by Alfredo Anania





Today psychiatry shows an increasing interest towards the physical, human and interpersonal environment that surrounds the individual. The ecology of mind in a working context doesn't have to see only with earning money, performances, career, success and similar things but all that is considered, over the abilities of the single one and the working group, also as a fruit of an ecologically plausible working environment; in other terms the psycho-hygienist thinks that a good eco-systemic quality of the working context (physical environment, emotional climate, relationships system) is essential to achieve the desired goals both by every component the operational structure (the whole team) and by the working group in its entirety (the team as a whole).

Besides, for the reason that the job is a fundamental moment of one’s “being in the world”, the psycho-hygienist will see the working environment as an agorà of fundamental importance for the meeting and the psychological coexistence with the other who is not anonymous passer-by or ordinary people but mate, friend, co-operator, co-constructor of a reality that comes true by means of the work. Insofar, the psychologist also will look at the workplace as an ecosystem, since it daily occupies a lot of the hours that one has, which is about one’s life-story as a highway for the process of his individualization and about the (working) group’s history as a fundamental “space” for its own becoming; from this point of view the ecology of mind cannot deny the enormous psychological value that the working environment has as a place of inter-human meeting that “produces” (over the production of material or intellectual and/or moral and aesthetical goods) also feelings, emotions, friendships, enmities, attachment, rejection, interpersonal dynamics and plays of role.


Today we consider the stress as a fundamental factor in the onset of many troubles, from those neurotics to those so said “psychosomatic”, but generally we neglect the importance of the stress as a source of psycho-physic well-being; in fact, when its “dose” is physiologically acceptable we can say “eustress” for differentiating it from the harmful stress or “distress”. So the stress can have positive worth (when it doesn't result excessive in comparison to the individual tolerability) since it can motivate, energize, stimulate us to more working and, in general, also help us to live better. It suffices to mention the old Latin motto: “Idleness is the root of all evil”! Effectively, one has to consider, for instance, how much every routine is enervating. Man, the most curious among animals, certainly go on stimuli, researching new things and the creativity but all this implies an effort, a working, a “stress”, that they are, at the end, highly rewarding.

But stress cannot get over a certain limit.

The term “stress” – which means effort, tension, solicitation – was adopted by Selye for describing a general syndrome (stress syndrome) that is the organism’s unspecific answer to every necessity to do an adaptation effort.

The stressors can be various: physic, chemic, biological, psycho-social. The first phase is characterized by the “alarm reaction”. Persisting the harmful stimulus a “adaptation stage” comes up. But, if the stimulus doesn't end, at last, the “exhaustion phase” takes place and it can provoke real illnesses just caused by the adaptation reaction.

Today we prefer to refer to the adaptation by individual rather than to the adaptation by “organism” for the simple fact that by now we have understood that the “stress reaction” is also the consequence of an “emotional activation” in wide part influenced by a “cognitive filter” or “cognitive evaluation” by the individual given the remarkable role that in the “stress reaction” have some purely psychological factors, as the “experiential memory” and the “learning processes”. In fact, these psychic functions play a fundamental role in the cognitive evaluation and, consequently, in the anticipation by the individual (through the simple mental representation of the action, without any acting on the external reality) the possible course of the events, namely the possible effects following the action mentally token into account by the individual. The cognitive evaluation besides concerns the forecast, also in relation to the personal experience, about one’s different behavioural answers realistically available, that is the various personal useful resources to face the stimuli. For instance, the Americans, with a play on words designate with the motto “fight or flight reaction” two opposite possibilities of reacting (among so many) when the individual has to face some difficult situations.


A stressing stimulus can potentially be valued as menacing and to determine an emotional activation for various causes: because too much intense (quantitatively excessive); because unusual (qualitatively abnormal); because it acts for too much time (temporally exorbitant). When the stimulus appears excessive as to ability to adapt it becomes so harmful that it can provoke morbid out-breaks.

In the animals evidently it is excludible “cognitive mediation”, because they are lacking a conscience of itself and some particular man’s psychic functions; therefore, in the animal world, innate biological and behavioural adaptation answers are mobilized (prevailingly) by physical and environmental and (less frequently) by social stimuli, even if the Ivan P. Pavlov’s researches have allowed to verify that some animal’s visceral organs are able “to learn” a reflex/answer as reaction not only to external conditions but also to exclusively internal body stimuli; such answers are various: from the neuro-vegetative reactions to the metabolic modifications and to the immunity answer.

