To What Extent is Mental Burnout an Identifiable Health Condition?

Aita Unuigbe

Burnout is widely recognized by healthcare professionals, and the general public as a widespread and detrimental occupational state of mind. Even though burnout is widely acknowledged, there are still ongoing debates within the scientific community regarding its definition and the legitimacy of classifying it as a separate mental health condition. 

What precisely is burnout? Until recently, burnout has been called a stress syndrome. However, according to the World Health Organization, burnout is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” in the organizations international classification of diseases diagnostic manual (World Health Organization, 2019). It is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon. It is not classified as a medical condition. It is described in the chapter: ‘Factors influencing health status or contact with health services’ – which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.  

The WHO goes on to define mental health conditions as a broad term that encompasses mental disorders, psychosocial disabilities, and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm. 

In a New York Times article, “Burnout: Modern Affliction or Human Condition? The Harvard professor of history Jill Lepore writes that to be burned out is to be used up, like a battery so depleted that it can’t be recharged.  

According to the Mayo Clinic here are questions you should ask yourself for symptoms of burnout

Have you become cynical or critical at work? 

Do you drag yourself to work and have trouble getting started? 

Are you irritable or impatient with co-works, customers or clients? 

Do you lack the energy to be consistently productive? 

Do you lack satisfaction from your achievements? 

Do you feel disillusioned about your job? 

Are you troubled by unexplained headaches, stomach or bowel problems, or other physical complaints? 

Once you have answered yes to more than two of the above questions, you may likely be suffering from job burnout.  

Physical symptoms of Burnout  

The Queensland Government Darling Downs Health lists emotional symptoms of burnout as 

Helplessness 

Cynicism 

Sense of failure or self-doubt 

Feeling detached or alone in the world 

Loss of motivation 

The same article lists behavioural signs as  

Reduced performance in everyday tasks 

Withdrawal or isolation 

Procrastination 

Outbursts 

Using substances to cope  

In countries like Sweden, burnout is relevant enough that it is considered valid grounds for sick leave. On the other hand, countries like the United States do not have such policies yet, as burnout is not recognized as a mental disorder by the DSM-5, published in 2013, and though there are ongoing conversations that it could one day be added, many psychologists object, citing the idea’s vagueness. A number of studies imply that burnout can’t be distinguished from depression, which makes it, as a clinical term, imprecise, redundant, and unnecessary. 

A Personal experience narrated 

Anne- Laure an ex-google employee and the founder of Ness Labs, blogs about her experience of burnout and how reaching out to her manager helped turn things around for her. Anne Laure narrates her story of how when she first started her job at google, she started doubting herself. She felt there were so many smart and talented people and felt sooner or later they would soon realise she wasn’t really good enough. At the time, she didn’t know but these were classical symptoms of imposter syndrome. 

This made her work harder and take on more tasks then required. She would say yes to everything, if someone needed a hand on a project, she was happy to help. At some point she was sent out of the country on training and was working and in order to keep up, she worked round the clock to keep up with two time zones.

 It was starting to tell on her, and she realised there was a problem when she broke down in tears when a colleague questioned the methodology she used on a small project. “I was lucky that I had an amazing manager that was I was feeling close to. We had started at Google on the very same day, and she too was working really hard. When I got back to London, I decided to tell her about what I was going through. She was incredibly understanding. We sat down and reviewed all of my projects together. Which ones actually aligned with our core business objectives? Which ones would be better managed by someone else? 

“There were things that were so new to me that they were taking me hours, whereas someone who had been at Google for years could do it with their eyes closed. She taught me that work is all about finding the right people for the right tasks, not about trying to do as much work as possible yourself.”

 Today she runs her own company and still applies the rules that she learned, which is prioritization and self-care in one’s day to day work and she regularly writes about mental wellness to share some of those experiences with others who may be going through those same challenges. This story was particularly interesting to me as google is a big, recognised company and one that I particularly like, and I have always been curious of how the work life balance is. It’s encouraging that such a big and successful company as google would have manager(s) as sympathetic as Laure’s manager(s) was. 

Prevention of Burnout syndrome 

There are lots of warning signs that individuals ignore which eventually leads to burnout due to negligence and ignorance. If one is aware of the warning signs, then it is easy to take preventive measures such as these: 

Relaxing morning rituals that are not chores but pleasurable such as stretching, meditation, yoga, journaling, exercise, praying, music therapy or even watching television 

Healthy eating and living 

Setting boundaries, this is where it is important to know when to say no, when to say I need help or when to say yes. 

