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I remember reading this published insight[1] from Marissa Mayer a few months ago:

Burnout is caused by resentment

Which sounded amazing, until this guy who dated a neuroscientist commented[2]:

No. Burnout is caused when you repeatedly make large amounts of sacrifice and or effort into high-risk problems that fail. It's the result of a negative prediction error in the nucleus accumbens. You effectively condition your brain to associate work with failure.

Subconsciously, then eventually, consciously, you wonder if it's worth it. The best way to prevent burnout is to follow up a serious failure with doing small things that you know are going to work. As a biologist, I frequently put in 50-70 and sometimes 100 hour workweeks. The very nature of experimental science (lots of unkowns) means that failure happens. The nature of the culture means that grad students are "groomed" by sticking them on low-probability of success, high reward fishing expeditions (gotta get those nature, science papers) I used to burn out for months after accumulating many many hours of work on high-risk projects. I saw other grad students get it really bad, and burn out for years.

During my first postdoc, I dated a neuroscientist and reprogrammed my work habits. On the heels of the failure of a project where I have spent weeks building up for, I will quickly force myself to do routine molecular biology, or general lab tasks, or a repeat of an experiment that I have gotten to work in the past. These all have an immediate reward. Now I don't burn out anymore, and find it easier to re-attempt very difficult things, with a clearer mindset.

For coders, I would posit that most burnout comes on the heels of failure that is not in the hands of the coder (management decisions, market realities, etc). My suggested remedy would be to reassociate work with success by doing routine things such as debugging or code testing that will restore the act of working with the little "pops" of endorphins.

That is not to say that having a healthy life schedule makes burnout less likely (I think it does; and one should have a healthy lifestyle for its own sake) but I don't think it addresses the main issue.

Then I finally realized how many times I've burnt out in my life, and I became much better into avoiding it. Which is really hard to do.

And it seems to me that this is one of the many points that Ben Horowitz talks about on his What’s The Most Difficult CEO Skill? Managing Your Own Psychology[3]

[1] http://iamnotaprogrammer.com/Burnout-is-caused-by-resentment...

[2] http://iamnotaprogrammer.com/Burnout-is-caused-by-resentment...

[3] http://bhorowitz.com/2011/04/01/what%E2%80%99s-the-most-diff...




" Burnout is caused when you repeatedly make large amounts of sacrifice and or effort into high-risk problems that fail. It's the result of a negative prediction error in the nucleus accumbens. You effectively condition your brain to associate work with failure."

A real definition of burnout! Everything else makes it sound so nebulous.

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Yep, I absolutely agree. I always thought Marissa's comment on burnout seem a bit off, and inaccurate.

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Marissa's definition is correct, although it applies mainly to super stars working for other people. That is the main way they burn out.

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Indeed! It sounds so simple and obvious now.

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Thank you for this! It totally reminds me of Feynman's spinning plates story:

http://www.physics.ohio-state.edu/~kilcup/262/feynman.html

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I came here to say the same thing.

And, Feynman had a gift at making these ideas accessible to the layperson. He is very missed.

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do you have any more of these stories you can recommend?

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There are more anecdotal stories like this in this book: http://www.amazon.com/Surely-Feynman-Adventures-Curious-Char...

Feynman's entire approach to life seems to be to "play" with it. He's an expert troll, the original pick up artist, nobel prize winning physicist, guest biologist, expert safe cracker, computer programmer, etc. His stories are fantastic, and a reminder that life is a ride. You should enjoy the ride, above all else.

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I work in security and I always cringed when I saw the, "nice job!", "+1", etc., comments on the various team email lists I have been on. I figured if it's a job well done other people will praise us and that there is no need to pat ourselves on the back. Thank you for helping me realize I was wrong.

So much of what security folks do everyday results in push back and delaying tactics that it eventually ends in failure or very small wins. It's easy to get burned out because of the perceived failure and I see the effects of it all around. Celebrating even the tiniest of wins makes complete sense.

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I think that's the most useful comment I've read on HN. For me working on the firmware for the Safecast Geiger counter was one of those projects. I guess this is one of the real benefits of hacking on some personal open source project too, you get a clear pay off which restores your belief in yourself.