Therefore, over the physical, environmental, alimentary, infectious factors – which are the principal threats for the animal world - the stress answer in the human being finds complicating factors in the psychological and social features that differentiate it. The psycho-social stress originates just from some peculiar characteristics of the human psyche that it will be opportune to shortly synthesize.

The psycho-physic condition of the individual is the result of all the influences which have until one time acted, more or less directly, on him (experiential route) in connection with the genetic and constitutional factors in their dynamic interlacement with the cultural, environmental, educational, factors and so on. The salient fact is that every external event – which however “belongs” to the individual because somehow it concerns him or belongs to his life - becomes a subjective event as psychic content; this in virtue of the psychological elaboration which, however, is influenced by some basic dispositions of the personality. In other terms, the objective event becoming subjective - and, therefore, internal psychic event - undergoes to a moulding action that is conditioned by the whole individual psychic characteristics. At last, it is necessary to consider that the individual cognitive elaboration in relation to the stimulus is a mental operation which, however brief, nevertheless requires, so that it is completed, one time lapse. Insofar, the psycho-behavioural answer to the stressor is not-synchronic with the immediateness of the answer at biological level. Besides, we have to consider also the symbolic importance they have for the human being the institutions, the hierarchy, the power, the social status, the environmental context, the relational events, the affective situations: in consequence of this man finds just in the social ecosystem - he has built - some fundamental and continuous causes of stress. It finally needs to keep in mind that some typically human psychic faculties - as the remembering, the day-dreaming or the creating symbols – constitute, in their turn, some continuous sources of potentially stressful stimuli not-depending on the external world.


The stressing events are appraisable according to their intensity (low, light, remarkable, intense, serious, extreme) therefore, they vary, according to a degree that also fluctuates in relationship to the age in which one has to sustain an adaptation effort. From the point of view of the working stress we can consider, according to an increasing scale, the following examples:

·light contrarieties, small problems to be faced and resolved, variations in the routine (for instance, to face a job trip or, for a young person, to begin a new scholastic year; etc.);

·small existential changes (for instance, a removal to a new office, to increase the working responsibility, an usual night-time job or, for a young person, to change school; etc.);

·meaningful existential changes, acute or continuous problems, situations of not-irreparable loss (for instance, the beginning of new working activity, a constant failure in the job, environment e/o continuously conditions of job uncomfortable or oppressive, accident in the job, loss of a colleague or, for a young person, constant scholastic failure, marginalization by the classmates, to be subject to oppressions by a teacher; a classmate's loss; etc.);

·acute or chronic existential events intensely suffered (for instance, to be subject to mobbing, dismissal, retirement, invaliding illness, emigration, or, for a young person, disability, to to be subject to abuse or to undergo to a severe education, institutionalisation; etc.);

·mourning, serious loss or irreparable situations (for instance, financial ruin, total loss of the ability to job or, for a young person, to be subject to a damaging physical aggression or to sexual violence; etc.);

·annihilating or catastrophic situations (disasters calamities, natural calamity; earthquake, seaquake; etc.);


Our organism tends towards the homeostasis that is the tendency to maintain the equilibrium and to preserve its morphological and physiological characteristics against the unbalances that can be determined by inside or external variations. The homeostatic function is not an action of the organism on the environment but a retroaction of the organism which has the tendency to maintain its equilibrium also in relation to the environment. Health depends on a satisfactory both physiological and psychological adaptation to the environment, which implicates the maintenance of an endogenous equilibrium and a suitable adaptation to the external stressful factors. Health is joined to a sense of comfort and a pleasure of life and to absence of pain and disability. The illness implicates a breaking of the organism’s homeostatic and adaptive functions.

A breaking of the homeostasis can begin at any level both physiological and psychological. For example, the appearance of an highly feverish viral infection represents a breaking of the homeostasis happened in the immunity system but they could be concomitant (according to the person) some feelings of anger or discouragement, for instance, by reason of the consequent impediment to end an engagement that cannot be postponed; all this in every case denotes a concomitant breaking at level of the psycho-cognitive functions. It is less considered the possibility that a feverish flu episode can represent the other face of the medal, that is the other aspect of a status (more rarely) of anger or (more frequently) of discouragement. In any case one has to know that an evident trouble at one of the three considered levels (somatic, psychic or relational) contemporarily implicates the homeostatic trouble of the other two levels. In reality, with Erik Erikson, we have to admit that the separation among bodily, psychic and relational events it is only our artificial and accommodating creation. In fact, we can describe the dimensions concerning the individual only as faces of his polyhedral unity: Biological Events
- Bodily Events - Psychic Events - Relational and Social Events - Bodily Events - Psychic Events - Biological Events - Relational and Social Events.


