Chapter 1: What is burnout? – Managing Burnout in the Workplace

1

What is burnout?

Abstract:

This chapter discusses recent changes in the workplace which have resulted in greater sources of stress for workers. Burnout is defined and distinguished from low morale, depression and stress. A consideration follows on how burnout manifests itself in terms of changes in behavior, feelings, thinking and physical and mental health.

Key words

burnout

low morale

depression

stress

Diagnostic and Statistical Manual of Mental Disorders

Fourth Edition (DSM-IV)

International Statistical Classification of Diseases and Related Health Problems

10th Revision (ICD-10)

changes in feelings

changes in health

changes in thinking

changes in behavior

Introduction

Over the last several decades, profound changes have occurred in much of the workplace. Budgets have been cut, workers have been downsized and often fewer employees have been left to carry out the same amount of work.

As a result, the pace of work seems far more relentless than it did only a few brief decades ago. Workers are more harried than ever, yet attempting to control or limit the volume of work assigned is often futile. An individual who says no to more work might, at best, be regarded as someone who is not a team player. At worst, saying no is viewed by the organization as unacceptable, and a step towards dismissal.

Given this demanding pace, time away from work should be the period during which an employee can relax and recover from the stresses of the day. Instead, setting clear boundaries between work time and personal time has become, for many, impossible. Employees are frequently expected by their employers to check their email at work and at home, and to be reachable at any time of the day or night, including vacation. Finding a work–life balance is made more difficult as a consequence of this “constant connectivity” and results in even greater stress on the individual employee (Study, 2012).

One might think that upper management would find some way to reward employees for accepting the grinding pace and the greater intrusions of the job into their private time. Instead, in an era of shrinking resources, individuals higher up the food chain are often as worried about their own survival as the people who report to them. As a result, supervisors may take credit for projects done well but may be slow to show support when things are going badly through no fault of the workers (Maslach and Leiter, 1997). Without such support from superiors, workers find it even harder to shoulder the stresses of the job. Eventually, the volume and pace of work, along with a myriad of other factors in the workplace, break down many individuals so that they can no longer function. Burnout is often the end result.

Burned out workers are those who find themselves suffering from severe emotional fatigue, which is frequently accompanied by physiological symptoms. They feel distressed, alienated, inadequate, and unmotivated. These employees often become unrecognizable to their colleagues, particularly as they withdraw from social and other interactions. Their behaviour also changes; they may exhibit signs of depression or anger, and may turn to drugs or alcohol or employ other dysfunctional coping behaviors in an effort to deal with the stress.

Overwork, of course, is a major contributing factor to burnout. An excessive workload and an unremitting pace are no longer facts of life only in third world sweatshops. Today, even in wealthy, industrialized countries, overwork has been found to contribute to serious illness and, somewhat surprisingly, death. In countries such as Japan, for example, death from overwork even has a name – karoshi. Since the 1980s, 30,000 Japanese have been recognized officially as having been victims of karoshi, i.e., their deaths have been recorded as having come about as a result of overwork (Pannozzo and Landon, 2005).

As for other industrialized countries, while accurate information on death from overwork is harder to find, it has become more common to find statistics on workplace stress and the role it plays in serious health problems. The president of the American Institute of Stress (AIS), Paul J. Rosch, MD, FACP, says that chronic workplace stress often leads to significant health problems such as high blood pressure, cardiovascular disease, heart attacks and strokes and can aggravate many already existing conditions (Walter, 2012).

Stress and burnout also make the likelihood of workplace accidents greater. Burnout has been linked to the risk of developing back problems and other musculoskeletal disorders in the upper body (Kalia, 2002). It is known to have a connection with diabetes, suppression of the immune system, memory loss, and the shrinking of neurons in the brain (Contenta, 2010). Researchers have, in addition, found a correlation between job stress and burnout and “various self-reported indices of personal distress, including physical exhaustion, insomnia, increased use of alcohol and drugs, and marital and family problems” (Maslach and Jackson, 1981).

What does all this mean for the workplace? As these and other studies indicate, employees pay a high cost as a result of burnout. But they are not the only ones. Worldwide, the syndrome presents a serious problem for all kinds of businesses, organizations and the economy as a whole. For example, in 2002, the European Agency for Safety and Health at Work estimated that work-related stress disorders in Europe resulted in a yearly economic cost of approximately 20 billion Euros (about 25 billion US dollars) (Awa et al., 2010).

In 2005, it was reported in the press that one in five workers in Scotland thought their jobs were “highly stressful” (Gray, 2005). Several years later, in 2011, the UK’s Health and Safety Executive (an independent body which conducts research and keeps an eye on work-related health, safety and illness issues) estimated that stress was responsible for 10.8 million lost workdays that year (Health and Safety Executive, 2011).

In the United States, in 2009, a survey conducted by the American Psychological Association found that 69 percent of all employees felt that their job was a significant source of stress. Forty-one percent felt stressed during a typical work day and more than half of those surveyed thought that stress had a negative impact on their productivity at work (Levinson, 2012). That same year, the US National Institute for Occupational Safety and Health (NIOSH) reported that 26 percent of workers are “often or very often burned out or stressed by their work,” and 29 percent said they felt “quite a bit or extremely stressed at work” (NIOSH, 1999, p. 4).

