Do We Put the Ambulance at the Top or Bottom of the Cliff? Burnout’s Missing Pieces

We have been formally studying burnout since the 1970s. In that time, we have landed probes on Mars, made extraordinary advances in medicine and developed technology capable of producing an essay in seconds.

Yet apparently, we still haven’t worked out how to stop ourselves becoming completely knackered, or figured out that taking a pound of flesh from workers every day can eventually lead to them not caring anymore.

So, what are we missing?

The World Health Organization defines burnout as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed, marked by exhaustion, increased mental distance or cynicism towards work, and reduced professional efficacy.[1]

Burnout may be formally defined through work, but the human being experiencing it doesn't exist only at work. The language and experience of feeling burnt out isn’t exclusively the purview of the workplace anymore. We now talk about parental burnout, caregiver burnout, student burnout and even self-improvement burnout.

This in part may be due to the optimisation fever we seem to be encountering through every phase of life, from the playground through to retirement. Add information saturation, rapidly changing technology and comparison culture, and managing modern life can sometimes feel like a full-time job in itself.

When it comes to the workplace, we know poor work design is part of the picture. Understaffing. Budget cuts that remove resources but not tasks. Unrelenting workloads. Ineffective leaders. Leadership that lacks empathy. Cultures that prioritise KPIs over the humans expected to achieve them. They all contribute to the problem.

But we’ve been having that conversation for a very long time.

Perhaps burnout has become so familiar and ubiquitous across all the landscapes of our lives that we’ve started tuning it out. Work design, organisational restructuring, work-life balance, sleep, exercise, diet, emotional management, boundaries. Despite all of these being important, here we still are. Maybe after all these years, the burnout conversation is starting to sound a little like Charlie Brown’s teacher: wah, wah, wah.

And here is one of those missing pieces. We start learning what keeps us safe and gives us a sense of belonging long before we arrive in the workplace and start ‘adulting’.

This means we may find ourselves acting unconsciously to meet someone else’s idea of who we need to be, without necessarily considering whether that suits us now, or will serve us in the future.

Consider the final years of school. Pressure has often already been turned up. Young people can be expected to study, go to after-school sports, work weekends, socialise, plan their future and somehow know exactly what they want to do with the rest of their lives.

Maybe our schools need to add personal resource management to their curriculum?

HR departments are, in part, concerned with the resources an individual contributes to an organisation. Perhaps their remit could likewise be expanded to include personal resource education and management.

By recognising the vulnerabilities that can accompany those resources and educating leaders about how they can build support around them from day one, those vulnerabilities could be considered and cared for rather than ignored, neglected or, at worst, taken advantage of.

If we learn earlier how cultural narratives can influence us, and our educational and workplace systems can help us understand this in relation to our own personality, values and experiences, we've started investing in prevention rather than waiting for the ambulance.

Thus, burnout prevention isn't limited to being an organisational or individual issue. It becomes an educational and cultural one too. Rather than simply deciding where to park the ambulance, we have started to look further into why people end up needing it in the first place.

But is that actually enough? Because experience shows that even those in the know can still be tripped up, caught out or influenced.

When strengths become vulnerabilities

Two people can work in the same dysfunctional environment and respond very differently.

Personality and culture may play a part, but neither operates in isolation. Our experiences, values, relationships, financial circumstances and the influences we've been exposed to can also affect our behaviour and decision-making.

And without us necessarily realising it, the very qualities we celebrate can sometimes become vulnerabilities under the wrong conditions.

Someone who is conscientious, loyal, empathic, responsible or inclined towards perfectionism can easily become the person who gets things done, picks up the slack and holds more space than their resources actually permit.

For some, work or roles can become so entwined with identity that there is little room left for anything else, including rest. Consider the health professional or social worker who repeatedly takes the extra case because the department is understaffed and public demand is real.

Or the manager who protects everyone underneath them while absorbing pressure from above, then has nothing left for family or friends. The employee who has become so indispensable in their mind that even taking a day off brings fears about the world stopping spinning on its axis.

Or the parents who become so hyper-focused on creating the perfect childhood that they leave no room for their own wellbeing. These people aren’t necessarily bad at boundaries. They may be very kind, caring and dedicated. They may also be extraordinarily good at survival.

Because burnout can be sitting on top of other issues.

Someone with previous traumatic experiences may have developed patterns around being useful, agreeable or hyper-responsible that once helped them feel safer.

Someone struggling with insecurity or low self-worth may have learned that doing more brings validation, or that people-pleasing brings acceptance.

For someone else, earning more might represent family security, while doing everything perfectly protects them from criticism.

And for the person who has built a life around pressure, being busy, rushing and working all hours, slowing down can raise an uncomfortable question: Who am I without all of this?

In those circumstances, telling people to “just say no” may not be a particularly viable intervention.

And here we can see why the ambulance still matters. Education and awareness may help us recognise the road we're travelling, but when survival is perceived to be at stake, knowing better doesn't necessarily mean we're able to do differently. How often do people say, “I Know,” when they are reminded about where their behaviour is taking them?

Because when survival is perceived to be at stake, survival can trump sustainability.

And that’s where influence gets interesting

Influence tells us what a good employee looks like. What a successful parent should manage. What our body should look like. How productive we should be. How much money we should earn and, increasingly, how much “work” we should be doing on ourselves.