Now if I could only find a few more projects like that...

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I definitely can relate to some of the points from your [1] source. I've noticed that my burnout levels fall when I'm working out on a regular basis. For me it's cardio and running that really helps. Also getting some sunshine now and again doesn't hurt.

Another biggie for me:

Unplugging from (stuff like) Facebook I think can also help prevent the false perception that everybody is having a way better time than I am. I think it's less effort to unplug than to have to constantly remind myself that everybody is putting on their happy faces on when it comes to social networking.

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The endorphins from working out really help -- I've gotten back into yoga and even at 20 minutes every morning, I feel like a more productive person, raring to take on the day.

I've found that there are people who just spam-post statuses to show off, garner attention, and/or put on their best face, but never really 'like' other people's posts or pay attention to their news feed. This behavior makes sense, because my FB news feed depresses me and augments any bit of subconscious insecurity I've willed myself to ignore. Except I deal with it by unplugging from FB, whereas the aforementioned type of person would overcompensate by ignoring the news feed, posting about their great life and garnering attention. This would be an interesting psychological study to read about.

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"On the heels of the failure of a project where I have spent weeks building up for, I will quickly force myself to do routine molecular biology, or general lab tasks, or a repeat of an experiment that I have gotten to work in the past."

I wonder what the equivalent would be for a programmer/software engineer? Prototyping? Proof of concepts?

I often find myself spending a lot of time on a new framework/architecture only to realize it didn't really accomplish the task at hand.

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Even simpler. Cleaning up code, fixing minor bugs, (simple) performance optimization, etc. Small things that add some value and are almost guaranteed to succeed.

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What I have started doing is working on a vastly reduced version of bigger projects that I want to accomplish. You could call them prototypes, but I try not to saddle myself with the baggage of the larger project...

I use the larger project as a starting point for deriving the smaller project, but once I've got the small project defined, I do my best not to be hindered by the larger project ideas and just work the smaller project by itself.

I try to make it small enough to finish in a weekend.

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Here's the old discussion thread on the "Burnout is caused by resentment" article:

https://news.ycombinator.com/item?id=3767931

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Nice read! It makes a lot of sense too.

We developers could probably do something as small as working on a projecteuler.net problem for 30 minutes at the end of a rough day.

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Unlikely to work as you probably don't see that as work therefore you're not fighting the link between work and failure.

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Your nucleus accumbens isn't necessarily very smart, and isn't necessarily segmenting its world into "work" and "not work". "Work" here is a poor term in this context, it's an English word and subject to a lot of ambiguity. It might be somewhat more accurate to rephrase that as "You are training yourself to believe that all effort is futile", effort towards anything, which is why you end up just staring into space. Or perhaps not, who knows what the truest truth is, I'm really more saying that I doubt that part of your brain sees "work" as you were using the term.

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I think it depends on the individual and how they see work, how one aspect of their life leaks into another another and so on.

Speaking personally I know that even when I'm stressed at work I still know the difference between tasks carried out as part of my job, and tasks carried out which are potentially similar, and which may be being carried out in a work setting, but which are not work.

Don't get me wrong, if I feel work is going badly, doing something else and being OK at it is almost certainly a good thing, I just think that doing something work related and doing it well is probably better.

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Not true. If you code and solve problems at work, and fail spectacularly, you don't want to try and solve more problems. The brain is very good at generalizing stimuli: having your code compile is like a programmer's own little Skinner box. So if you can find problems in other domains and solve them, you'll still enjoy programming and solving problems.

I do agree that you need some successes at work, though. If you were doing really well in private, but everything at work was going wrong that would cause problems.

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Very nice analysis. Thanks for sharing it.

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>>The best way to prevent burnout is to follow up a serious failure with doing small things that you know are going to work.

If you are making large amounts of sacrifice towards high risk problems and failing. You are likely doing something wrong and merely backing them up with 'small wins' is not going to help and shouldn't help.

The best thing in that case is to really burnout and quit, to do things that are better rewarding.