A price tag in the neighbourhood of $300 billion per year is what the American Institute of Stress has estimated stress and burnout on the job costs US businesses (Walter, 2012). It has also estimated that more than 75 percent of all visits to doctors are stress-related (Kalia, 2002). Costs are incurred as a result of reduced productivity and revenue, decreased job satisfaction, increased absenteeism and sick leaves, job turnover, low morale, and the necessity for replacement workers, along with compensation, litigation and disability claims. Employees who are burned out are also less inclined to assist their colleagues on the job and less inclined to care about the organization or its goals. It is worth noting that next door to the US, Health Canada has also reported problems related to stress: it is responsible, for example, for an annual price tag of C$3.5 billion as a result of absenteeism by Canadian workers (Contenta, 2010).

Several continents away, a 2010 University of Melbourne and Victorian Health report found that, in Australia, job stress and depression resulting from excessive pressure in the workplace cost the economy approximately A$730 million a year. Researchers arrived at this figure by estimating the costs of lost productivity, of finding replacement workers and of medical treatment of work-related mental health problems (“Huge cost,” 2010). As these figures show, burnout is a serious problem internationally.

To what extent the numbers are rising from one country to the next is not as clear. Despite the approximately 6,000 books, chapters, dissertations, and journal articles which have been published on burnout in countries around the globe over the last 35 years (Schaufeli et al., 2009), comprehensive country-wide data on burnout is not always easy to find, in part because it is not officially recognized in all countries as a specific health problem in and of itself. One country which does keep statistics – the Netherlands – has discovered that at any given time, 10 percent of employees are burned out (Senior, 2006).

Individual studies of various professional groups have also been conducted over the years and have estimated that, for example, approximately one out of every five doctors in the US and Germany is burned out at any given time and more than one in four are burned out in Great Britain (Awa et al., 2010). Reports also indicate that between 30 and 40 percent of teachers are burned out at any one time (Awa et al., 2010).

Clearly, the literature indicates that burnout results in tremendous costs to individuals, organizations and the economy. Nonetheless, the factors which contribute to burnout seem to continue unabated in the workplace, and recent surveys point to a rise in the number of burned out employees (“Jobs Mail,” 2005).

While relatively few statistics exist for individuals in the information professions, the reality of the problem of burnout pertains equally to them. Not surprisingly, economic costs in these workplaces are already known to be high as a result of

reduced employee productivity, increased sick leave, higher insurance premiums, early retirement payments, the need to recruit and orient replacement or substitute employees, provision of burnout treatment and prevention, employee sabotage, and litigation. (Nauratil, 1989, p. 4)

In this book, although the research discussed is drawn from the great wealth of literature on burnout from around the world and deals with a number of professions, we will also give special attention to the handful of studies devoted specifically to burnout in the information professions and what they say about workplace stress. The book will consider what exactly burnout is, the factors which are said to increase the risk of burnout, and how to keep burnout at bay.

To begin, therefore, the opening chapter will look at the various definitions of burnout and how experts differ on their views of the syndrome. It will review the differences between burnout, low morale, stress, and depression. The chapter will also examine how an individual feels, behaves, and thinks when burnout is on the horizon or when it has already closed in, as well as what burnout does to overall health. First of all, we turn to the problem of definition.

What is burnout?

Definition

The concept of burnout first figures prominently in print in the Graham Greene novel, A Burnt-Out Case. In the novel, Querry, an architect, has travelled to Africa in order to escape his former life. Although renowned in his field, Querry has lost interest in his work and in his private life. The reader comes to understand that Querry now finds his former accomplishments and relationships meaningless; he feels empty and numbed and seeks only to withdraw. He explains to a physician he meets why he came to Africa:

… I wanted to be in an empty place, where no new building or women would remind me that there was a time when I was alive, with a vocation and a capacity to love – if it was love. The palsied suffer, their nerves feel, but I am one of the mutilated, doctor. (Greene, 1977, p. 46)

In 1969, Harold B. Bradley, a correctional administrator, used the term burnout to describe staff in correctional programs (Bradley, 1969). But it was not until five years later, when psychiatrist Herbert Freudenberger (1974) used burnout to describe what he saw happening to volunteers at a drug addiction clinic, that the term drew more attention. Freudenberger described how the volunteers, when starting out at the clinic, approached their work with high levels of enthusiasm and commitment. They had elevated expectations regarding what they might be able to achieve and they worked hard to realize those expectations. Within a year, however, that enthusiasm and motivation had clearly diminished, and volunteers found themselves in a state of job distress which manifested itself both mentally and physically. As Freudenberger noted, “[w]henever the expectation level is dramatically opposed to reality and the person persists in trying to reach that expectation, trouble is on the way” (1980, p. 13).

