The Childhood Roots of Burnout
“There can be no keener revelation of a society’s soul than the way in which it treats its children.”
— NELSON MANDELA
Burnout and depression don’t spring forth whole like Athena from the head of Zeus. They grow in emotional soil polluted by helplessness that was deeply rooted in the nervous system during childhood. Given the right conditions—a bad economy, a mismatch of values at work, frequent rejection, an abusive or loveless relationship, or a world gone berserk—those seeds of burnout and depression often germinate many years later. While the immediate problem seems to stem from current circumstances, the ground that nourished it was tilled long ago.
As you read this chapter, reflect upon your own childhood experiences. If they’re at the root of your burnout and depression, healing them is a high priority. Taking pills may reduce your distress, but trauma that was hardwired into your nervous system as a child needs to be identified and rewired. While anyone can go through periods of stress and helplessness that culminate in burnout, some people (including me) who endured intense childhood episodes of helplessness are much more prone to periods of burnout as adults.
How I Learned to Be Helpless
I was seven years old when my blissful childhood innocence was lost . . . or more properly, was torn away. My protective Jewish mother had rigorously researched overnight summer camps, and I was duly dispatched to the famous (or so my mother said) “Camp Sunrise Lake,” where my bunk mates, who were a year older, derived enormous pleasure from my systematic torment. These little girls were bullies of the first order in a time before the long-term negative effects of bullying were understood.
Kids who are bullied tend to have low self-esteem and develop “learned helplessness,” the feeling that changing one’s situation is improbable or even impossible. That internalized sense of helplessness, in turn, leads to feelings of hopelessness, apathy, and depression in adulthood. The operative mind-set is that life is a trap, and you are the prey.
My pint-size tormentors tossed my tennis balls into the woods, humiliated me in sexually explicit games of doctor, and excluded me from their conversations. I complained to Carol—a particularly wimpy and ineffectual counselor—who, unbelievably, did nothing at all. Next I complained to the camp director, whose niece happened to be the torturer-in-chief, and she didn’t do anything either. I wrote home, but my letters were confiscated “for my own good.” I got the message that I was a bad person, and it was best that my parents be protected from that distressing knowledge.
Still indignant rather than helpless, I took matters into my own hands. One moonlit night I donned a dress for camouflage and stuffed all my gear into a long green duffel bag. I ducked under the searchlight beams, which rhythmically scanned the periphery of the property, and made a run for it. I walked all night in the general direction of where I thought home might be, dragging the heavy duffel bag behind me. At the time, I didn’t realize that its contents weren’t limited to my clothes and tennis racket. Also in that bag was my sense of agency in the world—that “I can do it” feeling. And it was as heavy as lead and would take me years to unpack.
By the morning, I knew I had to call my parents and tell them what was happening so they could pick me up. Still filled with the innocent trust of a seven-year-old, I knocked on the door of a homey cottage seeking help. I needed a glass of water and access to a telephone. The lady of the house seemed gentle and kind in her floral housedress with her hair pinned up in spit curls. Her brow crinkled as she listened to my story, and she shook her head in troubled disbelief. Then she disappeared into the kitchen, ostensibly to make breakfast before we called my parents. I sat in a chair by the window, safe in the thought that my parents would soon be there.
In a matter of minutes, the sound of tires crunching on gravel trumpeted a destiny that neither my parents nor I had foreseen when I’d been sent off to a camp for privileged young ladies. The dusty white station wagon marked Camp Sunrise Lake pulled into the driveway. I’d been caught, betrayed by the harmless-looking House-dress Lady.
It took just a few minutes to drive back. The car rolled slowly through the rear entrance past garbage bins and a pile of old construction materials poking out from under a tarp. The place was quiet, since almost everyone was in the mess hall eating breakfast. I was marched in, and there was sudden silence as 150 or so pairs of eyes looked up and tracked my progress.
“Stand up on that table, and don’t move a muscle until lunch,” is about the only dialogue I remember. Too shocked to cry and much too young to understand that I was the victim of a cruel camp director (who herself must have been victimized by malicious caretakers), I stood on the empty table for hours.
