Content uploaded by Flávio Fontes
Author content
All content in this area was uploaded by Flávio Fontes on Dec 03, 2020
Content may be subject to copyright.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
1
Herbert J. Freudenberger and the making of burnout as a
psychopathological syndrome
Herbert J. Freudenberger e a constituição do burnout como síndrome
psicopatológica
Flávio Fernandes Fontes
Universidade Federal do Rio Grande do Norte
Brasil
Resumo
O burnout se tornou um tema amplamente investigado no âmbito da psicologia
organizacional. Sua definição e escopo são objeto de um debate científico e
político internacional. Enquanto um dos fundadores do conceito, Herbert J.
Freudenberger desempenhou um papel importante na formação da pesquisa
sobre o burnout. Este artigo segue os diferentes sentidos e transformações do
conceito de burnout ao longo de sua carreira, baseado em uma leitura
minuciosa de suas obras. A metodologia é inspirada na história de objetos
psicológicos de Danziger e por estudos que mostram a importância de
metáforas no raciocínio científico. Os resultados mostram a importância do
movimento Free Clinic e da psicanálise na descrição original de Freudenberger.
Duas metáforas são identificadas e analisadas como o cerne do burnout: o
burnout como uma síndrome e o homem como um sistema de energia. A
conclusão argumenta que um melhor conhecimento sobre o passado do burnout
pode ser a chave para modificar seu desenvolvimento futuro.
Palavras-chave: burnout; história de objetos psicológicos; stress ocupacional;
medicalização; metáfora.
Abstract
Burnout has become a widely researched topic in the field of organizational
psychology. Its definition and scope are the object of an internationally
sustained scientific and political debate. As one of the founders of the concept,
Herbert J. Freudenberger has played an important role in the shaping of burnout
research. This paper follows the different meanings and transformations of the
burnout concept throughout his career, based on a close reading of
Freudenberger’s own work. The methodology is inspired by Danziger’s history
of psychological objects and by studies that show the importance of metaphors
in scientific reasoning. Results show the importance of the Free Clinic
movement and of psychoanalysis in Freudenberger’s original description.
Furthermore, two metaphors are identified and analyzed as being the core of
burnout: burnout as a syndrome and man as an energy system. The conclusion
argues that more knowledge about burnout’s past may be the key to change
its future development.
Keywords: burnout; history of psychological objects; occupational stress;
medicalization; metaphor.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
2
Burnout syndrome is today a widely researched topic. Some figures can give
a more precise meaning to this assertion: Schaufeli and others (2009) estimated
the existence of at least 6,000 works on burnout; Maslach and Leiter (2014)
claimed that about 1000 articles are published each year on some aspect of
burnout, a fact which led to the creation of a dedicated scientific journal, Burnout
Research, which was published from 2014 to 2017.
However, despite the sheer quantity of papers and research, not that much
attention has been given to the historical origin of the concept. Muheim (2013)
has found similarities between burnout syndrome and features of biblical
characters, as well as characters from literature and previous diagnoses. How to
define the scope of a research on burnout history, given such an array of
possibilities? We prefer to follow Friberg (2009) and Hoffarth (2017), who focus
on the period from the 1970s onward and search to analyze the subject from a
critical conceptual and historical approach. Our restrictive choice was to study only
what is explicitly treated as burnout (and, of course, its variations burnt out, burn
out, burn-out), leaving aside the comparison with other diagnoses and also the
search for a burnout not named as such.
The burnout expression appeared in print on a novel by Greene (1960/2004),
and on papers by Bradley (1969) and Sommer (1973), but in none of these
publications there was the intention to turn this expression into a concept with a
definition. This step was taken by Herbert J. Freudenberger (1926-1999), Jewish
psychoanalyst of German origin settled in the United States of America (USA).
Schaufeli and Buunk (2003) recognize that Freudenberger had a pivotal role in the
proposal of a "burnout syndrome" and in the definition of the phenomenon.
However, we couldn’t find any study that is dedicated only to Freudenberger, which
seems to show that he is not seen as an author to be studied in itself. Considering
the importance of his contribution to a concept that has had such a prolific outcome,
we believe that he deserves a more special treatment. The main goal of the present
paper is to present a general view and interpretation of the conception and
evolution of his ideas about burnout, based on a close reading of the author’s own
work.
Methodologically, our approach is inspired by Kurt Danziger’s history of
psychological objects (Brock, 2015; Danziger, 1997, 2010) and several studies
that have showed the importance of metaphors in psychology (Brown, 1992;
Gentner & Grudin, 1985; Leary, 1994; Pickering, 2006; Roediger, 1980; Soyland,
1994) and in human thought (Black, 1954, 1977; Carone, 2011; Lakoff & Johnson,
1980/2003, 1999). We aim to follow the different meanings and transformations
that the burnout concept undergoes throughout the work of Freudenberger. In
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
3
doing so, we exercise a mainly theoretical study (Fontes & Falcão, 2015); Laurenti,
Lopes, & Araujo, 2016; Slife & Williams, 1997) and recognize affinity with the
internalist approach in the history of psychology (Hilgard and others, 1991),
insofar as a great deal of effort is made to scrutinize the work and ideas of one
single author, emphasizing a close reading of his own texts.
To attain our goal, it was necessary to demarcate the extent of
Freudenberger’s scientific production. An estimation has counted more than 90
works, considering articles, book chapters and monographs (Gold Medal Award for
life achievement in the practice of psychology, 1999), while another estimation
affirms that there would be more than 100 items (Canter & Freudenberger, 2001).
