23 Apr Have We Been Thinking About Burnout All Wrong?
My peers started talking about burnout when Anne Helen Petersen first wrote about what she called the “impossible” task. She described a situation where a small, non-urgent task that would normally feel easy feels insurmountable (in her case, getting a pair of boots resoled). Burnout, she argued, was the overall condition of millennials as a generation. She made this argument back in 2019, before the pandemic.
I have experienced insurmountable exhaustion and hopelessness, but I never found myself totally incapable of doing the little things necessary to keep going. It might not be pretty — the laundry might remain undone for weeks, and the dishes for days — but I fed myself and I slept and I showed up for work and friends. So I hadn’t experienced burnout, I told myself.
But then the pandemic happened, and the stakes were raised for everyone around me. People were quitting jobs, people were anxious and hypervigilant, people were broke and angry. Inflation spiked, stimulus payments hiccuped and stopped, and promises of student loan forgiveness were walked back as rent prices blew up in urban areas and new variants of the virus peppered the map in clusters. And all through the last two years, the term burnout keeps getting thrown around. Everyone has it, everyone is on the edge of it, but the term has little of the shock value it had when I first heard it. Burnout isn’t special anymore.
When journalists began covering the societal effects of COVID-19, burnout was a free space on the bingo card of hot, pandemic-caused issues for media outlets to cover with great consternation. Piece after piece talked about it. Burnout in the medical field. Burnout among the educators. Burnout among parents. Burnout for cis, heterosexual mothers. Burnout for the therapists.
But a term suggesting a rock bottom stops meaning rock bottom when we’re all there and, somehow, still going despite the struggle. Which made me wonder whether the term was a misnomer. And in order to discuss it in any meaningful way and find solutions, we have to understand it. After all, we cannot fix that which we don’t understand.
The World Health Organization defines burnout as a syndrome resulting from workplace stressors, but it’s not recognized as a diagnosis by the DSM-5 — the standard manual of diagnosing psychiatric disorders in the United States, put out by the American Psychiatric Association — even though it’s studied and discussed as a serious topic of research in the field. Other definitions abide by the WHO’s guidepost, limiting it to an experience tied to work, which is in keeping with the origins of the term as first defined in 1974 by an American psychologist. At the most practical level, this makes it difficult to get official medical support for dealing with it. If it’s not in the DSM-5, it doesn’t officially exist to your health care provider.
The thing that made me wonder the most about what burnout might actually be, in terms of a diagnostic definition, was when we headed back into winter in 2020 after a summer of lockdown, before vaccines were rolled out, and my friends and colleagues started expressing a relationship to time and the future that alarmed me. They began talking about the future as if it didn’t exist, as if their imaginative powers were gone. There was no future, there was only this moment, this week, this day, and getting through it. We could be stuck here forever was the vibe at large. This shift was alarming, because up until that point, I was the only person I knew who consistently related to time that way — thanks to complex PTSD.
Complex PTSD, or C-PTSD, is a medical condition that results from long-term trauma, and is discussed as being a subset of PTSD, which is in the DSM-5 as a diagnosable condition. C-PTSD is often experienced like PTSD (e.g., flashbacks, hyperarousal, a distorted newly negative sense of self), but also can show up as emotional dysregulation and detachment from the self. Unlike PTSD, the experience of C-PTSD tends to be more chronic, in ways that make functioning at work or in relationships difficult without therapeutic intervention.
In my case, the long-term trauma was 20-ish years in an abusive religious environment. Over that period of time, sustained levels of cortisol and adrenaline leave a mark on the brain and body that is indelible and permanent. I’ve struggled with planning and time management for forever, and routinely joke that “time is fake,” as if I’m some kind of stoner bro. I’m not, I just really struggle with imagining possible futures. Only a crisis makes me feel truly alive. When the crisis is every day, though, I feel numb and fatigued. And that’s what I was watching happen to the people around me in the fall of 2020. But everyone was calling it burnout.
