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Burnout is an official medical diagnosis, WHO says (cnn.com)
256 points by alok-g on May 28, 2019 | hide | past | favorite | 81 comments



I was desperately scanning down through the article looking for what the cure was. Oh. It's just a diagnosis, it doesn't come with a cure yet.

Oh well - maybe if I can get our sprint velocity even higher this year, I can get a bonus and go on a vacation to /really/ recover!


I've heard of a couple, and used them successfully:

1) Learn something.

2) Get a small win after a big loss.

The ideal project to do when you're feeling burnt out is something that is well inside your comfort zone and can be completed in a couple days, but also teaches you something new. Something like learning a new framework, or building a quick new "toy" that isn't really critical to the business but users would find interesting, or doing a refactoring that you totally know how to do but have been putting off for months because other stuff is more important.

I've also had managers put me on projects like this after slaving away for months on a project that gets canceled. In hindsight they knew exactly what they were doing, and the fact that it was kinda fun and not critical to the business was actually a long-term investment.


I did a project like this recently. Had been using a particularly piece of crap java software for 3 months, got tired of it, and rewrote a much improved version in ruby that using KISS. It does 90% of what the other framework does and is about 10% the size. I haven't needed the 10% I left out at all and other people are adopting it. It definitely falls under your "take a small project, and get some success at the end of the tunnel and learn some new stuff"


This reminds me of the "make your bed" advice: https://jamesclear.com/great-speeches/make-your-bed-by-admir...


Making your bed is bad advice: http://news.bbc.co.uk/2/hi/health/4181629.stm


"Brush your teeth" would probably serve a similar purpose, "tidy your room" would be even better if you're the sort of person who wouldn't have it already tidied.


Not sure if you're jokingly referencing that simulation-based 2005 study, but it's a far cry to extrapolate it to mean that you actually shouldn't make your bed. For example, see https://www.aarp.org/health/healthy-living/info-2017/making-...


So really it'd be best to hang up the moist blanket and have a well-ventilated room.


This might be the most helpful comment I've ever read on Hacker News. Thank you. :+1:


YMMV. Sometimes a solution to too much work isn't taking on more work (even if it isn't "business critical").


Small wins can go a long way.


This would explain all my home projects that I do just to stay sane.


I'm sure #1 can be generalized to play. Do something fun with your own time. The activity can be creative or not.


You need stress to grow.

Burnout happens when stress isn't followed by rest. When stress feels endless. And when stress feels like it's pointless.

The solution therefore is to make sure you always know why you're working so hard, build in reward for your hard work, and take a break after a specific period of stress.

Always have the end in sight. Always know your goal. Always make sure you feel progress toward the goal.

Crucially, when the specified period of stress comes, take a fucking break. Whether you're done or not. Very important.

I myself often fail to follow these lessons. So I write them here to help me remember :)

PS: for a more in-depth exploration of these 3 rules, read Peak Performance. It helped me a lot.


I disagree; I believe burnout comes when labor isn't followed by expected reward, you learn to associate labor with negativity. I haven't burned out in about six years; and one thing is that taking a break after major stress could be exact the worst thing you can do. Take breaks at predetermined time points that are required to happen regardless of your labor situation.

Edit: oh I see now your suggestion is to craft an invariant as reward for your labor after a specific period of expected stress whether or not it's successful. That's probably not a bad choice, as long as the choice to go on a break precedes the stressful period


Im with you. I burned out 3 years ago, after working on a project where the customer was a major pain to work with, did not recognise developer effort and made sure to always point out issues in demeaning manners. Every sprint I started to dread the sprint demo more, as I knew what was coming.


The whole "stress causes burnout" thing is gravely misguided.

There's a whole sub-type of burnout which comes about even in relatively low stress environments.


Perhaps we define stress differently. How can burnout happen if you love every little second of your day and everything you do fills you with joy and energy?


The opposite of stress isn't a rosy life. It's absence of stress.


Literally no one lives like that.

If you or anyone you know feels like that, then it's a serious outlier condition worthy of academic study.


> Literally no one lives like that.

Why not? Let's bet a few people do. There are certainly people who live their life in a permanent joyous state, no matter what. Rare, perhaps but I wouldn't dismiss their experience as a condition.


Or drugs. That literally sounded like living being constantly high.


You can work in relatively low stress job, but not love it.

It can be boring, mundane, unfulfilling, uninteresting, repetitive, etc... That doesn't generally produce a traditional "stress" but does wear on you emotionally.


Good point. E.g. I have never seen a wave surfer or mountaineer with a burnout, though they probably put their body and mind through a lot of stress.


