Google 'chronic fatigue syndrome' to see what the end-point of burnout is like.
Some warning signs: depression, anxiety, insomnia, loss of appetite, constant illnesses, dreading going into work, racing heartrate, etc. Although to be honest by the time you've got to that point you are already pretty burned out and you're well on your way to CFS.
My solution for the past 10 years has been to live my life so there is little/no possibility of ever having burnout (and it has worked :)
Unfortunately there is no standard blood test for CFS/burnout. I agree with Amy that cortisol might be useful, but the problem is that it isn't always a reliable indicator of illness.
Anyway, just keep doing what you are doing and you will gradually recover. For more info, see: http://www.mind-body-health.net/recovery.html (a site I developed 10 years ago after recovering myself).
Unfortunately this is a very misunderstood area of medicine because doctors (and patients) like to pigeonhole illnesses as either physical or psychological, and psychiatric/psychosomatic illness has a very bad negative stereotype.
> Unfortunately this is a very misunderstood area of medicine because doctors (and patients) like to pigeonhole illnesses as either physical or psychological, and psychiatric/psychosomatic illness has a very bad negative stereotype.
That is, in fact, what I was trying to do. I actually said that to one of the doctors (something along the lines of 'I want to rule out physical issues first').
Thanks again. I'll write about it and submit to HN once I have finished climbing out of the hole :)
There are plenty of tests which can show what's wrong with you - but they're not "standard" in the sense of doctors using them.
If your morning cortisol is above a certain level or below a certain level; if your morning, before-you-get-out-bed axillary body temperature is above or below a certain temperature (under 97.8 or above 98.6); if your blood pressure deviates by a certain amount over a 16-hour day; if your average temps deviate by more than 0.2 F from day to day; if you have post-exertional malaise… you have an HPA malfunction of one kind or another.
I'd say "you should also get your thyroid checked" but the blood tests for that are atrociously useless. Check the symptoms. Low body temp, especially in the morning before you get out of bed (mine ranges from 96.5-97.4), slow heart rate if you're not an athlete (mine is 50-60 bpm and I am NOT an athlete!), puffy face/eyes, myxedema (non pitting) swelling/thickened rubbery skin on your upper outer arm or shin, changed ankle-tap reflexes, very cold extremities, Raynaud's phenomenon, etc., those are the signs that are actually diagnostic of a thyroid insufficiency.
These are how doctors have diagnosed and treated low thyroid successfully for a hundred years. The blood tests are a new thing but they aren't very indicative of actual dysfunction (or function).
All of the above is like a lot like low blood pressure. Low blood pressure is only defined by numbers when it becomes dangerous to life. Otherwise, you're diagnosed with low blood pressure if your blood pressure is "normal" or below and you have symptoms. E.g. I have low blood pressure at 100-110/60-70 even though that's considered just fine, because I feel faint when I stand up and other symptoms.
Generally, the best resource I've found is _From Fatigued to Fantastic_. It helped me get much, much, better.
While I agree with most of what you say, the problem is that a lot of studies have been done on the HPA axis and cortisol in CFS/burnout, but there is no agreement. Some studies find low cortisol, others don't. There is definitely HPA axis dysfunction, but nobody can seem to pin it down. I suspect that if you measured cortisol throughout the day and correlated it to a symptom diary and/or a stress test, you might be able to come up with a diagnostic test.
The other issue is that there is no cheap and easy cortisol test like there is for blood glucose. As far as I can tell it would be possible to develop such a test, but nobody has done it yet for a number of reasons (lack of demand, cost, FDA approval, etc).
If someone were to [1] figure out a definitive test for burnout/CFS and [2] develop/patent a home testing kit they would be very rich and help a lot of people into the bargain.
As for Teitelbaum: while he does have some useful stuff to say, he also peddles a lot of quackery.
Re: the contradictory studies… if you go with the group of practitioners who argue that there are different stages to the disorder, they're not contradictory at all. The stages argument says a person starts off with very high cortisol output (because you're under stress) and this is what causes the damage and fall-off of production later:
There are definitive clinical (non-blood) tests for hypothyroid (I mentioned several of them), there are also ways to test for FM/CFS (muscle recovery among others). They just don't get used a lot.
