Individuals who embark on a medical career under the duress of family pressures and expectations may develop the burnout syndrome while still in medical school. Some who have managed to soldier on despite chronic boredom, a sense of frustration at medicine's limitations or a loss of faith in their own abilities, are pushed over the brink by a particular event. Weir Mitchell's decisive and energetic Dr. Sydney Archer, who normally enjoys his work, feels weary after one particularly unsatisfactory session at his 'out-clinic' when he is unable to exercise his therapeutic talents. Obviously there comes a point, especially in hospital settings, when chronic sleep deprivation becomes so debilitating that it interferes with the doctor's power to make rational decisions. Ferdinand Bardamu graduates and actually sets up in practice, but his disenchantment with medicine is so overwhelming and his contempt for the entire human race so corrosive that he finds it impossible to practise 'normally'.