Thus began a month of punishment in semi-solitary confinement. I was held prisoner in my bunk unless it was mealtime. No swimming, no games, no rehearsals for the big play. I did become a champion jacks player, excelling in the fine art of solitary amusement. My letters home continued to be censored, and I was informed that if I ever told anyone about what had happened, my parents would instantly know what a terrible person I was and would surely reject me. I would be homeless and abandoned, revealed as the ugly creature that I’d been all along without knowing it.
My small world hung on a slender vow of silence, which lasted for several months until dinner one dark winter’s evening at our apartment in Brookline, an urban suburb of Boston. With a big smile that made the corners of his blue eyes crinkle, my father proudly announced that the family finances were in good-enough shape to send me back to Camp Sunrise Lake for another summer of wholesome fun and frolic.
First I held my breath and shut my eyes. Then in a rush of hot tears, the whole story spilled out of me. My parents sat still and listened from start to finish. Remarkably, they didn’t hate me after all, nor did they accuse me of exaggerating or making the story up. My mother even refrained from calling me Sarah Heartburn, which she always did if I was emotional about anything.
When I’d finally heaved a last jagged sigh of relief, my mother rose from her chair like an avenging angel. She was a formidable force—outspoken, fearless, and as relentless as a bloodhound. With her huge blue eyes narrowed and nostrils flared, she calmly assured me that the camp director’s wagon would be fixed good first thing in the morning. I would have loved to have heard that conversation.
The Long-Term Effects of Helplessness
Although the loving and protective response of my parents was a tremendous relief, it wasn’t enough to neutralize the feelings of helplessness and hopelessness that I’d lived with for several weeks, before and after solitary confinement. Before camp (BC) I’d been a spunky little kid; after camp (AC), I grew withdrawn and tentative, afraid of rocking the boat or calling attention to myself.
“Why can’t you be more like your friend Judy?” my mother asked one day when I was about ten. “She’s a natural.” I felt embarrassed and angry. Once upon a time—BC—I was a natural. But AC, I never made a move without mentally rehearsing it first. The world felt dangerous, and it was hard to know just how to act to avoid some awful fate. I became shy and insecure at the very time in the cycle of development when young girls should be at the pinnacle of their power.
The seeds of what psychologist Martin Seligman refers to as learned helplessness had been sown. Well before the time of adolescence—when vibrant young girls suddenly go quiet and temporarily fade into the woodwork—some essential part of me had already disappeared.
What exactly is learned helplessness? Consider this experiment: Three rats are put in a small chamber with a lever. Rat #1 can learn to press the lever to turn off mild electric shocks delivered to a metal grid on the bottom of the cage. Rat #2 is called a “yoked control.” When the first rat presses the lever, the shock turns off for the second rodent as well. Both animals get exactly the same amount of discomfort. The essential difference, however, is that the second rat isn’t in control of its environment. The shock goes on and off on its own whether Rat #2 turns in circles or whistles the rodent equivalent of Dixie. Rat #3 isn’t shocked at all and serves as a control for the stress of being handled and confined to a small space. In just a few days, one of the rats will develop bleeding ulcers. Which one do you think it is?
If you said Rat #2, you’re right. Having control rescues the first rat from stress; in fact, it makes Rat #1 even more resilient biologically. Rising to a challenge— as long as you can overcome it—is a positive experience. Rat #3, having never endured being shocked, isn’t all that stressed. But Rat #2 is made helpless, and animals that are helpless become hopeless. They lose the will to act. If the helpless rat is then put into the first chamber, it actually takes Rat #2 much longer than a naïve rat (one who has never been in this experimental situation) to learn how to turn off the electric shock. Rat #2 has learned to be helpless and may never master the art of controlling its environment.
Helpless rats are also prone to a variety of physical ills. They are, for example, less able to reject implanted tumors, in part because of deficits in immune function. They may also die suddenly from a heart attack. People who have learned to be helpless often suffer similar fates. Viktor Frankl wrote about helplessness, the loss of immune function, and sudden cardiac death suffered by inmates in the Nazi death camps of World War II.
Renowned psychiatrist George Engel developed a “biopsychosocial” model of health and illness in the 1950s, documenting the role of helplessness and hopelessness as precursors to physical illness and early death. More recent research is documenting the biological pathways through which this happens.
