Lost in the misty history of burnout is a truth about the patients treated at free clinics in the early seventies: many of them were Vietnam War veterans, addicted to heroin. The Haight-Ashbury clinic managed to stay open partly because it treated so many veterans that it received funding from the federal government. Those veterans were burned out on heroin. But they also suffered from what, for decades, had been called “combat fatigue” or “battle fatigue.” In 1980, when Freudenberger first reached a popular audience with his claims about “burnout syndrome,” the battle fatigue of Vietnam veterans was recognized by the DSM-III as post-traumatic stress disorder. Meanwhile, some groups, particularly feminists and other advocates for battered women and sexually abused children, were extending this understanding to people who had never seen combat.
Burnout, like P.T.S.D., moved from military to civilian life, as if everyone were, suddenly, suffering from battle fatigue. Since the late nineteen-seventies, the empirical study of burnout has been led by Christina Maslach, a social psychologist at the University of California, Berkeley. In 1981, she developed the field’s principal diagnostic tool, the Maslach Burnout Inventory, and the following year published “Burnout: The Cost of Caring,” which brought her research to a popular readership. “Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do ‘people work’ of some kind,” Maslach wrote then. She emphasized burnout in the “helping professions”: teaching, nursing, and social work—professions dominated by women who are almost always very poorly paid (people who, extending the military metaphor, are lately classed as frontline workers, alongside police, firefighters, and E.M.T.s). Taking care of vulnerable people and witnessing their anguish exacts an enormous toll and produces its own suffering. Naming that pain was meant to be a step toward alleviating it. But it hasn’t worked out that way, because the conditions of doing care work—the emotional drain, the hours, the thanklessness—have not gotten better.