The Burnout I Didn’t Know I Had: How the Pattern Started at Age 8

Today I’m sharing the origin story of burnout – not just mine, but probably yours too. How a diagnosis I ignored 7 years ago actually explained everything. How the pattern started in childhood with praise and performance. Why “trying harder” became the only tool I had. And what’s different now that I finally understand the system.

Seven years ago, I sat in a doctor’s office.

The diagnosis: Severe depression. Severe anxiety. Burnout.

I heard the first two. I ignored the third. I knew the word “burnout” but I didn’t know what it meant. I thought it was something that happened to other people. Weak people. People who couldn’t handle pressure.

Not me. I was a doctor. I could handle anything. Except I couldn’t.

The Pattern Started at 8 Years Old

I was great at maths. Reasoning puzzles. Problem-solving.

This was almost all I did. What I received praise for. The thing that made adults smile and nod and say “well done.”

So I did more of it. Because praise felt good. Because it was the closest thing I had to certainty in a confusing world. But somewhere around high school, it started to fall apart.

The Highly Competitive, High-Achieving Place

Highly competitive school. High-achieving kids everywhere. If I didn’t get something right immediately, I would feel painfully like a failure.

Grades compared to the people around me told me I was constantly wrong.

There was no feedback. Just criticism, or what felt like criticism. It felt like it was all a game I was failing at, whilst not really knowing the rules, and not knowing how to fix things. This became a norm.

If I happened to do well at something – big picture thinking type stuff – I would get praise. Then back to the grindstone of working, studying. Things were never good enough.

The message was clear: Your value is your performance. And your performance is never quite enough.

When Dad Died

I became quite numb when I was 17, 18 after my dad died.

Some of this was a normal grief reaction. But also, I was at the wrong place at the wrong time. I needed to be doing something different, more creative, more fun. But I didn’t know that. In fact, no one did.

So I stayed on the path. Because staying on the path is what you do when you don’t know there are other paths.

University: Achievement by Another Name

The drinking at university and into my 20s was partly the same thing.

Peer celebration. “Celebrating” being hugely drunk, a lot of the time. An achievement in itself, somehow. Look how much I can drink. Look how hard I can go. But it was painfully damaging to my mental health.

Another pattern: Push beyond limits. Receive external validation. Ignore internal damage. Repeat.

The Hero Phase of burnout starts early. It just looks different at different ages.

Junior Doctor: The Man Box Cements

Junior doctor work was the same pattern, amplified.

I felt out of place. Made to feel like I was doing things “wrong.” Again, a series of rules that always seemed out of reach. One thing I could do was “try harder.”

This wasn’t something I’d really engaged with in my life to that point. But it worked, to some degree. The long hours. Night shifts. Hey – I was valuable. Important.

Unfortunately, this was all cementing in external validation. The Man Box closing around me.

The Man Box Rules:

Your value = your output. Weakness = failure. Rest = laziness. Asking for help = admitting you can’t cope. Feelings = problems to be solved.

I learned these rules so well I didn’t even know I was following them.

The Thing I Really Struggled With

Asking for help.

Even now, it seems “wrong” when I learn something new. “Why didn’t I know this?” can sometimes kick in. But less often now. More often: gratitude. And the understanding that we all have our place.

That shift – from “I should already know this” to “I’m grateful to learn this” – took years. And therapy. And crashing twice.

What I Didn’t Understand About Burnout

When that doctor said “burnout” seven years ago, I heard it as a symptom. A temporary state. Something that would resolve when I “got better” from the depression.

I didn’t understand that burnout was the root.

Depression was what happened when burnout went on too long. Anxiety was what happened when I kept pushing despite every signal to stop. Burnout wasn’t the symptom. It was the system.

A system built from: childhood praise for performance, grief with no space to process, academic competition with no safety net, alcohol as achievement, medical training as endurance test, the Man Box as the only acceptable shape.

Each stage built on the last. Each stage made the next one inevitable.

