The dynamics of burnout: An analysis from a freudo-lacanian point of view

Stijn Vanheule[1]

Introduction

Since we know from epidemiological research that burnout is a widespread phenomenon, its negative consequences should be considered a major problem.

Social psychological research concerning burnout demonstrates that people afflicted with burnout often act in a destructive manner[2]. On the one hand, this destructive and counterproductive behaviour can be observed in their relationship towards the organisation they work for. For example, the mental condition of burnout seems to be statistically correlated to theft, dishonesty and other counterproductive deeds; in interpersonal contacts “the burned-out professional can be irritable and oversensitive but also cool and unemotional … bursts of anger may occur”; burnout in professionals correlates negatively with client-satisfaction. Other problems are that cognitive skills are often impaired, leading to all kinds of mistakes.

Research on creativity, moreover, indicates that creativity and innovation are inhibited in people with burnout. Their mental condition seems to contradict the mental condition necessary for creative action. Intellectual skills such as fluency, flexibility, and originality of thinking are impaired in burned-out professionals.

In 1974 Herbert Freudenberger - an American psychoanalyst - was the first to give burnout its psychological meaning. Although the problem was originally approached form a clinical point of view, the study of the phenomenon remained mainly academic and quantitative in nature. Classical burnout research also abounds with certain difficulties: for example, the discriminative validity of the concept is low (e.g. its difference from depression is hard to discern) and the quantitative research results indicate almost no starting points for intervention.

Recently there has been a renewed interest in research that is more clinically and conceptually based. The necessary move we have to make in burnout research is the same move Freud made, i.e. a move from a symptomatic and descriptive picture to a study of causal dynamics (cf. Freud’s study of traumatic neurosis). From our point of view, a study of causal dynamics is a precondition for a more precise understanding of the phenomenon.

Psychoanalysis and burnout

Psychoanalytic conceptualisations of burnout have always tried to grasp the dynamics of the process by which burnout comes along.

In this paper we will describe three psychoanalytic models that can help us in understanding burnout. All of these models concentrate on causal dynamics. We will explain them starting from a Freudo-Lacanian frame of reference. The first model considers burnout as the result of a gradual exhaustion process, the second model considers burnout as the result of losing an ego ideal in relation to a significant Other and the last one considers it as the result of inhibiting incompatible impulses. We make a parallel among the three models since we wonder if burnout comes about in only one way[3]. There undoubtedly exist several mechanisms that can result in a burnout-like symptomatology. We agree with Friedman and Farber, who state that a one-dimensional depiction of the burnout process is too simplistic.

1. Burnout as the result of gradual exhaustion

We begin with the first model, which considers burnout as the result of a gradual exhaustion-process. Freudenberger – the godfather of the burnout concept – presented a first framework for understanding burnout. Based upon his own experiences and upon clinical practice, he considered burnout as a chronic condition caused by exhaustion as a result of over-commitment. “Burnout is a process that comes about as a consequence of a depletion of energies, as well as feelings of being overwhelmed with many issues that may confront an individual”. The people he considers to be prone to burnout are “personal strivers and achievers” who don’t admit their limitations and who tend to set impossible tasks for themselves. Freudenberger describes the typical burnout candidate as “charismatic, energetic, impatient and given to high standards, throwing himself into whatever he does with all his might, expecting it to provide rewards commensurate with the effort spent”. Moreover, individuals prone to burnout see themselves as loners and they tend to have difficulties in expressing their feelings.

Burnout is the result of a gradual process and can be considered as the pathological continuation of job stress. An excess of stress causes burnout. Denial in order to be able to persist in current habits is a major characteristic of the problem. It is expressed in rigidity, inflexibility and over-involvement in the job. The underlying desire seems to be for a person to prove himself/herself in relation to others.

Freudenberger situates the kernel of the problem at the level of the ego. A burnt out person has suppressed and denied his or her real self for too long a time since he/she has been moulding himself/herself according to an externally imposed standard[4][5]. This causes the person to lose touch with his/her “own authentic voice and feelings”.

A typical complaint heard in this kind of burnout is the feeling that work consumes the worker. Due to a fusion between subject and work, the subject threatens to lose his/her own individuality. This causes anxiety and often also leads to a call for help (e.g. a doctor or a psychologist).

