Occupational burnout
The ICD-11 of the World Health Organization describes occupational burnout as a work-related phenomenon resulting from chronic workplace stress that has not been successfully managed. According to the WHO, symptoms include "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."
Occupational burnout is classified as an occupational phenomenon but is not recognized by the WHO as a medical or psychiatric condition. Social psychologist Christina Maslach and colleagues made clear that burnout does not constitute "a single, one-dimensional phenomenon." However, national health bodies in some European countries do recognize it as such, and it is also independently recognized by some health practitioners. Nevertheless, a body of evidence suggests that what is termed burnout is a depressive condition, that is to say, indistinct from, and overlaps with, depression.
History
Kaschka, Korczak, and Broich advanced the view that burnout is described in the Book of Exodus. In the New International Version of the Bible, Moses' father-in-law said to Moses, "What you are doing is not good. You and these people who come to you will only wear yourselves out. The work is too heavy for you; you cannot handle it alone." Gordon Parker suggested that the ancient European concept of acedia refers to burnout and not depression as many others believe.By 1834, the German concept of Berufskrankheiten had become established. The concept reflected adverse work-related effects on mental and physical health. In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which he argued was to be found in "civilized, intellectual communities." The concept soon became popular, and many in the United States believed themselves to suffer from it. Some came to call it "Americanitis". Beard broadened the potential symptoms of neurasthenia such that the disorder could be the source of almost any symptom or behaviour. Don R. Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful. In 2017 the Dutch psychologist Wilmar Schaufeli pointed out similarities between Beard's concept of neurasthenia and that of the contemporary concept of occupational burnout. The rest cure was a commonly prescribed treatment for neurasthenia in the United States, particularly for women. The American doctor Silas Weir Mitchell often prescribed this treatment. Other treatments included hypnosis, Paul Charles Dubois's cognitive behavioural therapy, and Otto Binswanger's life normalisation therapy.
In 1888, the English neurologist William Gowers coined the term occupation neurosis to describe cramps experienced by writers and pianists, translating the German concept of Beschäftigungsneurosen. The related term occupational neurosis came to include a wide range of work-caused anxieties and other mental problems. By the late 1930s, American health professionals had become widely acquainted with the condition. It became known as berufsneurose in German. From 1915, the Japanese psychiatrist Shoma Morita developed Morita therapy to treat neurasthenia. He had come to have a different understanding of the condition than Beard, preferring to call it shinkeishitsui; he published two books about the condition.
In 1957, Swiss psychiatrist Paul Kielholz coined the term Erschöpfungsdepression . The concept was one of a number of new depression-subtypes that gained traction in France and Germany during the 1960s. In 1961, British author Graham Greene published the novel A Burnt-Out Case, the story of an architect who became disenchanted with the fame his achievements garnered for him and volunteered to work at leper colony in the Congo. In 1965, Kielholz publicised therapy for Erschöpfungsdepression in the German-speaking world through his book Diagnose und Therapie der Depressionen für den Praktiker . His work inspired further writing on the topic by German psychiatrist Volker Faust.
In 1968, the second edition of the American Psychiatric Association's Diagnostic and Statistical Manual replaced "psychophysiologic nervous system reaction" with the condition neurasthenic neurosis . This condition was "characterized by complaints of chronic weakness, easy fatigability, and sometimes exhaustion." Another condition added to this edition was the similar asthenic personality, which was "characterized by easy fatigability, low energy level, lack of enthusiasm, marked incapacity for enjoyment, and oversensitivity to physical and emotional stress."
In 1969, American prison official Harold B Bradley used the term burnout in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders. Bradley's article has been cited as the first known academic paper to use the term.
