Burnoutul la artiști ca factor de risc pentru suicid – semne timpurii și pași spre o intervenție eficientă

Introduction

Being an artist involves much more than simple on-stage performance. In the scientific literature, researchers who have examined the impact of the artists’ life on mental health note that artistic abilities and the status of being an artist are often idealized and placed on a pedestal⁽¹⁾, which generates unrealistic expectations of continuous excellence. Maintaining high standards becomes imperative in terms of identification with the character, talent, dedication, inspiration and the capacity to provide entertainment. Nevertheless, beyond this idealized image, the artist is defined by human quality, with constant needs and limited resources. This means that, behind smiles and applause, there may be a silent struggle with exhaustion.

In contrast to professions with a predictable work rhythm, artistic activity involves free time “sacrifice” through continuous study and intense practice – rehearsals held more than five days a week, sometimes lasting over nine hours per day. The artist’s lifestyle becomes a mechanical one, shaped by increasingly meticulous criteria imposed by both trainers and the audience.

The human side of artists inevitably brings them into contact with natural limits of motivation, energy and time. No matter how strong the desire for artistic expression may be, the internal resources are not inexhaustible. As creative expectations increase, the reduction of these resources can become abrupt and difficult to manage, favoring the emergence of creative blockage⁽¹⁾. In such moments, the artist may experience intense negative emotions such as guilt, sadness, anxiety or aggression. The persistence of such emotions may affect the ability to perceive reality in artistic forms. Impairments in cognitive processing and hand-eye coordination may occur, with a significant impact on the quality of the artistic act.

For those around them, these manifestations may seem like simple signs of fatigue, indifference or a lack of motivation. For mental health specialists, they may represent indicators of a much more complex phenomenon: burnout.

Burnout among artists

In order to be more specific in describing burnout among artists, the Oldenburg Burnout Inventory (OLBI) was identified as an appropriate instrument. It was first published and validated in 1999 by Evangelia Demerouti and her colleagues⁽²⁾. This instrument contains 16 items, evaluated on a 4-point Likert scale, ranging from “Strongly disagree” to “Strongly agree”. It is straightforward to administer periodically to artists from different areas of activity, in order to identify their current level of burnout⁽¹⁾. Figure 1 presents the Oldenburg Burnout Inventory (OLBI) items⁽²⁾.

The theoretical model used in developing this instrument considers burnout to be defined by:

• exhaustion – intense physical, emotional and cognitive strain resulting from excessive stress;
• disengagement – a feeling caused by a lack of identification with one’s work and a reduced desire to continue. This process may lead to depersonalization.

Burnout as a risk factor for suicidal behavior

Physicists have been interested, since the 19^th century, in identifying the mechanisms underlying creativity and the expression of genius. According to Palaniappan’s paradigm⁽³⁾, creativity, viewed as a measurable cognitive ability, is characterized by fluency, flexibility, originality and elaboration. A moderate-to-strong positive correlation has been identified between creativity and levels of genius. Furthermore, the scientific literature has also explored the possible relationship between genius and mental health, an association that remains debated from both public and clinical perspectives⁽⁴⁾.

Initially, madness, understood as a negative mental health state, was attributed to individuals considered to be geniuses, on the basis of schizophrenia-related psychotic manifestations and bipolar disorder, as reported by Kayga and colleagues in 2011⁽⁴⁾. Subsequently, after analyzing a sample of 800 individuals regarded as geniuses, Lange-Eichbaum and Paul concluded in 1931 that such negative mental health states could be more accurately described as “nervous tension”⁽⁴⁾. A review published in The New York Times highlights that recent research (1960-1990) suggests that genius may predispose individuals to bipolar disorder, schizophrenia-related psychosis, depression, pathological anxiety, substance use disorders, eating disorders (particularly anorexia nervosa) and even suicidal behavior⁽⁴⁾.

Suicidal behavior, ranging from passing thoughts to completed suicide, may represent a consequence of burnout among actors⁽⁵⁾, dancers and vocal performers, with the associated risk being amplified through the following mechanisms:

• Chronic emotional exhaustion, caused by the constant pressure to deliver memorable performances⁽⁶⁾. Passion becomes a form of total commitment that shapes the artist’s entire existence, where eustress turns into distress, and perfectionism as a personality trait may evolve into “neurotic perfectionism”, a concept introduced by Frost in 1993⁽¹⁾. This process amplifies the sense of emptiness, the loss of personal meaning and professional disengagement.
• Depersonalization⁽⁵⁾, manifested through detachment from one’s own work and/or from the audience, may lead to the loss of creative identity and to a distorted perception of the artist as a “brand” rather than a human being.
• Reduced self-blame⁽¹⁾, which may lead to a sense of self-loss, with a negative impact on performance and an increased risk of prolonged social isolation.
• Reactivation of previous trauma through the performative act. Burnout may amplify the artist’s vulnerability on stage, and can significantly blur the boundary between personal and professional-artistic identity. Unprocessed internal conflicts may lead to an increased suicide risk⁽⁵⁾, especially in the absence of specialized support (such as psychotherapy).
• The stigma associated with seeking professional mental health support⁽⁵⁾ may lead individuals to avoid requesting emotional support. Under these conditions, the onset and consequences of burnout are not processed in a controlled setting. This, in conjunction with a distorted self-image and the pressure of the professional-artistic environment, may contribute to the fear of being perceived as vulnerable or falling short of the role they perform on stage.
• Professional instability⁽⁸⁾ associated with financial pressure and uncertainty regarding the duration of collaboration contracts.

