A medley of complaints and treatments

A medley of complaints and treatments

Catharina Pijls lecture on burnout

12-01-2023 · Background

Do burnouts actually exist? That might be a strange question, considering the number of burnt-out employees staying at home. But how is it possible that psychiatrists don’t know the diagnosis ‘burnout’ at all? These questions are answered by researcher Christiaan Vinkers during the Catharina Pijls lecture, organised by Studium Generale.

In 2021 it appeared that 1.3 million Dutch people were suffering from burnout symptoms. This comes down to one in seven, announced TNO and CBS (Netherlands Statistics) in November. These ‘patients’ spent eleven million days at home sick, costing employers three billion euro. 

These are bad tidings that come up several times a year. They are often based on online surveys with sometimes no more than five questions. What good is that to us? As good as nothing, says Christiaan Vinkers, psychiatrist and professor of Stress and Resilience at Amsterdam’s UMC. Even better, as far as he is concerned, it is time to stop with all those surveys. 

Why? Because there is not a single link between burnout symptoms and a burnout. That might sound illogical, but research shows that anyone showing symptoms does not run a greater risk of absence through illness due to a burnout. Most of them feel some stress or fatigue, from which they simply recover after a while. 

Losing control

It is one of his claims in his book ‘In de ban van burn-out’ (Under the Spell of Burnout), published last year, in which Vinkers refutes the suggestions about a washed-out working population. To start off, it is unclear what a burnout is; there are more than 142 definition circulating. Moreover, it is impossible to diagnose. There is no such thing as a reliable test or list of clinical questions.

Nevertheless, one can come home with the diagnosis ‘burnout’ after a visit to the GP. In that case, you have suffered from stress and suboptimal performance, combined with loss of control or feelings of powerlessness, for a period of at least six months. These criteria were drawn up by GPs for pragmatic reasons, says Vinkers. They need to do something with all those patients they see during surgery hours. But there is no scientific proof for the criteria. 

Psychiatrists don’t know the diagnosis; it is not included in the originally American psychiatrists’ bible DSM. According to Vinkers, Americans, who were the first to record burnout as a phenomenon in the nineteen-seventies, look at it completely differently from Europeans. They don’t see it as a disease, but as a social phenomenon. 

Hypnosis

It is also far from new or typical of our times, Vinkers writes. Around 1900 many people suffered from a disease that doctors hardly knew what to do with. It was recorded as neurasthenia and manifested itself – just like a burnout – in exhaustion, nervousness, angst and gloominess. Even then, people put it down to the high pace of the 19th-century society, with the advance of industrialisation, the cars that started to appear on the streets, inventions such as the telephone and telegraph. 

Exactly how many people were suffering from neurasthenia was unclear, because this also had many definitions and interpretations. The illness was mainly the domain of neurologists and psychiatrists, but because so many people suffered from it, they could visit many practitioners. A real ‘neurasthenia market’ emerged, Vinkers writes, “where medical advice, technology, remedies, cures were recommended and sold”.

Vinkers sees the same proliferation on the present burnout market, where some patients fall into the hands of self-proclaimed experts. Vinkers tested this out and pretended in e-mails that he was an overworked manager. The recommended treatment varied from hypnosis, a 4D treatment with neurofeedback, coaching in nature, to being hospitalised for a number of months.

Impotence

Vinkers emphasises that the patients’ symptoms and suffering are definitely real, but that at the same time one cannot make head or tail of it. He refers to it as a "medley" of things such as angst, fatigue, gloominess, sleeping poorly, irritability. Many psychiatrists label it as a depression or anxiety disorder.

Remarkable is the fact that the lower educated often receive the diagnosis ‘depression’, while the higher educated are diagnosed as suffering from a burnout. According to Vinkers, this cannot be separated from the connotations of both terms. A depression is easily linked to a character weakness, while a burnout would be the result of working too hard, of dedication, of tremendous effort. 

To give patients better treatments, more research is needed, says Vinkers. Scientists must go back to the drawing board, preferably in teams with representatives from different disciplines. What are the specific characteristics of people who are burned out? And what does that mean for the diagnosis? 

Or will it not come to that? Despite its popularity, neurasthenia disappeared fairly quickly after the first World War. The concept was too vague and the list of symptoms became longer and longer, including desperation, obstipation, impotence and migraine. Whether burnouts will still exist in a number of years’ time? Well, according to Vinkers, little to nothing can be said about that.

The lecture by professor Christiaan Vinkers is on 12 January, 20:00 hrs, in the auditorium on Tongersestraat 53

‘In de ban van burn-out’, by Christiaan Vinkers; Prometheus publisher, price 23.50 euro