[Paleopsych] NYT: Always on the Job, Employees Pay With Health

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Always on the Job, Employees Pay With Health
New York Times, 4.9.5
By JOHN SCHWARTZ
[Graphic available by clicking the URL]

American workers are stressed out, and in an unforgiving
economy, they are becoming more so every day.

Sixty-two percent say their workload has increased over the
last six months; 53 percent say work leaves them "overtired
and overwhelmed."

Even at home, in the soccer bleachers or at the Labor Day
picnic, workers are never really off the clock, bound to
BlackBerries, cellphones and laptops. Add iffy job
security, rising health care costs, ailing pension plans
and the fear that a financial setback could put mortgage
payments out of reach, and the office has become, for many,
an echo chamber of angst.

It is enough to make workers sick - and it does.

Decades
of research have linked stress to everything from heart
attacks and stroke to diabetes and a weakened immune
system. Now, however, researchers are connecting the dots,
finding that the growing stress and uncertainty of the
office have a measurable impact on workers' health and, by
extension, on companies' bottom lines.

Workplace stress costs the nation more than $300 billion
each year in health care, missed work and the
stress-reduction industry that has grown up to soothe
workers and keep production high, according to estimates by
the American Institute of Stress in New York. And workers
who report that they are stressed, said Steven L. Sauter,
chief of the Organizational Science and Human Factors
Branch of the National Institute for Occupational Safety
and Health, incur health care costs that are 46 percent
higher, or an average of $600 more per person, than other
employees.

"The costs are significant," Dr. Sauter said, adding,
"Those are just the costs to the organization, and not the
burden to individuals and to society."

American workers are not the only ones grappling with
escalating stress and ever greater job demands. European
companies are changing once-generous vacation policies, and
stress-related illnesses cost England 13 million working
days each year, one British health official said.

"It's an issue everywhere you go in the world," said Dr.
Guy Standing, the lead author of "Economic Security for a
Better World," a new report from the International Labor
Office, an agency of the United Nations.

White-collar workers are particularly at risk, Dr. Standing
said, because "we tend to take our work home."

Most stress-related health problems are a far cry from the
phenomenon known in Japan as karoshi, or "death from
overwork." But downsizing, rapid business expansion,
outsourcing - trends that some have credited with
increasing the nation's economic health - translate into
increases in sick days, hospitalization, the risk of heart
attack and a host of other stress-related problems,
researchers find.

The changing workplace, said Hugo Westerlund, a researcher
at the National Institute for Psychosocial Medicine in
Stockholm, "does pose a threat to people's health."

Growth of the Untraditional Job

The days when an employer
said "if you do your job, you'll have a job" are long gone.


The traditional career, progressing step by step through
the corridors of one or two institutions, "is finished,"
said Dr. Richard Sennett, a sociologist at New York
University. He has calculated that a young American today
with at least two years of college can expect to change
jobs at least 11 times before retirement.

Business has moved away from traditional employment, now an
almost quaint concept described in a recent RAND
Corporation study as "full-time jobs of indefinite duration
at a facility owned or rented by the employer."

Instead, that study found, one in every four workers in the
United States is "in some nontraditional employment
relationship," including part-time work and
self-employment. Four out of 10 Americans now work "mostly
at nonstandard time," according to figures cited by Harriet
Presser of the University of Maryland. The odd hours
include evenings, nights, rotating shifts and weekends to
meet the demands of global supply chains and customers in
every time zone.

These jobs require an increasing amount of time as well.
Workers in the United States already put in more than 1,800
hours on the job a year: 350 hours more than the Germans
and slightly more than the Japanese, according to the
International Labor Office.

Nonwork hours have also been increasingly invaded by
technologies that act like a virtual leash.

"The distinction between work and nonwork time is getting
fuzzier all the time," said Donald I. Tepas, professor
emeritus of industrial psychology at the University of
Connecticut, who has studied the health and safety effects
of overwork and sleeplessness.

One result is an office culture where too much work is not
enough.

And while some workers thrive in the changing workplace,
others find their workplaces ruled by what one expert,
Joanne B. Ciulla of the University of Richmond, calls "the
work ethic of fear."

More than 30 percent of workers say they are "always" or
"often" under stress at work, according to the National
Opinion Research Center at the University of Chicago, and a
quarter of those surveyed in 2002 said there often were not
enough co-workers to get the job done.

Other surveys show no end in sight. In a new report, Kronos
Inc., a human resources firm, found that 62 percent of
American workers said that their job activities and
responsibilities had increased over the past six months and
that they had not used all of their allotted vacation time
in the past year. And 60 percent of those surveyed said
they did not expect any respite from increased working
hours in the next six months.

Little wonder, then, that Dr. Richard A. Chaifetz, chief
executive of ComPsych, the largest provider of employee
assistance programs, said "the stress levels today are
clearly higher than they were a few years ago."

The strain of working in an uncertain economic world
weighed heavily on Sergey Shevchuk, a former programmer for
financial services companies. He said he was caught in an
emotional vise while the companies tried to weather the
post-2000 stock slump by purging the ranks and looking
toward cheaper labor through outsourcing.

