Psychiatric Annals

Patterns of Executive Stress and Depression

Harold M Visotsky, MD


1. Frankenhaeuser M: Quality of Ule; eriieria for behavioral adjustments. Internai ioml Journal of Psnhnlogr 1977: 1212:99-??0.…

Today's executives face a particular type of stress inherent in their highly mobile and demanding careers. The problems of executive stress frequently lead to depression, and ultimately, sought-after psychiatric treatment. This article examines the causes and effects of the problems facing so many of the members of the business world.

Depression occurs within every sub-culture in our society even though the precipitating factors and the particular symptoms or manifestations often vary greatly. These variations depend upon learned responses and values held by each particular group; but the depression, nonetheless, is basic and must be examined and alleviated. Depression is a syndrome with a number of dimensions. It is a psychobiological reaction with social overtones, affecting the totality of the human being, the bodily functions, the emotions, the behavior, and the individual's impact on his immediate environment.

One of the foremost aspects of depression isa history of changes in the mental state. The onset is slow and insidious. When depression affects the busy executive, the problem of pinpointing the origins becomes a difficult one. Like the emperor and his wardrobe, executives are not confronted by their staffs or peers when psychiatric symptoms gradually begin to appear. Severely depressed individuals who are socially, politically or professionally prominent will frequently refuse treatment, medication, and electroconvulsive therapy due to fear of this knowledge reaching the press with disastrous results. Executives, whose lives are commanded by routine and filled with stress and who function in an industry which sets them apart, frequently are alienated from their workers. The symptoms and signs of depression are often missed, ignored, or denied.

Depression is characterized by a number of symptoms. They can be grouped into the following major categories.

Affective Symptoms: Manifest in the lowered mood or the loss of spirits frequently following a diurnal pattern.

Psychobiological Symptoms: Affect the basic functions of eating, sleeping, digestion, and sexual activity.

Cognitive Symptoms: Relate to the elements of selfesteem, apathy and futility. Other frequent signs are boredom and lack of concentration.

Somatic Symptoms: Encompass a variety of bodily aches and pains. These symptoms (headaches, backaches, and fatigue) are the ones which bring the patient to the doctor.

Finally, there is the patient's philosophic viewpoint in general. During a period of depression, a person's outlook is often characterized by a sense of helplessness, or hopelessness, with a degree of despair, selfrecrimination, lack of motivation, and pessimism.

Man does not become ill in a vacuum; the surroundings and the circumstances of life play a significant role in illnesses. Work exerts a compelling influence upon a person's social behavior and relationships. One of the major precipitating causes for the onset of depression is related to work and job stress among executives. In a 1980 Gallup study the perceptions of over 300 executives from the United States* 1,300 largest corporations were studied. The responses indicated a basic pattern of job pressures and stresses which affect physical and emotional health. The executives stated that they worked 60 to 70 hours per week (no child labor laws or 40-hour weeks for this group of individuals). These people have open-ended jobs with no definite work hours. They travel six to ten days each month and frequently put their careers before family and health.

Companies are built on shorter product cycles (ie, they have to get the products out from development to production in a short period of time). Companies with such marketing philosophies see their executive employees scheduled for short, or shorter, executive cycles. The turnover of products and people becomes more frequent and frenetic.

Professional and technical populations are the most mobile of all Americans. Affluent executives move more frequently than even technical populations. In contrast to the "brain drain" from Europe in the past decade this country has what could be called a reverberating brain movement: executives moving from company tocompany and a shifting business migration from all sectors of the country. Corporations relocate executives not only because of corporate need, but also in response to training requirements. This movement, even if it only produces manageable stress on the executive himself, will affect the significant family members enormously. The adjustment reactions of children, adolescents, young adults, wives, and even housepets must be considered.

For many executives, the average residence in one place is less than four years. An in-housejokeat IBM is that the letters "IBM" stand for, *Tve been moved." Fortune magazine, in a recent study, surveyed over 1,000 young executives employed by major American corporations and found that one out of three held a job that had not existed until this executive stepped into it. Job turnover, therefore, is not merely a direct consequence of technological change, but it often reflects mergers and acquisitions that have occurred in industries.

The Labor Department states that, under conditions prevailing since the late 1960s, the average 20-year man in the work force can be expected to change jobs from six to eight times. Any change in a job entails a certain amount of stress. The individual must change old patterns, habits and ways of coping, and adapt new ways of doing things in new surroundings. Old relationships are abandoned and new relationships must be formed quickly. For the first time, obsolescence appears to be an imminent problem for management, because for the first time, the relative advantage of experience over knowledge seems to be rapidly decreasing.

