Expert: Total life change needed to break exhaustion
You cannot accelerate and decelerate your way out of exhaustion. A total lifestyle change is needed, says psychotherapist and researcher Giorgio Grossi. ‘Good women need to learn to let go and let others do it their way.
Ingibjörg Jonsdottir, professor of public health, emphasises that it is difficult to heal as long as the overload remains. Society has a huge challenge to prevent mental illness, she says, and calls for greater investment in occupational health services.
In 2028, the classification for exhaustion disorder will disappear in Sweden, to adapt to the WHO's diagnostic system. But whatever the classification, Sweden, like other countries in Europe, has a major problem to deal with. Stress-related mental illness must be prevented, says Ingibjörg Jonsdottir, professor of public health at the University of Gothenburg and director of the Institute of Stress Medicine in Västra Götaland.
- ‘We can't have the situation that many women in particular have today. It's a gender equality issue. We need to see what we can do to prevent this and not get bogged down in just talking about classification,’ she says.
The disease has increased significantly in recent years and eighty per cent of those affected are women.
What happens in the brain in exhaustion disorder is that our emotional centre becomes more easily affected, while our ability to plan and be rational is impaired. These changes can be seen on magnetic resonance imaging. When we recover, the changes seem to go back, say the researchers the paper spoke to.
In exhaustion disorder, we have less power to do things. According to Giorgio Grossi, our ‘battery’ may only have 20 per cent of its normal power. So we need to make big lifestyle changes to use it properly.
Giorgio Grossi is a licensed psychotherapist and associate professor of medical psychology at the Stress Clinic in Stockholm and has written a number of books on the subject.
- Studies show that there are regions in the prefrontal cortex that experience reduced activity in people with exhaustion disorder. This is where we have our executive functions, logic, ability to plan, set goals and analyse. It is thinner in patients compared to healthy controls,’ he says.
- ‘At the same time, the amygdala is larger in volume, where we have our emotional centre. So it's harder to plan, and at the same time you become more sensitive and more impressionable. If you treat the exhausted, the differences seem to go back.
At the Institute of Stress Medicine, Ingibjörg Jonsdottir's research team has looked at the medical effects of fatigue.
- We have looked specifically at individuals who fulfil the criteria for exhaustion disorder. Many have significant symptoms that can be long-lasting. When challenged, the brain needs healthy systems, but we see that patients with exhaustion disorder have lower levels of growth factors that are important for nerve cell regeneration and survival,’ she says.
- ‘In some individuals, but not all, we see an increase in the brain damage marker NFL [neurofilament light] compared to healthy individuals. This suggests damage to the neurons. In long-term follow-up, it has gone back.
There is ongoing research comparing exhaustion and depression. The problem is that many people suffer from both. Many patients also have co-morbidity with other diagnoses and it is common in other conditions.
- You can think about symptom relief. If the symptoms are the same, they should be treated the same, regardless of the diagnosis. What is specific to these patients is that there is a cause that must be addressed. Otherwise, you risk continuing to be ill. You can't put a plaster cast on a strained leg and expect it to heal if the strain is still there,’ says Ingibjörg Jonsdottir.
She calls for an occupational health service that could take a greater grip on preventive work. ‘Occupational health services have both knowledge and the ability to adapt the workplace. At present, stress-related illnesses are dealt with by overburdened primary care clinics, which do not have the same conditions.
- It is a major problem that occupational health services are being defunded, because the problems are often workplace-related. They could have worked on factors that cause the problems.
Why are women predominantly affected?
- A fairly large proportion can be explained by unequal workloads. There are biological links to many diseases, such as rheumatism. But there is no research to suggest that the entire gender difference is due to biology,’ says Ingibjörg Jonsdottir.
- ‘We see gender differences in other mental health diagnoses too. This may be partly due to men being more reluctant to seek treatment.
At the adult psychiatry department at Helsingborg Hospital, consultant Marcus Persson explains that everyone with anxiety is helped in the same way, regardless of why they have anxiety.
