The Untouchable Evolutionary Value of Depression (UPDATED)

A fifth group describes the people who are achuta, or untouchable. The primordial being does not claim them. Untouchables are outcasts—people considered too impure, too polluted, to rank as worthy beings. Prejudice defines their lives, particularly in the rural areas, where nearly three-quarters of India's people live. Untouchables are shunned, insulted, banned from temples and higher caste homes, made to eat and drink from separate utensils in public places, and, in extreme but not uncommon cases, are raped, burned, lynched, and gunned down. 

A few years ago, my wife brought home a couple of red-eared slider turtles for pets.  They were about the size of a toonie each when we got them.  They would snuggle together, side-by-side or one on top of the other - very cute.

One turtle was a bit of a pig.  It would eat all the food put into the tank, leaving none for its partner who wasn't as quick off the platform when it came to eating time.  It was behaviour that continued over time; the piggy turtle grew bigger than its partner, swam more actively, was generally more mobile.  The second one, however, began to move less and less and very noticeably lagged in terms of growth.

Then, we noticed that the turtles stopped snuggling.

We tried removing turtle #2 and feeding it separately; we tried removing turtle #1 from the tank so that its weaker cousin could get some nourishment.  It got to a point, though, that turtle #2 simply seemed to decide to stop eating, like it was sick, or perhaps resigned to its fate.  At only a few months of age, turtle #2 died.

Thinking that perhaps the turtle had been weak or ill from the get-go, we got a replacement.  At the pet store, all the red-eared sliders in the tank looked so happy, snuggling up to each other; our son picked the one he liked the best. 

For a time, it looked like turtle #1 was happy to have a healthy replacement and snuggling continued.  But so did the eating dominance.  It wasn't very long before the cycle repeated itself; turtle #1, growing big and healthy, ate all the food; turtle #2 became lethargic; the two turtles stopped snuggling.  Eventually, turtle #1 was alone again.  Five years on, the piggy turtle is alive, well and massive - but also alone, the last turtle standing.

Something about this repeated behaviour triggered something in me; a memory or an instinct, I'm not sure, but the concept of animals going off to die alone kept coming back to me.  Eventually, I decided to do some research.

Animals will go off to die alone; dogs do it, cats do it, even ants do it. 

This is where depression comes in.

Here are some recognized symptoms of depression, italics mine:

Talking about killing or harming one’s self Expressing strong feelings of hopelessness or being trapped An unusual preoccupation with death or dying Acting recklessly, as if they have a death wish (e.g. speeding through red lights)

Calling or visiting people to say goodbye Getting affairs in order (giving away prized possessions, tying up loose ends) Saying things like “Everyone would be better off without me” or “I want out” A sudden switch from being extremely depressed to acting calm and happy

Not eating is pretty reckless.  Wanting to remove oneself from the crowd is pretty symptomatic of depression as well.  Could depression in humans be similar to this animal instinct of removing oneself from the crowd for their protection, a genetic predisposition that pushes us to isolate and shut down to preserve the well-being and resource access of our peers?

We do live in a dog-eat-dog world; despite what we tell ourselves, success in many careers or relationships is still largely predicated on "how tough" or "how hungry" you are - a willingness to do whatever it takes to make the sale, soothe the boss, beat the competitor.  If you can't "make the cut" - and many don't - you could find yourself bullied either actively or passively; you might also find yourself suffering from symptoms of depression.  In fact, there's a high correlation between stressful work and depression. 

The rise of precarious employment (contract labour and internships with little pay, no benefits and no stability) has exacerbated the social increase - and social cost - of mental illness in national and global economies, sparking an unheralded business crisis in Canada.  While this concept has been recognized by the key players in one of the most precarious employment structures there is - politics - it has not been internalized.  Parties have no formal exit-strategy for their employees/Members, partially due to the very real concerns of political interference and nepotism.

Of course, politics is a notoriously cut-throat industry, one of those that encourages the "hungry" employee to get ahead and serves to excluded the rest as not man enough for the game.  If you're not tough, the logic seems to go, you're untouchable.  From having lived in that world, I can tell you there are countless walking wounded informing the policy decisions that impact your lives.  On the other hand, it's hard to imagine Stephen Harper's PMO taking occupational mental health that seriously - after all, they practise survival of the fittest social selection every day.

