Under the spell of burnout / Christaan ​​Vinkers

Burnout, long-term stress, always on and everything has to be done. They seem to be pre-eminently problems of our time. But is that really so? In this blog I (Christaan ​​Vinkers, psychiatrist and professor of stress and resilience) talk about the sense, the nonsense and the misconceptions surrounding burnout and stress.

Stress is not the boogeyman
We see stress mainly as something negative, because we actually only talk about it when it bothers us. Stress is always the boogeyman. But actually it is a very natural reaction of your body. Everyone experiences something difficult once in a while, we all end up in an unexpected situation from time to time. This is not to say that stress is good, but it is unavoidable. And we have to deal with that.

Too much stress is of course not good, but neither is too little. As a psychiatrist you sometimes see patients who lie on the couch all day, but they really don't have a happier life than people with a very busy job and many responsibilities. You shouldn't want to avoid stress, because that's actually not possible at all. It's about finding a healthy balance.

Unique orchestra
But that balance is different for everyone, because stress is also very personal. One gets stressed by different things than the other. That's because of your genes, how your brain works and how you are put together as a person. And if, in addition to a busy job, you also have a breakup or financial problems, then that of course counts. Everyone also has a unique orchestra of instruments in the body to deal with stress. From stress systems such as adrenaline and cortisol, to brain networks that respond quickly to threat and even our immune system is affected in the longer term. You just have that in you: a gift from mother nature, which ensures that we respond adequately to stress and then recover from it.

People are naturally resilient and resilient, but when our stress orchestra no longer plays well together and is out of balance, mental health is compromised. You see this, for example, in childhood traumas, but also in long-term stress at work. Our body and brain no longer respond well to unexpected situations and also recover less well from a stress response. This can lead to dropout, health problems such as cardiovascular disease, but also depression or anxiety disorders.

It's time for a different, transdiagnostic view of stress.

Burn out
Every person has a tipping point when stress becomes too much. And when that point is reached, we often call it a burnout. If you can believe the media, we are dealing with an epidemic, because in the Netherlands alone more than 2 million people / employees are said to suffer from burnout complaints. But the scientific basis for the phenomenon of burnout is still under discussion. Broadly speaking, we all seem to know exactly what it is, but the deeper you go into it, the more incomprehensible it becomes.

By the way, I don't want to trivialize the suffering of people. The people who are sitting at home with this really have a huge rotten period of sometimes more than a year. So it's good that vitality and mental health are high on the agenda. But in my view, these people do not benefit at all from the proliferation of definitions, self-proclaimed experts and treatments. Everyone has an opinion about it and everyone tells in all certainty how the fork is exactly, online, in books and on TV. People get the most diverse advice, from midweeks on a farm to months of 'where you get what you need' recordings.

Diagnosis
The problem of burnout already starts with the diagnosis. Because there isn't. It's not in the manual of psychiatry, the DSM-5. There is no agreement. The company doctor, the insurance doctor, the general practitioner, the practice assistant, the innovation manager, the work organization psychologist and the stress coach, everyone has their own opinion. And if no one can determine it reliably, you will never be able to find out how many people in the Netherlands have a burnout, and which treatments help.

Depression can be reliably diagnosed with structured clinical interviews. They don't exist for burnout. There are questionnaires with sometimes only five questions about general stress complaints and are not a good indicator at all. Stress cuts right through all diagnoses in medicine and it is a nonsensical idea that stress complaints can only predict a burnout. Stress also plays a role in depression, cardiovascular disease and neurological disorders such as MS and Parkinson's.

What is it then?
Of course, the fact that we cannot diagnose it does not alter the fact that many people suffer from it. But what exactly are they suffering from? We don't know that very well either. But we see a lot of overlap with depression and anxiety disorder. In one study, thirty people with depression and thirty people with burnout all completed two questionnaires, one for depression and one for burnout. You couldn't tell them apart in any way.

Because not much scientific research has been done, burnout is a kind of potpourri of anxiety, depression and an adjustment disorder. It is, incidentally, striking that highly educated people are much more likely to be diagnosed with burnout, and those with a lower level of education are diagnosed with depression.

What is needed?
First, we need to invest in more research. We must be able to make a clear, clinical diagnosis and develop scientifically proven interventions. As soon as we can scientifically substantiate what it is and how it works, we can work towards treatments such as VRelax. Scientific validation is extremely important and should be a hygiene factor for any intervention.

It is also time for a different, transdiagnostic view of stress. Stress plays a role in every psychiatric disorder and often stands in the way of recovery. Stress is by definition biological and psychological, but the environment also plays a role. To do something about it, you can look at the environment: the people around you, the employer, the government. Or to psychology: how do you deal with difficulties? And biologically we learn a lot from the stress hormone cortisol and the other parts of the stress orchestra in our body. This way we can focus on the stress on the road before that tipping point and prevent failure and illness.

Christian Vinkers