There is nothing you are going to gain being stuck in a situation of large sacrifice-zero gain. In many such cases you are likely a victim of office politics, bureaucracy, red tape or just stuck amidst inefficient team mates. Doing small wins and maintaining the status quo will trap you much deeper and cause a far bigger burnout later.

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>>For coders, I would posit that most burnout comes on the heels of failure that is not in the hands of the coder (management decisions, market realities, etc).

Maybe you missed that section of the quote; for me, it rings true. At times I have been in situations where I am sacrificing time for projects that are poorly managed, and it doesn't really matter that I'm doing everything right.

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If you AREN'T making large amounts of sacrifice toward high risk problems, I'd say you're doing something wrong.

Startups are a perfect example of this. We see serial entrepreneurs fail spectacularly (see Color), we read about entrepreneurs who kill themselves after a string of failures, and we read all of the time about the new guys and girls who tried their hardest yet never managed to take off. People like to write about "why my startup failed", but they are hurting a lot more than they let on.

Entrepreneurs shouldn't be risk adverse. If you want risk adverse, go work at Google. At the same time, we should understand what it means to live in high risk mode, and learn to recognize warning signs (depression, burn out, loneliness, etc.) in ourselves and others so that a high risk lifestyle can be manageable and even healthy.

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(Side note: Google's probably the wrong example if you want risk adverse. Projects fail all the time at Google. I would've picked a big company like IBM or Cisco, where I've heard you tend not to try at all.)

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The other side of risk adverse isn't apathy. At a big company, if you're smart, work hard, and do what tasks are assigned to you, chances are you'll have a long and profitable career. Fresh out of school, a smart and motivated engineer could expect to make say $750,000 - $1,500,000 over five years working there, with almost no personal risk. Over their career, at present value, probably pushing to $10 million.

If you start a company, however, your returns vary extensively. If you're smart and dedicated after five years you might come out broke - or even in debt. Or you'll come out being barely able to make the rent. Or you'll be a millionaire or billionaire. As an entrepreneur, your risk five year returns would be somewhere between -$100,000 to $10,000,000+, with the expectation I would guess quite a bit lower than the Googler's.

That's not to say that either is the right choice - mathematically, the big corporation choice will make you more money in the expectation and probably take less of your time. But you know, life's not about optimizing the integral of income over your career.

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I'm saying that "At a big company, if you're smart, work hard, and do what tasks are assigned to you, chances are you'll have a long and profitable career" is false, at least at Google. If you're smart, work hard, and do what tasks are assigned to you, you'll top out at SWE3 with a salary in the low six-figures. Getting promoted to Senior SWE requires selecting the right projects and some degree of leadership and organizational awareness. Getting promoted to Staff or above also requires sticking your neck out to promote some initiatives that may be controversial, and convincing people to go along with you. This is not all that different from the skillset required to be an entrepreneur.

That's why I suggested picking a big corporation with more of a reputation for "doing what you're told", like IBM, Cisco, or even Apple. Google in a couple years might be there, but right now you cannot get to the higher engineering levels without sticking your neck out on an initiative that may be controversial at first.

(It's also true that the risk/reward curve is flattened a bit at Google than at a startup: at Google, you're still being paid a relatively fat salary if your high-risk project fails, you just don't advance. And if it succeeds, you end up with a raise and a promotion, not F-U money [usually]. But this article is about the emotional aspects of failure, not the financial ones, and those are still just as relevant at fast-growers as at startups.)

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You need to strike a balance. I'm not saying you shouldn't make large amounts of sacrifice at something(Not just start ups), but you also need to do move on to something else if despite everything and many attempts things don't work out.

Being stuck in the status quo will eventually make your problem much worse. You will continue much more sacrifices without achieving nothing in the end.

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I apologize, I believe I misread your original post as being risk adverse. Absolutely agree with you here though - striving to fail fast is perhaps the one bit of startup advice that is nearly universally applicable.

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our modern goals could be on too large a time scale for our brains to understand; that is interesting w.r.t. gamification as well.

I experienced a purely physical burnout, which could be related to lack of sleep/dreaming or some kind of neurotransmitter depletion. It's a distinct sensation that seems to build exponentially so I am very touchy about this in my older age (30s). If I feel it coming on, that's the time to crack a beer.

