with her work group. The room was filled with joyous holiday spirit as we entered. My friend sat on my left and a woman she knew was on my right. As dinner was served, I chatted with the woman on my right. At some point, I asked her what she did.

She mentioned that she was working a temporary position for someone who was on a medical leave. Then she mentioned that the woman was on leave for “burnout.” I found that connection interesting since I had only heard of burnout and its course of treatment a few weeks earlier. I, of course, told her of the woman on the train and some of my own experiences.

The woman then explained that the term “burnout” is actually Umgangsprache. She didn’t know how to translate that word, and I didn’t immediately recognize the term.  Looking it up later, Umgangsprache translates to “slang.” So, “burnout” is a term used by the general public, but isn’t the official diagnosis. Too bad. “Burnout” certainly seems like a decent diagnostic term to describe what a person experiences.

I am quite thankful for the conversation on the train. Since then, I have continued to ponder the relationship between “burnout” and my experiences. How does untreated “burnout” morph and manifest over time? How might untreated “burnout” contribute to other conditions that are more painful and debilitating to the person involved? I certainly have my own opinions, but perhaps this should be researched in a broader context.

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28 COMMENTS

  1. Penni, Thank you for your very insightful essay. All too often, mental health professionals do not pay attention to the complexity of words. A word like “burnout” has many meanings and cannot be understood outside of the context in which it is used. To be “overstressed” is often seen as being a defect of character. We all communicate with metaphors which can only describe what something is like, not what it is. Michael Robin

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    • Thanks, Michael, for your comment. In my opinion, the role of language is a tricky one no matter what. I could argue that the language in the diagnostic manual is also rife with multiple meanings in different contexts — which is why the repeatability of diagnoses between multiple mental health professionals is generally poor. And of course the whole diabetes / insulin example was supposed to be a metaphor which ended up being treated by too many as literal.

      And yet, I noticed that in Germany and Liechtenstein, the concept of “burnout” was recognized and accepted — even as slang — by the population. It didn’t carry the stigma of the so-called ‘chronic illnesses’ that people in the US end up having to carry. It was also recognized that the person involved needed some time away for some type of rejuvenation / healing / reframing before going back to work.

      Ultimately, if my stress / strain / condition in 1996 had been recognized as a type of overall burnout and treated as such, the next couple of years would have unfolded quite differently and quite possibly avoiding a very traumatic and misunderstood experience.

      Penni

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      • Thank you for sharing your story, Penni. Like you, I had a Spiritual query / journey – and a common symptom of antidepressant withdrawal (but I was misinformed that Wellbutrin was a “safe smoking cessation med”) – misdiagnosed as the so called ‘lifelong, incurable’ ‘bipolar,’ too.

        “… It didn’t carry the stigma of the so-called ‘chronic illnesses’ that people in the US end up having to carry.”

        And I will thank you for pointing out the true insanity of the gas lighting (which is actually “mental abuse”), “we want to maintain the status quo,” US “mental health” industries of America today.

        Some US psychologists have truly lost their minds – due to their unchecked and undeserved power – in regards to their desire to “maintain the status quo.” Trust me, I have both medical and legal proof now.

        Thanks, also, for sharing your blog. I’m listening to your interview with RW now. Great interview!

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        • Someone Else — I was lucky in that I didn’t end up taking anti-depressants or other drugs. Sorry that that was an added layer of difficulty for you. I also use the term “mental abuse” often rather than “oppression.”

          Glad you liked the chat with Robert Whitaker. I really like that we had some moments of laughter in it.

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  2. Perhaps there may be a connection between the difference in how it is diagnosed and treated in Germany because they aren’t urgently seeking to medicate patients with pharmacuticals and prescribe natural medicine FIRST.
    Example being Hawthorne berry extract for three months to bring blood pressure down. If that isn’t successful, THEN they look into other options and if they need to, pharmacuticals as a last resort .
    Their culture probably doesn’t carry the shame or stigma attached like here in America still does in some pockets of the country.
    I appreciate your story and will share it alot to further help folks that need to know versus get tricked on the white coat train of thought .

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    • Though I have visited Germany often, I can’t say that I know enough about their approach to health and medicine to know their overall approach. What you describe is certainly more in line with the approach I would like to take. I am not necessarily “anti-pharmaceuticals.” I am “anti-reach-for-the-prescription-pad-first-without-really-understanding-what-a-person-is-and-has-been-deaiing-with.”

