DR. SUMNER ABRAHAM is a resident in Internal Medicine at the University of Virginia Health System.
Work is famously near to the to heart of American identity—but large-scale and still-emergent changes in the nature of work are introducing new kinds of turbulence to this relationship. Culture Briefing has long kept a pulse on this turbulence (see Vols. 5, 6, 13, 17, 48, 50, 62, 85, 89, among others), and today we examine it from yet another angle: the proliferation of the phenomenon called burnout.
Burnout, as we’ll use the term, refers to more than mere job dissatisfaction or occupational stress. It’s a sustained alienation from work; “manifested”—as one of this week’s authors puts it—“in exhaustion, cynicism, and feelings of inefficacy,” with no simple remedy. It’s a medical syndrome with its own diagnostic inventory—the Maslach Burnout Inventory—that measures emotional exhaustion, disengagement, and a reduced sense of accomplishment. Burnout does not respond well to the kinds of topical treatments we so often self-prescribe: I just need a good night’s sleep; I’ll get some rest this weekend; This vacation is really going to recharge my batteries. Individuals experiencing burnout can’t understand why they have the symptoms they do, nor why their attempts to alleviate them are so ineffective. How could they? Burnout is the sum total of thousands of miniscule betrayals, death by a thousand cuts.
As a medical professional, I know this reality all too well. Recently, the CEO of Mayo Clinic labeled physician burnout an “epidemic,” and the Kresser Institute reported that more than 50% of practicing physicians experience burnout. In fact, it’s nearly impossible to read recent issues of the New England Journal of Medicine without encountering burnout: the last year has seen articles on combating burnout by redesigning care, on how to confront the crisis as a profession, and, most alarmingly, on the phenomenon of learned helplessness that is omnipresent among graduate medical education trainees.
But as numerous journalists have noted, burnout is a kind of social contagion, affecting Americans working in various professions and, importantly, suffered by workers of all ages and stages of life. The Atlantic recently illustrated physician burnout with a story about an overworked chef; The Economist ran a series on burnout among investment bankers, followed by a piece on a psychoanalyst's "way out of burnout"; the New York Times reviewed four books on “killing dead-end jobs” and finding career happiness; Business Insider reported earlier this week that more than 50% of Silicon Valley tech workers experience burnout; and, perhaps most distressing, Vox recently chronicled burnout among high school students. Sadly, not everyone can find work-life balance by moving to Switzerland.
Burnout occurs at the convergence of two emergent trends regarding our relationship to our work. The first, reviewed in Vol. 20, is the peace many Americans have made with a kind of “purposeful Darwinism” in the workplace: the survival of the most innovative. In this environment, the cost of doing business, as it were, is placing the pursuit of innovative and groundbreaking work above all else. When this is combined with the social imperative to “do what you love,” which we examined in Vol. 97, the American worker is in the unenviable position of doing more and more for less and less. One understanding of burnout is simply the moment when these two trends converge and meet the limits of creaturely life.
Fortunately, while burnout seems to be on the rise, it is not fundamentally new. In fact, as Jonathan Malesic argues in an excellent article on the topic, St. Thomas Aquinas would be a good candidate for official “patron saint of burnout.” As he writes in “A Burnt-Out Case,” scholars remain puzzled at why Aquinas left his great Summa Theologiae unfinished. Accustomed to producing four thousand words a day, Aquinas had some sort of vision on St. Nicholas’s Day in 1273, after which he set down his pen and died within a few months. Interpretations of this episode abound, but Malesic convincingly argues that Aquinas suffered from what we would now call burnout. As he puts it:
I do not doubt Aquinas’s virtue. But I wonder if the story that gets told about his last days might be incomplete. Aquinas was not only a saint; he was also a worker. And although he died centuries before capitalism became an economic and moral force, the ideal of sanctity that he embodied—the union of productivity and humility—aligns neatly with an image of the ideal worker in today’s capitalism. That ideal comes with a cost, one that Aquinas’s final silence and death testify to.
In light of the productivity and humility that employers demand—indeed, that workers demand of themselves—and the moral consequences of that demand, we might see Thomas Aquinas somewhat differently. We don’t need to jettison his saintliness to recover his humanity, his acquaintance with the limits of body and spirit. He is not just a shining, inimitable exemplar, but a man whose sorrow is surprisingly familiar.