The problem is that with a few exceptions we have decided, as a society, that we want everyone to live healthy, happy, productive lives - hence, medicine, social infrastructure and the like.  Those who in the past would have been deemed untouchable - lepers, suffers of plagues, etc, - can now be treated or at least, cared for. 

That doesn't mean that genetic predispositions developed before the advent of medicine don't still exist; social evolution has a habit of moving faster than genetic evolution does.  Despite the infrastructure we humans have developed, the medicines and prosthetics and accommodation tools for persons with visible and psychological disabilities, we still rely on cognitive hardware not that dissimilar from other animals.

If human depression is the manifestation of a genetic predisposition towards protecting the group and if the people most likely to be in positions of power are those most likely to be the overindulgent turtle, we have a bigger hurdle to leap than we've imagined.

It's good that the federal government has created a National Standard of Canada for Psychological Health and Safety in the Workplace; with as ingrained an issue as this one, we're going to need solid leadership that sets the example. 

This isn't an issue employers and employees are going to be able to resolve on their own; it's one we're going to have to face together.

UPDATE DECEMBER 31 2013:    "Typical Liberal; tug at our heart strings, then dig into our wallets.  Sorry, Bob, but taxpayer money doesn't solve every problem.  Besides, depression being such a debilitating disease, shouldn't people have the "right to die."

A hard-working taxpayer suggesting suicidal people should just be left to kill themselves?  Objectivist thinking, of course; individuals are separate, don't impact each other and the only thing that connects us is economic activity.  What if the depressed person is a soldier who has fought to save our country?  Too bad, sucks to be them.  

What if average citizens see stats that more soldiers commit suicide, end up in jail and otherwise have miserable lives than everyone else?  Well, then they shouldn't sign up, should they?  And if they don't, and war comes to our soil, what then?

What if the depressed person is your wife, your son or daughter?  Still think no one else should be involved?  What about you?  What if your boss won't let you take time off to be with your sick relative, and they commit suicide in your absence?  What then?

Every man for himself doesn't work; not unless we are prepared to give up all the things that come with society, like specialized labour, healthcare and quality-of life.  

There's only one path available.

Typical Liberal; tug at our heart strings, then dig into our wallets. Sorry Bob, but taxpayer money doesn’t solve every problem. Besides, depression being such a debilitating disease, shouldn’t people have the “right to die”.
Typical Liberal; tug at our heart strings, then dig into our wallets. Sorry Bob, but taxpayer money doesn’t solve every problem. Besides, depression being such a debilitating disease, shouldn’t people have the “right to die”.

Adressing the Presenteeism Issue (Esther Huberman)

Addressing the presenteeism issue

Esther Huberman | October 15, 2012

On any given day, you may look around your office and see that all your employees are at work. But present doesn’t always mean productive. Presenteeism—absenteeism’s lesser known, but still costly, cousin—occurs when employees who are physically present are, due to a physical or emotional issue, distracted to the point of reduced productivity.

 

As employers increase their sensitivity to the issues surrounding mental and physical health in the workplace, they also increase their awareness of presenteeism. “Everyone is aware of situations where employees are at work but are not productive due to emotional or physical distractions,” says Greg Van Slyke, senior director, business development, with Homewood Human Solutions. “They may call these individuals the ‘walking wounded’ or, to use a sports analogy, say they are ‘playing hurt.’”

 

But beyond this simple definition, presenteeism has several nuances. If, once or twice, an individual is distracted at work by a personal matter, that is not presenteeism or, at least, it is notconsistent presenteeism. According to Emmanuelle Gaudette, prevention and health promotion manager with Standard Life, “If the problem that creates the distraction persists and results in chronic stress with unhealthy physical or emotional manifestations (racing heart, headaches, depression), it becomes a health issue that interferes with productivity.” That’s the presenteeism employers should be concerned about.

 

Lost productivity costs

 Increasingly, plan sponsors and their consultants understand that a well-designed wellness campaign should help improve workplace health and employee productivity. And it is generally understood that the more a wellness strategy is ingrained across all levels of an organization—from procedural to social—the more positive its influence on employee health. To measure the impact of such a strategy, plan sponsors typically track criteria such as degrees of absenteeism, increases/decreases in drug claiming for chronic conditions with a lifestyle connection, short- and long-term disability claims and return-to-work successes and failures.

