Four or five years ago Gordon Parker, one of Australia’s leading psychiatrists, started to develop symptoms of burnout.
“I wasn’t sure what the hell was going on,” says the man who set up the Black Dog Institute almost 20 years ago. “I thought, could this be burnout? I started reading on burnout and as soon as I started I got interested and thought, this is a good research topic, and I chirped up.”
His mojo back, the professor of psychiatry at the University of NSW began researching in earnest.
Next week brings the release of his 21st book, Burnout: A Guide to Identifying Burnout and Pathways to Recovery, co-authored with Gabriela Tavella, a research officer at UNSW who is pursuing a PhD into burnout, and Kerrie Eyers, a psychologist and writer.
It’s impeccable timing.
Across the world employers are grappling with managing workers who have faced unprecedented daily challenges during the pandemic. While some workers have done better under lockdown, many others report burnout from the 24/7 experience of working from home, back-to-back Zoom meetings and workloads exacerbated by downsizing and efficiency drives. The Washington Post reported this week that “employers across the country, from Fortune 500 companies such as PepsiCo and Verizon to boutique advertising firms and non-profit organisations” are offering special benefits – such as wellbeing days – in recognition that “a returning workforce is at high risk of burnout”.
Parker says 2016 data indicates that burnout costs about $US 332bn a year to the global economy. He says about 30 per cent of Westerners are likely to suffer burnout at some stage in our lives, but the figure is as high as 60 per cent among doctors, nurses, teachers, clergy and other carers and those, such as lawyers, who are required to be highly reliable.
Parker says Covid lockdowns could be generating higher rates of burnout because of lockdowns, but he suggests once the pandemic is over, rates will be about the same as pre-Covid – perhaps less if people permanently change their lifestyles and work arrangements.
But none of that detracts from the urgent need for employers – most of whom now understand more severe conditions such as depression and anxiety – to address the burnout of workers, many of whom are likely to be their most loyal and best performers.
The book demolishes many of the myths about burnout: it’s not depression, it’s not disillusionment, it’s not a Western existential angst.
It is a serious condition.
The book also presents a new diagnostic tool, the Sydney Burnout Measure, which Parker and his team have developed for use by GPs, psychologists and other health professionals, as well as individuals who can use it as a “self-report measure”.
The SBM expands the definition of burnout and can be applied in different contexts, with the researchers arguing burnout can occur outside formal work situations, with people such as carers of children or parents at risk.
The researchers also argue, unlike earlier diagnosticians, that personality is a key factor in burnout, with some people, such as perfectionists, predisposed to developing burnout.
Burnout entered the language about 50 years ago. It is not regarded as a formal psychiatric disorder but as an occupational condition. The World Health Organisation defines burnout as a “syndrome resulting from chronic workplace stress not successfully managed” and the American Diagnostic and Statistical Manual of Mental Disorders has never included burnout.
Even so, burnout is accepted as an occupational disease in countries including Denmark, France, The Netherlands, Portugal and Sweden, with sufferers able to access sick leave and insurance benefits. In Australia, US and Britain, burnout has not yet been recognised as a formal diagnosis.
The groundbreaking work by Parker and his team includes two extensive studies of more than 1600 sufferers. It’s a book for specialists as well as sufferers, with first-person accounts and advice on how to use the self-diagnosis tool and assess your results and your need for professional help.
Says Parker: “Ever since I came to psychiatry I have loved looking at, what is the zeitgeist here, what is the model, does it have validity? My work on bipolar and on depression has applied all those sort of issues over time. Burnout was a wonderful new example for me to say, hang on, I have had these symptoms, now what does the literature tell me?”
The literature told him that the measurement model used in almost all studies, the Maslach Burnout Inventory developed in 1981, is “very limited”. The MBI identifies three basic symptoms – exhaustion, depersonalisation or loss of empathy, and compromised work performance. Parker says the MBI suggests “burnout is essentially a simple equation where the individual is put under excessive work strain and the individual doesn’t bring anything to the party”. In contrast, he says: “We do two things. We expand the key symptom set and we argue that there is a personality contribution on many occasions.”
The authors agree exhaustion and a compromised work performance are strong indicators of the condition. But they expand “loss of empathy” beyond the idea of losing any ability to care for people.
“We have diffused it into a broader construct that (what occurs) is a general lack of feeling tone, a lack of joie de vivre,” says Parker.
“And there’s a fourth factor, which is impaired cognition. People report that they tend to scan, rather than read, that they can’t take in material, that their memory is compromised. Some women say it’s like the baby bubble they can remember from pregnancy.”
There are other pointers. Says Parker: “Most people report pretty dreadful sleep and some depressive symptoms, although we argue depression is not the same as burnout.
“They also develop anxiety and at times they will experience significant physical problems.”