Then you've never been an athlete at a high level. I don't mean that negatively, but I can assure you that even people who love every second of what they do, like many professional and even college athletes, can suffer burnout. Exhaustion and stress can cause burnout in anybody.


That kind of burnout could also be caused by the element of competition.


Michael Phelps seemed that way on his last olympics. He wasn’t really enjoying it even though he was setting historic records.


You can hate what you do, yet still not be stressed.


If do continue to do something you hate, you're inducing a stress response in the body every time.


Not really. I've had jobs that I hated, but that weren't stressful at all, because it was just a thing I had to do to get money, not something that mattered.

In fact jobs I loved and cared about have often brought much more stress exactly because I cared about the outcome, and when I failed to live up to my expectations at that job it felt like a personal failing and I was letting everyone down.


I believe we have a different understanding of the term hate. Hate is a strong word, and it's something you really want to avoid if you can.


I think you can give up and accept that’s what it is, too. Basically continuing doing it, but stopping hating it.


Honest question however, is that truly accurate? I'd be interested to know if that's actually the case.


I'd add that stress is experienced during a period of adaptation. However... in some modern high-pressure corporate environments (AKA office jobs) you can can never fully adapt, never get on top of things. The pressure is relentless and the environment de-humanising.

Human brains arnt built to withstand the onslaught of meaningless emails and endless reports and presentations. Offices are just awful in many instances.


> it doesn't come with a cure yet

The cure is rest. Since it was identified by Freudenberger and elaborated by Maslach this has been the accepted treatment.

Of course, this isn't much use to you if you can't rest due to your external commitments, but sometimes even just identifying that you have a problem can help.


Important to recognize that it's an accepted treatment. If we discover and confirm more treatments in future, which I think is likely, they'll sit right alongside rest and perhaps be equally or even more effective than rest. Bonus being they may be compatible with continuation of work. Not that I'm a zealot for work-till-u-die, but it can really help as far as the continuation of non-work life activities is concerned to have some incoming rolling in.

Some folks have pretty good in-band home remedies, or at least growth inhibitors, for burnout. Bringing them to bear isn't done by everyone, or may not even be universally applicable, but I'm not sure rest will bear out to be the only cure for this ailment in the long run.


Well what we're talking about is nervous exhaustion. Beyond the point of prevention I find it hard to imagine any other cure that wouldn't make it worse in the long run.


I agree with this. If you still have to work, then consider to sleep 10+ hours a day.


Pretty sure the cure is moving away from the capitalist mode of production.


No burnout when you are dead?

What is a good alternative to capitalist production that doesn't involve slave labor and or millions of deaths?


Burnout and clinical depression are extremely similar, and I think most people who self-diagnose as burned out actually are clinically depressed, though maybe mildly.

But I can see that diagnosis and treatment would be more difficult and less standard when there are no clear signs of depression or other disorders. And there would be a two-phase treatment: First phase is getting out of burnout mode. Second phase is preventing the relapse. Confusing the two phases will only result in frustration.


I agree that a connection is likely, though perhaps more like burnout may lead to depression. This is definitely the experience I had - first work was daunting, then everything. Both require a lot of care to get out of in a healthy way.


I'd say you are describing a temporal connection. Identifying causes for mental health conditions is problematic and not very fruitful. Depression can happen virtually on its own, as far as doctors or patients are concerned.


> Depression can happen virtually on its own

Given that CBT is the first-line treatment for chronic depression and has a really good success factor, we can see that what you are saying is technically correct (it can happen) but the assumption you make earlier:

> Identifying causes for mental health conditions is problematic and not very fruitful

Is, while also technically true in some cases (it is a broad statement that applies to more than depression), as connected to depression plainly false.

You've constructed a compelling argument that seems to check out based on only a tenuous relation between different true statements.

I hope that this is just a prejudice and not something you believe as someone suffering from depression. If this is in fact the case, know that in a lot of the cases causes can be discerned and you can with treatment in fact be able to live a lot better. In the small minority of cases where you are depressed because of a biological limitation (yes, this also happens - it's just not the most usual trajectory), that's when you treat it with a (hopefully life-long) line of antidepressants that work for you.


This has existed for 16 years, from ICD-10 v2003: http://apps.who.int/classifications/apps/icd/icd10online2003... (code is Z73.0)


Are there good resources online for strategies for dealing with knowledge worker burnout? It seems to be a different animal than other types of burnout (compassion fatigue, pure overwork, body breaking down, etc)


I think do less is pretty much the answer I consistently see. The worse the burnout the less you need to do and for longer.