In August 2021, Evette Dionne announced her departure as Bitch magazine’s editor in chief with an overt statement about burnout being part of why she was resigning. It caught my eye — she’s been talking about burnout for years.
“When I think about burnout, I think about exhaustion beyond the point of repair,” says Dionne, who now works as an editorial and publishing manager at Netflix. “It’s not something that can be solved with a nap or a massage or a vacation. It’s long, deep, soul-deep exhaustion. … I can’t do anything other than the basic minimum requirements for life,” she explains.
This, to me, sounded like my own rough patches, ones I’d attributed to C-PTSD and being broke. Dionne had symptoms like negative self-perception, emotional dysregulation, reduced mental capacity, and task avoidance — all of which align with C-PTSD, which was first defined by Dr. Judith Herman in 1988. So is burnout just a trauma response in disguise?
As I organized notes from my conversations with successful professional women of color, I found out I’d been rejected for yet another job I thought I had a good shot at getting. It’d been a long year of freelancing and getting rejection after rejection. I cried, and told my concerned friends that I didn’t want to talk about it. I have to finish this piece on burnout, I told them. The irony, they said. All I wanted to do was give up, stop working. I wanted to eat dinner and then go to bed early and call it quits.
But I wasn’t willing to call my employment search “trauma,” since — all things considered in 2021 — it wasn’t “that bad.” I’m also buffered from immediate consequences. I have stable housing, I have people I can ask for help if I’m floundering. I don’t want to say I’m burned out because it feels indulgent to say so, but probably I am. Yet, who gets to call in as burned out seems to be correlated to a person’s class-based access to resources.
“Who can take time off from work to recuperate from burnout?” says Dionne when I bring this up. “I think when we are talking about impoverished people, many of those people are indigenous folks, Black folks, brown folks — exhaustion is the baseline so often because capitalism is eating these people alive,” she says. “There is no safety net for those folks, so it really is either work yourself into the ground, or starve.”
Petersen, the author of the Buzzfeed article that launched burnout into the popular consciousness, has come around to echo this perspective, to some degree, in her writing about burnout. But in other industries, such as hospitality, it’s been the de facto reality for years. “It seems like this [term] became popular when white people were the ones going through it,” says Malandra Hastick, a longtime employee of the food and beverage industry and creator of The Wellness Sauce. “But in terms of the rest of us, it’s just like, No, you’re lazy. You don’t deserve to take a break.”
Hastick defines burnout as “the inability to sustain your wellness,” which severs the definitional tie between burnout and the workplace, and flips the focus onto what is being harmed. Instead of burnout being a set of symptoms, it’s a situation, she says. If that’s the case, in order for healing to happen, the person’s circumstances must change.
This idea is echoed by Hassel Aviles, the executive director of Not 9 to 5, a nonprofit in Toronto that advocates for mental health improvements in the hospitality industry. Burnout prevention is basically her bread and butter. “One of the biggest differences between exhaustion and burnout is that it is strongly associated with inadequate support in your environment,” Aviles tells me. You can address exhaustion through rest. To address burnout, she says, you need to step away from work.
Reframing burnout as what’s getting in the way of your wellness and a symptom of inadequate support led Aviles to conclude that the problem isn’t the burnout. It’s an economic system that makes individual workers essentially dispensable, so that the workplace becomes a site of survival struggles. “I really think it’s a tool of oppression, to keep folks constantly busy, and we’re overworking and underpaying them,” she explains. “You’re not allowing people to rest and relax and rejuvenate and refresh their minds and their bodies, [and] oftentimes, you can’t make clear decisions if you’re in that state.”
Every person I spoke with mentioned a physical breaking point. Trips to the ER often preceded massive lifestyle changes to prevent another crash. “You have to shut things down yourself and just completely pause,” says Hastick. “Because if you don’t pause, you’re going to be forced to.”