Learned helplessness can be induced in situations far less dire than concentration camps. For example, college students who volunteered for a psychological study were put at desks and warned that a loud noise would soon come on. Half of the students had a panic button to push if the noise got too loud, and the other half didn’t. The group that had buttons never used them, since the perception of control was sufficient enough to make the noise tolerable. All of the students were then asked to fill out a questionnaire about their experience in a room with very bright lights. Those who didn’t have panic buttons in the first part of the experiment were more anxious and less likely to turn down the lights in the room than the students who believed that they could have turned off the noise at any time.
But here’s an interesting twist: Not all the students lacking panic buttons became helpless. Their response was dependent upon their thinking style, which was in place long before the experiment. Those who were easily made helpless, according to Dr. Seligman, had a pessimistic mind-set, which he believes is the cognitive root of depression. The more optimistic thinkers, in contrast, experienced more control over their environment.
Contrary to popular usage, pessimism is more than a negative view of the future; it’s an explanatory style that is deeply rooted in a person’s neurological makeup. Specifically, if something bad happens, how do you explain it to yourself? A pessimist has an explanatory style that features the three P’s: personal, pervasive, and permanent thinking.
Let’s say that Pessimistic Peter’s girlfriend breaks up with him. He’s likely to take it personally and blame himself. “I always do the wrong thing,” he says. “I’m clueless when it comes to girls.”
Furthermore, Peter’s self-talk centers on being a loser not just with girls, but generally speaking. He could get better grades, be better looking and more popular, and have more money. That’s pervasive thinking. Instead of focusing on the problem at hand—the breakup—in Peter’s world, everything is wrong.
Bad things always happen to poor, miserable Peter. His life is a permanent disaster area. Seligman sums up Pessimistic Peter’s style as: “It’s my own fault, I mess up everything I do, and it’s the story of my life.”
Something happened during the formative years of individuals such as Peter to disempower them. They lost agency—the ability to change the world around them. Helplessness may come in the form of a sadistic camp director; a parent who is unpredictable (or one who leaves or dies); or a sexual, emotional, or physical abuser who functions like an inescapable electric shock.
Your brain develops neural pathways as you mature. If learned helplessness is part of that maturation, it becomes a robust biological predictor of behavior, thinking style, health, and burnout.
Mind-Body Medicine
When I was in hospital practice as a psychologist and medical researcher, many of my colleagues looked on those of us interested in psychological factors and disease as “soft scientists” at best. As I’ve mentioned, psychologists (and psychiatrists, too) were on the low end of the academic totem pole. According to the critics, we didn’t do “real” medicine; we just poked around in people’s childhoods and blamed their mothers.
Old-style psychosomatic medicine, which posited familial problems as a risk factor for everything from juvenile insulin-dependent diabetes to asthma, gradually gave way to the more modern specialty of behavioral medicine in the 1970s. The field of psychoneuroimmunology, for example, describes links among emotional states, hormones, brain function, immune factors, and illnesses. A brief look at the type of research being done in the field will set the stage for a better understanding of how stress and learned helplessness contribute to various diseases and premature death—including the health problems created by burnout.
Psychologist Janice Kiecolt-Glaser, a colleague of mine since the mid-1980s, is a professor of psychiatry and psychology at Ohio State University; and has authored more than 175 articles, chapters, and books, often collaborating with her husband, Dr. Ronald Glaser (who is the director of the Institute for Behavioral Medicine Research). Kiecolt-Glaser’s research is evidence based and shows that stress accelerates age-related changes in interleukin-6 (IL-6), an immune factor called a cytokine. High levels of IL-6 are linked to cardiovascular disease, type 2 diabetes, osteoporosis, arthritis, frailty, the functional decline of aging, and some cancers.
The older you are, says Dr. Kiecolt-Glaser, the more that stress matters. It even weakens your response to immunizations. And if you’re married but not getting along with your spouse, beware. It will take longer for your wounds to heal than it would if you weren’t so stressed out. And if you’re a caretaker for someone with Alzheimer’s disease (this heartbreaking situation is often used as a naturally occurring model of stress), your IL-6 levels may be up to four times higher than average. What you experience emotionally directly affects your health.