The Burnout Fire Series

This year, I wrote what became the Burnout Fire Series. Five posts about how burnout develops in men:

The Hero Phase: Stage 1 burnout nobody sees coming. You feel driven, focused, proud. Stress is there but you ignore it. This is when men overcommit. The warning signs are easy to miss.

Achievement Addiction: When drive becomes dysfunction. Loss of control. The stuck-on pattern. When you can’t stop even when you want to.

Imposter Syndrome: “Am I a fraud?” Fraudulent feelings despite evidence of competence. Meeting anxiety. The exhausting performance of pretending you belong.

Being a Man as Chronic Stressor: How masculinity itself creates the conditions for burnout. The five stages through a gender lens. Why “man up” is the worst possible advice.

Why Men Don’t Talk Their Way Out: Alternative to talk therapy. Action-based solutions. What actually works for male psychology.

These weren’t abstract concepts. These were my life, written down.

The System Nobody Talks About

Here’s what I understand now that I didn’t then: Burnout isn’t about working too hard. It’s about working in a system that requires you to abandon yourself to succeed.

The system looks like this: Praise for performance → More performance to get more praise → Identity becomes achievement → Can’t stop achieving without losing identity → Body breaks down → Keep going anyway → Burnout

And underneath all of it: The belief that your value is conditional. That you’re only worthy when you’re producing. That rest is something you have to earn.

The Man Box isn’t something that happens to men. It’s something we build, brick by brick, starting in childhood. By the time we’re adults, we’re so deep inside it we think the walls are just “how life is.”

What’s Different Now

I don’t talk much about my work with hormones and erectile dysfunction. My work at the Centre for Men’s Health.

I’ve taken on more work there. Helped the systems develop. But I’ve tried to do this in a sustainable way. Planning carefully. Using the energy I have wisely. And doing creative, teaching roles. Which enable me to grow, rather than be burdened.

This is what’s different: I’m not trying to prove anything anymore. Not to myself. Not to the high school version of me that never felt good enough. Not to the medical system that taught me my value was my hours.

I’m working from a different place now. Not “I have to do this to be valuable.” But “I have the skills to do this and I want to.” The work is similar. The motivation is completely different.

The Five Lessons This Pattern Taught Me

One: Burnout doesn’t start when you feel exhausted. It starts when you learn your value is conditional on your performance. For many of us, that’s childhood.

Two: The Hero Phase isn’t about being heroic. It’s about being praised for pushing beyond your limits. The praise makes the pushing feel right.

Three: Achievement addiction and imposter syndrome are two sides of the same coin. One says “I must achieve to prove my worth.” The other says “My achievements don’t prove anything.”

Four: The Man Box isn’t about individual beliefs. It’s a system that rewards certain behaviors and punishes others. You can’t think your way out of a system.

Five: Recovery isn’t about working less. It’s about changing the reason you work. And that means changing the question from “Am I valuable?” to “What do I value?”

The Question I Ask Now

Not: “Am I doing enough?” But: “Is this sustainable?”

Not: “What will they think if I say no?” But: “What will I lose if I say yes?”

Not: “Why don’t I already know this?” But: “What can I learn from this?”

Small shifts. But they change everything.

Change One Thing

As you head into Christmas and the end of this year, I want to ask you this: When did you learn that your value was conditional?

What was the praise you chased? The criticism you tried to avoid? The version of yourself you learned to perform?

And what would it mean to stop performing it? Not forever. Not all at once. Just for a week. Just to see what happens.

Because the pattern that started in childhood doesn’t have to run your adult life. Unless you don’t know it’s there. Now you do.

References

Maslach, C., & Leiter, M.P. (2016). Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry, 15(2), 103-111.

Chu, J. Y. (2014). When Boys Become Boys: Development, Relationships, and Masculinity. NYU Press.

Way, N. (2011). Deep Secrets: Boys’ Friendships and the Crisis of Connection. Harvard University Press.

Movember Foundation (2024). The Man Box: A Study on Being a Young Man in the UK, US, and Mexico.