As I ended my conversation with each source, I asked them to open an email I’d sent with a short list of recognized symptoms of complex PTSD, such as emotional dysregulation, avoiding relationships due to mistrust or feelings of inadequacy, and feelings of helplessness, guilt, shame, or self-loathing. Do you see any overlap here, I asked, between these symptoms and your experience of burnout?
The conversation slowed to a halt each time. “Wow,” they said, or, “Oh yes.” The recognition was instantaneous, and I felt like I could hear each person on the other end of the phone call begin to recalibrate the stories they had been telling themselves. If their burnout was a response to trauma, perhaps they would have approached their recoveries differently.
Diagnosing a mental illness is a process that’s often misunderstood and regularly changing. A diagnosis is often a summary of a cluster of symptoms, which provides insurance companies with a code that in turn allows patients access to treatment. You don’t have to have every symptom on a list. Your symptoms just have to line up most consistently with that particular diagnosis’s cluster of common symptoms. This means that, while burnout might not be recognized by the DSM-5 as a medical condition — despite much of the medical community studying it as such — PTSD is recognized by the DSM-5, and C-PTSD is recognized globally by the ICD-11. Having one of those diagnoses would make tailored therapeutic support easier to get.
But it’s hard to address a problem in any real, lasting way if you’re playing whack-a-mole with symptoms. And sure, giving employees mental health benefits at work is a nice way to mitigate their immediate experiences of burnout, but it’s unlikely to fix the cause of the issue. Plus, this puts the responsibility for healing burnout on the individual.
“I felt so ashamed that I didn’t say anything for a very long time,” Dionne tells me, “because I’m — at the time — a 30-year-old magazine editor who writes books. Like, who am I to feel entitled to feel exhausted living out my dream? … There’s so much shame that comes with that, and guilt, that it doesn’t permit many people, including myself, [to ask] for help. I did not ask for help for a very long time.”
At Edinburgh Napier University, Professor Thanos Karatzias focuses his research on traumatic stress. “One of the conversations [I’m having] with colleagues at the moment is explor[ing] the phenomenology of this distress,” says Karatzias, the university’s director of research. “Is it occupational stress? Is it depression? Is it anxiety? Is it burnout? Is it PTSD? Is it complex PTSD?”
He is hesitant to claim that burnout is caused by trauma, because trauma is generally characterized by surprise. (“A traumatic life event is a significant life event [such as] abuse in childhood or road traffic accidents, things that you wouldn’t expect to happen that would cause an intense, emotional reaction,” he says.) But work is changing. We’re expected to be constantly available and more productive for less money. This new landscape raises new questions, he says. “People are struggling with work, but why? Is there a label for this distress? Is this a hybrid of different things? We do not know that yet.”
If we don’t fully understand burnout and how it manifests in the body, it’s difficult to solve it. And even aside from individual remedies, what’s to be done on a structural level?
Fortunately, this path has already been laid for us by radical Black feminists like Angela Davis, Assata Shakur, and Audre Lorde, who conceptualized anti-work and abolitionism as a path toward liberation. (It’s been adopted by the movement du jour, dubbed fifth-wave feminism, according to journalist Mary Retta.)
When I spoke with Dr. Paul DeChant, a former family physician who now helps hospital leadership teams prevent physician burnout, he reiterated the need for structural change. “Oftentimes, people want to [make a better work environment], but don’t have the structural or process mechanisms by which to do it,” he says. “So once they get those in place, people start to get hopeful pretty quickly.”
Since starting this piece, I’ve landed a new job as a temporary teacher. It feels good to be working again, to be teaching, to have something organizing my everyday life. I also hold this loosely, knowing that all good things in 2022 are more fragile than we think. I am grateful for it, but also just one contract-ending away from feeling panicked about my stability all over again. The last year has taught me (and many of us) that work won’t love you back and that fixing our individual approaches to it likely won’t prevent burnout. Sometimes the only way to fix a broken system, it seems — to move toward a restorative approach to sustaining ourselves and our labor — is to refuse to play by the old rules. Work is good, but I am not my job.