The word burnout has become a bit of a buzzword, exploding in usage in recent years and even more since the COVID pandemic began. The topic of burnout has been the focus of increasing numbers of media reports, podcasts, blogs, and social media posts. We spoke to top Australian psychiatrist and Quest Board member Professor Gordon Parker on burnout to find out why burnout has become a topic of our times.
Burnout has become such a common problem for so many Australians that in 2022 the Quest for Life Foundation launched an online self-help course on burnout, Beyond Burnout, to provide easily accessible and practical tools for the rising numbers of people contacting Quest for help with this issue.
But what exactly is burnout? And is it happening to us more than it used to, or are we just hearing more about it?
To answer these questions, we spoke to top Australian psychiatrist and Quest Board member Professor Gordon Parker AO, a world-leading researcher on the topic of burnout, whose recent research may change the way burnout is identified, diagnosed and managed in the future.
Professor Parker was the founder of the Black Dog Institute, and previously headed the School of Psychiatry at UNSW, and was the Director of the Division of Psychiatry at Prince of Wales Hospital. Professor Parker’s recent book, Burnout: A Guide to Identifying Burnout and Pathwats to Recovery – co-authored by Gabriela Tavella and Kerrie Eyers – also helped to underpin some of the content in Quest’s Beyond Burnout online course, which aims to improve the lives of people living with the debilitating condition.
The Rise of Burnout
The rapid rise of interest in and focus on burnout has not gone unnoticed by Professor Parker, who was inundated with media requests and invitations to give talks to specialist groups after his recent book’s publication.
“There is pretty good evidence that the increasing requirements for workers to be on 24/7 in the last two decades has played a major part in increasing the prevalence of burnout,” Proessor Parker said.
“People can’t turn themselves off because they can’t turn their machines off. Then there’s been the extra impact of COVID.
“We also observe more and more people talking about their burnout experience, and commonly doing so comfortably, indicating that it is not viewed as a distinctly stigmatising condition.”
What is Burnout?
Burnout is a state of mental, physical and emotional exhaustion, accompanied by several other key symptoms. If you are experiencing burnout, you may notice it is difficult to engage in activities you used to find meaningful. You may no longer care about the things that were once important to you or experience an increasing sense of hopelessness.
According to Professor Parker, burnout has been around for centuries, being experienced by monks in the Fifth Century AD and described then as acedia, one of the eight cardinal sins before they were reduced to the seven deadly sins, but it has become increasingly common in recent years.
“Ancient descriptions of acedia correspond closely with our concept of burnout, including the key feature of cognitive impairment.”
The dominant modern definition of burnout was developed in 1981 by American psychologist Christina Maslach, who developed the Maslach Burnout Inventory (MBI). The MBI defines burnout by three symptoms – exhaustion, depersonalisation or loss of empathy, and decreased or compromised work performance.
But in 2021, Professor Parker and his co-authors developed a new burnout model, the Sydney Burnout Measure (SBM), which contains some important departures from Maslach’s MBI.
“In our model, we also have the key feature of exhaustion [but] we’ve challenged the overly narrow three-symptom model which has dominated for the last 30 years. There are a few problems with that measure and its conceptualisation.
“MBI lists as a second feature depersonalisation, or a loss of empathy. We suggest it’s a broader construct – more a lack of feeling tone, in that a person just doesn’t get as much enjoyment out of anything at all.
“That can extend to loss of empathy, particularly in those in the helping or caring professions – something one London nurse described as ‘compassion fatigue’, which can feel very catastrophic to people working in those professions if previously they’ve been very empathic.
“But the empathy component can go in two different directions. There are some in the helping or healing professions for whom it goes the other way. They’ll say, ‘when I developed this, I started to have more empathy or understanding for those who have had depression.’
“It’s the lack of feeling tone that’s far more important. People might say, ‘I just don’t get much pleasure out of anything anymore,’ or ‘I don’t spend much time anymore with other people,’ or becoming insular – perhaps preferring to sit by themselves at lunchtime.”
Professor Parker said burnout is often accompanied by a host of other psychological symptoms including anxiety, depression, insomnia, and comprised physical functioning.
“Some people will faint. Ariana Huffington in her book on burnout described falling to the ground and hitting her head on a table.
“We found cognitive impairment was a very important construct – some women say it’s a bit like ‘baby brain’ – they can’t focus, they can’t register information. That’s one of the effects of the stress hormones of the brain.”
Who Experiences Burnout? Good people.
Are kind-hearted and caring people more at risk of developing burnout?
According to Professor Parker: “Absolutely.”
