Burnout – Time Bomb or Fantasy?

Essay by Dr. Magnus Heier, neurologist, keynote speaker and radio host on Radioeins every Sunday

Cynically speaking, there are three types of illness: the accidental, the honourable and the tough-luck-diseases. There’s not much to say about the accidental: you’re in the wrong place at the wrong time and you get an infection. Sometimes it’s just a banana peel in your path.

The second type of illness is the seemingly honourable. Those you talk about at parties. A heart attack, for example, that serves as proof of one’s unfettered will to work until exhaustion. Lumbago is a testament to tenacity. Such interpretations are obviously nonsense, but this is how people make sense of them.

The tough-luck-illnesses, on the other hand, are those that aren’t taken seriously by others. Migraine is one such example. In his children’s book “Anna Louise and Anton” from 1931, Erich Kästner mischievously wrote the following sentence: “After lunch, the director’s wife Mrs. Pogge had a migraine. A migraine is a headache that you’re not actually having.” Of course, this is not true and Kästner knew that full well. He suffered from migraine himself. He also knew the migraine’s reputation: a justification for taking a break when needed. Those who wish to experience what a migraine feels like: buy ice cream, take large spoonful in your mouth and push it against your gums. That knife you feel slicing through your brain is what a migraine feels like. A terrible pain and not a relaxing time-out.

Today, there is another disease on the rise that no one used to talk about and it’s back with a new name: what used to be called depression is now called burn-out. Depression is for the weak, but burn-out is the ailment of the tireless worker. Surprising as it seems: medical experts are not sure what burn-out exactly is. Or if it exists at all, for that matter. It is often diagnosed in Germany, but never in the US. In any case, it is not the modern-day translation of the old depression. Depression is not merely a state of temporary exhaustion, depression is a serious illness. Depression requires a psychiatrist. At once. What does burn-out require?

For patients, naming it “being burned out” has been a great relief. No need for uncomfortable silence, it’s time to talk. The new name makes it easier to seek help. Among patients insured with the AOK (surely other insurance companies, too), this has resulted in a massive increase of patients, who missed work due to “mental health problems”. Surely this is not because we’re getting sicker, but due to the fact that mental health problems are being noticed and accepted (sometimes even misused). But can it be that three quarters of social workers are at risk of experiencing burn-out? The estimations are staggering.

Diagnostics are tricky: first symptoms can include insomnia, anxiety, panic attacks. Just like depression. It is at the doctor’s discretion who he diagnoses with burn-out or not. How does one diagnose something that isn’t defined?

If there is a risk profile for that specific type of exhaustion that many regard as burn-out, it’s the following: the typical patient works like a machine and desperately tries to function. Weaknesses are made up for with increased effort, longer hours and more discipline. Actually, showing weakness is the only way out. Show it! Stop! Forced leave! Rest at any price. If that’s not enough, seek psychiatric help.

By the way, burn-out also has a surprising twin called bore-out. This type of constant boredom and chronic mental underload is probably just as widespread. Being bored at work is stressful. Even more so since this is definitely not a problem one discusses at a cocktail party.