Toxic stress

“Stress” is too common these days in lots of jobs. Despite the stereotype, studies show that it’s those with:

  • lots of demands (on their minds and/or bodies),
  • little or no control or say in what they do and how they do it,
  • little or no support from “bosses”, unions or co-workers, and
  • lack of respect.

That means it’s not those in charge of workplaces who usually are “stressed out”. It’s those who collect our garbage and recycling, build our vehicles, answer office phones and check out our groceries. The work organisation hazards or stressors they face take a toll on bodies and minds, and hazards to the mind become hazards to the body, showing up in physical symptoms. (Others, like the CSA Standard Z1003-13 – Psychological health and safety in the workplace – Prevention, promotion, and guidance to staged implementation, talk about psychosocial hazards.)

The graphic shows the connection between a “stressor” — the hazard that causes a reaction. Acute effects or reactions are called “stress”; longer-term, chronic reactions or results are called “toxic stress”, “job strain”, effort-reward-imbalance and other phrases.

The short-term effects of stressors are well-known: butterflies in the stomach, tight muscles, breathlessness, sweaty palms, etc. The graphic (from the Hospital Employees Union’s very useful The workplace anti-stress guide shows these fight-flight-freeze responses or symptoms.

Using the same “body map”, I designed a second page to explain the symptoms of toxic stress or job strain — on the body and the mind, or the physical and non-physical effects. (Both graphics were used in the Seeing the workplace with new eyes guide.) They range from cardiovascular problems and menstrual disorders to anxiety, depression, irrational behaviour and social isolation.

For details about symptoms and reactions, see Stressors stress and strain basics. It includes a graphic adaptation of the demand-control-support approach to work-related stressors. People are “stressed out” or suffer from “job strain” with the red arrows in the graphic below. Good jobs, which are active and “stress-free” are shown by the green arrows; people have enough demands  or workload, lots of control/say, social support and respect.

In a workshop, U.S. education sector workers named the stressors in their work lives that fit into each category. The photo above shows the result. (They were just told to put each post-it in the category that best matched their situation. The same stressor could end up in several categories, depending on how each person experienced it).

Hazards such as violence, harassment and bullying are stressors that came up in different ways. So too did disrespect, long hours of work and

They then mapped the stressors on a physical map to get an overview and better set priorities for needed changes.

A hazard-specific Prevention triangle sets out principles for the kind of changes that prevent or eliminate stressors. Solutions that prevent harm deal with root causes and provide collective solutions (the public health approach). Like other hazards, they aim to get rid of the problem. They do not depend on “health promotion” programmes or rely on individuals taking care of themselves.

They require organisational changes, like those referred to in the innovative StressAssess and Mental Injury Toolkit, based on the Copenhagen Psychosocial Questionnaire (COPSOQ), which is available in 25 languages.

For more details, check out the resources listed below.

Resources

“Popular” materials for workers and organisations

  • for individual and organisational assessments/surveys — and solutions — see the Mental Injury Toolkit (with its app) and StressAssess from the Canadian Centre for Occupational Health and Safety (CCOHS) and Occupational Health Clinics for Ontario Workers (OHCOW)
  • articles and more via the U.K. Hazards group, with links to European and North American sources
  • Enough workplace stress: Organizing for change, from the Canadian Union of Public Employees (CUPE), with surveys and solutions
  • Workplace anti-stress guide, designed for health care workplaces by a Canadian union, the Hospital Employees Union (HEU)
  • Jeffrey Pfeffer’s 2018 book, Dying for a paycheck: How modern managment harms employee health and company performance — and what we can do about it, described in the article Your boss is working you to death.
  • managing “psychosocial” hazards booklet, developed in the SOBANE (Screening, Observation, Analysis, Expertise) method by Jacques Malchaire, and used in Belgium and other European sites
  • the European Trade Union Institute (ETUI) page that is regularly updated and links to news, reports and presentations
  • materials from the European Union’s Agency for Safety & Health at Work
  • CSA Standard Z1003-13 – Psychological health and safety in the workplace – Prevention, promotion, and guidance to staged implementation
  • National Institute for Occupational Safety and Health (NIOSH) materials about work organisation, including the very useful booklet, Stress at work

Resources with more of an academic bent

  • Copenhagen Psychosocial Questionnaire (COPSOQ) international network, which the MIT and StressAssess use
  • Job Content Questionnaire (JCQ), developed by Robert Karasek and others (also known as the demand-control-support approach to stress)
  • Center for Social Epidemiology’s Unhealthy Work activities, including the film project Working on Empty, focused on the United States
  • Wayne Lewchuk’s adaptation of the demand-control-support approach to precarious and temporary jobs
  • Effort-reward-imbalance theory, developed by Johannes Siegrist
  • Job Demands-Resources model, developed by Bakker and Demerouti