Burnout is a dangerous disease, which can lead to death in extreme cases. There is no clear medical definition, and many people equate burnout with being tired or fatigued. Often it is even used as a synonym for stress. In the traditional manual with the division of psychiatric diseases, the DSM-IV, burnout is not mentioned as a separate illness. Its definition is often most similar to the definition of depression. But in general, most psychiatrists agree that burnout is something different. They often define it as a situation of extreme exhaustion because someone has been living for too long in a way which is fundamentally against their nature. The real 'treatment' of burnout in the medical sense of the word is therefore often combined with providing insight and a change of behavior which leads to the patient starting to live life in the way they (deep down) want to live. They learn to make their behavior match their deeper, 'existential' life project. They answer the question 'Who do I want to be`' for themselves, and then live accordingly. In that sense you could see burnout as an extremely strong 'alarm signal' from mind and body, which says: 'Stop and take a hold of your life, because if you continue down this path, you will die!'

The life pyramid of 15Minutes4Me.com

To help us live a healthy life, our body has several protection mechanisms. These can be divided up into 6 stages. Each previous stage in this should normally seen protect us from the risk of sliding into the next - worse - stage. Each time we fail to do so, we move another step in the direction of the risk of a serious disease, or even death in extreme cases. levenspiramidemijnkwartier

1. Life joy

Life joy or contentment protects us from negative stress. By living happily and joyfully you gain a type of 'immunity' or protection against negative stress. Living happily develops certain zones in our brain which are responsible for positive thoughts and feelings (especially our left prefrontal cortex). It is something like muscle training: the more you use a muscle, the more it develops, as more muscle tissue is created through usage. Life joy is created by 'living like you want to live', in accordance to your fundamental life project. If you do not live this way during an extended period of time, distress and negative stress are created.

2. Stress

Stress in itself is something positive in nature. It makes it so that you  can respond quickly and adequately in life-threatening situations in order to survive. If a tiger wants to eat you, stress will help you to either flee or fight for your life. Acute stress is healthy, if it is limited to a certain amount of times per week or per month. However, when the 'triggers' which cause the stress are too frequent (e.g. any text, phone call, e-mail, communication which could focus our attention on something bad), our stress system becomes exhausted and inefficient. What happens in that moment? On the one hand, your memory for negative situations will be activated (as a result of excess adrenalin). On the other hand, a long-term overdose of the stress hormone cortisol will have a toxic effect on our hippocampus, which is a region in our brains. Up to 9 percent of our neurons or brain cells can be killed by long-term negative stress. This has recently been shown with new image formation techniques. The hippocampus is responsible for our memory and our concentration ability. Death of its brain cells therefore explains concentration issues and memory problems caused by long-term stress. The hippocampus really makes it so that we can link information from the past to information in the present, to use this for decisions made in the future. The zone in our brain which helps us make decisions and plan things in the future is the prefrontal cortex. Brain cells here, too, slowly start dying under extreme stress. And even worse: the left prefrontal cortex, which is responsible for positive thoughts and feelings, is affected first. That is why one becomes pessimistic in starting phases of a depression. The right prefrontal cortex (negative thoughts and feelings) follow later on, when our depression worsens. This explains why major depression causes apathy or a lack of feelings.

3. Depression, anxiety, fatigue, or the third stage

If chronic stress exists for too long, we end up in a vicious cycle of negativity and exhaustion. The phenomena describe above lead to depression, anxiety, or fatigue. On their own again useful bodily functions: Depression helps us to do less and to stop, to take a break. Anxiety is the typical feeling which helps us create a distance from something which scares us. Fatigue makes us stop, at least if we listen to our body and do not force ourselves to go on. Our Western economic model and our work ethic, however, make it so that we do force ourselves to ignore these useful (yet sometimes unclear) signals We use willpower, caffeine, nicotine or pills to force ourselves to go on. And if we continue to do this for a long enough period of time, we are punished with a real medical burnout.

4. Burnout

In this stage our complaints become chronic and are present for months on end. We have ignored the previous warnings and have been completely broken down. Our memory and focus (hippocampus) do no longer do their job, and our ability to plan the future and organize ourselves to reach our goals (prefrontal cortex) is also influenced. This stage should thus be the ultimate warning sign. It means: stop with what you are doing and learn who you are and who you want to be.

5. Illness

Unfortunately, the mechanism that causes a chronic overproduction of cortisol and adrenalin, also is responsible for regulating our own inner defense mechanism, our inflammatory responses, and our immune system. With long-term excess pressure, this system deregulates and becomes less effective in protecting us from outside attacks by, for example, bacteria, viruses or cancer cells. Even worse, is that this deregulation makes it so that we start to attack ourselves: our internal inflammatory responses might attack our vascular walls, causing arteriosclerosis, which in turn can lead to heart attacks, brain damage and other 'civilized illnesses'.

6. Death

If we have still not asked for medical help at this point, we die, indirectly because we did not listen to our bodies at any of the previous stages. Because we did not live like we, deep down, wanted to live. Most causes of death are attributed to a group which is sometimes called 'ailments due to civilization'. These are generally preventable by living happily and healthily and learning to reduce negative stress.