Freudenberger indicates that burnt out people attribute an excessive personal meaning to their work. Fischer (an American analyst who is in line with Freudenberger) states that this exaggeration ought to mirror the grandiosity of the ego. People vulnerable to burnout tend to consider their work as a medium for proving their importance. They stubbornly hold on to their self-conceit, cling to their ideals like a martyr and tend to work harder when they are confronted with obstructions. From a dynamic point of view an illusion of grandiosity is pivotal. According to Fischer, people vulnerable to burnout are characterized by their narcissistic aspiration to feel special and superior. Fischer as well as Freudenberger considers a fear of being inferior to others to be at the basis of this striving. They exhaust themselves in denying their own frailties. People prone to burnout typically invest a great deal in their job in order to find a sense of fulfilment and identity.

Along the same line of reasoning it is frequently observed that caregivers – the most studied professional group concerning burnout – look to their job to satisfy a longing to be appreciated. Grosch & Olsen state from a Kohutian perspective that people prone to burnout tend to treat their patients as self-objects, as objects who are there for them and whose autonomous self is not recognised. By means of the self-object a caregiver tries to satisfy a basic need, such as a need to be liked or to be admired. “Burned-out professionals may be exhausted by the efforts … to recreate consistently self-object experiences”.

Pines more generally links burnout to people’s need to believe that their life is meaningful. “When people try to find meaning in their life through work and feel that they have failed, the result is burnout”. From this point of view one is vulnerable to burnout to the extent that one attempts to derive a sense of existential significance from a job.

From a Freudian point of view, the people described seem to idealise an image of themselves in their job. According to Freud “idealization is a process that concerns the object; by it that object, without any alteration in its nature, is aggrandized and exalted in the subject’s mind”. By means of idealisation an object is cathected and overvalued. Idealisation is possible with regard to ego-libido as well as object-libido. The persons described by Freudenberger and Fischer seem to take their own ego as their object. They promise themselves a great future in order to conquer their daily misery.

According to Freud a person only adopts ideals in order to overcome a narcissistic lack. Ideals ought to restore the narcissistic completeness of one’s childhood, which was lost because of the castration-complex. From a Lacanian point of view idealisation is an imaginary process. In the process of idealisation a subject identifies with an object (such as the image of oneself in one’s job). This object is considered attractive to the extent that it reflects an image of completeness back towards the subject. First an object is exalted, and then the exalted object is expected to mirror what the subject’s ego is. In this way a subject anticipates a feeling of completeness, an ideal ego. Idealisation is highly narcissistic and it increases the claims the ego makes. On the one hand the object is treated as nearly perfect and on the other hand the ego is expected to resemble the object. Since the super-ego will tell the ego that a gap between the actual ego and the ideal ego remains, exhaustion is to be expected when someone excessively idealises himself/herself by means of his/her job and excessively tries to resemble this idealised picture of himself/herself.

According to Freud a one-sided libidinal choice furthermore implies a subjective danger. “Just as a cautious business-man avoids tying up all his capital in one concern, so, perhaps, worldly wisdom will advise us not to look for the whole of our satisfaction from a single aspiration”. People prone to burnout seem to be doing just the opposite. They do expect gratification from one domain in life since they are exclusively and stubbornly attached to their jobs and to an idea of what they want to realise in their job.

Whereas Freudenberger especially, but not exclusively accentuates the narcissistic nature of the burnout process, contemporary authors stress its externally imposed character. Aubert & de Gaulejac stress the compulsory influence of the contemporary search for excellence that seems to stimulate people to excel and exhaust themselves. Employees are continuously confronted with the objectives they are expected to reach, such that all their mental energy is invested in attaining goals and improving their performance. This results in an exhausting fusion between employee and organisation, which is stimulated by the profit-seeking firm. Berger observed a troubling interplay between the demanding environments in big firms and self-punishing and punishment-fearing tendencies in psychoanalytically treated burnout patients. Firms reinforce these tendencies and as such stimulate people to take on increasingly more work. Berger observed that self-punishing individuals are easily seduced into exhausting themselves in relation to their job. No matter how hard they work, these people’s super-egos will always tell them that what they do is never good enough.