What would it take to address this familiar sorrow—to get at its root, rather than just the branches? In an essay for Harper’s called “Punching the Clock,” author and London School of Economics anthropology professor David Graeber suggests starting with the blunt recognition that much of contemporary work is—pardon his French—bullshit. This isn’t mere griping, but a historical argument: at some point in the last few centuries, Graeber argues, humans began measuring much of our work in hours instead of results, which taught us to think that “some people ought to be working at all times, or that work should be made up to fill their time even in the absence of things that need doing.” The ensuing proliferation of busy-work made purposeless tasks—“pretending to be busy”—a basic feature of working life. Even modern labor reform movements accept this logic—when labor activists demand “free time,” Graeber writes, they “[reinforce] the notion that a worker’s time really [does] belong to the person who bought it.”
What good does it do to call pointless work what it is? For one thing, those of us who employ and supervise other people could be more sensitive to the psychological toll of busy-work, and recalibrate our evaluations to be simultaneously more results-oriented and more humane. For those of us with little power over the conditions of our own working lives, much less anyone else’s, a simple awareness of why, in Graeber’s words, “having a pointless job makes [us] quite so miserable” can go a long way.
On this point, we turn to Farr Curlin, physician and professor of humanities at Duke University. In an address given at the Library of Congress in 2012, Curlin reflects on the sources of burnout, and a line of thought that could offer relief. To understand burnout, Curlin suggests we look to the concept of irony. As he uses the term, irony is not the sarcasm we so often use to create distance from our convictions; rather (following the work of Jonathan Lear), irony names the experience of noticing a gap between what you actually do at work every day, and what you would be doing if you were to become the worker you are trying to be. Encountering this gap leaves the worker “unsettled, shaken.” Curlin quotes Lear:
In this ironic moment, my practical knowledge is disrupted. I can no longer say in any detail what the requirements of medicine consist in...I can no longer make sense of myself, to myself, and thus...I have lost a sense of what it means to be a physician, as I can no longer make sense of [the gap between what I aspired to and] what I have been up to.
In Curlin’s view, naming this “ironic moment” accurately is both vital and counterintuitive. This is because, as he puts it:
Irony calls me to a halt, but it also spurs me on. It calls me to a halt, because it reminds me that I have not yet gotten the hang of being a physician. It spurs me on, because it affirms for me, and lures me toward, the possibility that I could become the physician I’m not sure how to become.
Curlin suggests, in other words, that the antidote to lifelessness in our work is an admission that our work is always a work in progress, and a recommitment to the practices of learning and apprenticeship that brought us to that work in the first place.
This insight, when married to Graeber’s, shows us a path we can tread while living with burnout. First, as Graeber tells us, we should recognize burnout for the alienation it is, and be frank about the degree to which much of our labor is, in fact, pointless. Minimizing pointless work, to whatever degree possible, minimizes alienation. Equally important is to understand burnout as an opportunity to reflect on one’s daily work in light of one’s vocation—one’s sense of calling. By continually re-orienting to our vocations and recommitting ourselves to learning, we push back against stagnation—against believing that the only cards to play are those we’ve already been dealt.
Finally, it may be helpful to re-situate work within the context of a whole life, by reflecting on an insight of Wendell Berry’s: that health is ultimately a matter of membership. Part IV of Berry’s “Healing” reads:
Good work finds the way between pride and despair.
It graces with health. It heals with grace.
It preserves the given so that it remains a gift.
By it, we lose loneliness:
we clasp the hands of those who go before us, and the hands of those who come after us;
we enter the little circle of each other's arms,
and the larger circle of lovers whose hands are joined in a dance,
and the larger circle of all creatures, passing in and out of life, who move also in a dance,
to a music so subtle and vast that no ear hears it except in fragments.
This notion of membership in concentric circles of community ought to play a key role in learning to navigate burnout as a social phenomenon. The fact that, if trends hold, more and more of us will experience profound alienation from our labor points to the need for communities to respond to this alienation, with creativity and compassion. Without reliable structures of care, individuals in the grip of burnout suffer precisely as that: individuals.