As for quackery -- the only quackery I read in Teitelbaum's book was about the allergy treatment and it's not any more or less quacky than acupuncture (where the research was discredited) so I consider it harmless. Every "canonical" scientist has some kind of nutty side, from Isaac Newton on down the line. (Note: Not comparing Teitelbaum to Newton whatsoever. It's just an ideal, extreme, example.) Everything else in his book is supported with research citations. I've checked them, and others, because I followed his advice.
When you list ranges of temperatures you should indicate the body part that is being tested, because an oral temperature reading will be different than a rectal reading. Also, the temperature readings you gave are slightly inaccurate; this [1] says that the maximum oral healthy early morning temperature is 98.8°F, and 99.9°F overall.
Sorry if I forgot to say: Axillary basal temperature. That is, under the arm, measured for 5-10 minutes, with a glass thermometer or electronic one that'll let you keep measuring that long. If that's higher than 98.6, you really should be evaluated for hyperthyroidism. Doesn't mean you DO have it. It CAN be a healthy temperature. But it's a possible symptom.
Having experienced burnout and resulting chronic fatigue syndrome (which is really just an extreme version of burnout that persists long after the stress has ended), I pretty much agree with everything you say. However it's incorrect to say that burnout is physical rather than psychological as psychological factors do play a large part in determining whether or not you experience burnout.
Yes, CFS has a psychological component… In the way that, if X happens the same to you and me, and you don't care, but I do, then my adrenals/thyroid go into overdrive, yours don't; I get sick, you don't. Some people get CFS because of minor stress, some people don't get it until their life is a living hell. That's the psychological aspect of it.
But that doesn't make it a psychological disorder in any way, shape or form. Mind and body are just simply not separate. I have been depressed in my life. I was not depressed before my illness or even during it, except the natural kind of mourning a person goes through when suddenly they can't even stand up.
I'm sure lots of people have concomitant depression, since so many people are depressed, period. But many also do not. (I'm one of them.)
I'm more interested in understanding what is going on in the brain/body rather than arguing over terminology. Both psychological and other factors seem to cause burnout/CFS, although psychological factors do seem to be the most important. Depression is a resulting symptom, not a cause.
Stress and burnout affect different people in different ways: some people get depressed, others develop chronic pain (fibromyalgia, ME), others have chronic fatigue etc.
As for the psychological factors that seem to be important: motivation, goals and emotions all seem to play a large part.
While you're correct that CFS is not entirely psychological (functional would be a better term), it does appear to be mostly caused by psychological factors. If you look at the main triggers for CFS they are: job stress, relationship stress, and viral infection - and there is some doubt as to whether the viral infection is a cause or just a symptom of a weakened immune system.
If I am depressed and jump in front of a train, or if I think that's a safe and normal thing to lie on the tracks, or if somebody pushes me, or if I trip, the result is the same: Splat.
There's little point in saying "Splats are primarily psychological" if accidents and mistaken facts seem to be at play often enough. Or if people splat other ways (e.g. in car crashes, tightrope accidents). The result is the same. Splatty splat splat. The outcome only tells you so much.
I can tell you one thing: Totally overhauling my "motivation, goals, and emotions" did absolutely diddlysquat in making me better because while I started off with a combination of routine infection and "psychological" stress (which, of course, is a kind of misnomer because you can measure it with blood tests)... it did permanent damage to my mechanicals. Splat.
Also, a lot of doctors think FM/ME/CFS are the same thing. And a lot think adrenal fatigue/hypothyroid and CFS are the same thing. Maybe they are separate but cause each other.
Genetics certainly play a part; hypothyroid is incredibly heritable, for example. It causes lots of the same symptoms and may be a symptom/cause (or both) itself.
But nobody claims that hypothyroidism is psychological, not even slightly, much less primarily.
But the cause for an individual almost doesn't matter. You have to cut stress no matter whether it was a primary cause for you or not.
Some warning signs: depression, anxiety, insomnia, loss of appetite, constant illnesses, dreading going into work, racing heartrate, etc. Although to be honest by the time you've got to that point you are already pretty burned out and you're well on your way to CFS.
My solution for the past 10 years has been to live my life so there is little/no possibility of ever having burnout (and it has worked :)