Based upon a study of burnout in psychoanalysts, Cooper concludes that individuals with both masochistic and narcissistic defences are most prone to burn out. He considers both defences as different faces of the same pathological constellation.

To summarize, it may be said that according to this first model burnout is the consequence of a process of exhaustion. This exhaustion is caused by a narcissistic idealising trend whereby a person tries to resemble a glorious mirror image, or by a somewhat perverse interplay between a masochistic self-punishing individual and an exploiting firm.

2. Burnout as the result of losing an ego ideal in relation to a significant Other

According to a second point of view, burnout results from the loss of an ego ideal. From a Lacanian point of view this loss places a dimension of enjoyment into the forefront. Before we explain this point of view, we will first highlight a feature of Lacan’s theory of the ego ideal.

According to Lacan a subject (his term for a person) is not constituted as a unity but on the contrary is always internally divided. This division is the result of being a speaking being in a world of signifiers[6]. As a consequence of this non-unity, identity is not inherent in the subject. According to Lacan (and contrary to e.g. Freudenberger) there is no such thing as a ‘true’ identity. In its essence the subject does not know who he/she is; the existential core of subjectivity is a lack. It is only through identification that a subject acquires identity. Identity comes along if a subject adopts signifiers and starts naming himself/herself (e.g. as a man or a woman). Through the identification with a signifier a subject starts knowing who he/she is. According to Lacan the signifier the subject identifies with functions as an ego ideal. An ego ideal is a signifier a subject becomes attached to. This ego ideal has a structural function in remedying the central lack that typifies the being of the subject. By means of an ego ideal a subject starts anticipating a condition of subjective completeness[7].

Lacan gives this identification with a signifier a plainly social dimension. A subject only identifies with a signifier if he/she has the feeling that he/she can give an answer to the desire of the big Other[8] by means of this identification. It is only as a consequence of the Other’s response that a signifier becomes an orientating mark. By means of the ego ideal the subject tries to install a certain relation towards the Other. The subject tries to be in favour with the Other by adopting a characteristic the Other is considered to appreciate. The ego ideal is a point of view on the basis of which the subject considers himself/herself, and on the basis of which the subject feels loved by others. Basically a subject does not know what the Other wants from him/her. This uncertainty comes along due to the structural lack the Other is also marked with. The Other resembles the subject in being internally divided. What the subject does is translate the lack in the Other into a perceived desire, for the main thing the subject wants is being recognised by the other.

From a Lacanian point of view identification has a symbolic as well as an imaginary dimension. On the one hand identification is symbolic because the subject adopts a signifier or a symbol. On the other hand identification is imaginary since a subject anticipates a self-image. In Lacanian terms, through an ego ideal an ideal ego is anticipated. This ideal ego is to be understood as the successful version of oneself. Anticipating it always has an exalting effect.

Conceptually we assume that burnout will arise when a subject gets the impression that a big Other, whom the subject expects appreciation from, invalidates the subject’s ego ideal. In this process the idealised signifier of the Other, which the subject once isolated as an answer to the perceived question in the Other, is suddenly totally put into question. The ego ideal loses its assuring role in the relation between subject and Other.

Since it is by means of the ego ideal that a subject gets a feeling of unity, the questioning and disappearance of the ego ideal confronts the subject with his own and the Others’ lack. Clinically, we can expect feelings of depersonalisation to occur. The subject literally no longer knows what the Other wants from him/her, what he/she ought to do and who he/she is in relation to the Other. The subject loses his or her identity.

The burnout process will be stimulated directly if, at a cultural level (organisational as well as societal) a signifier once highly valued is put into question. By means of the cultural devaluation of a signifier the subject attached to it loses his or her desired relation to the Other (incarnated by the organisation or the society), or at least can’t gain the same amount of satisfaction from his or her attachment to the idealised signifier. This can happen if an organisation grows and new hierarchical levels are created. If a department head who directly reported to the CEO now has to report to a manager whose hierarchical position is between him and the CEO, the department head can have the impression that his rank in the firm has diminished. We don’t mean to suggest that this kind of degradation can cause burnout on its own, by bringing about a loss of the ego ideal. It can stimulate it.

