Tiredness rushes through your body when you get up, you are forgetful and lethargic. The muscles in your shoulders are full of tension and sometimes your heart skips a beat. When friends ask how you’re doing, you always say “busy, tired or mwah.” Is this still healthy stress or are you overworked? Maybe it’s a burnout or a depression?
“There is a lot of overlap between a burnout and existing diagnoses such as depression and an anxiety disorder,” says Christiaan Vinkers, psychiatrist and professor of stress and resilience at Amsterdam UMC. The funny thing is: the burnout is not officially an existing diagnosis. “There is no convincing scientific evidence that burnout is really anything other than a depression or anxiety disorder. Therefore, it cannot be reliably established by any doctor or psychologist.”
But how is it possible that the term is used everywhere and that there are countless people at home with a burnout? Do these people have a disease that doesn’t exist? “Absolutely not, these people have serious complaints and sometimes sit at home for a year. We should not underestimate that.”
The Dutch College of General Practitioners (NHG) has drawn up guidelines to distinguish between overwrought and burnout: anyone who has had stress and fatigue complaints for less than six months is overwrought. If you have the complaints for more than six months, it is often referred to as a burnout. “But there’s been no scientific research done on it, so there’s no good scientific evidence for these guidelines.”
Unreliable diagnosis
According to Vinkers, that is the biggest problem: due to the lack of scientific research, the diagnosis of burnout cannot be made reliably, so that proper treatment cannot be offered. To better understand what burnout is and how it differs from depression, Vinkers searched his book In the spell of burnout to the scientific sense and nonsense of it.
Because, in contrast to burnout, the diagnosis of depression is easy to diagnose. “These are validated criteria,” says Vinkers. “Two psychiatrists can do a structured interview with a patient and both diagnose depression. If you ask two professionals whether or not someone has a burnout, they can come up with a completely different outcome. A burnout is therefore no reliable scientific classification.”
Severe fatigue
Everyone uses the term burnout in a different way, from mild stress complaints, work problems to serious complaints. The term mainly has a social function, everyone understands what you have, it is an accepted phenomenon. While according to Vinkers many people with a burnout also meet the criteria for depression. “Severe fatigue is one of the criteria for depression for a reason.”
But there is a much less stigma attached to burnout than to depression. “With a burnout, you have mainly worked too hard, done too much. A depression hangs – wrongly – too much around the stigma of a weakness. A burnout is often said to be a work problem. That is not the case , just like depression is not. The stress that unbalances someone can come from all angles, often also in the private sphere.”
According to Vinkers, people who sit at home for a long time due to too much stress are sometimes diagnosed with depression, and sometimes with burnout, depending on where you end up and which professional you have in front of you. “I have nothing against the term burnout, but we shouldn’t pretend it’s a reliable concept. If you don’t know what it is exactly, how can you help people properly? That’s my big problem.”
Not a new disease
A burnout is not something of this time. The disease originated in America in the 1970s. There it was and is a social phenomenon, not a disease. “In those years, people, often doctors or lawyers, became so frustrated that they could no longer help the other person and became overwrought. This was called a burnout. It was a condition of frustration not being able to help the other person. That is changed silently over time: burnout is more about the me, not the other.”
Serious complaints due to stress have existed for much longer. Anyone who dives into the history books will read about neurasthenia, also known as ‘nerve weakness’, around 1900. “It was a different kind of stress, but in the past there was definitely stress and social insecurity and people were already suffering from it. People could become overloaded for a long time due to stress. They were called ‘nerve sufferers’, and there were many self-help books to overloaded nervous system.”
Stress can disrupt
In the event of overwork, burnout or depression, there is a common denominator: stress often plays an important and disruptive role. Stress can be caused by various factors such as work, private problems, poverty, relationship problems, illness, or the death of a loved one. “It is often a combination of factors that causes someone to have too much stress and suffer from it. That is why it is difficult to deal with stress properly.”
Incidentally, stress also plays an important role in cardiovascular disease, autoimmune disorders, and obesity. Stress does not distinguish between body and mind.
Vinkers explains what exactly happens in your body when you are under stress, using the metaphor ‘stress orchestra’. “Every person has a stress orchestra and the instrument group consists of your genes, the stress hormones adrenaline and cortisol, but also how you feel, what you think. The orchestra plays 24 hours a day and reacts automatically. It is a dynamic system that responds to and goes out. When you are stressed, all these things come under pressure together. This often goes well, people are resilient and often recover quickly. But it is possible that the stress orchestra comes under such pressure that you develop physical or mental stress complaints, or a combination of the two.”
Increase in burnout complaints
More and more people seem to be affected by this. Out figures from TNO shows that the number of employees with burnout complaints has been increasing for a number of years. “We don’t really know why this increase comes about. People often intervene too late, they only go to a professional if there is really no other way and they have to report sick because of their complaints. It is therefore useful to intervene preventively and better together to work, for example between employee and employer.”
The trick seems simple: avoid stress. But according to Vinkers it is not that easy. “People can say: make sure you have less stress, but how people react to stress differs per person. It is always a changing cocktail of factors such as someone’s private and working environment, youth, genetic predisposition, character.”
That makes a diagnosis such as burnout so difficult to make and that is why a treatment plan is complicated. “There are no proven effective treatments. A solution is now left to the free market. Anyone who has a burnout has to find out for themselves what to do. I find that strange, precisely because it can be really serious complaints.” That free market consists of many experience experts, coaches and self-explanatory experts who guarantee that they can help people get rid of a burnout. “While as a psychiatrist I have no idea. I miss modesty in that.”
Does it really matter for the processing which check mark is behind your name? You can also say: let go of the terms and focus on the treatment, or the prevention, of stress. “Of course you can prevent many complaints with prevention, especially at an early stage.”
Letting people down
And if someone is still at home with complaints, the solution, as far as Vinkers is concerned, is an interdisciplinary plan. “I prefer to see a collaboration between psychiatrists, psychologists, company doctors and general practitioners. If they look together at what is best to get a better grip on their patient, you can help that person better.”
To get a better grip on burnout, Vinkers would like to dive deeper into burnouts scientifically and unravel it. “In order to help people properly, more research must first be done into what a burnout actually is. It now feels like we are abandoning people with serious complaints.”
2023-08-04 10:52:01
#burnout #dont
