A symposium devoted exclusively to the topic of career as it relates to depression is somewhat unique. Isolated papers have been written, individual lectures have been given, case histories have been presented, and anecdotes have been exchanged between colleagues in the mental health profession. Considerable literature has accumulated from the pens of the press and lay writers, but the mental health professional has been slower in attempting to develop more serious and structured research and literature.
The symposium presented in this issue of Psychiatric Annata attempts to identify and understand the causes and effects of career-related depression. The symposium was presented during the 1982 American Psychiatric Association meeting in Toronto.*
Life changes and stress as they relate to psychiatric illness have been subjects of much concern. The increased tempo of today's lifestyles, with an accelerated rate of change, has been indicted by many as a factor in psychiatric and psycho-physiologic illness. Stress (as a direct result of pressure) has both its positive and negative attributes. Some individuals thrive on pressure, for them it is not stress. Stress can be positive, alerting us to dangers and/ or leading to accomplishments with increased self-esteem and genuine gratification. Whilestress often leads to depression, the two cannot always be equated.
When patients present to psychiatrists in a depressive state, it is important to consider them in the total context of their lifestyles, recognizing effects upon the family as well as effects of the family upon the individual. Occupations certainly play a major role in our lives as well as the lives of our children. They occupy most of our lives, whether the vocation be that of a housewife, air traffic controller, corporate executive, blue collar worker or psychiatrist.
However, it is easy to indict career and overlook the positive aspects that an effective career has on us and those important to us. The challenge is to achieve a balance between a healthy commitment to a career and a good adjustment in one's personal life insofar as self, family, friends and others are concerned. An individual working effectively at his or her career sets a model for the family, especially children. Parents set models for their progeny in the manner by which they handle their careers - hopefully in a balanced, consistent, and effective manner. This career model need not be at the top of the pyramid but can be as a good, dependable employee in any occupation (be it plant supervisor or assemblyline worker).
With the changing roles of males and females and a more egalitarian approach to interpersonal relationships, parenting, and work, many old models are being revised. In many families the father is no longer the only one going out into the world, leaving the mother to tend the nest. Women and men now share the responsibility of developing the family while also contributing to the outer world. Careful observation and study is merited by social and behavioral scientists.
Careers can be a commitment to reality and not just personal gratification and a constant upward striving. Careers may be a rapprochement with outer society and not necessarily an escape from inner or outer reality.
In this self-oriented age, in which fulfillment of personal and interpersonal needs is stressed, there is almost a put-down of the work ethic in Western society in favor of the narcissistic need for individuals to find answers to their own problems without being overwhelmed by work - even to the point of minimizing certain responsibilities to society which, ultimately, are responsibilities to self. There is more to life than personal sexual fulfillment, personal spiritual fulfillment, social power and "doing one's own thing."
Careers may be used as a defense against, or a retreat from, personal relationships. When the defensive needs of the career collapse, when the commitment to the career is predominantly motivated by neurotic efforts to resolve early developmental conflicts and to maintain a precarious life balance, it can be most destructive - often precipitating a clinical depression.
It is this depression, and its interrelating causes and factors which we concentrate upon in this issue.