Welcome to State of Mind, a new section from Slate and Arizona State University dedicated to exploring mental health. Follow us on Twitter.
When Cate Lindemann began having strange pains in her jaw and tightness in her chest one morning in July 2020, she was no stranger to work stress, depression, and burnout. As an attorney for a big law firm in Chicago, she’d spent years working long hours and prioritizing work before all else in order to become one of the few women to make it to partner.
When she was pregnant with her third child, for instance, she’d even worked through debilitating morning sickness, calling difficult clients from bed some mornings. And she felt so much pressure to argue a motion that she “pushed through” pregnancy-related pain and went to court. She wound up going into labor early a few days later. “You don’t stop to say, ‘This is so wrong. I’m not going to do it,’ ” Lindemann said. “You just do it. And I think that goes for a lot of people in a lot of jobs. They just suck it up and do it.”
Just sucking it up landed Lindemann in the emergency room that July morning. She was having a heart attack. At 39. More precisely, Lindemann was having a spontaneous coronary artery dissection, or SCAD—a tear inside an artery that carries blood to the heart. SCADs affect primarily women in their 40s and 50s. They’re little known, not easy to diagnose, and can be fatal if not treated promptly. Doctors aren’t sure what causes a SCAD. But they do know that one key factor is extreme stress. Or, in Lindemann’s case, work stress.
“My job made me sick,” she said.
Just sucking it up at work is, in fact, taking an enormous—and largely invisible—toll on American workers. Chronic work stress is actually so high and is associated with so much ill health (like cardiovascular disease, high blood pressure, and diabetes) and misery (like depression, anxiety, insomnia, and a 76 percent higher risk of missing work because of a diagnosed mental health disorder) that one meta-analysis of more than 200 studies found that work stress costs about $190 billion a year in health care costs. (In recent years, for instance, GM has spent more on health care than on steel.) Work stress can take years off one’s life and has become, technically, the fifth leading cause of death in the United States.
The U.S. Occupational Safety and Health Administration regulates and tracks many workplace hazards like being exposed to toxic chemicals or whether it’s safe to labor in a coal mine. But OSHA doesn’t keep tabs on what researchers call the “psychosocial stress” that is ubiquitous in many workplaces: long work hours, work-family conflict, toxic bosses, uncertainty, unemployment, lack of health insurance. The higher the job demands and the less control, the more that leads to job strain and work stress. The more the effort at work doesn’t match the reward, the more the stress is compounded.
And that damning research on work stress was done before COVID, which has disproportionately hurt women, caregivers, and the more exposed essential workforce where workers of color are overrepresented. Just the struggle to combine work and care that so many women face increases the odds of reporting poor physical health by 90 percent.
In U.S. hustle culture, work stress is seen as an individual failure of someone who just can’t hack the pressure, as well as an individual responsibility to fix. So executives proclaim that overwhelmed, stressed-out employees are one of their top concerns and offer “wellness” programs like lunchtime yoga, weight loss or smoking cessation programs, or meditation apps to the burned out “talent” they seek to retain. And workers in low-wage or precarious work are often just supposed to be grateful they have a job at all.
But, in truth, the problem of work stress doesn’t rest with individual workers like lawyer Lindemann, or Lyft driver Cherri Murphy, who put on weight and developed high blood pressure, asthma, and insomnia from sitting behind the wheel for longer and longer hours, while she worried whether she’d make enough to cover her bills. “My health deteriorated significantly,” she said.
Instead, psychosocial work stress is the result of the way work itself is organized.
That low-wage and precarious work with no benefits? (The United States is one of the only advanced economies with no paid family leave guarantee, no paid sick days, no paid vacation time, and low investment in care infrastructure.) That unpredictable retail worker schedule? That $2.13 tipped minimum wage for restaurant workers? That public safety net full of holes? (Barely one-third of unemployed workers actually receive unemployment insurance, and in some states it’s fewer than 10 percent.) That’s what’s responsible for so many workers’ chronic stress. Just the thought of losing one’s job stresses people out. And actually losing your job more than doubles the risk of heart attack and stroke among older workers; can increase the chance of developing stress-related diabetes, arthritis, or mental health issues by 83 percent; and even shortens life expectancy. Losing a job also often means losing access to health care in the U.S and is linked to a higher risk of suicide.
