Introduction
For the majority of them, health professionals are subject to a very important work intensity which causes considerable stress (Peisah, Latif, Wilhelm, & Williams, 2009). Making the right diagnosis, determining the right posology, taking the right surgical gesture are obligations that appear daily in the practitioner’s mind. On the one hand, his cognitive abilities must be at their maximum; however, Burnout (BO) decreases these last (Diestel, Cosmar, & Schmidt, 2013). On the other hand, the professional ethics involved in decision-making are paramount. One study explores failure in respect of medical ethics among student doctors in a BO situation (Dyrbye and al., 2008). Indeed, these authors postulate that student doctors suffering from BO have weaker altruistic attitudes and that this syndrome reduces the sense of their social responsibilities as, for example, with regard to access to care for the most deprived. Another study shows that BO occurs early in medical school, and produces these harms throughout the careers of the suffering doctors, if they continue in this profession and do not fall into a career severe depression (Ahola & Hakanen, 2007) or addiction (Walburg, 2014).
The important media boom experienced by the BO for the last thirty years does not allow us to think that BO can be a new phenomenon. Indeed, illustrations of this phenomenon are reported from the Old Testament, which relates, for example, the fatigue and deep discouragement of Elijah after killing the priests of the god Baal (Zawieja, 2015). In 1974 for the first time, Freudenberger described the lack of motivation of the employees in a detoxification center. Thus, he inaugurates the first theoretical reflections on the BO. Following this work, Maslach contributes to the popularization of the concept by providing the scientific basis that was previously lacking (Zawieja & Guarnieri, 2013).
Socio-economic Consequences of Burn-out
Burnout is like any syndrome: it has socio-economic impacts. It’s necessary to quantify its financial costs for the community. The study of Maslach and Leiter (2008) cited by Zawieja and Guarnieri (2013), taking up the study of Paine (1984), estimated the cost of suffering of the 23 million executives impacted to 300 billion dollars, integrating in this estimate sick leave, long work incapacity and staff turn-over. Today, BO is described in about sixty professions. If the first professions studied generally involved a sustained emotional investment (profession of assistance to the person), the highlighting of the BO in occupations remotes from this issue, and among populations not yet entered the world of work (e.g. students in musicology) alerts on the need for prevention and early care.
Definitions and Symptomatology
The use of the term ‘burnout’ mobilizes a set of theoretical and clinical knowledges (often structured around the work of Maslach, 1981) that it is necessary to know while the media and the daily language combine to this term all kinds of discomfort at work, regardless of the symptoms. Therefore, it is necessary to give a definition of this term.
Unfortunately, the term BO still has no consensual definition today; it even experienced difficulties in translating into French where the term ‘épuisement professionnel’, which it preferred, did not accurately reflects the complexity of this phenomenon (Bondre, 2009). Indeed, this translation refers to the exercise of a profession. However, it has been shown that this syndrome is also found in other non-working populations (Schaufeli, Martínez, Pinto, Salanova, & Bakker, 2002). It also confuses with one of the dimensions of the BO.
The former definitions of this phenomenon have the same shortcomings as the French translation. Indeed, the BO was originally highlighted in health Professionals (Maslach, 1976; Freudenberger, 1977; Maslach, 2001; Schaufeli, Bakker, Hoogduin, Schaap, & Kladler, 2001), these former definitions restrict it to this population.
Thus, Freudenberger describes BO as a state of fatigue or frustration induced by dedication to a cause, a way of life or a relationship that has not lived up to expectations (Freudenberger, 1974). Then in 1978, Kahn defined BO as ‘a syndrome of inadequate attitudes towards clients and oneself, often linked to unpleasant physical and emotional symptoms’ (quoted by Delbrouck, 2003).
Today, as we have stated above, burnout mainly refers to the work of Maslach (1981). She defines it as ‘a syndrome of emotional exhaustion, depersonalization, to which we prefer the term ‘disinvestment’, and loss of the sense of self-efficacy that may occur in individuals who work in any way with other human beings (Maslach, 1982, quoted by Zawieja and Guarnieri, 2013).
More concretely, patients in BO express a feeling of emotional exhaustion as well as a disengagement in their professional activities. However, in the long term, the BO reaches a pathological stage, it goes beyond the professional sphere and comes to overwhelm the private life. So, the individual no longer enjoys his activities or his relationships. From that moment, the individual changes, difficulties appear, such as a feeling of malaise, absenteeism and avoidance of stressful situations. More general problems will also surface as health problems, a lack of energy, a decrease in the quality of life, disorders of the use of one or more substances and a decrease of the satisfaction of life (Dumanget Faye, 2015).
Today, depending on the model, burnout is considered from a diachronic point of view (dynamic process) or from a synchronic point of view (burnout as a state). These two visions of BO, far from being independent, complement each other to create a more consensual vision of this disorder, which is then defined as a three-dimensional syndrome associating :
- a state of intense physical and mental exhaustion,
- a set of attitudes of cynicism, disinvestment and
- a collapse of the feeling of self-efficacy.
The symptomatology of the BO also lacks precision. Indeed, Schaufeli and Enzmann (1998), quoted by Zawieja (2015), have identified about 130 different manifestations of the BO among a body of poorly controlled studies. The BO is distinguished by an unclear clinical picture of physical, emotional, interpersonal, attitudinal, and behavioral manifestations that are expressed at the individual, interpersonal, and organizational levels.