The Effects of Adverse Childhood Experiences
Enter Dr. Vincent J. Felitti, the director and founder of the Department of Preventive Medicine at the Kaiser Permanente Medical Group in San Diego. He and his colleague Robert Anda, M.D. (from the Centers for Disease Control and Prevention in Atlanta) have hammered the last nail in an argument that’s been bandied around for years: whether or not adverse events in childhood predict health in later life. The ACE (Adverse Childhood Experiences) study is a major research project that investigates the ways in which childhood experiences have affected health decades later.
The ACE study began with a curious observation. In the mid-1980s the Kaiser Permanente Department of Preventive Medicine noticed that one of their obesity programs had a high dropout rate. Oddly, many of those who left the study had actually lost weight. To the surprise of the investigators, who conducted in-depth life interviews with 286 of those individuals, childhood abuse turned out to be a very common theme in the patient narratives. When individuals reported being abused, they were likely to comment that their weight gain had started shortly thereafter. A number of patients said that they’d made an association between their abuse and the obesity years before, but when they had pointed it out to their doctors, they were discounted. The abuse was so long ago, after all. How could it still be affecting them 10, 20, 30, 40, or even 50 years later?
The obesity, according to Dr. Felitti, wasn’t their problem. It was, in fact, their solution He cites the case of a woman who was raped and gained over a hundred pounds that year: “Overweight is overlooked, and that’s the way I want to be,” she said.1
Felitti’s response to the stories of his patients is both insightful and compassionate:
We saw that things like intractable smoking, things like promiscuity, use of street drugs, heavy alcohol consumption, etc., these were fairly common in the backgrounds of many of the patients. . . . These were merely techniques they were using; these were merely coping mechanisms that had gone into place.2
The Department of Preventive Medicine where Dr. Felitti made his observations kept detailed records of psychological, social, and biomedical data for more than 55,000 members, most of whom were middle-class Americans. It’s a sad fact that 22 percent of this population reported childhood sexual abuse on their questionnaires. When asked subsequently, “How did that affect you later in life?” their responses, Felitti found, often provided important clues about how best to approach the treatment of their adult ills.
Felitti and Anda asked 26,000 consecutive adult patients if they would be interested in helping them understand how childhood events might have affected their health, and 68 percent agreed to be included in the study.
This large group of willing patients helped the researchers identify eight categories of adverse experience: the three abuse categories were emotional, physical, or sexual; and the five categories of household dysfunction included living in a home where there was violent treatment of the mother, a substance abuser, a household member in prison, a chronically depressed or mentally ill household member, or the loss of a biological parent through any cause. If a person wasn’t exposed to any of these eight categories of ACE, they scored a zero. Otherwise, one point was given for each kind of adverse experience.
Since the average age of participants was 57, the researchers were looking at the association between current health and childhood experiences that occurred as far back as a half century prior. What they discovered was that time doesn’t heal It only conceals the roots of illness and dysfunction due to adverse childhood experiences
If all physicians were trained to identify and understand the effects of early childhood experiences on health and well-being, the savings both in human suffering and health-care dollars would be astronomical. As Dr. Anda commented:
I think of my training as a medical student; I learned nothing of this. I think every medical student should be taught about adverse childhood experiences, abuse, violence, and neurodevelopment, and how the consequences will lay hidden right in front of their eyes unless it’s a standard part of medical care to inquire about it.3
Just over 50 percent of the Kaiser Permanente patients had ACE scores of 1 or above. One in four had scores of 2 or higher; one in 16 had scores greater than 4. Total ACE scores predicted future mental and physical health, as well as behaviors such as drug abuse, smoking, and alcohol abuse in a most remarkable way—there was a direct correlation. The higher the ACE score, the more serious the adult health and behavioral problems.
Take cigarette smoking—and for many years, I wish someone would have taken mine! I must have quit a thousand times (sometimes succeeding for a few years and then relapsing again) before I finally quit for good. My own ACE score, by the way, is at least a 3 and perhaps a 4. My father was depressed, my mother was a genteel alcoholic, a service person sexually abused me, and then there was the emotional abuse at Camp Sunrise Lake.
