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By Associate Professor Maureen Dollard, Director of both the Centre for Applied Psychological Research and the Work and Stress Research Group, University of South Australia

If you are reading this and haven't had some sort of threat to your wellbeing due to the stress of your job, like a flagging libido, high blood pressure, anxiety or even depression, you are one of the lucky ones. Or you may just lack exposure (recently appointed?), or you may even have enough resources in your job to offset demands (a supportive manager perhaps?).

And all the better if you remember what you have just read - you probably don't have hippocampal damage that comes about from chronic exposure to job stress. Recently, in a presentation at the University of South Australia, Professor Dick Dienstbier, University of Nebraska, reminded me (luckily, as my hippocampus has surely shrunk) that exposure to chronic work stress over time without sufficient opportunity for recovery leads to degradation of the hippocampus. This is a major problem not only for individuals but for knowledge organisations/industries and especially knowledge economies (which we claim to be), because the hippocampus is required for higher level cognitive functions. I highlight this because we always emphasise the emotional impacts of work stress and underplay the devastating effects it can have on cognitive functioning and on physical health. Under Australian law, workers are protected from psychological injury as employers are required to provide a Duty of Care under Federal, State and Territory OHS legislation. Further, under the various Workers Rehabilitation and Compensation Acts employees may claim compensation for psychological injury (an illness or disorder of the mind). What is not pursued at law often enough is the relationship between stress at work and its incontrovertible link to physical ill-health and death (Michie & Cockcroft, 1996).

Are jobs getting better?

Last year in Japan at the International Commission on Occupational Health Conference on Work Organization and Psychosocial Factors at Work International, Professor Wilmar Schaufeli from Utrecht University set an engaging scene in an opening keynote address. Using national surveillance data (European and North American) he proposed that working conditions have indeed improved in recent times, with workers now experiencing reduced work demands and increased job control. While it was intended to be provocative it certainly achieved its objective. A large contingent of international participants wondered how this conclusion could be drawn. Did the surveys miss itinerant, migrant or indigenous workers and their understudied conditions? Is it really the truth, reflecting the successful export of dirty jobs to emerging economies? Can the conclusions be generalised to emerging economies, or non-western economies? Or did the surveys only canvas those who aren't on the scrap heap?

In the meanwhile there was some food for the positive thought that jobs could theoretically be improved. Indeed, late last year a Green Paper issued by the European Commission, 'Improving the mental health of the population: Towards a strategy on mental health for the European Union', stated that "while good mental health increases work capacity and productivity, poor working conditions including intimidation by colleagues lead to poor mental health, sick leave and increased costs" (pp. 8-9). Further, it argues that, as people spend large parts of their time at work, the workplace is a crucial setting for action. It noted that interventions to improve individual capacity and to reduce stressors in the work environment will increase population health and economic development.

Contextualising the problem

But it is important to remember that people work in jobs, situated within complex organisations, and these in turn are embedded in economic, political, and social systems. Years ago Marx talked about the alienation of workers when their labour, land, and means of production were appropriated by others. Today we have masses of empirical evidence, mainly accumulated in capitalist societies, which show that lack of control in decision making, in choosing work scheduling and work methods (Karasek & Theorell, 1990), a lack of control over emotional expression, and a lack of meaning in work are major contributors to poor wellbeing, illness, and death.

While executive salaries increase to astronomic levels, as with the emperor's new clothing we turn a blind eye. When workers perceive their efforts are not matched by rewards (including the old fashioned 'you are doing a good job') they are found to be at risk of a host of stress related illnesses, including cardiovascular disease (Seigrist, 1996). We found in a community study that the mechanism through which this might occur is increased anger at work due to these perceived injustices, leading in turn to cardiovascular risk (Smith et al., 2005). And just as the wealth in organisations is unevenly distributed towards the higher echelons of the organisation, so the experience of stress and illness cascades downwards. It is well known that there is a socioeconomic gradient in relation to health status and that executive stress is largely a myth.

Added to this is a rapid pace of change in workplaces due to increased competition from the globalisation of the economy, with serious consequences for workers (Schabracq & Cooper, 2000). Take for example the Japan experience. The National Defence Council for Victims of Karoshi estimates that there are 10,000 deaths annually in Japan that are attributable at least in part to stress and exhaustion from overwork (News Updates, 2000). Many experts believe that 'Karoshi', meaning death due to overwork, and 'Karu-Jisatsu', suicide provoked by overwork, are modern phenomena which result from the dominance of enterprise in the Japanese culture, an intense work ethic, and the introduction of 'lean production' manufacturing systems (Nishiyma & Johnson, 1997). While advocates of the production system argue that it improves economic productivity, the relationship between lean production and Karoshi has been debated since the 1970s (Nishiyma & Johnson, 1997, p. 625). Global pressures and cost cutting measures upon which lean production relies, have led to reductions of staff in Japanese enterprises, and to Japanese workers reporting the highest average working hours in the world (Asia Labour Update, 2004). Research shows that the risk of heart attack for those working long hours (e.g., 11 hours per day) is 2.5 times the risk of those working an 8 hour day (Sokejima & Kagamimori, 1998).