 

But absent from this list, due to its difficulty in quantifying, is measurement of presenteeism. To properly measure, presenteeism requires initial benchmarking followed by a form of intervention to address its causes. A follow-up remeasurement, post-intervention, then quantifies the degree of presenteeism. It sounds straightforward, but it’s not when you consider the depth to which employee actions, reactions, expectations regarding output and individual physical and emotional influences need to be identified and measured—all while using statistical protocols.

 

The labour-intensive components of this activity—and its need for a command of sophisticated measuring and statistical criteria—preclude many from doing so. Nonetheless, many sponsors continue to want, and need, to know what they can anticipate as their return on investment (ROI) before investing time in planning and delivering a possible solution.

 

Numbers game

 Unfortunately, despite the existence of various North American studies on the matter (some dating back to the mid-’70s), quantifying presenteeism in terms that relate to businesses across the board has been difficult because of issues around consistency and integrity of the studies. Fortunately, clarity is on its way in the not-too-distant future. Soon, Canadians will be able to look to a number of Canadian research projects on absenteeism, disability and presenteeism in relation to wellness investment that will provide metrics rooted in scientific, objective and reputable research mechanisms. These projects, currently under way, are the result of a partnership of insurance companies, educational institutions and others with a vested interest in quantifying the human and ROI value of wellness programs.

 

In one such effort, Standard Life has partnered with the University of Montreal in the study called Developing Better Assessment, Interventions and Policies in Occupational Mental Health: A Multi-disciplinary Approach. The objective of this five-year project is to analyze the link between personal and organizational characteristics; namely, to better understand the influence of a company’s management practices on employee mental health. Early results will be released this fall, with the remainder throughout 2013.

 

Standard Life’s objective is to help educate employers to help them visualize the human and financial cost of mental health issues in the workplace. “We want to put numbers around this issue to help our plan sponsors better understand the negative implications (including presenteeism) of having unhealthy or distracted employees—whether or not they are at work—as well as the value of investing in wellness,” says Gaudette.

 

Getting to ROI

 In an effort to generate quality, scientifically sound data on the ROI of wellness, the Sun Life Wellness Institute partnered with the Richard Ivey School of Business for the Return-on-Investment (ROI) Study of Workplace Wellness Programs, intended to increase evidence and insight into Canadian workplace wellness. Phase 1, completed earlier this year, consists of a comprehensive review of all published literature on the issue of workplace wellness programs and their outcomes. Phase 2, under way now, is a two-year field study involving a number of Canadian organizations and examines wellness strategies in relation to ROI.

 

Dr. Michael Rouse, director of the Health Sector MBA with the Ivey School of Business and head of the joint study, recently shared results of the completed Phase 1 with industry members and says the study’s rigorous review of global literature and studies on the ROI of wellness programs “reveal a savings of 1.5 to 1.7 absentee days per employee, per year when a wellness program is in place. This translates into a savings of $251 to $274 per year, per employee.”

 

Bear in mind, the above statistic is only what has been revealed by research literature to date and includes data from outside Canada. Phase 2 of the study is restricted to Canada.

 

The Burnout factor

 Further insight into the effects of presenteeism, its hidden costs and impacts within the workplace can be found in Sun Life’s recently published report The Burnout Factor. The following details from the report highlight the high toll of poor physical and mental health on workers and, by extension, their employers.

1. The group with the highest average “burnout factor” (stresses in emotional, financial, personal, professional and health areas) is that of full-time employees. They received a score of 38, which is high in relation to retired individuals (with a score of 20) and in comparison to all Canadians (with a score of 31).
2. Of the full-time employee group, it is the individuals between the ages of 35 and 44—prime productive working years—who are at a particularly high risk of stress. Their burnout factor score was, on average, 40.4, which is 30% higher than that of the average Canadian.

Why the focus on chronic stress? Because medical research indicates prolonged exposure to stress has strong links to chronic health conditions such as high blood pressure, hardening of the arteries, obesity and more. While other research on this matter is taking place in North America, these two studies are uniquely Canadian and, therefore, are expected to be influential in helping Canadian plan sponsors better understand and quantify expectations around investing in wellness.