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  3. I went through something similar 5 or 6 years ago, as well as 12 years ago, too. Severe burnout and breakdown. I had alot of stress from work as an RN in a nursing home, as well has having been a caregiver for years before that. I had alot of unhealthy work habits, as well as unresolved trauma from childhood.

    You are right, it’s like the frog in the pond. They always say, until things reach a level 10, you won’t change. For me, it was hard to notice, because I looked so young and good on the outside, and did a good job at masking my symptoms. Nobody noticed. Even my doctors. I tried to talk to my psych NP, and she just suggested more pills. I knew something needed to change, but I didn’t know where to turn for help, or that real help was even available. I was always just told that I had a condition and need to take pills.

    At one point, some years earlier, I was diagnosed with schizoaffective disorder. But there were numerous stressors preceding this. Stress from work and school, sleep deprivation, breakup of a committed relationship, the influence of charismatic religion. I can see how these maladaptive patterns were affecting my mental health.

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    • That’s one of the most insidious dangers of the “label and drug” approach. It gives the impression that your environment is harmless and YOU have the problem. If only your brain worked better, you wouldn’t MIND being worked 60 hours a week at a mindless job that challenges your personal ethics on a daily basis! It’s all about Bad Brains, never about fixing the environment and expectations that lead to burnout!

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      • Preach it, Steve! 🙂

        I like your phrase “label and drug approach” — though I would say that even the “label as disorder” approach is equally insidious. Your use of “insidious” is so spot on in so many ways. I am sensitive to it because at the start of the breakdown, I examined my codependent role in the mental and verbal dynamics of the swim team I was coaching. At a parents’ meeting, I looked around and thought, “this is insidious.” The subtle, seemingly unnoticeable and unimportant things that happened that allowed a poor system to grow into a toxic one. A person going through a crises often recognizes that — and they recognize that the people around them, including mental health professionals are also affected, yet they don’t see it.

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    • LILA — thanks for your comment. Your statement about doing a good job at masking your symptoms, which is really masking your pain, difficulty, and suffering. I am thankful that you can see how those maladaptive behaviors adversely affected your mental health. It’s a tragedy the the person or people you sought help from did not.

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  4. This is not new to me. In our Social Service Department we had a stufy group and one of the topics was burnout. This was just into the start of the massavive paper chase cascade. It was a known enity.
    I also saw how German social workers before the fall of East Germany managed burnout they would switch jobs ti taxicab driving. That made perfect sense to me as an already stressed social worker in the field.

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    • In the last few months, I have noticed the word “burnout” more in the morning news programs, but what I don’t hear is that it is treated more formally as a medical issues — that is, handled as what was described to me in Germany and Liechtenstein. I can understand why people would leave their profession, yet in my opinion, it doesn’t address the real issue of overwork and “workplace abuse” — often due to inadequate resources to do the job and not being compensated appropriately for it. That moves away from the psychology of the individual into what is deemed acceptable to the society as a whole.

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        • Unfortunately, what you say about profits is true. We are conditioned to prop up our economic system whether it is through constant marketing (manipulation) or us feeding our collective addictions.

          A few years ago, I was talking with a new friend about my experiences and how everything comes back to money. We met for coffee and chatted for about an hour and multiple times in the conversation, I pointed out that we were again talking about money and profit. He said, “Gee, it really does all come down to money, doesn’t it?”

          Through my own experiences with non-ordinary states of consciousness, I came to better understand the systems around money and the need for some type of change in our economic system that is so manipulative and even abusive, not to mention fear-based. That of course would need a massive shift — dare I say — a “collective awakening” — to bring that about. People are waking up and may that continue.

          I also like to point out that I love it when the conversation comes down to money — given that my name is Penni / penny.

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        • Germany 1973. Horst Herold

          Laid out the world he saw coming. The violence and the horror that the terrorists created, he said, did not just happen because of something ‘sick’ or ‘evil’ inside their heads. It was a reaction to the new system of power that was rising up across the world.
          It was the system that the ‘radicals’ had identified in the 1960s – the new global networks of multinational corporations and international finance that they believed were ruthlessly exploiting the world.

