“A state of vital exhaustion”

The WHO describes burnout as “a state of vital exhaustion” (World Health Organization, 2018). I think that’s a terrific (and rather poetic) description. The word ‘vital’ conjures up images of energy and liveliness, and of something that is absolutely essential. ‘Exhaustion’ is a state of extreme physical and mental tiredness, and to exhaust something means to use it up to the point where all reserves are depleted. These two words beautifully sum up the experience of burnout. The person suffering from burnout feels exhausted. They feel that their resources have been completely depleted. At the same time, the person experiences a sense of agitation and energy. They feel that they just can’t switch off or relax. All the people I have met who have been suffering with burnout have experienced this combination of agitation and exhaustion.

ICD-11 goes on to describe burnout as being:

a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

  • 1 feelings of energy depletion or exhaustion;
  • 2 increased mental distance from one’s job, negativism or cynicism related to one’s job, and;
  • 3 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. (WHO, 2018)

This definition focuses squarely on the occupational context of burnout rather than the individual ‘illness’ context. It follows that the best way to avoid burnout and help people suffering with burnout is to focus on fixing the workplace as well as ‘fixing’ (helping and supporting) the individual employee. A systemic and multi-level approach to burnout is important.

Burnout is related to poorly managed stress in the environment, rather than weakness on the part of susceptible employees. Taking an individual approach to managing burnout brings to mind the experiences of shell-shocked soldiers and airmen in both World Wars. According to military psychiatrists at the time, shell shock (or PTSD as it would now be known) was a result of individual weakness rather than the hellish conditions of trench warfare or the terrible casualty rates of World War II bomber crews. Servicemen who developed shell shock would have their military records stamped with the terrible acronym ‘LMF’, which stands for lack of moral fibre. These soldiers were told that the cause of their shellshock wasn’t the appalling environment but a weakness in their personality. That attitude persists in many organisations, where burnout is attributed to the weakness of the employee rather than the toxicity of the organisational culture and environment. This attitude adds to the distress of the individual, who sees themselves as being weak as well as burnt out. It also absolves the organisation of any blame, guilt and need to change.

BOX 1.2 ROB’S STORY

It is one a.m. and in the bedroom of a modest semi-detached house in a London suburb Rob lies next to his wife, Marie, who is quietly snoring. He is wide awake and staring into the darkness. Two hours ago he was exhausted. He couldn’t keep his eyes open, let alone focus on the TV programme he was watching with Marie. Now, he can’t sleep. He is worrying about work. Rob’s typical pattern is to fall asleep quickly and then wake up a few hours later with a feeling of panic.

He decides to get up, thinking that he may as well be working rather than just not sleeping. He swings his legs out of bed, puts on his slippers and dressing gown, and tiptoes quietly downstairs to the kitchen. He pours himself a large whisky and switches on his laptop, which he’s left open on the kitchen table, and begins work.

Rob is the in-house solicitor and company secretary of a global professional services firm. The firm is in the middle of a multimillion-pound piece of litigation, which Rob is leading. He feels terrified that he has missed something, because his concentration and memory have been terrible of late.

As he stares at the screen, he hears Marie padding down the stairs. He quickly hides his drink in the cupboard over the sink. A brief argument follows, the gist of which is Marie telling Rob off for working at home. He replies along the lines of, “I know, I know." Then Marie smells the whisky and loses her temper. Rob shouts back, “Just bloody leave it, will you!” This is quickly followed by, “I’m sorry, love, I didn’t...” But Marie is already climbing the stairs, sobbing. Rob goes back to the document on his laptop.

He has been a lawyer for over 20 years. After he qualified, he worked for a private practice law firm, but he didn’t like the competitive business development aspects of private law. It just didn’t suit his personality. So he decided to move into a general counsel role, firstly with a retail company and now with the global professional services firm. He enjoyed his job up until the last two years, when the pressures really escalated because of a combination of the uncertainty around Brexit and a merger with a rival firm. These events doubled his workload, which was big to begin with. He also had to become involved with tasks he found upsetting, like advising on redundancies. As the pressures increased, he took on more and more work. He felt sorry for the junior lawyers whom he managed and would support them by taking on their more complex tasks himself. He began to hate his job, but felt trapped.

The only way he could keep on top of things was to take work home, and this caused a lot of tension between Rob and Marie. He’d always enjoyed a couple of glasses of wine at night, but now he was having a ‘nightcap’ of Scotch before bed to help him sleep. His increasing alcohol consumption was another cause of conflict with his wife. The main thing that bothered him, though, was his insomnia. He just couldn’t sleep, and this made his workload all the more impossible to tackle. He felt tired all the time, but also tense. If only I could get a good night’s sleep, he would think. Sometimes Rob would daydream, and his favourite fantasy was becoming ill or breaking a leg so he wouldn’t have to go to work. Cod, I hate my job and I hate my life, he would think as he lay there in the dark next to his quietly snoring wife.

 
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