Many times the reasons why it's hard to do less are mental hangups(like fear of failure, perfectionism, the Ides that you're worthless as a coder if you're not coding 24/7) that prevent people from doing less and a therapist would help with that.

Of course sometimes what is preventing someone from doing less is their financial situation in which case you unfortunately have a lot fewer options.

For me it was quitting my job and starting a consulting company with a couple of friends. I make less money and work more but I have a way better time doing it and that has allowed me to recover.


I always thought burnout was IT lingo for work induced stress.

Don’t get me wrong, it’s serious, but it always seemed to me akin to “shellshock” vs “PTSD”. Shellshock just carries a lot of weight as a word on its own. It sounds serious and traumatizing and you don’t really need to know what it means in order to respect the diagnosis.


Burnout is also used as a socially-acceptable reason for mental health problems.

"I work so hard that I get sick" is more acceptable than "I get sick because I'm crazy/mentally ill". Which is in itself a false choice.


Every year the WHO adds and subtracts medical conditions depending on the milieu of the year. Hopefully at least one person is helped.


Last year or so they classified “gaming disorders” for people who spent too much time playing video games. FWIW


Putting a name on things helps.

There is little reason to doubt that problem-gaming exists, sure, it is a manifestation of something more general (à la Behavioral-Addiction/OCD) but having a name for it helps to talk about it more precisely, and being able to talk about a problem is the first step to finding a solution or way out.


Not sure if that is true. Sometimes adding a label simply adds unlimited anxiety.


So you're saying our understanding of medical conditions changes over time? Weird.


It's probably about staying in the media.


My wife is a therapist and has so many clients who say they have a "small burnout" or something similar.

People fight to not have the label "depression" over them. It is really sad in my opinion. It's your health, it is time to put the pride away and don't care about terminology and do whatever you can to get better.


It's wise to avoid getting any of these labels tagged onto you. There is a strong current of people that really believe that you are forever defined by a temporary state, something like people that really, really believe in the AA model of alcoholism think that people who once drank too much are forever and ever at least dry-drunks.

And I sure as hell wouldn't want to get onto any of these anti-depressants with all of their side effects and tapering problems if you ever want to get off them again.


Just because you have depression doesn't mean you have to go on anti-depressants. They are many other therapies available. As mentioned in another comment thread Cognitive Behavioral Therapy is very successful.


I dunno, I sort of accept that I am depressed, but I also definitely don't see it as a health issue. I've always been like this and for me, it's just part of my personality. It's not very severe, it does not preclude me from functioning in the society. Could I be happier on some drugs? Perhaps, but I don't like experimenting on my body. Btw I know a guy who's like me but a bit more severe, still functioning (no wive/kids, a bit of a shut-in, with a good remote job) and he's not taking meds either. I guess it's about accepting who you really are.


Except this goes in your permanent record and increases insurance fees from then on. At least that is how it works in Germany. The only way to avoid this is to pay in cash. It‘s probably also a good idea to not bring your phone, so that there is no location tracking of you.


Yip, an similarly how many pilots with completely manageable temporal lobe epilepsy upgrade their diagnosis to trigeminal neuralgia.

Trigeminal neuralgia being impossible to refute and sharing the same medicine (tegretol).


With the exceptionally low amount of real detail in this post, I am left with the most salient question: How can it be on a permanent record at a company when all involved parties (except for you of course) are sworn to secrecy?

Given this critical center concern, your closing thought of location tracking (while relevant for a nation-state actor) pushes the whole thought process a bit over the line of sounding reasonable.


Pretty simple, if you visit a psychiatrist/psychotherapist you have to pay them somehow. One way of doing so is by using your medical insurance. So you hand over your medical insurance card, and now they know you’ve visited a psychotherapist. If at any later point in time you want to get work disability insurance or switch to private health insurance you have to disclose any preexisting medical conditions, since there is a record of you going to a therapist, they could otherwise retroactively find out that you got treated for depression and deny your claim if you have burn out.


> Except this goes in your permanent record and increases insurance fees from then on. At least that is how it works in Germany.

[citation needed]

Neither is true as far as I know. What do you refer to?


You will have to disclose the treatment if you apply for work disability insurance or switch to private health insurance later.


What are the implications of this? Will insurers cover time off due to burnout?


I would hope that maybe people will become more aware of work conditions that lead to burnout. Harassment is not OK anymore, so are a lot of other negative behaviors, maybe people will become aware of the dangers of overworking.


It’s guidance for diagnosis. Doctors can already diagnose whatever they want. This is just a step toward agreement on what “burnout” means.


I'm in Quebec, so it can be different, but when my SO had a burnout, all the doctors we saw said that there was no diagnosis for "burnout" and they had to declare it as a clinical depression. I guess it's different here because the government insurance is involved, but that was an issue for us.

