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What my burnout taught me about Sweden’s exhaustion epidemic

“Hitting the wall” is a well-known and widespread phenomenon in Sweden, where thousands are forced to take long-term sick leave because of clinical exhaustion. David Crouch, who hit the wall himself, examines this uniquely Swedish condition.

What my burnout taught me about Sweden's exhaustion epidemic
A depressed woman sits on a bed. Photo: Isabell Höjman/TT

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.

Member comments

  1. I was very touched and appreciative of David’s candor about his burnout experiences. Hearing him on the LOCAL podcasts, I never would have guessed what he had been going through. As a bit of solace if you don’t mind, but here in the USA the condition ‘ED’ means quite something different altogether, and David is fortunate that is not the ‘ED’ condition he experienced. Thank you David for putting this all out in the open for us to read and attempt to understand. I hope you and your family prevail.

  2. The only argument that I have with this article is that exhaustion disorder is not a uniquely Swedish occurance. It happens to people all over the globe for the same reasons. I also know someone who was diagnosed with it in the US, and I have seen a few people in my life suffer from it.

    What might differ is how much support you get from healthcare services in dealing with it, how acceptable it is to take time off for mental health reasons at your workplace, and cultural and social expectations surrounding exhaustion. Depending on where and in what field you work, it is almost expected to be afflicted by it and still work in spite of it, while others are more forgiving.

    I wish everyone across the globe could take time off for this. At least in my experience, it would have greatly reduced the stress at work and led to a better work environment for sure!

  3. I like the article, though I disagree thoroughly with the statement that this would be a unique Swedish phenomenon. Burn-out stats are rising everywhere, and luckily here they realise that it is not only work-related. Maybe that is the unique Swedish part of it. In many other countries, only the work-aspect is being taken in consideration. Other aspects are being neglected, so everything is named « burn-out », although most exhaustions include life stresses like young or evennsick children, divorces etc…

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OPINION: Racism doesn’t get much more obvious than Sweden’s refugee bias

When you look at Sweden's reception of Ukrainian refugees, it's clear that what was good enough for poor Muslims from Syria, is not considered good enough for white Christians from Ukraine, notes Stockholm University Professor Christian Christensen.

OPINION: Racism doesn't get much more obvious than Sweden's refugee bias

As thousands of Ukrainian refugees began to arrive in Sweden following the invasion by Russia, the headline of a recent opinion piece by the leader of Sweden’s far-right, anti-immigrant Sweden Democrat party spoke volumes: ‘There is a Difference Between Refugees and “Refugees”’

For Åkesson and his nationalist supporters, Ukrainian refugees are “real” refugees. They are from ”a Christian country with a culture that is more closely related” to that of Sweden, while refugees who escaped Syria and Afghanistan were framed as being made up of millions of backward, poorly-educated “professional migrants” (his term) devoid of European values and sensibilities.

With this backdrop, recent comments posted on Twitter by a municipal council member in Sweden’s second-largest city, Gothenburg, provided a disturbing insight into how politicians, not only the far-right but on all sides of the political spectrum, use different sets of standards when considering Ukrainian and Syrian refugees. And how the vision of refugees held by the Swedish far-right has bled into the Swedish political mainstream.

On May 5, Daniel Bernmar, the group leader for the opposition Left Party in the Gothenburg municipal council, sent a series of tweets in which he detailed how fellow council members expressed dismay over the poor services and paltry benefits available to refugees arriving from Ukraine. While on the surface an egalitarian position, the irony, Bernmar pointed out, was that the levels of financial support and services about which they were complaining were set by the very same group of politicians…when the arriving refugees were predominantly Syrian.

In other words, what the local politicians considered to be acceptable support for Syrians was now considered unacceptable support for Ukrainians.

Bernmar detailed a number of the specific concerns expressed by his colleagues.

Members of anti-immigration Sweden Democrats complained that the small amount of spending money given to Ukrainian refugees meant that they could not even afford to take local buses. Why, they asked, had the policy of allowing refugees to ride for free been scrapped? Others asked how without access to public transport Ukrainian refugees could be expected to take their children to school or look for work? And, in perhaps the most Swedish of issues, municipal councilors expressed concern that Ukrainian parents could not send children under the age of three to state-subsidized daycare.

Bernmar noted that he had “never before heard these parties or people address the unacceptable social or economic situation for refugees.” He then addressed the elephant in the room. The dismay expressed by colleagues over conditions facing refugees – conditions the same politicians approved when refugees were Syrian – was unsurprising, he wrote, given that they, “did not previously apply to white, Christian Europeans.”

These revelations should come as no surprise. While seemingly at odds with Sweden’s reputation for openness and egalitarianism, the fact is that political parties at both ends of the Swedish political spectrum have adopted increasingly aggressive anti-immigrant rhetoric and policies. Yet, when structural discrimination is presented in such a transparent fashion, it is still jarring.

At the most fundamental level, the case demonstrates how perceptions of the value of human life and human dignity are shaped by ethnicity, religion, and nationality. What was good enough for poor Muslims from Syria just isn’t good enough for white, European Christians. Racism and ethnocentrism don’t come much clearer than that.

But this revelation cuts even deeper and wider. And it applies to nations beyond Sweden’s borders, where immigrants and refugees struggle to construct new futures. What is evident from the comments made by the local politicians in Gothenburg is that they are fully aware of the impact of their policies on the everyday lives of refugees, how the ability to participate in the workforce, for example, is dependent upon basics such as transportation and childcare. That “integration” isn’t just a question of some mythological will, but of available material resources.

To remember that with Ukrainians, but forget it with Syrians, is cynicism of the highest order. It is to amplify the smear that there is a difference between refugees and “refugees.”

Listen to a discussion on Sweden and immigration on Sweden in Focus, The Local’s podcast. 

Click HERE to listen to Sweden in Focus on Apple Podcasts, Spotify or Google Podcasts.