Our search was able to identify 87 items (Fontes, 2016), which makes it certainly
unfinished, but close enough to the total number to serve as a guide in the absence
of a more complete list. The analysis that follows is based on 23 texts: 21 articles
and 2 books.
The emergence of the burnout concept
The context of the emergence of the burnout metaphor in Herbert J.
Freudenberger's work is the Free Clinic movement. According to Freudenberger
(1971a), the movement emerged when the first Free Clinic was created in 1967,
in Haight-Ashbury, San Francisco, in order to serve the indigent and young
population, who sought care for issues such as “infections, bad drug trips, venereal
diseases, abscesses, and general medical problems” (Freudenberger, 1971a, p.
169). Freudenberger visited the Haight-Ashbury district in 1967 and 1968, before
helping to organize a Free Clinic in New York, which opened in January 1970
(Freudenberger, 1969a, 1971b, 1971c). At that time, Haight-Ashbury was a center
that attracted people from all over the USA, due to the effervescence of the hippie
movement. The summer of 1967 became known as the "summer of love" and was
considered the peak of the vividness in the area. Drug use was common and there
was, in many hearts, the hope of a revolution in the realm of behavior and values
that would spread throughout the nation. Freudenberger himself wrote at least two
texts reflecting a concern on the ongoing conflict of generations (Freudenberger,
1969b, 1970).
As for the Free Clinic movement, it did in fact have a strong expansion: only
four years later, Freudenberger (1971a) would claim that there were 80 of them
in the USA and Canada. At the third meeting of the National Free Clinic Council in
1973, the estimated number of free clinics in these two countries was 300, with a
workforce of 3,000 people (Freudenberger, 1973a). For Freudenberger, the Free
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
4
Clinic was not only social work, but an instrument for questioning the traditional
medical model and provoking change in a community (1971b, 1973b). The word
“free” has more than one meaning in this context. It is "free" because the clinic
did not charge for care, and functioned mainly through voluntary work and
donations. But it also meant that the clinic was the result of a philosophy of
community life that was proposed as an alternative to traditional society, animated
by the spirit of questioning and sharing that the hippie culture gave rise to.
It is in the context of the discussion on the psychologist’s work in free clinics
that the issue of burnout is examined by Freudenberger. After addressing (1) the
organizational structure of the clinic and (2) the risk of having professionals
identifying themselves with the patients, the third subject is that of the “’burnt out
syndrome” (Freudenberger, 1973b, p. 56), written in quotation marks, with the
verb burn conjugated in the past participle and without a hyphen. A syndrome that
Freudenberger recognizes as a problem that he had suffered himself and which he
relates directly to the context of working in a Free Clinic (Freudenberger, 1973b).
The St. Mark's Clinic operated from Monday to Friday, from 6:00 p.m. to
10:00 p.m., and received approximately 40 patients per night (Freudenberger,
1971a). Thus, Freudenberger (1973b) reflects on the work conditions:
most of what you do there you do after your normal professional
working hours (...) you start your second job when most people go
home (...) And you put a great deal of yourself in the work. You
demand this of yourself, the staff demands it of you, and the
population that you are serving demands it of you. As usually
happens, more and more demands are made upon fewer and fewer
people. You gradually build up in those around you and in yourself
the feeling that they need you. You feel a total sense of commitment.
The whole atmosphere builds up to it, until you finally find yourself,
as I did, in a state of exhaustion (p. 56).
It is clear in Freudenberger's description that his understanding of the burnt
out syndrome is based on the relation he had with his own work. In another text,
he states that he worked 10 to 12 hours during the day, as a psychoanalyst in his
office, and then worked until midnight or more in the free clinic (Freudenberger,
1975). In the 1973b article, despite using the word "syndrome", the author does
not seek to establish signs and symptoms that characterize it but rather, provides
the extremely autobiographical description reproduced above.
He goes on observing that other volunteers in therapeutic communities who
work with drug users have sought him in a state of “depression, apathy, and
agitation” (1973b, p. 56), and that “for many, part of the explanation was the
‘burnt out’ syndrome” (1973b, p. 56). This passage seems to show that the term
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
5
was starting to be used by different people, something which will be confirmed by
the following quotation from the best-known article of 1974a: “Some years ago, a
few of us who had been working intensively in the free clinic movement began to
talk of a concept which we referred to as ‘burn-out’” (1974a, p. 159). It is also
important to add that, according to Schaufeli and others (2009), “burnout” was an
expression used in the illicit drug scene and “colloquially referred to the
devastating effect of chronic drug abuse” (p. 205).
This shows that Freudenberger did not consider himself the author or creator
of the burn-out term (now written with the verb in the present tense and with a
hyphen). This expression appears as a collective creation of the community of
workers engaged in the Free Clinic movement, an anonymous and popular creation
that does not have a certain origin or author, but which became part of the
vocabulary of these people to account for an experience that had been sufficiently
observed to deserve receiving a denomination.
Metaphors that organize the concept of burnout
In 1973, Freudenberger’s assertions about the syndrome were extremely
concise, occupying only a paragraph of a section of problems found in the clinics,
within a text whose main goal was to promote and talk about the Free clinic
movement. The tone of some advice given by Freudenberger is striking because it
can be interpreted as promoting fatigue and not denouncing or preventing it:
“Spend all the time you can spare – and some you cannot” (1973b, p. 61) and “be
prepared to work long hours for no pay” (1973b, p. 61). These statements seem
significant in the way he viewed work in the clinic, and was perhaps shared by
other Free Clinic workers.
