Psychiatric Views on the Daily News - Episode 205
Burnout: likely not a result of isolation, despite claims.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
In the October 9, 2022 New York Times, an article asked, “What if burnout is less about work and more about isolation?”1 Certainly, isolation and loneliness are increasing problems with adverse repercussions in the United States. Yet, I and so many other physicians have burned out without isolation or loneliness being the major factor.
In the clinics where I did most of my clinical work in the early years of the new millennium, a time where I never heard the word burnout at work or elsewhere, I was surrounded by other people. Sometimes, to be sure, having other people around will exacerbate isolation because you feel psychologically separate or distant from them even though they are right in front of you. As I was burning out, I felt like that with some people, but closer to others who seemed empathic and compassionate. I also had close relationships outside of work, but that was not nearly enough to prevent burnout.
We also had hangout places in the clinics, a space where one could go to decompress and chat about lighter subjects. This was before the internet replaced so much live interaction. That space provided rest and connections, but did not alleviate burnout.
For those with such religious beliefs, the New York Times author asks: “So where is God in the midst of burnout?” The interviewee answer was: “I would say God’s where he always is. He’s right in the room.”1 If so, this may still involve feeling separate from one’s perceived God, but how is this really an isolation that causes burnout rather than a spiritual or moral crisis?
The article also makes the point that perhaps burnout could begin when you were 6 years old. There are personal historical vulnerabilities to burnout, like trauma or social anxiety, but these are not the major etiology. Besides, though having a therapeutic alliance with a clinician can reduce isolation, and is sometimes called bought friendship, it is not the recommended treatment for burnout.
The major causative factor of burnout, sometimes put at 80% of the variance, is a system that block one’s abilities to heal in medicine, raise a child in parenting, and other obstacles in other jobs.2 Perhaps the solution is so difficult that we turn to other explanations like working too hard, social isolation, or childhood problems. But I would predict we are going to be disappointed with the results, similar to what I wrote on October 3rd about another burnout etiologic myth, that of long hours.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Warren TH. What if burnout is less about work and more about isolation? The New York Times. October 9, 2022. Accessed October 18, 2022. https://www.nytimes.com/2022/10/09/opinion/burnout-friends-isolation.html
2. LoboPrabhu S, Summers RF, Moffic HS. Combating Physician Burnout: A Guide for Psychiatrists. American Psychiatric Press; 2019.