“I AM not just busy, I am being overwhelmed by an onslaught of requests like yours…”
There is a certain irony to the email I have just received: the pioneer of burnout research is feeling utterly swamped by work. Christina Maslach, a psychologist at the University of California, Berkeley, spearheaded the study of burnout back in the 1970s and has been working on ways to tackle the problem ever since. Her expertise was already highly sought after even before the coronavirus pandemic. Now she can barely move under the weight of her inbox.
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It is hardly surprising. In the year since the word lockdown became ubiquitous, it seems as if almost everyone has hit the wall at least once. But amid the emotional roller coaster of work stress, homeschooling, social isolation and the not inconsiderable fact that there is still a pandemic raging outside, how can you tell when you have reached the end of your tether? When does feeling understandably stressed in difficult times turn into an irretrievable case of burnout? And what can you do to protect yourself?
Thankfully, five decades of research means we have a fairly good idea of what burnout is and what causes it. According to Maslach’s Burnout Inventory, an assessment tool she co-developed, burnout arises when three factors coincide: an overwhelming feeling of emotional exhaustion, feelings of cynicism and detachment and a feeling of lack of accomplishment. For those experiencing burnout, these criteria might manifest in feelings like being exhausted even after plenty of sleep, being emotionally distant from loved ones or no longer caring about jobs that need doing.
This definition, like most of the research that has been done on the subject, focuses on burnout in the workplace. In 2019, the World Health Organization chimed in, ” that results from “chronic workplace stress that has not been successfully managed”.
Yet, while the situation we find ourselves in now is about much more than work stress, Maslach says that the experience of burnout is the same. “What’s different is that it’s happening more,” she says, and in response to new types of stress.
Hidden picture
Exactly how much more is hard to ascertain in terms of hard data, not least because we are still in the eye of the storm. But some strong trends are emerging from studies that have been investigating people’s emotional state before and during the pandemic. For instance, in the UK in April 2020, a month into the country’s first lockdown, found that mental health had already deteriorated considerably compared with before the arrival of covid-19.
However, according to Carmine Pariante, a psychiatrist at King’s College London, the UK population as a whole has been remarkably resilient to the changes it has faced. But when you drill down into the detail, there are two very different pictures hidden among the averages. “For some populations, like young people, women with small children and people with pre-existing mental health problems, the deterioration was quite noticeable,” he says. . of burnout among doctors there, for example, found that women were affected more than men, probably because women are also absorbing more of the increased workload at home.
Clearly, most of us aren’t dealing with the life-or-death situations faced by many medical workers, and which may be fuelling problems (see “Front-line burnout“). But with renewed lockdowns and travel restrictions in many countries, the fear is that more vulnerable groups will be pushed further towards burnout and could be joined by people who coped alright first time round.
Burnout isn’t, Maslach is keen to point out, a mental disorder, although it can certainly stem from and lead to mental illness. Instead, it is a natural reaction to a situation that has become intolerable to the person experiencing it.
Still, the more insidious kind of burnout from the pressures we all face during the pandemic isn’t to be sniffed at. Last month, Mark Ormrod, a former Royal Marine who lost both legs and an arm in an explosion while serving in Afghanistan, told the BBC that homeschooling his two children while also trying to keep up with his day job “.
A random poll of workers in the US found that almost 60 per cent were feeling the effects of burnout in August 2020, up from 45 per cent in the early days of the pandemic, with 39 per cent of those affected blaming their burnout symptoms on the struggle to balance work and home life.
And research by psychologist MoĂŻra Mikolajczak at the Catholic University of Louvain (UCL) in Belgium has found that people experiencing parental burnout can have higher stress levels than those experiencing chronic pain.
What is more, while burnout isn’t a mental illness, it can leave people vulnerable to more serious mental health problems. “We know that burnout, even within the classical work-related literature, is a major risk factor for depression and anxiety,” says Pariante. There are a number of factors that we know put us at risk of both burnout and mental illness.
Out of control
The first is control, or more importantly, a lack of it. In the pandemic, front-line workers in the medical profession are likely to be feeling this the most keenly. Dealing with infected people every day isn’t only exhausting, it also takes away much of the control over their personal chances of catching the virus and of protecting their loved ones from exposure.
For people who have the relative luxury of being able to avoid the virus by working at home, feelings of lack of control can come from elsewhere. The fact that lockdowns are imposed rather than voluntary seems to be an important factor. A recent review in The Lancet looked at the effects of enforced quarantine or social isolation during outbreaks of SARS and Ebola. It found that and long-term mental health problems than restrictions that are mandated by law.
This is probably down to the psychological impact of having freedom of choice taken away, says Lynden Miles, a social psychologist at the University of Western Australia in Perth. Because we are no longer able to choose how often we go out and who to meet, lockdowns may lead to the psychological phenomenon of “learned helplessness”, he says, where a person “gives up once they realise their efforts to improve the situation are futile”. Learned helplessness is associated with depression and post-traumatic stress. And in terms of Maslach’s definition of burnout, it very much comes under the banner of “cynicism and detachment”.
The Lancet review also concluded that enforced quarantine is less stressful when people feel that they are sacrificing their freedom for the greater good. In the UK, comparisons have been made with the so-called Blitz spirit, especially during initial lockdown. This is the sense that personal suffering is worth it for the common cause – and is said to have sustained morale during the bombing of the UK in the second world war.
According to an August 2020 study comparing the pandemic and the Blitz, there are many similarities, including the fact that a community wide stiff upper lip is more myth than reality. As with the pandemic, the bombing had peaks. During a later wave of attacks, when air aids were faster, quieter and more deadly, .
