Frayed social bonds, toxic and demanding work environments, and even helicopter parenting are all contributing to an American epidemic of burnout. Dr. Richard Friedman, Professor of Clinical Psychiatry and Director of the Student Mental Health Program at Weill Cornell Medical College, explains how we can better deal with everyday adversity, stress, and discomfort without succumbing to burnout – and how we can prepare our kids for the workplace of the future.
Dr. Stieg: Hi, I'm Dr. Phil Stieg. It seems that workers young and old, whether part-time, self-employed or corporate executives are experiencing increasing levels of stress and burnout. The World Health Organization has signaled burnout or chronic workplace stress as a national health concern. To help us better understand what burnout is, how it affects our brain and physical health and what to do about it, I'm glad to welcome back one of our regular guests, Dr. Richard Friedman. Richard is professor of clinical psychiatry and director of the psychopharmacology clinic at Weill Cornell Medical College. He is also an op-ed contributor to the New York times. Richard, welcome.
Dr. Friedman: Thank you. It's great to be here.
Dr. Stieg: Since the World Health Organization has given the concept of either burnout or chronic workplace stress, credibility, what is it? How do we try to get our arms around it and so we understand what's going on?
Dr. Friedman: The way to think about burnout is as a particular form of stress and the World Health Organization underscored that burnout has become somewhat of an increasing problem where at least that's what everybody is hearing. So the people are feeling more and more burned out in their jobs.
Dr. Stieg: What are the symptoms that people manifest that have, quote, burnout?
Dr. Friedman: So burnout consists of the sense of being exhausted, stressed, distant from work and feeling like you're not really effective at it. It sounds like when you describe it like this, this is the kind of thing that almost everybody has felt at some point along the way in their work life. So the question is, are you talking about an illness? Are you talking about an understandable reaction to a situation that you find difficult from time to time?
Dr. Stieg: Interestingly, even in the world of neurosurgery, there are now increasing numbers of articles about burnout and what they emphasize in these articles is this sense of depersonalization, lack of appreciation, lack of variety in terms of what they're experiencing in the workplace environment. I didn't hear you list those kinds of things, right?
Dr. Friedman: This, so they're in there as well, feeling that things have become routinized and there's a lack of meaning and attachment to your work. So you don't feel integrated, you don't feel excited by it. It feels like drudgery and people can't wait to get away from it. And they say, I'm so burned out. The vernacular is I can't wait to go on vacation. I'm so burned out, I can't wait until the weekend comes. So I can have relief from this. But I don't think that burnout is the result of adversity, meaning that are tough at work. It's probably more related to the sense that something is repetitive and numbing at work. So I've talked to people who say they're burned out and when you ask them about their work, you quickly discover that what makes them burned out is that they feel in a rut. Things are stressful in a way that they can't, they can't manage it. And often it's because there's something actually about the expectation that they have were something about their work that's actually toxic.
Dr. Friedman: So I think there are two factors. One is on the social and the attitude and expectation that people have about work. And the other actually might be about the changing nature of conditions in the workplace. So, it will take them each separately. But let's do the second one first, which is the institution and the place where people work. So I think there are real factors that do contribute to burnout, where the expectation that people have greater productivity and they work faster. Everyone read the article about Amazon for example, where you know, the workforce is like the equivalent of a conveyor belt. People are expected to, you know, produce so many widgets in such a period of time and it is the sort of condition that would, that would be stressful and they would make people feel routinized and burned out. On the other hand, I think there's also this change in attitude that people have an expectation that they have about being in work and being happy and being content and having a sense of fulfillment all the time.
Dr. Friedman: And it's what people talk about in the vernacular as the helicopter parents and the problem that millennials have and the sense that any discomfort at work is a sign that there's a problem in the environment that it needs to be fixed. So the expectation is you have to be satisfied and happy and stress is a really bad thing and you shouldn't ever feel it. Then you're going to have a situation where people expect to feel good all the time and that's also a problem. And then you take those two things together and they collage and you may have the perfect storm where there is a lot of burnout because the nature of work has changed. Things are harder. I'm sure medical school for example, is harder now than when I was a medical student for the simple reason there's less knowledge when we went to medical school, if it was easier to master things.
Dr. Stieg: The issue in my mind is about how we prepare individuals for the next aspect in their life. So if we're going to talk about the workplace, are we adequately preparing people? And we in neurosurgery sometimes take a bit of the Navy SEAL approach accepting the fact that what we do is stressful. What we do is art. There are multiple life and death decisions on a day to day basis, which I'm not trying to magnify or glorify and make it sound like we're some superhero, but there's just real decisions. And how do we prepare individuals for that? Do we do a Navy SEAL thing? He put them in the ice cold water and say, learn how to enjoy it or learn how to survive it.
Dr. Friedman: So there are different approaches to this. I think you don't want either extreme where you say, you know what? We don't care at all about your subjective well-being. You just need to adapt and we are not going to pay any attention to your experience or your well-being and you're just going to sink or swim. Or that's one extreme or the other, which is, Hey, you're feeling unhappy? The slightest bit stressed? We should stop the clock, stop the work and figure out how to make you happy. And it seems to me both ends on that spectrum are problematic. So I like the idea of healthy stress. People can experience a certain level of stress at work where they feel a little uncomfortable, but it's not necessarily a bad thing. It's not a sign that either the work is bad for them or something's wrong with them. It's a sign, frankly, that they're alive and they're engaged in work. And it means that there's a certain amount of discomfort and struggle and it's part of growing. I don't see that that's a bad thing. I think in fact, healthy stress promotes hardiness and it promotes resilience.