          If you want to get rid of terrorism, Herold said, there are two alternatives.

          Use political power to change and reform the global system

          OR

          you decide to systematically control the people, and their anger and discontent. But to do that you would need to create a surveillance network, like the one he (Herold) had built, but on a global scale.

          Your right Steve, no money in the first alternative……. and the second is now pretty much in place and psychiatry is a big part of that surveillance network and IS being used to deal with anyone who would suggest that they systems of power be changed.

          “if the real Jesus Christ were to stand up today, he’d be gunned down cold by the CIA” (The The. Armageddon Days are here again)………… or worse, ‘treated’ for the ‘illness’ they could make up on the spot.

          And with a State that is passing euthanasia laws and “editing” legal narratives post hoc for lawyers who are turning a ‘blind eye’ when requested, I don’t expect things to improve for the ‘mentally ill’ any time soon.

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          • Thanks, Bones, for your comment. I definitely want to learn more about Horst Herold.

            With regard to your comment about Jesus Christ, they wouldn’t have to make up an illness. I think in today’s society, Jesus would have been diagnosed with schizophrenia and so would many of the saints, including St. John of the Cross.

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  5. Most “mental illness” is actually burnout (stress) that comes from being continually subjected to emotionally toxic people and environments. A good primary care doctor knows this and won’t just chalk things up to being overworked. But unfortunately, a lot of doctors aren’t very insightful (much less sensitive) and on top of that most believe whatever the drugs reps tell them.

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  6. It seems to me that there is a pejorative connotation to the word “burnout.” The word is used in many contexts and has many connotations. If someone works too many hours, has too many demands on their life, or is simply exhausted from the exegesis of life, doesn’t mean they are “damaged goods”. I think a much better word than burnout is the word exhausted. I think of Olympic Athletes who put in great effort to achieve their goals, who simply become exhausted. What they need is a chance to catch their breathe before they can appreciate the accolades being offered. I’ve learned that acknowledgement is the balm that heals traumatic wounds. It is not pathology to put in great effort on important tasks. I think of all the caregivers who become exhausted from caring for their loved ones. The concept of “burnout” is part of the medicalization of what is used to be called caring.

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    • Michael,

      In my opinion, this is running into the problem of language.

      I disagree about your take on “burnout” and “exhaustion.” I consider “burnout” to be more extreme than exhaustion. I am exhausted after a 10-mile hike or after driving for three long days to a destination. That is the response to a specific event o circumstances over a relatively short period of time. Exhaustion, to me, is a car that has run out of gas.

      I would say burnout affects a person much more deeply–where a person has been struggling with a system or a set of circumstances over an extended period of time — and even that the system and circumstances have even evolved to a worse state. Yet the person keeps trying to adapt and the person starts shutting down internally.

      I don’t see anything perjorative about that. If anything, focus shifts toward the system that does not treat its people well — I could say that the system exploits or even abuses a person. Oppression is another word that comes into play.

      In the case of a car, burnout is when the conditions for the engine are no longer favorable and the car starts burning oil or blows a piston. Resolving that situation requires much more effort to restore the car to first, a working condition, and next, and optimal condition.

      Just my take, of course.

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  7. “How many people who have experiences that get labeled “psychotic,” “bipolar,” “schizoaffective” or even “schizophrenic” are people whose burnout has gone untreated for an extended period of time?”

    Me! In 2018 I had a psychotic episode and was labeled “schizophrenic”. I was told I was incurable and doomed to a lifetime of antipsychotic medication. It took me two years to recover from those injections once I rejected those labels.

    Reading Jung, especially “Man and His Symbols”, and “The Vital Balance” by Menninger helped me understand what I instinctively knew but couldn’t express – environmental factors (a divorce and simultaneous death of my younger brother while also being the “scapegoat” from this event for my family) caused me to “burnout” or “unbalance” temporarily. The idea fed to me by psychiatrists that i had always been a ticking “schizophrenic” genetic (no family history) time bomb that was doomed to go off when i hit thirty was a complete lie. Resting and dealing with the environmental factors that caused my events through therapy has allowed me to live a happy normal life free of medication. When I felt a “burnout” approach again in 2022, five days of isolation and rest without medication was enough to stabilize me.

