How burnout became a sinister and insidious epidemic

Half a million people in the UK suffer from work-related stress, and psychological breakdown can creep up without warning. But what, exactly, is this ‘state of vital exhaustion’, and how can you come back from it?

In a bedroom in North Yorkshire at 2am, Sara Cox lay next to her sleeping husband in the dark, her eyes open and her jaw clenched shut, anxious thoughts whirling. For the previous two years, the stress of her job at an independent local pharmacy had gradually become intolerable. That night, in June 2013, she made a plan. She crept out of the bedroom and sat at the kitchen table with a pen and a piece of paper. She says now: “I just thought: ‘I can’t do this any more, I need a safety net. I’m going to write out my resignation letter, keep it in my handbag, and if I have another really bad day, I’ll just quit.’” She wrote it out by hand and put it in an envelope, signing herself a cheque for freedom that she could not yet give herself permission to cash.

Over breakfast, she told her husband what she had done. “He told me: ‘That day has come. I’m going to drive you to work and you’re handing in your notice today. We will cope,’” she says. “So that’s what I did.”

In September 2017, in the headquarters of a London high-street bank, Adam was celebrating having completed a major project on deadline. But, moments later, he felt a sharp pain in the side of his abdomen that went on to keep him up all night. The next day, he took 30 minutes to walk from the station to the office – usually just a 10-minute journey. A colleague sent him home, and later that week he found himself rolling on the floor, clutching his stomach in agony. The following week, he was back at the office. “Even though, physically, I was better, I couldn’t focus or think straight,” he says. “I would stare at my screen, unable to engage my brain to send a simple email. I couldn’t remember how to solve a simple problem on a spreadsheet, or who to call – all of which would have been instinctive before. I had blurred vision, like a fog hovering over me. That’s when I realised that what I was experiencing was mental burnout.”

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Burnout is what connects Cox, 51, with Adam, 32, both of whom contacted the Guardian in answer to a request to hear from readers who have experienced psychological breakdown following stress at work. They were among 80 teachers, accountants, social workers, architects, students, lawyers and more, aged between early 20s and late 60s, and drawn from all over the UK. According to the Health and Safety Executive (HSE), 526,000 workers in the UK suffered from work-related stress, depression or anxiety in 2016/17, and 12.5m working days were lost as a result over that period. The independent watchdog’s research shows that workers in health care, social care and education are more likely to suffer than those in other industries – a recent review found “a worryingly high rate of burnout” among UK doctors – and women are more likely to suffer than men. Clinical psychologist Rachel Andrew finds that burnout-related symptoms are taking up more and more of her time in the consulting room. “I have certainly seen more of it over the last 15 years that I’ve been practising, and I’ve particularly seen an increase in men,” she says. “I don’t think that’s a negative thing; I’m seeing it earlier on, and seeing more men talking about how they are feeling.”

The most poetic definition of burnout appears in the ICD-10, the World Health Organization’s International Classification of Disease, which characterises it as “a state of vital exhaustion”. Although burnout manifests in our mental health, says Kate Lovett, consultant psychiatrist and dean of the Royal College of Psychiatrists, “it is not considered to be a mental illness, but rather a form of chronic workplace stress”. It encompasses a spectrum of experiences, says Andrew: “At the extreme end there are people who entirely shut down and end up in hospital having physical investigations; at the other end is someone showing signs of anxiety, low mood and feeling detached from day-to-day life.” In the ICD-11, due for publication this year, the condition is described as “not a single event but a process in which everyday stresses and anxieties gradually undermine one’s mental and physical health”.

That’s what makes it so insidious, says Brian Rock, psychoanalyst, clinical psychologist and director of education and training at the Tavistock and Portman NHS Foundation Trust. He describes it as, “a drip, drip, drip. Patients will say: ‘I didn’t know this was happening to me.’ It’s like a mission creep of sorts, where you find yourself working a bit later, taking calls on weekends, being less inclined to play with your children or feeling more isolated and irritable.”