The main cause of burnout can be considered indirect. Burnout will primarily occur if a subject has the impression – it’s a matter of interpretation – that a significant Other (boss, patient, the firm…) radically invalidates or attacks the role the subject aspires to play and the place he/she took in relation to the Other. Burnout will occur in situations where the big Other doesn’t recognise the subject in the way this subject expected to be recognised. If this is the case, the relation the subject installed as a supposedly sensible answer to the Other’s desire suddenly seems to be dead wood. In this case the ego ideal, mediating between subject and Other, is indirectly invalidated by means of the implied relation to the big Other.

This process is clearly illustrated by Aubert & de Gaulejac in their case study of a woman (the case of Noémie) afflicted with burnout. The woman has a breakdown the moment she concludes that her idealised firm doesn’t allow her to play the role she wants to play; the role she thought the firm wanted her to play. This happens when the company promotes a male colleague to the position of her direct boss. This promotion places her in a lower position with respect to the rival she thought she was superior to. This colleague receives the very recognition she had been striving for through her endeavours. Her ego ideal – as a supposedly fitting answer to the desire of the Other – suddenly proves to be invalidated and the loss of this ego ideal causes feelings of depersonalisation.

Through the disappearance of the ego ideal in the relation between the subject and the Other, a fantasmatic dimension takes hold of the situation. The Other, formerly viewed as a significant Other, now suddenly takes the shape of a threatening agent. The Other appears as a usufructuary acting at the subject’s expense; as a cruel person who enjoys in a strange and impermissible way. Zizek argues that this dimension of enjoyment destabilises the relation between subject and Other, in contrast to the ego ideal that stabilised this relation. We can find this destabilising dimension in research showing that people with burnout perceive others as a source of threat and interpret others’ critical opinions as an indication of their own failure. The dimension of enjoyment is expressed in the case study of Aubert & De Gaulejac when the woman says “I did not want to work for them anymore; I felt that it was either I or them; if I were to return, I would certainly die.” Her relation with the company became too threatening because of her ego ideal being lost. The only thing she could do was run away.

Precisely this dimension of the enjoying Other enables us to differentiate between burnout and depression from a Lacanian point of view. According to the Lacanian theory of depression, depression is – just like burnout – evoked by the loss of an ego ideal. As an ego ideal disappears, the lack in both subject and Other is pushed to the fore. This lack is a troubling nothingness the subject has to deal with (in burnout as in depression). In cases of burnout (unlike depression), the Other as an enjoying entity is always in the foreground. In this case the cause and the blame for losing the ego ideal are attributed to the Other. This dimension offsets the subject’s concurrent (typically depressive) tendency to blame him or herself for the lack in his or her relation with the Other. In depression the opposite is true since the depressive subject tends to blame himself/herself for things going wrong. As a consequence of these attributions burnout is more localised to one domain of life than depression is. The burnt out subject can blame one specific Other in one specific context, while the depressive subject has to go on with himself/herself in different contexts.

We hypothesise that the loss of an ego ideal can come along gradually as well as suddenly. In the case study we described, burnout came along suddenly. The gradual loss of one’s ego ideal is described by Farber in his study of the worn-out type of burnout. This worn-out type of burnout is characterised by a clinical picture whereby a person stopped “attempting to succeed in situations that appear hopeless”. They gradually lost their dedication “by the cumulative effects of dealing with situations that they perceive as beyond their control”. People who gradually lost their ego ideal have the impression that their former motivation was based upon an illusion. What they once did now seems to be irrelevant.

To sum up, it may be stated that according to this second point of view burnout results from the loss of an ego ideal. As a result of this loss a subject loses his or her identity in relation to others. This places a dimension of enjoyment in the forefront. The once significant Other now seems to enjoy the subject in a threatening way.

3. Burnout as the result of inhibition due to incompatible impulses

The third model we will describe is based upon the Freudian neurotic inhibition mechanism. This dynamic model is hardly ever applied to the burnout problem. Some of the described burnout problems nevertheless reflect the inhibitory mechanism.

