Some Aspects of Burnout Are Natural For Psychiatry to Address

Definition and diagnosis: What really are we talking about when we talk about “burnout”? As a colloquial term, burnout doesn’t have a precise definition. Generally, it’s assessed by isolating some items on the most commonly used questionnaires, say the Maslach Burnout Inventory. The term is not mentioned in DSM-5, but in ICD-10 it is included as a “life management difficulty.” A couple of European countries have included it as an official diagnosis in their classification system, with accompanying reimbursement for its treatment.

Protective factors: If half of physicians are not burning out, why not? Are they working in better systems, or do they have personal characteristics that protect them? Protective factors may include genetic vulnerability, prior life experiences, and adaptability (the ability to realistically lower one’s ideal expectations via cognitive reframing to prevent undue frustration with systemic obstacles).

Resilience: Personal resilience is almost universally regarded as a positive for everyone, an unalloyed protective factor. But learned resilience is a part of being a doctor—we learn along the way to bear the trauma of patients dying or worsening, the stress of needing to master rapidly increasing knowledge (some of which may convince us that our earlier treatments were wrong), and the frustration of having less time to spend with patients. What if this learned resilience is simply enabling us “to keep plowing ahead” at the expense of our well-being? Our resilience can allow us to keep working in a system that needs to change or even prevent us from seeking out a better system.

Transference and countertransference: Perhaps we can better understand what psychodynamic forces help or hinder the development of burnout. That would include how individual clinicians relate to administrators as transference authority figures, at times perhaps with learned helplessness, and how our countertransference reactions to our systems plays out in our relationships with patients.

Denial: It is clear that physicians often don’t recognize that they are burning out and can even be satisfied with their work at the same time. Perhaps this reflects a counter-phobic denial of our fear that our ability to heal is being thwarted. Since we know how to address denial in our patients, some of that knowledge should be applicable to our colleagues at work.

Personal narratives: Personal narratives are our own stories—personal and professional—about how we strive to be healers, often in the face of systemic barriers that make our professional lives needlessly complicated. Personal narratives are a vital way for us as individuals to connect with our own history, and as a profession to connect with each other. Perhaps because of a tradition of not sharing about ourselves with patients (Freud’s blank screen), as well as the stigma of having our own mental health problems (not to mention the concern about whether disclosure will imperil our licensure), we have been reluctant as psychiatrists to self-disclose. You can view a brief video I made for the work group website in which I describe my own experience with burnout.