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No. Burnout is caused when you repeatedly make large amounts of sacrifice and or effort into high-risk problems that fail. It's the result of a negative prediction error in the nucleus accumbens. You effectively condition your brain to associate work with failure.

Wow. Fuck. That is spot-on. Just... fuck! You nailed it.

I feel like I've been badly conditioned over the past few years. I've worked on failed software projects (only one my fault, years ago and I didn't know what I was doing) and in bad managerial environments, and I've never experienced team synergy or symbiotic management-- I know it exists, but it hasn't been my experience. Yet as an almost-succeeded creative writer, I'm really good at kvetching because I can capture peoples' complaints in a way that almost no one else can. I'm terrified of conditioning myself out of tech just by being so much better at kvetching (I can write a top comment on almost any forum).

I don't failure is that bad. I'm old enough to realize that good ideas fail for all kinds of reasons, and that it's pointless to get married to an idea, a project, or even a job. I can hack failure. It comes with the territory. Scrap the old project, start a new one. Most people who achieve great things were much bigger failures than I am, up until a couple years before the "overnight success".

What really drives the nail in is the low social status that comes with failure. Project cancelled? Ok, fine. Is it a transfer or a layoff? Just let me know and be fair about it, and we're cool. Lose a job? That happens. Dealing with humiliation afterward-- applying for subordinate roles for which I'm way overqualified, having to go through 47 goddamn phone screens for each company just to prove I'm not an idiot-- is harder. It doesn't help that we're a tribe (technologists, software engineers) with extremely low social status (especially per IQ point) in comparison to project managers and bike-shedding executives.

I don't know that it's the association of hard work with failure itself that's so devastating, but the association of it with low social status is, I think, what drives so many people out of our industry before age 35. Project failure would be okay if it wasn't so devastating to our social status, especially in an industry where ageism begins at 27. Then, we see people of mediocre talent and work ethic getting ahead (including $200M+ acq-hires) on social polish and it's just more demoralizing.

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The people in the know now understand that what we call "burnout" is not a psychological disorder at all, but sub-clinical[1] adrenal fatigue caused by stress, period. In other countries with superior medical system integration, like Austria/Germany, this is an accepted medical fact.

If you stress out a rat long enough, its adrenal glands will actually bleed. If you stress out a human long enough, you cause first a huge ongoing spike in cortisol etc., and later, a serious drop as the damage is done. This can be measured easily using a 24-hour cortisol saliva or blood test, but it rarely is. (Related hormones: DHEA, thyroid).

Symptoms of burnout are just like the symptoms of CFS/low thyroid because they are part of the HPA (Hypothalamic-Pituitary-Adrenals) Axis. They're tightly coupled.

While short bursts of endorphins will make you feel better, the effect will be temporary. Endorphins will not make your adrenal glands or thyroid work again. Instead, they mask the symptoms… but only for a while. There are only three ways to get better: Dramatically cut stress. Wait. Take medication. Pick 2.

[1] "Sub-clinical" usually means "not measurable," but in the case of "burnout" and adrenal fatigue, it is absolutely measurable. However, I call it sub-clinical because of the way most doctors think of the adrenal glands. Most doctors believe that the adrenal glands are binary: they are either working perfectly, or totally non-functional (Addison's disease). Unless you're on the verge of death from lack of cortisol, they will tell you you're fine.

If you have burnout, get your 24-hour saliva test. Take your morning temperature with an old-fashioned thermometer under your arm for 10 min. Look up the other symptoms of adrenal fatigue and hypothyroid. There's plenty of research published about how burnout is measurable and related to the HPA axis -- you don't have to take my word for it. There are lots of support groups, too, where the sufferers have often presaged the research.

And for god's sake, stop telling yourself it's about failure or investment or whatever and stop stressing yourself out, period, or you can get like I am and it can become permanent.

EDIT: If you google "burnout syndrome" you will read several sources claiming that there is no proof it's a real thing. This is 100% false. They also say it's not accepted by the medical community, but rather a quacky way to sell supplements. It's true that most doctors are unaware of the research, but the ones who do treat it with real medicine (see below).