Climbing up the executive ladder is part of the great American dream, but for some it has become a nightmare. Is executive burnout the price for reaching the top? Even solid American companies, where job security was oncea comforting tradition, are now turning the screw on their executives. A midwestern utility recently established a new policy of demoting inefficient executives and cutting the salaries of nonproducers. At one time, if you stayed in the executive game long enough, you got rich. Now, if you stay in long enough, you have as equal a chance of getting ill as you do of getting rich.

Organizations change their table of organizations and their internal shape with a frequency that is stressful - titles change frequently, executives are transferred, and responsibilities are shifted. Vast organizational structures are taken apart, restructured, and reassembled in new forms. Departments and divisions originate overnight, only to vanish in another reorganization. Acquisitions, mergers, de-mergers, conglomerates, disinvestures, and reacquisitions are occurring. This process obviously adds to the stress of all executives.

At Duke University Dr. John Rhoads (personal communication, 1980) found the following complaints, in order of frequency, among overworked executives: fatigue, depression, insomnia, irritability, loss of sex drive, apathy, anxiety, diminished concentration, gastrointestinal disturbances, memory impairment, suicidal thoughts, chest pains, confusion, crying spells, excessive smoking, general aches and pains, dizziness, and shortness of breath. Other related types of "business symptoms" are: poor quality of presentations, inappropriate delegation of authority and assignments, and poor judgment in previously competent individuals. Symptoms of sadness are frequently seen as tiredness. Feelings of failure associated with depression are lost in the confusion of balance sheets, or reversals of the Dow Jones indices. Thirteen-hour work days accompany promotions and salary increases. Entertaining, drinking, and eating are frequently part of executive tasks. Fatigue drives the executive home, where drinking leads to relaxation.

Denial is also a predominantly career-associated defense mechanism among executives. To admit or to complain of illness diminishes the executive's stature. Alcohol and drugs mask depression and are used to "treat" fatigue, thus concealing the illness. Many executives present themselves at the initial work-up denying the presence of depression.

The corporate balance sheet has indicated that the cause, directly or indirectly, of more than half of the medical problems company doctors have to treat is stress. Stress is not only troublesome, but extensive. Many corporations are beginning to admit that "stress is costing us a lot of money." One personnel director for a large New York company became concerned with the problem when the company's medical department reported that 2,400 employees a month were using the medical services - the equivalent of the entire employee population was going through the medical department every two months.

A study at the midwestern utility company revealed that 20% of those under high stress became ill. The most frequent stress-related illnesses and problems noted were: cardiovascular changes, hypertension, arrhythmias, ulcers, anxiety, depression, increased accident rates and suicides. Also linked to recent life changes and stresses are multiple sclerosis, the onset of diabetes, tuberculosis, and leukemia.

Yale University's Adrian Ostfeld studied 2,052 workers at the Western Electric Company in Cicero, Illinois (personal communication, 1964). The link between on-the-job stress and heart disease was found to be significant. Stimulation of the sympathetic system affects the heart and stimulation of the parasympathetic system, through the vagus nerve, affects the sinus node. Those who reported most stress had 1. 8 times the chance of developing cardiac pathology, a fatal myocardial infarction, or chest pain than workers reporting less work-related stress.

Another contribution to executive stress is the growing trend of company policies toward early retirement. Companies are also using early retirement to clean out "deadwood." Some of the reasons given by corporate industries for the rise in executive stress are as follows

* Increasing federal regulations about equal opportunities for women and minorities.

* Dead end positions. Bosses are not as capable as they used to be; they need to have greater skills and broader training.

* Competition for high-paying jobs. More people are "gunning" for the executive jobs than ever. Each year more than 60,000 are graduated with master's degrees in business administration to start their climb up the executive ladder.

* Competition from foreign and domestic companies. This competition, as well as the fluctuating value of the dollar abroad, adds to the traditional worries of inflation.

* An erosion of power. At one time, the executive was often the absolute boss. But federal regulations, court decisions, labor unions, and stockholders' coalitions have eroded this ultimate authority. The executive still carries big responsibilities but often has less control over solutions.