The health centres normally deal with exhaustion disorders. Psychiatrists see people who have been referred for severe problems with sleep, appetite, anxiety and depression, for example.
- The diagnoses overlap. It is not dangerous to try antidepressants. Patients with depression as part of exhaustion disorder may also benefit from magnet therapy,’ he says.
Giorgio Grossi also emphasises that women's overwork is central to the problem. He has long experience of treating patients with severe exhaustion disorder. Nowadays, he often gives lectures to both psychotherapists and companies that need concrete advice to prevent their staff from ‘walking into the wall’.
This includes social factors, with the burden of responsibility for work, home and various relationships. The most affected occupations are health, education and social care, which are still female professions. The monthly fluctuations of hormones can also make some women more fragile and vulnerable.
- In the name of gender equality and in the service of health, there needs to be a much more equal distribution of responsibilities in the family. Men need to take on more responsibility, but good women also need to let go of responsibilities and let others do things their way. And not be there to nag,’ says Giorgio Grossi.
‘It's about a major lifestyle change in a situation where you have too much pressure, and that's not easy,’ he says.
- ‘You won't have a stress-free life, but you might be able to focus on what's important. Like taking care of yourself. You need to dare to break patterns and think carefully before saying yes.
According to Giorgio Grossi, there is often a co-morbidity between fatigue and GAD - generalised anxiety disorder. People with GAD often see problems and visualise difficult scenarios. They may be able to solve problems before others realise there has been one. Outwardly, these individuals are often just perceived as efficient and caring people who get a lot done.
You have written that there are other things that keep us sick than those that caused the exhaustion. What do you mean?
- You might get sick from clashing demands at work, scattered organisation and a fast pace. You are temporarily relieved from the stress of work when you are home on sick leave. But in your head you worry about what your colleagues are thinking, whether you'll ever get well and what will happen to your finances. It becomes a perpetuation pattern that keeps the bad mood going. You never get back on track.
Is there any medicine or treatment that can speed up recovery?
- If you suffer from pure exhaustion disorder, there is no scientific evidence that any treatment is superior to others. But they do work. Most treatments that have been tried are effective.
Exhaustion consists of three phases: the risk phase, the acute phase and the recovery phase. In the recovery phase, many people make the same mistakes, according to Giorgio Grossi.
Accelerating and braking.
Accelerating and braking.
On days you feel better, you carry on as usual. It drains your battery, so you become afraid to do anything at all.
- Then life becomes very restricted. You see yourself as fragile and lock yourself away. The longer you go on, the worse you feel.
When you're exhausted, you can do anything, but with a strategy. According to Mr Grossi, the structure of everyday life needs to be reorganised quite thoroughly. ‘If you have a good day and perhaps intend to cook, you have to stick to your plan, without fiddling with your mobile phone, picking around the house, watering the flowers and starting a washing machine.
- Otherwise you are completely exhausted and lie flat for the rest of the day without having cooked. You're ashamed, agonising and feeling sorry for yourself. On a better day, you have maybe twenty per cent of your battery. If you just keep going, you use it up in one go,’ he says.
- ‘If you break everything down into doses and constantly take breaks, you get things done, even if it takes a little longer in the beginning.
Eight tips for managing overload
- - To overcome an unmanageable situation, you need a clear strategy. When you're exhausted, you can do anything, but according to a plan.
- Don't think you're going to exercise as you usually do. Set the bar at the level you can handle on a bad day. You can do that every day. Raise it as you go.
- Do one thing at a time.
- Switch between different types of activities and different types of rest. Vary from body to mind, so you can recover. Active rest can be yoga or a walk.
- Rest before you get tired.
- Say no to things, both to yourself and others. This could mean leaving work on time or leaving the party after a few hours instead of in the early hours.
- Dare to break patterns.
- Let go of control and let others do things their way.
Source: Giorgio Grossi.
, to an active thing, which is 
. It feels like doing something. Even if that thing is mostly harmful. Which I guess is 
to them.