It's painfully easy to say "There's no proof" but a 5-minute search of Google Scholar shows otherwise:

http://www.psychosomaticmedicine.org/content/61/2/197.short (from 1999!)

http://psycnet.apa.org/index.cfm?fa=search.displayRecord&...

http://www.sciencedirect.com/science/article/pii/S0022399999...

http://www.psychosomaticmedicine.org/content/62/2/286.short

http://gimle.fsm.it/28/1s_psi/05.pdf

The theories from doctors who've spent their lifetime researching it go as follows: Burnout happens in stages. In the early stages, cortisol etc. are elevated. In the later stages, the "fatigue" sets in, and cortisol is too low. I personally spent 3+ months in low-cortisol hell and it was the most awful time in my life… and there have been some really bad times in my life. .

And there are quite a lot of endocrinologists etc. who will treat low-testing cortisol patients with hydrocortisone, isocort or florinef or other drugs which are not "supplements" by any stretch of the imagination.

IF you are stressing yourself out, and IF you keep going down that road, this is what you have to look forward to:

Being unable to get out of bed. Being unable to make the simplest of decisions without feeling like you're having a panic attack. Being unable to read, because it's too much information at once. Being unable to watch TV shows that have too many "facts" in them. All of the above -- including simple questions of "What do you want for lunch, honey?" -- triggered panic-like attacks in me, who'd never had a panic attack despite years of physical and emotional abuse as a child. It was like being surrounded and squeezed and shouted at by a million people all at once, just to try to listen to my lunch options. That is because cortisol is required to rise to the "stress" of every day living… standing up from sitting is a stress, making decisions, etc., all create tiny spikes of cortisol to help you cope. If your cortisol is too low, you are screwed.

Is there any "victory" worth a life like that? Can you even call that a life?

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> Being unable to get out of bed. Being unable to make the simplest of decisions without feeling like you're having a panic attack. Being unable to read, because it's too much information at once. Being unable to watch TV shows that have too many "facts" in them. All of the above -- including simple questions of "What do you want for lunch, honey?" -- triggered panic-like attacks in me, who'd never had a panic attack despite years of physical and emotional abuse as a child. It was like being surrounded and squeezed and shouted at by a million people all at once, just to try to listen to my lunch options.

Holy...! You have described my current condition even better than I could. Interestingly, I just came back from a doctor who, after reviewing my blood tests(standard blood tests), said that there wasn't anything wrong with me and my issues were lack of exercise. Which may be true, but getting out of the bed currently IS an exercise for me. It is getting better though, two months after quitting my job - I can even enjoy Hacker News again.

Since you've gone down this path, what would you suggest? I am having a hard time convincing any doctors to do a more complete examination. I was going to focus next on sleep disorders, but now I think it might be worth talking to an endocrinologist...

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I've been through something very similar to this as well and it was a severe depression for me. It was due to pushing myself too much while going through chemo, but it's possible that it can happen with any major life change (like leaving a job). I wrote about my story of depression http://jensablelopez.com/depression-what-summer-made-of/ - not sure if that helps at all.

But I agree with others, go see a different doctor. Perhaps try a Naturopath. They'll help you without giving you drugs.

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jennita, I'm glad you're feeling better now. I don't mean to belittle your experiences whatsoever, because depression is a terrible thing. I just want to explain:

You wrote your husband was able to "force you" to get out of bed (good man) and brush your teeth and do sit-ups etc.

When I say "I can't get out of bed," I mean if I stand, my heart rate doubles, it feels like the "bottom falls out" of my head, the world starts going dark, if I do not sit down I will faint, I can't lift my arm above my head to brush my hair, etc.

No amount of "forcing" could have made me stand up and brush my teeth. When I was over the worst of it, if I would walk two or three blocks to the store, I would feel like I had been hit by a truck for days afterwards. Even years later, I came within a hairs' breadth of passing out doing nothing more strenuous than walking around the ground floor of a museum. Never before in my life had I ever fainted, before I got sick. This is a physical ailment, caused by low blood pressure, disordered autonomic nervous system response, a lack of muscle energy replenishment that is characteristic of CFS/FM, etc.

