In 2023 I was running a wildlife shelter, raising two kids and a partner, building a retreat business, and trying to finish a thesis. I was getting up at 3am because it was the only time the house was quiet enough to think. Three words on a page felt impossible. My eyeballs felt like cement. My brain was mushy.
I couldn’t be bothered speaking to my family. I hadn’t had a haircut in more than a year. I couldn’t summon the energy to care anymore. About anything.
I am a Physiotherapist. I know the symptoms. I dismissed them all. Then I hit the wall hard.
It took me a long time to recover. Maybe I’m still recovering. The thing about burnout, the hardcore clinical kind, is that it doesn’t end on the plane home from a 7-day yoga retreat in Bali. It doesn’t disappear after a winery weekend followed by green juice and a sound bath. And it especially doesn’t resolve itself with a five-step morning yoga routine you saw on Instagram, no matter how confidently the influencer in question delivered it.
If you are nodding your head as you read this, you are not alone. And it’s time to take it seriously.
But you sell burnout recovery retreats. Why should I trust what you have to say?
Fair question. Let’s get it out in the open.
Yes, we run a 5-day clinical retreat called The Burnout Prescription at Little Farm of Calm in regional Victoria. That’s a commercial offering. We make money when people book it (and then spend it on wildlife rescue, but that’s a separate tale to tell). That is indeed a conflict of interest you should know about before you read another word.
Here’s how we manage it. The writing here must stand on its own. If the facts in this piece are wrong, my having a retreat doesn’t make them right. If my arguments are on point, my having a retreat doesn’t make them wrong. The evidence is the evidence.
That’s the disclosure. Take it on board, then keep reading or stop reading. Your call.
What is burnout?
Burnout is not a bad week. It is not the feeling of being tired after a big project. It is a clinical state, recognised by the World Health Organisation (WHO) under code QD85 of the International Classification of Diseases (ICD-11) as an occupational phenomenon resulting from chronic workplace stress.
The WHO definition is a narrow window. It captures the occupational stress and workplace contexts. The clinical reality is broader. The same physiological state, the same inflammatory profile, the same cognitive impairment, the same exhaustion, develops from any source of chronic, unrelenting demands that you cannot adequately recover from. Paid work qualifies. So does the unpaid work.
If you are caring for young children full-time, you are at risk. If you are managing a household with a chronically ill partner or family member, you are at risk. Belgian psychologists Isabelle Roskam and Moïra Mikolajczak’s parental burnout research, and their subsequent 42-country study, document a clinical state for carers that mirrors occupational burnout, with equally serious consequences. If you are caring for ageing parents while also raising kids (aka Sandwich-generation caregivers, mostly women), you are in the highest-risk group.
What does the lived experience of burnout look like? Exhausted down to your bones, cynical and disengaged about things you used to care about, unable to summon the brain power for tasks you used to find easy, and you have been like this for months. That is what burnout looks like. Whether your job caused it, your toddler caused it, your dying mother caused it, your partner’s illness caused it, or all of the above, is irrelevant. You are in a defined state with measurable physiological and psychological consequences.
And the burnout problem is growing. The numbers are large. Gallup’s State of the Global Workplace and population data from the Maslach Burnout Inventory identified significant burnout symptoms in 40 to 75 percent of workers in western countries. Within those figures, healthcare workers, teachers, and frontline professionals rank the highest.
At a deeper level, the chronic stress underlying burnout disrupts the hypothalamic-pituitary-adrenal (HPA) axis, alters cortisol patterns, elevates inflammatory markers like interleukin-6 (IL-6) and C-reactive protein (CRP), impacts our sleep patterns, and changes how the brain encodes effort and reward. These are not vague feelings. They are physical, measurable changes.
Burnout also doesn’t stay in its lane. A 2017 systematic review by Salvagioni and colleagues found burnout independently predicted the later onset of depressive symptoms, type 2 diabetes, coronary heart disease, and musculoskeletal pain in initially healthy workers. The mechanism is not mysterious. Sustained low-grade inflammation in the periphery, and increasingly recognised inflammation in the central nervous system driven by activated glial cells, creates the biological conditions through which several other clinical states become more likely. Hodges, Watkins and colleagues’ 2026 review sets out the framework for understanding chronic pain, and by extension chronic stress conditions, as neuro-immune diseases (which is how clinical burnout presents) rather than purely psychological or purely structural states. The relationship runs both ways. Existing chronic conditions raise the risk of burnout, and burnout raises the risk of acquiring or worsening chronic health conditions. Which is part of why burnout, left unmanaged for years, is rarely just burnout by the time someone seeks help. And if you are wondering what this does to your brain health in the long term (dementia, Alzheimer’s, the lot), watch this space. It is a whole topic in itself.