Even wellbeing has become something we can apparently fail at, or become stuck in an endless loop trying to achieve. Get better sleep. Eat the latest diet. Count your steps and compare your progress. Work on yourself while you build your career, be present with your children, maintain ALL your relationships, look after your family, squish in some meditation and don’t forget to relax.

It’s quite the to-do list. I’m exhausted just reading it.

Of course, if we look to individual boundaries and behaviour, we must be careful not to give organisations the chance to pass the proverbial buck and rapidly shove responsibility away from themselves.

This isn’t a free pass.

Quite the opposite.

An under-responsible system combined with an over-responsible human can be a particularly unsustainable combination.

Many of us have watched five jobs gradually become three. When people with a strong work ethic, particular values, personalities, identity attachments or experiences that incline them towards overdoing continue picking up the difference, the system can keep functioning.

Until the people can’t.

Where’s that damn ambulance again?

Is it just burnout, though?

There is another complication. Experiences commonly associated with burnout, including exhaustion, reduced motivation, irritability, poor concentration, memory difficulties, sleep disruption, emotional detachment and feeling that you simply don’t have much left to give, aren’t limited to burnout.

Some can also occur alongside depression, grief, trauma-related difficulties, vicarious trauma, chronic stress and the physical and psychological changes that some women experience during menopause.

And these things aren’t mutually exclusive either.

Research examining healthcare clinicians, for example, has found relationships between moral injury and burnout, trauma-related experiences, depression, anxiety, PTSD and stress, while recognising these as related but distinct constructs.[2]

Someone can, unfortunately, be experiencing it all while being busy trying to have it all.

They can experience occupational burnout while grieving. A healthcare worker may be dealing with burnout alongside the cumulative effects of repeated exposure to trauma and moral distress arising when circumstances prevent them from providing care in a way that aligns with their professional values. A woman may find that menopause changes her capacity, turns up the volume on pressures she previously managed and increases that feeling of, “I have nothing left to give.”

The overlap warrants attention if we want to shift the burnout conversation from reactive to proactive.

And this is where the work we did further up the cliff can help. Creating awareness before the crisis can lead to earlier recognition and targeted intervention through a broader understanding of the drivers that push us to do more, alongside an awareness that the issues might not all be due to burnout.

In this way, it’s not that a bubble bath will fix the depletion, but it might provide a safe place to reflect:

Why am I struggling to say no right now?

Are there other reasons that might be contributing to me feeling this way?

Or, from a leadership perspective:

We keep losing staff. What are we missing?

What factors are affecting performance and are they work-related, personal or organisational?

Much of what makes us vulnerable is, to some degree, foreseeable. Menopause is a foreseeable life transition for women. Vicarious trauma is a recognised risk in certain high-intensity roles. Most of us will encounter grief and significant life stressors. Particular working conditions can generate an environment that can result in burnout.

We can develop greater awareness of personality. Values can be identified. Experiences and their impact can be understood. Influence can be examined within cultural contexts. Workplaces can improve how they care for their people.

If we understand earlier what leaves us vulnerable to overdoing, and educational institutions and organisations help people recognise how personality, values, experiences and changing capacity might show up at study, work or just about anywhere in our lives, we can build in systems, support and check-ins before someone reaches the point of:

Oh shit. I don’t think I can do this anymore.

Perhaps we need to think more like athletes

High-performance sport understands something the rest of us sometimes conveniently forget: human capacity is not infinite or static.

Athletes don’t plan careers on the assumption that their physiology, recovery requirements and performance capacity will remain exactly the same forever. Yet many of us build working lives as though ours will.

Psychological sustainability asks a slightly different question.

Not simply:Can I do this?

But:What happens if I keep doing this?

What does this choice mean for my future capacity? What am I responding to: genuine necessity, my values, fear, habit, expectation or influence? Where does this choice eventually take me?

And is the environment around me replenishing any of what it continually takes out?

Sustainability requires us to consider what we continually take from a system and what needs to go back in.

Burnout is unlikely to have one neat cause or one neat solution. Perhaps that’s why, nearly 50 years into the conversation, we’re still having it.

We need educational institutions prepared to teach more about personal sustainability, capacity and recognising limits.

We need individuals equipped to understand the experiences and influences shaping their choices.

And we need workplaces prepared to examine what they continually take from people, alongside leaders capable of recognising when responsibility has become dangerously one-sided.

Because sustainability isn’t simply something we need to apply to the planet.

At some point, we might need to start applying it to ourselves.

And perhaps the question isn't where we park the ambulance, but how well we equip people to live more sustainably before they need it.

PAUSE: Why might these influences be getting in the way of how we challenge and change burnout culture?

REFLECT: What could we to do differently to address this?

LANDSCAPE: What have we already learnt that could help us consider where our next steps might take us?

If psychological sustainability is something that strikes you as interesting, you can learn more through The Adaptable Sustainable Psychology Collection .

References World Health Organization. Burn-out an occupational phenomenon: International Classification of Diseases (ICD-11). Thibodeau PS, Nash A, Greenfield JC, Bellamy JL. The Association of Moral Injury and Healthcare Clinicians’ Wellbeing: A Systematic Review. International Journal of Environmental Research and Public Health. 2023;20(13):6300.