One paper was acknowledged by the literature as an especially important
moment for the introduction of the concept of burnout as an object of academic
study: "Staff Burn-out" (Freudenberger, 1974a). This statement can be supported
by the fact that the literature in this field of research regularly highlights the
importance of this particular text (Friberg, 2009; Heinemann & Heinemann, 2017;
Hoffarth, 2016, 2017; Muheim, 2013; Schaufeli & Buunk, 2003; Schaufeli &
Enzmann, 1998; Schaufeli and others, 2009). This can also be perceived in
quantitative terms by observing the number of citations that the article has and
comparing it with other articles by Freudenberger. While "Staff Burn-out" has
9,013 citations, the paper that comes second in number of citations is "The staff
burn-out syndrome in alternative institutions" (1975), which appeared only a year
later, with 1,205 citations. Other articles on burnout, written by Freudenberger in
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
6
the 1980s, had fewer quotations: 147 for "Issues of staff burnout in therapeutic
communities" (1986) and 76 for "Burnout: past, present and future concerns"
(1989)
1
.
The 1974a article is found in a special number of the Journal of Social Issues
dedicated to the topic of Free Clinics and edited by Herbert J. Freudenberger
himself, who also wrote the introduction (1974b). In this introduction, he refers to
the special number as a Handbook, and claims to have tried to address as many
general and specific, practical, and theoretical issues as possible to assist the
reader and the Free Clinic movement to keep striving for “health care as a right
for all, not a privilege for just a few” (1974b, p. 7). The article on burn-out has
only three references, all of them of Freudenberger's own works. To quote only
himself is a practice quite common in his papers (1970, 1971a, 1973a, 1974c,
1975, 1977), with one case in which he even makes no references at all (1973c).
This can be interpreted as a sign of poor scholarship, but also as the consequence
of advancing new, yet undiscussed ideas – in this case, both explanations are
probably true.
The very definition of burn-out is taken from a dictionary that does not appear
in the references: “to fail, wear out, or become exhausted by making excessive
demands on energy, strength, or resources” (1974a, p. 159). The same definition
can also be found in Freudenberger (1977) and in Schaufeli and Enzmann (1998),
also without the exact reference of the dictionary being quoted – in fact, it is only
referred to, in all three occasions, as "the dictionary".
Following the rationale of the 1974a paper, the text proclaims that one of the
preliminary signs of burn-out is the loss of the leader's charisma and the
disappointment of the clinic staff, who often has high expectations on the founder.
Here it is important to remind the reader that Freudenberger was the founder of a
free clinic and that this work context is central to his initial reflections on the matter.
Although the word "syndrome" does not appear in the 1974a article - as it
had in 1973b - the syndrome idea can be observed when Freudenberger proposes
a list of signs that are divided into physical and behavioral. Physical signs are: “a
feeling of exhaustion and fatigue, being unable to shake a lingering cold, suffering
from frequent headaches and gastrointestinal disturbances, sleeplessness and
shortness of breath” (Freudenberger, 1974a, p. 160). Behavioral signs involve
difficulty to hold in feelings, instantaneous irritation and frustration responses, and
quickness to anger. Other signs are the attitude of suspicion and paranoia, in which
the victim may feel that everyone wants to harm him/her, as well as a feeling of
1
Citation figures retrieved from Google Scholar (January 30, 2020).
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
7
omnipotence, which can lead the individual to take unnecessary risks. The person
becomes rigid, stubborn and inflexible, having the feeling that he/she has gone
through everything in the clinic and knows more than anyone else. The person
acts and seems depressed, spending a lot of time in the clinic.
After reading the description above, one question remains: why did
Freudenberger chose to speak of this phenomenon in terms of syndrome? Did the
medical clinic context influenced in this direction? The import of a medical term to
speak of the described psychological/behavioral phenomenon is a decision that is
not self-evident and which carries serious consequences for the future of the
psychological object known as burnout. "Burnout is a syndrome" is a statement
that will become customary in the literature about the subject and that appears in
1973 without a clear justification.
What seems to be at stake is that Freudenberger proposes to think of burn-
out “as if” it was a syndrome, that is, he provides a metaphor from which it is
possible to organize a discourse on causes, signs, treatment. However, this is not
a metaphor that is thought of as such, but instead comes as a statement about
which there is no doubt. Here we see the making of a myth, in the sense given to
this word by Leary (1987): to take an analogy or metaphor as an identity,
forgetting to say “as if”. That is, we go from "burnout can be seen as if it were a
syndrome" to "burnout is a syndrome".
Another metaphor used by Freudenberger is that of man as an energy system,
whose level may be high or low, that spends energy or “recharges” its batteries.
An individual who is potentially at risk of developing burnout is someone who needs
to overgive and expend energy. As the population to be cared for has many needs
and demands, the individual who wants to help can do this in excess. “If we don’t
get feeding from somewhere, we will most assuredly burn out” (1974a, p. 162).
Supplies may seem endless, but they are not, they can dry up (Freudenberger,
1975, p. 75).
