In May 2019, the World Health Organisation announced that in the ICD11 (international classification of mental illnesses) there would be a new category of “burnout” as an occupational phenomenon – not a medical condition. But what causes burnout? Heather Beach discusses…
Burnout, is defined as:
“A syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- Feelings of energy depletion or exhaustion;
- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- Reduced professional efficacy.
Burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
For some years now, in other countries in Europe, burnout has been a condition recognised by doctors and managed often through time off work and counselling. Connie Munsters, a Sales Director at Wolters Kluwer in the Netherlands said: “When I burnt out in 2001, I was off work with full pay for nine months. I returned with some reasonable adjustments in place, was well supported by my manager, and have since been promoted twice in the organisation. Mine emerged due to some difficult personal circumstances combined with work changes”.
Along with the HSE – which treats work related stress as a discreet package, the WHO appears to believe that there can be a purely occupational related phenomenon which is not impacted by other areas of life….
Whilst I am a great proponent of the fact that looking for the root causes of work-related stress should be done in parallel with training for all in understanding mental health, I struggle with this relationship we have with work related stress as if it existed in a vacuum and was purely down to the organisation to “fix”.
What causes burnout?
Whilst if we believe the WHO and the HSE that a great deal of sickness absence is down to purely work-related stress, there is little agreement from scholars in terms of what in work specifically, creates burnout. In 1983, a macro study "Towards a theory of Burnout", Scott T Meier posited. “Burnout is defined as a state in which individuals expect little reward and considerable punishment from work because of a lack of valued reinforcement, controllable outcomes, or personal competence”.
In the last 30 years, however, the world of work has changed significantly with much less of a divide between home and work, and demands in both places, increasing. This comes at a time of greater job insecurity.
Psychology Today in 2019 links burnout to a lack of meaningful work, a lack of autonomy and the cynicism which may ensue. However, I prefer this definition from an Iranian study performed in 2013:
Job burnout is a consequence of the perceived disparity between the demands of the job and the resources (both material and emotional) that an employee has available to him or her.
Material and emotional resources
Let me tell you an ironic little story. Earlier this year I was studying in my Applied Positive Psychology masters (MAPP), a module on resilience. Busy congratulating myself on having built work in which I was constantly learning, surrounded by people I wanted to work with, and which played exclusively to my strengths, the divide between work and play was minimal – because work was like play. I also have a huge sense of purpose and lots of autonomy – all the good things good work can bring. Our module started with a questionnaire on psychological capital (an individual’s positive psychological state of development as defined by Luthans et al). With a strong sense of self-efficacy, self-esteem, optimism and hope, I scored very high and proudly declared myself very resilient.
Two weeks later, a fellow course participant on the MAPP, found me in tears. Concerned about me when I declared myself to be completely overwhelmed – business, local politics, family, friends, dog and studies – he asked what the most important thing to me was right now? I declared that it was to gain a distinction in my essay for the masters.
I did have the wherewithal to see that this was actually a little bit ridiculous. I promptly developed the cough which won’t go away which I remembered from the months I spent in this state 10 years ago (I had been here before only much worse) and took myself off to bed for six weeks. I was defeated, disengaged, disinterested and hopeless.
I am nothing if not prepared to look at what it is which led me to this place and my studies led me towards not only a lack of rest (remember my work seemed like play) but also to perfectionism of which there are three main types: self-oriented, socially prescribed and other oriented. I turn out to have incredibly high standards for myself. “Holds oneself to (impossibly) high standards yet maintains unwavering motivation to achieve perfection. A key incentive is the avoidance of failure” (Hewitt and Flett).
This together with other characteristics which ensure I always have plenty of balls to juggle creates almost impossible amounts of things to do – all of which, clearly, have to be done perfectly.
Stacy Thomson from the Performance club says: “I believe burnout is caused by the fact that many of us do not know how to stop. The problem is therefore deepened by the fact that organisations, in the pursuit of power and profit, also do not install the boundaries which are required to make us stop.”
However big a part occupational chronic stress may play in developing burnout; it is not the only factor. We are responsible for knowing ourselves and our drivers.
How many of us have such engaging careers, and gain much of our self-esteem from work, making it actually less attractive to switch off? How many of us spend enough time understanding ourselves – our unhelpful thinking patterns, the rules and assumptions we have?
And then there is the critical relationship with our manager. Too often when we train people where the demands of their jobs are too great, they feel some moral duty to do everything they are asked to without pushing back – but as Stacy says (above) – managers will often not stop giving us work, unless and until we do have that conversation with them. What is often missing in organisations is an ability for managers to support their teams in understanding their own boundaries (which those among us who are very conscientious may struggle with) and individuals having confidence and the self-esteem necessary to discuss them.
What is missing in many organisations is compassionate leadership where we all relate to each other as fellow human beings doing our best with the tools we have available.
Recovery from burnout
Research agrees that reaching the burnout stage means you need to stop or at least slow down. This is quite useful because taking one step at a time in recovery forces you to consider step two – which is to hone your goals. This may mean giving up certain things you may have been quite wedded to, some “it has to be this way” thoughts – for me it meant putting on hold being a student and leaflet deliveries for local politics, saying no to social occasions and being really clear on who does what at work.
I was lucky to be surrounded by people who forced me to question what was really important to me, and to help me look at the smartest way to get there. Was there a shorter, more efficient route to take? What did I really need to focus on? When you feel able to deal with it (one hour with a coach absolutely exhausted me) then looking at the drivers which led you there is also important. So, for me, understanding my perfectionist tendencies has given me a choice – I could just do fewer things really well or look at self-compassion when I do get it wrong (check out Brene Brown here).
Benefit of a new diagnosis
What is the benefit of having this new potential diagnosis of burnout due to occupational stress? It may indeed give legitimacy to someone who is struggling to be heard and needs time off to recover. It may be easier for an organisation to have a name for what someone is suffering from and provide them with better tools to support that individual.
However, is there a danger inherent in all this that we are developing a tendency to pathologise what it is to be human?
Stacy Thompson again: “We have a powerful Apple Mac computer in our heads, and we don’t know how to use it”.
Spending time understanding ourselves, how our brains work and why we think the way we do is work which is never wasted. We are like onions – there is always another layer and if like me you find this hugely interesting, rather than hard work, then you are lucky!
I am not seeking here to let our organisations off the hook. Stress mainly due to the workplace, exacerbated by the workplace or even due in full to the workplace is real. Creating a culture of care for each other, of listening and supporting, of managers who make time to coach and have the confidence, self-esteem and necessary self-regulation to really have their team’s back is the most important thing of all. With these things in place, other stress risk factors can be managed with much greater ease. Returning to Connie’s story, her managers recognised her past contributions and supported her. They have had payback in full.
And back to me. Once I had got beyond my embarrassment that someone who has made a study of positive psychology for the last 10 years should fall over, I thought it might be useful to share. I’m absolutely fine now. I understand myself a bit better than I did and have people to turn to support me if I show signs of going there again (a particular thank you to Tom Oxley, who was incredibly supportive.
The perfectionist has had to own that she isn’t perfect.