In late summer of 1971, a 25-year-old with fluffy chestnut hair strolled across the pristine campus of Stanford University. As a recent doctorate, Christina Maslach was on her way to chat with a previous dissertation advisor, her current lover, who had just embarked on an elaborate new experiment. When she arrived, Dr. Zimbardo explained that things were even stranger than he’d planned on. Maslach agreed and encouraged, then demanded, that he end the experiment. At day six into a two-week plan, the Stanford Prison Experiment ended, but Maslach and Zimbardo's relationship endured. Oh the romance! They were married a year later.

As was her husband, Maslach was interested in the human breaking point, in her own way of course. She took a professorship at University of California Berkeley and dedicated her early career to the work lives of nurses. By 1981, she was troubled by a pattern of cynicism, exhaustion, and decreased performance among her study participants, so she developed a survey tool to study the phenomena. She called it the Maslach Burnout Inventory.

By the late 1990’s, the MBI was considered a gold standard of organizational psychology. Versions of the tool were modified for applications in the human services, in education, in medical personnel, and finally, for general services. But the survey was lengthy to administer and was mostly used by researchers.

Enter Evangelia Demerouti.

Following in Maslach’s footsteps, she was also fond of mauve lipstick and quantifying the woes of modern work life, but her research contested that burnout had three categories. A young, European professor, Demerouti challenged Maslach's prevailing wisdom and advanced that decreased work performance was only a symptom of the exhaustion and cynicism—sometimes called disengagement—that defined the experience of burnout. She developed her own tool, which was shorter, more publicly available, and also intended for general application. She called it the Oldenburg Burnout Inventory and it was the first of several more Burnout measurement tools that were popularized in the early 2000's.

Although burnout had become a familiar term among nurses, physicians, and teachers in the US, it was about to be ubiquitous in the cultural consciousness. After all, human service and healthcare professionals weren't the only ones subjected to chronic stress in the modern workplace.

Academics had a heyday.

By the mid 2010’s, burnout was being studied across the globe and measured in nearly every field imaginable. Studies found that nurses and teachers, from Poland to Iraq, experienced burnout; but so did Swedish coaches, South African construction workers, Canadian caterers, and Australian midwives. Researchers in the US measured burnout in professionals as varied as executive directors and librarians. In Zimbabwe, a study found low job resources and high job demands were strong predictors of burnout among public bus drivers. In India, researchers discovered that HR policies designed for employee involvement had positive impacts on burnout when compared with policies that emphasized employee control. Some science, in retrospect, can appear quite obvious.

But, researchers knew something the public was soon to forget. Burnout Inventories measured the experience of workers, not their work environments. In academia, the Inventories were used to test hypotheses about how different workplace policies impacted the experience of burnout among their workers. When burnout entered the popular jargon, it became a state of being.

Right before the pandemic, an MD-slash-YouTube-personality known as Zdogg released a video contending that “Burnout is a form of victim shaming.” He argues that burnout implies “You’re not resourceful enough, you’re not resilient enough, you’re not strong enough to adapt to a system. So… maybe you should meditate?” The video, splattered with the f-word and shared over forty-nine thousand times, proposed that moral injury is a more accurate and useful alternative to the concept of burnout.

Moral injury originated as a term in the psychological study of war veterans and is characterized by shame and anger that results when an individual commits or is unable to prevent an action that violates their deeply held moral beliefs. For example, a nurse may experience a moral injury when their clinic is short staffed during a pandemic, the staff-to-patient ratios are compromised, and the nurse knows that patients aren’t getting the level of care they need. Moral distress, a related concept, has also been proposed as a line of inquiry transcending burnout. It focuses on the unease that results when a someone is aware of "the right thing", but unable to execute it due to external circumstances. Researchers are calling for these concepts to also be explored in fields adjacent to primary healthcare, such as behavioral health and social worker. At least in academia, there's a growing recognition that professionals who work with an ethic of care experience specific consequences when the conditions of their workplace prevent them from acting on that ethic. Consequences that fail to be explained by burnout.

Zdogg's argument was rather eloquently rebranded in the Surgeon General’s Advisory, “Addressing Healthcare Worker Burnout”, which was released in late 2022. The Advisory sited that additional research is needed to “Measure, track, respond to, and share findings on the extent of health worker burnout, moral distress, moral injury, and well-being across health care settings using validated tools.” Per the title, burnout remains the more comfortable concept, but, the vocabulary is expanding. 

In Maslach's defense, she tried to set the record straight during the pandemic. Still a prominent professor, but now at the end of her career, she authored a five-part series in the Harvard Business Review explaining that her Inventory had been abused. She emphasized that it was not intended for individual-level diagnosis, but rather for institutional-level discovery. She condemned that the tool has been used, in sales firms and school districts and hospitals, to score workers, even assigning corrective actions like “you should seek counseling” or “you need to be more committed to your team.” Maslach insists that, “Research studies consider this nonconfidential use of MBI scores within organizations to be unethical.”