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Biopsychosocial · understanding burnout

Burnout is a continuum. Full throttle, yes – but not forever.

Peak performance when it counts is possible – as long as the engine gets to cool down afterwards. In the long run, you need both: focus and recovery.

If the clock keeps ticking without a break, a brief overheat turns into real damage. How overload builds up, why resonance is the most underestimated factor – and why the best time for coaching is long before the warning light comes on.

Burnout clockClock face with twelve phases: proving yourself, more effort, needs put aside, conflicts suppressed, withdrawal, problems denied, physical symptoms, irritability and numbness, strength fades, inner emptiness, depression, exhaustion. The ring around the clock grows denser towards twelve: health and illness as a continuum.1Provingyourself2More effort3Needs putaside4Conflictssuppressed5Withdrawal6Problemsdenied7Physicalsymptoms8Irritability,numbness9Strengthfades10Inneremptiness11Depression12ExhaustionSALUTOGENESISHealth and illnessas a continuumWHERE ARE YOU?
  1. 1Proving yourself
  2. 2More effort
  3. 3Needs put aside
  4. 4Conflicts suppressed
  5. 5Withdrawal
  6. 6Problems denied
  7. 7Physical symptoms
  8. 8Irritability, numbness
  9. 9Strength fades
  10. 10Inner emptiness
  11. 11Depression
  12. 12Exhaustion
Phases based on Freudenberger’s 12-phase model; the transitions are fluid.

Burnout as a process, not a label

When the engine overheats.

Health insurers need labels to define and bill treatment. Research needs categories, too, to measure what works. Whether burnout is a diagnosis in its own right or a depression brought on by overload matters in practice mainly for billing. For you, the label doesn’t matter. So if you read something about depression, assume for now that it may well apply to burnout too.

For those affected, the balance between focus and recovery has gone. Warning signs have been ignored for so long that people partly or completely stop noticing them. Self-regulation starts to erode. Alongside the sheer strain, the loss of resonance plays a central role. Thoughts like “Why am I even doing this?” or “Whatever I do, there’ll be trouble!” make things worse.

Of course, it’s not as if you’re healthy one day and wake up ill the next. The engine has been running flat out for so long that the overheating finally becomes impossible to ignore. Burnout typically unfolds roughly like this:

Foot to the floor

More commitment, more pace, more responsibility. That’s fine – for a while. It becomes critical when it turns into a permanent state.

Neglect and denial

Your own needs, recovery and relationships take a back seat. Warning signs get ignored, and you gradually stop noticing them at all.

A narrowing life, resistance

Productivity, creativity and your belief in your own effectiveness decline. Values and life plans get rewritten. Work is mostly what’s left – and you fight even harder for a resonance you can no longer find there.

Exhaustion

Five minutes to midnight. It can show up in many ways: depressive symptoms, anxiety, addiction, psychosomatic complaints such as pain, skin reactions or tinnitus. The way back is now a lot longer.

Every textbook phase model is only an approximation of what people actually go through. As a rough guide to where you stand, though, it helps. The closer the clock gets to twelve, the longer the way back – and that relationship is anything but linear. Complex systems, and humans with their brains are extraordinarily complex systems, tend to stay stable for a very long time before they hit a tipping point. An overheated engine needs little time and attention; a wrecked engine needs a lot. One thing is clear: easing off early pays off. But if you’re used to driving with your foot down, that’s easier said than done.

Positive experiences of resonance in the past can be “addictive”. If your identity is closely tied to the resonance you get at work, stopping or pausing feels hard, even impossible. And after ten years of overload, I very often hear the hope that a week or two off should surely be enough. If slowing down is planned well, it can take a lot less time – but only up to a point. Restart the engine too soon, again and again, and the damage only gets worse.

Mentally ill – or just not tough enough?

On the stigma of mental illness.

When you injure a muscle, you lose some independence: things get harder or are temporarily impossible. Psychological injuries such as burnout can be seen in exactly the same way. What counts as “functioning well enough” differs from person to person – for the body as for the mind. In 1979, Aaron Antonovsky replaced the black-and-white split between health and illness with a health–illness continuum and coined the term salutogenesis: just as we are all mortal, we are all, as long as there is life in us, healthy to some degree.

So working on your own strain can’t – and shouldn’t – wait until you qualify for a diagnosis. Prevention, in the sense of regulating proactively and improving how you feel, is a natural part of my work along this continuum. There’s no simple on/off switch between healthy and ill. Rather than just fixing deficits, looking after your resources and potential matters just as much. A balanced person is less vulnerable, less likely to relapse and more resilient than someone who is stressed and unhappy. That’s exactly what coaching is for: knowing when to step on the accelerator and when to brake – so you stay effective for the long run.

Many of us assume that our mind should always run smoothly and, ideally, at peak performance. If it doesn’t, it must be our fault. Guilt usually comes with shame – and in organisations, with stigma. We’re hard on our minds but much kinder to our bodies: we train, eat well, see a doctor without embarrassment, wear a cast. Yet our brain is part of that very body. Around one in three people will face a serious mental health problem at some point in their life. This is not a niche issue.

Put simply, depression means the brain’s chemical messengers have fallen out of balance. In an organ with around 86 billion nerve cells and more than 100 trillion synapses, both measuring and correcting that balance is an imprecise business. That’s why medication doesn’t always work as hoped – and that’s not an argument against it: for almost every indication, medication combined with psychotherapy works best. If we think of the brain as a muscle, it needs training. If it’s injured, it needs combined treatment.

How do entrenched patterns and illness develop?

The biopsychosocial model.

