From Burnout to Punchlines: Freud's Solution

Sometimes the solution to a professional problem is buried in the history of that profession, which brings us the unusual discovery by the Viennese contractor Helmut Braunschweig. We will get to hear Braunschweig in a minute. A bit of historical background is in order. The Allgemeines Krankenhaus had a problem. The problem was that they, as in many of our current medical centers, had a problem with physician burnout. And, decidedly, it was a problem that none of the honored professors at that venerable institution wanted to discuss. The highest level of the medical staff committee and administrative structure had discussed the problem. Committees were set up to which burned out physicians were referred, reminders were posted, codes of conduct were implemented, and yet such behavior continued, nurses were berated, medical students were demeaned by ruthless questioning in a group setting, Culturally insensitive examinations were administered.

Even Gregor, the livery man responsible for feeding the professor's horses, logged a complaint because of a joke made at his expense by the chief physician. In desperation, the chief of the medical staff consulted with Professor Sigmund Freud. He posed the following question, Herr Professor Freud, we have a problem. Many of our staff are feeling burned out. We cannot allow this behavior to continue.

As a matter of fact, our chief of nursing says it has gotten worse. Nothing we have done is helping. Do you have a suggestion?" Now Freud was a contemplative type. He sat around in his parlor puffing on a cigar interpreting the dreams of wealthy, unemployed Viennese women. But Freud was no Dummkopf.

In a moment of brilliant psychoanalytic insight, Freud came up with a unique idea. The answer he posited to physician burnout was to transform these physicians into comedians. The timing was perfect. Freud had just completed his manuscript, Jokes and Their Relationship to the Subconscious. Freud thought that the psychoanalytic pathway to rejuvenated attitude should go through the innermost comedic pathways of the mind.

By taking burned out physicians through a crucible of comedy, they would begin to feel renewed and re-engaged in their profession. The physician would be funny. It was Freud who, through specific neuroanatomic dissections, had recently worked out the Jungmann-Berle-Rickles Pathway of the Limbus. This pathway defined human comedic abilities. It exists in all humans, except those who are compliance officers.

But how could Freud implement this concept? Comedy school had not been invented, except for Act II, Scene 7 of Wagner's Götterdämmerung, in which Alberich uses a metaphor regarding Brunnhilde's posterior anatomy. There was little German comedy. Austria, except for the occasional medical school dropout, had the lowest comedian population ratio in all of late 19th century Europe. The timing was perfect for Freud to create an innovative method of encouraging physician well-being, a method that would convert burned-out physicians into comedic physicians.

His idea was simple but challenging. The mandatory open mic for burned-out physicians, demanding that they perform a comedic interlude, would open up the comedic pathways of their id and re-energize them. Their ego and superego would be transmogrified from the weary indifference to highly engaged interest and caring in their patients and colleagues. Situations that had previously resulted in despair would be seen in a different perspective.

The exsanguinating bleed with an unprepared nurse would now not be a medical catastrophe leading to irritable dismay. These events would become Freudian jokes. The double-footling breech, the failing heart refractory to medicine, the recalcitrant patient, the crushed extremity shipped in from the Krupp factory, the unruly resident all would be analyzed and managed comedically rather than in a disengaged, demoralized manner. Which brings us back to Helmut Braunschweig. Medical historians have been acquainted with burnout for years, but always lacked a primary source.

Was this a Viennese urban legend or did this actually happen? Even in late April, of 2022, as the Allgemeines Krankenhaus was expanding by building the Sophie and Heman Klopstein pediatric wing, a discovery was made. Helmut Braunschweig was a supervisor of the construction. While digging a foundation, an old dirt-encrusted box was found, unopened. The box was then brought to the Staatsgeschichte Department of Viennese Antiquities.

The box was quite puzzling, and historical anthropologists were summoned. Under humidified control, after assembling all of the professors from the department, the box was carefully opened. What these distinguished researchers found was academically astonishing. I say academically astonishing to separate the emotion from the usual astonishment we might feel, since most of us are not professors. Inside the box were the minutes of 140 meetings of the gesellschaft for whom Licia Discosin in medicine. Loosely translated, these were the recorded proceedings of a society dedicated to humor at the Allgemeines Krankenhaus. Yes, humor. In the box were parchments and reams of paper that specifically recorded these sessions of Freudian conversion from the burned out to the comedically revitalized.

We now, in fact, have a transcript of Open Mic at the Allgemeines Krankenhaus, Freud's answer to physician burnout. Freud's meetings were held in the basement of the hospital. The audience averaged about 75 members, some of whom were medical students. Billroth as Bill Roth, Semmelweis as Manny Semmel. As these documents were reviewed, the researchers put together a fascinating picture of these iconic medical generals as human beings with a sense of humor.

Let us examine what these documents revealed. The notes for January 15, 1876 reveal that it was Billroth's and Heinz Stuttermann-Geisling's turn for the humoresque. Stuttermann-Geisling, you may recall, was the originator of the Pimpfragen or pimp questions for the interns and residents. First, Billroth. I saw a charwoman in the clinic last week. Von Giesen. Was she charming? Such is the semantic counterplay among the professorial Illuminati. Charwoman juxtaposed with charming was heady stuff back in those days. The writing seems very uneven, leading graphologists to surmise that the secretary was convulsed with laughter. Zweiter Oberarzt, Heinz Stuttermann-Geisling:

On Tuesday, last I saw a cooper from Bad Wenheim, to which General Kurt Mannheim, recently returning from the Prussian front minus his left eye, yelled from the back of the amphitheater, How bad was it? To which Herr Stuttermann-Geisling responded, It was so bad that meine Schwester looked like a Valkyrie, badda boom. The record recorded gales of laughter at this interplay between Bad and bad, given the particular characteristics of Stuttermann-Geisling's sister, who had dated several of the professors. Stuttermann-Geisling's sister was not an attractive woman in the Prussian turn-of-the-century view, but she was a stalwart. She fought in the Russo-Balkan War of 1897 and earned the nickname of, loosely translated, she is not attractive, but she will bring the water to the troops, and she can cook a schnitzel.

In part 2, we turn to modern methods of dealing with physician burnout.