The specific trouble referred to by Freuedenberger was burnout, a term that had been used casually by workers and volunteers in the field to describe the long term effects of drug abuse on chronic drug users. Freudenberger himself now used burnout to describe the exhaustion and lack of motivation that he saw present among the volunteers after they had been working for some time. These people were experiencing a “state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that failed to produce the expected reward” (Freudenberger, 1980, p. 13). Striving beyond the mental and physical limits of their bodies, the volunteers had found themselves exhausted, depressed, and disillusioned.

Today, the term is widely used even in casual conversation to describe fatigue and exhaustion. But it is also used by hosts of researchers who study the phenomenon. In scholarly studies and empirical research involving burnout, one of the definitions most commonly used came about as the result of the work done in this area by two Americans: professor of psychology Christina Maslach and professor of human resource management Susan E. Jackson. Their definition was not, in the beginning, the product of a theory empirically tested in the field; instead, it was developed from the ground up as the result of extensive research involving various employee groups – day care workers, mental health staff, attorneys, police officers, physicians, educators, nurses, etc. – all of whom were asked to describe their jobs and work experiences.

From these studies came the definition of burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity” (Maslach et al., 1996, p. 4). Burnout was seen not as the product of an occasional crisis in the workplace, but rather as the “response to chronic, everyday stress” and the “never-ending onslaught of emotional tension” which wore individuals down (Maslach, 1982, p. 11).

This wearing down of individuals and the resulting emotional exhaustion is the first dimension of the syndrome and is key to understanding it. As Maslach and Jackson describe it, burnout is

a syndrome of emotional exhaustion … that occurs frequently among individuals who do “people-work” of some kind. … As their emotional resources are depleted, workers feel they are no longer able to give of themselves at a psychological level. (Maslach and Jackson, 1981)

Emotional exhaustion is often accompanied by a general weariness, the inability to sleep properly at night, physical lethargy, and a host of physiological symptoms including stomach problems, digestive problems, muscle fatigue, and headaches.

In burned out individuals, exhaustion is generally accompanied by feelings of depersonalization and/or cynicism, the second major dimension of the syndrome (Maslach and Jackson, 1981). Employees develop negative attitudes and feelings towards the recipients of their services (i.e., patrons, clients, patients, students, etc.). They also become disenchanted with their work. Communication becomes a strain, and burned out employees respond by seeking to avoid contact with the people around them.

In the library setting, for example,

Burnt-out librarians who stay on the job … withdraw from it in other ways – extending breaks and lunch hours, missing meetings, going home early, and routinely taking advantage of their maximum sick leave. In a library where burnout is prevalent, professional collegiality may be seriously eroded. Intra-organizational communication may break down at the informal level between coworkers, between departments, and between management and staff. (Nauratil, 1989, pp. 3–4)

Enthusiasm for the job requires energy. Where that energy is depleted, enthusiasm is replaced by cynicism, not only towards the group of people the employee is intended to help, but often towards colleagues and supervisors as well.

According to researchers, changes in personality or attitude are observable in people who are burning out: formerly even-tempered employees are suddenly short-tempered, easily irritated, rude and insensitive. They no longer feel the same commitment to the job and may fluctuate between feelings of anger, disillusionment and not caring at all. Indeed, one of the hallmarks of burnout is that individuals at risk do not notice the signs or symptoms of burnout for some length of time. One wake-up call is when they understand they are behaving in ways they do not recognize as being consistent with their own personality (Casserley and Megginson, 2009).

Finally, the third dimension of burnout is what Maslach and Jackson call reduced personal accomplishment or ineffectiveness. This involves a “tendency to evaluate oneself negatively, particularly with regard to one’s work with clients. Workers feel unhappy about themselves and dissatisfied with their accomplishments on the job” (Maslach and Jackson, 1981). Their accomplishments seem trivial to them. They suffer from a lack of confidence; they feel less effective on the job and have doubts about their self-worth. Ironically, the more such an employee thinks about failure, the more failure begins to look like a self-fulfilling prophesy.

There have been debates about the extent to which exhaustion, depersonalization/cynicism and reduced personal accomplishment/ ineffectiveness make up the burnout syndrome. Maslach notes that early studies of burnout were dismissed by other researchers as nothing more than pop psychology. But there seems little debate anymore that burnout exists and that it is pervasive. Over the last 30 years, research from around the world has contributed to what is now a large body of empirical evidence (Schaufeli et al., 2009) in addition to various theoretical models (Maslach, 2003).

The concept of burnout as a workplace phenomenon has also extended beyond individuals in the human services professions to include those who do not deal with people to any large extent in their jobs. Instead, these individuals may problem solve, mentor or work creatively in their jobs. In such cases, burnout has been defined as “ … a state of exhaustion in which one is cynical about the value of one’s occupation and doubtful of one’s capacity to perform” (Maslach et al., 1996, p. 20).

Other definitions

As noted above, though the definition of burnout as set out by Maslach and Jackson is the one cited most widely in the literature, there has been considerable debate about the three components of burnout they posit.

