ARE WE SATISFIED WITH TREATING THE MERE SYMPTOMS OF MEDICALLY UNEXPLAINED SYNDROMES?

by Karin Mohn Engebretsen, Better Evidence for a Better Healthcare Manifesto

As a Gestalt psychotherapist, I have seen an increasing number of individuals over the last fifteen years that experience themselves as burned out. This fact has triggered my interest to explore the phenomenon further. Burnout is as a medically unexplained syndrome (MUS). As with other MUS, there is a tendency to assume a narrow perspective to focus on problems related to psyche or soma as pathologies located exclusively within the patient. Research has mainly looked for clear-cut one-to-one relations between cause and effect. These relationships are however difficult to find in complex syndromes.

Burnout might instead be seen as a reaction to complex causes and a broad contextual setup, but unfortunately, such point of view has only been marginal. Consequently, medical professionals are faced with comprehensive challenges due to factors such as lack of a causal explanation, lack of diagnostic descriptions and lack of a treatment or medical interventions.

A matter of debate is whether burnout should be considered a distinct medical diagnosis or a form of depression. Recent research has suggested that public health policies should focus on and medically treat one of the core symptoms, which is asserted to be depression. The preferred medication is selective serotonin reuptake inhibitors (SSRI). A problem however, is that these patients, referred to me by their general practitioners, often complain about worsened symptoms that might be a side effect of the medication they are on.

Although burnout and depression have similar symptoms, my experience is that there may be substantial differences on the underlying psychological process. I experience the patients grieving a loss quite differently from patients being ill due to an overwhelming life situation. Treating the symptom without any idea of the underlying process in this case might provoke serious trouble. For instance, as some research pointed out, SSRI can lower cortisol levels and therefore worsen the symptoms in stress-induced conditions, possibly though interfering with hypothalamic – pituitary – adrenal axis functioning. Therefore if burnout, as we can reasonably suppose, is a stress-induced syndrome, SSRI can hurt much more than they can help.

To increase the knowledge of burnout as a phenomenon, complementary research methods are required. Person centred healthcare and the Biomedical Model represents two central methodological perspectives that constitute the main camps in contemporary medical/social science. They depict two extremely different ways of studying social phenomena and as such, they may complement each other. Instead of limiting the medical model to specific biological factors, I argue that it is necessary to include the entire human being within a contextual setting to be able to understand the underlying mechanisms. So to improve the health care system related to MUS it is due time to open up for a philosophical reflection on what research questions we need to answer and choose the methodology that will provide these answers.

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