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Burnout

The Unsolvable Problem of Burnout

Why efforts to reduce burnout may actually increase it.

Kaspars Grinvalds/Shutterstock
Source: Kaspars Grinvalds/Shutterstock

After a relatively short commute from work, you walk into your house and you are instantly hit by a wave of unrelenting fatigue. Your plan to go to the gym after work fell by the wayside—the fourth time you skipped this week—because you just couldn’t muster up enough energy. You lie on the couch, hoping to recover quickly and start working on dinner.

After a few minutes, you realize that you can barely lift the phone to order something let alone go in the kitchen and cook. You wonder what is wrong with you. Should you see a doctor? Hours of inactivity go by and now it’s time to go to bed but the thought of having to wake up and spend another day at your job saps the last ounce of energy out of you. Where will you find the stamina to deal with the pile-up of tasks, to solve the senseless problems your clients bring to you, and to pretend that you care about the company mission?

This is what burnout feels like.

A pervasive sense of stress that affects you physically, mentally, and emotionally, the effects of which are not limited just to work hours. Burnout can follow you at home and interfere in other areas of your life. Long-lasting burnout can affect your mental health and cause anxiety, depression, and low self-esteem.

Burnout is a disruption in the relationship with the work we do. Work that was at one point meaningful and enjoyable is now meaningless and unpleasant. The disruption creates an approach-avoidance dynamic: a conflict between the need to keep our job and our desire to disengage from it—I want to quit, but I can’t.

External factors, such as an anemic job market, limited finances, or the need for health coverage, intensify the conflict. The need to keep our job undercuts our desire to change jobs. The longer this tension lasts, the worse the burnout gets.

Beyond its effect on employees individually, burnout has a negative impact on the ability of companies or organizations to fulfill their mission, as it has been linked to issues like job dissatisfaction, productivity, and turnover.

What exactly is burnout?

While burnout is one of these terms that has a wide range of definitions, the researchers who study burnout concur that there are three dimensions: exhaustion, detachment, and ineffectiveness. Think of burnout as a syndrome for which you get a positive diagnosis when you present with all three of these symptoms.

The first and most common symptom of burnout is exhaustion. Exhaustion refers to the depletion of the internal resources you need to respond to the physical, cognitive, or emotional demands of the job. Exhaustion is not what you feel after a long or difficult day, but the feeling that most days are long and difficult. Putting in long hours, being handed an overwhelming amount of work, being given big problems to solve with few resources to solve them with, or feeling stressed and overwhelmed with the demands from managers and clients are all signs of exhaustion.

The second symptom of burnout is detachment. Detachment is a sense of disconnection from the essence and value of your work. It means feeling less emotionally connected to the job, to your coworkers, or to your clients. Detachment leads to cynicism and doubts about whether what you do really matters or can make a difference. People who experience burnout may feel an emotional distance between them and the people they serve, which could in some cases make them less caring, less concerned, less supportive, and more indifferent and unsympathetic.

The third symptom of burnout is ineffectiveness. Ineffectiveness refers to a sense of incompetence and lack of accomplishment. Ineffectiveness has less to do with how much work gets done or how well deadlines are met, but more with how energized and rewarded you feel by it, how competent you feel in dealing with problems, and how big a contribution you are making to the lives of the people you serve. Ineffectiveness is the fear that you are not able to deliver on your or your organization’s promises.

How have we been dealing with burnout?

The impact of burnout on individuals and organizations is undisputed. As a result, many efforts have been put forth to assess, prevent, and reduce burnout. The majority of these efforts have focused on employee wellness as an antidote to burnout. Organizations hope that by engaging employees in programs that teach them coping skills to reduce stress and improve well-being, they will be able to effectively combat burnout.

Here is the paradox. To prevent burnout or to recover from it, employees need to learn new skills. Leaders and managers provide access to resources within and outside the organization and encourage employees through planned activities to take charge of their wellness and burn off burnout. This means that in addition to all their other responsibilities, employees now have to learn how to deal with the stress that their work causes, to adjust their mindset, and to change their behavior so they can remain competitive and efficient. Is adding more work going to reduce burnout?