You also wrote that you couldn't stop thinking. When you have what I have, thinking is almost as difficult as physical activity.

Depression vs CFS is the difference being out of gas, and an engine that is rusted solid.

That doesn't mean your experience wasn't equally terrible in different ways. Your car still wouldn't go. It's an issue of terminology, we only have so many words.

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Dang :( I'm really sorry you have to deal with this. I've definitely not been through anything like that. Thanks for explaining it better, I really had no idea what it was. (I also just googled it and am reading more about it) Don't worry, I hope it didn't bother you that I tried to relate to it. I do hope you can find a way to get better though!

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No worries at all. I haven't had to go through chemo, so I'm sorry you had to go through that! That must have been terrible. We've all had our problems, and nobody was saying "Mine is worse!" -- I know you weren't, and I certainly wasn't, and hopefully it didn't sound like I was.

Like I said… I blame the lack of words!

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haha let's hug it out! :D

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Unfortunately there is no standard blood test for CFS/burnout. I agree with Amy that cortisol might be useful, but the problem is that it isn't always a reliable indicator of illness.

Anyway, just keep doing what you are doing and you will gradually recover. For more info, see: http://www.mind-body-health.net/recovery.html (a site I developed 10 years ago after recovering myself).

Unfortunately this is a very misunderstood area of medicine because doctors (and patients) like to pigeonhole illnesses as either physical or psychological, and psychiatric/psychosomatic illness has a very bad negative stereotype.

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Thanks for the link.

> Unfortunately this is a very misunderstood area of medicine because doctors (and patients) like to pigeonhole illnesses as either physical or psychological, and psychiatric/psychosomatic illness has a very bad negative stereotype.

That is, in fact, what I was trying to do. I actually said that to one of the doctors (something along the lines of 'I want to rule out physical issues first').

Thanks again. I'll write about it and submit to HN once I have finished climbing out of the hole :)

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There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them.

If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your average temps deviate by more than 0.2 F from day to day; if you have post-exertional malaise… you have an HPA malfunction of one kind or another.

I'd say "you should also get your thyroid checked" but the blood tests for that are atrociously useless. Check the symptoms. Low body temp, especially in the morning before you get out of bed (mine ranges from 96.5-97.4), slow heart rate if you're not an athlete (mine is 50-60 bpm and I am NOT an athlete!), puffy face/eyes, myxedema (non pitting) swelling/thickened rubbery skin on your upper outer arm or shin, changed ankle-tap reflexes, very cold extremities, Raynaud's phenomenon, etc., those are the signs that are actually diagnostic of a thyroid insufficiency.

These are how doctors have diagnosed and treated low thyroid successfully for a hundred years. The blood tests are a new thing but they aren't very indicative of actual dysfunction (or function).

All of the above is like a lot like low blood pressure. Low blood pressure is only defined by numbers when it becomes dangerous to life. Otherwise, you're diagnosed with low blood pressure if your blood pressure is "normal" or below and you have symptoms. E.g. I have low blood pressure at 100-110/60-70 even though that's considered just fine, because I feel faint when I stand up and other symptoms.

Generally, the best resource I've found is _From Fatigued to Fantastic_. It helped me get much, much, better.

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While I agree with most of what you say, the problem is that a lot of studies have been done on the HPA axis and cortisol in CFS/burnout, but there is no agreement. Some studies find low cortisol, others don't. There is definitely HPA axis dysfunction, but nobody can seem to pin it down. I suspect that if you measured cortisol throughout the day and correlated it to a symptom diary and/or a stress test, you might be able to come up with a diagnostic test.

The other issue is that there is no cheap and easy cortisol test like there is for blood glucose. As far as I can tell it would be possible to develop such a test, but nobody has done it yet for a number of reasons (lack of demand, cost, FDA approval, etc).

If someone were to [1] figure out a definitive test for burnout/CFS and [2] develop/patent a home testing kit they would be very rich and help a lot of people into the bargain.

As for Teitelbaum: while he does have some useful stuff to say, he also peddles a lot of quackery.