As a complex system, a human being is in constant interaction with their environment. The biopsychosocial model of health can explain every kind of mental illness. It consists of three areas that constantly influence each other:

System

Social environment

We’re in constant interaction with our environment. Systems theory focuses less on the individual elements than on the connections between them – and those connections form powerful patterns. The organisation you work for, and your family too, can be a resource or a serious source of strain. That’s exactly where systemic coaching comes in.

Vulnerability

Biology

Everyone comes with a genetic make-up. Epigenetics shows that how our genes are expressed is in turn shaped by our environment. Twin studies point to a genetic component in almost all mental disorders, mainly in the form of vulnerability. That’s why diagnoses in close relatives matter for prevention and therapy.

Patterns

Psychology

Attitudes, skills, problem-solving habits and personality make us more resilient or more vulnerable. How we perceive reality is always partly constructed: what do I see as a threat, what as an opportunity? This is where unhelpful patterns form – and changing them is at the heart of cognitive behavioural therapy.

The interfaces between these areas matter too. Systemic coaching, relaxation and exercise can make a real difference here – especially when they’re tailored to you rather than standardised. Once you understand the causes, you can choose the right building blocks far more precisely.

When is stress good, and when is it harmful?

And what emotions have to do with it.

Put simply, emotion can be defined as a rise in activation. When we’re startled, in love or enjoying something, we experience it intensely. Numerous studies show that how we interpret tension is surprisingly flexible: different areas of the brain handle arousal and evaluation. We don’t automatically know what our tension means – we work it out in the moment. That’s a mechanism we put to use in coaching and therapy.

So tension isn’t negative in itself. Too little of it goes hand in hand with low drive and motivation. Flow happens at the optimal level of arousal. Up to that peak we speak of positive stress (eustress); beyond it, of negative stress (distress). Yerkes and Dodson described this relationship as a curve:

Yerkes-Dodson curve Inverted U-curve: performance rises with arousal up to a peak (flow) and then falls. Eustress on the left, distress on the right. FLOW EUSTRESS DISTRESS TENSION / AROUSAL → PERFORMANCE →
The Yerkes-Dodson curve: performance in relation to arousal.

Flow is captivating because it takes us to the edge. And since emotion is fertiliser for the brain, we want more of it. But at the peak it’s easy to tip over the wrong side. Being there now and then is fine. Living there for long stretches is not. Stress is the body’s emergency mode: blood is sent to the arms and legs, blood pressure and heart rate rise, higher brain functions give way to instinctive reactions, and the immune system is dialled down – driven mainly by adrenaline and cortisol.

Being constantly on alert makes you ill – and it’s usually the key mechanism behind burnout. Stress often disrupts sleep and, through high blood pressure or a weakened immune system, contributes to a wide range of other conditions. And if you can’t get restful sleep, you feel even more stressed: a vicious circle. That’s why sleep and personalised relaxation are a core part of the approach.

Organisations: without resonance, nothing works

At work and in the way organisations are designed, the focus tends to be far too narrowly on workload and performance. The sociologist Hartmut Rosa adds another factor: technology and the way we do business keep speeding society up. The more available things and people are, the better. Smartphones and AI make that availability possible – and turn from everyday helpers into everyday burdens. Today’s success becomes tomorrow’s mortgage: an outstanding sales result becomes next year’s baseline. In the race for higher, faster, further, there’s no room for easing off after a big push.

Acceleration and growing complexity lead to increasing alienation – to a loss of resonance. More and more people in organisations end up, through no fault of their own, in situations where they simply can’t feel good about their work any more. In practice, this lack of resonance is a consistently underestimated source of strain.

Two weeks in tough conditions, 12 to 14 hours a day. And then a 30-minute questionnaire was enough to make it all count for nothing.

An example from my time as head of Industrial Processes at an international plant manufacturer and service provider, where I was also responsible for health, safety and environment on site: for an emergency repair in Africa, a team of engineers flew out at very short notice to a location with a difficult security situation and poor infrastructure. For around two weeks they worked 12 to 14 hours a day to get the plant running again. On the flight home, despite all the stress, the mood was excellent. They had experienced resonance.

Back home, they had to fill in a site safety questionnaire. It was obvious: whatever they wrote, there would be trouble – because on paper the organisation had safety standards that could never be met in a region like that. A 30-minute questionnaire changed how the whole two weeks were remembered. Organisational sociology has two fitting terms for this: contradictory rationalities and, as a result, disorganised all-responsibility. Staff functions, finance and line management, each with their own KPIs and logic. At the operational level, I’m forced to go against one of those logics – and even with full commitment, I can expect negative consequences.

Complex organisations are getting ever harder to steer, and the reflex is to add more control. Slogans like “it’s all about people” or “total quality management” reflect this trend: a claim on everything, responsibility for nothing. The result is something like an autoimmune disease. The organisation’s control functions become overactive, and so the organisation falls ill – and its people with it.

What this means for you as a leader

The model has three consequences. And although coaching is distinct from therapy, I never lose sight of what you need:

  1. The best time for coaching is long before the warning lights come on. Coaching uses the same clinical depth as therapy, but preventively: focus, environments that give you resonance, boundaries, delegation, self-leadership. Working on the continuum before things tip over.
  2. Resonance can be shaped. Your role, your positioning and your environment aren’t fixed. Systemic coaching reveals the patterns you’re caught in – and the points where you can change them.
  3. When the lights are already on: if it becomes clear during our work that you need therapeutic treatment or further assessment, I’ll tell you, and we’ll agree on the next steps outside the coaching setting. Once a condition has tipped over, it needs stabilising through therapy – where necessary and possible, in consultation with doctors. With a way back that deliberately includes your job, to help prevent relapse.
How we work on this: the method

Where are you on the continuum?

Not something to work out with a quiz – but in a conversation.
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