The best of PANIC!: Mental health and the workplace.

For those of us not lucky enough to have been born into great wealth, not working because we have panic or anxiety (or their cousin, depression) isn't a great option.

Trust me. I've tried it. For most of my life since developing panic disorder in the late 1980s, I've avoided working in crowded districts of the cities where I've lived, or anywhere where I might have to endure a busy rush hour to commute to or from work. Over the years I've had panic attacks during all kinds of commutes -- driving, and on buses, subways, and commuter trains -- as well as in elevators, on crowded business-district sidewalks, and while just plain sitting at my desk.

Too often, my morning commute has been one of hyperventilation and white knuckles. More than once, I've left work early because panic was pending or already full blown. Once, I even had a panic attack just steps from the door to the office building where I worked, and was compelled to turn around and go home rather than having to open that door. More times than I care to remember, I've turned down jobs that, before panic, I would have jumped at, whether because of the commute or my growing fear of offices in general.

For much of my adult life I've been chronically underemployed, unable to keep a job for very long, unable to secure enough work that I could do from home to make a real living. Luckily I've now found a full-time job that's interesting, pays well, and allows me to telecommute almost all the time. But I'm in debt, behind on my taxes. My credit score sucks worse than that Kevin Federline CD. I'm in my mid-40s, and I've only just gotten into a situation that allows me to start building a nest egg. I know intimately what it's like to live from paycheck to paycheck, from month to month.

In other words, the price of not working is equally as formidable as the price of going to work while experiencing panic attacks. Unfortunately, a degree (even an advanced degree) and a desire to do good work aren't enough, most of the time; there are few ways to build a career without putting in your fair share of face time with the people you're working with or for.

I believe I might have averted at least some of my problems if I hadn't felt compelled to hide my panic and depression from employers. In that case, I believe, I might've dealt with my mental health issues before they'd conspired to create an agoraphobia as sturdy as the one I've been blessed with.

Which is why I laud the efforts of a Brit named Jonathan Naess. Naess battled bipolar disorder while building a successful legal career, which he's since left to start a non-profit dedicated to fighting stigma against the mentally ill in the workplace. From the link:

"I think there is a really deep-seated and gut reaction to the mental health issue that's been around for hundreds of years," says Naess. "It's socially unacceptable."

To combat stigma effectively he says people "from all walks of life" including those in senior positions need to be visible and to use the exposure to prove that people who experience mental ill-health are not "tarnished, broken, sub-species". For Naess, this means focusing on an arena where people who have a mental illness are more likely than any other group to be discriminated against: work.

Recent research shows the extent of the problem. Mental Health: The Last Workplace Taboo, published last year by the charity Shaw Trust, concluded that there was "widespread discrimination towards people with mental ill-health". In its survey of employers, one in three said they thought people with a mental health problem were less reliable than other employees.

The study found that most companies do not have an effective formal mental health policy and that 71% of employers estimated that only about 5% of their workforce may have a mental health problem - a severe underestimation when considering that three in 10 employees will experience mental health problems during a single year. One in four people are expected to have an incidence of mental health difficulty in their lifetime. Naess says the need to educate employers "cannot be underestimated".

With this in mind he has for the past 18 months been establishing a network of professionals to campaign alongside him and contribute professional expertise. The list includes directors, chief executives, managers from the private and public sectors, lawyers and communications experts, and each with personal experience of dealing with a mental illness while sustaining a successful career. Naess admits that he was concerned people would be reluctant to sign up, fearing negative ramifications at work. "I thought there might be just two or three of us and I wasn't sure if we'd only get retired people." All of the volunteers are of working age.

Naess says he wants to use the collective business experience of the volunteers to convince employers to come to terms with the fact that people who are mentally ill can make good employees, and encourage them to put in place mental health policies.

 First posted here.

Stress: portrait of a killer.

Panic, of course, is an extreme reaction to stress. It may seem like it comes from out of the blue, but it doesn't. More often than not panic disorder develops in one's 20s, a particularly stressful time of life in our society, when most of us first have to deal with the responsibilities and worries that coming with making our own way in the world. (Think: career, rent, finding a mate...) We become more likely to develop panic again in middle age, after we've raised our kids and suddenly have to adjust to an empty nest and increasing reminders of our mortality. (Think: health concerns, ageism in the workplace, increasing numbers of friends and associates passing away...) Regardless of when it happens, though, panic is at least in part the product of stress.

So readers of this blog will be interested in this National Geographic documentary. Among others it features Stanford neurobiologist Robert Sapolsky, whom I've mentioned in the past here on PANIC!

Sapolsky has been studying stress in baboons for decades. He's found that a baboon's location in its social hierarchy is central to its stress level. The more power a baboon has to control its environment, the less stress it experiences. The less power, the more stress.