NERD ALERT. Skip if you want the headline; stay if you want the mechanism.
Your brain has its own immune cells: microglia and astrocytes. They are not passive scaffolding. Both have receptors that detect inflammatory signals from elsewhere in the body, including IL-1β, IL-6, and tumour necrosis factor alpha (TNF-α), arriving via the blood-brain barrier or the vagus nerve. When the rest of the body sits in chronic inflammation, the kind that builds during prolonged HPA-axis activation, those signals reach the brain continuously. The microglia and astrocytes switch on. Activated microglia release their own pro-inflammatory cytokines. Activated astrocytes change how the brain regulates glutamate and the trophic support they normally provide to neurons. The brain is no longer running in a neutral environment. It is running in an inflamed one. Over months and years, that produces the structural and functional changes seen on imaging. This is the framework Hodges, Watkins and colleagues describe across their pain literature. The same mechanism applies to any condition of sustained physiological threat, including chronic burnout.
What this means. Burnout is brain inflammation, triggered by your own immune cells. Your body treats burnout as a physical injury, not a state of mind.
It gets worse, and if you weren’t already convinced, this is why you really need to take burnout seriously. Recent science tells us that the brain changes seen in severe burnout look uncomfortably similar to the brain changes from a traumatic brain injury (the kind you get from being knocked on the head too many times). Reduced prefrontal cortex thickness. Hippocampal volume changes affecting memory and learning. Elevated neuroinflammation. Karolinska Institute work led by Ivanka Savic documents these changes directly in burnout populations. The same underlying neuro-immune mechanism has been shown clearly in brain scans in the closely related chronic-stress condition: chronic pain. Shraim, Hodges and co (2024) at the University of Queensland used PET-fMRI (positron emission tomography combined with functional magnetic resonance imaging) to directly visualise neuroinflammation in the sensorimotor cortex of chronic pain patients. The more inflammation they imaged in a brain region, the worse the patient’s movement control in the corresponding region of the body. While burnout and chronic pain are not the same clinical condition, they are both conditions of sustained neuro-immune activation. Sharing the same neuroinflammatory cascade that follows a concussion, a fall, or a car accident, or in this case, months of chronic stress. The trigger differs. The neuro-immune response does not.
NERD ALERT. Skip if you want the headline; stay if you want the methodology.
Brain imaging can now show inflammation directly. The Shraim/Hodges 2024 PET-fMRI study used a special PET tracer called TSPO (translocator protein). TSPO sits on the outer membrane of mitochondria, and shows up in higher amounts when microglia and astrocytes are activated. More TSPO signal in a brain region means more glial activation there. The team scanned chronic pain patients with TSPO-PET and matched it with functional MRI taken while patients did motor tasks. That gave them a way to see where neuroinflammation was sitting in the brain, and to link it to actual behaviour. A few caveats. TSPO PET tracers behave differently depending on which version of the TSPO gene a person carries (polymorphism). TSPO is also not unique to microglia. So the signal is a strong indicator of neuroinflammation rather than a pure read on microglial activation. None of that undermines the central finding. Cortical neuroinflammation in chronic pain is real, sits in specific regions, and tracks with how patients function.
What this means. Brain fog shows up on brain scans. This shit is real. It is a cloud of inflammation.
That comparison should land hard. Burnt-out people are often dismissed as “just stressed” or told to “take it easy.” This dismissal is biologically incorrect. The language people use about their own burnout, brain fog, forgetful, unable to hold a thought. These are not soft metaphors. They are an accurate description of measurable cognitive impairment driven by sustained neuroinflammation. When I said at the top of this piece that my brain felt like mush, I was describing exactly this.
For the reader privately wondering whether all of this is just the modern way of saying “toughen up”: it isn’t. You can’t push through neuroinflammation. You cannot character-build your prefrontal cortex back into normal function. The longer you try to keep going, the longer and deeper the injury becomes.
Always-on, never recovered. Burnt-out has become the new normal
Burnout rates have risen sharply over the past decade. They didn’t rise in a vacuum. The same period has seen the global proliferation of smartphones, the maturation of social media, and the collapse of the boundary between work and not-work for anyone with an internet connection.
