Sisyphemia, a new work-related disorder characterized by obsessive ambition, chronic stress and pathological fatigue

There are dozens of words that reflect 21st-century work dynamics — freelance, engagement, networking…. There are also many ways to express the ills associated with them: someone is a workaholic when they work too much, a person experiences burnout because of the accumulated stress and fatigue from years of working life. But there wasn’t a term to describe the obsession with doing everything right at work that stems from ambition, self-imposed demands and perfectionism. But it is a dangerous tendency that can have serious consequences for both mental and physical health. That is why José Manuel Vicente, chair of the expert evaluative medicine department at the Catholic University San Antonio of Murcia (UCAM; Spain), coined the term sisyphemia in 2022.

The condition’s name is inspired by the Greek myth of Sisyphus, who was condemned by the gods to push a boulder up a hill and repeat the task over and over again. “It is a health disorder resulting from the psychological and physical exhaustion of employees who are forced to pursue unattainable goals, whether they are set by their company’s management or because they set such goals for themselves. They have excessive workloads that they strive to meet but never manage to complete, despite their best efforts,” Vicente explains.

The doctor, who is also the director of the INSS Disability Assessment Team’s Medical Unit in Gipuzkoa, Spain, observed that increasingly more patients with similar personal and work-related characteristics were suffering from an ailment for which he did not have a name: “We saw people who were emotionally devastated, who ended up dying and wound up developing other symptoms. Sometimes we could refer to a situation of discouragement or constant anxiety, but there wasn’t a specific name,” says the physician. He gathered evidence and profiles and realized that his patients’ sudden tiredness had a common cause.

Those who suffer from sisyphemia cannot distance themselves from work on their days off or when they go to bed, because, over time, their minds have been configured to ruminate automatically and constantly on a to-do list, on what they could have done better or on whether or not they have responded well to the boss. They extend their working hours and put in overtime. They do not sleep well, reduce their leisure time and confine their social circle to just the work environment. As a result, they don’t perform the way they want to. “It’s a loop. To compensate, we drink a lot of caffeine, or we resort to anxiolytics. We tell ourselves, ‘I have to do my best to be perfect even if I slept badly,’” says Vicente. Those self-imposed demands, that high level of responsibility and perfectionism, that feeling of only having one chance, is what differentiates sisyphemia from other disorders related to the work environment.

If these traits and behaviors persist over time, anxiety, anguish, depressive symptoms and sleep disorders may emerge. But Vicente warns that there are also physical consequences: “In the long run, there is some evidence that one can develop cardiac conditions — heart attacks, cardiac rhythm disorders, elevated blood pressure that can be permanent, with sustained hypertensive symptoms. There is also some evidence that those who have a condition like this are at greater risk of having a stroke.” In addition, physical pain results from the relationship between our body and our brain, which go hand in hand even though “they may seem separate to us,” says Vicente. “For example, low back pain, migraines and obesity [are affected by the mind-body connection].”

Sisyphemia is evidence of the unhealthy relationship that many people have with their work. This is partly because of the need for external validation, but it also stems from a highly competitive market. That’s “especially [true] after the rise of teleworking during the pandemic, which makes it easier for us to take work home and blurs schedule boundaries. In such cases, the company is an accomplice in some respects, because it knows that we are putting in more hours than we do during our usual working day, but that time isn’t recorded as overtime,” says Vicente. In November, the Labor Inspectorate launched an investigation into Spain’s major consulting firms — known as the Big Four: Deloitte, PwC, EY and KPMG — for their employees’ marathon working hours. It concluded that these companies would have to shell out at least €700,000 ($760,410) in voluntary payment of overtime. Thereafter, the consulting firms implemented time-tracking systems.

In this regard, experts recommend paying attention to the relationship between our work and mental health. “It is essential. In the workplace in particular, mental health takes on paramount importance because it affects our entire performance process as workers and helps [to] avoid accidents at work,” explains Noelia García-Guirao, who holds a doctorate in social and legal sciences and is a legal expert in occupational risk prevention. “Fortunately, we know how to do that thanks to [Spain’s] Law 31/1995 on Occupational Risk Prevention of November 8, 1995. Workers have the right to effective protection in terms of health and safety at work, and this law gives us the keys [for it]. It also addresses psychosocial issues. That is to say, we have the necessary legal tools for it. And we have professionals who are knowledgeable about the matter. We just have to put the mechanisms in place for prevention in psychosocial matters, which are a bit neglected,” says García-Guirao, who is also an occupational psychologist.

García-Guirao points out that we must be careful when it comes to labeling things. “The danger of over-labeling can cause psychological problems to be attributed to normal personality traits, leading to unnecessary pathologizing. Moreover, a given name is not going to absolutely define the complexity of a particular person’s ailment,” she warns. On the other hand, she also explains that there are advantages in specifically identifying and naming things: “It aids in the recognition and comprehension of an ailment and its symptoms, because it provides the necessary framework for understanding what a person is experiencing. It also facilitates progress in research and appropriate treatments, because professionals have a common terminology… [it] will lead to the development of more effective treatment strategies.”

Vicente points out that in psychiatry the designations are based on the DSM-5, the publication that establishes diagnostic codes. “There are many other relevant phenomena that do not appear as such, like burnout, but it’s necessary to name and identify [those problems].” The physician insists on the importance of doing so: “When we don’t name something, we don’t make it visible. It does not exist.” Organizations such as the Association of Occupational Medicine Specialists and the Spanish Association of Legal Psychiatry, as well as the UGT union and others, have already echoed the term.

Vocational professions

Sisyphemia does not affect all professions equally, nor do all people run the same risk of falling into this loop. Vicente explains that the problem especially affects demanding, high-pressure vocational professions: doctors, financial consultants, auditors, lawyers at large firms, social services. “On a personal level, people with a high sense of responsibility [are] very demanding of themselves and have a strong tendency toward perfectionism,” Vicente explains. But it can also affect anyone who feels they have something to prove, [someone] who has just started working in a new situation, such as a promotion. “For example, it happens a lot with young people and interns, who are part of a sector that is routinely crushed or exploited and often underpaid,” the physician notes.

For this reason, sisyphemia should not be confused with the widely used term burnout. Vicente clarifies that the latter occurs at the end of a career and has a very long latency period. “Burnout implies disaffection with work, no longer feeling that one’s company is one’s own, largely because one does not feel valued or appreciated. On the other hand, sisyphemia [relates] to the daily rush to complete tasks, to setting unattainable goals, to giving oneself entirely to achieve them. There is a strong connection between the company and the worker, and the consequences appear in a much shorter period of time,” the physician explains.

“We must be clear,” says Vicente, “that work has its time and that living means experiencing more than just work.” García-Guirao emphasizes that “workplace conditions should not pose any risk to the worker, in any profession.” She concurs with Vicente: “The safety culture and, specifically, each company’s preventive culture, and how it deals with the psychosocial aspect, is critical. The care and maintenance of workers’ mental health is closely linked to a company’s good preventive culture in psychosocial matters. They cannot be separated. The company must treat a worker’s mental health as equally important as physical health. And we still have a lot of work to do on that front.”

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