Flame of fire

Burn burnt burnt – burn-out

The world health organisation (WHO) is currently working on the latest update of its international classification of diseases (ICD). The ICD is used world wide by medical staff to diagnose patients (and by health insurances to bill them right afterwards). The term burn-out is listed in paragraph Z73.0 in the current 2010 version of the ICD under section Z73: Problems related to life-management difficulty:

2010 ICD-10 Code Z73.0 Burn-Out: State of vital exhaustion

The definition seems to change slightly, taking the ongoing revision for version 2014 of ICD-10-CM into account, which offers the following for Z73.0:

2014 ICD-10-CM Code Z73.0 Burn-Out: Physical AND emotional exhaustion state

The definition seems to change. Nevertheless, it is still given as a state of exhaustion. It is not listed as a disease. In my opinion, that might be, because the term burn-out is very hard to define specifically. It is a term, mostly formed by pharmaceutical companies and burn-out clinics. Burn-out is an easy enough term. It hides the complexity and individuality of each single case. And most important: Having a burn-out is socially acceptable. A burn-out you can only get, if you worked really hard and working hard is something that we honour. Working hard, so hard that it affects your health means giving everything for the cause. This is true commitment. Is it?

First, I believe, most burn-outs are really one or the other form of a depression. If you look that term up in any version of the ICD, it becomes obvious that there are so many different variants of a depression out there, that it is of no question a complex disease.

Second, having a depression instead of a burn-out comes with the stigma of not being normal anymore. Of being a psycho of some sorts. And that is, where it all goes wrong. With that problematic view of society on people who suffer from (even a mild) depression, we end up with people not asking for help in time. Not asking for help accelerates the spiral that lets the depression getting worse and causing at the very least unnecessary extra costs for the health system.

And finally third, the number of diagnosed burn-outs has significantly increased over time in several developed countries. Are we really all that burnt-out or depressed? Given the average potential earnings on a treatment per case I believe the reasons for that increase are not within the nations health. A portion of it might be just an over diagnosed exhaustion.

Bottom line: I believe we should stop fooling ourselves by calling a depression by a fancy name and treating everybody who has an exhaustion with the most expensive treatment available. No question asked: working hard gets you exhausted. Very exhausted, if you do it for long and if you never stop, you might get a depression. But as long as one is exhausted, listen to what your grandmother already new: try getting yourself a rest. Take your time to refill your batteries with the energy you need to being able to work at your best level for long. Don’t over do working hard on a regular basis and for a long time.

If you follow my opinion about burn-out and depressions or not, the topic of exhaustion is interesting enough to peak ones attention when working in a challenging environment:

Leute brennen innerlich aus, wenn ein anderer immer fester auf das Gaspedal drückt, sie selbst steuern sollen, aber nicht wissen wohin.

That quote by Heike Bruch, director of the institute for leadership and human resource management at the University of St. Gallen (source: Brand Eins 06/2013, Brennen. Ohne zu verbrennen) translates roughly to:

People burn out from the inside, if somebody else is pressing the gas pedal down while they are supposed to steer but do not now were to go.

I quite like that picture. It tells you, that not only hard work has the potential of bringing you into a different state of mind, it is also undirected, high pressure without any clear defined goal or target that will make you trip. And there we are again, back at the big question of leadership vs. management.

Image Source: Wikipedia, Luc Viatour, Amada44
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