Given the resurgence of the coronavirus at the end of 2020 in much of the world, along with the emergence of significantly more transmissible variants, this comparison holds up. And there is already some evidence that second and third lockdowns are denting morale.
Sara Simblett, a clinical psychologist at King’s College London, is part of a team that has been tracking stress-related coping strategies before and throughout the pandemic. While data sets from the current UK lockdown have yet to be fully analysed, there are early indications that resilience is waning, with people feeling much less confident about being able to cope in the long term compared with the short term, she says. It remains to be seen whether this prediction is borne out by the team’s follow-up data, due to be published soon.
A lot will depend on how people feel about the high-level decisions being made about our freedoms. In the workplace, , or unequal enforcement of those decisions, is a key risk factor for burnout. Similarly, a sense of unfairness in government-mandated restrictions and their enforcement could well be fuelling a sense of burnout in people asked to obey them.
“Burnout is a major risk factor for depression and anxiety”
In short, if you are forced to surrender your freedom and make sacrifices for the greater good, then the people restricting your freedom had better be doing the same.
According to , this pact between citizens and the UK government was severely dented when Dominic Cummings, a key adviser to the prime minister, was accused of breaking lockdown rules by driving his wife 420 kilometres from their home, even though he suspected she had covid-19. The episode was directly linked to a significant drop in confidence in the UK government’s handling of the crisis and to the chances of people following the rules. There are signs that confidence in the UK government has fallen further with successive lockdowns.
A similar trend has been seen in the US, Canada and in some European countries, where indecision and changes to rules have been linked to public anger and decreasing confidence in authorities’ handling of the pandemic, all of which is likely to increase feelings of burnout.
Adding to these factors, we know that burnout can be fuelled by feelings of being unable to escape from home. Research on parental burnout, for instance, has found that going to work has protective effects as it offers a breathing space from the pressures of home. Even a commute can give us a chance to clear our heads. All of these escape mechanisms are now, of course, much harder to come by.
The more we understand about the causes of burnout, the more we can do to try to protect ourselves. On a personal level, the biggest challenge may be to take back as much control as possible over the day-to-day. That may not be easy when the usual options that help us battle through tough periods – going on holiday, meeting friends or enjoying certain hobbies – are off the table.
Meaningful connections
Even so, one thing we do know is that any kind of stress, whether from work, home or the fear of a deadly virus, . Even in the absence of actual physical contact, there are plenty of ways to keep in touch emotionally and how you do it doesn’t matter, says Pariante – it could be via a text, the phone, a socially distanced walk or a video call. Doing this takes effort, which is particularly difficult if you are reaching the exhausted or cynical stages of burnout, but we are a social species. “It’s easy to be lazy, but in the end, you will pay for it if you’re not committing to some level of social connection,” says Pariante.
We can also borrow from the many well-researched tips for safeguarding our mental health, including getting as much fresh air, exercise and time in green spaces as possible, regardless of the weather.
Simblett’s research has found that, during the first UK lockdown, going for daily walks or other forms of exercise proved to be an important coping strategy for many. For those who are isolating or shielding and therefore not allowed out of the house, exercise is perhaps even more important. If online exercise classes aren’t your thing, turn up the music and dance: studies have found that it lifts mood and, when done with another person, , hitting two anti-burnout strategies at once.
Other than that, it is a case of building in as much separation between your work life and home life as possible, and making a commitment to do things that make you feel good. Finally, when things get too much, it pays to know when to stop.
Maslach, the doyenne of burnout research, provides a masterclass in how to do this. Faced with yet another request from a journalist asking about burnout, she answered two out of five questions, sent some links to further resources and wished me good luck. If we are going to come out of this in one piece, we will need to manage expectations: do what you can and know when to say no.
Need a listening ear? : 116123 (samaritans.org). Visit for hotlines and websites for other countries
Front-line burnout
Burnout in the medical profession was a concern long before covid-19 threw it into the spotlight. Now there are fears that, for many, the pandemic could be the last straw.
There is some evidence that, when in the thick of a crisis, focusing on the task rather than emotions can help to protect the mental health of medical practitioners. A study of Italian doctors during the first wave of the epidemic there found that . The researchers concluded that this was because, in the early days, “emotions related to the pandemic [were] too intense to be regulated and used productively”.
The worry is that once the immediate threat passes, this tendency to push emotions aside will backfire. “My fear is that once we come out the other side and have a chance to realise what we’ve survived, the impact will be monumental,” says National Health Service anaesthetist in England and mental health advocate Christina Hoskins.
In a recent article in the , Jo Shapiro at Harvard Medical School, who studies clinician burnout, and Timothy McDonald, a Chicago-based medic and lawyer, made the case for a large-scale effort to safeguard the mental health of clinicians from the pandemic’s impact. They suggest peer support and a system of monitoring and interventions to assist front-line staff as they come to terms with the past year. Actions aimed at encouraging people to help themselves, they note, .
Forget burnout, I’m bored-out
With so much emphasis on burnout caused by being overwhelmed, it is easy to overlook the other side of lockdown and social isolation: many people are unable to work, isolated and as tied to home as everyone else.
The term boreout was coined in 2007 by two Swiss business consultants and has begun to creep into the world of employment psychology. It is defined as the emotional toll of not having enough to do or not finding meaning in your everyday work, or the stress that comes from having plenty to do, but all of it being utterly boring.
As with burnout, the problem often boils down to a lack of control. This means that the best way to avoid the anxiety and exhaustion that accompany boreout is to try to spend time doing things that mean something to you, whether that is learning to cook, volunteering in a food bank or reading something stimulating instead of mindlessly scrolling on social media. What matters is that it takes you out of the here and now and stretches into the future, when this will, eventually, end.