Dr. Stieg: I guess I have a hard time believing that this is something that all of a sudden comes on in medical school or in the workforce. It's gotta be occurring earlier in life. What do you think is happening in grade school and in high school? How have things changed so that people feel more stressed in their day to day lives?
Dr. Friedman: So I think that if you grow up with the expectation that the way will be paved for you and that you are not going to have a hard time and that you're going to be spared adversity, you're going to have a more difficult time with rolling with the ups and downs and the stresses of everyday life — not just work and you're probably at a greater risk of having burnout. On the other hand, if you grow up with little expectation, and I'm not saying this is a good or bad thing, but just as a fact, if you grow up with little expectation that systems are going to help you, you are probably going to be more self-reliant for better or worse and maybe less likely to burn out. I think much of it has to do with what you expect. I think some of it is the nature of social expectation that's changed and this may not be going, this may not be a phenomenon that cuts through social class.
Dr. Friedman: This may be a sort of upper class phenomenon where for example, you know, parents are aware that the world is more competitive and they want to ensure success for their kids, which is completely understandable. So from the moment they're really young, they have them preparing, you know, since kindergarten to get into a good school. So there's tremendous pressure that these kids succeed. And the attitude is, you know, we're going to do everything we can to ensure your success, which means we want to be sure that you don't fail, which means we're going to give you everything in the world and every advantage and smooth the path and be sure you don't need with adversity and you don't make a mistake. And that message creates an expectation in that group of kids that if they meet up with adversity, the problem is the adversity needs to go away. The world has to change to accommodate this expectation that they've grown up with. And I'm not saying that most kids these days grew up like that, but I think there's a social class aspect to this.
Dr. Stieg: Is there any neuroscience, behavioral data, imaging kind of data that shows that there are changes in the brain and as a result of this kind of approach or you know, feeling stressed at the high school level,
Dr. Friedman: There aren't good imaging data, I think to actually demonstrate this. There are an animal models for sure. The idea doesn't go away, that when you stress animals and it's tolerable stress that they can manage and they can get out of, they become hardier, they become more resilient. And you could see it at the neural level. There's no question that chronic stress, the bad kind of stress where people feel de-skilled and they can manage and they can solve the problem is bad for them and it's actually toxic to the brain because the brain is exposed to chronic cortisol, the stress hormone, and you know, that damages regions of the brain like the hippocampus.
Dr. Stieg: And it doesn't stop once you get out of high school.
Dr. Friedman: No.
Dr. Stieg: The statistics show that the universities are now spending exorbitantly much more money on their student health programs.
Dr. Friedman: Yes.
Dr. Stieg: Is this just a continuation then of uh, you know, the goal is to lead a stress free life?
Dr. Friedman: So it's complicated. You know, I run student mental health at Cornell, so I have, and for the last 20 years, and I've actually seen the trajectory and what's happened is the number of students who are seeking help has gone up significantly in the last 10 years. And it's not just here at Cornell, it's throughout the country. I've spoken to my colleagues elsewhere and in analyzing the data, what I found is that the excess and the number of students coming in for help for their actual real cases, it's not the case that they're, you know, complaining and they feel that everyday stress is, you know, intolerable. The number of people, you know, increased —is actual students, they're actually students with anxiety and depressive disorders. So, I think what's happening is the following: the stigma for having a psychiatric problem has gone down. Acceptance has gone up. So kids are getting treated at younger ages and psychiatric illness used to be a sorting mechanism that would keep kids out of college and certainly out of graduate school, which means this is a good thing. So a lot of people who have these problems are getting treated but more of them are showing up on our doorstep. So I don't think it's because the rates of these illnesses are going up. I think it's the rates of the treatment of these underlying illnesses is going up because acceptance is going up.
Dr. Stieg: I'm in the workforce or I feel it personally. What are some of the symptoms and signs that we should be looking for in people around us so that we can help them, at least, get help?
Dr. Friedman: You mean who are depressed?
Dr. Stieg: Signs of burnout.
Dr. Friedman: Signs of, well… burnout is different than depression and, it's important to I think distinguish them. So, people who are burned out look detached, but so do people who are depressed. I think the best way to distinguish them is people who are burned out actually feel tired and stressed and separate from work, thought, their self-esteem is, is preserved. People who are depressed feel exhausted and they look burned out, but, they start talking negatively about themselves. So self-esteem is harmed and depression, but it's preserved in burnout.
Dr. Stieg: So in depression we think about sleep abnormalities, diet changes, routine life alterations. Is that seen in burnout?
Dr. Friedman: So there's a crossover. There are some people who are burned out and not depressed who have trouble sleeping. Typically what they have is difficulty falling asleep, but what they don't have is early morning awakening, which is what depressed people have. So it's not that hard to separate them, but we want to separate them because the treatment's very different for depression than it is for burnout.
Dr. Stieg: What does family play in this? The solution in the American family?
Dr. Friedman: Yeah.
Dr. Stieg: Saying raised by a nanny, being raised single parents, all that kind of stuff. Does that, you know, people don't go to their family anymore for, you know, “I'm feeling stressed.”
Dr. Friedman: Yeah, well, some of that is social class as well, but in the larger sense of social community has frayed over time, you know, so that people feel more alone. I mean, Americans are the single loneliest people on the planet after the Brits in, in all research, if you ask people, you know, how do you feel? How lonely do you feel? Americans are very lonely. They do things alone, they feel alone. There's a dissolution of social bonds. They feel alone.
Dr. Stieg: Richard, as always, it's fascinating be able to talk with you, and this is really a pertinent subject for all of us. You know, it's on the front pages of the newspaper popularized by editorial comments such as yours, and I don't think it’s something we're gonna answer quickly.
Dr. Friedman: No, thank you. My pleasure.