A meaningful aspect of the Stress Syndrome is the importance of the personality factors on its onset, so much it is true that we can describe a typical “psychosomatic personality”. Its two salient aspects are: the “alexithymia”, that is the incapability to mentally live the emotions, and more the feeling by the individual to be in a situation of “external locus of control”, namely the personal feeling that the events go in way relatively independent from the personal behaviours (on this point we will return below). So one with a “psychosomatic personality” will not only have the tendency to deny some psychological factors that can engrave on the soma (and, therefore, to somatize) but he will also have the intimate conviction not to be able to practice any substantial form of personal control on the situations and on his own troubles.


We now have to pose this question: what's the individual least unity of stress beyond which it occurs a solicitation damage (damaging stress)? The matter could appear “sophistic” if we didn't consider that the classrooms of the civil courts are inflated by insurance cases, concerning the accidents, for legal controversies about the different evaluations of the biological damage and the psychic damage.

If we accept the hypothesis that there is a psychic damage concomitant to the biological damage in consequence of a soma-stressful event, we have to set to ourselves the question if the breaking solicitation (breaking stress) is subdivisible in equal parts between both the factors of tension: physical and psychic. If a student is submitted to a continuous applicative surmenage by one excessively pretentious teacher, could we, in this case, to make reference to a projected excessive solicitation (designed stress)? Could we define this as a case of educational mobbing?

Interesting seems a pronunciation of the Italian Supreme Court of Cassation when admits the possibility that the biological damage can subsist «not only in presence of a lesion with permanent posthumous, but also in presence of lesions that have caused a psychological stress» (Cass. 29.11.1999 ns. 13440).


The term mobbing comes from the English word “to mob” (to storm, to attack) with reference to the typical behaviour adopted by some animal kinds when they try to estrange from the group one member of theirs: they encircle and threaten it. What interests here to underline it is that when the individual is attacked (or he feels, to blame or reason, attacked) he has to face the situation; this facing a situation of danger or threat is a behavioural process which, in a technical language, is denominated coping (from the term English «to cope»). By the personal style of coping it will depend in large part the ability of the individual to face the stress.

In the last years it is happened, in the western countries, a increase of moral harassment cases on the job. Such expansion of the mobbing could find an explanation taking into account that people today are more “informed” about this phenomenon and, therefore, are more able to be on the watch and to protect the personal rights on-the-job, and also less dependable and more able to legally defence themselves in comparison with the past times when a owner’s thinking was in force about job. But another reasonable explanation is that the mobbing phenomenon both it is strongly increasing because there is today the tendency, in working circle, to yoke more and more the people, in a form certainly less violent and immediate in comparison with the epoch of “The Ironmaster” but with a logic that, also if a lot more deceitful respect the gone times, it is pursued with tenacious constancy, and that tends more and more to become system: from the worker it is expected, before the assumption (because the job can be gotten) and later (because it can be maintained), something in exchange (something more or different from the efficiency and the working ability), that is something physical, as sexual matters (above all it concerns the women), or something economic (a kickback for job) or something moral (a quiescent complicity in some shady deal) or the abandonment of the freedom of choice about own political membership (a manner used by politicians for electoral and/or patronage ends).


The expression locus of control designates the perception, by the individual, to succeed or not in acting effectively on his own social reality. The internal locus of control refers to the feeling to have the ability to engrave on the events and, therefore, to be able to actively check them; contrarily, the external locus of control, as we have already said, is the feeling that the events happens without one can somehow influence them.

Empowerment, that means the increasing of the feeling to be forceful, fits needs for increasing the own social chances, reducing the inequalities, enjoying some opportunities according to the healthiest principles of democracy. The empowerment can find application at different levels: individual, social organization or community. The individual psychological empowerment is the activation of a process that allows one passes from a feeling of learned helpness - because of the accumulation of frustrating experiences (belonging to marginalized groups, constant economic insecurity, stressful conditions of life, insufficient access to the information, etc.) - to a feeling of hope (learned hopefulness) thanks to one reacquired trust in own social role, through the endeavour and the participation, both as a cooperation to stimulating changes and as ability to prevent them (when they are believed iniquitous or not shareable). From this point of view as fundamental appears the possibility to operating through a group which is able to valorise the individual participation. The empowered individual is a person who, through various articulated multi-modal interventions, finally has developed the ability to practice an incisive role inside his community, the working group and the family.

From this point of view, extremely interesting is the capacity by the people, when they are submitted to stressful events, to adopt suitable strategies of coping both seeking a new equilibrium in relation to the changed situations, both avoiding of losing the self-esteem. We must not neglect, among the external resources of coping, the importance of the social support and the financial resources, considering the high economic cost has today the guardianship of the individual health; clearly, how much greater they are the financial resources so much greater they will be the possibilities to adopt also models of coping alternative to those not-closely medicals.