“One of the poignant things about burnout is that it’s much more likely to be experienced by good people,” Professor Parker said.
“The dominant Maslach model sees a simple equation between the work situation and the individual developing the syndrome and doesn’t give any credence to any personality contributions.
“Our view is that burnout is unfortunately much more likely to be experienced by caring people, people who are diligent, dutiful, reliable and perfectionistic. They work longer hours, they don’t want to renege on anything, they’re dedicated, they’re conscientious, they take their work home and so on.”
Professor Parker said people in ‘caring’ professions can be much more likely to develop burnout, with some studies suggesting that up to 30 per cent of workers at some point in their careers develop burnout, with similar rates for people in caring roles, and with the high prevalence reflecting the need for those in such professions to be reliable and dutiful.
“They’re estimates, but there is a reasonably consistent estimate that at any one stage, 30 per cent of medical practitioners will have burnout and over the course of their careers 60 per cent will have it. The rates are also high in nurses, teachers, and other carers, high in veterinarians, and probably highest in the clergy.”
Another important factor to acknowledge about burnout that is not covered by the MBI definition is that burnout is not limited to people in formal workplace situations.
“There’s growing recognition of ‘carer burnout’ as a distinctive and prevalent problem.
“Carer burnout can occur in people looking after demanding young children or elderly parents with dementia, for example or other demanding requirements. Another example of potential carer burnout was during COVID when people were asked to home-school their children as well as maintain their jobs.”
Professor Gordon Parker on Diagnosing Burnout
One of the interesting things about burnout is that it’s not officially classified as a psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook used by health care professionals in much of the world as the authoritative guide to the diagnosis of mental disorders.
You may have noticed that some of the symptoms of burnout sound like symptoms of depression. In particular, what Professor Parker describes as a ‘lack of feeling tone’ and a loss of interest in hobbies and other activities.
According to Professor Parker, this has caused contemporary debate around whether the two are one and the same. In fact, when there were eight cardinal sins, acedia or burnout was separate from tristitia or depression, before Pope Gregory I said they were the same and combined them into one sin, known today as sloth.
“That’s one of the key ticket items. Is burnout synonymous with depression, or is it not?
“Depression commonly accompanies burnout but, in our view, they’re not the same. That’s hugely important because I commonly see people who refer to their depression as burnout and I commonly see people being treated for their burnout as if they have depression and the antidepressants haven’t done a thing.”
For frontline GPs, it can be easier to treat depression than burnout. It’s more recognised and there are clearer treatment models. It’s relatively simpler to prescribe SSRIs than it is to explore the possibility of burnout.
“I’m not critical of GPs because they haven’t had the training in identifying burnout or how to manage it. Over all my years of medical and psychiatry education I’ve never had a lecture on burnout.
“It’s not listed in DSM. It is listed in the International Classification of Diseases (ICD) as a phenomenon, but not a condition. So, it’s not surprising that most people who turn up to their GP with a burnout syndrome receive a diagnosis of depression rather than burnout, and that can lead to a whole series of management problems.”
How Can Burnout be Managed? Professor Gordon Parker on Burnout Management
Importantly, Professor Parker’s work on burnout has also presented a burnout management model, which firstly involves identifying the particular workplace or life stresses that are relevant to you and putting in place corrective strategies, and secondly, developing “de-stress” strategies.
“Examples that might be helpful are taking time off work, strenuous exercise, meditation or mindfulness,” Professor Parker said.
“The third component is – if there is a personality predilection such as perfectionism – the individual needs to do something about addressing that. There are things perfectionists can do to adjust their style of functioning, which takes the pressure off them and reduces their chance of burnout.”
Professor Parker gave the example of an employer who ran a warehouse receiving goods, who would make his employees thoroughly inspect every single item received in a perfectionistic way that was above and beyond what was really required to keep the business functioning smoothly.
What a psychologist eventually told that warehouse owner to do – was simply to stop.
“What happened was there was no catastrophe like he’d imagined, and his employees liked him for the first time, because he was no longer breathing down their necks the whole time. So, it was a win-win.”
Resources on Burnout
Beyond Burnout: an online self-paced course on burnout delivered over 4 video modules that provides practical tools and strategies to manage burnout symptoms.
My experience with burnout – and what helps by Quest Founder & CEO Petrea King
More from Professor Gordon Parker on Burnout:
Burnout: A Guide to Identifying Burnout and Pathways to Recovery by Gordon Parker, Gabriela Tavella, Kerrie Eyers.
This book co-authored by Professor Gordon Parker on burnout helped to underpin the content in Quest’s Beyond Burnout online course.
