How Does Untreated “Burnout” Manifest?


Wir würden das al “Burnout” nennen, the woman told me.

Translation from German: We would call that “burnout.”

Different stages of burnt matches on yellow  background, flat layLast November, I was riding on a train from Basel, Switzerland, to Hanover, Germany. As the train left Basel, I settled into my window seat and enjoyed watching the countryside as the train rolled along. A couple hours into the trip, a woman boarded the train and asked me if the seat next to me was free. I nodded yes and adjusted the bag at my feet to make a little more room for her. As the train pulled away from the station, we began chatting in German, asking the typical questions such as where are you traveling to and where are you from.

“I am from the US. I was in Basel and am now heading to Berlin. Years ago, I lived in Basel for eight months while studying at the university,” I said. As we continued to chat, I told her that I get a lot of synchronicity and improbable connections that are often a lot of fun. I then told her how synchronicity is related to Basel. Swiss psychiatrist, Carl Jung, who coined the term synchronicity, grew up near Basel. In addition, he studied at the University of Basel and for a few years, he was a professor there. So even my relationship to Basel has a much deeper meaning and connection for me. As we continued chatting, I shared a few of my “goofy” synchronicity stories as I call them. She enjoyed them, and we laughed together.

At some point in the conversation, the woman asked me what I do for a living. I told her that I have worked as a statistician, a technical writer, a knowledge engineer, and as a software tester. I then said that I really want to get into writing and public speaking to help bring about change to the mental health system. I told her of the severe stress breakdown that I endured back in 1998 and how I was traumatized worse by the Employees Assistance Program at my former company and by the mental health system in general. I explained that at the time, I was told I was “seriously mentally ill” and there is no cure. I briefly described the dysfunction I had been crutching and how the experience overall was a breakout from that.

That’s when she said it. “Wir würden das al “Burnout” nennen.”

“Burnout?” I asked. Then I thought about that term. In the years since 1998, I’ve used many different phrases to describe my experiences. “Burnout” wasn’t one of them. Over the next few hours, we continued chatting, often laughing together. We even took a selfie, which she messaged to her friend to tell her about me and the fun we were having. She encouraged me to get going on sharing my stories because she enjoyed them so much. She told me she was a fan and would look for my book in the future.  For someone who endured so much trauma in 1998, I enjoyed the grace of her enthusiasm. We exchanged contact information so that we can keep in touch.

In addition to my studies in Basel, I was also an exchange student in high school to Germany. A couple days after the burnout conversation on the train, I was visiting my host brother in Berlin, I told him about the conversation. He said, “Oh, yes, I know people who have had burnout. One woman I worked with went through that. She spent some time on a leave of absence. When she returned to work, she returned to a different position and started working part-time for a while and then increased to full-time.” He didn’t mention whether some kind of anti-depressant medication was involved. Most likely, he didn’t know the woman well enough to know something that specific.

As I continued my travels in Germany, I also stopped to visit another host brother and mentioned the conversation on the train about “burnout.” He also recognized the term and knew of someone who had experienced it. That person also had some time off work for rest, unwinding, and recovery before returning to work part-time as a transition to full-time employment after that.

I don’t remember just when I realized that the 1998 experience wasn’t the “burnout” as the woman on the train indicated. The “burnout” actually happened two years earlier.

In the summer of 1996, I first visited my medical doctor because I had short, periodic feelings of lethargy, which were uncharacteristic for me. I wasn’t “depressed” in mood or outlook in life, yet I knew there were aspects of my life that I didn’t like. I enjoyed my work, but I certainly didn’t appreciate the politics of it. Overall, I didn’t like being part of the “rat race” in a big city, which wore on me. The problem was I didn’t know where else to go.

I thought that perhaps something was wrong with my thyroid or some other physical condition. My doctor ran some tests and the results were fine. Some doctors might have just focused on the physical symptoms. Thankfully, she asked me what was going on in my life. I told her about my family history, including my middle brother who at that time had been out of touch with his family for more than six years. I also told of other stressful situations involving contentious divorces in my family and how I grieved for my nephews and nieces. I don’t remember if I told her of the stress at work specifically.

When she heard of what was going on in my life, my physician said, “You’re under a lot of stress. I don’t think you have bipolar or schizophrenia or anything like that, but you are under a lot of stress.” Unfortunately, she didn’t say, “You are burned out and something needs to change. You are heading right into some kind of breakdown.” If she had said, “You are burned out and should be on a medical leave for a time so that your system can balance better,” I would have heeded that caution. Since “burnout” and “breakdown” are not official diagnostic conditions, that wasn’t part of her diagnostic vocabulary. She did encourage me to seek counseling as a starting point to determine how to deal with the stress and alleviate it in some way.

Over the next 20 months, I pursued several things, including counseling, reading numerous books suggested by the counselor, taking stress management classes at work, and even switching jobs to another division in another part of the company. I continued to consult with my medical doctor. Nowhere in that time did the concept of “burnout” come into play, nor any suggestion of taking some kind of medical leave with some assistance to later return to a work environment. On an interesting note, my plan prior to the 1998 breakdown was to take a personal leave of absence for a few months through the summer of 1998. As I look back, I instinctively knew that I needed some type of “break” from my life. That came a few months early in a very different way than I was planning.

My efforts from 1996 to 1998 did relieve some stress and processed some grief. However, that relief was minor and short-lived. The counseling and stress training didn’t address enough of the underlying issues causing the buildup of stress. I continued to carry a significant amount of stress and remained unaware (unconscious) as to how unhealthy my work and social environment was.

