‘Burnout’ isn’t diagnosable, but that’s hardly relevant

[ magazine@irishtimes.com ]

More and more people claim to suffer from burnout. Experts disagree as to whether it is a diagnosable health condition with distinct signs and symptoms. They agree that, if burnout exists, it is usually work-related and can also be experienced by people who take on stressful caring roles. Signs and symptoms include depersonalisation, cynicism, negativity, and physical and mental exhaustion.

Apart from cynicism, which seems to be unique to burnout, these signs and symptoms can accompany depression and anxiety, making diagnosis difficult. People with burnout become cynical about their working conditions and work colleagues. They see themselves as overworked with little or no management support. Cynics hugely affect workplace morale.

Those in caring roles become cynical about the support provided by the health and social protection systems and the State. They feel negative about all aspects of life, leading to even more isolation. As William Butler Yeats wrote in the poem Easter, 1916, "Too long a sacrifice can make a stone of the heart."

Life-management difficulty

Burnout is not a diagnosable condition, according to the World Health Organization's ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. This manual is used by health professionals to accurately diagnose mental health problems and identify prevalence rates. In the manual, depression, anxiety, panic, and fatigue syndrome, are among the mental and behavioural disorders experts agree are diagnosable. Burnout is listed under "Problems related to life-management difficulty".

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This category includes “lack of relaxation or leisure”, “inadequate social skills” and “social role conflict” implying that burnout is due to an individual’s poor life skills and lifestyle choices. According to this classification, people with burnout can’t say no, deal with conflict or criticism, or be generally assertive with themselves and others when they need to be, including with social media.

This is a classic case of victim-blaming. Blaming individuals for their burnt-out state is like blaming greedy people for obesity or drinkers for alcohol problems. There is convincing evidence that obesity is the result of the obesogenic environment created by the food industry, poverty, local authorities (few play areas, homelessness, safe places to walk, etc), as well as lifestyles.

The alcohol industry spends billions advertising their products and at the same time fights all legislation that tries to control alcohol availability.

Some psychologists believe that the ICD-10 does not recognise burnout as a diagnosable disorder because this would put too much blame on employers and the State for creating the workplace and societal conditions that cause burnout. Blaming individuals for their mental and physical health status does not help anyone and neither does blaming workplaces or the system.

Structural determinants

The truth is that health status, including the mental health status, of whole populations, communities, families and individuals is 80 per cent determined by how society is organised – what are known as the structural determinants of health – as well as by lifestyle choices (20 per cent). Structural determinants include age, gender, employment, unemployment, educational attainment, housing, crime, poverty, social supports, social inclusion, and so on.

Women are twice as likely to be depressed as men but men are four times more likely than women to kill themselves.

Those of us lucky enough to be housed can only imagine what must be the physical and mental health status of homeless people. Older people are discriminated against because of their age and end up in nursing homes. Workplace culture is an important determinant of health which is not easily changed if it has a negative effect on morale.

Whether burnout is a diagnosable disorder is irrelevant. The fact is many people claim to feel burnt out which means something must be done about it. In addition, more and more people are being diagnosed with depression and anxiety disorders. The World Health Organisation’s global burden of disease study (2015) estimated that nearly half a million Irish people suffer from one or the other.

The prevalence rates for depression increased by 18 per cent from 2005 to 2015 and that for anxiety by 15 per cent. The good news is that Irish suicide rates are coming down: from 541 in 2012 to 399 in 2016.

Well-known people are talking about their mental health problems, which reduces stigma. But until policymakers and the health services accept that 80 per cent of health status is determined by the way society is structured and start creating health-promoting workplaces and health-promoting health and social protection systems, large numbers of citizens will continue living with distressing mental conditions, diagnosable or not.