Stating preventive measures, Freudenberger suggests that it is a good idea
to check the “energy level” of the volunteer who wants to work in the clinic because,
if his energy level is low, it may be better to advise him not to work in an institution
that is “such an energy drainer” (1974a, p. 163). Getting workers to do workshops
and trainings is a very good way to get them to rest and “recharging their depleted
batteries” (1974a, p. 164). Freudenberger (1974a) explains that the exhaustion
of burnout is mental and emotional, but not physical: “It is this type of exhaustion
that will not let you sleep” (p. 164). Therefore, the recommendation is to do
physical exercises that leave the individual physically exhausted, but recovered
from mental strain and fatigue.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
8
Freudenberger remained true to the metaphor when he dealt with the theme
of burnout in another context, that of caregivers of children in orphanages and
shelters. Caregivers may not realize that “as they day-in-and-day-out psychically
‘feed’ the needy young person, they day-in-and-day-out deplete themselves”
(1977, p. 92). The process is intensified if the child is emotionally needy and
hungry, what makes him warn about the “inherent dangers that exist in the
treatment relationship” (1977, p. 92). Living in the context of a difficult childhood
experience, “the young boy or girl seeks to receive, to take, to grab whatever is
available (…) the ‘gimmes’ may get out of hand” (1977, p. 93). The population
assisted by various aid institutions is characterized by phrases such as “they
continually take, suck, demand” (1975, p. 75). If the worker has difficulty leaving
work “in the office” and takes it home, concern with the children may “severely
drain his energies and intrude on all aspects of his personal life and relationships”
(1977, p. 94).
In order to protect the workers from these dangers, Freudenberger stresses
the importance of trusting and sharing information with the staff: these
interactions “feed” the workers and allow them to “feed” clients (1977, p. 96).
Energy investment at work needs to be balanced with a life outside of it (1977, p.
97) and “any activity that is physical may replenish the mental and emotional
energy that are expended as part of the work” (1977, p. 97).
Individual intrapsychological dynamics, institutions and society
The description of burnout that Freudenberger provides explores the
motivation and personal characteristics of the caregiver. Those who are dedicated
and committed tend to be the people who will burnout: “We feel a pressure from
within to work and help and we feel a pressure from the outside to give” (1974a,
p. 161). This statement may translate the feelings of the workers: “Our own needs
and wants are usually secondary. Theirs are primary” (1975, p. 75). The individual
in danger of burnout has an excessive need to give that is not realistic. Failing to
meet his own high expectations, he starts to feel guilty, and this can lead to even
more work. Another factor to consider is what kind of commitment the person has
with work. Engagement and commitment can either be mature or just a sign of a
personal need to be accepted and receive approval from others (1974a).
According to Freudenberger, different types of people are prone to burnout.
The overly committed uses the clinic as a substitute for his personal life: all his
gratifications in life come from the institution, and even in his free time he wants
to go to the clinic. His identification with the institution is so great that any attack
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
9
on his person is an attack on the institution and vice versa. The authoritarian needs
to be always in control and believes that no one can do the job as well as he does.
The administrator may be someone who is unable to delegate.
While addressing the psychology of child caregivers (1977), Freudenberger
points out that the caregivers themselves may have come from the streets or from
unstructured homes, which may explain why “their motivation may be very strong
to help fellow sufferers who have come from the same place they did” (1977, p.
91). The caregiver who came from the street may be identifying with the child he
helps through his own unresolved personal experiences and problems.
These thoughts may be related to the life story of Freudenberger, who went
through difficult times on the streets during his childhood, fleeing from Nazi
Germany, and passing through several countries until arriving in New York (Gold
Medal Award for life achievement in the practice of psychology, 1999, Canter &
Freudenberger, 2001). In fact, there are many elements that support this idea.
The text that registers his award at an American Psychology Association (APA)
ceremony reads as follows: “He speaks of his involvement in psychology and his
work with patients and addicts as a way of giving back to people when he so often
thought that he would not survive” (Gold Medal Award for life achievement in the
practice of psychology, 1999, p. 579). Freudenberger showed a continuous interest
in topics related to childhood and adolescence in difficult situations (Freudenberger
& Torkelsen, 1984; Freudenberger & Gallagher, 1995), and has directly related his
interest in the subject with personal experiences on at least two occasions
(Freudenberger & Richelson, 1980; Freudenberger & Gallagher, 1995).
The feelings of the caregiver are analyzed by Freudenberger through the
concepts of transference (1974c) and countertransference (1977). For example,
when talking about therapeutic counseling: the practitioner can transfer to the
patient what he has experienced as a child, or how he would have liked to be
treated as a child (1974c). He can even give his personal phone number, meet
with the patient in the weekend, take him to a job interview, get him an apartment,
etc. A relationship of dependency between them can be established, the
professional may feel compelled to take care of all the problems, and start to
burnout (1974c).
Despite this focus on the caregiver's intrapsychological dynamics,
Freudenberger established a relationship between burnout and the wider political
and social struggle in which he placed the action of free clinics. Practicing
psychological counseling, either individually or in groups, “without being able to
effect change in the immediate surrounding community, can be a frustrating task
indeed. It is like doing band-aid treatment when major surgery is called for” (1974c,
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
10
p. 85; see also the use of the same metaphor in 1973b). Doing only counseling “is
merely to attend to the symptoms of the disease, rather than tackle the causes”
(1974c, p. 86). That is why “we need to be as much concerned with making our
sick institutions healthier, as with making individuals, who come to us for help,
healthier” (1974c, p. 86). How does all this relate to burnout? “Without putting our
energies in those directions [of institutional and communal change], there will
never be enough counselors to go around. As fast as we turn them out, we
ourselves will burn them out” (1974c, p. 86).