The Japan experience is not so removed from the Australian workplace. Research published by The Australia Institute in 2004 found that Australians now work the longest hours of any country in the 'developed' world. Australian employees work an average of 1855 hours each year compared to an the developed country average of 1643 (p.1). Further, Chris Maxwell QC, in the Occupational Health and Safety Act Review (Victoria), March 2004, noted an increase in new and emerging psychosocial risks. "Patterns of employment have undergone fundamental change, in both the public and private sectors. Employers have sought to reduce output costs per unit, by aiming for improved productivity. 'Downsizing' and 'lean production' have been recurrent themes....There has been a rapid increase in flexible and insecure forms of employment. This has occurred in almost all OECD countries, but particularly in Australia. These work arrangements are referred to generically as 'precarious', 'contingent' or 'flexible' employment" (p. 25). Further, he noted that the number of occupational stress claims as a percentage of total claims is trending upwards, that there is an increasing level of stress among workers in a wide range of industries as a result of the changing nature of work, and coincidentally that union visibility in workplaces has declined. In fact, on a national basis, workers compensation claims for work stress increased by 62 per cent from 1996-97 to 2002-03 whereas all other types of compensation claims decreased over the same period (Office of the Australian Safety and Compensation Council, 2006).

According to Greg Combet, Secretary of the Australian Council of Trade Unions, the new industrial relations changes will reduce take-home pay and employment conditions. "They are a threat to workers' health and well-being with particular concern that there will be a significant rise in stress in the workplace. These changes are certain to increase job insecurity, work overload and bullying in the workplace, which are major contributors to stress in the workplace and are aimed at putting the power into the employer and taking away the rights of workers. This will not only have a negative effect in the workplace and on Australian families, but will also have a serious social impact on our country" (personal communication, 25th Aug 2005).

Yet we don't hear much about death statistics due to long working hours or to these poor psychosocial working conditions. Professor Bobby Banerjee, University of South Australia, has developed the concept of necrocapitalism by discussing contemporary forms of organisational accumulation that involve dispossession and the subjugation of life to the power of death (Banerjee, 2006, p.1). Drawing on notions of biopolitics (Foucault, 1980) and necropolitics (Mbembe, 2003), he discussed how contemporary corporate practices contribute to the subjugation of life in a variety of contexts. The fundamental feature is accumulation by dispossession; necrocapitalist practices destroy livelihoods, "they create death worlds, new and unique forms of social existence in which vast populations are subjected to conditions of life conferring upon them the status of the living dead" (Mbembe, 2003, p.40). Banerjee (p.1) discusses necrocapitalism in terms of "conflicts between governments, multinational corporations and indigenous communities, and the effects of development in rural areas of the Third World", but it can also be legitimately discussed in relation to worker experiences within the corporations, and the emergence of Karoshi, and Karu-Jisatsu.

And what worker characteristics are required for these 'dispossessed' environments? According to a managing director of an Australian call centre there are two types of people who make successful cold callers: extroverts and psychopaths - extroverts because they thrive on interactions with others, and psychopaths because they are not emotionally hurt by constant rejection (Warne-Smith, 2006). Should we select for these characteristics?

The role of psychologists

Psychologists have historically focused on treating the individual and so have situated themselves at the tertiary end of the stress intervention continuum. Work and industrial psychologists have much to offer in the prevention of stress at work, and in secondary intervention (e.g., running interpersonal conflict workshops). As Albee and Fryer wrote in the Journal of Community and Applied Social Psychology, 2003, "psychotherapy and other forms of individual treatment can sometimes reduce or eliminate phobias, anxiety, bizarre behaviour, depression and social withdrawal in some people but the rate of these conditions in the population does not reduce either, in fact they appear to be increasing" (p.71). The stress phenomenon is highly medicalised and we know that a common reason people visit their GPs these days is for work stress. Yet there is a clear and important role for work and organisational psychologists to facilitate work-based strategies to prevent and address stress and its associated negative outcomes for individuals and organisations.

Discussion about work stress has generally been avoided in organisations. It is a difficult issue because stakeholders view it with conflicting beliefs and values positions and ultimately any change requires resources (and resources in organisations are always finite).

A sticking point for many organisations is moving towards addressing work stress. Most international evidence points to comprehensive participation frameworks to enable participation by diverse stakeholder groups for the resolution of stress issues in the workplace. This promotes so-called dialectics first discussed by Max Weber, where the resolution of opposing ideas (the thesis and antithesis) leads to synthesis and then new understanding and practice.