How to prevent burnout?

Rule 1: Life joy

By balancing your life and behavior against how you truly, authentically want to live, you develop life joy and contentment. This protects you against stress and burnout and is therefore healing. It is therefore important to regularly ask yourself if you live int he way you want to live. This process can take months at a time. Rediscovering what you want takes time and dedication. Tips to train life joy: A simple 'golden rule' is to plan at least one thing every day which brings you joy. Another technique could be to, at the end of every day, note down in a diary how many minutes of pleasure of contentment you have experienced during that day. By going through your day to note this down, you make yourself think about it. You can then ask yourself: 'What can I do tomorrow to increase the amount of content time?'

Rule 2: Take a creative break every 90 minutes

The American psychologist Dr Ernest Rossi did research on the use of natural rhythms on our health. Analogous to the cycles we experience at night when sleeping - from light sleep to heavy sleep, then back to light sleep with dream phases (REM-sleep or Rapid Eye Movements) - there also are cycles during the day, of 90 minutes each. Every 90 minutes, our level of activity and our logical-rational thinking abilities increase, and then decrease again meaning we go through a phase of absentmindedness in which we start to daydream. During these moments of creative absentmindedness, nature creates a natural creative break. This is the moment during which creative insights can suddenly appear. Insights which often help us to work more productively afterwards, or even help us to save time to reach the same goal. Our rational thinking calms down, and we build up more energy for the next 90 minutes. The modern Western human being often tries to get rid of these mini breaks with the help of willpower, caffeine, nicotine, alcohol or other stimulants. One can do this for a few days or sometimes even weeks, but not for months. People who chronically ignore their natural tendency to take such a short time-out every 90 minutes, build up a chronic stress, which eventually develops into a burnout.

Rule 3: Take a time-out every 6 weeks

If we want to let our mind and body enjoy life productively and actively for years without needing to pay economically, we need to take breaks. Just like we have a natural rhythm warranting a break every 90 minutes, we have a regular need of a longer break of several days, too. The ideal schedule which we have successfully used for years with successful professionals goes as follows: Weekend getaway To deal with years of high demands, we regularly need an extended weekend. Experience teaches us that 3 nights of sleeping over an hour away from home has a larger effect than a normal weekend. So if you can afford it, it is a good idea to leave your normal home and environment for a night or three. Boost your love life This weekend is best planned - if you are in a relationship - with your life partner and preferably without the kids. No matter how much you care about your children, a couple sometimes simply needs to be together like they were in the beginning of the relationship, sort of like a mini-honeymoon. A second advantage of such a break is that you make time for affection and sex. And these are both driving powers in your relationship as well as for your physical and mental health. I often hear couples in my medical practise say: 'That weekend we rediscovered each other. I did not realize that we had grown apart that much. This has brought us closer together again,'

Rule 4: 1 week every 3 months

Even if you are self-employed or when you are able to compensate working hard with more spare time, taking one week off after three months is a definite recommendation. From experience as a business coach, beside my medical practise, I often see that sales and profits of company managers or entrepreneurs increase by over 20 percent in one year's time with the help of the creative business-ideas which spontaneously arrived during or after these vacations. Because you are in a different environment, your creative mindset is stimulated. For employees under contract, the financial advantages are not seen on such short notice when you look at your personal income. However, we still often see that young professionals and managers who work with such a vacation rhythm are more quickly promoted, as they have more to offer to their company and learn to present themselves with the charisma which is projected by a fresh mind and body.

Rule 5: Continue this vacation-like feeling during your workweek.

It is important to daily reflect on and enjoy the feeling you get after such a mini-vacation, in order to incorporate this vacation feeling into your daily life. Take fifteen minutes every day for yourself in order to relax and work on self-reflection. There is namely a risk that your vacation-effect is quickly lost if you do not take action in order to continue and keep up your newfound rest when you are once again in a hectic working environment. Extra watchfulness is thus needed. Looking forward to your next vacation The best results are gotten by planning your next break as soon as you come back from your last vacation or weekend off. Our participants report that, by returning and immediately making plans for a new vacation or weekend, this works stress-reducing on its own. That is why it is best to book your next break as quickly as you can. Final words: To test if you are heading toward a burnout, you can try the self-test on '15Minutes4Me.com'. The pointers of the 3 stress meters of this stress test should be in the green zone, like they are for 80 percent of the Flemish and Dutch population. If any of the pointers are in the red or orange zone, you need to be extra vigilant. Do you know people who are heading toward a burnout? Then show them this article and ask people who have prevented a burnout to send their success stories to me. It brings me pleasure to see how readers take matters into their own hands in order to make life more beautiful and to create more life joy by taking regular breaks. The worksheets of this and previous articles in this series can be found on www.15minutes4me.com/psycheandbrain Read / donwload here the pdf of the original article in Dutch: This is how you prevent a burnout Share this article with your friends on Facebook, Twitter, or Linked-In, and do our free self-test afterwards.

Paul Koeck, MD