"I was depressed and getting easily sick very often," he
recalled. "I was coming home empty."

Mr. Shevchuk has since left the world of programming, where
his work could bring $135,000 a year, and started Distinct
Construction Service, a home contracting business in
Fairlawn, N.J.

Diane Knorr, a former dot-com executive, said she believed
that the stress of her job contributed to persistent
stomach pain and sleeplessness. At first, she said, the
feeling of being on call at all hours was exciting.

"The first time I got a call way after hours from a senior
manager, I remember being really flattered" and thinking,
"Wow! I'm really getting up there now."

But gradually, her work and family life became a blur with
hours that were hard to scale back.

"If I leave at 5 and everyone else leaves at 6:30, I might
look like the one who is not pulling his weight," she said.


In college, Ms. Knorr set a goal of making a six-figure
salary by the time she was 49. She reached it at 35, and
"nothing happened; no balloons dropped," she said. "That's
when I really became aware of that hollow feeling."

A doctor suggested that she begin taking an antidepressant
for the stomach pain, "which struck me as bizarre," she
said.

The doctor described it as a treatment to increase the
amount of serotonin in the digestive tract, but Ms. Knorr
said she now realized he might have been giving her a
subtle message about her own level of anxiety and
depression. She eventually quit her job, and used her
savings to start a nonprofit group, Wonder Inc., which
provides mentors and activities for foster children.

Work can be seductive, said Dr. Arlie Hochschild, a
sociologist at the University of California, Berkeley. One
in five of the people she interviewed in the course of
research for her book "The Time Bind" said the rewards of
work could actually become stronger than the comforts of
home, so "home became work, and work became home."

Dr. Hochschild warns of "the splintered self," a state of
constant distraction, doing one thing and expecting
another.

"It's not just time" that is lost, she said, "it's
basically attention: what we give to one another."

Stress Equals Illness

Researchers are beginning to
document the toll that the changing nature of work takes on
health. The National Institute for Occupational Safety and
Health, which has studied the links for decades, began a
major initiative two years ago to study "the changing
organization of work" and has worked with the American
Psychological Association to build up the field of
occupational health psychology at a dozen academic
institutions nationwide.

Downsizing, studies find, is associated with poorer health,
whether workers are fired or survive the downsizing and
continue in their jobs.

Pioneering studies in Scandinavia, where centralized health
care allows researchers access to vast databases of medical
conditions and treatment, also have shown a strong link
between downsizing and illness. A study by Finnish
researchers published in February in the British Medical
Journal, for example, found the risk of dying from a heart
attack doubled among permanent employees after a major
round of downsizing, with the risk growing to five times
normal after four years.

Two other studies, led by Dr. Westerlund, the Swedish
researcher, suggest that other forms of strain in the
workplace can also affect health. An analysis of medical
records for 24,036 Swedish workers from 1991 to 1996 found
that in workplaces that underwent large-scale expansions,
the workers were 7 percent more likely to take sick leave
of 90 days or more and 9 percent more likely to enter a
hospital for some reason.

Health risks rose if the expansion, defined in the study as
more than 18 percent annual job growth, continued year
after year, he said. Employees in companies experiencing
moderate growth, on the other hand, were slightly less
likely to take extended leave, perhaps because the growth
rate was more manageable.

One explanation for why expansion might lead to poor
health, Dr. Westerlund said, is that it often involves
tumult: in some cases, offices expand when the parent
company centralizes operations or merges offices through
downsizing.

In another study, Dr. Westerlund and colleagues gave a
series of medical tests to 3,904 white-collar employees
working in stable businesses and workers in other companies
in various states of stressful transition, including
reorganization, downsizing and outsourcing, in some cases
because the companies were threatened by the difficulties
of competing in a global marketplace.

The workers in organizations that were in transition had
higher-than-average levels of cholesterol, high blood
pressure and other biochemical markers of heart disease
risk, the researchers found.

"All forms of structural insecurity or instability may pose
risks for the health of the employees," Dr. Westerlund and
his colleagues wrote, "although the mechanisms may vary."

One result of this uncertainty, experts say, is that
employees are increasingly turning to medication like
antidepressants and anti-anxiety drugs to help them cope
with the added pressures.

"Medication has, for some people, become a coping mechanism
to help them feel better so they can perform better," Dr.
Chaifetz of ComPsych said.

Some researchers are trying to tease out the types of
stress that are most detrimental to workers. In a large
study conducted in the 1990's, Dr. David M. Almeida, a
developmental psychologist and associate professor of human
development and family studies at Penn State, interviewed
1,500 people, asking about their "daily hassles" and
"chronic stressors" at work and at home over a period of
eight days.

Different types of stress produced different reactions, Dr.
Almeida found. Tension with co-workers and overbearing
bosses was more likely to lead to psychological and
physical health symptoms, he said, while deadline pressure
could actually "make you feel masterful."

Central to understanding how much stress the workers
experienced, he said, was whether they felt in control.
Citing research by Robert A. Karasek of the University of
Massachusetts and colleagues, he said workers who felt that
they had a measure of control over their environment were
far less likely to find work stressful than those who felt
utterly at the mercy of a capricious boss, a child's
illness or a lurching economy.