First, there was telepressure, a term defined by Larissa Barber and Alecia Santuzzi’s work, capturing the expectation to respond rapidly to communications regardless of where you are or what time it is, which applies just as much to carer settings as to work. Being unreachable for a few hours feels transgressive in a way it didn’t twenty years ago.
The result is that we never truly switch off, and that has consequences. The cognitive systems that monitor for incoming “danger” stay permanently on. Sleep is disrupted by late-night phone-checking, blue light, and anxiety about what we see on social media and the news. Doomscrolling hours of our lives away even though we are so very tired, and deep inside we know it’s not helping. Over time, even this chronic low-grade on-ness, with no respite, can start to produce the full physiological burnout signature.
Thinking about your kids right now? Yep. You should indeed be worried. But this is too important to squeeze into a paragraph, so just know that there is a whole post on this coming soon.
NERD ALERT. Skip if you want the headline; stay if you want the endocrinology.
The HPA axis (hypothalamic-pituitary-adrenal axis) is the body’s main stress-response circuit. When something stressful happens, the hypothalamus releases corticotropin-releasing hormone, which tells the pituitary to release adrenocorticotropic hormone, which tells the adrenal glands to release cortisol. The system is designed to spike for a short threat, deal with it, and quiet down. That is acute stress, working as intended. Chronic activation breaks the feedback loop. The natural daily cortisol curve flattens. The morning peak that normally wakes you up becomes weaker. The evening trough that normally lets you sleep gets higher. Your tissues respond differently to cortisol over time. And the brake that normally turns the stress response off stops working properly. Smartphone-driven, 24-hour connectivity contributes to this by delivering continuous low-level stress. Each push notification triggers a small sympathetic-nervous-system surge. Each anticipated message keeps the brain’s threat-monitoring systems quietly switched on. Over months and years, the cumulative effect is the same flattened cortisol curve and elevated inflammatory tone seen in clinically diagnosed burnout.
What this means. Being always available and ready for action has a biological cost. It is literally messing with your hormones, now and forever, unless you consciously do something about it.
From here, it just takes one small push to topple you over the edge. Work stress, illness, financial worries, family dramas, uni exams, a job hunt. Any of which, by itself, you should have been able to rebound from. But you were already compromised, and this is the icing on the cake. This time you cannot scrape yourself back up off the floor. You have hit the clinical burnout wall.
Now for the sting in the tail. The wellness industry, the holders of the supposed cure, lives entirely on the platforms that drive the problem. The Instagram influencer selling you a digital detox sends you push notifications counting down the minutes till your special offer expires. The meditation app is on the device you are trying to step away from. The boundaries coach with 200,000 followers asks you to engage with her content seven times a day instead of setting some, well, boundaries. The platform is the problem. The platform is also where most of us start searching for a solution. Which gets picked up by the algorithms, and the next thing you know, your feed and browser are filled with wellness hogwash promising the cure for all your problems. All for just $399 USD (claim your exclusive discount when you register for emails and SMS updates). Hmm.
This publication is also on a platform. The irony is not lost on me. The difference: we don’t run algorithmic loops, push notifications, or live off your continuous attention. Read something thoughtful once every week or two, then step away from the device.
When even your doctor might miss it
Let’s go back to 2023 Jill (though she wasn’t very nice to be around).
After hitting my own burnout wall, I discovered that while people might be sympathetic, no-one seemed to fully comprehend what I was going through.Most of the world is blissfully unaware that burnout is a physical injury to the brain, as opposed to a state of mind. The default response, even from healthcare practitioners, is that you just need some sleep, a nice herbal tea, and maybe a holiday. Worse, some of those healthcare practitioners may diagnose you with depression, anxiety, or another related condition, while completely missing the root cause. The good news is that the research and public awareness are improving. The bad news is that you will still need to do a lot of your own research to formulate a way out of this hole. Which is the last thing you want to hear when you are chronically burnt out… But let me do my best to lighten the load (hint hint - this is where you subscribe to make sure you stay abreast of all my long winded ramblings.
Burnout Recovery: The long and winding road back to Kansas
Burnout is complex. Recovery is a long road. Here is the framework. The next pieces in The Prescription unpack each element in detail (since we’re already at way-too-many-words-thanks-for-reading-this-far):
Removal or reduction of the acute stressor/s. Your job, your children, your ageing parents, the bills, the illness. The thing that has been doing the damage. Even partial, even temporary. This is the hardest part by a mile. I get it - you can’t just close the door and walk away. But something here needs to meaningfully change before you can truly get better.