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Re: the contradictory studies… if you go with the group of practitioners who argue that there are different stages to the disorder, they're not contradictory at all. The stages argument says a person starts off with very high cortisol output (because you're under stress) and this is what causes the damage and fall-off of production later:

http://www.ncbi.nlm.nih.gov/pubmed/10633533

The 24-hour saliva cortisol test costs about $100 and should tell you a lot:

http://labtestsonline.org/understanding/analytes/cortisol/ta...

There are definitive clinical (non-blood) tests for hypothyroid (I mentioned several of them), there are also ways to test for FM/CFS (muscle recovery among others). They just don't get used a lot.

As for quackery -- the only quackery I read in Teitelbaum's book was about the allergy treatment and it's not any more or less quacky than acupuncture (where the research was discredited) so I consider it harmless. Every "canonical" scientist has some kind of nutty side, from Isaac Newton on down the line. (Note: Not comparing Teitelbaum to Newton whatsoever. It's just an ideal, extreme, example.) Everything else in his book is supported with research citations. I've checked them, and others, because I followed his advice.

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When you list ranges of temperatures you should indicate the body part that is being tested, because an oral temperature reading will be different than a rectal reading. Also, the temperature readings you gave are slightly inaccurate; this [1] says that the maximum oral healthy early morning temperature is 98.8°F, and 99.9°F overall.

[1] http://jama.jamanetwork.com/article.aspx?articleid=400116

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Sorry if I forgot to say: Axillary basal temperature. That is, under the arm, measured for 5-10 minutes, with a glass thermometer or electronic one that'll let you keep measuring that long. If that's higher than 98.6, you really should be evaluated for hyperthyroidism. Doesn't mean you DO have it. It CAN be a healthy temperature. But it's a possible symptom.

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Amy will almost certainly have more/better advice, but I'd say:

1. Do something for fun/relaxation other than read HN. 2. Find a doctor who will run the tests you want. You're the customer.

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Get the book _From Fatigued to Fantastic_. The "standard" tests your doctor would ordinarily order won't show jack. (See my comment below for more specific test information.) This book is the single best resource I have found. Even if you don't technically have full-blown CFS, it will probably be able to help you.

The five things that made the biggest difference in my life: Trazodone (Desyrel) to fix my constant waking at night, melatonin to work against the delayed sleep phase syndrome, magnesium/ATP/d-ribose to ease the excruciating muscle pain, B-vitamin complex for energy, and lots and lots of electrolyte supplementation to help with the POTS/low blood pressure.

Does your heart race when you just stand up? Doctors are famous for telling you that you just need exercise. I told mine that my heart rate doubled when I stood up (a classic symptom of POTS), and he said "You're just de-conditioned." I told him, "I wasn't de-conditioned three months ago before I got sick, and I was exercising every day. Tell me how I de-conditioned from being able to do aerobics, walk around and climb things to being unable to stand up in 60 days." and he just shrugged. Asshole. I discovered much later that electrolytes solved the worst of that particular symptom.

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My main take away from what your are stating is that it doesn't matter whether you succeed or fail at something, it is whether you are running the engine too hot for too long.

Stop, breathe, relax, pace yourself.

One can burnout after a failure as quickly as after a success. However, one might want to get back on the stress train quicker with a success, since one expects a victory rush at the end of the stress which apparently made the stress worth it.

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That's a great way to put it.

Yes, positive stress can cause it just as well. I had met the love of my life, traveled to Europe 7 times over a year, gotten married, moved to a foreign country I loved… and founded a new business. Life was pretty good.

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Having experienced burnout and resulting chronic fatigue syndrome (which is really just an extreme version of burnout that persists long after the stress has ended), I pretty much agree with everything you say. However it's incorrect to say that burnout is physical rather than psychological as psychological factors do play a large part in determining whether or not you experience burnout.

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Yes, CFS has a psychological component… In the way that, if X happens the same to you and me, and you don't care, but I do, then my adrenals/thyroid go into overdrive, yours don't; I get sick, you don't. Some people get CFS because of minor stress, some people don't get it until their life is a living hell. That's the psychological aspect of it.