It was only during the breakdown that I embraced the analogy of the frog in a pot of water. In that metaphor, a frog is in a pot of lukewarm water and conditioned to the initial temperature of the water. If heat (stress) is added to the pot slowly, the frog adapts and conditions itself to the rising temperature of the water and fails to try to jump out of the pot. From 1996 to 1998, the stress and even toxicity in my life continued to build, and I continued to try to adapt. I didn’t know how to jump out. I also didn’t know in which direction to jump.

A few months after the conversation in the train, as I reviewed the progression from 1996 to 1998 as it relates to the concept of “burnout,” I recognized not only my struggle in those two years of worsening conditions, but also my strength. In 1996, my functionality was already compromised with what could have been called “burnout.” For two years, I continued to function and tried to work to a solution even when the mental health and medical systems didn’t assess the full scope of what was happening and how those factors continued to increase.

Ultimately, that breakdown was very much a “breakout.” Even as I experienced it, I knew that the breakdown / breakout, would be a temporary condition. Surreal? Yes. Permanent? No. My experience was a culmination of factors. It was not an “illness” or “disorder.” Any “disorder” I had was in the two years prior while continuing to crutch the unhealthy, even toxic, environment and systems I had become enmeshed in.

When I realized that the “burnout” happened two years before the severe stress breakdown in 1998, I then wondered how things might have unfolded differently had there been a recognition of “burnout” in 1996. Most likely, I would have gone on a medical leave for a couple months or more. In that time, I could have not only rejuvenated, but also possibly learned useful tools to recognize my role in my environment around me and to learn how to stand up for myself as to what I need to become and stay “healthy”—even if the environment isn’t. Or I would have realized that I did need to leave that environment entirely.

Had that worked, I likely wouldn’t have endured the breakdown and breakout of 1998. The breakdown would have been avoided, saving me from intense pain and trauma. Yet paradoxically, I also wouldn’t have had the incredible learning experiences that I had in 1998. Through the intense process, I learned so much more from the non-ordinary states of consciousness that I reached than I could have otherwise.

In looking at the relationship of when the “burnout” actually happened, I realized there is a pretty important question to be asked.

How many people who have had experiences similar to my 1998 journey exhibited signs of significant “burnout” prior to their experiences? In addition, how long prior to those experiences did the person experience some type of “burnout?” What factors were causing and contributing to that “burnout?”

Or to use words and phrasing that I am not wild about: How many people who have experiences that get labeled “psychotic,” “bipolar,” “schizoaffective” or even “schizophrenic” are people whose burnout has gone untreated for an extended period of time?

One ironic aspect of this comes from a slogan that was used frequently in my work environment. I worked in Quality Assurance with regard to reducing variation in processes and hardware as a way of saving costs and reducing or eliminating defective product that would either need to be reworked or scrapped. One of the slogans that pounded in my mind in 1998 was “defect prevention, not defect detection.” When I was in Banff, Alberta, in the initial phase of the breakout, I recognized that I was the “defect” that wasn’t prevented.

I showed signs of significant stress for years. I actively sought help for almost two years. I tried everything suggested to me. Yet my mind still exploded and imploded. In that state, I was the “defect” in the sense that I couldn’t work and ultimately ended up losing that job, despite meeting the company’s medical leave requirements not once, but twice.  Ultimately, though, despite the pain, it was the best thing that could have happened to me.

After my visit to Germany last November, I visited a friend in Liechtenstein. She invited me to attend a holiday dinner with her work group. The room was filled with joyous holiday spirit as we entered. My friend sat on my left and a woman she knew was on my right. As dinner was served, I chatted with the woman on my right. At some point, I asked her what she did.

She mentioned that she was working a temporary position for someone who was on a medical leave. Then she mentioned that the woman was on leave for “burnout.” I found that connection interesting since I had only heard of burnout and its course of treatment a few weeks earlier. I, of course, told her of the woman on the train and some of my own experiences.

The woman then explained that the term “burnout” is actually Umgangsprache. She didn’t know how to translate that word, and I didn’t immediately recognize the term.  Looking it up later, Umgangsprache translates to “slang.” So, “burnout” is a term used by the general public, but isn’t the official diagnosis. Too bad. “Burnout” certainly seems like a decent diagnostic term to describe what a person experiences.

I am quite thankful for the conversation on the train. Since then, I have continued to ponder the relationship between “burnout” and my experiences. How does untreated “burnout” morph and manifest over time? How might untreated “burnout” contribute to other conditions that are more painful and debilitating to the person involved? I certainly have my own opinions, but perhaps this should be researched in a broader context.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Penni, Thank you for your very insightful essay. All too often, mental health professionals do not pay attention to the complexity of words. A word like “burnout” has many meanings and cannot be understood outside of the context in which it is used. To be “overstressed” is often seen as being a defect of character. We all communicate with metaphors which can only describe what something is like, not what it is. Michael Robin

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    • Thanks, Michael, for your comment. In my opinion, the role of language is a tricky one no matter what. I could argue that the language in the diagnostic manual is also rife with multiple meanings in different contexts — which is why the repeatability of diagnoses between multiple mental health professionals is generally poor. And of course the whole diabetes / insulin example was supposed to be a metaphor which ended up being treated by too many as literal.

      And yet, I noticed that in Germany and Liechtenstein, the concept of “burnout” was recognized and accepted — even as slang — by the population. It didn’t carry the stigma of the so-called ‘chronic illnesses’ that people in the US end up having to carry. It was also recognized that the person involved needed some time away for some type of rejuvenation / healing / reframing before going back to work.

      Ultimately, if my stress / strain / condition in 1996 had been recognized as a type of overall burnout and treated as such, the next couple of years would have unfolded quite differently and quite possibly avoiding a very traumatic and misunderstood experience.


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