Knowledge workers like Lindemann are expected to put work before everything else, including time for self, family, health, and rest. Yet people who work long hours are two and a half times more likely to experience depression than those who work an eight-hour day, and they have a 60 percent increased risk of coronary heart disease. In medicine, like law, the jobs may pay well and come with benefits, but stress, depression, substance abuse, and suicide rates are shockingly high; the expectation of total work devotion is known as the “Iron Man” culture. And despite study after study showing how ideal worker and burnout cultures are not conducive to productivity, innovation, or even profitability and lead to more mistakes, leaders stubbornly continue to create them.
When job demands are high and exceed one’s ability to cope, that’s when job strain kicks in and can lead to burnout, higher blood pressure, heart disease, and depressive symptoms.
In Japan, where long work hours are also commonplace, there’s a word for dying from the stress of overwork: karoshi. The government collects and publishes data on karoshi-related illnesses, depression, and deaths. Victim families, unions, and labor lawyers can sue companies for recompense and lobby the government for worker protections and better laws. In the United States, we have no such word. We don’t track work stress—Lindemann would be hard pressed to make a workers’ compensation claim. But that doesn’t mean it isn’t happening here.
“We have widespread karoshi. We simply don’t call it that. We basically are in denial about the work environment,” said Peter Schnall, emeritus professor of medicine at the University of California, Irvine, who has studied work stress for decades. “We don’t examine the way in which society organizes itself, or organizes work, as potential contributors to those outcomes.”
Researchers like Schnall explain that acute psychosocial stress itself could be having a direct biochemical impact on the body, and lead to heart attack and stroke, for instance. And chronic stress over long periods of time may shape individual choices and lead to changes in lifestyle that have a negative impact on health and well-being. “Chronic stress over time, when you have so many stress hormones circulating in your blood, is going to make you feel tired,” said Marnie Dobson, a medical sociologist who, along with Schnall, directs the Healthy Work Campaign. “So if you’re fatigued, you may not feel like exercising, or eating properly, which can lead to illness in the long run.”
According to Schnall and Dobson, Scandinavia, the European Union, Canada, Colombia, the U.K., and other countries put a premium on worker well-being and stress reduction. But the United States has always focused instead on worker efficiency and productivity. For instance, when many other countries were passing laws in the 1970s to regulate and make illegal job strain in the workplace, the Nixon administration was just proposing to create OSHA in the first place, and then only to regulate physical workplace hazards like coal dust, not stress.
“The lack of attention to the psychosocial stress of workers is just part of unfettered capitalism in the United States—you work until you drop, or put work above all else,” Dobson said. “Business and management have more power than workers to determine what’s best for business. Squeezing labor is seen as a means to unfettered growth.”
As a result, Gallup has consistently found that workers in the United States are among the most stressed-out in the world, with 57 percent saying they were stressed every single day in 2020. (That year, 62 percent of women reported high stress at work, compared with 52 percent of men; that’s hardly a surprise as women were also more likely to be shouldering the lion’s share of child care, home-schooling, and other caring responsibilities, in addition to work.) The American Psychological Association’s annual Stress in America Report typically finds work stress rated the second-highest source of stress, after money. Up to 20 percent of all causes of cardiovascular deaths among those of working age in industrialized countries can be attributed to work and work stress.
Yet there are good solutions: make work better. When workers with care responsibilities do feel supported at work, research on “work-family enrichment” shows they sleep better, spend more quality time with family, and are more loyal and productive at work, among other benefits. And while feeling you have little control over your job, your workload, or schedule increases mortality by almost 45 percent, research shows that unionized workers enjoy better work schedules than nonunionized workers, and are happier, with greater job satisfaction and well-being. Uncertainty, precarious gigs, and shift work are major stressors and can cause burnout and mental health problems. But research has found that stable schedules improve subjective well-being, sleep quality, and economic security. Another psychosocial stressor, low organizational justice, or feeling that your organization treats you and other workers unfairly, is linked to burnout and poor mental health, as well as cardiovascular disease. But research on the pioneering approach of “family-supportive supervisor training” shows that worker health, well-being, job satisfaction, and engagement improve when workers feel supported at work.
Cate Lindemann’s heart attack has completely changed her life. She’s quit working and is too afraid for her health—and her life—to go back to a high-pressure law career. For nearly two years, she hasn’t been allowed to get her heart rate above 130 beats per minute. She can’t mow the lawn. Shovel snow. Or lift anything heavy. She knows she’s privileged that her lawyer husband earns enough to support the family, and she’s lucky just to be alive. “But it has definitely changed my mindset as an employment attorney, like, wow, legally, a corporation is a person and has an identity. But we don’t prioritize humans at all.”
State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.