Another passage where this preoccupation with supra-individual aspects can
be seen is in the proposition of the notion of functional Burn-Out. For
Freudenberger, work in large organizations can become fragmented and
meaningless. The worker might find himself in a situation where he cannot
communicate with the decision makers in the company. In this case, the worker
can be lead to a functional Burn-Out, that is, a Burn-Out generated by the system
itself (Freudenberger & Richelson, 1980, p. 164). He examines a case of group
Burn-Out in which a whole team of seven people works hard for a candidate who
uses the results of that work in a timely manner to be elected, but then ignores
the project after coming to power (Freudenberger & Richelson, 1980, p. 172).
Continuing in the perspective of a wider questioning of society, Freudenberger
states: “Why, as a nation, do we seem, both collectively and individually, to be in
the throes of a fast-spreading phenomenon – burn-out?” (1980, p. 3). Elsewhere
in the same book, we see that the metaphor is related to an ecological concern,
taking into account the possibility of a global burn-out: “Burn-Out of the planet’s
energy and resources” (Freudenberger & Richelson, 1980, p. 200)
2
.
A concept in motion
Freudenberger continued to mention burnout in later articles that did not
focused on this topic (Freudenberger & Torkelsen, 1984, Freudenberger and others,
1989, Freudenberger, 1990, 1993), but it is in the books of 1980 and 1986 that
he makes some of his most elaborated theoretical contributions after the
pioneering papers of the 1970s. These two books (Freudenberger & Richelson,
1980; Freudenberger & North, 1986) are characterized by a large number of
clinical histories, by the style of self-help literature, and by frequent interaction
2
This aspect of Freudenberger's thinking was taken up more recently by Chabot (2013): “burn-out
is a disease of civilization. We have exhausted the earth” (p.13). “Burn-out is the mirror of society
that makes it possible” (p. 62). In the French original text: “Le burn-out est une maladie de
civilisation. Nous épuisons la terre” (p. 13). “Le burn-out est le miroir de la société qui le rend possible”
(p. 62).
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
11
with the reader, such as 1) the Burn-Out scale (Freudenberger & Richelson, 1980,
p. 17); 2) an exercise in self-reflection and self-awareness aimed at discovering
infantile messages and defenses (1980, p. 30-32), and 3) a checklist for
prevention and recovery of burnout (Freudenberger & North 1986, p. 232).
The first book, “Burn-Out: the high cost of high achievement”, gives the
following definition of the phenomenon: “To deplete oneself. To exhaust one’s
physical and mental resources. To wear oneself out by excessively striving to reach
some unrealistic expectation imposed by oneself or by the values of society”
(Freudenberger & Richelson, 1980, p. 16). This definition not only does not use
the word syndrome, but it also does not provide a list of “signs”. It should be
noticed that there is not a necessary relationship with work, and the example used
just a few pages after this definition is a Burn-Out of a marriage. The focus is on
the energetic aspect of exhaustion and how it happens, that is, the dynamics that
leads to exhaustion. This dynamic is described as the conflict between one person’s
idealized image of himself and a real, imperfect image that is denied. Burn-Out is
described primarily as the result of this denial, and healing happens through a
process of awareness and integration of the denied part. It is surprising that Freud
is not cited even once
3
, and that there is no use of the terms "suppression" or
"repression". Further on, a list of “symptoms” (not signs) is provided: exhaustion,
detachment, boredom and cynicism, impatience and heightened irritability, a
sense of omnipotence, a suspicion of being unappreciated, paranoia, disorientation,
psychosomatic complaints, depression and denial of feelings. (Freudenberger &
Richelson, 1980, p. 62-67). Among these symptoms, it is the denial mechanism
that will receive the most detailed analysis, and it becomes clear that it is thought
of as a Freudian defense mechanism that can be a drain of energy, insofar as
denial is used to maintain a false image, whose origin is usually found in childhood
and family relations.
In the second book – “Women's Burnout” – the definition given to burnout
confirms the focus on the energy aspect as the central component of the concept
and more explicitly covers different contexts of application: “It is an exhaustion
born of excessive demands which may be self-imposed or externally imposed by
families, jobs, friends, lovers, value systems, or society, which deplete one’s
energy” (Freudenberger & North, 1986, p. 9). In the 1980 book, the denial process
already had greater significance than the other symptoms. But in 1986, it will be
raised to the central mechanism of burnout: “If you think you’re burning out, you
can be certain you’ve assumed the posture of denial in critical areas of your life”
3
In the references list the reader can find Freudenberger himself, Christina Maslach and other 1970s
authors who wrote about stress and burnout.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
12
(Freudenberger & North, 1986, p. 10). The symptoms are now presented as a 12-
stage cycle: the compulsion to prove, intensity, subtle deprivations, dismissal of
conflict and needs, distortion of values, heightened denial, disengagement,
observable behavioral changes, depersonalization, emptiness, depression and
total burnout exhaustion. Comparing these items with the “signs” of 1974a, the
abandonment of the more psychosomatic or corporeal aspects is evident, and a
greater elaboration of the more properly psychological aspects is presented.
