Interview with Marie Åsberg, Professor Emeritus KI
Professor Emeritus KI
Researches stress and fatigue, suicide - KIDS KI at DS
Educational materials in psychiatry
Few people in Swedish psychiatry are as associated with knowledge about stress and exhaustion as Marie Åsberg. Herpsychiatric research spans over decades, and has from an initial neurobiological focus over the years focused more on the individual's symptoms related to their psychosocial context.
Like so many senior people these days, Marie has been in quarantine for months, why we meet for an interview over a video link, a communication form many of us in a short time have become accustomed to. To my surprise, it works almost as well as a physical meeting.
Our conversation theme is about both hope and resilience. “Stress” as a concept means that you are exposed to pressure, but later return to your normal state. Basically, stress is something positive, something that makes us mobilize in pressured situations, for fight or flight. “Resilience” however, can more be described as extensibility and the ability to stretch back, in a humane context the possibility of recovery.
Interestingly, resilience is a concept that for long has been used in the military, and more with a focus on how to increase the soldier’s resilience. In our medical profession, we have far too long focused too much on the role of the individual, and his or her vulnerability. Marie draws a parallel with coal workers in the past, who used to bring a canary down into the mine. When the bird stopped singing or died, it was understood that the air was not favorable, and therefore time to get up into the fresh air. Somewhat later the workers went down again (with a new bird?).
There are indeed similarities with how we look at human health. When an individual falls ill from stress at work, employers sometimes gets rid of that person and simply hire another one. There is a danger in focusing on the importance of the individual for falling ill from exhaustion. In fact, several of the personality factors that predispose to this are traits (sense of responsibility, empathy, moral sensitivity for example) that actually are desirable, says Marie.
We return to stress. It has been known for decades that long-term stress is linked to cardiovascular disease, but few know that there is also a link to the development of cancer. Chronic stress changes our biology, but in what way? More research is needed to understand the causes of this. It is quite clear that sleep and security in a group are factors that are protective against stress - and also promote resilience. Marie usually refers to the image of young Swedish soldiers in Afghanistan, who in an extreme situation are able to seek security with each other and in the middle of it all manage to fall asleep.
Some circumstances contribute to transform stress to something negative and dangerous: Such as when we suddenly are overwhelmed by stress, when our coping mechanisms simply are not enough to handle the situation. Some people will then respond with an adjustment disorder or with post-traumatic symptoms. But not all.
Prolonged stress increases the risk of fatigue syndrome. It is precisely the time aspect and the absence time for recovery that is central to the exhaustion process. Experiments on both animals and humans have shown similar structural findings on the hippocampus, prefrontal cortex and amygdala. This is probably due to an impact on centers for stress management. Thus, in a stress context, resilience then means the ability to find factors that protect against fatigue. Some people have the ability to relax in chaotic situations, especially with preserved sleep. These people are almost by definition more resilient.
The positive personality traits such as accuracy, ambition, sensitivity and empathy are highly appreciated. In this way, they arenot what we normally would refer to as vulnerability factors, but can still be perceived as such, as people with these traits are more susceptible to be exploited in some working environments. Therefore, it is more the work context itself we must focus on, rather than on the individual's presumed fragility. -How can workplaces be designed to identify and prevent chronic stress? It is not the canary that is basically fragile, it is the air it breathes that is toxic.
Among nursing staff who suffer from fatigue, these personality traits are more prevalent. However, it is the working context itself that has become toxic to them. The typical health care situation consists of a large group of people working intensively towards the same goal. Some of these persons take too much individual responsibility over time.
About 25 percent of people who have been on sick leave for exhaustion relapse later. As in so many other contexts, comorbidity plays a major role. Personality disorder, ADHD and substance abuse are prognostic unfavorable factors.
We also have time to talk a little about the importance of hope. Depression is the condition most commonly associated with hopelessness and can also be suicidal. - One of the doctor's tasks is to be the patient's substitute hope, says Marie, with many years of experience of depression patients. Even in depression, resilience seems to be important. Some people find it easier to endure diy cult feelings, to endure in the midst of suffering. Knowing this, new therapeutic methods have been developed, with a focus on treating and relieving the pain of depression. □