Stress and the Workplace
Question: which of the two people below is most susceptible to heart disease?
Person A: The CEO of a large corporation. He drinks in excess, smokes like a train, and loves red meat and bacon. He eats these every day. He is overweight and likes ice cream at night.
Person B: Janitor of the same corporation. Rarely eats red meat. Has a low-fat diet. Doesn’t smoke or drink and exercises every other day. His weight is normal.
Are you ready with your answer?
The correct answer is Person B, the janitor, and by a wide margin.
Are you surprised?
Where you are in the pecking order has a greater influence on your susceptibility to Coronary Heart Disease (CHD), than any other risk factor. This holds true for humans. It holds true for other primates.
These are the results of the Whitehall and Whitehall II studies conducted in the UK. These studies are longitudinal studies. They follow the individual test-subjects over a long period of time taking periodic measurements of the variables of interest. Follow-up studies are often done and, in the case of the Whitehall studies, are still in progress.
Whitehall I began in 1967 and examined the mortality of 18,000 male civil servants between the ages 20-64 over a 10-year period. The study showed that the job position and mortality from Coronary Heart disease (CHD) were correlated. Men in the lowest pay grade had a three times higher mortality rate than those who worked at the highest level. Controlling for various risk factors such as obesity, smoking, and exercise still showed employees at the bottom of the totem pole had 2.1 times the risk of those at the top.
One possible explanation cited in the study was job control and job support. Those at the top had more control over their jobs than those at the bottom. The risk factor that differed the most between the top and the bottom categories was smoking. Exercise was also more prevalent in higher status jobs.
In 1985 a similar study called Whitehall II was performed. It involved 10,308 civil servants, one third of which were women.
The Whitehall II study had similar findings. It concluded that there is a social as well as a hierarchical gradient that corresponds with probability of death from CHD. Where one is in a pecking order matters. Even those just one step from the top have rates twice as high as those at the very top. The gradient was adjusted for such things as obesity, exercise, smoking, blood pressure and hundreds of other variables yet the gradient remains. Other factors accounted for only 25% of the gradient.
The difference between the top and the bottom again was dependent on how much control the individual exerted over his or her environment. Not being at the top creates stress and makes one liable to greater morbidity. 1
Research into the social rank and health in primates such as Macaques has shown similar correlations. The lower one is down the hierarchy, the greater the stress on the individual.2
When studying genes and human DNA, one can get attached to the concept that our genes and our interaction with the environment stimulate gene expression and thus dictate our performance and mental state. Our genetic makeup becomes the source point of our long-term behavior, our susceptibility to disease, as well as our physical attributes, and thus indirectly how we feel.
While this is certainly true, it is incomplete because stress turns this idea on its head.
Stress is one instance where one’s mental state can control gene expression. Our thoughts matter and can influence our bodies even to the genetic level. In addition, this is true whether a threat exists in the environment in actuality, or is just imagined.
Stress does have a genetic component in the form of the CYP17 gene which controls the manufacture of cortisol. To understand its impact on stress and the susceptibility to disease requires we become familiar with a chemical compound that has played heavily in health news: cholesterol.
Cholesterol has gotten a bad name. It shouldn’t.
It is part of a group of organic chemicals called sterols. Sterols are a type of alcohol. In chemistry, there are many kinds of alcohols not just the one you drink which is called ethyl alcohol*. Sterols occur naturally in plants, animals and fungi.
Cholesterol is a sterol. It is essential to all animal life mostly because it is required to build and maintain membranes such as those that surround a cell. Without cholesterol, the multi-cell organism would not exist. It is that important.
Cholesterol also plays a key role in the manufacturing of certain steroids.
A steroid is a modified sterol in the sense that it is larger and more complex. Steroids also have a bad name because of their connection to sports doping. The stigma is not deserved. Without them humans would not exist either.
Steroids are found in animals, plants and fungi. There are hundreds of distinct steroids. In the human body many steroids act as messengers. They are released in one part of the body and affect cells in other parts of the body. Such messengers are known as hormones, hence the class of compounds called steroid hormones.
