Minds Turned to Ash — Burnout, Stress and Physical Health
Is burnout simply the result of working too hard? The root of the problem lies deeper than that.
When Steve first came to my consulting room, it was hard to square the shambling figure slumped low in the chair opposite with the young dynamo who, so he told me, had only recently been putting in 90-hour weeks at an investment bank. Clad in baggy sportswear that had not graced the inside of a washing machine for a while, he listlessly tugged his matted hair, while I tried, without much success, to picture him gliding imperiously down the corridors of some glassy corporate palace.
Steve had grown up as an only child in an affluent suburb. He recalls his parents, now divorced, channelling the frustrations of their loveless, quarrelsome marriage into the ferocious cultivation of their son. The straight-A grades, baseball-team captaincy and Ivy League scholarship he eventually won had, he felt, been destined pretty much from the moment he was born.
“It wasn’t so much like I was doing all this great stuff, more like I was slotting into the role they’d already scripted for me.”
It seemed as though he’d lived the entirety of his childhood and adolescence on autopilot, so busy living out the life expected of him that he never questioned whether he actually wanted it.
Summoned by the bank from an elite graduate finance programme in Paris, he plunged straight into its turbocharged working culture. For the next two years, he worked on the acquisition of companies with the same breezy mastery he’d once brought to the acquisition of his academic and sporting achievements.
Then he realised he was spending a lot of time sunk in strange reveries at his workstation, yearning to go home and sleep. When the phone or the call of his name woke him from his trance, he would be gripped by a terrible panic.
“One time this guy asked me if I was OK, like he was really weirded out. So I looked down and my shirt was drenched in sweat.”
One day a few weeks later, when his 5.30am alarm went off, instead of leaping out of bed he switched it off and lay there, staring at the wall, certain only that he wouldn’t be going to work. After six hours of drifting between dreamless sleep and blank wakefulness, he pulled on a tracksuit and set off for the local Tesco Metro, piling his basket with ready meals and doughnuts, the diet that fuelled his box-set binges.
Three months later, he was transformed into the inertial heap now slouched before me. He did nothing; he saw no one. The concerned inquiries of colleagues quickly tailed off. He was intrigued to find the termination of his employment didn’t bother him. He spoke to his parents in Chicago only as often as was needed to throw them off the scent. They knew the hours he’d been working, so didn’t expect to hear from him all that much, and he never told them anything important anyway.
Can anyone say they’ve never felt some small intimation of Steve’s urge to shut down? I certainly have, sitting glassy-eyed on the sofa at the end of a long working day. My listlessness is tugged by the awareness, somewhere at the edge of my consciousness, of an expanding to-do list, and of unread messages and missed calls vibrating unforgivingly a few feet away. But my sullen inertia plateaus when I drop my eyes to the floor and see a glass or a newspaper that needs picking up. The object in question seems suddenly to radiate a repulsive force that prevents me from so much as extending my forearm. My mind and body scream in protest against its outrageous demand that I bend and retrieve it. Why, I plead silently, should I have to do this? Why should I have to do anything ever again?
We commonly use the term “burnout” to describe the state of exhaustion suffered by the likes of Steve. It occurs when we find ourselves taken over by this internal protest against all the demands assailing us from within and without, when the momentary resistance to picking up a glass becomes an ongoing state of mind.
Burnout didn’t become a recognised diagnosis until 1974, when the German-American psychologist Herbert Freudenberger applied the term to the increasing number of cases he encountered of “physical or mental collapse caused by overwork or stress”. The relationship to stress and anxiety is crucial, for it distinguishes burnout from simple exhaustion. Run a marathon, paint your living room, catalogue your collection of tea caddies, and the tiredness you experience will be infused with a deep satisfaction and faintly haloed in smugness – feelings that confirm you’ve discharged your duty to the world for at least the remainder of the day.
The exhaustion experienced in burnout combines an intense yearning for this state of completion with the tormenting sense that it cannot be attained, that there is always some demand or anxiety or distraction which can’t be silenced. In his 1960 novel “A Burnt-Out Case” (the title may have helped bring the term into general circulation), Graham Greene parallels the mental and spiritual burnout of Querry, the protagonist, with the “burnt-out cases” of leprosy he witnesses in the Congo. Querry believes he’s “come to the end of desire”, his emotions amputated like the limbs of the lepers he encounters, and the rest of his life will be endured in a state of weary indifference.
But Querry’s predicament is that, as long as he’s alive, he can’t reach a state of impassivity; there will always be something or someone to disturb him. I frequently hear the same yearning expressed in my consulting room – the wish for the world to disappear, for a cessation of any feelings, whether positive or negative, that intrude on the patient’s peace, alongside the painful awareness that the world’s demands are waiting on the way out.
You feel burnout when you’ve exhausted all your internal resources, yet cannot free yourself of the nervous compulsion to go on regardless. Life becomes something that won’t stop bothering you. Among its most frequent and oppressive symptoms is chronic indecision, as though all the possibilities and choices life confronts you with cancel each other out, leaving only an irritable stasis.