That combination effect is well known to psychiatrists like
Jeffrey P. Kahn, president of WorkPsych Associates, a
consulting firm in New York. "Stress at home plus stress at
work doesn't equal two units" of stress, he said. "It
equals five."

Dr. Almeida is now starting a second round of surveys, with
an additional biological dimension: the interviews about
daily stress levels will be augmented with a twice-a-day
self-administered test for levels of a stress hormone,
cortisol.

The physiological changes associated with stress are part
of a complex system that once saved the lives of human
ancestors, warning them of danger, said Dr. Bruce S.
McEwen, director of the neuroendocrinology laboratory at
Rockefeller University. The quick flood of hormones like
adrenaline and cortisol pump up the body for fight or
flight.

"We wouldn't do very well without our stress hormones," he
said.

But human physiology, Dr. McEwen said, was not intended to
handle the chronic stress that is an inescapable
accompaniment of modern life. The wear and tear of long
hours, ringing phones, uncertain working conditions and
family demands lead to what he calls "allostatic load," a
stress switch stuck in the half-on position. The result:
fatigue, frustration, anger and burnout.

Dr. McEwen and other stress researchers have linked
persistent stress to a variety of conditions, including
obesity, impaired memory, suppressed immune function and
hardening of the arteries.

What is more, chronic stress contributes to behavior that
makes it harder to recover, he said. For example, sleep
deprivation may increase hunger, causing a stressed-out
worker to seek comfort in a midnight bowl of pasta or a
nightcap, which can lead to further weight gain or
cardiovascular troubles.

Researchers are also finding links between stress and
disease at the molecular level. At Ohio State University,
for example, Dr. Ronald Glaser, a viral immunologist, and
his wife, Dr. Janice Kiecolt-Glaser, a psychologist, are
reaching across disciplines to understand how stress causes
illness.

Working with other researchers at Ohio State, they have
studied the immune response of people who live with an
enormous burden of stress: people who care for a spouse who
is suffering from Alzheimer's disease, and who are, on
average, 70 years old. The immune systems of the caregivers
are clearly compromised, they found.

"What we know about stress is that it's probably even worse
than we thought," Dr. Kiecolt-Glaser said.

Their most recent work focuses on cytokines, molecules
produced by white blood cells, and in particular
interleukin 6, which plays a beneficial role in cell
communication. Like cortisol and adrenaline, interleukin 6
can damage the body in large and persistent doses, slowing
the return to normal after stressful events. It has been
linked to conditions that include arthritis, cardiovascular
disease, delayed healing and cancer, Dr. Glaser said.

The immune systems of the highly stressed subjects, Dr.
Glaser said, "had the levels of Il-6 that we saw in the
controls that were 90 years old," which suggests that their
experiences "seemed to be aging the immune system"
drastically.

These results might be especially important for older
workers.

"If you're 50 years old and you hate your job, you're going
to be stressed; that probably translates into immune
changes," he said.

Stressful working conditions can have more indirect
effects, worsening illnesses that are already present.

Libbi Lepow, who lives in Kensington, Calif., worked at a
dot-com that epitomized the 24/7 lifestyle. Her days, she
said, were dominated by "action junkies," who she said
lived on adrenaline.

"There has to be a crisis, or these folks feel that they
aren't doing anything," she said.

Before long, Ms. Lepow said she was gaining weight and
getting by on junk food and soda.

By March 2001, the combination of stress, lack of sleep and
poor nutrition apparently contributed to a flare-up of
multiple sclerosis, a condition that she had lived with at
a low level for years.

The company, she said, was "very kind to me," and allowed
her to continue working from home, but work continued to
affect her.

"I never took a nap without the two phones in the room,"
she said, and people called constantly. "It was still
exhausting," she said. She resigned in June 2002 and now
lives on disability.

The Benefits of Slowing Down

Recognizing workplace stress might be as simple as counting
the broken pencils on a desk, but doing something about it
is harder.

"We cannot stop change," Dr. Westerlund said, although it
may be possible to "help the people cope with the
environment."

The advice that most experts offer is deceptively simple:
Dr. McEwen, for example, recommends getting enough sleep,
avoiding cigarettes and alcohol, eating sensibly and
exercising.

Emotional support can also make a difference, Dr.
Kiecolt-Glaser said.

By "overworking, not spending time with family and friends,
you're limiting the things that are most likely to do you
good," she said.

Career consultants tell clients to examine the degree to
which they themselves are the ones cracking the whip.

"Consider the possibility that you are colluding in your
own demise," said Rayona Sharpnack, founder of the
Institute for Women's Leadership in Redwood City, Calif.
"Suffering," she said, "is optional."

Ms. Lepow, whose work stress contributed to her disability,
calls her illness "a kind of gift," because without it, she
said, "I could have lived my whole life without stopping."

She recalled striding across her deck to her home office
without ever taking in the view.

"It took something like this disease to make me stop and
slow down," she said.

http://www.nytimes.com/2004/09/05/health/05stress.html