Explainer: how do you die from overwork?

Time for another holiday. Compscigrad

The end of the summer holidays mean office workers will be firmly back to the daily grind of attending meetings, sending emails, organising diaries and paperwork, and overtime. But after a number of cases of deaths caused by overwork and exhaustion, what is it and why does it happen to some people?

“Death from overwork”, or Karōshi as it is known in Japan where the phenomenon was first described, has become more common in the western world. The major medical cause for a Karōshi death is a heart attack. And usually, individuals have been working in an extreme and excessive way.

Personal traits that are usually beneficial often become skewed. For instance, a young person who died from Karōshi in Sweden had excellent planning skills. In fact, she died on her kitchen table lying over her calendar. It turned out that her planning skills were more than normal; she had been planning her days almost in minute intervals. In this case a perfectly desirable skill was taken to an absurd level.

Another was a man who increasingly trained more because he knew that physical exercise was good for performance. Before his death he was training twice a day and working two jobs – day and night shifts. In order to be able to stay awake he abused various stimulants such as coffee, energy drinks and nicotine. Under such circumstances, it may be more easy to understand how an overloaded body might suddenly give up.

Exhausted or worn out?

So what is the difference between being exhausted and just being worn out? The most obvious difference is that a worn out person feels better and recovered after sleep and rest. Emotionally exhausted individuals continue to feel fatigued irrespective of how much they sleep. And they have difficult sleeping in spite of overwhelming tiredness.

If you offer a worn out person a vacation, they will usually be happy to take it with a sigh of relief. But although they need one, someone on the path to exhaustion will often have the sense that the world will collapse if they leave.

Carrying around such beliefs motivates them to continue their excessive engagement, in spite of all the warning signs. Even if some individuals pay some attention to their medical and psychological symptoms, most won’t take enough steps to change.

Stressing out

Modern man: fight or flight?. PA/Lindsey Parnaby

The stress reaction, which includes an increased heart rate and rapid breathing, and causes that “fight or flight” feeling is there to supposedly protect us. But it also means we’re less likely to focus on rest or medication when we feel like we’re being hunted. Unless of course you have learned how to deal with stress in advance and integrated this into daily life.

The word “stress” was originally adapted from physics by Walter Cannon and as the case is with many expressions, there’s no single, generally agreed definition. It has numerous different meanings within scientific contexts and is often self-diagnosed in everyday life, the severity of which often depends on subjective perceptions. Stress can come from both external exposure and internal response, that is, it can be both a cause (stressor) and a consequence (the stress response).

Physiologically, stress is a process of increased arousal with the primary biological function of maintaining a stable body system (homeostasis). In terms of behaviour, it is supposed to help us mobilise our energy for survival in situations we perceive as threatening. While short-term stress with enough recovery time is generally beneficial, exposure to long-term stress without sufficient recovery isn’t.

Short-term stress, as we’re exposed to during normal physical exercise for example, increases the secretion of stress hormones like cortisol and anabolic hormones such as testosterone. When the stress ends, the process of anabolism and recovery-related responses increases. This type of stress reaction is adaptive and may have several health-beneficial effects.

However, without sufficient restitution, recovery functions, for example the activation of the parasympathetic system (sometimes called the rest and digest system), which conserves energy by slowing the heart rate and increasing intestinal activity, is disturbed. One negative consequence of long-term stress without sufficient recovery is emotional exhaustion, and symptoms that include physical exhaustion, anxiety, fatigue, insomnia, depression and impaired work performance.

The main neuroendocrine system that mediates the stress response is the hypothalamic-pituitary adrenal axis, together with the sympathetic nervous system. Cortisol, along with adrenaline and nor-adrenaline, is one of the central hormones that elicits stress responses. The process is initiated in the hypothalamus part of the brain that co-ordinates and interacts with other brain regions.

Over time, repeated stress exposure can lead to plastic changes in the central nervous system and long-term stress without recovery time can lead to several physical and psychiatric disorders like long-term pain, hearing problems, depression, anxiety and immunological deficiencies.

But if you’re suffering from the negative effects of stress, it isn’t too late to put into place daily steps to help. These include everything from simple relaxation exercises and physical activity to mindfulness-based approaches, cognitive behavioural therapies, and more.