The original Star Trek television series, in my opinion, stands out as the best of the bunch. It lasted only three years (1966-1969), but it has retained a cult following. Among its many television “firsts” were the initial inter-racial kiss (between Captain Kirk and Lieutenant Uhura) and perhaps the first depiction of burnout, as seen in the two-part episode “The Menagerie.”

Originally intended as the pilot, “The Menagerie” was postponed to the 11th episode of the first season. It featured Christopher Pike as the U.S.S. Enterprise’s captain before James T. Kirk assumed command. Mr. Spock served as Pike’s science officer, and Dr. Phil Boyce played the role of the starship’s medical officer.

It’s not until part 2 that we discover Spock’s motive for risking the death penalty, which is to provide Pike with a semblance of a normal life after a tragic space accident left Pike disfigured and unable to move or speak.

One of the most poignant scenes in this classic adventure, written by Gene Roddenberry, the creator of Star Trek, occurs in part 1. Captain Pike asks to see Dr. Boyce for a second opinion about whether a distress signal coming from Talos IV is real or fabricated by Spock. Boyce enters Pike’s room with his doctor’s bag, and the following conversation (condensed) ensues:

PIKE: What the devil are you putting in [that glass], ice?
BOYCE: Who wants a warm martini?
PIKE: What makes you think I need one?
BOYCE: Sometimes a man will tell his bartender things he’ll never tell his doctor. What’s been on your mind, Chris, the fight on Rigel Seven?
PIKE: Shouldn’t it be? My own yeoman and two others dead, seven injured.
BOYCE: Was there anything you personally could have done to prevent it?
PIKE: Oh, I should have smelled trouble when I saw the swords and the armor. Instead of that, I let myself get trapped in that deserted fortress and attacked by one of their warriors.
BOYCE: Chris, you set standards for yourself no one could meet. You treat everyone on board like a human being except yourself, and now you’re tired and you …
PIKE: You bet I’m tired. You bet. I’m tired of being responsible for two hundred and three lives. I’m tired of deciding which mission is too risky and which isn’t, and who’s going on the landing party and who doesn’t, and who lives and who dies. Boy, I’ve had it, Phil.
BOYCE: To the point of finally taking my advice, a rest leave?
PIKE: To the point of considering resigning … There’s a whole galaxy of [other] things to choose from.
BOYCE: Not for you. A man either lives life as it happens to him, meets it head-on, and licks it, or he turns his back on it and starts to wither away.
PIKE: Now you’re beginning to talk like a doctor, bartender.
BOYCE: Take your choice. We both get the same two kinds of customers. The living and the dying.

“We both get the same two kinds of customers. The living and the dying.” What a terrific analogy between doctors and bartenders. How true! It makes a great joke: “How are doctors and bartenders alike …”

This scene is also a great backdrop for understanding burnout. Pike believes he is omnipotent. He sets personal standards that are too high. He blames himself for not achieving them. He begins to imagine there is a better life elsewhere, far away from the Enterprise, where he can participate in activities that once were pleasurable, or at least pursue ones that hold promise – and Pike has a whole galaxy to choose from.

Burnout is defined in the 11th edition of the International Classification of Diseases as an “occupational phenomenon” rather than a mental health disorder. The syndrome is conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

1. Feelings of energy depletion or exhaustion.
2. Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job.
3. Reduced professional efficacy.

It is important to note that burnout refers specifically to workplace issues and is not considered a mental health disorder, although seeking professional help is crucial if symptoms of burnout persist or lead to feelings of depression or anxiety.

When Star Trek was being filmed in the 1960s, the concept of “burnout” in the context of psychology did not exist. (The term “burnout” was first coined by the American psychologist Herbert Freudenberger in 1974.) Thus, Dr. Boyce’s advice to Captain Pike – to “meet life head on,” insinuating he should suck it up and continue doing his job – made sense for the time period (forgetting that Star Trek took place in the 23rd century). Plowing through burnout in the 1960s was the obvious way to go. Now we know better, and there are options to deal with burnout, including exploring different career paths.

Who knows what would have become of the Star Trek series had Captain Pike disregarded Dr. Boyce’s advice and resigned his position. After all, it was Captain Pike’s tragic accident – an accident he sustained after Dr. Boyce convinced him to remain as captain of the Enterprise – that effectively ended Pike’s career. It proved to be Kirk’s good fortune, however, since Kirk was able to succeed Pike as captain and give us two more glorious seasons of Star Trek.

I guess that’s why writers invented Hollywood endings – “to boldly go where no man has gone before.”

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.