gms | German Medical Science

Theo R. Payk

Burnout – Basiswissen und Fallbeispiele

Psychosozial-Verlag, Gießen

year of publication: 2012, pages: 84, € 12,90

ISBN-13: 9783837922592

As part of a seminar for medical students at the University of Frankfurt, students were asked to collect differential diagnoses for a 16 year-old teenager who was suffering from a sleeping disorder, exhaustion and the acute onset of concentration problems in school and who was presented at the hospital outpatient clinic. As usual, the students came up with surprisingly good ideas: thyroid disorders, substance abuse, depression, PTSD, Lyme disease. Finally, a group of highly motivated students came to the conclusion that the teenager was most likely suffering from “burnout syndrome“, since the symptoms occurred after switching to an elite private high school.

“Burnout“ is an expression that is not uniformly defined and therefore difficult to get a grasp on and one that has been used more and more frequently in clinical settings over recent years. Patients, the media, and medical students often use the term as if the meaning were self-evident, and physicians (including the author of this text) have been annoyed and challenged by the inflationary use of this expression. Getting the facts straight appears necessary.

Written in a down-to-earth manner, this brief, practice-oriented book "Burnout – Basiswissen und Fallbeispiele" presents some valuable information on the phenomenon of “burnout“. The author, a professor emeritus of psychiatry, has most certainly seen some diseases come and go during his professional carreer (e.g. neurasthenia and chronic fatigue syndrome). His many years of clinical experience are obvious on all 80 pages of this book. Despite this, after reading the book some points remain unclear. In the beginning the author plausibly criticizes the concept of the disease and the one-dimensional etiological view that is part of the expression “burnout“ (disease-causing exhaustion resulting from the conditions of modern working life), but in the subsequent chapters (“Wie erkennt man Burnout?“ and “Burnout oder Depression?“), the author considers diagnostic and differential diagnostic aspects as though he is already fully convinced of the existence of an independent disease identified as “burnout“. This is puzzling to the reader. The chapter “Was sind die Ursachen von Burnout?“ presents interesting and intelligent insights as to why the putative diagnosis has spread in our society in such an inflationary way. A review of the socio-historical context regarding the increased expectations of people concerning the quality of work and life, the dimensions of modern poverty, and the impact of reduced familial and spiritual ties on mental health show the multiple facets of this topic. Of interest for clinical work are the differential diagnostic comments by Professor Payk: clinical depression, adjustment disorders, somatoform disorder, bipolar disorders (with increased ability to perform during manic episodes and possible feelings of being burnt out in the subsequent depressive episodes). The importance of somatic diagnosis is also emphasized by Professor Payk: tumors, chronic infections, blood diseases, metabolic disorders. Ultimately, the target group for this short book remains unclear to the reviewer. Concrete guidelines for physicians and psychotherapists are certainly missing. Most likely, the book seems suitable for affected persons of an educated background along with their family members, but this group could possibly be disappointed by the therapeutic recommendations in the chapter “Was tun gegen Burnout?“, as these are mostly abstract (promoting the social environment, physical activity, creativity, etc.).

Some complex, but seemingly important aspects are missing from the book or are insufficiently considered: patients appear to see an unstigmatized, figurative notion in the expression “burnout“ that can be easily abstracted (“to be burnt out“), whereby the actual cause of the disease is mainly external to the individual patient. The existing mental “weaknesses“ are justified to oneself and others through the previous motivated, enthusiastic and selfless activity. Thus “burnout“ primarily presents a subjective disease model that should be taken seriously in routine medical work; however, not one that should be taken directly from the patients, but rather must be examined critically in terms of differential diagnostics. For medical professionals the main problem is the lack of a universally applicable definition. Moreover, the disease classification in modern psychiatry (ICD-10, DSM-V) only very simply describes typical constellations of symptoms without speculating about the causes. Therefore, the use of the expression “burnout“ by medical specialists seems to be a step backwards. On the other hand, patients seem to have different needs, which should also be taken seriously. Very likely, doctors can learn some important lessons about the patients’ point of view from the wide success of the expression “burnout“. (Do we need new, unstigmatized designations for disorders? Do patients need a better understanding of the causes of their disorders and how we can communicate this to them?) Departments of preventional medicine and company doctors need to confront the question of how working conditions should be (e.g. in hospitals) in order to maintain not only physical, but also mental health. For all practitioners, the challenge will be not to blindly accept the expression “burnout“ or to demonize it.

In summary, this brief book by an experienced physician offers informative reading, but is unable to dispell the confusion in the professional sector. For this, the critical reviewer recommends the up-to-date position paper of the Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) on the topic of burnout from March 2012. (Available free of charge on the DGPPN website:

http://www.dgppn.de/fileadmin/user_upload/_medien/download/pdf/stellungnahmen/2012/stn-2012-03-07-burnout.pdf)

This position paper offers helpful clinical instructions for handling the phenomenon of burnout. However, even in this text some questions remain unresolved, leaving the continuing discussion surrounding burnout exciting and full of suspense.

The author declare that he has no competing interests.