Is Burnout Real?

Burnout is everywhere. Students, workers, parents — nearly everyone seems to have suffered from it.

Last week, the World Health Organization upgraded burnout from a “state” of exhaustion to “a syndrome” resulting from “chronic workplace stress” in its International Disease Classification, the official compendium of diseases.

That sounds like such a broad definition that it could well apply to most people at some point in their working lives. A good friend told me she recently had to take a wellness survey for her job. She answered yes to just one question, about whether she ever felt irritable at work, and got the laughable result that she was at risk of burnout.

Employers seem alarmed by the phenomenon. A 2017 survey by Kronos found that 95 percent of human resource executives think that burnout is hurting efforts to retain workers.

But when a disorder is reportedly so widespread, it makes me wonder whether we are at risk of medicalizing everyday distress. If almost everyone suffers from burnout, then no one does, and the concept loses all credibility.

This would be unfortunate for many reasons, not least because burnout is real — classically defined by the triad of emotional exhaustion, disconnection and a sense of inefficacy. Most people have experienced some of these symptoms, but they’re persistent and impairing for only a minority. That doesn’t make it a national epidemic.

What’s also real is a shift in cultural attitudes about the workplace and school. However well intended, we have created an unrealistic and misleading expectation that students and workers are supposed to be happy and stress-free at all times, and if they aren’t, it is a problem that needs to be fixed.

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Medical school, for example, can be intellectually and physically grueling. It’s impossible to get through it without experiencing stress and discomfort. In an attempt to help students manage stress and think about how to balance life and work, these schools, like many employers, are investing in wellness programs that emphasize exercise, meditation, healthy eating and more. That’s great, of course, but by emphasizing their commitment to wellness, they are at risk of making promises they can’t keep.

How do you imagine students and workers will feel when the same institution that promotes happiness and work-life balance inevitably turns around and stresses the hell out of them? Obviously, they will feel angry, detached and probably less invested in their work. Sounds a lot like “burnout.”

Though I can’t prove it, I suspect that my generation suffered less burnout than current students for the simple reason that we expected to have a rough ride, and our expectations often turned out to be worse than the real stresses we confronted.

Don’t get me wrong — there was plenty that was bad about the good old days. For one, we did a poor job of recognizing the mental health needs of students. Fortunately, that is now a critical mission of all schools and something I’m passionate about.

I have run my school’s student mental health service for the past 18 years, and when I orient the incoming medical students every August, I always tell them this: These next four years will be exciting and challenging and stressful. We care about you and have every confidence that you can handle adversity. You would never have made it this far if you couldn’t. It’s entirely natural to feel anxious, overwhelmed at times and exhausted. In fact, it’s evidence you are alive and engaged in your work.

Of course, we must do all we can to detect and treat serious mental illness — like depression, and drug and alcohol abuse. But let’s not medicalize everyday stress and discomfort as burnout.

Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, and a contributing opinion writer.

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