After those previously considered, it needs to face other aspects related to the environmental stress as, for instance, the dynamic unbalance between the individual and the environment (we can define it as tense-corrosion individual-environment), both it is an excessive pressure by the environment towards a specific individual, both it is the incapability by the individual to opportunely use the environmental resources. Also the environmental stress can bring to the breaking or to the psycho-physic falling down of the individual (environmental stress cracking), both because the strength of the solicitations, to which he is submitted, overcome his basic capacity of tolerance, both because the solicitations can have the characteristics of the turbulence, both even because he, from an eco-systemic perspective, can constitute the most point (or better the person) gathering the environmental tensions.

As collateral connotation, it can result interesting to mention a Court’s ruling in Turin, where the judge has recognized the right to the reimbursement of the biological damage caused by mobbing, relatively a job case where the employee has been held as object of impositions by the superior and, in particular, that he had been subjected to various measures finalised to isolate him from the working environment. In the most serious cases, such practices can extend to expel the employee; those, the judge affirms, generally have the effect of gravely tarnishing the psychic equilibrium of the worker, diminishing the working ability and the self-assurance, inducing an emotional catastrophe, and sometimes a grave depression.


We have seen that the stress can induce a such breaking of the homeostatic equilibrium to produce a series of alterations going from the psychological suffering to true organic illnesses where, from the aetio-pathogenetic point of view, the psychological factors appear primaries.
We can now consider the following questions.

What is the difference between the Burn-out Syndrome and other typical neurotic troubles as Anxiety and Organ Neurosis or Mood Troubles, for instance the Depression? What is the specificity of the Burn-out Syndrome?

Can we prevent the Burn-out Syndrome?

Can we cure the Burn-out Syndrome?

The English term has the following synonyms: suffer exhaustion, to be exhausted, to be on fire, to be destroy by fire, damaged, injured, corroded, eaten away, to go red, to crash. Practically it means generally a physical or emotive exhaustion, in particular as a consequence of an enduring stress or debauchery; from the individual point of view it indicates one who is physically or emotionally weary, as a result of an excessively continuing stress.

From the psychological point of view, with the burn-out syndrome we refer to a state of fatigue or frustration arising above all by the devotion to a cause or to a way of living or to a interpersonal relationship without however achieving the hoped reward. Effectively - as underlined by Herbert J. Freudenberger, the psychologist that has coined the term “burn-out” - it is purely a problem of good intentions, since the syndrome develops just in people who try, also without succeeding, to reach some result or finality. These unsuccessful attempts end with to remove every energy from the individual that tends more and more to cut himself off.

What is the difference between the Burn-out Syndrome and other typical neurotic troubles as Anxiety and Organ Neurosis or Mood Troubles, for instance the Depression? What is the specificity of the Burn-out Syndrome?

Already in the aetio-pathogenesis of the burn-out syndrome we find the answer to the questions we have posed: it is true, the symptoms could easily be believed a classical depressed state, a anxious neurosis or a psychosomatic trouble:

- lacking in vigour, emotional exhaustion, sense of dissatisfaction, oppositive attitude, reduced resistance to the onset of illnesses, absenteeism, scarce working performance, isolation;

- and, also, feeling to physically be down, irritability, easy explosiveness, feeling to be besieged, lack of sleep, suspiciousness, loss of weight, frequent headache and stomachache.

Would not all this be diagnosed like an anxious syndrome or a depressive trouble?

Certainly! But the fact that the person previously was an active person, desirous to reach positive results, meant well and wishing for appreciation, obliges us to value the possibility of a typical burn-out syndrome.

What it is the extension of the “burn-out phenomenon”? Which contexts at institutional level and macro-social they favour the burn-out?


Everyone knows the importance that the job has for our life because it allows us to survive, to flourish, to have material goods, but also because it gives us a refreshing sense of efficiency, of productivity and of membership; besides an satisfying sense of participation to the construction of the social reality. Every one however would like his job not to be somehow debased by decisions to which he has not been called to participate, or by initiatives to which she has not called to give his own opinion. The mere execution of projects or assignments, imposed by the head or unknown about their aims, is a problem that can concern, from some points of view, many public dependents and, from other points of view, a great number of workers for private enterprises.
Everybody knows that the working dissatisfactions at last they intrude, at times dramatically, on the family and the extra-working life.