Burnout appears as a compensation movement, responding to a time of great
initial deprivation. It is indiscriminate, since “it feeds on starvation of any kind”
(Freudenberger & North, 1986, p. 146-147). When love, recognition and approval
are not present, “they leave a hungry void” (Freudenberger & North, 1986, p. 90),
and low self-esteem drives a non-realistic quest for excellence, recognition and
approval (Freudenberger & North, 1986, p. 17).
Examining the metaphors
We have identified two main metaphors that structure the concept: burnout
as a syndrome and man as an energy system. When we compare the presence of
these metaphors with the conceptual variations suffered, what stands out is that
the metaphors are more stable than the definitions and components of burnout.
However, the two identified metaphors do not have the same status. Given
that every metaphor has consequences, we can discuss and evaluate them. Gaete
and Cornejo (2014) propose the following criteria: 1) do they foster productive
and meaningful reasoning to advance knowledge in a given context? (productivity
criterion); 2) are they consistent with the assumptions and theoretical framework
in which they are embedded? (consistency criterion).
In fact, the first metaphor (burnout as a syndrome) seems fragile and not
essential since Freudenberger himself soon ceases to use the word “syndrome”
and proposes definitions that do not include the term (recent criticism on the
subject can be found in Heinemann & Heinemann, 2017; Millan, 2007; Rollo, 2017).
This metaphor places “burnout” in a medical vocabulary and frame of reference,
without presenting elements to support this, since the psychoanalytic
intrapsychological dynamics studied by Freudenberger does not need the notion of
syndrome to state what it does. Moreover, it promises a stability of signs and
symptoms that was never found and tends to individualize and medicalize the
treatment (through psychotherapy and drug administration). Moreover, it is not
able to deliver an etiological agent to a problem that is admittedly multi-factor and
involves many psychosocial determinants. In this case, the metaphor not only does
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
13
not enhances our knowledge about the phenomenon, but it actually has harmful
consequences. The main outcome of these remarks is that the syndrome metaphor
has too many problems and difficulties to justify itself theoretically, and should be
abandoned.
On the other hand, the metaphor of man as an energy system seems to be
at the core of the burnout concept. It can be seen at various moments and
constitutes a central vocabulary: energy level, energy drainer, to recharge to feed,
etc. Signs and symptoms are severely questioned and criticized, but there seems
to be no doubt, among those who believe that burnout is a useful concept, that
exhaustion is its central aspect, and it is generally conceived in energetic terms.
In this case, the energetic metaphor seems to have had special resonance for two
reasons: 1) it expressed a suffering that demanded a name, recognition and
treatment; 2) it did it in a language that is both easily understandable and open,
so that anyone could interpret it, giving meaning to the metaphor in a personal
way. Thus, it can be argued that the energetic metaphor is productive, even if its
openness carries the risk of turning it useless to scientific purpose. It is also
consistent with the psychoanalytical framework of reference, since it can be seen
as anchored in the Freudian concept of libido.
Conclusion
The main results will be summarized by section. “The emergence of the
burnout concept” shows the importance of Freudenberger’s personal experience of
suffering and the anchoring of burnout in the collective experience of the free clinic
movement, where the expression was already in use. “Metaphors that organize
the concept of burnout” identifies two main metaphors as central to the making of
this psychological object: “burnout is a syndrome” and “man is an energy system”.
“Individual intrapsychological dynamics, institutions and society” provides an
account of Freudenberger’s initial analysis of the inner psychology of the individual
with burnout, while recognizing that he also pointed at the importance of groups,
institutions and society, even if these broader topics were not as well developed.
“A concept in motion” discusses how his views evolve to a more detailed
psychoanalytical-oriented frame of comprehension in the books “Burn-Out: the
high cost of high achievement” and “Woman’s burnout”. In the end, “Examining
the metaphors” argues that the syndrome metaphor is not consistent and has
harmful consequences to the way we deal with the subject, while the energy
system metaphor is at the core of the burnout concept.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
14
The present study has at least two important limitations that may suggest
further research. The first one is that we only had access to a limited portion of
Freudenberger’s published work, and did not had the opportunity to consult the
“Herbert Freudenberger papers” archive in the Center for the History of Psychology,
located at the University of Akron. This means that the comprehension of
Freudenberger’s work can be significantly changed by a more extensive knowledge
of these bibliographical and archival sources. The second limitation is that we
emphasized a theoretical and internalist investigation of one single author. As
argued by Waitrin (2017), internalist and externalist approaches should not be
seen as mutually exclusive, but as complementary. Therefore, the comparison of
Freudenberger with other researchers, the history and meaning of the word
“syndrome”, as well as the investigation of broader sociological and historical
aspects of Psychology, Psychiatry and the classification of mental disorders in the
USA of the 1970s and 1980s are possibilities that could enhance our knowledge
about the development of burnout.
It is rather surprising that recent history of psychological research can be
little known, as we can see in the case of Herbert Freudenberger’s work. While
citing the 1974a article has become practically a ritualistic procedure in the
burnout literature, Freudenberger as a psychoanalyst seems to have found only
oblivion. Thus the importance of historical studies that try to analyze the
development of scientific concepts, unveiling epistemological, methodological and
theoretical assumptions. The choices made in the metaphorical construction of the
burnout syndrome are not mandatory and their analysis can bring many different
challenges to the surface.
Why did a psychosocial phenomenon became ruled by a metaphor that
induces individual treatment? Are we ready to recognize psychological suffering
that is not medically framed? At the end of this review, it is possible to conclude
that the past of burnout as a concept can help us question its present usage and
maybe even change the course of its development.
