My burnout was like a slow-motion car crash. But I can name the precise day in July 2020 when I finally “hit the wall”, or as they say in Sweden, gick in i väggen.
It was nearly midnight and I was working – as usual. I was always on, using the flexibility of working from home to spread work across the days and into the weekends.
At that moment, I was also boiling a large saucepan of water filled with baby’s bottles to sterilise them. I completely forgot about it. Suddenly the smoke alarm went off and thick, poisonous fumes were filling the house.
But instead of getting our child away from the danger, I lost my temper with my wife for suggesting we call the fire brigade. In other words, I didn’t cope. The situation said stop, and I said go. The facts were black, but my head saw white.
That was the start of the worst 18 months of my life. This article, and another to follow next week, are an attempt to find out if other non-Swedes have experienced something similar, and hopefully to prevent others enduring the same.
The issue is also unusually Swedish. Sweden has a problem with burnout and a unique approach to understanding and treating it.
This country is going through a minor epidemic of what in Sweden is termed “exhaustion syndrome” (utmattningsssyndrom), known clinically in English as exhaustion disorder (ED). No other medical condition has seen such a big increase in Sweden over the past decade.
Yet 20 years ago there was no such diagnosis, and it does not even exist abroad. So what is going on?
A major study of psychiatric disorders in Sweden identified more than 32,000 cases of exhaustion disorder in the period 2018-19. Psychiatric diagnoses have become the most common cause of sick leave in the country, and among these, stress-related conditions such as ED are particularly common. The rise in ED is an important reason for the increasing average length of sick leave, with many suffers needing to take six months or more off work.
In general, low-skilled occupations tend to have higher rates of physical injuries and illness. When it comes to mental illness, however, the pattern is reversed: well-educated occupational categories and desk jobs predominate. Employees in the media, for example, are three times more likely to be on long-term sick leave due to mental illness than farmers, while a lawyer runs double the risk compared to a construction worker. Among academics on sick leave in 2017, almost 55 percent had a stress-related diagnosis.
ED is most prevalent between 35 and 44, in line with the assumption that the condition is often caused by prolonged, uninterrupted stress. A divorce or having young children are risk factors.
If you combine work with taking on the brunt of responsibility in the family, this also increases the risk – which possibly helps to explain why women have a 40 percent higher risk of ED than men. This might be a particularly Swedish thing, as many women feel pressure to return to work soon after childbirth and continue their careers, while still being the mainstay of the family.
In recent years, many countries have seen an increase in people requiring sick leave due to psychiatric diagnoses. Many patients with stress-related problems suffer from extreme fatigue, sleep disturbance, and cognitive impairments going beyond the term “burnout”, which is more normally used to describe exhaustion due to work-related stress.
In Sweden, the diagnosis of exhaustion disorder (ED) was developed around 20 years ago and has been gradually – and unevenly – implemented in clinical practice. There is a considerable overlap between ED and burnout, but ED includes not only work-related stressors but also those that happen in private life.
In my case, I ticked all the boxes. Looking back, my descent into ED had been coming for the best part of a decade. Divorce, redundancy, kids, house-hunting, parental death, re-marriage, not to mention stressful jobs – frankly, well done to me for not crashing a long time ago.
However, I am certain that moving to Sweden was an additional factor. There are multiple stresses involved in abandoning family and friends back home and building a new life in a foreign country. Immigrants to any country are setting sail on deep waters – in the case of refugees, sometimes literally as well as metaphorically. Some cope with it better than others.
I coped pretty badly. After my embarrassment with the baby’s bottles, I more-or-less went to bed for six months. All I was fit for was watching TV. I couldn’t even ride a bicycle – my balance was shot to pieces. Exerting myself physically could mean going back to bed for a couple of days. I was miserable, irritable, and hell to live with.
Luckily I had fantastic care from the Swedish health system, which took my complaints seriously and guided me expertly back to health. Meanwhile, money from Försäkringskassan enabled us to keep the wolf from the door. My only disappointment was that, although health care professionals had warned me about exhaustion, nobody had stepped in to stop me hitting the wall.
In next week’s article, we will look in more detail at the growing debate around ED in Sweden, its symptoms, treatment and preventative measures.
David Crouch is the author of Almost Perfekt: How Sweden Works and What Can We Learn From It. He is a freelance journalist and a lecturer in journalism at Gothenburg University.
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