Permanent lifestyle changes. Sleep hygiene, morning light exposure, reduced major decision-making while you are still depleted, reduced screen time and device usage. These are just examples – but they are examples based on strong evidence.
Psychological counselling. To work on the behavioural patterns that led you down this path, and that will still be there waiting for you when you come out the other side. And if you find the right therapist, they can provide all that and more.
Targeted physical therapy. Recent work from Professor Paul Hodges' group at the University of Queensland (cited above) describes movement and motor control as direct modulators of central neuroinflammation. Not "more cardio." Specific, supervised, neuro-immune aware – which in grossly over-simplified language means performed at an intensity matched to the current state of your nervous system on that particular day – not just any old yoga or gym program.
Personalised therapies to turn down the fight-and-flight system. Yoga, meditation, float therapy, nature walks, time with animals. Bringing the rest-and-digest system back from its offline status. What works best will be different for each individual.
Feeling overwhelmed already?
This is where things need to start, along with understanding that you are not alone. Burnout is a massive topic, so reaching this point (i.e. wanting to truly understand the condition for yourself) is great. It means that you are ready to make a change.
Are you burnt out? Take a free Burnout Assessment (here’s one I prepared earlier) to help establish whether what you are experiencing is in burnout territory or something else that needs different support. It is not intended as a formal diagnosis tool. But it is a good conversation starter for talking with your GP, family, or a clinician you trust about what you are experiencing.
You might also get some benefit out of the Burnout Recovery Handbook, which covers some of the elements above in more depth. It’s free and honest. It details the main rules I put in place to prevent severe relapses in my own burnout.
Spoiler alert: it is not going to tell you to click your heels together, buy the right wellness product, and that the answer was within you all along, Dorothy. Recovery is going to take work and look different for each and every one of us. The only consistent factor is that it definitely won’t require a $399 microcurrent gua sha comb with built in red light therapy and magnesium-infused conducting gel (yes, this is apparently a thing now).
The next pieces in The Prescription unpack what actually helps in detail (yes, I do love detail), one evidence-based intervention at a time. Meanwhile, The Crank Files asks the question this piece deliberately leaves open. Who is allowed to sell burnout interventions in the first place, and who is held accountable when those interventions cause harm? Both pillars stay in lane.
Stay sane and skeptical. Or at least not too nutty.
— Jill
References and further reading
World Health Organisation. Burn-out an “occupational phenomenon”: International Classification of Diseases (ICD-11 QD85). Link.
Roskam, I., Brianda, M.-E., & Mikolajczak, M. (2018). A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA). Frontiers in Psychology, 9, 758. Link.
Roskam, I., Aguiar, J., Akgun, E., et al. (2021). Parental Burnout Around the Globe: A 42-Country Study. Affective Science, 2(1), 58–79. Link.
Pew Research Center (2013). The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. Link.
Gallup. State of the Global Workplace. Link.
Maslach, C., Jackson, S. E., & Leiter, M. P. Maslach Burnout Inventory (MBI). Link.
Salvagioni, D. A. J., Melanda, F. N., Mesas, A. E., González, A. D., Gabani, F. L., & Andrade, S. M. (2017). Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLOS ONE, 12(10), e0185781. Link.
Savic, I. (2015). Structural changes of the brain in relation to occupational stress. Frontiers in Integrative Neuroscience, 9, 10. Link.
Hodges, P. W., Fiore, N. T., Watkins, L. R., Klyne, D. M., Coppieters, M. W., & Grace, P. M. (2026). Pain and the immune system. Musculoskeletal Science & Practice, 82, 103484. Link.
Shraim, M. A., Massé-Alarié, H., Farrell, M. J., Cavaleri, R., Loggia, M. L., & Hodges, P. W. (2024). Neuroinflammatory activation in sensory and motor regions of the cortex is related to sensorimotor function in individuals with low back pain maintained by nociplastic mechanisms: A preliminary proof-of-concept study. European Journal of Pain, 28(9), 1607–1626. Link.
Barber, L. K., & Santuzzi, A. M. (2015). Please respond ASAP: Workplace telepressure and employee recovery. Journal of Occupational Health Psychology, 20(2), 172–189. Link.