References
Black, M. (1954). Metaphor. Proceedings of the Aristotelian Society, New Series,
55, 273–294.
Black, M. (1977). More about metaphor. Dialectica, 31(3-4), 431–457.
Bradley, H. B. (1969). Community-based Treatment for Young Adult Offenders.
Crime & Delinquency, 15(3), 359–370.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
15
Brock, A. C. (2015). The history of psychological objects. Em J. Martin, J.
Sugarman, & K. Slaney (Eds.), Wiley handbook of theoretical and
philosophical psychology: methods, approaches, and new directions for social
sciences (pp. 151–165). New Jersey: Wiley.
Brown, J. (1992). The definition of a profession: the authority of metaphor in the
history of intelligence testing, 1890-1930. Princeton: Princeton University
Press.
Canter, M. B. & Freudenberger, L. (2001). Herbert J. Freudenberger (1926-1999).
American Psychologist, 56(12), 1171.
Carone, I. (2011). Metáfora e psicologia: uma relação perigosa? Curitiba: CRV.
Chabot, P. (2013). Global Burn-out. Presses Universitaires de France.
Danziger, K. (1997). Naming the mind. How Psychology found its language.
London: Sage.
Danziger, K. (2010). Problematic encounter: talks on psychology and history.
http://www.kurtdanziger.com/Problematic%20Encounter3.pdf
Fontes, F. F. (2016). Teorização e conceitualização em psicologia: o caso do
Burnout. Tese de Doutorado, Universidade Federal do Rio Grande do Norte,
Natal, RN.
Fontes, F. F. & Falcão, J. T. da R. (2015). A psicologia teórica e filosófica como
uma área de pesquisa acadêmica. Psicologia Em Pesquisa, 9(1), 72–
79. https://doi.org/10.5327/Z1982-1247201500010009
Freudenberger, H. J. (1969a). The Drug “Scene” in Haight-Ashbury, U.S.A.
International Journal of Offender Therapy and Comparative Criminology,
13(1), 13–17.
Freudenberger, H. J. (1969b). Treatment and dynamics of the “disrelated”
teenager and his parents in the American society. Psychotherapy: Theory,
Research & Practice, 6(4), 249–255.
Freudenberger, H. J. (1970). The case of the missing male authority. Journal of
Religion and Health, 9(1), 35–43.
Freudenberger, H. J. (1971a). Free clinics: what they are and how do you start
one. Professional Psychology, Spring, 169–173.
Freudenberger, H. J. (1971b). The “Free Clinic” Concept. International Journal of
Offender Therapy and Comparative Criminology, 15(2), 121–133.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
16
Freudenberger, H. J. (1971c). New psychotherapy approaches with teenagers in a
new world. Psychotherapy: Theory, Research & Practice, 8(1), 38–43.
Freudenberger, H. J. (1973a). Third Gathering of the National Free Clinic Council:
Where Were the Psychologists? Professional Psychology, 4(4), 369–372.
Freudenberger, H. J. (1973b). The psychologist in a free clinic setting: an
alternative model in health care. Psychotherapy: Theory, Research and
Practice, 10(1), 52–61.
Freudenberger, H. J. (1973c). Developing a Paraprofessional Staff Enrichment
Program in an Alternative Institution. Professional Psychology, 4(4), 429–433.
Freudenberger, H. J. (1974a). Staff Burn-Out. Journal of Social Issues, 30(1), 159–
165.
Freudenberger, H. J. (1974b). Introduction and Acknowledgment. Journal of Social
Issues, 30(1), 1–7.
Freudenberger, H. J. (1974c). Crisis Intervention, Individual and Group Counseling,
and the Psychology of the Counseling Staff in a Free Clinic. Journal of Social
Issues, 30(1), 77–86.
Freudenberger, H. J. (1975). The staff burn-out syndrome in alternative
institutions. Psychotherapy: Theory, Research and Practice, 12(1), 73–82.
Freudenberger, H. J. (1977). Burn-out: Occupational hazard of the child care
worker. Child Care Quarterly, 6(2), 90–99.
Freudenberger, H. J. (1986). The issues of staff burnout in therapeutic
communities. Journal of Psychoactive Drugs, 18(3), 247–51.
Freudenberger, H. J. (1989). Burnout: past, present, and future concerns. Loss,
Grief & Care, 3(1-2), 1–10.
Freudenberger, H. J. (1990). Therapists as men and men as therapists.
Psychotherapy: Theory, Research, Practice, Training, 27(3), 340–343.
Freudenberger, H. J. (1993). Treating Alcohol and substance abusers in an
independent practice setting. Psychotherapy: Theory, Research, Practice,
Training, 30(2), 245–250.
Freudenberger, H. J., Freedheim, D. K. & Kurtz, T. S. (1989). Treatment of
individuals in family businesses. Psychotherapy: Theory, Research, Practice,
Training, 26(1), 47–53.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
17
Freudenberger, H. J. & Gallagher, K. M. (1995). Emotional consequences of loss
for our adolescents. Psychotherapy: Theory, Research, Practice, Training,
32(1), 150–153.
Freudenberger, H. J. & North, G. (1986). Women’s burnout: How to Spot It, how
to Reverse It and How to Prevent It. New York: Penguin Books.
Freudenberger, H. J., & Richelson, G. (1980). Burn-out: the high cost of high
achievement. Massachusetts: Anchor Press.
