Neckel S, Schaffner AK, Wagner G (eds.): Burnout, fatigue, exhaustion. An interdisciplinary perspectives on a modern action. Palgrave Macmillan, Cham, 2017
I am not an English language professional by profession, nor an obsessive by nature, yet the title (subtitle) of the book does not sit quite right with me. I can say already here that the content does not either.
Burnout – that is what Freudenberger called the state of total exhaustion, in which, despite his previous energy, he could barely crawl to the toilet for several weeks. Since it was a rather unrefined term picked up from the jargon of drug addicts, it did not enjoy due respect from the scientific community for some time. Neither the term nor its substance impressed, and it might have even faded into obscurity had it not been taken up in its time of peril by the fearless wife of Philip Zimbardo – Christine Maslach – who moved it from the consequences of predominantly human stupidity, as its originator saw it, up a notch on the winner's podium among social problems. She also developed a questionnaire to make it measurable, and researchers eagerly took it up. But it was still a domain reserved for ambitious workaholics from the helping professions who paid for their overly zealous and overly energetic approaches with disillusionment (in Maslach's case, more with the psychological consequences of disenchantment than with physical exhaustion resembling withdrawal from opioids). Neither of them suspected that Freudenberger's compatriots half a century later would devalue the concept so thoroughly as to incorporate into it everything related to job dissatisfaction, and that German sociology would turn a predominantly medical term into a label for a rather imprecisely defined social problem, occurring epidemically (?), which would furthermore be framed in class terms as a consequence of contemporary capitalism.
One must therefore be careful whether one speaks of burnout in the original clinical sense or in the sociological sense, where masses of disgruntled employees suffer from it, employees who have refused or are unable to fulfill the modern (or postmodern?) requirement that one should go to work because it fulfills one, and not to earn money for a living. This shift causes me difficulty, and I assume I will not be alone.
Why entire masses? Firstly, because since the 1950s the helping professions have expanded considerably; thus the movement, which originally had a predominance of altruistic and voluntary elements, became professionalized, and this was followed by bureaucratization. The zenith was inevitably accompanied by great disappointment, because achieving goals was more difficult than it had seemed at the outset. At the same time, the rise of a culture supporting the satisfaction of hedonistic and narcissistic ideals brought more frequent frustrations in this sphere. Then it spread elsewhere as well. Into this, somewhat inorganically, the question repeatedly arises whether the "neurasthenia" of the 19th century, which had an entirely different sociocultural background, was something analogous.
So let us take a closer look at the collection. It contains a total of thirteen contributions, mainly of German and British provenance. The introduction and the first two are devoted to a cultural-historical perspective. Here we learn that society is in decline, manifested not only by the dissolution of moral qualities but also by increased morbidity. The fatigue of the middle class stems from its constant struggle for survival (I do not quite understand this, because everyone – including the middle class – in Europe is living high on the hog), which is a manifestation of neoliberal capitalism. The British author of the historical essay, on the other hand, states that fatigue in various forms under various labels has always occurred throughout history. Always and everywhere, including in Chinese society, it was less stigmatizing if it was situated in "the body and not the soul." This is how we get, in the next contribution, to neurasthenia, whose name appears in the USA at the end of the 19th century, where it was considered a "functional disorder of the nervous system caused by a lack of nervous force," which could manifest in all bodily organs.
George M. Beard, who described it, unlike today's analysts, did not blame society, because the problems concerned the upper-middle and upper classes, moreover in the progressively developing United States, but considered the cause to be "genetic degeneration," and women – as the weaker sex – were more susceptible to these difficulties. Neurasthenia has since left psychiatric classification in the USA and is of little interest in Europe, but it has taken hold in China, where it is considered a primarily somatic disorder, which makes it more universally respectable and acceptable. The same cannot be said there for depression with very similar symptomatology, but considered primarily psychogenic.
The sections devoted to reflections on the etiopathogenesis of fatigue, while originating from workshops labeled "clinical psychobiology," completely lack information on biological findings in CFS/ME (a primarily autoimmune disorder with high concentrations of pro-inflammatory cytokines, changes in cellular immunity, mitochondrial dysfunction manifesting as insufficient ATP production). The emphasis on sociogenesis prevails. And so it is no wonder that aside from an analogy with the definition of pain (a subjective experience, objectively unmeasurable by any method), we learn nothing substantial. There is nothing to be found that would fundamentally distinguish the individual clinical entities – fatigue syndrome, exhaustion in burnout, depression, and also the ancient neurasthenia – and on that occasion, Latour's quarter-century-old question is perhaps partly self-critically recalled: whether science is a reflection of reality or a social construct.
