Exhaustion

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Regardless of who you are, we have all had times when we wake after few hours sleep and spend the rest of the night rolling around the bed getting angry with ourselves because we cannot get back to sleep. But imagine if this pattern became a routine and you know fully well, that when you go to bed within a few hours you will be awake again repeating the events of the night before. But what makes matters worse is that the resulting tiredness effects moods, concentration, thoughts and even appetite. So, your body ends up lacking nourishment and craving rest. Like an alcoholic or a drug user craving their new fix an exhausted person desires rest. Yet, unlike the drink/drug user there is no ready access to gaining support. When it is announced that you are suffering with fatigue all is offered is having a lazy day on your day off. But it not as simple as that. The lead up to exhaustion is more complex than just getting your eight hours sleep at night. There are overlapping and related factors that need to be considered.

Same problem, different name.

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

Like depression or domestic abuse, men fail to either recognise the signs or fail to admit that the problem exists. Indeed, following simple research I have found that exhaustion is extremely dangerous and is actually deadly. In some cases, exhaustion is a sign of an underlying disease, including cancer, low thyroid, anemia or other metabolic abnormalities, such as adrenal insufficiency. Exhaustion is commonly seen with depression and is a possible side effect of many prescription drugs, including beta blockers, muscle relaxants and mood stabilizers. However, given that depression also tends to involve lethargy and detachment, some have argued that burnout is just a stigma-free label for depression. In her book, Exhaustion: A History, Schaffner quotes one German newspaper article that claimed burnout is just a “luxury version” of depression for high-flying professionals. “Only losers become depressive,” the article continued. “Burnout is a diagnosis for winners, or, more specifically, for former winners.”

Suffer

Exhaustion, by any name, is hardly a new phenomenon. In the 1800s, women were said to suffer from hystero-neurasthenia, or “nervous exhaustion.” Triggers included excessive amounts of exercise, cohabitation, brain work and worries over motherhood, according to an 1887 article in the Journal of the American Medical Association. Women were also at risk if they worried too much about “impending or actual misfortune.”

In the 1950s, around the time women were having “nervous breakdowns,” scientists published research showing that it was, indeed, possible for business executives to suffer from exhaustion. Today the term burnout, which is characterized by emotional exhaustion, is recognized in Europe and is a common concern among those who work in the medical or humanitarian aid fields.

Four humours
Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

When Schaffner explored the historic literature, however, she found that people suffered from extreme fatigue long before the rise of the modern workplace. One of the earliest discussions of exhaustion was written by the Roman physician Galen (129 –  216 AD ). Like Hippocrates (460 –  370 BC), he believed that all physical and mental ailments could be traced to the relative balance of the four humours – blood, yellow bile, black bile and phlegm. A build-up of black bile, he said, slowed the body’s circulation and clogged up the brain’s pathways, bringing about lethargy, torpor, weariness, sluggishness and melancholy. Although by modern standards and knowledge we now know it has no scientific basis, the idea that our brains are filled with a tar-like liquid certainly captures the foggy, clouded thinking that many people with exhaustion report today.

By the time Christianity had taken hold of Western culture, exhaustion was seen as a sign of spiritual weakness. Schaffner points to the writing of Evagrius Ponticus in the 4th Century, which described the ‘noonday demon’, for instance, that leads the monk to stare listlessly out of the window. “It was very much seen as a lack of faith and a lack of willpower – the spirit versus the flesh.” Schaffner also discovered a case of a monk compulsively and restlessly seeking out his brethren for idle chit-chat rather than engaging in useful employment – Is this not too dissimilar to the way that 21st-century sufferers may find themselves compulsively checking social media?

Modern views – class struggles

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

Religious and astrological explanations continued to abound until the birth of modern medicine, when doctors began diagnosing symptoms of fatigue as ‘neurasthenia’. It is now understood that nerves transmit electrical signals, so perhaps someone with weak nerves may therefore dissipate energy like a badly insulated wire. Intellectual figures from Oscar Wilde to Charles Darwin, Thomas Mann and Virginia Woolf were all diagnosed with neurasthenia. Doctors blamed it on the social changes of the industrial revolution, although delicate nerves were also seen as a sign of refinement and intelligence – some patients languished with pride in their condition. As stated previously, exhaustion is associated with success. To give it another comparison the rich are eccentric but the poor are mad.

In modern, industrial nations, a problem is that the main treatment for exhaustion — sleep — is often seen as laziness and being lazy is a barrier to productivity. In 1960, the average adult received a luxurious amount of sleep at eight and a half hours sleep a night. Today, most people get by on an average of less than seven hours, and a substantial proportion sleep less than six hours, according to National Sleep Foundation data.

Inevitable?

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion
But are periods of lethargy and detachment as inevitable a part of human life as head colds and hunger? There is no doubt that exhaustion is a pressing concern. A study of German doctors found that nearly 50% of physicians appeared to be suffering ‘burnout’, reporting, for instance, that they feel tired during every single hour of the day and that the mere thought of work in the morning left them feeling exhausted. Interestingly, men and women seem to deal with burnout in different ways: one recent Finnish survey found that male employees reporting exhaustion were far more likely to take extended sick leave than burned out women, for instance.

Like I have said at the begining, we have all had these moments. But to live with exhaustion is extremely difficult. Even more so when those around you do not have any idea what it is like. There have been times that I know I could not get through the day without a moments rest. In fact, the need to just stop often outweighs the need for food or drink. The need to sleep overshadows everything around me. As a result, a zombie like status emerges and the recognition of the world around you no longer makes sense or even exists. A sense of heaviness emerges and as a result the simplest of tasks literally sap any reserve energy out of you. Alongside the feelings of weariness also comes feelings of emotional despondency, disillusionment and hopelessness.

Although few countries tend to diagnosis neurasthenia today, the term is often used by doctors in China and Japan – again, with the occasional accusation that it is an alternative, stigma-free way of labelling depression.

Distinct

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion  

In general, however, the two conditions are generally considered to be distinct. It is generally agreed that depression entails a loss of self-confidence, or even self-hatred or self-contempt, which is not the case for burnout, where the image of the self often remains unbroken. The anger felt in a burnout is generally not turned against the self but rather against the organisation or persons who are seen as the cause of the problem (for example, work or the ex). Nor should burnout be confused with chronic fatigue syndrome (CFS), which involves prolonged periods of excruciating physical and mental exhaustion for at least six months.



Some data suggest “vital exhaustion,” or a state of excessive fatigue, irritability and hopelessness, can be a risk factor for heart attacks and death. Dutch researchers found that people with high vital exhaustion scores were three times as likely to suffer a subsequent heart attack, perhaps because it increases blood clotting.

I suppose I could give you some obvious advice and suggest you visit the doctor should you develop these symptoms over a significant period. Indeed, you should. But the battle to disassociate ourselves from any form of illness seems to be the norm for many people. In essence, I should state that tiredness does indeed go hand in hand with depression. The two factors together, however, are a burden of which carries a heavy weight upon a daily existence and routine. True fatigue cannot be cured by sleep alone like telling a depressed person to pull themselves together. To me that is the same as telling an obese person to think themselves thin.

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