Shirom (1989), for example, offers a definition that focuses specifically on exhaustion: “[b]urnout refers to a combination of physical fatigue, emotional exhaustion and cognitive weariness” (pp. 33–4). He and other researchers (Kristensen et al., 2005) do not view depersonalization as one of the hallmarks of burnout but rather see it as a coping behaviour which precedes burnout. Similarly, they view the inability to take satisfaction in one’s job (i.e., reduced personal accomplishment) as a consequence of burnout rather than a defining characteristic.

Other researchers (e.g., Pines and Aronson, 1988) concur with Shirom that the various types of exhaustion (physical, mental and emotional) are the key determinates of burnout. Pines and Aronson define the syndrome as “[a] state of physical and emotional exhaustion caused by long-term involvement in situations that are emotionally demanding’ (Pines and Aronson, 1988, p. 9). Similarly, Schaufeli and Greenglass see burnout as “a state of physical, emotional and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding” (Schaufeli and Greenglass, 2001, p. 501).

As with the debate over the three dimensions of burnout posited by Maslach and Jackson, there has also been discussion over how burnout is to be measured outside of human-services jobs or professions. Researchers have indeed concluded that burnout is a problem in all areas of employment, not just the human-services area (Beemsterboer and Baum, 1984), but the instruments which measure these disparate groups are necessarily different and have produced unexpected results. For example, through the use of an instrument designed to measure the problem among those who don’t necessarily work with the public, psychology professor Evangelia Demerouti and her colleagues have discovered that the burnout syndrome appears to have two separate but correlated components – job demands and job resources. Job demands, these authors explain, involve physical workload, time pressure, recipient contact, physical environment and shiftwork. In a non-human services workplace, emotional exhaustion is often the product of “extreme job demands” (Demerouti et al., 2001). Extreme job demands, they explain, may lead to exhaustion but not necessarily a disengagement from the workplace.

In contrast, in the matter of job resources, worker disengagement is not caused by exhaustion but by the lack of the appropriate resources (feedback, rewards, job control, participation, job security, supervisor support) required to meet the demands of the workplace. Here, an emotional withdrawal takes place resulting in disengagement and depersonalization (Demerouti et al., 2001).

The above are just some of the ongoing efforts being made to pin down what burnout is and why it occurs. Additionally, just as researchers have sought to define burnout and to determine the groups of individuals to whom it might apply, they have also tried to understand how the burnout syndrome differs from low morale, depression and stress – three other problems which plague individuals in and away from the workplace. What follows is a brief discussion of how burnout may be differentiated from low morale, depression and stress, and why.

Burnout and low morale

Morale has been defined as “the collective spirit and motivation of a group of employees” (Helms, 2006). It is

how employees actually feel about themselves as workers, their work, their managers, their work environment, and their overall work life. It incorporates all the mental and emotional feelings, beliefs, and attitudes that individuals and groups hold regarding their job. (Helms, 2006)

Both individuals and groups of workers can suffer from low morale; however, the term is used most often to refer to the state of mind of a group of workers (Lee, 2012). Burnout, in contrast, is not a group phenomenon (although more than one worker at a time in a workplace might be burned out). The syndrome is not a shared experience but, instead, endured alone.

Not surprisingly, the symptoms exhibited by workers suffering from low morale and burnout do at times appear to overlap, particularly in the case of absenteeism and lack of enthusiasm (“10 warning signs,” 2010). Low morale, however, has to do largely with job dissatisfaction and manifests itself in group attitude and behaviour, i.e., employees lack enthusiasm, discipline and commitment, appear uncooperative, complain frequently, and so on.

Individuals who are burned out, in contrast, experience a profound fatigue and lack of energy accompanied by a variety of other mental and physical problems including headaches, trouble sleeping, and feelings of helplessness and anger (Hoopes, 2006). Also important is that low morale in the workplace can be repaired with relative ease and speed given a change in supervision or management or given other necessary changes to the conditions of work. Burnout, however, takes an individual longer to recover from, even when key changes are made to the workplace.

Burnout and depression

The initial problem with the use of the term burnout, Maslach has noted, was the accusation by some in the research community that it was merely a “new label” slapped over old problems such as stress, depression, apathy, and a general unhappiness with one’s employment (Maslach, 2011). But as Maslach and others explain, while certain symptoms may be shared by one or more of those mental states, both burnout and depression contain unique features which differentiate each from the other.

The two terms are sometimes used interchangeably in popular literature, but they are not synonymous. The confusion is, in part, attributable to the fact that depression, like burnout, can sometimes be defined in terms of a depletion of energy, withdrawal from other people, and feelings of reduced personal accomplishment. Additionally, just as depression may take several forms – “neurotic versus psychotic depression, agitated versus retarded depression, bipolar depression, atypical depression, dysthymia” (Farber, 2000) – several different subtypes of burnout may also be distinguished, as some researchers have suggested:

(1) a “wornout” subtype, wherein an individual essentially gives up, or performs work in a perfunctory manner, when confronted with too much stress and too little gratification;

(2) a “classic” (or “frenetic”) burnout, wherein an individual works increasingly hard, to the point of exhaustion, in pursuit of sufficient gratification or accomplishment to match the extent of stress experienced; and

(3) an “underchallenged” subtype of burnout, wherein an individual is faced not with an excessive degree of stress per se (i.e., work overload), but rather with monotonous and unstimulating work conditions that fail to provide sufficient rewards. (Farber, 2000, p. 677)

So while the lines between burnout and depression may be blurred at times, research has shown that they are distinct (Leiter and Durup, 1994; Bakker et al., 2000) and yet consistently correlated with one another (Firth et al., 1986; Maslach and Jackson, 1986; Meier, 1984). In other words, there is a proven relationship or connection between them.

