Some new facts have appeared in the mental health field. If you live in The Matrix. And you undergo Inception. While wearing the glasses from They Live.
Schonfeld, in a recent medscape article, puts forward 7 reasons why “[physician] burnout is not something separate from a depressive condition.” They are as follows:
“First, A physician may face career barriers if he or she admits to being depressed. Although true in many instances, such a situation does not support the view that burnout and depression are separate entities…Second, the work-related causes of burnout and depression are essentially the same. Toxic work environments featuring constricted autonomy and excessive psychological workloads are implicated in both.”
Playing loose with facts of diagnosis also aligns with a (relatively) recent article from medscape, showing this new data:
You should be asking yourself: WTF is colloquial depression? Yes, I can via negativa abduct the meaning, but why ask about it? Worse still, a follow-up article links the two together as if equivalent. This is supposed to pertain to medicine and doctors right? So, do I find this diagnosis in the DSM? The PDM? You’re telling me its a scandal when we allow bereavement to count for depressive criteria but now we’re covertly putting in the ad-hoc modifier “colloquial” to depression without any fuss?
The problem with this type of loosening of standards is that it can easily lead to medical mistranslations and an eagerness to pathologize. Such scenarios include when we separate a personal response to loss, such as grief, and a bodily response to loss, such as depression. You may initially elide over the difference but in practice this becomes a salient point. This means that you don’t become depressed from losing your house, you have depression and a factor was losing your house. Life no longer is depressing, its you that are depressed. I cannot overstate the fact that the implications for this are very far reaching.
We should not be too quick to label a state of affairs as pathological because pathologization reduces the individual’s ownership – not just “responsibility” in being culpable for self-afflictions, but in having a hand in treatment. You can think you’re saving the patient from blame when you re-frame things as merely a description of events, but you’re also linking the pathology deeper, all the way down to their identity as carried through their body and their biology. Even those who believe “I can overcome anything” may become hesitant if the obstacle to overcome is one’s very self.
“Third… Burnout is ordinarily measured dimensionally with a questionnaire, either self-administered or administered by an interviewer. Scores on the three reputed dimensions of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) are obtained. Although measures such as the commonly used Maslach Burnout Inventory are not diagnostic instruments, when researchers treat burnout categorically/nosologically, they ordinarily operationalize “clinical” burnout by arbitrarily identifying individuals with a score on one of its three burnout dimensions at or above some threshold, often merely the top tercile.
Fourth, emotional exhaustion is considered the core of burnout. When emotional exhaustion and depression are treated dimensionally, their correlations, when corrected for measurement error, equal or exceed .80. This is a very high correlation, suggesting substantial overlap.”
I still don’t see “overlap” meaning “identical” and I’ve checked my dictionaries. In science, have we not heard of confounds? Or, in logic, a third man? If you don’t look out for that third, the third will overtake you.
“Fifth, the above cited studies indicate that emotional exhaustion correlates with depressive symptom scales more highly than emotional exhaustion correlates with depersonalization or reduced personal accomplishment, the other two putative dimensions of burnout. The implication is that if burnout is a syndrome, it should embrace emotional exhaustion and depression. In other words, depression is at burnout’s heart. Moreover, the symptom items on Maslach’s emotional exhaustion scale map onto fatigue symptoms used to diagnose depression. The reader should also bear in mind that fatigue is often the presenting problem when an individual seeks help from a clinician for depression.”
Measuring mental illness, like materializing the immaterial, is a tricky business. For example, a common measure for depression such as the Hamilton scale has no questions to screen for atypical depression symptoms. This is problematic because those symptoms (excess sleep, excess eating) can be chemically modulated and so a better score can look like improvement but could be just switching from one type of depression to another.
This is to say nothing of the pop psychology spurious associations, such as that between depression and chocolate which is based on tenuous measures such as the CES-D score, which doesn’t make a diagnosis so much as quantify behavior in only the last week.
So the overlap in symptomatology between two methods of scoring is not definitive. Nor should it be. Nor should it be convincing.
“Sixth, when burnout and depression are treated categorically, there is also substantial overlap. More than 80% of individuals with high burnout scores meet criteria for provisional diagnoses of depression.
Seventh…Wurm and colleagues show that with increasing burnout symptoms, the risk for depression monotonically increases. For example, the odds ratio that depression is present in individuals with very high burnout scores exceeds 0.93… Aloha and colleagues found that burnout and depression symptoms cluster together and change synchronously over time…Freudenberger, the investigator who published the first paper in a social science journal on burnout, wrote that the burned out individual ‘looks, acts, and seems depressed’.”
Again, correlation is not causation, nor is it identity. For instance, suicidal ideation does not have to be mean depression. Examples like this can be multiplied indefinitely, but I hope the point has been made already.
But let’s ignore all of this. Arguendo, let’s assume he’s right. What’s supposed to be the end result of all this?
“When we recognize that some physicians may be suffering from depression, we can make thoughtful progress in helping them with evidence based treatments.”
Is this a silver lining? One could argue that loosened standards will end up not discouraging people from seeking help. At the very least, we won’t turn people away on the basis that we don’t think they have depression.
But, honestly, does that seem like a reasonable problem in our current state of affairs? Or does the current milieu more likely resemble this?:
So that’s a dubious hope. “Colloquially” depressed yet? I’m sure there’s an app for that.
All that’s left to do is to act as Baudrillard suggested: “Since the world is on a delusional course, we must adopt a delusional standpoint towards the world.” But on the second thought, no such luck – you can’t even act like Nietzsche and take refuge in madness since mental illness itself is what is being coopted.
All that’s left is simulacra. Enjoy that then – if you can. At this point you may be only able to simulate that even. Colloquially, of course.