Take medicine, for example, where the topic of burnout is prevalent. One of the models created by the American Medical Association and recommended by the Agency for Health Research and Quality is a five-step approach to creating a wellness culture, which was designed to prevent burnout in residents and fellows. Some of the recommendations include: administer a survey to assess burnout; enlist trainees and faculty as wellness advocates and champions; put together a team; create a role for a senior resident as a wellness leader with specific duties and responsibilities; create and offer interventions that address various aspects of wellness; provide trainees with tools and resources for individual wellness (e.g., nutrition, exercise, mindset); reassess burnout on a regular basis.

Many residency programs follow this model and if I were applying for residency I would be delighted to attend a program that places so much emphasis on well-being. The flip side of such a program is that I’d now have to attend more didactics about wellness, I’d have to learn and apply strategies on my own, I’d have to adjust my mindset, I’d have to take a burnout survey every four to six months, and I may also choose to take on a leadership role to plan and monitor wellness interventions for my program. In other words, I’d have to add hours to a schedule that is already filled-to-the-brim. More exhaustion, more burnout.

These approaches—preventing burnout by teaching individuals about wellness—would be fair, and in fact very considerate, if the burnout were due to a weakness or gap in knowledge that the employees seem to bring to the job, such as low competence, low stress tolerance, or poor coping skills, to name a few. But is this the case? Do employees experience burnout because they lack the ability to improve their wellness?

To answer this question, we must first consider what causes burnout.

The causes of burnout.

Researchers in this area point out that to identify the source of burnout, it is important to consider the person and the workplace in tandem, not in isolation. It is the interaction between person and context that better explains burnout. When personal characteristics and organizational context are incongruent, when the fit between you and your organization is loose, you are more likely to experience burnout.

Based on a comprehensive review of the literature, Maslach et al. (2001) proposed six factors that contribute to burnout:

Workload: when you perceive that your workload is disproportionately large, you are assigned to do tasks that exceed your skills or training, or you do work that does not capitalize on your strengths.

Control: when you have high responsibility but low decision-making authority in terms of the resources you can access, or the manner in which you are allowed to do your work. You have to deliver but you cannot choose what you think the best way to do so is.

Reward: when you do not get rewarded or acknowledged for your work. The deficient rewards, in this case, could be tangible (e.g., salary, overtime pay, vacation days) or intangible (recognition for work well done, appreciation for going the extra mile, opportunities for growth).

Community: when you work with people who do not share the same values as you, and on whom you cannot rely for support or assistance with work-related issues. When there is frequent conflict among coworkers, it often remains unresolved.

Fairness: when you notice that your work environment lacks equity in terms of workload or pay, or that it appears to mishandle promotions or evaluations. The unfairness could extend to disputes and grievances, in which case the procedures or the culture does not allow both parties to have a voice.

Values: you may perceive that your own values are inconsistent with the organizational values, or you may perceive the organizational values as conflicting (what we tell people we do and how we do it are a mismatch). You may also feel pressure to engage in actions that seem unethical or contrary to your values.

The bigger the mismatch and the more of these factors that it affects, the more extensive the burnout.

This is where the paradox lies. If it is the lack of fit between a person and their place of employment that gives rise to burnout, the responsibility should be shared, not shifted. Expecting an employee to add to their to-do list wellness activities to fight off the stress that various aspects of their workplace causes may be expecting too much, and it may unintentionally increase burnout, frustration, and disengagement, instead of reducing it: "Yet another thing that my company requires me do now." When the organization's efforts focus on teaching you skills to deal with your physical, mental, and emotional distress, it is like telling you: I love you, you’re perfect, now change (so we can get along).

While to me this approach seems unfair as it places employees in an untenable position, it does not mean that we should abandon these efforts. Research supports the effectiveness of some of these approaches, with mixed results. Improving our wellness skills can translate into reduced stress, better relationships, and higher involvement in behaviors that promote health. The only area in our lives in which we have full responsibility and control is how we run ourselves. Bolstering our wellness means we can at least win half the battle against burnout. This leaves the other half of the battle for the organization to fight. Not by delegating responsibility to employees, but by working together to improve engagement and well-being for all.

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