In 1974, Herbert Freudenberger, a German-born American clinical psychologist, used the term "burn-out" in his academic paper "Staff Burn-Out." The paper was based on his qualitative observations of the volunteer staff at a free clinic for drug addicts. He characterized burnout by a set of symptoms that includes exhaustion resulting from work's excessive demands. Other symptoms he identified were headaches, sleeplessness, "quickness to anger," and closed thinking. He observed that the burned-out worker "looks, acts, and seems depressed." After the publication of Freudenberger's paper, interest in the concept grew.
The American psychologist Christina Maslach described burnout in a 1976 magazine article as reflecting the impact of interpersonal stress on human service workers. The impact manifested itself in symptoms such as fatigue, quickness to anger, and cynical attitudes toward the people the service workers were supposed to help. Also in 1976, Israeli-American psychologist Ayala Pines and American psychologist Elliot Aronson, using group workshops, began to treat people having symptoms of burnout. Pines collaborated with Maslach in writing essentially data-free papers about burnout in individuals who worked in day care centers and mental health facilities.
In 1980, the DSM-III was released. It abolished the concepts of neurasthenia and asthenic personality, both with the explanation "This DSM-II category was rarely used." Neither was directly replaced. Also in 1980, American psychologist Cary Cherniss published the book Staff Burnout: Job Stress in the Human Services.
In 1981, Maslach and fellow American psychologist Susan E. Jackson published an instrument for assessing occupational burnout, the Maslach Burnout Inventory. It was the first such instrument of its kind, and soon became the most widely used measure of occupational burnout. The two researchers described occupational burnout in terms of emotional exhaustion, depersonalization, and reduced feelings of work-related accomplishment. In 1988, Pines and Aronson wrote the popular book Career Burnout: Causes and Cures, an updated version of a book they had published in April 1981 with American psychologist Ditsa Kafry. They found that "marriage burnout" was just as prevalent as "job burnout."
The WHO's ICD-10 removed the diagnosis of asthenic personality; the WHO, however, continued to include neurasthenia. In 1998, Swedish psychiatrists Marie Åsberg and Åke Nygren investigated a surge of depression-related health insurance claims in their country. They found that the symptoms of many cases did not match the typical presentation of depression. Complaints like fatigue and decreased cognitive ability dominated, and many believed their working conditions to be the cause.
In 2003, the American psychiatrists Philip M. Liu and David A. Van Liew advanced the view that the concept of burnout is largely bereft of meaning and has often come to refer to "stress-induced unhappiness" with one's job. They also noted that burnout can mean "everything from fatigue to a major depression and now seems to have become an alternative word for depression but with less serious significance".
In 2005, the Swedish Board of Health and Welfare created the national ICD condition of "exhaustion disorder" as a specific "Other reactions to severe stress". Treatment programs followed. In December 2007, the Swiss Expert Network on Burnout was established. It has since held a number of symposia, and published recommendations for treating burnout.
In 2015, French psychologist Renzo Bianchi and his colleagues published a literature review on the burnout–depression overlap and concluded that the studies fail to demonstrate the nosological distinctiveness of the burnout phenomenon. A number of papers followed that showed the overlap of burnout with depression, suggesting that burnout is a depressive condition.
File:Deaths from Karoshi.png|thumb|400px|Deaths due to long working hours per 100,000 people, joint study conducted by World Health Organization and International Labour Organization in 2016. Also in 2015, the WHO adopted a new conceptualization of "occupational burnout." The conceptualization was consistent with Maslach's. However, occupational burnout was "not itself classified by the WHO as a medical or psychiatric condition or mental disorder." As of 2017, nine European countries legally recognized the burnout syndrome as an occupational disorder, for example, by awarding workers' compensation payments to affected people.
In 2020, the Occupational Depression Inventory was published and was considered to be a potential replacement for burnout scales such as the MBI.
The WHO's ICD-11 began official use in 2022. Within this categorisation, the concept of neurasthenia became part of the new condition known as "bodily distress disorder". The WHO also modified their definition of burnout that year. This new edition additionally saw the WHO abolish nation-defined conditions, leading to Sweden's planned end to its specific recognition of exhaustion disorder in 2028.