Much like the idea of the Victorian Government's beyondblue campaign helping people become literate in mental health issues, a similar campaign also needs to be launched to help those at work become literate in psychosocial risk factors - the factors that cause stress in the first place - and to understand their consequences. Workers can be relied upon to know what local stressors are, and hearing others raise similar issues validates these concerns. Once identified, action needs to be taken to reduce the stressors, followed by feedback, and by evaluation to confirm reductions or inform improvements in the process that need to be made. In the field this is referred to as the risk management approach (identify, assess, control). Studies using this approach have found that workers can be relied upon to evolve actions agreeable to key stakeholders. While the approach is extremely important for improving the quality of the dialogue between stakeholders regarding work stress, there are some limitations. One is that there is a power differential between management and workers, and sometimes even between workers that need the guidance of a skilled facilitator. An obvious example is where the local manager is a bully. So here is a role for work psychologists in the facilitation of dialogue between key stakeholders at various points in the organisation to discuss the issue of work stress, to identify work stress risks, and engage in joint action to reduce the stressor.

A more important limitation is when the primary source of work stress is not at a task or local level but emanates from management systems, or even further upstream from broader socio-political-economic contexts. This is where social activism is required and is an area where psychologists feel least prepared. This is because our conservative tradition in the laboratory, and the attitude of scepticism and tentativeness about scientific findings renders us somewhat incapacitated as social activists. Psychologists can however work with unions and associations, regulators and policy makers for the betterment of working conditions.

Ultimately the impact of stress is felt at home and in the community. For example we found effort-reward imbalance to be associated with road rage behaviours like hanging out of the window and shouting at someone while in the car (Hoggan, 2004). So we see that stress affects personal wellbeing, and also the collective health of the organisation and community. As community structures break down due to the inordinate demands placed on modern workers - including the need for more frequent mobility of families and workers, long work hours, a blurring of work and family space - and as the problem takes its toll on the public health dollar, perhaps the community will take a stand. Now here is a new and innovative role for social and community psychologists.

Where to from here?

So how do we know if job conditions are getting worse? And what is the impact of new management systems in Australian workplaces? And what is the likely impact of the new IR laws on peoples' working lives? Australia is one of a few western societies that does not have a national surveillance system to assess psychosocial risk at work. We urgently need a national system so that we can monitor job conditions and at-risk groups. It will need to be robust and sensitive to reflect the experiences of those who usually don't have a voice in society. And it should give due consideration to the workers of Australian companies located in other countries (e.g., call centre workers). Given the world's economies are now globally interlinked, we need to consider economic achievements through the necrocapitalist lens. The epidemic of suicides in Indian farmers has been blamed on policies of trade liberalisation and corporate globalisation: "under globalisation, the farmer is losing her / his social, cultural, economic identity as a producer. A farmer is now a 'consumer' of costly seeds and costly chemicals sold by powerful global corporations through powerful landlords and money lenders locally. This combination is leading to corporate feudalism, the most inhumane, brutal and exploitative convergence of global corporate capitalism and local feudalism, in the face of which the farmer as an individual victim feels helpless. The bureaucratic and technocratic systems of the state are coming to the rescue of the dominant economic interests by blaming the victim" (Shiva, 2004). Meanwhile here in Australia, PhD candidate at the Work and Stress Research Group, Centre for Applied Psychological Research, Alison Wallis, recently found extremely high levels of psychological distress among dairy farmers following deregulation. Deregulation of the industry has exposed them to fluctuations in milk prices driven by world events, declining terms of trade where the profit margin between input and output costs is diminishing, environmental regulation pressures from the community and government, labour management issues, and increasing reliance on technology for successful farming (Wallis, 2006). As psychologists we can't afford not to look at these upstream stress drivers.

And what about when people lose everything, when their business or farm fails? According to one caller, when your business fails "receivers come and get all your stuff, and there is no support, while you feel like an absolute failure, and feel shame. There needs to be 'social-psychological' back up so that people don't kill themselves". Major support services are clearly needed in this area.

Those working in the informal economies (e.g. fruit pickers, building construction) are also at risk because they work in ambiguous jobs and are thus not acknowledged, registered, governed or protected under labour laws (Duraisingam, 2004; Duraisingam & Dollard, 2005). According to the International Labour Organisation (ILO) (2003), these workers are unable to exercise or defend their basic human rights as they have little or no collective representation. Yet they work in jobs characterised by inconsistent incomes, long working hours, insecurity, small or indeterminate workplaces, and hazardous and unhealthy work conditions, and have limited access to information, training, finance and technology (ILO, 2003), all well known psychosocial risk factors. The issue of work stress should be just as much a concern in developing economies as it is in industrialised economies, particularly among the informal sectors.

So, throwaway worker, if you think you have a load on your shoulders just imagine 10 bricks! And when thinking about the causes of work stress always remember to also look up (wards). And when theorising about healthy work, theorise in the context of a healthy society.

This article is based in part on a paper prepared for the international workshop 'From healthy work to healthy society', 31 May - 1 June 2006, Sweden Institute for Psychosocial Medicine, Stockholm. Kind thanks to colleagues for feedback on the article.


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