On the whole, the higher the occupational level, the better (on the average) is the mental health and the coping capacity of these executives. They have been able to deal with threatening forces on their climb up the corporate scale. But it is the executive's emotional distress which causes even a relatively small reduction in the quality of performance to have far-reaching effects on subordinate personnel. It is the cumulative effects of stress that seem to affect executive health. It is important to assess the mental health of executives. There are a number of factors which can be clues to emotional distress and the assessment of adaptive competence:

Appearance. The lack of usual conventionalized aspects in dress may signal emotional distress. First impressions and external appearances are very important for this group, and any change in appearance may signal a change in health status.

Ability. Coping skills are used defensively rather than accepting new approaches or analyzing information. This signals a decrease in resistance to stress. In senior executives, a drop in mental acuity, gaps in memory, and factual errors in thinking may be due less to any of the cerebral-vascular changes than to hidden emotional distress.

Affectivity. When executives reach their goals, they may experience feelings of obsolescence and depression from their inability to find further meaning or purpose in life. Compensations must be found for "summit loneliness" and the dread of retirement.

Authority. Many abnormal stress reactions and hostile conflicts in organizations spring from unawareness or inability of executives to tolerate certain psychodynamic forces, often originating in early childhood. Such examples may be reactions to authority figures, identifications formed under previous superiors, or their own perceptions of themselves as authority or father figures.

Attitudes. The executive's attitude toward health care (including mental health care) for himself and his employees is important. It is important to know whether he can reduce his dependence on alcohol, or drugs, or even on more "work" - all of which simply compound the stress.

Adaptability. The maintenance of executive mental health depends on motivation, temperament, mature judgment, ego strength and, most importantly, the capacity to cope with change. These are essential elements in appraising executives who are working in stressaccumulating situations.

Marianne Frankenhaeuser from the Karolinska Institute in Sweden has an interesting theory. She says.

Special attention should be given to risks involved in over-stimulation, one of the hallmarks of the technologically advanced society and an inducement to "live faster" in order to keep up. Over the long run, the most serious consequences of over-stimulation are likely to lie in the emotional sphere, in the process of habituation. When we are bombarded with excessively many, too strong, or too frequent stimuli, the response of the nervous system gradually weakens, the stimuli lose their impact, and the reactions are toned down. The physiological stress effects become less intense, and feelings of distress and discomfort may even fade. But so do the feelings of involvement, empathy, and consideration for others. By its very nature, emotional erosion is an "invisible" process, and there is a risk that we will not notice the gradual attrition of our capacity for psychological involvement.1

Frequently this is the beginning of a slip into depression.

Executives who cope with stress share three common characteristics:

1. The belief that they can control or influence the events in their jobs.

2. An ability to feel deeply involved in. or committed to, the activities of their lives.

3. Anticipation of change as an exciting challenge to further development.

Executives who got sick were less hardy and felt powerless, nihilistic, and poorly motivated for achievement. When stress occurred, they were without recourse for its resolution, gave up what little control they possessed, and succumbed to the incapacity of illness.

Long hours do not make the executive sick. If work is enjoyable, and if it provides a reasonable amount of freedom of time and judgment and is free from immediate supervision, there is no reason for the person to become ill. Those who are able to work long hours without suffering exhaustion have an ability to suppress and postpone thinking about problems until it is appropriate to confront them. They are able to recognize and deal promptly with fatigue and they have a good sense of humor. Humor is essential to cope with frustrations inherent in any work, and provides a sense of proportion. Those who worked beyond their endurance had few outside interests, had little sense of humor, never took vacations, worried about problems when it was inappropriate to do so, and failed to realize they were pushing themselves too hard.

The important factor in dealing with executive stress and depression is first to recognize, and to make the executive recognize, stressful reactions. Frequently it is important to focus on the physical symptoms and relate them to the executive lifestyle. At that point the treatment of the depression (and later, the focusing on the stress factors) can be useful to increase the individual's capacity to cope with stress.

In the executive health-promotion area, companies are bringing in psychiatric consultants to work with executives and their spouses. There are many strategies for handling job stress: meditation, biofeedback, insight therapy, exercise, and an assessment of personal strategies aimed at changing one's work environment. There are also organizational strategies for handling job stress. They may be directed at changing the organizational process, structure, and programs, changing role characteristics or job conditions and tasks. Finally, strategies should be aimed at changing the person. An intervention such as psychotherapy, the use of training and coping skills, and reworking the support system of the individual can be very helpful in maintaining the recovery of depression.


1. Frankenhaeuser M: Quality of Ule; eriieria for behavioral adjustments. Internai ioml Journal of Psnhnlogr 1977: 1212:99-??0.


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