He who burns does not burn out

I often advise patients who come to my practice to integrate music into their lives as a resource against exhaustion syndrome. The situation is different when musicians come to me complaining of exhaustion. In this case, it is the social and personal conditions surrounding music that give rise to burnout symptoms. Music then becomes a source of worry and stress and loses the positive meaning that may have led to this particular career choice.

But what actually is burnout? According to Matthias Burisch (Matthias Burisch: Das Burnout-Syndrom. Springer. 2005, 3rd edition), seven phases are decisive, with clinical and pathological relevance arising from the fourth phase onwards:

First phase of the first warning signs (you work overtime or at weekends to cope with the workload)

Second phase of reduced commitment (you become more silent, develop a negative attitude towards work)

Third phase of emotional reactions (feelings of inferiority and pessimism develop)

Fourth phase of decline in cognitive abilities (concentration/memory disorders, increase in errors and reduced motivation)

Fifth phase of flattening of emotional and social life (for example, loss of previously loved leisure activities)

Sixth phase of psychosomatic reactions (muscular tension, sleep disorders, increased alcohol consumption)

Seventh phase of depression and despair (feeling of futility and fear of the future)

It should be noted that chronic fatigue syndrome can always have a physical cause. On a psychological level, too, a distinction must be made, mainly from depression, but also from chronic fatigue syndrome, generalized anxiety disorder, eating disorder or substance abuse (alcohol or tranquillizers). We call this differential diagnosis.

If there are no findings here, work can begin on the musician's professional environment and personality: The specific nature of the professional environment can promote the problem of burnout. In the case of orchestral musicians, for example, this could be overly busy schedules and communication problems with superiors, while in the case of music teachers it could be the more difficult children and group lessons, to name just two things for the sake of brevity. In both groups, bullying between colleagues and between hierarchies plays a major role. Solutions in this area lie in the structure of the workplace and the colleagues, which must be looked at separately in each case.

But musicians can also work on themselves and learn various strategies to prevent burnout. Psychology distinguishes between different personality types. For example, it has been shown that "a strong identification with the practice of music in combination with great ambition and a lack of ability to distance oneself leads to risk pattern A in a third of music students, which is characterized by excessive stress and susceptibility to performance" (Claudia Spahn et al.: MusikerMedizin: Diagnostik, Therapie und Prävention von musikerspezifischen Erkrankungen. Schattauer, 2011).

This provides clues as to what the musician can improve: He must take the warning signs of the phases mentioned seriously and quickly find cognitive and emotional solutions. In addition to mental training, such as learning to keep your distance, various well-known relaxation techniques can help on an emotional level. I have had very good experience in my practice with the technique of self-hypnosis, in which relaxation also occurs, albeit as a positive by-product. Much more important are the therapeutic suggestions that become effective in this process and that can be adopted as a coping strategy in everyday life.