Hi Steven,

I’ve heard about Karoshi — and great point about it. In a relatively old journal article (http://www.workhealth.org/whatsnew/lpkarosh.html) that I found, there was this statement near the end, however:

The results of Japanese studies that have examined the association between job strain and adverse health outcomes are mixed and rather inconclusive [41-43] Although few epidemiological studies have actually been performed, those that have did not use measurement methods that would allow a real test of the job strain hypothesis. One case-control study of coronary heart disease patients reported higher demands among cases compared to controls but failed to examine the effects of work control [41]. More recently, a study of hypertension in Japan, actually reported a negative association between job strain and blood pressure [42]. It has only been recently that measures have been developed and applied in Japan that will permit standardized international comparisons in the future [43].

… which would lead one to think that there hasn’t yet been shown to be a firm medical reason for this phenomenon.

Furthermore,

It has not been clear how karoshi fits into these historical paradigms in occupational health. One problem is that there continues to be considerable confusion about the concept of karoshi and indeed some researchers have considered the term itself problematic. Some call it, “not of pure medicine” but a socially constructed disease entity that is not ‘real.’ Japanese scientists have not agreed on a single definition, the kinds of death involved or whether only death itself should be included. As mentioned earlier, karoshi involves not just death from cardiovascular disease, but can also include other acute deaths, i.e., those related to delayed medical treatment because of lack of free time to see a doctor, and suicides attributed to overwork. For example, some karoshi victims have died due to diabetic coma, rupture of the esophageal vein related to liver malfunction, peptic ulcer, bronchial asthma, and so on. Case fatality rates also vary according to factors other than overwork. If a victim fortunately survives, the case may not be treated in the context of occupational causality. Indeed, deaths may only be the tip of the iceberg — the most visible indicator of the health effects of overwork in Japan.

All fairly interesting, suggesting that there may be underlying causes that might, under situations of prolonged stress, cause that cause to flare up and when this happens, being ignored.

How all this applies to otherwise young and healthy males who haven’t been over-stressed for years … not quite sure.

Anyway, great idea, Steve. If I find anything else definitive or current I will let you know . ;)

Hi Mark,

Thanks for pointing that out. Couple things.

First of all — and I have great respect for psychiatrists, for what they do — I wouldn’t trust a psychiatrist to necessarily make a diagnosis of heart failure, any more than I’m sure they’d like me to make a diagnosis of borderline personality disorder.

Secondly, if he didn’t drink for 5 straight days, it was probably dehydration that did him in, as it probably led to an imbalance in his sodium and potassium. Its possible if his potassium was too high (probably complicated by renal failure if he was dehydrated) then he could have had a cardiac arrest because of this; alternatively, he could have seized if his sodium levels were too high, aspirated (choked) and died that way as well.

“Heart failure”, which is a failure of the heart to pump, however, isn’t something that usually develops over the course of a few days. However, if he did have an underlying cardiac condition leading to an undiagnosed cardiomyopathy — i.e. heart failure — then all of the above would have made it worse, and in that case, it could have been a situation that contributed to it.

Thanks for letting me know about the article, though.

Oh, don’t get me wrong — I think that there are consequences to working long hours for years at a time.

I think that there is, however, a very different phenomenon to gamers who “drop dead” after long gaming sessions.

First of all, because what they’re doing has a generally pleasurable goal (perhaps what psychiatrists call “egosyntonic”), and secondly, because many gamers haven’t been consistently doing this kind of behaviour, without end, for extended — and I mean years — amount of time.

Its this kind of phenomenon that I’m querying the pathophysiology of … and not drinking for 5 straight days might be one way you might “do” it, I think. ;)