Introductory Chapter: Understanding Burnout

1. Introduction

The term “burnout” is a popular expression that is used to describe general feelings of exhaustion and fatigue. After a hard day at the office or dealing with misbehaving children at home, for example, one might report, “I am just so burned out.” Statements such as these become part of common parlance and are basically self-reports of fatigue from having engaged in an activity that is draining. The “cure” for such feelings is to stop engaging in the activity and perhaps to seek relaxation or engagement in a distracting or enjoyable activity. Often, this is all that is needed to alleviate the condition of burnout and to feel reinvigorated so that one can then reengage in the former activity with renewed energy or, at the very least, reduced feelings of fatigue.

This popular perspective of burnout contrasts with the same term used in clinical psychology. Here, the term represents a far more serious condition that is not so easily alleviated by distracting activity. In extreme cases of burnout, the only solution to reducing the feelings of emotional exhaustion and depletion is to permanently cease the activity that is associated with burnout [1].

2. Clinical perspective

The concept of burnout and the use of this term has been associated with Herbert Freudenberger [2, 3] who, in the 1970’s, dedicated himself to the development of clinics to treat the underprivileged in California. These “free clinics” served the poor, homeless, drug addicts, and those with various medical diseases, all of whom had limited ability to pay for treatment services. What Freudenberger noted was that some of the particularly dedicated personnel who worked in these clinics, and especially those who treated many people and spent long hours in treatment, began showing some characteristic signs of fatigue and emotional exhaustion. Other symptoms included depression, sleeplessness irritability, frustration, cynicism, negativism, and others. These accumulated symptoms and behaviors appeared to be so common among some members of the treatment staff, and Freudenberger referred to this commonality of clinical signs as “burnout syndrome” [4]. A popular measurement device, The Maslach Burnout Inventory [5], and other such standardized measures are commonly used to measure the all-too-common phenomenon of burnout. The existence of a verifiable clinical syndrome and associated measurement devices shows that the concept of “burnout” is not just a term of common expression but that it is a recognized clinical entity.

While Freudenber focused primarily on treatment clinic personnel and their stressors, it is now recognized that burnout is found in a wide variety of professions and activities. A partial listing of these are psychotherapists, physicians, nurses, first responders, those caring for seriously impaired family members, teachers of various kinds especially those who work with special education children, and many others. A variety of treatments have been put forward including leaving the stressful environment, meditation, yoga, exercise, engagement with animals, social support, and others [6]. What these treatments have in common is that they are non-traditional forms of intervention and do not fall along the lines of cognitive-behavioral psychotherapy, psychoanalysis, etc. Burnout is not considered to be a treatable emotional or cognitive disorder. Rather it seems to be, as Freudenberger suggested, the outcome of intense commitment to the welfare of others and the consequent exhaustion and depletion that commonly follows. It thus requires effective interventions specifically targeted to the alleviation of the felt distress associated with burnout syndrome.

3. Current status

The recent worldwide COVID-19 (2020–2022) pandemic has provided a reawakening of interest and research on the burnout syndrome. It is well known that healthcare workers, and particularly those involved in treating COVID patients in hospitals, were under a great deal of stress and were likely to have experienced high levels of burnout. The question that arises is, now that this epidemic has subsided, is there now an equal subsiding in burnout?

The residual impact of COVID-19 on burnout was addressed in a recent study that compared the mental health of approximately 1500 workers prior to COVID-19 in 2018 to an approximately equal number of workers in 2022 [7]. One might expect that, in 2022, there would be a decrease in burnout and mental health challenges in comparison to what was seen during the active phase of the pandemic. The surprising results revealed an increase in burnout as assessed in 2022, and this finding was particularly apparent for healthcare workers. Healthcare workers in 2022 reported burnout rates of approximately 45%. What these results suggest is that burnout is pernicious and that once acquired, it tends to persist. Two factors that appeared to reduce levels of burnout were supervisory and administrative support of workers and including workers in decision-making processes.

4. Summary

Burnout and the burnout syndrome are terms that came into common use during the 1970’s. The terms described persistent feelings of depletion and emotional exhaustion that could occur from giving oneself to others over an extended period. Healthcare workers were found to be particularly vulnerable to developing burnout although many other groups could also experience the syndrome. Interventions for burnout do not follow traditional psychotherapy lines, but many diverse approaches designed to alleviate distress appear to be helpful. The relatively recent COVID-19 epidemic has provided an opportunity to study the impact of burnout on healthcare workers and others. Overall findings of present and past studies show that burnout syndrome continues to be a mental health problem that afflicts a large number of individuals, that it is persistent, and that continuing studies are needed to identify the most effective interventions for dealing with this mental health challenge.