Franco-Paredes, Carlos

Tuells, José

English

Repositorio Institucional de la Universidad de Alicante

Lepr Rev (2023) 94, 86–88 doi:10.47276/lr.94.1.86LETTERBurnt-out leprosy: The origin of the concept ofpsychological burnoutCarlos Franco-Paredesa,b & Jose TuellscaColorado State University, Colorado, USAORCID: https://orcid.org/0000-0001-8757-643XbHospital Infantil de México, Federico Gomez, México City, MéxicocDepartment of Community Nursing, Preventive Medicine, Public Healthand History of Science, University of Alicante, 03690 Alicante, SpainORCID: https://orcid.org/0000-0003-1159-429XSubmitted and accepted 6 December 2022Keywords: Anesthetic foot, leprosy diagnosis, Graham GreeneThe Ridley–Jopling staging was introduced in 1962 and 1969 to describe the spectrum ofleprosy based on clinical features, histopathology, the degree of the cell-mediated immuneresponse against Mycobacterium leprae, and bacterial load.1,2 Before implementing theRidley–Jopling staging, there were many attempts to define the spectrum of clinical forms andstages of leprosy. In 1924, Muir proposed a classification that described nerve involvementand skin manifestations.3,4 This classification described nerve injury as A1 for evidence ofearly nerve involvement and A2 for burnt-out (advanced nerve injury with loss of sensationor limb loss), B1 for early skin involvement, and B2 for moderate skin lesions. In the Muirclassification, burnt-out leprosy describes patients with long-standing nerve injury. This nervedysfunction would manifest with profound loss of sensation, marked atrophies, contractures,trophic ulcers, and mutilations (limb loss).3 During the annual leprosy meeting in Manilain 1931, experts recommended substituting the term ‘burnt-out leprosy’ for ‘arrested leprosy’,with mutilation. Many clinicians continued describing patients with tuberculoid and borderlineleprosy as ‘burnt-out’ when the disease self-healed. They had a negative bacterial index, butpatients developed significant nerve loss and disability.3–5 We explored the potential historical link between the term ‘burnt-out’ used as an adjectivein the pre-antibiotic area to describe an advanced stage of nerve injury in patients with leprosyand the contemporary use of the concept of burnout referring to a negative psychological stateof mind in the workplace. The current use of the noun ‘burnout’ represents the psychologicalCorrespondence to: Carlos Franco-Paredes, MD, MPH, Department of Microbiology, Immunology, and Pathol-ogy, Colorado State University, Fort Collins, Colorado, USA (e-mail: Carlos.franco-paredes@colostate.edu)© The author(s). This article is Open Access under CC BY 4.0 86Burnt-out leprosy: The origin of the concept of psychological burnout 87state in which individual experiences reduced motivation to achieve optimal outcomes with adecline in the quantity and quality of work produced in one’s professional role.6,7 The term‘burnout’ in clinical psychology was initially used in the early 1970s by the North Americanpsychiatrist Herbert Freudenberger.7 Since then, burnout encompasses a spectrum of mentalconditions ranging from depression to compassion fatigue related to specific occupations.8–10Dr. Freudenberger cited the occurrence of burnout among caring professionals in emotionallydemanding roles, such as healthcare providers and first responders.7,9 Human error by air trafficcontrollers linked to air accidents in the 1960s and 1970s raised awareness about workplaceburnout and the institution of organizational and individual interventions addressing resourceand stress management.8 Burnout is considered a negative consequence of healthcare workers’unrelenting demand for altruism.9 Not surprisingly, burnout has been frequently cited amonghealthcare workers during the COVID-19 pandemic.9The modern use of psychological burnout can be traced back to the 1960 novel “A Burnt-Out Case” by the British novelist Graham Greene.10 In this account, the main character,Querry, arrives via the bishop’s riverboat through the Congo River to aid in a leprosy colony(leproserie) run by Catholic priests and nuns in the then-Belgian Congo (now the DemocraticRepublic of Congo). Greene dedicated this book to Dr. Michael Lechat, with whom he spenttime in Yonda, a large leprosy village near the Congo River.11 Greene describes Dr. Colin asthe fictional character representing Dr. Lechat, a skilled and dedicated physician. Querry, afamous European architect, arrives at the village, escaping from his previous life as he feelsthat his vocation to design buildings and his desire to live have been extinguished. As Dr. Colinbecomes acquainted with Querry’s mental state, he compares Querry’s emotional numbnessto a burnt-out case of leprosy. The defining feature of burnt-out leprosy is a long history ofuntreated infection associated with advanced nerve damage that produces numbness and lossof all types of sensation.We conclude that the contemporary use of burnout as a mental state of emotional numbnessand psychological depletion originates in Greene’s novel. However, Dr. Freudenberger wasresponsible for the everyday use of the concept of burnout in clinical practice as a negativepsychological state that occurs in occupational settings. Conflict of interestAll authors no financial conflicts of interest to report.References1 Ridley DS, Jopling WH. A classification of leprosy for research purposes. Lepr Rev, 1962; 33: 119–128.2 Ridley DS, Jopling WH. Classification of leprosy according to immunity – a five group system. Int J Lepr OtherMycobact Dis, 1966; 34: 255–273.3 Muir E. Leprosy, self-healing disease. Lancet, 1924; 1: 277–280.4 Balina LN, Jotimliansky L, Sasiain MC, Minnuci F, Kien C, Chouela E. Immunology of a burnt out lepromatousleprosy patient. Int J Leprosy, 1992; 60(1): 102–104.5 Lepore J. Burnout: Modern affliction or human condition? The New Yorker, 2021.6 Freudenberger HJ. The issues of staff burnout in therapeutic communities. J Psychoactive Drugs, 1986; 18(3):247–251. doi:10.1080/02791072.1986.10472354.7 Samra R. Brief history of burnout. We have much to learn from established countermeasures in aviation. BMJ,2018; 363: k5268.8 Listopad IW, Michaelsen MM, Werdecker L, Esch T. Bio-psycho-socio-spirito-cultural factors of burnout:a systematic narrative review of the literature. Front Psychol, 2021; 12: 722862. doi:10.3389/fpsyg.2021.722862.88 C. Franco-Paredes and J. Tuells9 Raudenská J, Steinerová V, Javůrková A, Urits I, Kaye AD, Viswanath O, Varrassi G. Occupationalburnout syndrome and post-traumatic stress among healthcare professionals during the novel coron-avirus disease 2019 (COVID-19) pandemic. Best Pract Res Clin Anaesthesiol, 2020; 34(3): 553–560.doi:10.1016/j.bpa.2020.07.008. Epub 2020 Jul 18.10 Greene G. A Burnt-Out Case. New York, NY: Bantam Books, 1960.11 Lechat M. Graham Greene at the Leproserie. London Rev Books, 2007; 29(15). Available at: https://www.lrb.co.uk/the-paper/v29/n15/michel-lechat/diary (Accessed 04 December 2022).

Burnt-out leprosy: The origin of the concept of psychological burnout

http://rua.ua.es/dspace/bitstream/10045/132945/1/Franco-Paredes_Tuells_2023_LeprRev.pdf

Burnt-out leprosy: The origin of the concept of psychological burnout

Abstract

Similar works

Full text

Available Versions

Repositorio Institucional de la Universidad de Alicante