 

Outside of any research taking place, the reality is that employers will always need to be sensitive to the human and financial costs of presenteeism, absenteeism and disability in the workplace and will always wish to mitigate those costs. If plan sponsors currently believe in the strong correlation between improved ROI and the time, effort and initiative involved in creating and sustaining a proactive organizational culture that is committed to mental and physical health, then following this data will be key to developing wellness programs in the future.

 

Esther Huberman is a communications consultant with Pal Benefits. ehuberman@palbenefits.com

Justice For Mental Health

No one should be meant to feel they need to suffer in silence.

 

Think your life is hard?  Suck it up - it's a tough world.  Boss too hard on you?  Maybe you're just not up to the job.  Trouble at home getting you down?  Nobody cares - leave your baggage at home, where it belongs.  Never tell people how you really feel, 'cause nobody cares; if you do, they'll just avoid you.  The people you deal with annoying?  Maybe you're being to soft on them. 

 

That's common wisdom in on our streets, in our places of business, in our homes and on the playground.  Emotional responses are for weak-kneed, bleeding hearts and rage-o-holics.  Those aren't the kind of people you want working for you - right?  The worst employment advice I've ever received was also the most practical - when someone asks how you're doing, always answer "living the dream."  They aren't asking because they are sympathetic, but because they want to judge your usefulness in that moment.

But here's the thing - everyone has limits.  When they are pushed, something gives.  Nearly every majorly successful person I know has suffered a collapsed family, harbours deep-rooted narcissistic self-doubt or partakes in substance abuse.  Frequently, it's all of the above.  This shouldn't come as any surprise, because stress is stress, whether physical or mental.  We have designed our society from top-to-bottom to facilitate work, not people.  The something that's giving is why we have a growing mental health crisis on our hands - and it's costing us.

 

This is most observable among two groups - those with mental illness who are coming into contact with the Justice system on the one side, and First Responders on the other.  Police, Nurses, EMTs, Paramedics, Teachers, parents, spouses and yes, bullied children are the canaries in the cognitive coal mine.  People are chafing, falling, dying because we refuse to realize how harmful our social "suck it up mentality" is.

 

But it doesn't have to be this way.  There are tools, internal and external, that can be applied.  There are mental exercises people can do to nurture resiliency and better manage stress.  Simple things like stopping and counting the positive things in your life can reshape your thought patterns, resulting in more broadly positive attitudes.  There are external solutions like drugs, walks, music and laughter that salve emotional strain.  There's nothing corny about this - it's scientific fact.  Just as eating junk food is bad for your physical health, constantly thinking negative thoughts is harmful for your brain.  The reverse is also true - the entire field of positive psychology was developed around this concept.

 

There are also environmental changes that can be made - innovative workplace designs and work schedules that not only reduce stress, but enhance productivity.  It's the next labour revolution and it's already begun to happen - some players are just ahead of the curve.   

 

We get that planned physical exercise strengthens, but sudden blows or repetitive stresses are harmful.  Some people are designed to be faster or taller or more prone to illnesses than others, physically; the same applies mentally.  

 

Sometimes, pushing against a closed door even harder isn't the solution - sometimes you need to try and give it a pull instead.  That's not being lazy, or weak, or a quitter; it's being smart.

 

Mental health is a pull door that we are still collectively pushing on, to our own detriment.  It's time we stop working against our cognitive natures and proactively, collectively pull the door open.  There's a whole world of opportunity on the other side - we just need to be conscious of this.

 

The Global Mental Health Crisis: A Bubble Soon to Burst?

"The urgency is very clear," she said. "It's kind of like hearing about the initial banks that failed, then the whole housing market. I'd hate for the whole system to fail before people wake up and respond to this as the true crisis that it is."

It has been recognized there is a global mental health crisis.  The OECD has mental health very much in mind.  Countries like Australia and the UK have recognized the fundamental truth that you can't have health without mental health; the mind, after all, is simply another system in the body.  Here in Canada, we have our first national mental health strategy - from a government that doesn't believe in nationalized anything.

That shows how seriously people at the highest levels take this emerging crisis.

Yet, economic times are tight and when there really is no more money to be spent, services like mental health are among the first to get trimmed.  Worse still; on the whole, people still don't get mental health.  The recent CAMH Defeat Denial campaign brilliantly sets out the common responses people with mental illnesses have.