We cannot stop too for a long time on the problems related to the invasion of the computer tools inside the world of the job; in reality they are means which enrich our potentialities and that, besides, enrich us with a ludic dimension till when they don't break down, naturally!). The only matter is the possible missed safeguard of the necessary physical and environmental ergonomics, when one use the computer equipments.

Other problems are, instead, more general and they concern the dimension of the technological changes that we are living: realities and sceneries as those proposed by some cinema subjects, like “Matrix” and “Nirvana”, are not so distant, all this produces marked anxiety at the macro-social level. But the principal and more immediate macro-social problems are something quite different. We could call them “daily harmful stimuli of man struggling for life”.

It is our opinion that in the western world currently it is diffused a double message that increases, especially among young people, the tendencies borderline at the social level: on the one hand they are exalted and solicited the autonomy and the individual creativeness of all the age and all working brackets, on the other hand the power tends to be channelled more and more into the hands of oligarchic closed groups and in a hegemonic way. All this securely produce an increasing numbers of burn-out syndromes. The phenomenon of the globalisation could also be read as a worldwide expression of a phenomenon that, as de-powering the most people, capillary concerns also the local community. Besides, the environmental degradation perhaps could be read as the macro-social expression of the pollution of the local single souls devoted to vortically consume and to use the other one rather than to construct together with the other.

In the world of work the solutions can be found seeking in the local realty the models most useful to be exported elsewhere. For instance, in certain countries an increasing value is given to the job flexibility and to the respondence of the (chosen or assigned) type of job to the characteristics and the personality dispositions of the worker.


Extremely important appears the institutional analysis useful to study some particular aspects tied to the working context - the type of management, the dynamics of the power, the playing of roles, the interpersonal dynamics – which allow to disclose the problems emerging within the place of work.

The institutional analysis is important not only to the workers and the employees that have interest to improve the quality of the working context but it is useful also to the managers that have the necessity to understand what it is wrong in their managing the structure they are at the head and also to know if in the grass-root group is active some not-much visible factors which nevertheless preclude the whole operational staff from working as an enough harmonious and effective working group. Often one studies about the institutional structure only the way as the vertexes work, above all because it is usual to essentially look at the organization in its pyramidal configuration, but it is neglected to observe the structure as an unique context (circular configuration) in which every single member occupies one of the so many possible vertexes (any point along the circumference) of the ideal circle, undoubtedly by virtue of the individual can make a certain action however (and to induce a retroaction) on the whole context, that is limited however to the power that he has (as per the place occupied within the hierarchical scale). Well greater it is, instead, the weight of the emotive status of the various subgroups (individuals “united” independently of the hierarchical degree) which can spontaneously rise inside the institution, and whom influence on the whole system haven’t any correlation to the hierarchical power of every component the subgroup. The addressing to the social psychologist can turn out precious both to deeply understand the psychological dynamics which undermine the whole institutional context and its good course, both to cure it.


On the individual level, we can use, over the psychological interview, some questionnaires fit to reveal an incipient burn-out syndrome. On the working context level, the work psychologist can intervene on the specific ecosystem in which requiring his counselling.

The psycho-social intervention starts wits the institutional analysis to pinpoint the apparent problems and the underground dynamics that pollute the working contest, afterwards it will be focussed on: strengthening the creativeness and the operational resources of every component the institution (or operational structure) at every hierarchical level; favouring the emersion of the team spirit, stimulating the rediscovery of the social value of that institution, valorising the place of work as an opportunity for a social co-construction of the reality. Finally a fundamental part of the psychosocial intervention is the planning of a psychological formation to the professional object relationship regarding all the components (of all ranks) the institution.


The most protected individuals from the burn-out syndrome are endowed with a good self-esteem; they often have a good social support, a few confidants, a net of friends; they are people who keep the ability to smile also within a too much austere or oppressive working environment.

A greater conscience about the really stress status and the factors that have provoked it, they are the first resource of a person with a burn-out syndrome. Also a main point is to avoid to cut himself off looking for family persons, friends and acquaintances with which to pass moments of relaxation so that to distract the mind from the obsessive rumination on the problems suffered in the working environment. Paradoxically the intensifying the working activity can result at times useful. The techniques of relaxation and the sporting activities can generally be useful to find again that energy and that self-esteem necessary to reacquire the individual not-passive defences: the ability to not being yet dominated, the respect for himself and for personal opinions, the ability to say no when the acquiescence is not-due. In this sense also the possible addressing to some professionals figures able to offer an helping relationship can reveal precious: a good lawyer (the legal support for the safeguard of one’s rights) and a good psychotherapist (the psychological support for the safeguard of one’s spirit)!





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