Maybe she did have a depression though, it was quite a bit of work just to get a work leave for her, we had to see so many doctors. We didn't push to further afterwards and now that she no longer work at the same place, she is much better.


> This is just a step toward agreement on what “burnout” means

Which is really important. Right now it seems to me like we classify many different things with vaguely similar symptoms as burnout.


Hopefully corporate incentives will be more aligned to prevent burnout. In many cases, the employer should be at fault when this happens.


Not sure about burnout, but similar announcements sure do trigger some companies: http://www.koreaherald.com/view.php?ud=20190526000118


I feel it everyday. In addition to other comments, the following have been helpful. - Manage expectations. - Work for yourself. Learning time that sets you up for goodness a year down the line is good. But same repetitive work getting to burnout is not. I am taking objectives to be in the former. - Manage my time. I should not cry burnout if spending hours of time just browsing without objective. So far, been a failure at managing time, but successful at self-realization that I need to manage my time well. For example, I should not be here on hacker news instead of sleeping.


From the article:

> According to the handbook, doctors can diagnose someone with burnout if they meet the following symptoms:

> 1. feelings of energy depletion or exhaustion > 2. increased mental distance from one's job, or feelings of negativism or cynicism related to one's job > 3. reduced professional efficacy

Is there anyone here who hasn't had this ? I have this constantly, for almost a dozen years now. How is calling this a medical problem even remotely reasonable ? You're paid for your job, because it takes energy to do it ...


I think there are severity levels.

I think everyone's typical week has at least a couple of "OMG I hate this place!" moments that are related to a particularly difficult commute, a technical problem that crops up at a particularly frustrating time, repeated runins with a difficult coworker that you usually only have to deal with once a month, etc. But you're able to "talk yourself down" within a few minutes.

But when it's every day much of the day, it's a problem.

So where do you draw the line is the question.


> So where do you draw the line is the question.

That's the whole point: that's actually not the question. Read the diagnosis guide. There is no line there. None whatsoever.

Makes you wonder why we even tolerate psychiatric care ... https://en.wikipedia.org/wiki/Rosenhan_experiment

> Rosenhan's study was done in eight parts. The first part involved the use of healthy associates or "pseudopatients" (three women and five men, including Rosenhan himself) who briefly feigned auditory hallucinations in an attempt to gain admission to 12 psychiatric hospitals in five states in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and had to agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release.

I repeat "All were forced to admit to having a mental illness and had to agree to take antipsychotic drugs".

What

The

F


At my last job, I was getting paid $45k/yr and was expected to work 80-100 hours per week, on top of a 1.5 hour round-trip commute, because the other people on the team for the project were pulled to do other things that were deemed "more important", but the timeline for the project didn't shift at all, because it was also "vital".

There's a really great Usenix talk about burnout I stumbled across, and it so perfectly described what I was feeling, even down to the fact that I found myself drinking more and more each night just to be functional.

On paper, I took a pay cut at my next job, but I earned enough in overtime to more than make up for it, and I've gotten significant raises since then.


I find this sort of thing really destresses me. That may sound stupid, but stressfull is when your managers asks 90%, or 110%, 120%. You know, vaguely realistic. Just a tiny bit less, or more than you can realistically do. So that it really matters how you feel. An unpredictable illness (you or kids, or ...) can easily make the difference between delivering or failing. You start worrying if your breaks are too long.

When your manager asks 200%, there's zero stress. It's like someone pointing a gun at you demanding you lasso the moon. It's funny. Because you see, whether you get shot or not does NOT depend on whether you try. Therefore it's a sunk cost. There's no point worrying about it. In fact, there's very good reasons to be very easy going about it. No point shortening any break.

The same with your manager. He asks the impossible, and of course you won't deliver. So whatever will happen, has already happened. It does NOT depend on your level of effort. Whether you get blamed ... is already determined at that point. Whether you get fired ... is a done deal. No point worrying about it, as the decision is made. Find an online course, or watch some esports on Youtube. Put in the hours, but ...

It's no more worrying than the idea that an asteroid might be (in fact almost certainly is) on a collision course with the earth right now.


Is this true, though? Looking at the ICD-11 draft [0], burnout appears in chapter 24 which lists "factors influencing health status or contact with health services" but no proper disorders. This has already been the case since the release of ICD-10 [1]. So there doesn't appear to be a change.

[0] https://icd.who.int/browse11 [1] https://icd.who.int/browse10/2016/en#/Z73.0


Isn't burnout depression?


What about Bore-out?




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