Adding to the challenge - the way we look at work is completely counterinuitive to the way mental health functions.  Micro-managing bosses are convinced that their approach is both right and necessary; they have the gold, they make the rules, employees owe them for the right to work and therefore must be at their beck-and-call 24/7, since work cycles now run without end.  Have you ever told a micromanager that their "management style" is actually detrimental to business functioning and damaging your state of mental health?  If you don't get fired, you'll probably hear one of the defeat denial lines.

Which is why people suffer in silence.  Nobody wants to be judged and know that if they speak out, that's exactly what will happen.  Heartbreakingly, that's often as true for the micromanagers (see micromanaging disorder) as it is for the micromanaged.  As we're afraid of labels or are concerned about ourselves or the nation becoming overmedicated, we simply try to ignore the realities of mental health.  When we do that, we're missing the obvious, affordable but ultimately frightening solution that's really all that's left to us: culture change.

As a society, we need to rethink the way we view mental health - which will mean challenging some confabulated notions we have about identity and self-control.  Neurscience has already got the information - we just need to accept and internalize it.  We need to revamp the way we look at work and motivation.  We also need to understand cognitive development more closely and keep how individual brains work in mind as we develop our next models of education.

In short, we need to stop focusing on curing lead poisoning and start taking the lead out of our water.  This is all possible - we can make our systems work more efficiently, fostering better outcomes - if we do so consciously and proactively.

That's the challenge of the 21st Century - our cognitive equivalent to the labour movement that stemmed from the Industrial Revolution. 

Welcome to the Conscious Revolution.

Rethinking Work: The Impact of Occupational Mental Health on Productivity

  

Mental performance will drive corporate success in the information economy. Innovation, a mental function, is key to competitiveness.

Meanwhile, depression and stress disorders at work are driving disability rates – they are more than 30 per cent of all disability recorded at three of Canada’s best known corporations.

For instance, a company employing 1,000 people will have cases of depression but only 25 will be diagnosed and only six receive proper treatment.

Establish organizational and employee health as “twin priorities” among managers in business.

Survey employees to identify stress which threatens individual health.

Interrupt the treadmill effect plaguing employees with too many priorities and too much to do at once.

Combat distrust, disrespect, autocratic management styles and too-repetitive tasks – all contribute to stress-related health problems.

Of course, conventional wisdom tells us this is all nonsense. Depression and anxiety are excuses, not sicknesses - people just need to get over themselves. In fact, working through anxiety and depression makes you strong on the other end.

When it comes to micromanagement, hey; tough managers are effective managers; employees need close oversight, otherwise they'd be the bosses, wouldn't they? Life is tough; if you can't rise to the challenge then you're probably in the wrong environment. I went through the same thing - look how I turned out. Some folk are just in denial about the way the world really is.

And yet, study after study indicates we are facing a rise in work-related mental health concerns. You might even call it a global business mental health crisis. Countries around the world are trying to find reactive ways to tackle this elephant in the room; Canada has just released it's own plan for a national mental healthcare strategy. The question largely being ignored is this; iis there a correlation between the rise in workplace mental illness and the increasing amounts of cognitive work people are being given to do under increasingly tight deadlines? Is it the people or the nature of work that's the problem?

I once had a baffling conversation with a woman in business who's partner, also in business, was facing heart health concerns. This fellow works ridiculous hours and has an enormous set of expectations put on him. He also tends to drink excessively, but that's as much part of his work culture as anything else. This woman, wickedly smart, incredibly strategic and prone to making informed decisions told me she'd done her homework and found there was no significant correlation between stress and heart health.  She was worried about her partner's well-being, yet determined the stress of his (and her) lifestyle was not a factor.  I had looked at the exact same data she had and come to a completely different conclusion; she was going to take her counsel over mine, though, because she had a track record of success to fall back on.  When you're used to being right, you're not likely to consider the advice of someone with less related experience - if anything, you'll seek the advice of consultants (but might not necessarily follow it). 

 

 

Since then, I have done even more research (largely listed in the E-Library column to the left of this blog), stretching beyond mental illness and including cognitive processes, how and why the body reacts to physical stimuli and even mental health in other animals.  I wonder what my friend would have said if I had told her that zebras don't get ulcers?  It's kind of a human thing.


