Burnout & Depression - some thoughts

Burnout, unlike major depressive disorder & like grief, is linked to a specific context (excessive & prolonged stress). While MDD is descriptive & acontextual, burnout is contextual & partly explanatory in addition to being descriptive. /1

MDD is also conceptualized as a construct with specific thresholds of severity. These thresholds don’t apply to burnout.

Burnout & MDD are different but overlapping constructs. They are not mutually-exclusive: they can be present simultaneously. /2

That is, burnout can be severe enough to meet criteria for MDD but that doesn’t mean it’s no longer burnout (just as grief can be severe enough to meet MDD criteria but that doesn’t mean it stops being grief). /3

The symptoms of burnout are on a continuum with symptoms of MDD but that is because *all* ordinary misery & reactive stress responses are on a continuum with symptoms of MDD; there is no natural boundary which separates MDD from everyday unhappiness & adjustment reactions. /4

There may be forms of MDD that are discontinuous with everyday unhappiness (“endogenous” forms or certain descriptions of “melancholia”) but we haven’t identified them with any validity yet & MDD remains a hodge-podge category with reactive as well as non-reactive types. /5

Questions such as “when is it burnout & when is it depression?” arise to a great extent from the artificial, acontextual, operational nature of MDD, & they are aggravated by the erroneous assumption that burnout & MDD are mutually exclusive with a distinct dividing line. /6

Proposals that we should give up one construct in favor of the other (calling burnout depression or vice versa) are similarly mistaken. These concepts have different lineages & serve different purposes. /7

Burnout is an everyday notion; it links exhaustion to an occupational context, imbues it with moral & sociopolitical significance, it embeds the individual within a community that bears some responsibility for the individual’s distress. /8

To treat burnout as just another psychiatric diagnosis, to operationalize it with specific criteria, to make it artificially distinct from depression, would be an error, one that would render burnout antiseptic and medicalized. /9