Where they differ lies in the fact that burnout is context specific; in other words, it is the product of the workplace, and the questions which are asked of members of occupational groups studied have to do with the effect of the job on the survey respondent (for example, “I feel that this job is hardening me emotionally,” “I feel exhilarated after working closely with my recipients" (emphasis added by Leiter and Durup, 1994 citing Maslach and Jackson, 1986). Burnout originated and still is most often associated with occupational groups in which there is interaction with recipients and is the emotional toll paid by a worker as the result of that interaction.

Depression, in contrast, is about personal thoughts and feelings, and while it can be situational, it is not necessarily focused on the workplace. As a result, tools which measure depression, such as the Beck Depression Inventory (BDI (first published in 1961) and BDI-II (the 1996 revision)) do not concern themselves with the context for depression, but instead measure more broadly feelings and emotions and the physical manifestations of depression. The inventory measures, for example, the extent to which an individual is critical of herself, and the extent to which that individual feels pessimistic, guilty, worthless, or suicidal. The inventory also measures the physical manifestations of depression including crying, irritability, lack of interest in people, lack of interest in sex, loss of libido, inability to make decisions, difficulty sleeping, and poor appetite.

Individuals who are burned out, though they may lack energy, do not suffer from the same types of physical symptoms and, compared to those who are depressed, sometimes still find moments of enjoyment in life. Also, while burned out individuals are mentally and emotionally exhausted, they do not share the same inherent self-loathing, feelings of guilt, and thoughts of suicide, nor do they suffer from the same physical symptoms as those who are depressed. Typically, individuals who become burned out have been, until then, relatively mentally healthy and have not suffered from any prior psychopathology (Maslach et al., 2001). Research has shown that those who are burned out make fewer work-related errors than those who are depressed (Fahrenkopf et al., 2008) and any reduction in their work performance is generally the result of negative attitudes and behaviours (Maslach et al., 2001).

Finally, while those who are burned out and those who are depressed might have problems sleeping, the types of problems experienced by each group in this regard also differ measurably (Brenninkmeyer et al., 2001; Hoogduin et al., 1996). The same is true regarding feelings of self-worth; depressed individuals are more likely to assess themselves lower than those who are burned out in terms of “superiority” (i.e., defined as inferior versus superior rank, undesirable versus desirable appearance, and unaccepted versus accepted by others). Depressed individuals, when questioned on these items, are more likely to respond as though they have given up; only the most severely burned out individuals who feel utterly defeated have been shown to respond in a similar manner (Brenninkmeyer et al., 2001).

Burnout and stress

Researchers often speak of burnout as “an extension of the construct of stress” or a “distinct consequence of work-related stress” (Halbesleben and Buckley, 2004, p. 871). Unlike stress, however, which can occur in any part of an individual’s life, burnout is most often related specifically to the workplace. Brill (1984), for example, defines burnout as an

expectationally mediated, job-related, dysphoric and dysfunctional state in an individual without major psychopathology who has (1) functioned for a time at adequate performance and affectual levels in the same job situation and who (2) will not recover to previous levels without outside help or environmental rearrangement. (p. 15)

Burnout is the point at which employees can no longer deal with the demands made of them, accompanied by a loss of meaning in that they no longer believe in the work they are doing (Casserley and Megginson, 2009). As Pines and Aronson (1988) explain,

[p]eople experience burnout as a gradual erosion of their spirit and zest as a result of the daily struggles and chronic stresses that are typical of everyday life and work – too many pressures, conflicts, demands, and too few emotional rewards, acknowledgements, and successes. Stress, in and of itself, does not cause burnout. People are often able to flourish in stressful, demanding careers if they feel valuable and appreciated and that their work has significance. They burn out when their work has no meaning and stress continuously outweighs support and rewards. (p. 11)

Individuals who are stressed are often over-engaged, whereas those who are burned out are disengaged. Stress is characterized by an emotional state which is over-reactive, producing a sense of urgency and hyperactivity. In contrast, the burned out individual has blunted emotions and feels helpless, detached and defeated (Smith et al., 2012). Individuals who are stressed and/or burning out can feel that “control of the boundaries between work and non-work [is] temporarily threatened.” Even so, when periods of stress are not too prolonged most workers believe they have the resources and the ability “sufficient to wrest control back again” (Casserley and Megginson, 2009, p. 16). Those who suffer from burnout no longer have that same confidence.