This is the piece that gets left out of the conversation - life, in general, is meant to be stressful, but only in short bursts.  Predators spend most of their time resting, conserving energy for the physical toll hunting takes on them.  The same holds true with prey; stress is a short-term burst of hormones like cortisol and adrenaline that allows them to survive an encounter or not, after which they can either go back to relaxing or are dead.

The human world of work is increasingly moving away from that model.  In the Industrial Age, workers would clock in, do their shifts, take their breaks and then go home.  There was a clear divide between work and home life; work itself was more about one-off activities rather than complex, long-term commitments.  Writing a note or building a widget is one thing; seeking out new business opportunities, creating long-term strategies and maintaining networks is another beast completely.  Add to this gridlock, picking up the kids, making it to the grocery store, etc, etc; we have developed a work/life system of non-stop stress.  It's clearly not a sustainable model.

So, why are some people - say, 1% of the population - so willing to clinging to it?  To me, it seems to go back to biology.  In a survival-of-the-fittest model, we assume the environment isn't the problem; if you're tough, you'll manage and if not, you don't.  Until a tipping point gets reached where a sufficient proportion of the population falls below the cut, we can still keep telling ourselves that it's a success thing, not a culture thing.  Those at the top are comfortable in the model; like a lion resting after a full meal, they see no need to expend the necessary energy to change a system that is working for them just fine.  Sadly, it takes until the social unrest at the bottom is so severe that the people at the top will face enough disruption (cortisol) to look at alternatives, while still trying to preserve their relative positions.  Don Tapscott calls this the burning platform - personally, I like the metaphor of the boiling frog.

 

The fact is, the platform is burning and unrest is bubbling to the surface.  Worse, if you're in business, you're bottom line is being impacted.  There's only one way to get ahead of this problem; by rethinking work, revising the way we understand mental health and beginning to consciously consider the collective impact of our actions.

If you don't like it, too bad - you're just gonna have to get used to it.

The Knowledge Economy, Healthcare, Human Capital and the Occupational Mental Health Solution

Two of the biggest issues currently facing jurisdictions around the world are a tightening of the economy and the rising pressure being put on our healthcare system, which translates into ever-mounting healthcare costs.  I believe that both of these issues are deeply linked to our transition to a knowledge economy where cognitive ability is in greater demand than physical ability – and therefore, is linked to mental health.

Just as safety equipment and labour laws were developed in response to the new challenges of the industrial revolution, I believe we have a social need for new accommodations in response to this conscious revolution.  These accommodations will stem from a new public perspective on what constitutes mental health.

We tend to differentiate between mental health, thought of in terms of mental illness and cognitive ability, the suite of skills that involves tasks like problem-solving, time-management, multi-tasking and innovation.  Yet we recognize that both stem from our brains.  The brain is part of our body and therefore subject to environmental stress factors that can lead to physical illness.  Just as poorly-adapted workplaces can expose a body to unnecessary physical risks, the same holds true for our mental health.

The number one cause of workplace absenteeism is mental illness.  Every day, 500,000 Canadians are absent from work due to mental health problems.  In Canada, the resulting direct and indirect economic impact, including days absent from work, has been placed in the range of $51 billion by the Canadian Mental Health Association (CMHA).  This cost is compounded by the “offset effect” where individuals will seek treatment or advice, including expensive diagnostic tests, for the physical effects (back pain, cardiac discomfort, etc) of what eventually is determined to be a mental condition.

While Employee Assistance Programs (EAPs) are of great help to those suffering from mental health challenges, they are reactive.  A proactive approach is needed.  The solution for reducing this drain on economic productivity and strain on healthcare budgets is to proactively accommodate mental health/cognitive ability in the workplace.  Just as occupational health and safety led to the development of a safety equipment industry, proactive “mental fitness” can create new business opportunities.

Here are a quick few examples of how: kinesiologists, physical therapists and occupational therapists can expand their services to include assessing the “cognitive workspace”; employee training programs can include cognitive exercises and accommodation tools; gyms can add individual mental health assessments and training to their offerings by adding psychologists to their teams.  All these initiatives bring proactive mental health care to the people, helping to keep them out of the healthcare system.

With the right knowledge and proactive accommodations, we can avoid unnecessary mental stress and maximize cognitive capacity and productivity.  Given that our strained economy now depends on mental ability for growth, this isn’t just a matter of good social policy – its good business.