Title : To burn-out or not to burn-out- that is the question ? Nurses need to understand the difference between occupational burnout and depression to reduce this syndrome in the healthcare profession
Freudenberger coined the term burn-out in his seminal 1974 book Burn-out: The high cost of high
achievement, situational anxiety. It was a term at that time used to describe chronic drug use.
Probably the most famous researcher that has taken up the cause of giving burn-out some kind of
identity and meaning is Christina Maslach (1981) who has broken burn-out down to :
- Burnout is a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment.
Emotional exhaustion: As emotional resources are depleted, workers feel they are now longer able
to give of themselves at a psychological level.
Depersonalization: negative, cynical attitudes about one’s clients or colleagues
Reduced personal accomplishment: The tendency to evaluate oneself negatively particular with
regard to ones work with clients. Workers may feel unhappy and dissatisfied with their
accomplishments on the job. For the purpose of this blog though I want to leave the academic
definitions at this point and discuss practical issues surrounding the concept of burn-out.
Ive worked as a Nurse Consultant Cognitive Behavioural Psychotherapist for 23 years in the field of
occupational health and medicine with large private and public sector organisations including
emergency Blue Light services. Knowing what I know now I can safely say I’ve treated people with
burn-out many times under the umbrella of calling it depression.
I have always felt there was a major difference and with the World Health Organisation defining
burn-out as an Occupational Syndrome in 2019 but also making it clear it is not a medical condition
then I began exploring the difference
Well from what Maslach talks about ……it’s the PROCESS.
This sounds obvious to clinicians as the process of becoming depressed (loss driven) can be very
different from the burn-out process but its NOT for the clinician to see this difference it is for the
patient/client to understand this difference. By showing the client their journey by going through the
timeline they can see the stages of burn-out (Hans Seyles’ 3 phases can also serve as a template –
General Adaption Syndrome of Alarm, Resistance and Exhaustion) and thus learn from the process
reducing chances of this happening again. If we treat it as depression, then we treat the outcome
not the process.
The reason I feel this is paramount is that for some people burn-out is written on their birth
certificate in their genetic predisposition. Think of the one of the big five traits of personality that is
biggest marker (along with IQ) for success……….
Conscientiousness – it makes people but it breaks people.
Given the strong trait factors that can lead to burn-out then LEARNING from hitting the wall the first
time will hopefully prevent a second or a third as bouncing back each time gets harder as we’ve all
no doubt seen in the occupational health setting. Add this to the fact that nursing promotes
conscientiousness then this perfect storm needs to be addressed.
Also delving deeper into the concept – how can we prevent a process that starts off so exciting,
supplying abundance of dopamine and serotonin, feeding our ego and self-esteem, giving us the
accolades we desire before it tips us over the edge into suffering ??