Worried Sick: A Prescription for Health in an Overtreated America

Twelve: Working to Death

Chapter 1 introduced the notion that longevity in a resource-advantaged country is largely predicated on socioeconomic status and employment. The most powerful life-course hazards relate to impediments to the pursuit of nurturing, gainful employment. That such is true for any who have no gainful employment is obvious. A life­ time of poverty, even tottering on the edge of poverty, is a lifetime likely to be base, mean, often discouraging, sometimes desperate—and short. Poverty is defined as a disposable income less than three times what is necessary for subsistence in your community. Some living in poverty are so desperately poor that inadequate shelter and nutrition are mortal threats. But not all are quite so desperately poor. What is it about a lowly socioeconomic status (SES) that is so malevolent? The clues derive from studies that explore life in poverty, or on its edge, for elements most closely associated with compromised longevity. Multiple psychosocial factors have emerged. Some factors operate from conception. There is no reason to think that a small number of such factors will emerge. Something about the loss of self-respect and the resentment, if not hostility, that results from the sense of abject vulnerability associated with and imposed by poverty is clearly detrimental. There are hints of other associations from life-course studies of nutrition, life-stage maturation, and more. Much remains unknown, but it is clear that the array of psychosocial challenges to be faced in poverty day by day, and that prove insurmountable day after day, levy a toll on health and longevity like none other in the “advanced” world. Poverty in nations that are not resource-challenged is a reproach to both their political systems and public-health agendas. However, the dreadful consequences of the psychosocial milieu that is poverty can be dissociated from “poverty level” or other measures of disposable wealth. Employment is no generic solution. There are aspects to life in “modtwelve chapter Working to Death 172 | working to death ern” workforces that rival the psychosocial aspects of poverty in extracting a toll on healthfulness and longevity. For example, downsizing and outsourcing may warm the hearts of stockholders, but they assault the happiness, health, and longevity of the targeted workforce. A consistent story is emerging with major implications for the health of the public. Working Well Do you like your job? Are you valued at work? Do you feel justly served? Is your job secure? These four questions deserve a prominent place in whatever caring community life affords us, let alone in clinical history gathering. They should anchor a major public-health initiative. They demand a prominent place in the body politic. Untoward answers associate with much personal pain and clinical morbidity . Untoward answers harbor crucial secrets to longevity, even for those who could change jobs. For growing numbers of workers whose answers are untoward, job mobility is not an option or leads to less acceptable alternatives. For growing numbers of the aging workforce who commenced their career assuming a meritocracy and expecting job security, this reality comes as a surprise with awful personal consequences. Most of us are all too aware when employment is such that it would elicit a negative response to any or all of these questions. Most of us could verbalize our awareness. Very few of us, if any, can leave this awareness in the workplace at the end of a workday. Very few of us realize how such adverse circumstances play on the other aspects of life. Interpersonal relationships outside of work are strained. Tendencies toward substance abuse are unbridled to various degrees. I am not downplaying these aspects in the least. However, in keeping with the thesis “worried sick,” I am going to focus on another predictable adverse consequence : the culturally facilitated tendency to somatize. If the psychosocial context of working is adverse, your sense of invincibility will be compromised and you are at risk of feeling ill. As illustrated in chapters 8 through 10, life for all of us presents challenges to coping with unusual and unpleasant symptoms—morbidities. We will all experience variations in mood, intermittent musculoskeletal discomfort, occasional headaches, episodic respiratory symptoms, and much more in the way of intermittent and remittent physical distress. To be well, to feel invincible, is to have the personal wherewithal to cope with both the physical and the psycho- working to death | 173 social challenges that cannot be wholly avoided, if avoided at...