The book quotes blogger and publisher Arianna Huffington, who “fell to the floor” during a burnout episode. “People go to bed for weeks or months,” says Parker. “Grace (whose account is included in the book) was admitted to hospital with an extraordinarily high pulse rate.” There are accounts of people suffering incontinence.
“There can be dramatic physical presentations that mystify doctors,” says Parker. “So the symptom set, in our view, is much broader.”
What’s also new is recognition of the role of personality. “Burnout is distinctly over-represented in people who are dutiful, reliable, conscientious and often perfectionistic,” says Parker. “These are the people who are more likely to stay at work for longer hours, stay on after they are supposed to leave.
“As you go up the work hierarchy your chance of burnout increases.
“Up to now, management strategies have focused on addressing the burnout drivers and (implementing) de-stressing strategies, but without any recognition that there is also a need to say, is there a personality contribution going on here which, if tweaked and modulated, could result in a better outcome?”
The book also expands the situations where burnout occurs. “Most people writing on burnout have limited it to those in formal working positions, and those who are at home have largely been ignored in the literature,” says Parker. “We found burnout had exactly the same pattern and severity in people at home in deeply demanding caring roles.”
Through the years, burnout has been equated with everything from moping to disillusionment and it is often misdiagnosed as depression or anxiety.
But Parker says people suffering burnout don’t tend to mope: “They are much more likely to hide it. When someone is clinically depressed you can usually pick it up because they become very insular, they lose the light in their eyes. People with burnout tend to be on the margins. They don’t tend to whinge, and the great majority don’t know what’s going on, they are thinking, I have lost my elan vital, I can’t read in depth any longer, what the hell is going on? Am I dementing? Am I depressed? Is it all down to sleep?
“So most people are confused and they don’t tend to mope or carp, they tend to suffer in silence with compromised work performance and compromised quality of life.”
It’s very tough for individuals, but is burnout really an issue for employers to solve?
Yes, says Parker, because burnt-out employees will often leave. Even if they turn up to work there is the problem of presenteeism – “they are there but not fired up and working sufficiently”. As well, they will often absent themselves on sick days.
“In America there are a number of companies that have done the cost-benefit equation and they have brought in organisations that run programs on burnout and have shown that while it’s expensive, they save money because people stay on longer, they have better work-life balance,” says Parker.
Programs overseas focus on changing work-life balance and identifying work stressors. They emphasise de-stressing by taking time away, talking to people, mindfulness and meditation. Parker says more is needed to address personality traits such as perfectionism.
There are practical steps to help you avoid burnout: one is to schedule your “worry time”.
Says Parker: “Worriers worry all the time but if you can encourage them to dedicate a certain time to worry, just one hour a day, maybe in the morning and maybe at the end of the day … That’s your time and you can’t go over it. That goes against the grain of worrying all day, but a high percentage of people will buy into it. It’s a very useful strategy.”
He agrees burnout has increased with the intense downsizing of the modern workplace but says we need different strategies to manage the pressure.
“I don’t think it will change,” he says.
“Employers will continue to try to get people to do as much work as possible, so the numbers issue is not as important as the way we have changed the way we work. Many of us have our mobiles on the whole time. We have become used to multi-tasking and regarding that as the new norm.”
Sometimes the only answer is to leave work, Parker says. “I get a lot of patients from Canberra, it’s common to see people who have a burnout scenario either because of some excessive workload demands or bullying and they can’t step away,” he says.
“They are dutiful and when you have that interaction it can become very morbid. It’s about how the individual responds to work factors: do they get preoccupied, do they go to HR, is HR going to be constructive, or is HR on the side of the employer and effectively going to harass them? How do they step out of the game?
“So I spend quite a lot of time trying to suggest that getting into an ongoing dispute (with the employer) is often the worst thing to do. Sometimes it is really important if the situation at work is impossible to correct to encourage the person to get out. Perfectionists are not inclined to do that. You have to lever them out.”
What of those who argue burnout is just another word for the normal problems of life?
“That’s a shame because burnout is variable in its severity and its impact, but it’s debilitating. It is a bit like people saying in the old days, with regard to depression, that a person should pull up their socks. Well, depression has got nothing to do with socks.
“When I set up the Black Dog Institute, I got distinctive people … artists, people everyone admired, footballers who were as tough as buggery (to talk about their depression) to try to destroy the zeitgeist that if someone is talking about symptoms of psychological distress that they are therefore weak-willed and in need of more character and backbone.
“Burnout can be insufferable, incredibly debilitating and horrible to experience so we should not encourage any view that it is a mild condition of necessity and that it is some sort of moral failure.”
Burnout: A Guide to Identifying Burnout and Pathways to Recovery, by Gordon Parker, Gabriela Tavella and Kerrie Eyers (Allen & Unwin, $32.99).