Treating oneself to what is pleasurable such as doing something creative, reading, nature walk, a day at the spa. Otherwise known as self-care 

Taking vacation time. This can be staycations or travelling away  

Sleep. Incorporate at least 8 hours of sleep every night 

Work with purpose – Look at the deeper impact of what you do and how it impacts others.

Perform a job analysis – Identify what your role is so that you can delegate task that aren’t part of your role 

Give to others – Acts of kindness often reenergises and helps put meaning to your work. 

Take control – Effectively prioritize and manage your time. Implement a task list. 

Burnout in comparison to depression a recognized mental health condition 

A prevalent issue of particular relevance for psychiatry is the link between burnout and mental illness. In my extensive reading on burnout, as I did more research on if mental burnout is an identifiable mental health condition, I pondered on the actual definition of mental health condition. What does mental health condition mean? 

According to the Mayo clinic’s definition, “Mental illness, also called mental health disorders, refers to a wide range of mental health conditions- disorders that affect your mood, thinking and behaviour. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviour.” 

Although burnout has not been classified as a mental health condition which answers my question, it shares many similarities to some identifiable mental health conditions such as some mentioned above, case in point depression. This often leads to a confusion when the disorder takes place.  To help understand this further, I decided to investigate the relationship between both to see why burnout can mirror depression in many cases and even create the wrong diagnosis.

 Interestingly enough, most symptoms of burnout and depression are ever so similar. It appears some people may experience one but not the other or both at the same time and it is often difficult to distinguish between the two. Burnout as mentioned earlier is caused by chronic stress which is long-term stress and work related. However, depression isn’t usually caused by a single activating event but rather different things leading to it. 

Some contributing factors include genetics, traumatic events, family issues, culture, medication etc. The major similarity is the loss of interesting and impaired concentration. The key difference to remember about both burnout and depression is that burnout relates to a specific situation whereas depression is more generalized. 

Where burnout may cause a person to feel negative about a specific situation depression causes a person to gain a negative attitude towards a lot of different things at once, burnout may also cause a person to feel less confident about completing particular task, depression causes a person to lose confidence in their ability to do anything at all.  

In an article in the New York times, it further spotlights that burnout is an “occupational phenomenon” not a medical condition where depression however is a clinical diagnosis. Sufferers of depression may often experience anhedonia, the inability to enjoy activities they once did. “You can be reading a book you used to love and now you hate it” said Dr Jessi Gold, a physiatrist at Washington university. 

In the case of a burnout individual, you may have a lack of energy for hobbies whereas with depression you may not find it fun at all, said Jeanette M. Bennett, an associate professor who studied the effects of stress on health. People with depression may segregate themselves from others and may often feel intense sadness, hopelessness and worthlessness and these feeling could last up to two weeks however burnout symptoms are more short-term and get better when you step away from work according to Dr Rebecca Brendel.

With burnout a change of circumstance may cause you to feel better however with depression even taking a holiday or changing of circumstance doesn’t make a difference.  It is worth noting that in clinical practice, exhausted employees are being diagnosed with burnout and frequently, in order for the clinicians to proceed with their treatment, they turn to alternative diagnoses like the ones of depression or exhaustion (Kaschka et al., 2011). 

From my readings, I found that one can be depressed about a particular situation so even in the workplace working on a project with say group A may be depressing but once that is done, that feeling is better. However, burnout is more long-term as you are disconnected and even the completion of the task doesn’t fix the emotion. 

Burnout made its way to the famous medical TV series ‘Greys Anatomy’. In season 18, episode 16, it covered the topic and used the World Health Organizations’ definition to start the show. It ended with a great quote “put simply burnout comes from a deep imbalance, too much stress with too few rewards. You are exhausted, depleted, you no longer have patience, pleasure of serotonin.” – Meredith Grey

To conclude, burnout remains categorized often times as a form of depression rather than a differentiated type of pathology. Thus far, burnout is only limited to workplace alas no scientists or researchers have been able to add any other categories to it. It is without doubt that results of various research have shown that burnout needs to be addressed at both individual and organizational levels as it is a growing issue that affects individuals across various industries and professions. 

To mitigate the effects of burnout, it is important for individuals to prioritize self-care, establish boundaries between work and personal life, and seek support from friends, family, and mental health professionals. Employers also play a crucial role in preventing burnout by creating a supportive work environment, encouraging work-life balance, and providing resources for employee well-being. Addressing burnout is not only important for individuals to lead fulfilling lives, but also for organizations to maintain a productive and motivated workforce.   

*This is an abridged thesis by an 18-year-old Miss Unuigbe as part of her extended project qualification for A Levels.