When Adam was promoted in the summer of 2015, he says: “I knew it would be a great opportunity, but I also knew people in similar roles had suffered burnout – you would hear horror stories about the pressure and the hours. My reaction, instead of saying, ‘I need to be careful and have open and honest conversations with my employer,’ was to say, ‘I’m going to do it better than everyone else. I’m going to be the guy to buck the trend.’” And, at first, he thrived. “I loved being the last man standing in the office, when the lights turned off around me because no one had moved on my floor, and even the security guards had gone home.” But, two years later, he could see the damage he had done. “I definitely wasn’t happy,” he says. “It was such a warped mentality.” He started drinking every day, and neglected his marriage. “I was so irritable and grouchy, my wife was afraid to talk to me,” he says. “She really suffered for a long time.”

Before stress overwhelmed her, Cox had thrived on the challenges of working in a community pharmacy: “I liked the responsibility, the learning and the knowledge, and I was so proud to have that career,” she says. But after nursing her mother for her final two years, she had only one week off to arrange the funeral. Around that time, an experienced colleague left and was replaced by well-meaning but inexperienced staff, so Cox felt she was having to help them with their jobs as well as doing her own.

She says: “It wasn’t the hours; it was the nature of the work. Time away didn’t alleviate it. Every Sunday, I had that feeling of dread that the next day I was going to have to juggle everything all over again. I put on weight. I’d wake up exhausted, it felt like every day I was walking through thick mud.” She would grind her teeth until they cracked and she had to pay for expensive night-guards and remedial massages to alleviate the pain in her jaw. “All I was doing was masking the problems caused by the pressure I was feeling at work,” she says.

Andrew understands burnout as a defence against intolerable pressure and stress: “In the people I have met, it can be quite functional – the only way your mind and body have left to keep you safe, of protecting you when there are no other options available. But it’s not a decision that you make; it happens unconsciously.”

So whom should we blame? The experts warn against leaping to conclusions about incompetent and aggressive management, or “snowflake” employees with no resilience. Rock argues that we need to think in a systemic way, and see experiences of burnout as symptoms of an ailing organisation, rather than a sick individual. To this end, the Tavistock also works to support organisations in the corporate sector. Robyn Vesey, organisational consultant for Tavistock Consulting, says the question of blame itself is symptomatic of a burnt-out workplace: “Blame is indicative of the problem in the first place: there can be an atmosphere and a system which is supportive of collaboration, sharing out the stress of the team and creating a sense of shared purpose and healthy interaction – or there can be one that leads to blame and people reaching a point where they can’t carry on.”

Beyond the workplace, we live in an age when society itself seems to be burning out, with austerity, rising poverty and the uncertainty caused by Brexit pushing people to and beyond their limits. “Burnout could be seen as a condition of our times,” Andrew agrees, as cuts to services are making it harder and harder for people to cope: “Alongside cuts to social care, there are cuts to the voluntary sector, projects around domestic violence, for parents, for older people. Stopping a group for carers of people with dementia might seem like a tiny thing, but we have reached a critical point of extremely limited support, and if you’re in that situation, over a period of time, it makes complete sense that your body and mind would shut down. I see strong, capable, independent people who have reached a stage where there is no other option.”

There are certain factors that protect a workplace from burnout, says Vesey – a sense of purpose, a sense of belonging, and a management style that finds “a balance between clarity and presence, but also offer people autonomy to allow them to get on with what they need to get on with”. Without these, a business and its employees are more vulnerable. Rock is realistic that businesses need to prioritise performance, but says: “It’s about thinking how you get the best performance out of your people. We should not move the way a charity operates into the financial sector – it would lose its competitive advantage very quickly – but there are things managers can do to support their staff, such as creating an environment where people can talk about what’s happening in the organisation, what’s happening for them.” What Cox suggests a boss should say is: “We recognise you’re having a tough time. What can we do to help you?”