Alain Ehrenberg, a French sociologist focusing on the anxiety of modern man and issues of mental health, at the most general level sees a shift in the theme he summarily labels "depression" from a Freudian sense of guilt to a contemporary sense of inadequacy, precisely expressed by the questions May I do this? from times past to the question Can I do it? asked today. From this then unfolds further pathological symptomatology.
Another contribution from Sweden brings information about increasing morbidity and work incapacity, in which morbidity for serious psychiatric disorders accounts for 5% and other psychiatric diagnoses 15%. The relationships between an unsuitable work environment and psychiatric morbidity are evident here, with the helping professions being worse off and the main problems being fatigue, burnout, and depression. Using examples of selected case studies, the authors show the causes, which they consider to be a shift of work effort from working with people toward performance, bureaucracy, confused restructuring, and a lack of workers in relation to tasks. A significant factor is the degree of altruistic commitment and the subsequent feelings of failure and ensuing self-punitive attitudes.
The chapter devoted to doping with stimulants comes from Germany, where conditions – including prescription restrictions – are similar to ours; certainly the situation will be different, for example, in the USA with the availability of methylphenidate. But even under conditions of restriction, this issue is underestimated. The author believes that Ehrenberg's analysis fully characterizes the breeding ground for this trend. I leave it to each person's own consideration to decide whether the sentence typical of an amphetamine abuser, It's about getting shit done, tells us more about personality factors or about social pressure. One of the essential recommendations for recovering drug addicts is the reminder that life is not just fun and games. This reminded me of the characterization of a patient made by Professor Heveroch more than a century ago: He was not possessed by an attachment to work.
Another German sociologist, Ulrich Bröckling, focused on the semantic aspect of the problems, on the transformation of the "strong" into the "weak," and asks whether, when the headlines of leading magazines and newspapers proclaim that all of Germany is exhausted, they are thereby creating "burnout" as a separate entity, as a being with its own rights. Although burnout is a metaphor, fire is a very powerful element. It is there as passion, but also as danger. A good servant but a bad master. Also, illustrations in various handbooks often depict burnt matches. Firefighters arrive at fires with delay. Does burnout represent "collateral damage of globalization"?
Further comparisons are to fast cars, dead batteries, hamsters on a running wheel, and it ends with the question of whether those dead batteries can be recharged and how. Whether the hamster can stop when it is in a cage and has no chance, instead of the rungs of the wheel, to use the rungs of a ladder and look at everything from a higher perspective. The chapter concludes with six recommendations, which are essentially no different from those that have been offered for decades. In a nutshell, they provide guidance on how to remain oneself and not let oneself be "industrialized."
Exhaustion in literature provides an overview of some works devoted wholly or partly to fatigue and exhaustion; Kafka's Gregor Samsa is naturally not missing. The cited Futurist Manifesto I do not count among the works that would solve this problem, because its blazing flight did not consider the short life of the burning energy of all enthusiasts. There is more: Beckett's heroes, Joyce's Ulysses, and others, and I think it is a text usable for bibliotherapy.
The last sections are more or less a sociological critique of contemporary neo-capitalism, which is quite difficult to understand when we think of the rest of humanity and its socio-economic conditions, mostly beyond the poverty line. Those reflections remind me a little of the character of the end-of-the-world old man from Thurber's wonderful depiction of a performance of King Lear in his hometown, a local madman who interrupts the final ravings of Edgar and Lear's lamentations with a resolute message: Pre-pare, pre-pare, the end of the world is heeeeere...
I have my own ideas about burnout from Freudenberger's by no means exaggerated description in the slim book entitled Burnout – The High Cost of Success and How to Cope with It (including the information that the author continued to work 12–14 hours a day until the end of his life, or rather until the last three weeks of it) and I see its image somewhat differently from the image of a poisoned and disappointed consumer frustrate who discovers that his neighbor has a better car and is devastated by it. Václav Havel called it a lousy mood. And I also think that the minimal stress tolerance of the current generation of working age is contributed to by a whole range of other factors besides the ruling neo-capitalism. Starting with idiotic permissive (non-)upbringing, through the availability of everything for everyone, and ending with biological factors that have completely changed the environment in which we live and undoubtedly ourselves as well.
Author: MUDr. Radkin Honzák, CSc.