When it happens…

In the previous posts I have touched back on the problem of stress-related Exhaustion Syndrome. A frein of mine got hit, much worse than I did. But when I heard about his first days I could very well relate to what I heard. The sad and bad truth is that a person who has run into this syndrome will have changed afterwards, both in short and in a long term perspective. So what happens? Well, in some cases it appears almost as the aftereffects of a stroke. I am not sure whether it is a physical change to the brain, but according to the way it affects a person, it may well be.

Short-term effects
The short-term effects are often the ones that people see, and which are of a more explicit kind. It is important, however, to note that the profile is individual. Different people display different effects in varying strengths, and I think it might be very difficult to be exhaustive in the descriptions. But the most common ones are:

• Extreme Fatigue – Here the important keyword is “extreme”. It is not like any ordinary tiredness, and you can’t sleep it away, no matter how much you sleep. The degree of fatigue might vary over time, but it is very unpredictable, also for the person affected by it. Different activities may trigger the fatigue, such as social gatherings, big or small, going shopping, or even very loud of visually intensive situations.
• Loss of memory – Most of the memory functions will be affected, to some extent, such as:
• Short-term memory – It is difficult to remember things that are kept in the immediate memory. People tend to forget what they were about to do. I have even opened a kitchen cupboard to take out a cerial package for breakfast five times, without getting the package on the table in the end.
• Long-term memory – There is a great tendency to miss meetings and appointments. Unless they are in a calendar or in the cell phone, appointments don’t exist. The main long-term memory is seldom affected (in contrast with dementia). However, names or faces, even well-known ones,may be difficult to remember and recognize.
• Semantic memory – The semantic memory may also be affected, resulting in what I have myself called “Associative aphasia”. You have difficulties finding the right term, and it was in my case many times not the right word that appeared, but rather an associated term. I heard myself, e.g., telling the passengers in the car, that I was going to put the trailer in the trunk of the car, rather than the garage.
• Episodic memory – The episodic memory is also affected sometimes. There are difficulties remembering the context of activities and events afterwards. The time of the events are also confused, not only in terms of hours and minutes, but also in terms of week days and even weeks.
• The memory of often-used knowledge is also affected. The remembering of pin codes, passwords, important telephone numbers and other simple (but easy to confuse) pieces of information becomes an increasingly difficult task.
• Unfocused activity – this is probably to do with short-term memory, in that people tend to either not start or not finish things they do. It might be that while cleaning up the room, you start by cleaning the table, and then suddenly see some other cleaning task that needs doing. This means that you start on the new task, forgetting about the previous one you started. Associativity plays a large roll in this difficulty.
• Decreased social competence and activity level – Social situations are very hard to handle after a stressrelated Exhaustion Syndrome (even positive ones). This can take on many shapes, such as not responding even to social invitations from close relatives or friends. Parties may cause days of fatigue, even if they were great. Initially, it might even be too much with family, which leads to a kind of isolating behaviour.

This is a very depressing list of symptoms, and the worst part of it is that the healing process is long (≈ years). Even when a person is considered to be healthy again, many of these symptoms will appear now and then in different situations. A person with a stressrelated exhaustion syndrome will probably never be a party popper afterwards, because the environmental stress from the social situations will be too hard to handle.

But now comes the real difficulty. What happens to people in the immediate social context? In many cases the efforts are focused on the person who is ill. The wife, husband, partner, children, etc. are very seldom addressed, despite the fact that they are equally affected by the illness of their relation. The people around the person who has fallen ill, are very likely to feel very lonely and isolated, since the person who is ill needs their constant attention, and of course the social activities will also be removed from the agenda. There remains (often a single) a person who is responsible for everything that happens, where there used to be more people around.

I think it is very important that we also acknowledge those who are affected around the person who has fallen ill. They need to talk! They need to talk much about their situation, and they need to do it often. So one of the important things to do is to lend the person an ear. Helping out with simple things can also be very supportive in this situation. But the most important thing is to be there for the person.