Anxieties about burnout seem to be everywhere these days. A quick glance through the papers yields stories of young children burnt out by exams, teenagers by the never-ending cacophony of social media, women by the competing demands of work and motherhood, couples by a lack of time for each other and their family life.
But while it may seem to be a problem rooted in our cultural circumstances, burnout has a history stretching back many centuries. The condition of melancholic world-weariness was recognised across the ancient world – it is the voice that speaks out in the biblical book of Ecclesiastes (“All is vanity! What does a man gain by all the toil at which he toils under the sun?”), and diagnosed by the earliest Western medical authorities Hippocrates and Galen. It appears in medieval theology as acedia, a listless indifference to worldly life brought about by spiritual exhaustion. During the Renaissance, a period of relentless change, Albrecht Dürer’s 1514 engraving “Melancholia I” was the most celebrated of many images depicting man despondent at the transience of life.
But it was not until the second half of the 19th century that writers began to link this condition to the specific stresses of modern life. In 1879, the American neurologist George Beard published “Neurasthenia: (nervous exhaustion) with remarks on treatment”, identifying neurasthenia as an illness endemic to the pace and strain of modern industrial life. The fin-de-siècle neurasthenic, in whom exhaustion and innervation converge, uncannily anticipates the burnout of today. They have in common an overloaded and overstimulated nervous system.
A culture of chronic overwork is prevalent within many professions, from banking and law to media and advertising, health, education and other public services. A 2012 study by the University of Southern California found that every one of the 24 entry-level bankers it followed developed a stress-related illness (such as insomnia, alcoholism or an eating disorder) within a decade on the job. A much larger 2014 survey by eFinancialCareers of 9,000 financial workers in cities across the globe (including Hong Kong, London, New York and Frankfurt), showed bankers typically working between 80 and 120 hours a week, the majority feeling at least “partially” burnt out, with somewhere between 10% and 20% (depending on the country) describing themselves as “totally” burnt out.
A young banker who sees me in the early morning, the only available slot in her working day, often leaves a message at 3am to let me know she won’t make it as she’s only just leaving the office – a predicament especially bitter because her psychoanalytic session is the one hour in the day in which she can switch off her phone and find some respite from her job. Increasing numbers of my patients say they value a session simply because it provides a rare chance for a moment of stillness freed from the obligation to talk.
A walk in the country or a week on the beach should, theoretically, provide a similar sense of relief. But such attempts at recuperation are too often foiled by the nagging sense of being, as one patient put it, “stalked” by the job. A tormenting dilemma arises: keep your phone in your pocket and be flooded by work-related emails and texts; or switch it off and be beset by unshakeable anxiety over missing vital business. Even those who succeed in losing the albatross of work often quickly fall prey to the virus they’ve spent the previous weeks fending off.
Burnout increases as work insinuates itself more and more into every corner of life – if a spare hour can be snatched to read a novel, walk the dog or eat with one’s family, it quickly becomes contaminated by stray thoughts of looming deadlines. Even during sleep, flickering images of spreadsheets and snatches of management speak invade the mind, while slumbering fingers hover over the duvet, tapping away at a phantom keyboard.
Some companies have sought to alleviate the strain by offering sessions in mindfulness. But the problem with scheduling meditation as part of that working day is that it becomes yet another task at which you can succeed or fail. Those who can’t clear out their mind need to try harder – and the very exercises intended to ease anxiety can end up exacerbating it. Schemes cooked up by management theorists since the 1970s to alleviate the tedium and tension of the office through what might be called the David Brent effect – the chummy, backslapping banter, the paintballing away-days, the breakout rooms in bouncy castles – have simply blurred the lines between work and leisure, and so ended up screwing the physical and mental confines of the workplace even tighter.
But it is not just our jobs that overwork our minds. Electronic communication and social media have come to dominate our daily lives, in a transformation that is unprecedented and whose consequences we can therefore only guess at. My consulting room hums daily with the tense expectation induced by unanswered texts and ignored status updates. Our relationships seem to require a perpetual drip-feed of electronic reassurances, and our very sense of self is defined increasingly by an unending wait for the verdicts of an innumerable and invisible crowd of virtual judges.
And, while we wait for reactions to the messages we send out, we are bombarded by alerts on our phones and tablets, dogged by apps that measure and share our personal data, and subjected to an inundation of demands to like, retweet, upload, subscribe or buy. The burnt-out case of today belongs to a culture without an off switch.
In previous generations, depression was likely to result from internal conflicts between what we want to do and what authority figures – parents, teachers, institutions – wish to prevent us from doing. But in our high-performance society, it’s feelings of inadequacy, not conflict, that bring on depression. The pressure to be the best workers, lovers, parents and consumers possible leaves us vulnerable to feeling empty and exhausted when we fail to live up to these ideals. In “The Weariness of the Self” (1998), an influential study of modern depression, the French sociologist Alain Ehrenberg argues that in the liberated society which emerged during the 1960s, guilt and obedience play less of a role in the formation of the self than the drive to achieve. The slogan of the “attainment society” is “I can” rather than “I must”.