Burnout as a risk factor for suicidal behavior – case studies report

In relation to the applicability of the theoretical aspects presented above, three case studies relevant to the current topic were outlined. The artists’ initials are fictitious. The case studies presented below are conceptual case portrayals and integrate theoretical and empirical aspects from the scientific literature. What they have in common is the fact that the individuals described in these case studies are professionals from different artistic fields (acting, dancing or music). Each of them was identified in time following a suicide attempt, as experiencing long-term burnout. They were promptly brought to clinical attention and stabilized through physiological, psychiatric, and psychological interventions.

1. E.D. studied at a theatre academy in the late 1990s. He worked both in state theatres and in independent theatre companies. Throughout his career, he performed in fictional roles as well as in emotionally challenging performances in auteur productions⁽⁹⁾, where the director maintained full artistic control, articulated a personal view on a chosen theme, and conveyed profound ideas and authentic emotions through the actor’s performance. E.D. received consistent professional recognition and appreciation for the quality of his artistic work.

By the age of 35, he was involved in up to five productions simultaneously, participating in both national and international tours.

The constant pressure to perform, the loss of artistic autonomy and the stigma around mental health struggles – reinforced by the fear of exposing his vulnerability – contributed to the onset of burnout. People close to him initially perceived as “a simple reaction to stress”, reflecting the tendency to normalize exhaustion in high-performance cultural professions⁽¹⁰⁾. Over time, he developed persistent fatigue, episodes of crying before and after performances and, also, a growing sense of detachment from both his role and the audience.

His acting gradually came to feel like a mechanical task. Although he continued to receive applause and positive reviews, a profound sense of creative emptiness generated significant distress. The long hours spent in rehearsals and on stage were considered a usual sacrifice.

As burnout progressed, he experienced insomnia, sudden mood fluctuations, social isolation and a pattern of overwork sustained by excessive caffeine consumption and intentional sleep restriction for professional purposes⁽¹¹⁾. Alongside intense self-criticism, E.D. began to experience persistent intrusive thoughts about suicide and sought information related to harmful methods.

On a day off, he left a note containing a self-deprecating message and ingested a laxative overdose. He was found in time and stabilized by healthcare professionals.

Thereafter, he received cognitive-behavioral psychotherapy⁽¹²⁾ adjusted to the needs of performing artists. The intervention focused on establishing personal boundaries and developing a healthy process for transitioning into and out of character.

The theatre company subsequently introduced a six-week dedicated rest period for primary cast members, who were also included in support groups coordinated by psychologists.

2. Since the age of 17, C.C. had been a member of a national ballet company within a prestigious European theater. Over the following 12 years, she became deeply committed to her development as a principal dancer, engaging in daily six-to-eight-hour rehearsals, evening performances and international tours.

Over time, notable changes in her thinking, attitude and behavior surfaced, leading to chronic exhaustion that persisted even during weekend rest periods. Her motivation and personal satisfaction declined significantly, despite receiving professional recognition. She maintained strict discipline despite physical discomfort, often stating that “pain is part of my profession”. Her distress intensified due to frequent minor injuries, which contributed to insomnia, performance-related anxiety during rehearsals, irritability and reduced social interaction. She perceived her colleagues and the audience as “silhouettes that drain me”.

Burnout developed amid rigid expectations regarding physical appearance, the extensive hours of rehearsal required for leading roles, the absence of meaningful personal relationships (such as family) and limited emotional support. This pattern illustrates evidence indicating that performing artists face psychological demands and reduced recovery commitments, which increase vulnerability to burnout⁽¹³⁾.

One night, after the final performance in a series of five consecutive shows, as she experienced severe ankle pain, she wrote a goodbye note, describing the stage as “a place of torture where I no longer recognize myself” and stating that her physical and emotional suffering felt inescapable. Similar perspectives have been described in the literature on dancers exposed to prolonged performance pressure⁽¹⁴⁾. She subsequently attempted suicide by a medication overdose. She was found in time and received medical stabilization.