Unlike burnout, stress can be short term and buffered by adequate organizational infrastructure (Brill, 1984). Also, unlike burnout, not all stress is bad. Job stress which is short term is not unusual for most occupations, and some employees have been shown to thrive in a stressful environment (Pithers, 1995; Whitehead and Ryba, 1995). Chronic and long term stress, however, can lead to burnout. Also, while stress may be here today and gone tomorrow, burnout is something which develops over time (Leiter, 1993; Maslach and Leiter, 1997; Schaufeli and Enzmann, 1998) and from which it takes time to recover.

Expectations, however, play a greater role in burnout, which is, in part, a response to the difference in expectations between what the job will be versus what it really is. Burnout can also be fed by unrealistic expectations of oneself. As one researcher has noted, “[b]urnout is considered preeminently a disorder of the over-committed and thwarted” (Roberts, 1997).

Using the terms stress and burnout interchangeably is misleading in that it fails to account for the

strong phenomenological perception of “inconsequentially” among those who feel burned – the sense that their efforts on their job are not met with commensurate rewards, satisfactions, or fulfillment. (Farber, 2000)

Burnout has much to do with stress, but ultimately has hallmarks that are not necessarily present in other stress-related disorders.

Classification

The term burnout does not appear in the fourth and latest edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published in 1994. This manual, which classifies mental disorders, is published by the American Psychiatric Association and used primarily in North America. At the time of writing, the next major revision (“DSM-V”) was due to be published in 2013, although whether the term will appear in that edition is yet unknown.

One of the very practical ramifications of the term not appearing in the DSM-IV is that treatment is often not supported by insurance companies, and there has not been the same kind of research involving diagnosis, treatment and effective therapies as in those parts of the world which regard it as a recognized disorder. Instead, in the regions which use the DSM-IV, burnout is generally treated as “a nondistinct stress-related phenomenon. Thus, suggestions for its remediation tend to parallel those for any stress-related disorder” (Farber, 2000, p. 676).

In contrast to the North American situation, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is the classification work used primarily in Europe and in certain other parts of the world. The ICD-10, published by the World Health Organization, is a manual which classifies diseases and other health-r elated problems that appear on death certificates and in medical records. World Health Organization member states rely on it to help generate meaningful statistics and related information on health and mortality in various segments of the population. The term burnout has appeared in this manual since 1992. It is classified under the heading “Problems related to life management difficulty” (Z73) and is defined as a “State of vital exhaustion” (ICD-10, 2012).

Accordingly, in certain European countries (e.g., Sweden and the Netherlands), burnout is a legitimate medical diagnosis, and individuals who are diagnosed as burned out by a psychiatrist are eligible for sick benefits or disability. The criteria for the diagnosis are:

physiological or mental symptoms of exhaustion for at least two weeks, an essential lack of psychological energy, and symptoms such as difficulties to concentrate, decreased ability to cope with stress, irritability or emotional instability, sleep disturbances, muscle pain, dizziness or palpitations. These symptoms have to occur every day during a two-week period and must cause significant suffering with impaired work capacity. Finally the symptoms must not be related to other psychiatric diagnosis, substance abuse, or medical diagnosis. (Schaufeli et al., 2009, pp. 213–14)

Health care professionals in these European countries are not only able to diagnose burnout, but are also able to provide forms of treatment and other interventions. In various places of employment, workshops are held on preventing and dealing with burnout. Health care professionals also act as consultants to a variety of organizations on the problem of burnout (Schaufeli et al., 2009).

Outside of these specific countries, however, burnout remains a vaguer malady. While the term appears with relative frequency in the news as a catch-all word to define overwork and exhaustion, the specifics of the syndrome and how to deal with it are still mysteries to most employees and their organizations. What we turn to next is a discussion of some of these specifics.

Symptoms and diagnosis

Individuals who burn out are likely to blame themselves, thinking that something must be wrong with them if they are unable to handle the stress (Maslach, 2003). This is often reinforced by the situation in which they find themselves. Chronically stressed individuals remember a time when the stress wasn’t a problem for them. As one employee commented,

I pretty much felt I was untouchable and I could handle anything. And in point of fact the jobs that I was given to do were the most difficult, and I thrived on it. I was given impossible people to work with and I could get results that no one else could get and that fed the sense of superiority that I was invincible. (Glouberman, 2002, p. 68; italic in original)

Burned out workers often don’t understand that burnout is the end result of prolonged stress experienced on a daily basis, and that it has taken some time for the cumulative effects to manifest themselves. They are unaware that they have been burning out over a period of time; they only know that they once were able to function more effectively than they do now; hence the tendency to blame themselves or others (co-workers, supervisors, clients) with whom they work.

Given that burnout takes place over time, one of the great difficulties lies in identifying it as it is taking place. Burnout has been described as a “fuzzy set” (Burisch, 1993), which means that it is not easy to distinguish its symptoms from those of similar phenomena such as low morale, depression, exhaustion and stress. Nonetheless, burnout is a syndrome which is empirically distinguishable from these other similar phenomena and “not just a ‘flabby’ synonym for more established symptomatic states” (Roberts, 1997, p. 282).