After working her notice, Cox took 10 months off. A counsellor helped her grieve for the loss of her mother and of the career she had worked so hard for. “It helped me see that I hadn’t failed,” she says. At first, she was scared to leave the house, but she forced herself out for a walk each day. She went swimming. She says: “I thought I’d walk into the pool and it would be full of gorgeous people with great bodies, and they would see this frumpy woman plod in. It was mortifying. But as soon as I got in the water, the sun shone through the glass walls and I could feel it warming my skin. It felt so good.” She learned to knit: “It’s so therapeutic; doing something with your hands and counting the stitches with your brain. If anything pops into your mind that’s stressful, it can’t stay there long.” A few months in, she says, “I turned to my husband in the kitchen and he gasped and said: ‘You look 10 years younger.’”

Adam was signed off work for two months with stress-related illness on the understanding that he would have a phased return to work and find a new role within the company. He took short-term medication to help with anxiety and insomnia, and for two months saw a counsellor, who challenged his beliefs about success and failure. He spent time reading, visiting family and cooking for his wife, making time to reconnect.

Now back at work, Adam has been helped by a supportive team, but says: “Being rescued by colleagues was humbling for me and difficult to accept. Looking back on it, I realise I should have been relying on them much earlier and accepted the fact I’m not Superman.” He has thought about how to protect himself in future: next time, he says, he will notice the warning signs. He will rest. He has removed all phone chargers from the bedroom so he cannot check his email in the middle of the night. He now gets his adrenaline from playing regular tennis games rather than working until the early hours. “My wife and I are going to see a movie tonight – I can’t remember the last time we did that,” he says.

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But he doesn’t have it all figured out. “I still feel broken – I’ve got a broken mindset,” he says. “I’m aware of what the issue is, but the issue is still there. Everyone’s got a boss, and if the top man is stressed, the people below get stressed. I do know people who have somehow found a level of tranquillity in that environment, who don’t let that get to them – that’s where I aspire to be. It’s a difficult journey, but if I want to make it to 40, I’ve got to do it.”

Cox now works in a small museum, running the shop and admissions desk. “I bounce to work now,” she says. “But there is a sense of loss, and regret. I had to mourn my old job.”

This attitude is crucial for recovery from burnout, says Andrew. “Your body and mind are saying: stop. You need to take a break and have the space to reflect on how you have reached that point, either on your own or with support.” The danger, Rock says, is when people come back fighting. “If you say, ‘I’ve had burnout but I’m going to get on top of this, beat the burnout and get back to work; people may have lost confidence in me, so I’ll work even harder to prove them wrong’ – well, you can tell that’s not necessarily going to end well.”

Rock sounds optimistic when he speaks of recent developments: there is the new network Minds@Work, while Lord Dennis Stevenson and Paul Farmer, CEO of Mind, have published Thriving at Work, an independent review of mental health and employers. Both emphasise the responsibility of employers to take care of their employees’ mental wellbeing. “I think that is resulting in a change about how people think about limits and vulnerability,” says Rock.

A senior colleague recently told Adam: “I saw that coming, I’m sorry I didn’t intervene.” Can we all learn from his regret, to support our colleagues, to notice if someone is struggling and to offer support? Rock says the right approach is the same for a psychoanalyst, supervisor, colleague or partner: “Being open.” That is why Cox and Adam have spoken out; they want to be open about their experiences, so they can help others. Cox says: “It’s one of those hidden things in the workplace, that people are suffering with stress and pressure, and they’re ashamed to talk about it because it’s seen as a sign of weakness, and it shouldn’t be.”

This is about all of us. As Andrew says, “People say that one in four people suffer from mental health difficulties. It’s time to move away from that thinking. It’s not ‘us and them’; it’s each of us living a life with peaks and troughs, and anyone suffering from enough pressure could be at risk of developing burnout.”

Five signs you could be suffering from burnout
People in the throes of or heading towards burnout might experience the following symptoms, say psychologists Rachel Andrew and Brian Rock:

• You feel exhausted, with no energy to do anything. You might experience disturbed sleep, and some flu-like symptoms.

• You have difficulties concentrating, and feel as if your mind is zoning out, going into a daze for hours on end.

• You feel irritated and frustrated, often becoming self-critical.

• Supermarkets and similar places begin to feel overwhelming – the lights are too bright and there is too much noise.

• You feel detached from things you used to love.