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OPINION AND ANALYSIS

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.

Published: 29 April 2022 15:09 CEST

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

Anonymous - 30 April 2022 at 07:17 CEST

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.
Anonymous - 30 April 2022 at 08:44 CEST

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!
Anonymous - 30 April 2022 at 10:12 CEST

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…
Anonymous - 16 October 2023 at 14:12 CEST

Hitting the wall is of the soul. Its like a thick black cloud always lurking in your mind and you just keep going and never have a chance to acknowledge it. Mine was so severe that I went straight into my Boss’s Cabin and started crying and sobbing e. It includes a lot of factors like, housing situation, loneliness, high ambitions, family disputes and finally colleagues who don’t care.
Thanks David for putting out it clean and clear. Hope you now are getting back into the working!

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What should you do when someone dies in Sweden?

If your loved one dies unexpectedly at home or elsewhere, you should call Sweden’s emergency number 112. If their death was expected, due to illness or old age, you can call the person’s medical contact if they have one. A doctor will come to the house and confirm their death.

If the person dies in hospital or a care home a doctor will confirm their death.

The doctor will send the death certificate (dödsbevis) to Swedish authorities. As soon as the Tax Agency receives the certificate, they will register the death in the Swedish population register.

Who do I need to inform?

If the person is a foreign citizen, you need to notify the authorities in their home country. If you contact their country’s embassy in Sweden, they will be able to help you figure out the process.

You need to inform people as soon as you can, including friends, family and colleagues.

The first step after that may be to contact a funeral home (begravningsbyrå) who will be able to organise the funeral and the reading of a will, but also advise on what needs to be done next.

One of the first admin tasks is to order a so-called dödsfallsintyg (which also translates as death certificate, but is different from the one the doctor writes) from the Swedish Tax Agency. This will show the date of death and remaining family members, including spouse and children. If you choose to use the services of a funeral home, they will be able to order a dödsfallsintyg for you.

Swedish authorities run a site called Efterlevandeguiden for people who have lost a loved one. It contains among other things a checklist in English for what to do when someone dies (their guide is genuinely very helpful, so we advise having a look if you’re in this situation).

A funeral home can help you with as much as you need, but there’s usually a lot of decisions and tasks that you’re best placed to do, so it’s a good idea to get as much help as possible.

Many Swedes don’t like to intrude on other people’s business, so there is a risk you find that fewer people than you expect will reach out to you to offer to help or even send their condolences. In most cases, this is due to a (perhaps misplaced) respect for privacy rather than an unwillingness to help, but we’ve generally found that Swedes, when asked, are more keen to help than you think.

How do I organise the funeral?

Sweden allows a lot more time between the death and the burial than many other countries and cultures, with the laws stating that the burial must take place within one month of the death.

That said, the aim is always to respect the traditions and culture of the deceased person.

All residents in Sweden, including foreign citizens, pay a yearly funeral fee (begravningsavgift – it’s part of your tax statement, so chances are you’ve never noticed you’re paying it). This gives them the right to be buried or cremated in their Swedish home municipality for free.

Most cemeteries in Sweden are public spaces and are run by the Church of Sweden on behalf of the state, which means people from other religions may also be buried there. If you want the Church of Sweden to organise a funeral ceremony for you as well however, the deceased person will have had to be a member of the church in order to receive the ceremony for free.

If you want to spread the person’s ashes in a place other than a cemetery, you need to first get permission from the country administrative board (Länsstyrelsen).

Who pays for the funeral?

Some of it, such as a burial plot and a venue in which to hold a ceremony, has already been paid for through taxes, but there may be other expenses such as a fee for the funeral home, flowers, food for the funeral goers, a bespoke coffin, any music you wish to play, and so on.

A funeral usually ends up costing around 20,000-30,000 kronor, which is primarily paid for through the estate (dödsboet). If there’s not enough money, the estate can apply to the social services for financial support in order for the deceased person to receive a dignified burial.

If you want the deceased person to be buried in another country than Sweden, the transport of the coffin or urn will be paid for by the estate, but it could be expensive, so you should also check whether they had travel or home insurance which could cover the cost of transport.

You need to request documents from the Swedish Tax Agency to transport the body from Sweden. The form is called passersedel för lik or, if the person is cremated in Sweden before their ashes are to be moved abroad, passersedel för stoft.

You also need to get the funeral home to confirm that the coffin or urn is safe for transport and contains what it is said to contain, and you need to get permission from the authorities in the other country.

How do I deal with all the admin?

Again, a funeral home can help you out, but the first step is the death certificate from the Tax Agency. This document will help you not only in organising the funeral, but also in dealing with administrative matters such as cancelling direct debits or contracts, or redirecting post.

Note that banks are automatically informed when someone dies, and then automatically block some of the services used by the deceased until the person’s will has been executed, including joint accounts. If you and your partner have joint bank accounts, it may for this reason make sense for you to also have individual accounts so that you don’t get blocked from all your accounts if your partner dies.

Any outstanding bills that still need to be paid should be paid for by the estate (if there’s money left after paying the funeral and probate costs, which are prioritised). Any debts will also be paid by the estate, or written off. You are not responsible for paying the deceased’s debts yourself.

Before all of this, a so-called bouppteckning will have to be arranged. This is the procedure for going through all of the deceased’s assets and debts. It can be done privately, or with the help of the funeral home, and needs to be submitted to the Tax Agency within four months.

Here’s a useful guide for administering the estate.

What about inheritance?

In general, the inheritance laws of the country where the deceased lives apply.

In Sweden, if the deceased was not married, but had children, the children inherit.

If the children are no longer alive, their children, i.e. the grandchildren of the deceased person, are next in line, followed by the great grandchildren (and so on, if they exist).

If there are no direct descendants left, inheritance passes to parents, followed by siblings, nieces or nephews, grandparents, and aunts or uncles.

Cousins do not automatically have inheritance rights, and note that neither do sambos (co-habiting but non-married couples) unless they are listed in the deceased’s will.

If there’s a will, it trumps the above order with one major exception: direct heirs (bröstarvingar), i.e. children, grandchildren et cetera, always have the right to half of their inheritance, the so-called legal share (laglott).

If the person was married, a division of joint assets (bodelning) first needs to be carried out to see how many of their assets belong to the estate and how many belong to the surviving spouse – unless they did not have children, in which case all their assets are automatically inherited by their spouse.

If the deceased and their spouse had children together, the spouse inherits everything and is allowed to spend the assets as they wish as long as he or she is alive. Their joint children are only entitled to their share of the inheritance – whatever is left – once both parents are dead.

If the deceased had children with someone else before they married their current spouse, those children (known as särkullbarn) have the right to get their share of the inheritance before their parent’s spouse dies. They are however free to waive this right in favour of the surviving spouse.

There’s no inheritance tax in Sweden.

The above guide tries to address some of the main matters, but barely scratches the surface. Do you have any specific questions about what to do when a loved one dies in Sweden? You’re always welcome to email our editorial team at [email protected].

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