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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: What would a Sweden Democrats backed government look like?

With opinion polls suggesting the nationalist Sweden Democrats could become the largest force in a right-wing coalition, David Crouch asks how the party might behave in power

OPINION: What would a Sweden Democrats backed government look like?

Ella is frightened. Well dressed and with perfect hair, she is a successful immigrant to Sweden – an East European of Jewish descent who has joined Sweden’s comfortable middle class.

“The fascists are growing everywhere and are coming to power in Sweden,” she says, stoney-faced. “Is history repeating itself?” History for Ella means the gas chambers, and for her, today’s fascists are the Sweden Democrats (SD).

I was taken unawares by Ella’s outburst and my reassurances sounded unconvincing. But I was less surprised by her confusion and fear. Prime minister Magdalena Andersson herself has accused the SD of being neo-fascist, and the insult is commonly bandied about by prominent figures on the centre-left. So, having now had time to think, here is what I feel I should have said to Ella.

In early 2000, there was international uproar when Austria’s conservatives formed a ruling coalition with the far-right Freedom Party, whose leader in the 1950s was a former officer of the Waffen SS. Condemnation was widespread, and both the USA and Israel recalled their ambassadors to Vienna.

Twenty-two years later, there is no such outrage when far-right, nationalist and right-populist parties win government positions – their presence on the political scene has become mainstream. Once censured as pariahs, they are increasingly considered suitable partners for governing coalitions.

In this sense, Sweden is following a trend in Europe. Far-right parties have entered governments from Italy to Norway, and the world has not stopped spinning as a result.

In the Nordic region, Sweden is behind the curve. In Norway, the Progress Party has frequently polled over 25 percent, and from 2013 to 2020 governed the country together with the centre-right Conservatives. For periods, the PP controlled the ministries of justice, finance, energy, transport, agriculture, labour and – wait for it – equality. The party’s most notorious former member is the Nazi terrorist Anders Behring Breivik.

The far-right Danish People’s Party became Denmark’s second largest party around a decade ago. DPP backing after the 2015 general election enabled a minority Liberal government to hold office and enact some of the strictest asylum and immigration policies in Western Europe. In Finland, the anti-immigrant True Finns (now the Finns Party) joined a centre-right coalition government in 2015.

The recent electoral success of far-right parties in the Nordics has contributed to policies and rhetoric hostile to asylum seekers and Muslims. But these parties have also been subject to the democratic process and been voted out of office. In Denmark and Finland they have been burned by their experience of power, with a collapse and splintering of their vote.

If the right bloc wins next weekend’s Swedish election, how much influence could the Sweden Democrats demand? What might be the direction of a government that relies for its survival on their support?

The other parties in Sweden’s loose centre-right bloc – the Moderates, Christian Democrats and Liberals – say they will exclude the SD from ministerial positions. But recent polls suggest the SD could out-perform the Moderates and become Sweden’s second party. In any case, the SD is likely to extract a high political price for its backing.

“On issues of migration, crime and sentencing, culture and international collaboration, this can drive a [centre-right coalition] government further to the right,” says Ewa Sternberg, political commentator for the liberal Dagens Nyheter. One might say “even further to the right” – pressure from the SD has already seen a substantial rightward shift in the Swedish mainstream.

Coalitions demand compromises. Government is messy and resistant to clear ideological commitments, let alone extreme ones. When The Local recently visited Sölvesborg, where the SD runs the local administration, it expected to find tension and polarisation, but instead encountered little more than a collective shrug of the shoulders.

But what of the SD’s historical roots in the Nazi movement, recently confirmed by the party itself? What about the stream of media exposés – which always accelerates around election time – revealing individual Sweden Democrat politicians as holocaust deniers, Muslim baiters, Nazi sympathisers, homophobes and old-style racists? What about the party’s talk, as recently as 2019, of “inherited essence” (nedärvd essens), smacking of 1930s race biology?

Although leaders such as Åkesson and Mattias Karlsson joined the party in the mid-1990s when its umbilical chord with National Socialism had not been cut, they have tried to exclude the neanderthal element, at one point kicking out the entire youth organisation for being too extreme. This has led some to argue that the Sweden Democrats have transcended their extremist roots and are now right-wing populists, just like other similar parties all over Europe. 

However, while direct connections at the level of ideas between the party and outright Nazis might now be weak, cultural connections are still strong. Some of the popular songs sung at big SD events, for example, are straight from the Swedish white power movement.

And where the party seeks to take root, extremist weeds also seem to flourish. The magazine ETC obtained recently a document with a list of words banned by the party from the comment sections of its social media channels. This is a glossary of extreme right conspiracies and racial hatred, suggesting that the party attracts a milieu in which these ways of thinking are commonplace. 

This poses the question whether the party has the potential to radicalise even further to the right, pulling its coalition partners with it. In Poland and Hungary, for example, conservative parties have become authoritarian in power, gutting democratic institutions and turning them into compliant puppets. Could something similar happen in Sweden? 

I think this is extremely unlikely. Poland and Hungary have recent histories of totalitarianism, their democratic traditions are weak. By contrast, Sweden’s history of political pluralism has deep and active roots in society. When the Nordic Resistance Movement made the mistake of trying to march to a synagogue in Gothenburg in 2017, it seemed as if the entire city came out to oppose them.  

So Ella, please don’t be frightened. We live in a scary world of wars and climate catastrophes, and there are worrying developments in politics on both the left and right. But Sweden is a stable democracy and will remain so regardless of the outcome of next week’s elections.

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.