At first glance, Mr L seems to be a successful man with a well-rounded life: middle management, happily married, father of two. If you ask him how he is, he responds with a smile and a “Fine thanks”. But everything is not fine. When he was admitted to the psychosomatic clinic Kloster Diessen, Mr L described his emotional life as hollow and empty.
Although outwardly he is still putting on a good face, he has been privately struggling for some time. Everything that used to bring him joy and fun has become simply another chore. He can hardly remember what it feels like to enjoy his life.
For psychotherapist Professor Bert te Wildt, who heads the psychosomatic clinic in Ammersee in Bavaria, Germany, the symptoms of Patient L. make him a prime example of a new and so far under-researched syndrome, that he calls “burn-on”. Working with psychologist Timo Schiele, he has published his findings about the phenomenon in a book, Burn-On.
The syndrome is closely related to the better-known burn-out and bore-out — exhaustion due to being over- or underworked. The common factor: they are all closely linked to the type and quantity of work a person does, whether paid (career) or unpaid (volunteering or childcare).
What is burn-on?
Burn-out is the result of sustained periods of stress at work. Being overworked reduces productivity. The affected individual tries to combat this by working even harder, which raises stress levels further and reduces productivity even more. It’s a vicious circle that can have serious physical consequences, making the individual more likely to suffer from high blood pressure or even have a heart attack.
Burn-out can eventually lead to serious exhaustion-related depression. Dr te Wildt says it means feeling like “nothing works any more”. The patient feels paralyzed, has no energy left. According to a report on lost working hours, the number of working days lost to burn-out in Germany tripled between 2011 and 2022.
On the other side of the coin, bore-out is not caused by being overworked, but by having too little work or finding work unchallenging: those who are affected find their jobs meaningless and highly boring. That can also lead to exhaustion-related depression.
Burn-on is still such a new phenomenon that there are no studies or even figures about it
So, how is burn-on different? Schiele, the lead psychologist at the Kloster Dießen Psychosomatic Clinic, uses the image of a hamster wheel to explain how it works: whereas those suffering from burn-out or bore-out have already given up running and are lying helplessly next to the wheel, burn-on patients are still driving the wheel round, desperately struggling to keep up and meet their own expectations.
“Our patients love their jobs and want to stay in them at all costs,” says te Wildt. If they do complain, it is usually of physical issues: high blood pressure, headaches, stomach issues, tinnitus or extreme muscle tension – all symptoms related to being in a physical state of high tension.
Working despite severe symptoms
Of course, not every headache or backache is a sign of being overworked. It’s not easy to determine how often these complaints point to cases of burn-on. Firstly, because research into this condition is still in its infancy. Secondly, because people suffering from burn-on generally don’t call in sick, preferring to struggle on and come into work despite their symptoms.
That is, until one or more of the physical and mental symptoms forces them out of the race. In the statistics, these cases are often recorded as heart attacks, stomach ulcers or depression. According to the homepage for health insurance company Barmer, “burn-on is still such a new phenomenon that there are no studies or even figures about it.”
However, in their daily work at the clinic, Bert te Wildt and Timo Schiele are treating more and more people who are putting on a good show but have already reached the end of their physical and mental resources.
While those suffering from burn-out come to the clinic having already been brought to a standstill by depression, people with burn-on have often worked late into the night the evening before or even smuggle documents into Kloster Dießen so they can secretly carry on working. They see their treatment at the clinic as a way to “get better as quickly as possible so they can then go on working as they did before,” says te Wildt. “Our first task is to make them realize that this can’t be their goal.”
A constant state of stress
It is not always immediately obvious that burn-on patients are suffering from depression, as they often try to hide it, determined to keep up appearances. “Sufferers sit in front of us with a beaming smile and assure us that they’re actually doing very well,” explains te Wildt. “It’s only when we probe a bit more deeply that it becomes clear the opposite is true. That outside of work they are sleepwalking through life. Nothing seems to touch them any more.”
If burn-out is an acute form of exhaustion-related depression, then te Wildt and Schiele contend that “burn-on syndrome is the chronic form.”
According to the experts, burn-on sufferers experience a constant state of stress. It is typical for them to have endless to-do lists. Any activities without a set date – going to the cinema, calling a friend – always get shunted to the bottom of the list. These activities would help them to achieve a healthy work-life balance, but they don’t make time for them. Relaxation means coming home just to carry on working on the sofa with a glass of wine.
They comfort themselves with the illusion that that if they just manage to finish this or that task, they can then relax. Or that work will soon calm down. Sometimes their escape fantasies even become morbid: they dream of falling ill and being admitted to hospital, so they can be relieved of their workload in a socially acceptable way.
The pandemic has made things worse
They find it very difficult to stop and do nothing – although they long to be able to switch off. Unlike burn-out patients, when they are at the clinic, they have the feeling that they’re wasting time by being unproductive. But that is an important part of their treatment.
“We don’t fill their schedules up completely. We deliberately leave periods of free time so the patient learns to deal with these and spend them doing other things,” explains te Wildt. “In the beginning they often find it painful and even threatening to be forced to relax.” Being in the here and now, not achieving anything concrete, doesn’t come easily to them.
The first step to making a change
But why are more and more people struggling on, despite the fact that they are reaching the limits of what they can endure? Bert te Wildt and Timo Schiele say this development is partly “the consequence of a society that is obsessed with functionality and productivity”. Another issue is the fact that burn-out is seen as a badge of honor, showing an employee’s dedication to their job. “In many circles, it’s seen as positive to be constantly on the brink of burning out.”
And for many, the pandemic has made things worse. Working from home has dissolved the natural boundaries we place around work, blurring the distinction between working hours and free time. For those at risk of burn-on, te Wildt says it is “especially dangerous to be able to work anywhere and at any time”. On the other hand, the lockdowns were beneficial to some people suffering from burn-on. Being forced to press pause made them ask questions: How much value do I place on my job? What else in my life is important? How do I treat other people?
Self-awareness is the first step to making a change. Bert te Wildt and Timo Schiele advise people who are showing signs of burn-on to think about their personal values and order them by importance. How important are areas of my life such as my partner and family, career, culture, friendships and hobbies? And how much time do I dedicate to each of these? For many patients it’s a real eye-opener, the experts say, as the exercise highlights areas where their world has fallen out of balance.
Burn-on can be treated
The good news is that “burn-on can be treated,” say te Wildt and Schiele. In their psychosomatic clinic Kloster Dießen, they work with patients to broaden their emotional toolbox and reduce internalized perfectionism and the demands they make on themselves. That isn’t something you can change overnight — it takes time.
Patient L is on the way to making changes in his daily life. A life where he doesn’t take work home with him. Where he makes time to talk to his partner and socialize with friends. And where he doesn’t feel guilty about doing so, but enjoys it.
According to te Wildt, treatment is successful when a patient is able to see the value in things and activities that have nothing to do with being productive. If during their time at the clinic they are able to identify areas of their life that can counterbalance work and ensure it doesn’t take over. Schiele puts it more succinctly: “If the patient has found good reasons not to go back to the way they were before.”