We will explain this inhibitory mechanism with a case study by Schwartz & Will. This case study concerns a nurse, Miss Jones, who works at a ward with highly disturbed patients. After a brief absence from the ward Miss Jones seemed to be functioning less well than she did before. Within a context of low morale among the personnel she interacted less effectively with the patients. She had the impression that patients withdrew from interaction; many were negativistic and resistant, and their negative characteristics were exaggerated: aggressive patients were more aggressive; demanding patients were more demanding… These negative traits in the patients led Miss Jones to feel hostile, angry, and resentful towards the patients. Her negative attitude was reflected in the way she approached the patients. However, Miss Jones couldn’t bear her own hostility: “My hostility towards them was most disturbing”. As a consequence she had the impression that she couldn’t fulfil both her own and the institution’s expectations, and she felt guilty. In order to avoid negative interactions she tended to withdraw from patients. She minimised her interactions with patients to the briefest essential contacts. Moreover, she felt fatigued, disinterested and indifferent towards the patients and she was sporadically ill. As a consequence of this avoidance her anxiety was reduced. By withdrawing, she prevented herself from experiencing discomfort. “If I make no effort to move toward patients, I won’t fail. If I don’t get involved with them, I won’t be uncomfortable”. She avoided the sources of her hostility and guilt.

We will clarify this example by using the Freudo-Lacanian theory of inhibition. According to Freud, an inhibition or neurotic inhibition is “the expression of a restriction of an ego-function”. Working is a possible ego- function that could be affected by an inhibition.

On a phenomenological level a variety of disturbances in the exercise of a function can be considered inhibitions. Possible inhibitions described by Freud are a decrease in the pleasure of a function, the less well carrying out of a function or negative reactions (such as anxiety) if a person is obliged to carry out a function.

Lacan summarises this classification by stating that inhibition produces a halt: the expected exercise of a function doesn’t come along. There is a block at the level of movement, a dimension that is at least metaphorically present in all functions. Because of inhibition one is no longer able to do the work one did. Job performance is at least partially hampered by it. In the case of Miss Jones, inhibition is observable in her withdrawal from interactions with patients, in her falling ill, and in her fatigue.

Inhibitions are typically based upon renunciation. According to Freud the inhibiting ego renounces a function in order to avoid a psycho-neurotic conflict (i.e. conflict with the id or the super-ego). This psycho-neurotic conflict is a conflict between two inner tendencies: on the one hand we have a tendency within the ego and on the other hand a contradicting impulse. The subject chooses to shun this conflict and limits the associated ego-function. This self-imposed limitation consequently serves as an indication of an underling conflict. Lacan further elaborates this point of view upon inhibitions. According to him an inhibition is the consequence of introducing a desire into a function that is different from the desire the function normally satisfies. The inhibition results from a defence process against this secondarily introduced desire. The subject attempts to have nothing to do with the secondarily introduced desire and renounces the function altogether. In Miss Jones’ case this contradicting impulse of desire is her anger and hostility toward the patients.

Neurotic inhibition differs from the formation of symptoms. Whereas a symptom is the consequence of the ego repressing an impulse and an idea, inhibition is a matter of renouncing a function “in order not to have to undertake fresh measures of repression”. Inhibition is an attempt to flee from a conflict and can be situated as logically anterior to repression. It prevents the formation of symptoms that would be the symbolic expression of a conflict.

In fact, inhibition involves a double avoidance. On the one hand it’s a strategy to avoid repression, but on the other hand the avoided repression is already avoidance in itself. After all, repression is a strategy to avoid anxiety by binding anxiety to a signifier. A symptom is a signifying answer to an anxiety-provoking enigma. As such inhibition is a double operation for avoiding difficulty[9].

Roughly speaking, working in the human services presents a particular difficulty for the professionals concerned since it provokes ideas and experiences that are experienced as unbearable, and that contradict the ideals of caring. Psychoanalysts from within the Tavistock tradition, who studied burnout in human service professionals by institutional consulting, describe this duality as a substrate of burnout. The reality of caring places a dimension[10] into the foreground that the caregiver prefers not to be confronted with, such as feelings of helplessness and inadequacy or feelings of aggression and hatred. Other incompatible feelings professionals are confronted with are disgust, sexual impulses towards clients, and the tendency to identify professional situations with situations in private life. The ideals of caring, on the contrary, imply a denial of one’s own destructive and sexual impulses.

