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mental health mondays :: employee of the month

one of the things that makes mental health difficult to manage is that it can be difficult to tell which are the symptoms and which are the root causes of a disorder. another is that sometimes the symptoms can disguise themselves as things we normally value. both of those things collided for me reading this piece in the atlantic, which deals with the possibility that work addiction may be a coping mechanism employed by people with post-traumatic stress disorder.

the idea isn't particularly farfetched; after all, 52% of men and 28% of women with ptsd will at some time in their lives meet the clinical criteria for addiction. and ptsd is often first identified through habits linked to displaced anxiety. and what gets linked to anxiety more than a demanding job? but drawing the line between the two isn't quite as easy as it looks.

work addiction isn't accepted as an addiction disorder in the way that alcoholism and drug addiction are. that makes it a little difficult to talk about overwork as a serious mental problem at all, although it's not like we haven't been bouncing the term workaholic around for decades. [and yes, that article questioning whether or not work addiction even exists is from the same publication that more recently wrote about it being related to ptsd.] getting psychiatric experts to agree on whether or not something constitutes a disorder is not an easy process, because in order to be accepted, it should conform to a pattern established by other disorders. questions of whether withdrawal from work meets the same criteria of addiction as opiates do is complex. unfortunately, the complexities don't filter through to the broader public, so when something isn't accepted as an official disorder, the impression is that it's not that serious. [to be clear, i'm not saying that every condition posited as a disorder automatically is one, just that the lack of official sanction isn't in itself a wholesale dismissal.]

further complicating things is the moral premium many cultures place on work. there are lots of articles on the toll of overwork, the decline of satisfaction at work, and the seeming inability of businesses to address the problem, even when they want to. japan, of course, is held up as the ultimate example of a culture with an unhealthy work obsession: as unbelievable as it sounds, there is really a word for "death by overwork" [karoshi]. but while japan may be the leaders, it's not like things are that much worse than in north america: more than 20% of japanese workers put in more than 80 hours of overtime a month, but 16.4% of americans do as well. that emphasis on the "goodness" of work means that people who are harming themselves through overwork often look like the sort of people we should all be emulating.

for people with ptsd, then, compulsive overwork can be a very successful way of hiding in plain sight. ptsd sufferers seek ways to cope with pain by medicating; only rather than using an actual medication, they use work. after all, even if you discount the money you can earn, work can be rewarding because it garners you admiration and praise, something that childhood abuse victims, for instance, crave. it can also generate sympathy. many of us have worked in places where a clear workaholic has been referred to as being incredibly dedicated, self-sacrificing and strong. those are things that trauma victims desperately need to know.

but medicating through overwork is also different than drug addictions, because it gives the sufferer something they can control. in that way, it might actually be similar to anorexia and other body dysmorphic disorders, which are linked to fears and memories of helplessness and powerlessness. being able to assert control keeps the trauma at bay, but keeping that "high" becomes more and more difficult, until...

treating ptsd is incredibly difficult, as is treating addiction. [and some promising potential cures are more controversial than the diseases.] add to that the complication that this compulsion is still not a clinical problem and it's unlikely that a solution is coming any time soon. but that doesn't mean that  nothing can be done. for now, if someone seems like they're putting way more of themselves into their job than they should, consider that it's a warning sign. ask whatever questions you feel you can, of the person, of coworkers, of anyone who might be able to help. it may not be the most satisfying approach, but raising the subject at least means the subject is out there.

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