Do we need to address our stress?

June 21, 2002

As the working week gets shorter, work-related stress appears to be on the rise. David Wainwright and Michael Calnan ask why.

In February, an appeal court ruling overturned compensation payments of nearly £200,000 to three workers who were unable to return to their jobs because of work-related stress. Such cases had increased 12-fold over the previous year, from 516 to 6,428 new cases.

Media commentary has divided along political lines, with liberal commentators broadly supporting the claim that work-related stress is a genuine threat to health, while those on the right have been more sceptical. The appeal court judges appear to support the latter view, stating that no occupations should be regarded as intrinsically dangerous and that employers are entitled to assume that an employee can withstand the normal pressures of the job. So is their verdict a victory for employers over the legitimate interests of an overstretched workforce, or is it a triumph for common sense over a burgeoning culture of compensation?

To answer this question, we need to look at why the work-stress epidemic has emerged now. Proponents cite a rapid intensification of work over the past 20 years, coupled with the rise of job insecurity and long hours spent at work. This will resonate with those working in the hospital, the school or that modern-day sweat-shop, the call centre - yet the empirical evidence is equivocal.

While there has been a small decline in job tenure for some, the average has remained relatively stable since 1975. Overtime has increased slightly in some sectors, but the average number of hours at work, excluding overtime, has fallen. The claim that work has intensified over the past 20 years often relies on workers' subjective appraisals, which may be unreliable.

Even if we accept such claims, there remains the question of the extent to which this results from the "stick" of managerial coercion or the "carrot" of pay incentives. In a series of workforce surveys, personal discretion was overwhelmingly the most commonly reported determinant of how hard people worked. Whether workers are choosing to work harder or being coerced, is it really the case that they have reached the natural limit of human endurance, beyond which mental and physical illness are likely to result?

In the mid-19th century, London's fitters and turners worked nearly 60 hours a week, virtually every week of the year. By 1968, manual workers not only enjoyed two to three weeks' paid annual leave, but their average working week had fallen by one-third to 40 hours. This point is often countered with the claim that the physical demands endured by earlier generations of workers have been replaced by psychological demands that are more damaging to health.

However, the lives of 19th-century workers were dominated by insecurity about how much they would earn in a week, how long their job would last, if and when they would find another, and what would happen to them when they were unable to work because of sickness, injury or age. Despite these pressures, there is no evidence of a late-19th century work-stress epidemic. Work today may be more demanding than it was 20 years ago, but even in comparison with work in the first half of the 20th century, it can hardly be seen as the psychologically scarring and unendurable experience portrayed in the work-stress discourse.

So is it just that workers have become less resilient? A nationwide decline in the stiff upper lip is difficult to prove, but there are social and cultural trends that suggest that this might be the case. A key factor is more awareness of physical vulnerability prompted by countless health scares. Despite major improvements in life expectancy and the health of the population, the belief that the mundane activities of everyday life - eating, drinking, making love, breathing city air, lying in the sun - may lead to an early death has never been more deeply embedded in the public consciousness. In a world where a relationship is posited between events as prosaic as dyeing one's hair and dying of cancer, it is hardly surprising that the equally banal experiences of working life should take on the appearance of pathological agents. If the body is vulnerable to sunshine or sex, then why not to a heavy workload or a bullying boss?

This conclusion is reinforced by the perception that we are also vulnerable to mental health problems. The categories of "abnormal behaviour" recognised by the American Psychiatric Association rose from 60 in 1952 to 384 in 1994, permeating virtually every aspect of mental life. Naughty children may be suffering from attention deficit hyperactivity disorder, people who eat too little (or too much) may have an eating disorder, post-Christmas gloominess may be a symptom of seasonal affective disorder. Emotional problems that might previously have been considered a normal response to everyday life are increasingly redefined as symptoms of mental illness. The impression is that the mind as well as the body can be easily damaged by everyday life.

This lowering of expectations about human resilience coincides with a rapid expansion in psychotherapy and counselling. These factors have led problems at work to be increasingly interpreted through the medicalised prism of epidemic and disease. In the 1970s, conflict in the workplace led to strikes and the three-day week: today they lead to therapy, early retirement on medical grounds and the pursuit of financial compensation. These changes in Britain's emotional script or ethnopsychology mean that heavy workload, intensive working, and coercive management are no longer seen as collective issues to be fought over through industrial action or political activity, but as individualised threats to the mental and physical health of the worker, to which therapeutic intervention is the proper response.

So does this mean that work stress is simply a myth? Well, yes and no. The stress response may be conditioned by socio-cultural factors outside the workplace, but it also has an embodied reality in the actions of the autonomic nervous system and the hypothalamic-pituitary axis. Over the life course, the body learns to respond to external threats by instigating changes that prepare it to fight or take flight. These responses become so deeply embedded that they can operate autonomously and unconsciously. As a result, we may experience problems at work as physical symptoms, such as panic attacks and nausea, reinforcing the belief that work stress is essentially a health problem over which we have no subjective control. But many workers experience the physical correlates of stress as something they can and should struggle against.

The discourse of work-stress also offers socially acceptable pathways or careers for the work-stress victim, from therapy to financial redress. But what are the political implications of medicalising problems at work? Although becoming a work-stress victim enables workers to gain concessions from their employers, it also entails relinquishing their identity as a mentally competent social actor and means they have to rely on others (either the therapist or employer) to manage their subjectivity. It is the anti-thesis of the radical political activist capable of transforming the world. It is in this light that the political character of the appeal court's guidance on work-stress compensation cases can be understood. The significance lies not in the likelihood that the judgment has made it harder for compensation to be won, but in the extent to which it reinforces the therapeutic imperative by suggesting that employers can be found liable only if they are notified of a particular problem or vulnerability and fail to act on it, and that any employer who offers a confidential counselling advice service with access to treatment is unlikely to be found in breach of duty. As such, the ruling creates a further incentive for employers to colonise the mental life of their workers.

David Wainwright and Michael Calnan's research is part of the Medical Research Council's Health Services Research Collaboration, based in the department of social medicine at the University of Bristol. Their book, Work Stress : The Making of a Modern Epidemic , is published by Open University Press on June 28, £17.99.

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