But that doesn't make it a psychological disorder in any way, shape or form. Mind and body are just simply not separate. I have been depressed in my life. I was not depressed before my illness or even during it, except the natural kind of mourning a person goes through when suddenly they can't even stand up.

I'm sure lots of people have concomitant depression, since so many people are depressed, period. But many also do not. (I'm one of them.)

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I'm more interested in understanding what is going on in the brain/body rather than arguing over terminology. Both psychological and other factors seem to cause burnout/CFS, although psychological factors do seem to be the most important. Depression is a resulting symptom, not a cause.

Stress and burnout affect different people in different ways: some people get depressed, others develop chronic pain (fibromyalgia, ME), others have chronic fatigue etc.

As for the psychological factors that seem to be important: motivation, goals and emotions all seem to play a large part.

While you're correct that CFS is not entirely psychological (functional would be a better term), it does appear to be mostly caused by psychological factors. If you look at the main triggers for CFS they are: job stress, relationship stress, and viral infection - and there is some doubt as to whether the viral infection is a cause or just a symptom of a weakened immune system.

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If I am depressed and jump in front of a train, or if I think that's a safe and normal thing to lie on the tracks, or if somebody pushes me, or if I trip, the result is the same: Splat.

There's little point in saying "Splats are primarily psychological" if accidents and mistaken facts seem to be at play often enough. Or if people splat other ways (e.g. in car crashes, tightrope accidents). The result is the same. Splatty splat splat. The outcome only tells you so much.

I can tell you one thing: Totally overhauling my "motivation, goals, and emotions" did absolutely diddlysquat in making me better because while I started off with a combination of routine infection and "psychological" stress (which, of course, is a kind of misnomer because you can measure it with blood tests)... it did permanent damage to my mechanicals. Splat.

Also, a lot of doctors think FM/ME/CFS are the same thing. And a lot think adrenal fatigue/hypothyroid and CFS are the same thing. Maybe they are separate but cause each other.

Genetics certainly play a part; hypothyroid is incredibly heritable, for example. It causes lots of the same symptoms and may be a symptom/cause (or both) itself.

But nobody claims that hypothyroidism is psychological, not even slightly, much less primarily.

But the cause for an individual almost doesn't matter. You have to cut stress no matter whether it was a primary cause for you or not.

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Amy, this is great. Thank you!

> cortisol is required to rise to the "stress" of every day living

So stress seems impossible to avoid completely right? There's going to be some amount of it. When an email comes in about some snafu in the thing I'm making I can't avoid a spike in cortisol right?

What's the smartest approach to managing it? I seem to do typical things like working out, etc. But I also love working. Should I be somehow measuring cortisol and when it gets above X level, I need to take some action to reduce it? This seems like a hard thing to do right, if I'm just going by gut instinct to check where I'm at.

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There's a spring drizzle, and then there's a hurricanes, both of which you can call "rain." One makes flowers come up, the other crushes and rips the flowers out of the ground. So. "Stress" is not a good conversational word for what happens when you go from laying in bed to standing up. But it is the technical term.

I loved working, too. I'd work when I was moderately ill. I'd work long hours. I was enjoying it… mostly. That is no protection.

If I'd dropped certain responsibilities, rested when I was sick, worked fewer days, and cared less [1], I probably wouldn't have ever gotten this bad.

That's about all I got for you. I don't know all that much about that stage of the syndrome because I never had any tests at the time. I would get sick, take some of the time off, then get right back to it. Nobody was forcing me. When not sick, I would need to take several days off in a row to relax and then I'd find myself more creative again. I guess that was a sign.

If you can get the test for cheap, why not? But it'll only tell you trends compared to yourself, unless you are either very high or low. There's info on the Stop the Thyroid Madness site about reliable labs.

[1] (By "cared less" I don't mean "stopped caring about my work/life" but rather "stopped caring about stupid shit" which, believe it or not, is most of it. But that's not something you can understand until you've experienced it. It's great to know just how little what I do matters. Very freeing and not at all demotivating.)

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Similar to learned helplessness. Maybe Nietzsche wasn't so far off after all when he identified resentment as the scourge of civilization...

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