During her recovery, she attended cognitive-behavioral psychotherapy focused on restructuring cognitions related to self-perception. At the same time, she took part in group psychotherapy developed for performing artists, focused on addressing performance-related trauma. This was facilitated by a psychotherapist specialized in occupational health in the performing arts. She also received nutritional counseling and physical rehabilitation therapy, in line with recommendations for structured recovery and organizational strategies to prevent long-term exhaustion⁽¹¹⁾.

A revised employment contract was later negotiated, including regular periods of rest and recovery.

3. J.P. studied classical music. Over 12 years of activity in European opera theaters, she achieved a position in a state institution and participated in international tours. The prolonged rehearsal schedule and the pressure to maintain high-level performance resulted in professional distress, in accordance with the Job Demands-Resources model of burnout⁽²⁾. Such distress was overlooked by the team and management. Burnout developed after a period of vocal and emotional overstimulation, a phenomenon reported among opera singers and other performing artists⁽⁷⁾.

The moment that triggered the verbalization of suicidal intention was the cancellation of an important performance due to vocal difficulties. Research indicates that performers may experience vulnerability to suicidal ideation due to occupational instability and also performance pressure⁽¹⁵⁾.

Amid this identity crisis, she attempted suicide by a drug overdose. She was found in time and received medical stabilization. A goodbye note was discovered, where J.P. mentioned: “I became a soulless voice. I no longer recognize myself”.

During recovery, she attended cognitive-behavioral psychotherapy focused on restoring her artistic identity and improving her strategies for managing stress. She also participated in group psychotherapy adapted to vocal performers, in addition to receiving psychiatric treatment. She was supported by artistic mentors, an approach commonly used to reinforce social and professional resources in performing artists⁽¹⁶⁾.

The management later renegotiated her collaboration contract, including psychological protection clauses, reflecting organizational measures demonstrated to reduce work-related exhaustion⁽¹¹⁾.

Burnout interventions for artists

Suicide prevention requires professional intervention before the long-term consolidation of burnout symptoms and before any suicidal behavior occurs, and not afterward, as illustrated in the previous case studies. For instance, in Australia and Great Britain, structured and early interventions have been implemented since 2019 through:

• Mental health specialists⁽¹⁶⁾, such as psychologists and psychotherapists, who collaborate with artists for preventive monitoring, periodically administering burnout screening tools, as well as evaluating depression and anxiety through standardized instruments. Interventions may include individual and/or group counseling programs, coordinated by specialists in occupational mental health for artists, or psychotherapy, most frequently cognitive-behavioral therapy, aimed at reducing exhaustion and depressive symptoms.
• Psychoeducation⁽¹⁷⁾ dedicated to artists, trainers, managers and coordinators, which may be delivered through well-structured workshops designed to identify early signs of burnout. Rational-emotive and behavioral therapy, as well as mindfulness practices, can significantly reduce stress levels, support team cohesion and increase personal satisfaction.
• Reducing suicide risk by promoting resilience may occur through the inclusion of artists in mentorship programs, with a focus on clarifying roles, boundaries and coping strategies, both from a personal and a professional-artistic perspective.
• Developing and maintaining a support circle⁽¹⁸⁾, by defining a trusted group for periodic debriefing, including colleagues, family members and professionals. Artists may also be included in support groups specifically focused on performers, which may include 24/7 remote emotional support services.
• Artists’ emotional self-regulation through somatic practices such as breathing exercises, body-awareness techniques, yoga, emotional self-monitoring using journals or self-report measures for exhaustion and distress, as well as engaging in hobbies for relaxation and tension release⁽¹⁹⁾.

The aim of such interventions is cognitive-emotional restructuring and maintaining a healthy balance between personal and professional life by supporting resilience training through both professional support and the artist’s own active involvement.

Intervention directions to prevention

As mental health specialists, we may consider the following directions in our professional collaboration with artists:

• including continuous psychological counseling services for artists within the institutions where they are professionally active;
• developing and maintaining support networks to prevent emotional and physical isolation;
• recognizing burnout as a serious occupational mental health condition within the artistic field;
• facilitating the participation of artists and mentors in psychoeducational workshops designed to develop skills for the early identification and management of burnout;
• promoting a climate where seeking psychological support is viewed not as a weakness but as an act of responsibility;
• encouraging periodic self-monitoring of exhaustion symptoms.

Conclusions

Burnout in artistic professions represents a major risk for declining mental health and for increasing suicide risk. Recognizing early warning signs, validating personal struggles and reducing the stigma associated with seeking professional help become fundamental steps for optimizing prevention and intervention strategies.

As mental health professionals, we may focus our attention on collaborating with artistic institutions, with the aim of integrating policies that encourage and reward seeking emotional support, while also creating and sustaining open dialogue spaces on stress and burnout within these institutions, from specialized high schools to cultural centers such as theaters, film studios, music and dance institutions. Additionally, collaboration with other mental health specialists is required in order to develop specific prevention and intervention programs.