A person with an ACE score of 4 is 390 percent more likely to develop chronic obstructive pulmonary disease (COPD), which is strongly related to smoking. There is a similar relationship between a high ACE score and hepatitis. Patients with an ACE score of 4 have a 240 percent higher chance of developing hepatitis in comparison to patients whose ACE score is 0. Other conditions including heart disease, diabetes, alcoholism, and other types of substance abuse follow the same trend. A male with an ACE score of 6 is 4,600 percent more likely to become an intravenous drug abuser compared to a male with an ACE score of 0. The heroin, according to Felitti’s thinking, is not the problem. It’s a solution— though crude and ineffective—to blunt internal pain and anguish leftover from a childhood of helplessness and hopelessness.
Now let’s take a look at depression. A person with an ACE score of 4 or more is 460 percent more likely to develop depression than someone with a score of 0— and there is a 1,220 percent increase in suicide attempts between the two groups. Extrapolating the Kaiser Permanente data to the general population, Felitti estimates that 75 to 80 percent of all suicide attempts nationally are related to adverse childhood experiences.
It’s an eye-opener to realize that the most important determinant of our nation’s health is childhood experience. Felitti compares the health problems that appear in adulthood to smoke. The fire that needs to be put out is the high occurrence of adverse childhood experiences that relate so strongly to these health and emotional problems in later life.
I believe that adverse childhood experiences are a factor that predisposes us to burnout not only in our adult years, but also when we’re teenagers. Here’s an example from my own life.
My First Burnout Experience
I am 16, a junior in high school. Like many people with high ACE scores, I’m already on track for health problems. I smoke and I’ve just had unprotected sex for the first time. I also have serious migraine headaches, stomach problems, and anxiety. But I’m very smart and scholastically responsible. My French teacher goes on vacation and apparently no substitute can be found, so she asks me to run the class. I’m remarkably good with French idioms and pronunciation, which is why I get a 4 out of 5 on the Advanced Placement (AP) exam after studying the language for a single semester. I’ve also scored a 5 on the English AP exam and have won an award from the National Council of Teachers of English in my home state of Massachusetts. My parents are proud and frame the letter of congratulations that I get from freshman senator Edward Kennedy.
During this time, I’m also in rehearsal for a play. My role is Ismene, the sister of Antigone, and our drama club is taking part in a state competition. In addition, I’ve won first place in physics in the science fair for a project that involved growing crystals with lattice defects and then measuring the effect of the defects on the crystals’ piezoelectric properties. I’m preparing to exhibit the project in the state finals.
And then, there are boys. The young man who has recently seduced me (he is a senior in a private high school and has started carrying a long umbrella as some sort of presumptive Ivy League affectation) tells me that the signal flags prominently plastered on the door of his Corvette are my initials. My mother intuitively despises “Umbrella Man” and doesn’t trust him one bit. She checks out a book on signal flags from the library and—standing by the curb, squinting in the afternoon sun—duly inspects Umbrella Man’s car doors. They are not my initials. I’ve been had in the most serious sense of the phrase. He is leaving for Yale in the fall, and despite myself, and the fact that my parents have forbidden me to see him again, I’m crestfallen.
This is the last straw for my sanity.
“Everyone wants a piece of me!” I whine dramatically. “There’s nothing left for me.” I gave everything to my French teacher, the drama club, the science fair, my parents, and that stupid Umbrella Man who got just what he wanted. My response to all this is to shut the door to my room and refuse to come out. I stay in there for a week, except to visit the bathroom and dining-room table. I am apathetic, withdrawn, disagreeable, and emotionally exhausted.
Am I depressed? No way. At the end of the week, my mother reports that the school has serious concerns about my mental health. Well, that makes me furious. Galvanized by the need to prove myself as invincible and perfect, I return to school and function beautifully.
My soul, however, is roaming untethered in the Land of the Lost, but I continue to go through the motions so well that no one notices that I’m an empty shell. I don’t even notice until somewhere in my mid-30s. That’s when I begin the arduous process of coming back home to myself. In the meantime, I’m hardwired to overachieve, search for perfection, and crash and burn repeatedly.
My childhood experiences, in combination with inborn temperament and external environment, put me at very high risk of burnout. Let’s now focus on personality types and makeup, and the ways in which those factors contribute to burnout.