Freudenberger, H. J. & Torkelsen, S. E. (1984). Beyond the interpersonal: a
system model of therapeutic care for homeless children and youth.
Psychotherapy: Theory, Research, Practice, Training, 21(1), 132–140.
Friberg, T. (2009). Burnout: from popular culture to psychiatric diagnosis in
Sweden. Culture, Medicine and Psychiatry, 33(4), 538–558.
http://doi.org/10.1007/s11013-009-9149-z
Gaete, A. & Cornejo, C. (2014). The Brain Is Not a Tool. Integrative Psychological
and Behavioral Science, 48(1), 100–109. http://doi.org/10.1007/s12124-
013-9241-3
Gentner, D. & Grudin, J. (1985). The Evolution of Mental Metaphors in Psychology:
A 90-Year Retrospective. The American Psychologist, 40(2), 181–192.
Gold Medal Award for life achievement in the practice of psychology - Herbert J.
Freudenberger (1999). The American Psychologist, 54(8), 578–580.
Greene, G. (2004). A burnt-out case. London: Vintage. (Original publicado em
1960).
Heinemann, L. V. & Heinemann, T. (2017). Burnout Research: Emergence and
Scientific Investigation of a Contested Diagnosis. SAGE Open, 7(1), 1–12.
http://doi.org/10.1177/2158244017697154
Hilgard, E. R., Leary, D. E. & McGuire, G. R. (1991). The history of psychology: a
survey and critical assessment. Annual Review of Psychology, 42, 79–107.
https://doi.org/10.1146/annurev.ps.42.020191.000455
Hoffarth, M. J. (2016). Executive Burnout. Business History Review, 90(4), 701–
708. https://doi.org/10.1017/S0007680517000046
Hoffarth, M. J. (2017). The making of burnout: From social change to self-
awareness in the postwar United States, 1970–82. History of the Human
Sciences, 30(5), 30–45. http://doi.org/10.1177/0952695117724929
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
18
Lakoff, G. & Johnson, M. (1999). Philosophy in the flesh: the embodied mind and
its challenge to western thought. New York: Basic Books.
Lakoff, G. & Johnson, M. (2003). Metaphors we live by. Chicago: University of
Chicago Press. (Original publicado em 1980).
Laurenti, C., Lopes, C. E. & Araújo, S. de F. (Eds.). (2016). Pesquisa teórica em
psicologia: aspectos filosóficos e metodológicos. São Paulo: Hogrefe CETEPP.
Leary, D. E. (1987). Telling likely stories: The rhetoric of the New Psychology,
1880-1920. Journal of the History of the Behavioral Sciences, 23(4), 315–
331.
Leary, D. E. (Ed). (1994). Metaphors in the history of psychology. Cambridge:
Cambridge University Press.
Maslach, C. & Leiter, M. P. (2014). Editorial. Burnout Research, 1(1), 1–2.
Millan, L. R. (2007). A síndrome de Burnout: realidade ou ficção? Revista da
Associação Médica Brasileira, 53(1), 5–5. http://doi.org/10.1590/S0104-
42302007000100004
Muheim, F. (2013). Burnout: History of a Phenomenon. Em S. Bährer-Kohler (Ed),
Burnout for Experts: Prevention in the Context of Living and Working (pp.
37–46). New Jersey: Springer.
Pickering, N. (2006). The metaphor of mental illness. Oxford: Oxford University
Press.
Roediger, H. L. (1980). Memory metaphors in cognitive psychology. Memory &
Cognition, 8(3), 231–246.
Rolo, D. (2017). Le burn-out : mal d’époque ou retour de la fatigue pathologique ?
Annales Médico-Psychologiques, Revue Psychiatrique, 175(7), 595–599.
http://doi.org/10.1016/j.amp.2017.01.020
Schaufeli, W. B. & Buunk, B. P. (2003). Burnout: An Overview of 25 Years of
Research and Theorizing. Em M. J. Shabracq, J. A. M. Winnubst, & C. L.
Cooper (Eds), The Handbook of Work and Health Psychology (2nd ed., pp.
383–425). New Jersey: John Wiley and Sons.
Schaufeli, W. B. & Enzmann, D. (1998). The burnout companion to study and
practice: a critical analysis. London: Taylor & Francis.
Schaufeli, W. B., Leiter M. P., & Maslach, C. (2009). Burnout: 35 years of research
and practice. Career Development International, 14(3), 204–220.
Memorandum 37, 2020
Belo Horizonte: UFMG
ISSN 1676-1669
19
Slife, B. D., & Williams, R. N. (1997). Toward a theoretical psychology: Should a
subdiscipline be formally recognized? American Psychologist, 52(2), 117–
129.
Sommer, R. (1973). The Burnt-Out Chairman. American Psychologist, 28(6), 536–
537.
Soyland, A. J. (1994). Psychology as metaphor. London: Sage.
Watrin, J. P. (2017). The “new history of psychology” and the uses and abuses of
dichotomies. Theory and Psychology, 27(1), 69–86.
https://doi.org/10.1177/0959354316685450
Nota sobre o autor
Flávio Fernandes Fontes é psicólogo. Doutor em Psicologia. Professor-adjunto
do Curso de Psicologia da Faculdade de Ciências da Saúde do Trairi – FACISA,
Universidade Federal do Rio Grande do Norte – UFRN. E-mail:
flaviofontes@outlook.com.
Data de recebimento: 30 de janeiro de 2020
Data de aceite: 08 de agosto de 2020
