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Atlanta Medical Psychology
The clinical practice of Dr. David B. Adams is located in The Medical Quarters in the northside of Atlanta at the junction of Scottish Rite, Northside and Saint Joseph's Hospitals. Dr. Adams consults to occupational medicine, surgeons, nurse case managers, insurers and employers regarding the psychological impact of work-related injury and the role of psychological factors in short- and long-term disability. 

 

PSYCHOLOGICAL ASPECTS OF DISABILITY

 

The Psychological letter
July, 1999

Questions and Answers for Case Management:
"...relationship between stress and health…?"

"Dr. Adams: "Since a number of states consider work-related stress an occupational injury (sic), what is the relationship between stress and health...and where do we stand today versus ten years ago?"

We have gone from referring to work-overload to terms like time poverty and time famine to describe what has happened as both husband and wife must work to maintain the family’s standard of living. In March, 1999, the National Institute for Occupational Safety and Health met to discuss the increased risk of physical health problems arising from psychological stressors. This includes the behavioral problems (substance abuse and other concerns) that increase when workers are under increased stress.

In the past ten years, the number of hours worked by the average worker has increased by 8-percent to 47 hours per week. Between 25 and 33-percent of all workers perceive that they have inordinately increased job stress and are burned out by the end of the day. There has been a drastic increase in the number of daily hours worked, and due to mergers, cutbacks and downsizing, there is an increased perception of workers that their jobs are continually at risk. Concurrently, many workers do not see their job as a lifetime commitment, seeing themselves and their jobs as expendable, and with that end of commitment to the job comes a decreased investment in the work.

Thus, the worker puts in more hours, feels at risk for job loss, and feels less of sense of attachment of themselves to the job, and less sense that the employer is attached to them. The more jobs that are eliminated by companies, the more we see an increase in claims of disability, decrease in levels of productivity, and decrease in morale. Not surprisingly, once again, there is a concomitant increase in the cost of health care, with more workers becoming ill or perceiving that they are ill due to work stressors.

There are two ways of conceptualizing the emergence of greater stress: a. Americans are working longer and harder because there are vastly expanded job opportunities especially in high technology, and hard work translates into increased income, or b. wealth going to those who work hard and achieve more is discouraging to many who simply give up and cease to produce, feeling that striving is futile and success is illusory. Much of this may also arise from the average American worker understanding little of what constitutes the economic base of their company or even their country. Large dollar amounts verbalized by the media without explanation to the worker as to how these numbers are achieved, leaves the worker with the belief that he/she cannot possibly succeed at the levels of others. Therefore, much of job stress can be confusion on the part of the worker as to what constitutes economic responsibility and success.

Stress is not an objective phenomenon. Stress is response to a demand for change. Some individuals can change with ease. They readily absorb new responsibilities and take on challenges. They see life as a series of opportunities to prove their ambition, creativity and investment. They do not seek shortcuts, relief from responsibility or compensation beyond that which others demand. They want no special consideration.

The problem begins when we conceptualize stress as though it were objective, and that everyone would perceive increased work week and competition as stressful. If we begin to think in terms of long hours of work, high productivity, and ambition as inherently stressful, and we begin to encourage people to avoid those activities because they are inherently unpleasant aspects of life, we shall see a decline in productivity and for many a decline in self-image.

 

My own concern is based upon a realization of what happens when humans have no boundaries. I refer to this as my "merging lane theory": When highway builders construct merging lanes to assist traffic flow, people invariably use the merge lane inappropriately to gain the advantage over other drivers. Rather than wait in line, they race up the merging lane and cut ahead, thereby avoiding the expectancy that they, like everyone else, will wait their own turn in line. Similarly, if everyone is permitted to not only see their work as stressful but then to use that perceived stress as a rationale for not working, we shall see many workers building up in the health care merging lanes, just to cut ahead in the line toward retirement-through-disability. D.B.A.

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