Since the appearance of these antithetic tendencies resembles a situation of transgression, their presence may result in psychic conflict and anxiety. They will nourish the subjective feeling of guilt and result in a flight from the situation. The more distressed the client group is, or the more a client group appeals to a dimension the professional denies, the more difficult it will be for the professional to deal with these impulses.

Professionals spontaneously tend to deny these antithetic tendencies and to defend against their unbearable reality. Inhibition[11] is a defence-mechanism often observed in such cases[12]. By means of inhibition the situation that would elicit the uncomfortable feelings is avoided. From a Lacanian point of view this anxiety is elicited by the appearance of a desire one can’t bear. The inhibited subject shuns an intolerable but pushing impulse.

From a Freudian point of view we can nevertheless state that both the compatible and incompatible tendencies have a similar origin. Freud claims that people’s ideals “proceed from the same perceptions and experiences as the objects they most abhor”. In other words: the idealisation of an object is always closely connected to the repression of another dimension. Lacan affirms the role of repression in the formation of ideals and states that an ego ideal is formed through the repression of a desire.

To summarize, we can say that according to this third model of burnout a conflict between two inner tendencies is pivotal. Through inhibition the subject shuns this conflict by avoiding the activity that elicited the conflict.

Conclusion

In this paper we sketched three models for understanding burnout[13]. The first model considered burnout as the result of a gradual exhaustion-process, the second model considered burnout as the result of losing an ego ideal in relation to a significant Other, and the last one considered it as the result of inhibition due to impulses that are experienced as incompatible.

The theoretical distinctions between these models is crucial, since they imply that different approaches towards therapeutic intervention need to be used in each case. In the first case an intervention will have to focus upon the narcissistic or masochistic function of the job in the relation between subject and Other. In the second case intervention must be focused upon the void between subject and Other. In the third case intervention will have to focus upon the necessity for a subject of dealing with his/her ambivalent feelings.

Notes

[1] Clinical Psychologist. Assistant professor at the University of Ghent (Belgium). Member of the Department of Psychoanalysis and Clinical Consulting. Member of the Research Unit Psychoanalytical and Psychodynamic Studies.

[2] Burnout also coincides significantly with self-damaging behaviour as well (e.g. suicidal thoughts, addiction).

[3] In this paper we don’t describe other subtypes such as the under challenged or bored employee, or the worn-out employee who is vaguely dissatisfied with his or her working conditions.

[4] Freudenberger considers this way of behaving to be the consequence of personal family dynamics.

[5] The main cure Freudenberger proposes for this problem is inner-directedness and closeness to oneself. He states that it is imperative “to integrate the ‘you’ that’s been suppressed for so long and the ‘you’ of the image”. The aim of therapy is to develop constant and sound ego boundaries so that a person refrains from fusing with work.

[6] The term signifier is a term Lacan borrowed from linguistics. It refers to the ambiguous dimension of a word (a word has no definite meaning and only obtains meaning in a context).

[7] “The ego ideal is an organism of defence established by the ego in order to extend the subject’s satisfaction” (Lacan)

[8] With the concept ‘big Other’ (written with capital O), Lacan designates the significant other, the other we trust in, the other we experience as a guarantor.

[9] Freud establishes a link between inhibition and anxiety, just as he does between symptoms and anxiety. Both inhibitions and symptoms are strategies for dealing with anxiety and for avoiding anxiety. From a Freudian point of view this anxiety is ultimately a fear of the demands of the libido (which is connected with a fear for castration). From a Lacanian point of view, it’s a fear of the consequences of fulfilling one’s own desire. In fact, Miss Jones was afraid of her own anger and hostility towards her patients. The presence of these feelings resulted in her feeling guilty and anxious.

[10] Projective identification often seems to be the underlying mechanism.

[11] Depersonalisation – the tendency to deal with patients in an impersonal way and to treat them as objects – is an example of inhibition. Depersonalisation is a characteristic often observed in people with burnout. By acting this way a situation of relational closeness that could elicit the impulses that are to be avoided is prevented from coming about.

[12] Another often observed defence-mechanism is reaction-formation, e.g. compensating for aggressive impulses by means of ‘chronic niceness’. Menzies Lyth described several collective defence-mechanisms.

[13] Further psychoanalytic research in order to validate this tri-structured point of view is still necessary.