I Treat Burnout Like I Treat Concussions: With Boredom

I met a woman recently who is balancing work, family, and life, weighed down by overwhelm, guilt, and general fatigue. Her “what’s the point” attitude sharply contrasted with the passion she claimed for her work. As we talked, her apathy morphed into anger and frustration with herself for what she called “laziness.” I gently reflected that she sounded burned out—a diagnosis she recognized but felt was a deep hole she couldn’t escape. “To me, burnout is like a concussion,” I told her. “The best way to heal is to do nothing.”

I’ve been treating burnout as though it is a concussion ever since I experienced severe burnout myself in August 2020. I was a family physician at a mixed-income community clinic in Brooklyn, NY. The pandemic layered on loneliness, grief, and an unspoken pressure to keep patients out of the hospital. The collective explosion of anger due to George Floyd’s murder compounded the emotional pressure. Cognitively, I was operating at my highest level since residency—managing heart failure, infections, and other serious conditions over Zoom, coordinating chemotherapy infusions, and helping families make tough decisions about loved ones in the hospital. 

While there was no physical trauma to my brain—no risk of hemorrhage or shearing of brain tissue—the neurological impact felt akin to a linebacker violently tackled to the ground. My boss, concerned by my apathy, anger, and disengagement, strongly urged me to take two weeks off. I begrudgingly agreed. At the time, I had been reading about grief and functional freeze in order to better counsel my patients. I decided to put some of that work into practice.

A concussion is a traumatic brain injury in which the brain physically slams into the walls of the skull, shearing tissue through rotational movement and blunt impact. Symptoms include physical effects like headaches, nausea, vomiting, and vision problems, but also cognitive, emotional, and behavioral symptoms like brain fog, trouble concentrating, irritability, anxiety, and insomnia or excessive sleepiness. The brain is bruised and unable to function optimally. Treatment for concussion involves full cognitive rest for the first 24–48 hours after initial injury, followed by a graded return to activity. While sitting in a dark room is no longer recommended for the first 48 hours, limiting screens, work, and complex decision-making remains essential. Most symptoms resolve within the first two to four weeks.

Burnout is cognitive overwhelm that leads to functional freeze. Freeze is an adaptive nervous system response to danger. It’s a physical shutdown, likely caused by neurological overload, that compels animals to “play dead” when faced with a predator. In today’s late-stage capitalist society, freeze is a response to cognitive overload, warring priorities, and unachievable expectations—often self-imposed.

The biggest similarity between burnout and concussion is the full dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which governs hormones that regulate every metabolic and stress pathway in the body. Persistent burnout, in fact, is linked to grey matter volume loss in a manner similar to chronic brain injuries. Clinical burnout also disrupts serotonin and dopamine pathways, increases inflammation, and activates the amygdala—our emotional response center—fueling a vicious cycle of stress and dysfunction.

If burnout and concussion share such cognitive, emotional, and molecular dysfunction, why don’t we prescribe full cognitive rest for burnout? Instead, the interventions for burnout continue to put pressure on the individual to “care for themselves.” Therapy, boundary setting, community support, eating better, and exercise are all excellent interventions. They help create psychological safety for those experiencing burnout. But I believe the initial intervention is much simpler.

The best way to reanimate the nervous system is to allow it to rest: no decisions, no travel, no excitement, no screens, no news, no “should dos.” Just as I would advise a teenager with a concussion, the more boring your life is, the faster your brain will recover. Full cognitive rest means no pressure to exercise or eat a certain way and no “to-do” lists. The goal is to allow the brain to do its own healing.

We know cognitive rest works for student-athletes, even though there is nothing more devastating than having to tell a young, excited athlete that they can’t play sports or do anything of consequence. It works for burnout too. Boredom begins to create space for healthier habits, glimmers of which I encourage my patients to follow. For example, if sitting on the couch staring at the wall inspires a patient to go for a walk outside or make a nourishing salad, I encourage those behaviors. However, I’d rather patients trace the shapes of the stucco on the wall instead of  passively watching TV. Slowly but surely, the overwhelm dissipates, and the fall into brain fog begins to clear.

I typically recommend two weeks of doing nothing—though by no means is this a panacea. From experience, the first week of rest is a challenge but feels amazing. Many people start to unfreeze and even feel well enough to go back to work or start participating in life, but this is a trap. They feel amazing because their tank is finally back to zero– they’ve been so used to functioning below empty. A second week of boredom is actually what starts to fill the tank. For some, it may take even longer to feel like themselves again.

There is a necessary level of privilege to take time to heal. That, I believe, is why physicians should start to talk about burnout like it is a concussion. I freely put people on short-term disability in order to get them cognitive rest. The same way a physician might prescribe bed rest is the way a physician should officially prescribe boredom—to shield patients from life’s demands. It’s not always possible, I understand—even burned out parents need to dress the kids and drop them off at school. However, as with any doctor’s note, a formal prescription can help work, family, and patients respect the need for rest.

Ultimately, how we talk about burnout needs to shift. Recognizing it as neurochemical dysfunction and grey matter loss is a start. Treating it in a similar way to concussion may allow us to impact the burnout epidemic for the better.