Are psychiatrists ever honest about their patients?

Burnout: "Most of the time it hits people who consider themselves indispensable"


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Burn-out is omnipresent, every second German feels threatened by it. The psychiatrist Rainer Hellweg has to do with people who suffer from work-related fatigue on a daily basis. Some professions seem to make you sick noticeably often.

TIME ONLINE: Mr. Hellweg, how does burnout come about?

Rainer Hellweg: It usually starts with those affected often thinking about work after work. You can no longer switch off properly, brood a lot and sleep little. You are tired. This makes it difficult for them to concentrate and their performance decreases. You lose the joy of your work. Some become cynical about their employer. People are irritated when they meet colleagues or withdraw. And they work harder to make up for the shortfall in performance. As a result, they become even more exhausted.

What is burnout?

What is burnout?

Emotional and physical exhaustion, reduced performance, difficulty concentrating and a feeling of Being burned out - this is how psychologists describe typical symptoms of the exhaustion syndrome Burnout. Often those affected also show signs of depression. Burnout is mostly due to permanent stress triggered that can no longer be dealt with.

Real Illness?

In spring 2019 the World Health Organization (WHO) Burn-out as a factor recognized that affects health. The WHO defines it since then as chronic stress in the workplacewhich is not processed successfully. It will be included in the list of internationally classified diseases called ICD-11, which will come into effect in 2022. Before that, burnout at the WHO only ran under "Problems related to difficulties in coping with life" - and without reference to the professional environment.

For a long time experts argued about whether burnout was considered to be in the spectrum of mental illnesses own diagnosis recognized should be. The therapy for classic depression has long been different from that for exhaustion syndrome.

ZEIT ONLINE: What are the first signs?

Hellweg: Burn-out syndrome is characterized by various symptoms - but there is no precise list of symptoms. They develop over time and change over time. Different phases of the syndrome are often spoken of. In the initial phase, many of those affected are still very committed to their jobs. You achieve a lot, but you are also constantly tired. In the next phase, they become more and more exhausted, irritable and internally restless. Fatigue becomes chronic. The final phase is characterized by resignation, difficulty concentrating and listlessness. Many of those affected are then also very depressed.

ZEIT ONLINE: Sounds like depression.

Hellweg: The two disorders are very similar, especially in the symptoms. Sometimes patients are told they are burned out and they are depressed. But burn-out patients have fallen into a state of exhaustion as a result of too much work; depressives do not necessarily. The depressed wakes up early and ponders, believing that he will not be able to make it through the next day. Burnout patients, on the other hand, often find it difficult to fall asleep. And while a depressed person no longer seems to feel any joy at all, "burned out" people sometimes still manage to gain something from life apart from work, for example on vacation or when they are with friends. At least in theory. In practice, it often looks like those affected have burnout and depression. Accordingly, both disorders are often found in one patient.


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ZEIT ONLINE: Are there people who are more likely to suffer burnout than others?

Hellweg: There are certainly genetic factors that have not yet been adequately researched. Some life events are also more likely to lead to burnout than others. In my experience, those who no longer consider their work to be meaningful and manageable are more at risk. Most of the time, they don't believe that they can do it to their satisfaction. You are in a state of permanent overload.

ZEIT ONLINE: It is often said that very perfectionist people are more likely to do so. Is that correct?

Hellweg: In fact, it hits people more often who identify strongly with work and consider themselves indispensable. You have high demands on yourself and on others. For example, those less at risk of burnout take it more calmly if they fail to complete a task. You then think: "If there wasn't enough time, I can't help it." Others relate mistakes in their work more often to themselves and to individual working conditions. They are disappointed because they did not give one hundred percent or more. But there are also jobs that are associated with an above-average rate of mental illness, regardless of how critical a person is with themselves or how much stress they can withstand.

ZEIT ONLINE: Which occupational groups are particularly at risk?

Hellweg: Teachers, for example, often find their work frustrating. They often receive little appreciation from parents, students and colleagues. Hospital staff are also at risk of burnout. It works under pressure, fast and a lot. In addition, it cannot help some patients. Not everyone is curable. And not every doctor can handle the uncertainty whether his work will lead to the goal at all. Police officers and firefighters are also at risk of burnout. Performance is required of them very quickly. When they start their shift, they often don't know what to expect. You have to work a lot of overtime. And top managers often suffer burnout because their daily work is designed in such a way that they have little free time.

ZEIT ONLINE: Suppose someone has a stressful job. How does he or she prevent burnout?

Hellweg: The person should organize the work so that there are also breaks. And it's important to really enjoy your time away from work. In the end, it doesn't matter whether the person is meeting other people, playing chess or just sitting on the sofa and watching TV or listening to music. Exercise helps to fall into bed with tired limbs and fall asleep even after a long day in the evening. The important thing is: Free time must be experienced positively and as a change from work.