Congratulations if you aren’t burned out. Perhaps you learned to play the guitar, wrote a screenplay, or took up French during the pandemic. But if you’re like me and most of my patients, you’re running on fumes.
Burnout is usually reserved to describe work-related phenomena: exhaustion, feelings of negativism, and reduced professional efficacy. In 2019, the World Health Organization officially recognized burnout in its International Classification of Diseases but clearly stated that the term “should not be applied to describe experiences in other [nonoccupational] areas of life.” Burnout “is not classified as a medical condition,” the agency declared, using boldface for emphasis. Similarly, the Mayo Clinic calls burnout “a special type of work-related stress—a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity,” and specifies that it “isn’t a medical diagnosis.”
I beg to differ. The symptoms of burnout have become medical. The work of living through a pandemic has been making us sick. As a primary-care doctor, I’m witnessing the physical-health toll of collective trauma—high blood pressure, headaches, herniated discs. And this has been before many people have returned to the office or resumed their pre-pandemic schedules.
Simply being human carries occupational risk. Now is the time to redefine burnout as the mental and physical fallout from accumulated stress in any sphere of life, whether that’s work, parenting, caregiving, or managing chronic illness. To muster the energy for reentry into non-pandemic life, people need more than a vaccine and a vacation; they need validation of their experience, a broader reckoning with how they lived before March 2020, and tools to dig out from more than a year of trauma.
Americans were flirting with symptoms of burnout well before the pandemic. The combination of hustle culture, toxic stress, and poor access to affordable health care conspired to make Americans among the least healthy populations in wealthy countries. Diseases of despair—including depression, anxiety, PTSD, and addiction—were already rampant.
Living through COVID-19 brought the simmering pot to a boil. By stripping our emotional reserves even further, the pandemic has laid bare our unique vulnerabilities—whether medical, social, emotional, occupational, or logistical. Every aspect of life has required added work during the pandemic—eating and sleeping, shopping for necessities, getting routine medical care, learning, relating to others. Despite heightened anxiety, we’ve had to juggle parenting, caregiving, and working without our traditional support structures.
The mental-health crisis of the pandemic is real. A staggering four in 10 adults have reported symptoms of anxiety and depression, a quadrupling of the pre-pandemic rate. More than one in four mothers reported that the pandemic has had a major impact on their mental health. Twenty-four percent of parents have reported being diagnosed with a mental-health disorder since the start of the pandemic. Visits to primary care for anxiety and depression have increased 13 percent among kids.
The full array of suffering has yet to completely present itself. The available data show that traumatic events and the related upheaval directly affect our individual and collective mental health. Studies on major life disruptions—natural disasters, epidemics, civil unrest—show that the burden of mental illness increases afterward.
Evidence also shows that people who experience trauma and adverse childhood events, particularly those that are sustained, are at significantly higher risk for developing subsequent medical problems such as obesity, diabetes, and heart disease. The American Heart Association recently acknowledged the interconnection between emotional distress and cardiovascular risk.
A whole new set of stresses awaits people who have not yet gone back to the office or resumed their hectic pre-pandemic schedules. But in this new chapter of the pandemic, we can create a better way forward. The first step is to recognize that anxiety is to be expected and that accumulated stress will have physical manifestations. Normalizing these attitudes can help remove the shame and self-stigma of feeling unwell. Simply because 330 million other Americans have experienced some version of the same trauma doesn’t mean that you aren’t suffering in your own way.
The second step is for Americans to recognize that, objectively, we have ample reason for optimism. The number of new cases in the United States has dropped more than 95 percent since January. We have stunningly effective vaccines that protect us against COVID-19, including from the coronavirus’s known variants and others that could emerge in the future. It’s time to recalibrate lingering fears to prevent further mental exhaustion.
The third step is to create strategies to better meet our biological needs. Even when people really mean to exercise and eat healthy foods, burnout—a state of low energy and low motivation—is a common barrier to realizing those good intentions. Psychologists have long understood that people’s perception of whether they control their own fate—or are at the mercy of outside events—affects their health. Dealing with a prolonged externalized locus of control—a combination of the coronavirus itself and the public-health restrictions that have been governing our lives—is associated with stress and cardiovascular disease.
Shifting to an internal locus of control—that is, taking charge of our own lives again—can restore our sense of agency and self-determination. Reassessing and simplifying our home life, work, and relationships can be a good place to start. With limited space in our schedules and brains, we must populate our calendars with intention. Setting realistic expectations for ourselves, erecting boundaries, and asking for support are some of the ways to find calm amid chaos. We need to acknowledge the toll of constant vigilance and hold ourselves accountable for what we feed our eyeballs and brains.
Most important, as a society we must accept responsibility for creating a culture of burnout. Its effects have bled into every aspect of our lives. It threatens our health and well-being. Now is the time for employers, community leaders, teachers, parents, and doctors to help identify and snuff out this smoldering health problem.
This week I saw yet another overwhelmed patient—a divorced working mother of three. Her blood pressure and weight both have gone up during the pandemic. In addition to adjusting her medications, we zoomed out on her life situation. We discussed how she could reclaim her sense of control, starting with spending less time online and cutting nonessential events from her calendar. These changes, plus a dose of self-compassion, should open the door to reducing burnout. In the end, it’s about putting her back in command of her own life. I reassured her: “You’re not crazy. You’re human.”