Watch out! Burnout warning!

At the end of 2016, congress centre Arminius was packed with young, ambitious and highly qualified people. The reason: a discussion evening about burnouts.

The importance of this subject emerged back in 2013, when the National Students Union concluded that half of all students suffer from mental health problems. At the end of 2016, it became clear that there is increasing demand among students for help with mental health issues and waiting lists are growing.

Furthermore, according to the CBS at the end of 2015, burnouts occur most frequently among staff in education. In other words: universities constitute an extremely combustible environment for burnouts. Why is that?

Witte Hoogendijk, head of the Psychiatry department at Erasmus MC and co-author of (translated) From big bang to burnout, explains what a burnout is. “It starts with being stressed, caused by a stressor.” This stressor doesn’t have to be a catastrophe. “Usually, it’s something quite normal such as exam stress that prevents the person from functioning properly. This is expressed in exhaustion, concentration problems and forgetfulness.”

If this feeling of stress lasts longer than six months or if the symptoms are more severe, we talk about a burnout, says Hoogendijk. “With a burnout, the focus is on sleeping problems, exhaustion, demotivation, cynicism and a feeling of being run down.” This is usually due to a combination of factors, including high workload, low appreciation from the environment and lack of control over work times and tasks. “This is a very toxic mix.”

Students have a great deal of freedom and autonomy and don’t always have a heavy workload, says Hoogendijk. So you might think that they’d be less susceptible to burnouts. However, certain characteristics make study and education a prime arena for burnouts. “Perfectionism is an important one. These students have problems differentiating between primary and secondary issues and want to do everything perfectly. For that reason, they don’t have enough time for the really essential things. And because some of these students are eager beavers that dedicate much time to their study, there’s little room for leisure.”

Student life also increases the risk of a burnout. “All that social novelty, always having to make an impression, but there’s little social support. Many are concerned with themselves. This, in combination with the constant presence of social media and its illusory ideals, means that students are building up an uncertain identity. In addition, there are few certainties on which to fall back. This can cause stress and anxiety. And because there’s little time for relaxation and leisure when you’re studying, one can become sombre. Combined with the lack of support, this can give rise to a burn-out.”

Hoogendijk advises universities to minimise the risk of student burnouts. “It’s not that difficult. However, universities must focus more on the causes rather than the treatment of the individual cases. So organise courses in which students learn to distinguish between primary and secondary issues to create time for relaxation, for example.” Another important tip for universities: bring the subject out into the open. “Students must realise that they really don’t have to conform to the perfect picture. We need to remove the negativity associated with burnout.”

Medical students are particularly susceptible to burnouts: one in five suffer from symptoms. Why so many? “Medical students have often dreamed of becoming a doctor from a very young age,” explains Mirjam Kemmeren from De Geneeskundestudent, an association run for and by medical students.

“But once they start their studies, they often don’t realise the enormity of what they’ve started. Particularly during internships, medical students have to give up more than their peers. They often work long days. At the same time, they encounter many emotional situations, for example patients dying, which are not always properly evaluated and processed. And students often put too much pressure on themselves.”

Luckily, Kemmeren notes, the subject is no longer taboo. “In the past this was much less the case. There were always doctors who said: stop moaning, we had to work hard too and no one suffered. But they are now in the minority, allowing students to admit sooner that they’re having problems.”

Medical students are also bringing the subject into the open themselves. Take the workshop project Jezelf Beter Maken (Making Yourself Better), which aims to promote awareness about burnout, both among students and policymakers. “The project was launched last October and all four hundred tickets went really quickly. This shows how important the subject is among students. Over the next few months, we’ll be going to all the universities to give workshops and talk about burnouts.”

At EUR, students can also talk to the student psychologists about their burnout problems. Most universities have such staff, like the team of four at EUR (who were not available for an interview due to their workload).

One of the staff at the University of Amsterdam (UvA) is student doctor Claudia van der Heijde. She feels the current education system is one of the causes of burnouts (such as shorter degree programmes and fewer resits), as well as your personality (perfectionism, fear of failure, dyslexia) and the home situation (carer role). “One in four students say that they have problems with self-confidence or have a fear of failure. Students also consistently indicate that they find things like healthy eating, rest and enjoyment difficult, despite these being vital for recharging their batteries.”

The student psychologists at the UvA help trace the cause of the stress. Van der Heijde notes that prioritising activities is particularly useful. “And don’t keep things to yourself! Talk about any problems with friends, family and fellow students. Seek help if necessary. You don’t have to do everything alone.”

Staff are susceptible for burnouts too, says EUR occupational physician Bert van Balen. Together with his colleague, he sees Woudestein staff (from PhD students to managers) who have been ill for longer than six weeks. Half of the annual 250 visitors suffer from mental health problems, mainly caused by stress (usually a combination of home and work situations).

According to research, the cause of all that suffering among staff is often the combination of high workload and lack of appreciation. Van Balen: “This combination is particularly present among PhD students, who have to do a lot of work in a short period of time. If they don’t, they don’t receive any appreciation.”

An overly high work rate, too little autonomy, little control over their own work, time pressure and substantial mental effort are also breeding grounds for a burnout. Van Balen also emphasises the importance of support from colleagues and managers, which is confirmed by national research. “In departments where everyone is working for themselves, the percentage of burnouts is significantly higher.”

A common cause for burnout symptoms on the shop floor according to Van Balen is that people devote a lot of energy into things they have no influence over, such as worrying about a reorganisation. Another stressor is too much work. Van Balen’s advice: ask your manager as soon as possible what has highest priority. “This helps you regain control.” If all this sounds familiar, the occupational physician emphasises that it’s nothing to be ashamed of. “Anyone can get a burnout. It has nothing to do with a certain personality.”

Anne Annink recognises what Van Balen is saying. Her PhD research focused on the work/life balance of self-employed workers in different countries, but she suffered a burnout herself in the process. “First of all, I was in denial. My parents sometimes said: aren’t you suffering a burnout? But I wouldn’t listen. Five years ago there was an even greater taboo about it. No one talked about it, so it felt like failure. I thought: everyone else can do it, why not me?”

Experience expert Annink agrees with the words of the experts: listening to yourself is the most important step you can take. “In discussions with people from the university, the word burnout was never mentioned. That was very awkward. People often said: oh, are you going home already? I’d pretend that I had a meeting. Now I know: just be honest. If it works for me to go to the gym halfway through the afternoon and then continue work at home, then that’s what I need to do.”

In order to take that step, one indispensable link is required, according to Annink: support. “Looking back, that would have helped me a great deal. Being able to talk to colleagues or an occupational physician about my burnout. Then I’d have found out that I’m not the only one. That would have been very helpful. The occupational physician only said that I needed to build up my hours again. I’m sure that’s right, but I didn’t get much support. That was very disappointing.”

So she now gives workshops for other PhD students and undergraduates to help prevent burnouts and possibly cure them. “The most important lesson I learned from this whole period? Listen to your body. And everyone has a different work – life balance. So it doesn’t matter what other people think. You need to discover what works in your own situation.”