As we have seen, burnout shares certain traits with other problems such as stress and depression, yet it is still possible to identify burnout as a distinct problem. What follows is a discussion of some of the symptoms that have been definitively identified in the literature, including changes in behavior, changes in feelings, changes in thinking and changes in health.

a) Changes in behavior

One of the hallmarks of burnout is withdrawal from others. As Christina Maslach notes, “[o]ne way people try to get out from under their emotional burden is by cutting back on their involvement with others. They want to reduce their contact with people to the bare minimum required to get the job done” (Maslach, 1982, p. 3). Co-workers and supervisors tend to notice this. Indeed, studies in which co-workers describe the behavior of their colleagues in the months leading up to complete burnout note this withdrawal from co-workers and a tendency to want to complete tasks alone (Ericson-Lidman and Strandberg, 2007).

Employees who are burning out distance themselves from an assortment of people: supervisors, co-workers and/or the group of people whom they are trained to serve or help. Where these employees once had a great interest in the welfare of the recipients of their services, for example, they begin treating these same recipients with callousness and negativity (Maslach et al., 2001).

They spend less time and energy on their work and are absent more often. Once an individual has burned out, both the quality and the quantity of the work may suffer significantly.

Withdrawal can also include a withdrawal from social activities. Individuals who are burning out begin to ignore or cancel invitations and do not pay attention to relationships with those who are close to them. Even so, they often still believe the situation is temporary (Ekstedt and Fagerberg, 2005).

Other unexpected changes in behavior appear. Some individuals report that, in the course of burning out, they have found themselves losing their temper in a way that was unusual and quite unlike their “normal” selves (Casserley and Megginson, 2009). Emotionally exhausted workers suddenly become more irritable or hostile, and exchanges with co-workers become emotionally charged. As one burned out worker described it,

The person sitting there wasn’t me. I wasn’t really there. I wasn’t enjoying anything. I felt like I didn’t fit my life. I was in the wrong position, doing the wrong thing, and I shouldn’t be there.

I was definitely losing it at work. I started to feel more indifferent to my clients. I felt angry at colleagues. I had a combination of anger, cynicism, hate and disillusionment. I was furious – hating myself and hating them at the same time. An impotent rage. I was also terribly exhausted, and started getting physical symptoms. I also began to get more addicted to things, one minute chocolate, then drinking, then a phase of casual sex. (Glouberman, 2002, pp. 56–7; italic in original)

The particular changes in behavior like those described above are among the hallmarks of burnout. Not only are co-workers and recipients surprised by these changes, but the burned out employees in question no longer recognize their old selves.

b) Changes in feelings

Individuals who are burned out no longer feel the same way they did about the people they were hired to help, or about the organization for which they work. They are often, at first, frustrated and angry; later they become disengaged from the workplace and are no longer enthusiastic about the work they once enjoyed. According to one sufferer,

I was just fed up with living. That was the main symptom. Everything in life was an effort. There was no joy in anything I was doing. I couldn’t feel anything and wondered if I had any feelings at all. I think I’d been pretty shut down for quite a lot of my life, but I was just absolutely emotionally dead. I felt like I’d lost all sense of who I was and what I was. (Gloubermann, 2002, p. 149; italic in original)

Schaufeli and Enzmann (1998) discuss the affective, cognitive, physical, behavioral and motivational signals which indicate burnout. Significantly, the affective, cognitive and motivational signals all have to do with changes in feelings. For example, affective signals include depressive/ changing moods, tearfulness and exhaustion. Cognitive signals include feelings of helplessness, hopelessness, powerlessness, guilt and feeling trapped: work has lost its meaning. Finally, motivational signals include loss of enthusiasm and zeal, along with disappointment and resignation (Schaufeli and Enzmann, 1998).

Along similar lines, there are noticeable changes in attitude which are largely negative. Burned out employees no longer appear to have the work goals they once had; not only have they lost their initial idealism, but they may also display a new heightened self-interest which is yet another means by which they are attempting to cope (Benbow, 1998).

c) Changes in thinking

Employees who are burning out worry about being able to fulfill their work responsibilities, in part, because they are having difficulty concentrating and making decisions (Ekstedt and Fagerberg, 2005). These individuals describe problems with memory and “blackouts” during which “they suddenly could not remember how to perform familiar tasks, or [they forget] to carry out routine work, which then took a great deal of time to catch up on” (Ekstedt and Fagerberg, 2005, p. 64). One employee explained,

I went into a kind of blank space, where I was almost frozen into inaction and beyond caring what happened. Some days it was a heavy feeling, like wading through treacle and everything being an enormous effort, or like having your foot on the accelerator and the brake at the same time so that the net response was zero. Other days it just felt remote and disconnected and empty/indifferent.

