Burn-out isn't just 'psychobabble' anymore

Doctors debated burnout for 45 years. Now, they say it's real.

I’m Bill Murphy Jr. Welcome to Understandably (formerly “The Byliner”), my new regularly published email about the “story behind other stories.” Please consider subscribing!

We all have tough days at work sometimes. We all have stretches where we feel burned out, and we wonder if there isn't something better we could be doing with our lives.

For most of us, I hope, those thoughts are fleeting -- or else if they're not, I hope you're able to summon the courage, make a plan, and make a big change.

But if the feelings persist, according to the World Health Organization's newest guidelines, the problem with your work might not be you. Instead, the blame might fall squarely on your work.

New medical condition: 'Burn-out'

In its latest International Classification of Diseases (ICD-11), presented last week, the WHO added a new syndrome: "burn-out" (they include the hyphen).

I think the symptoms ("dimensions") are going to sound familiar to a lot of people. The controversy over this idea has gone on for 45 years, however, since it was first described in a 1974 academic paper by Herbert Freudenberger, a New York City psychologist.

Freudenberger also wrote a popular book on the subject in 1980, Burn Out: The High Cost of High Achievement. (It's long out of print, but reviews are pretty amazing. I've ordered a copy and will likely follow up on this story once I've had a chance to read it.)

Since then, according to a 2017 review of the academic literature, burnout was not universally accepted "as a mental disorder in its own right in the academic field, especially in clinical psychology and psychiatry, and scientists have repeatedly asked whether burnout is a useful diagnosis or just 'psychobabble.'"

(Credit to Ryan Prior of CNN for finding that survey.)

A simple syndrome

The WHO's summary of burnout syndrome is brief. Burn-out is described as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed," and is "characterized by three dimensions," including:

  1. feelings of energy depletion or exhaustion; 

  2. increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and 

  3. reduced professional efficacy. 

Also, they're quick to point out that "burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life."

In other words, the symptoms sound like they could also have to do with other conditions, especially depression, which caused a lot of the controversy and kept it from being recognized for more than four decades.

The WHO itself suggests doctors should attempt to exclude other disorders, like like adjustment disorder, various stress disorders, anxiety or fear-related disorders, or mood disorders, before labeling a patient's troubles, "burn-out." 

Um, what about the ADA?

Personally, I think the last time I had signfiicant "burn-out" at work was probably close to 20 years ago, after I'd gone to law school and spent a few years working as a lawyer for the U.S. Department of Justice.

It wasn't a good fit, and ultimately I made some big changes. But I do sometimes automatically "think like a lawyer," as the saying goes, so when I first read about this new medical condition, I wondered what it might mean for employers.

Specifically, could an employee come to work for you, find it's a horrible fit, wind up getting "burn-out" which is now an officially recognized medical condition--and then be entitled to legal remedies under the Americans With Disabilities Act?

That doesn't seem to be the case, because under the ADA an employee has to establish that they can't work because of job-related stress -- not simply that they can't work at the specific job that's causing the stress.

version of this article originally appeared in my column on Inc.com.