Occupational burnout

The ICD-11 of the World Health Organization (WHO) describes occupational burnout as a work-related phenomenon resulting from chronic workplace stress that has not been successfully managed. According to the WHO, symptoms include "feelings of energy depletion or exhaustion; increased mental distance from one's job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy."

Occupational burnout is classified as an occupational phenomenon but is not recognized by the WHO as a medical or psychiatric condition. Social psychologist Christina Maslach and colleagues made clear that burnout does not constitute "a single, one-dimensional phenomenon." However, national health bodies in some European countries do recognize it as such, and it is also independently recognized by some health practitioners. Nevertheless, a body of evidence suggests that what is termed burnout is a depressive condition, that is to say, indistinct from, and overlaps with, depression.

Kaschka, Korczak, and Broich (2011) advanced the view that burnout is described in the Book of Exodus (18:17–18). In the New International Version of the Bible, Moses' father-in-law said to Moses, "What you are doing is not good. You and these people who come to you will only wear yourselves out. The work is too heavy for you; you cannot handle it alone." Gordon Parker suggested that the ancient European concept of acedia refers to burnout and not depression as many others believe.

By 1834, the German concept of Berufskrankheiten (occupational diseases) had become established. The concept reflected adverse work-related effects on mental and physical health. In 1869, New York neurologist George Beard used the term "neurasthenia" to describe a very broad condition caused by the exhaustion of the nervous system, which he argued was to be found in "civilized, intellectual communities." The concept soon became popular, and many in the United States believed themselves to suffer from it. Some came to call it "Americanitis". Beard broadened the potential symptoms of neurasthenia such that the disorder could be the source of almost any symptom or behaviour. Don R. Lipsitt would later wonder if the term "burnout" was similarly too broadly defined to be useful. In 2017 the Dutch psychologist Wilmar Schaufeli pointed out similarities between Beard's concept of neurasthenia and that of the contemporary concept of occupational burnout. The rest cure was a commonly prescribed treatment for neurasthenia in the United States, particularly for women. The American doctor Silas Weir Mitchell often prescribed this treatment. Other treatments included hypnosis, Paul Charles Dubois's cognitive behavioural therapy (this is distinct from and devised much earlier than Aaron Beck's cognitive behavioral therapy), and Otto Binswanger's life normalisation therapy.

In 1888, the English neurologist William Gowers coined the term occupation neurosis to describe cramps experienced by writers and pianists (repetitive strain injury), translating the German concept of Beschäftigungsneurosen (occupational diseases affecting the nerves). The related term occupational neurosis came to include a wide range of work-caused anxieties and other mental problems. By the late 1930s, American health professionals had become widely acquainted with the condition. It became known as berufsneurose in German. From 1915, the Japanese psychiatrist Shoma Morita developed Morita therapy to treat neurasthenia. He had come to have a different understanding of the condition than Beard, preferring to call it shinkeishitsui; he published two books about the condition.

In 1957, Swiss psychiatrist Paul Kielholz coined the term Erschöpfungsdepression [exhaustion-depression]. The concept was one of a number of new depression-subtypes that gained traction in France and Germany during the 1960s. In 1961, British author Graham Greene published the novel A Burnt-Out Case, the story of an architect who became disenchanted with the fame his achievements garnered for him and volunteered to work at leper colony in the Congo. In 1965, Kielholz publicised therapy for Erschöpfungsdepression in the German-speaking world through his book Diagnose und Therapie der Depressionen für den Praktiker [Diagnosis and Treatment of Depression for the Practitioner]. His work inspired further writing on the topic by German psychiatrist Volker Faust.

In 1968, the second edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual (DSM-II) replaced "psychophysiologic nervous system reaction" with the condition neurasthenic neurosis (neurasthenia). This condition was "characterized by complaints of chronic weakness, easy fatigability, and sometimes exhaustion." Another condition added to this edition was the similar asthenic personality, which was "characterized by easy fatigability, low energy level, lack of enthusiasm, marked incapacity for enjoyment, and oversensitivity to physical and emotional stress."

In 1969, American prison official Harold B Bradley used the term burnout in a criminology paper to describe the fatigued staff at a centre for treating young adult offenders. Bradley's article has been cited as the first known academic paper to use the term.