I still more or less functioned day to day, in a going-through the motions kind of way, but the cracks began to show in other silly but completely uncharacteristic ways: things like going out and forgetting to turn the iron off, or realizing only at the very end of a day that I’d put on the jacket of one suit with the skirt of another that didn’t go at all, and on a couple of occasions, I lost my temper with different bosses. I knew I couldn’t go on like this, but couldn’t see an alternative. (Glouberman, 2002, p. 149; italic in original)

Such employees no longer have a sense of accomplishment in their job. While there is some debate as to whether this is a result of the other two dimensions of burnout (exhaustion and depersonalization/cynicism) (Byrne, 1994; Lee and Ashforth 1996) or whether reduced personal accomplishment develops in parallel with the other two aspects (Leiter, 1993), this conviction that one is not working as effectively, competently or productively is a hallmark of burnout.

Paradoxically, despite their worries about job performance, studies have shown that, on the road to burnout, employees’ perception of their own work performance differs from how it is objectively viewed. For example, when Dutch nurses were asked to rate their job performance, researchers discovered that burnout was positively related to how well one is doing on the job. In other words, those individuals who are burning out feel they are performing poorly when in fact, their supervisors noticed higher performance levels (Keijsers et al., 1995; Parker and Kulik, 1995).

Nonetheless, colleagues do notice the discrepancy between how their at-risk colleagues feel they are doing at work and how they are actually doing. For example, one study in which co-workers were asked to describe the behavior of colleagues in the months before those colleagues burned out reported that their at-risk colleagues were working harder to exacting standards but often felt that they were not doing a good job. The colleagues on the verge of burnout believed they could not perform their work adequately because they felt emotionally drained and stretched for time (Ericson-Lidman and Strandberg, 2007).

Eventually, however, the fear that one is not doing a good job becomes a self-fulfilling prophecy. Once burned out, workers really do have difficulty performing their work, often because of increased absenteeism which may, in its most severe form, eventually lead to a change of jobs (Toppinen-Tanner et al., 2005).

d) Changes in health

Physically, burnout manifests itself most profoundly as constant fatigue. Individuals feel drained and exhausted; they suffer from sleep disturbances and insomnia. Here is one self-analysis:

Exhaustion. I was driving myself to carry on and to work harder and harder and I was having to work harder to achieve the same or less. There were huge amounts of effort put into not achieving much, but I was pushing myself very hard. I felt exhausted and just couldn’t carry on. I was disconnected from people. I started suffering from quite bad insomnia. I wasn’t sleeping more than two or three hours a night. (Glouberman, 2002, p. 148; italic in original)

Interestingly, disturbances in sleep are so much a part of the burnout syndrome that one can predict the other or vice versa. Researchers, for example, have shown that not only does burnout predict subsequent cases of insomnia or changes in intensity of insomnia but that insomnia or a change in intensity of insomnia predicts subsequent cases of burnout and changes in levels of burnout (Armon, 2008). What all this means is that employees at risk have trouble sleeping. They also find themselves unable to unwind in the evenings (Ekstedt and Fagerberg, 2005).

A century ago, the renowned physician Sir William Osler believed “stress and strain” along with hard work and worry were the preconditions of heart disease (Spielberger, 1979). Since that time, burnout has been linked to a number of health-related problems, including an increased risk of cardiovascular disease (Melamed et al., 2006). It has also been associated with diabetes (Melamed et al., 2006) and musculoskeletal disorders (Honkonen et al., 2006).

Those burning out often find themselves suffering from headaches and muscle tension or pain in the neck, arms and shoulders (Ekstedt and Fagerberg, 2005), high blood pressure, lingering colds and gastrointestinal problems (Freudenberger, 1974; Maslach, 1976).To this list, researchers have also added “dizziness, nausea, allergies, breathing difficulties, skin problems, muscle aches and stiffness, menstrual difficulties, swollen glands, sore throat, recurrent flu, infections, colds, headaches, digestive problems, and back pain” (Brock and Grady, 2000, p. 30).

Individuals who are burning out may also attempt to cope in ways that are self-destructive. It is not unusual to find that they are self-medicating with alcohol and drugs which tend to exacerbate the problems. Ultimately, these symptoms and destructive coping mechanisms spill over into their private lives affecting relationships with family and friends – the very individuals needed more than ever during these difficult times.

Conclusion

Burnout is a syndrome which was originally thought to affect only human services professionals but is now understood to affect a much broader range of workers. Its primary characteristic is emotional exhaustion, although there is a wide consensus among researchers that it is accompanied by feelings of depersonalization/cynicism and feelings of reduced personal accomplishment/ineffectiveness.

Burnout shares some characteristics with low morale, stress and depression, but is unique and stands apart from these other phenomena. Specific changes, for example, in the way an employee thinks, behaves, and feels can signal that the individual in question is at risk of burnout. Specific health problems can also accompany the syndrome.

The co-workers of employees who have burned out have reported behaviors which, in retrospect, were clear signs that their co-worker was in distress. These behaviors include the desire to work alone; the appearance of being weighed down by the demands of the job; withdrawal from co-workers, service recipients, and work; isolation; distraction; sleep disturbances; and the appearance of being at the breaking point (Ericson-Lidman and Strandberg, 2007). These are acknowledged to be the classic signs of burning out but they provide no information, in themselves, as to why they are occurring in the first place. In our next chapter, we explore some of the key socio-demographic and workplace factors which researchers have determined put workers at greater risk for burnout.

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