A more prohibitive society, which tells us we can’t have everything, sets limits on our sense of self. Choose to be a bus conductor and you can’t be a concert pianist; a full-time parent will never be chairman of the board. In our attainment society, we are constantly told that we can be, do and have anyone or anything we want. But, as anyone who’s tried to decide between 22 nearly identical brands of yoghurt in an American organic hypermarket can confirm, limitless choice debilitates far more than it liberates.
The depressive burnout, Ehrenberg suggests, feels incapable of making meaningful choices. This, as we discovered in the course of analysis, is Steve’s predicament. In his emotionally chilly childhood home, the only attention he received from his parents was their rigorous monitoring of his schoolwork and extra-curricular activities. In his own mind, he was worth caring about only because of his achievements. So while he accrued awards and knowledge and skills, he never learned to be curious about who he might be or what he might want in life. Having unthinkingly acquiesced in his parents’ prescription of what was best for him, he simply didn’t know how to deal with, or even make sense of, the sudden, unexpected feeling that the life he was living wasn’t the one for him.
Steve presents an intriguing paradox: what appears from the outside to have been a life driven by the active pursuit of goals feels to him to be oddly inert, a lifeless slotting-in, as he puts it, to a script he didn’t write. “Genuine force of habit”, suggested the great philosophical misanthrope Arthur Schopenhauer in 1851, might appear to be an expression of our innate character, but “really derives from the inertia which wants to spare the intellect the will, the labour, difficulty and sometimes the danger involved in making a fresh choice.” Schopenhauer has a point. Steve is coming to understand that his life followed the shape it did not from the blooming of his deepest desires but because he never bothered to question what he had been told.
“You know”, he said to me one day, “it’s not like I want to be this pathetic loser. I want to get up tomorrow, get back in the gym, find a new job, see people again. But it’s like even as I say I’m gonna do all this, some voice in me says, ‘no I’m not, no way am I doing that.’ And then I can’t work out if I feel depressed or relieved, and the confusion sends me crazy.”
I suggested to him that he was in this position because he had realised that he had almost no hand in choosing his life. His own desire was like a chronically neglected muscle; perhaps our job was to nurture it for the first time, to train it for the task of making basic life choices.
The same predicament arose in a different, perhaps subtler way in Susan, a successful music producer who first came to see me in the thick of an overwhelming depressive episode. She had come from Berlin to London six months previously to take up a new and prestigious job, the latest move in an impressive career that had seen her work in glamorous locations across the world.
She had grown up in a prosperous and loving family in a green English suburb. Unlike Steve, her parents had been – and continued to be – supportive of the unexpected professional and personal path their daughter had carved for herself. But they resembled Steve’s parents in one respect: the unvarying message, communicated through the course of her childhood, that she had the potential to be and do anything. The emotional and financial investment they made in her musical and academic activities showed their willingness to back up their enthusiasm with actions. While Susan appeared to follow her own chosen path, there came a point where her parent’s unstinting support and encouragement made it difficult to identify where their wishes stopped and hers began.
For all their differences, Steve’s and Susan’s parents were alike in protecting the child from awareness of the limits imposed by both themselves and the world. Susan would complain that the present, the life she was living moment to moment, felt unreal to her. Only the future really mattered, for that was where her ideal life resided. “If I just wait a little longer”, she would remark in a tone of wry despondency, “there’ll be this magically transformative event and everything will come right.”
This belief, she had come to realise, had taken a suffocating hold on her life: “the longer I live in wait for this magical event, the more I’m not living this life, which is sad, given it’s the only one I’ve got.” Forever anticipating the arrival of the day that would change her life for ever, Susan had come to view her current existence with a certain contempt, a travesty of the perfect one she might have. Her house, her job, the man she was seeing – all of these were thin shadows of the ideal she was pursuing. But the problem with an ideal is that nothing in reality can ever be remotely comparable to it; it tantalises with a future that can never be attained.
Feeling exhausted and emptied by this chase, she would retreat into two contradictory impulses: the first was a compulsion to work, asking the hydra-headed beast of the office to eat up all her time and mental energy. But alongside this, frequently accompanied by chronic insomnia, was a yearning for the opposite. She would fantasise in our sessions about going home and sleeping, waking only for stretches of blissfully catatonic inactivity over uninterrupted, featureless weeks. Occasionally she managed to steal the odd day to veg out, only for a rising panic to jolt her back into work. In frenzied activity and depressive inertia, she found a double strategy for escaping the inadequacies of the present.
Susan’s depressive exhaustion arose from the disparity between the enormous effort she dedicated to contemplating her future and the much smaller one she devoted to discovering and realising her desires in the present. In this regard, she is the uncanny mirror image of Steve: Susan was frozen by the suspicion there was always something else to choose; Steve was shackled by the incapacity to choose at all.
Psychoanalysis is often criticised for being expensive, demanding and overlong, so it might seem surprising that Susan and Steve chose it over more time-limited, evidence-based and results-oriented behavioural therapies. But results-oriented efficiency may have been precisely the malaise they were trying to escape. Burnout is not simply a symptom of working too hard. It is also the body and mind crying out for an essential human need: a space free from the incessant demands and expectations of the world. In the consulting room, there are no targets to be hit, no achievements to be crossed off.
Josh Cohen/Illustrations: Izhar Cohen/The Economist