Cholesterol is used to build several different steroid hormones such as progesterone and testosterone which are fairly familiar. It also makes cortisol, also known as hydrocortisone. It, too, is a steroid hormone. The creation of cortisol from cholesterol is regulated by the gene, CYP17A1. Inhibiting this gene has also been used as a possible treatment for prostate cancer.
Cortisol by its association to stress has also gotten a bad reputation. It weakens the activity of the immune system by suppressing the alertness of the body’s white blood cells, but like many aspects of genes it has many other functions. Cortisol controls the body’s ability to retain water, regulates potassium and sodium levels, contributes to skin health, and has a role in fetal lung formation during pregnancy.
Just the same, high cortisol levels are indications of stress and a weakened immune system.3
What seems to be at work here is that if we view life as out of our control, then we feel stress. Those at the lowest levels feel they have the least control of their lives. They have to show up on time, leave on time, not do this, and only do that. They have to follow orders, or their survival is jeopardized.
If this concept is true, then if one believed one had control, would not the stress level go down and with it the corresponding health risks?
In 1975 another longitudinal study was begun at the Illinois Bell Telephone Company. The study followed 430 male and female supervisors, managers and executives. Each year they were subjected to a battery of tests.
In 1981 deregulation occurred, and the company’s work force dropped from 26,000 to around 12,000. This was a time of intense change. Jobs, functions, responsibilities, and scope changed monthly. The study was nonetheless continued through 1987.
Approximately two-thirds of the employees experienced health effects similar to those in the UK studies as a result of the lack of control and the stress from this workplace turmoil. The other one-third not only suffered no ill effects, but thrived during this period. Their familial relationships improved as well as their status in the company. They experienced no adverse health effects.
The common denominator of this one-third was three key beliefs:
Commitment: They decided to become involved in the process.
Control: They decided to take an active role and try to influence outcomes rather than believe themselves powerless in the face of change.
Challenge: Changes, whether good or bad, stressful or non-stressful, are opportunities for learning.4
The study of the human genome and the brain has created many new insights into how the body and the mind interact. The relationship is not as simple as “genes dictate long-term behavior”. It is also not as one-sided as the concept that the environment is projected into our retinas, and the brain processes the result. Life is more complex and interesting.
The reality is that the brain internally manufactures what we see as much as it receives external inputs.
The actuality is that the mind can command genes and genes can command the mind.
Both channels are a sophisticated avenue of two-way interaction.
It is neither mind over matter, nor is it matter controlling mind. It is both.
*Technically, an alcohol is any organic compound containing one or more hydroxyl groups (OH) attached to a carbon atom. There are many types of alcohol depending on the number of carbon atoms. For instance, there are methanol (wood alcohol), ethanol which is drinking alcohol (C2H5OH), isopropyl or rubbing alcohol, butanol, and others. Note that the chemical formula for rubbing alcohol is C3H7OH which is different from drinking alcohol and significantly more toxic to humans.
- Ferie, J. E., (2004) Work Stress and Health: The White Hall Study II. London, U.K., Published by Public and Commercial Services Union of Council of Civil Service Unions/ Cabinet Office. Retrieved March 14, 2013 from http://www.ucl.ac.uk/whitehallII/pdf/Whitehallbooklet_1_.pdf
- Riddick, N, Czoty, P., et al. (2009). Behavioral and Neurobiological Characteristics Influencing Social Hierarchy Formation in Female Cynomolgus Monkeys, Neuroscience, 158(4): 1257-1265. Retrieved March 14, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170522/
- Ridley, M. (1999). Genome, The Autobiography of a Species in 23 Chapters. New York, NY: HarperCollins
- The Illinois Bell Telephone Study: How Hardiness Began, The Hardiness Institute, Inc. Retrieved March 14, 2013 from http://www.hardinessinstitute.com/?p=776.
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