“Burn-out” As A Medical Condition

Every few years, the World Health Organization produces a new version of the International Classification of Diseases, a catalog of acknowledged medical conditions that is used as a diagnostic guide by health care providers.  With every new version of the ICD, there seems to be some controversy about whether or not a particular ailment or complaint should be recognized.

burnoutThis year, the “should it be included or not” controversy swirls around “burn-out.”  Apparently there has been a long, ongoing debate about whether “burn-out” should be recognized as a medical condition, and the WHO has now weighed in with a “yes”:  the ICD-11 lists “burn-out” and defines it as “a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed.”  According to the WHO, “burn-out” syndrome is characterized by “1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.”  Notably, the ICD-11 tries to draw a kind of line in the sand by stating that “burn-out” “refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

My guess is that many — if not all — workers have, at some particular point or another in their careers, experienced “burn-out” as defined by the WHO.  Jobs typically involve stress, and it’s almost inevitable that there will be periods where multiple obligations pile on top of each other, leaving the worker feeling overwhelmed, exhausted, and dissatisfied.  But . . . should “burn-out” be viewed as a medical condition?  What, exactly, is a doctor supposed to do for a patient who presents with classic “burn-out” symptoms — prescribe a three-month vacation, or a new job, or new job responsibilities, or a change in the patient’s workplace manager?  Will employers be required to allow leaves of absence, beyond their designated vacation periods, for employees whose doctors diagnose them with “burn-out,” and will health insurers be required to pay for vacations as a form of treatment?  By classifying “burn-out” as a diagnosable health condition, aren’t we really going far down the road of “medicalizing” common aspects of our daily lives?

And can “burn-out” really be limited to the “occupational context,” as the ICD-11 instructs, or will the same concepts underlying workplace “burn-out” ultimately be recognized in other areas, like family or marital or college “burn-out”?  Here’s a possible answer to that question:  the ICD-11 now recognizes video gaming, with cocaine, and alcohol, and gambling, as a potential source of addiction.

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First Ebola, Then Zombies

The news about Ebola in west Africa is dreadful.  A new assessment of the outbreak by the World Health Organization forecasts that the number of people infected and killed by the disease may increase dramatically and become “endemic” in that region — which means that it would never be fully eliminated in countries like Sierra Leone, Guinea, and Liberia.  The WHO also says the death rate for those infected with Ebola is 70 percent.

The Centers for Disease Control and Prevention predicts that the Ebola epidemic may infect 1.4 million people in west Africa by the end of January.  Multiply that number by the 70 percent death rate and you see an enormous human disaster if steps to control the disease don’t work.  Even worse, with each new infected person, there is an increased risk that the devastating disease will break out of west Africa and penetrate into the world at large — and if that happens the forecasted numbers will become astronomical.

And then there is this story from Liberia, which reports that two women killed by Ebola have mysteriously risen from the dead.  The two were about to be buried when they returned to life, causing panic in their communities.  The news report of the incident helpfully notes:  “Since the Ebola outbreak in Nimba County, this is the first incident of dead victims resurrecting.”  The report is silent on whether the two women have since exhibited the signs of undead behavior — like staggering around and munching on the brains of the living — that are familiar to any fans of zombie movies.

Of course, under these circumstances jokes about a zombie apocalypse aren’t very funny.  The zombie story just highlights the fact that west Africa is totally ill-equipped — culturally, medically, and scientifically — to deal with an outbreak of a highly lethal contagious disease.  When you combine superstitious people, the absence of doctors who can reliably diagnose and treat the disease and determine whether its victims are actually dead, an insufficient supply of bodysuits, decontamination supplies, medication, and other necessary supplies, and inadequate sanitation and means of disposing of the bodies of those killed by Ebola, you have created an ideal setting for an uncontrolled epidemic.

A recent New York Times story about one overworked gravedigger in Freetown, Sierra Leone paints a bleak picture and powerfully makes the case that the Ebola outbreak may have reached a terrible tipping point.  We had all better hope that — zombies or not — the efforts to control the disease are effective.