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    • Stacey,

      So sorry for the diagnosis that you go and worse the quick response of reaching for the prescription pad.

      I always find it dumbfouding that professionals seem to think that a situation like yours — a reaction and response rather than a disorder — just comes out of nowhere. That environmental and situational factors have NO role in such a chain of events that lead to a “breakdown” which is ultimately a “breakout” and “breakthrough.”

      Part of the reason for that diagnosis, though, is because things like burnout, stress breakdown (or breakout / breakthrough), ego collapse, identity crisis, spiritual awakening, and spiritual emergency are not in the diagnostic manual. (There are of course many other discussions around the DSM…)

      I find it interesting that in looking at the word etymology for “schizophrenia,” it literally comes from “split mind.” That is an indication of a transformational process. When a cocoon “splits” the butterfly emerges. When an egg “splits,” the chick emerges. When the water breaks for a pregnant woman, the baby is about to be born. Those are all transformational processes.

      Personally, I think that when a “mind splits” due to crushing external factors, the true essence of a person is trying to emerge from the layers of stress, trauma, toxicity and garbage that has buried them. And that is often a very forceful, even violent, confusing, exhilarating, difficult process. In that type of transformational process, you don’t shove the chick back into the egg or the baby back into the womb.

      I am glad that you were able to recognize a potential problem in 2022 and take a course of action May you continue to heal and recover and grow from your transformation.

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  8. Thanks for sharing this story! I’m a family physician and I can tell you that burnout is a big concern in medicine and medical training, talked about often, but little has been done to prevent and diagnose, stigma as a physician is high and penalties for burnout can be career long (5-10 years of drug and mental health tests, even for those without a drug history), I frequently brought burnout up with my patients (especially pandemic time), a very common type of burnout is in caregivers, and many feel relieved that they’re not alone in their feelings.

    Unfortunately for me my employer refused to acknowledge burnout out in its employees, after being diagnosed with a significant neurologic sleep disorder my employer decided my apparent tiredness and difficulty with administrative tasks warranted and inpatient admission for drug and mental health evaluation, I already had a psychiatrist and psychologist urging me to take time off for burnout, and I wish I had listened (I only took 4 days off over my first year and mostly for Dr’s appointments). To undo the damage done I’ve seen 2 sleep specialist and 2 psychiatrists to try and protect my license, all agreeing that what happened was burnout on top of a new sleep disorder and not a mental health or drug crisis. The damage from misdiagnosis of burnout can be very significant. Thanks for spreading awarensss

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    • Thanks, Matt, for your comment. I am glad the article was of value to you. Your role as a physician certainly includes an interesting combination of factors — which includes even more stigma and threats to your career.

      With regard to “burnout,” a job and/or environment leads to a stage of burnout – and yet there is no official diagnosis of “burnout.” As a result, any actions that you take are purely of your own volition and at your own cost rather than covered by insurance, such as a two-month medical leave and then transitioning back into work part-time.

      In my case, since “burnout” wasn’t an official condition to be treated in the medical and / or psychological sectors, I limped along for another 20 months or so — heading straight into some kind of breakdown / catastrophe that was quite traumatizing. As a result, I ended up with at least one diagnosis of having “bipolar disorder” — a chronic long-term, rather serious condition.

      That is, due to the lack of what could have been (should be) a diagnosable condition, “burnout” of some kind, instead, I end up with a heavily stigmatized and so-called permanent “illness” because “burnout” doesn’t exist in the medical system. Are they kidding? This is why so many people reject both their diagnoses AND the mental health system entirely.

      You mentioned that your employer refused to acknowledge burnout, which doesn’t surprise me. Having employees assessed / diagnosed with burnout could lead to huge liability implications – and of course, they don’t want that. So not only is the individual struggling with some type of “burnout,” now they are also caught up in the power dynamic associated to the entity that is contributing so significantly to said “burnout.” Sheesh.

      As you know, this is a SYSTEM problem — a problem with the system that humans have built and created. That system labels and pathologizes the people who “break” in a sense and say that the person has the disorder rather than identifying what caused the “break” in performance or function.

      In business systems, when there are problems where something “fails” or doesn’t perform, the business will often do a “root-cause-analysis” to determine why something (in this case “someone”) failed to perform. There certainly needs to be much more root-cause-analysis done within the mental health fields.

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