This is also the case among humans, as the Whitehall Study mentioned in the documentary showed. That study looked at stress among British civil servants. Despite all the subjects sharing the same basic work environment (desk jobs) and access to health care, the lower workers were in the workplace hierarchy, the higher their risk of disease.

There's no way around it: Stress is bad news. Chronic stress shrinks the hippocampus, the brain's seat of memory and learning. It accelerates the shortening of our chromosomes' telomeres, which prevent the ends of chromosomes from fraying. It causes hypertension and heart disease. It surely contributes to anxiety. And it probably even contributes to the global obesity epidemic.

The problem in humans is that in addition to experiencing stress based on real-world threats, we spend so much of our mental energy creating imaginary or only-possibly-justified stress in our minds. As Sapolsky puts it, referencing animals' response to threats from the environment:

We turn on the exact same stress response for purely psychological states. Thinking about the ozone layer, taxes coming up, mortality, but we’re not doing it for a real physiological reason, and we’re doing it nonstop.... No zebra on earth running for its life would understand why fear of speaking it public would cause you to secrete the same hormones.

But there are steps we can take to reduce stress. As Sapolsky discusses, when the baboon troop he was studying lost most of its alpha-male members -- who relied on aggression rather than social skills -- it became permanently less stressful and more healthy.

The same effect holds in humans. By and large, society values aggressive, multitasking behavior. But that's the pathway to higher stress. Compassion and nurturing, on the other hand, not only feel good but make us more healthy and less stressed. Building closer social connections even spurs the repair of shortened telomeres.

The pathway to lower stress is clearly marked. Why not take it?

A Buddhist approach to anxiety and panic.

So I've been spending time lately listening to dharma talks (not familiar with Buddha-speak? think "sermon") and guided meditation recordings from Josh Korda of Dharma Punx NYC, whose plain-speaking approach and ability to connect Buddhist wisdom to 21st century neurology even newbies will find friendly and rewarding. (Free audio downloads here.)

Along the way, I encountered a talk entitled "Anxiety relief", which I found to be of real value. Trust me, you don't need to renounce the world and become a shaven-headed monk to appreciate the Buddha's wisdom regarding coping with anxiety and panic. In this talk, Korda talks about the seven anusayas, or underlying tendencies of the mind:

1. The tendency to latch onto things that feel good

2. Fear of things we have no control over

3. Views and opinions about how we think the world should be and people should behave

4. Lack of faith in things that are good for us in the long term but don't pay off immediately

5. Self-centered thinking, or the tendency to take everything personally

6. The lust for life, or desire to live forever

7. The ignorance of what causes our stress (in Korda's words, "We tend to blame the world and the people in the world for all of our anxiety and our stress and our discomfort, when in fact it's created by the mind itself...As the Buddha said, we shoot ourselves with arrow after arrow after arrow. We tell the stories in our heads over and over again of how we've been wronged, and that causes so much more pain and stress than the original event")

Korda goes on to discuss how the anusayas cause stress, anxiety, and panic:

"The Buddha's perspective is that these tendencies are always present, and they're waiting for something to attach to...And then something comes along, the Buddha said, and we make what's known as contact...and then out of this contact...an underlying physical stress and mental mood arises...Then the thoughts come up, trying to explain why we've got this stress or sudden craving...

The entire mechanism, as the Buddha explained, is largely unconscious. There's the unconscious tendencies, then there's the unconscious contact...then there's the underlying physical and mental state that arises, and then finally consciousness notices...

Then the mind begins to shrink, awareness begins to shrink, and we start going into projections, maybe the future or what people are thinking of us...and the mind rifles through possible explanations [for what we're feeling]...If we leave it unchecked it can blow out into panic attacks or avoidance tendencies.

(Sound familiar?)

Korda then goes through the Buddhist approach to dealing with anxiety:

1. Work first with the physical symptoms; bring tranquility within; don't fight acute anxiety by trying to figure out the source of your anxiety

2. Practice restraining the mind from thinking about things you have no control over; train the mind to focus on things we have control on here and now

3. Take care of yourself. Eat well, have good conversations with wise people, get enough sleep...

4. Tolerate the inevitable rather than taking it personally (Korda: "I was humored to read about the number of people who got virulently outraged after the huge snowstorm that there was snow on their street...")

5. If you've identified a source of stress, avoid it if you can (Korda: "This is one of the 'duh' ones...")

6. Be aware of the body when you have anxiety, and immediately discount any thoughts you have at that moment; those thoughts are not to be trusted

7. "If you have even the most minor of daily meditation practices, that goes an enormous way toward taking your amygdala off of its hair trigger"

Good stuff. Try it; it can only help.