Stress, it appears, is part of life. I recently read a new book, "Workplace stress: Past, Present, and Future" (2020), by Don DeCarlo and Judge David Torrey. The book is focused upon the workplace specifically, and divided into three chapters focused upon the existence of stress, workers' compensation compensability of stress claims, and then methods for addressing stress. Of course, the workplace is where we spend about two days out of our week (48 hours). Many spend another 56 hours each week sleeping. Those two account for over half (104) of our weekly 168 hours (24 x 7). Despite that math, a great many often feel as if sleeping and working is all they accomplish.
Somehow, we still find time to be stressed. Stress contributes to our individual lives, the occurrence of injury and disease, and is costly. Staggeringly costly, "roughly $100 billion yearly."
The authors define stress as a "'non-specific' response of the body to any demand made upon it." Stress is thus not singular, but plural. There are a variety of responses to outside stimuli: "physical, mental emotional strain or tension" or "a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize." The authors contend that the scope of stress is increasing, as the term is used to describe "progressively broadened" items and categories.
The book is timely, addressing the subject matter through the lens of our collective 2020. There are references to the "COVID-19 pandemic," and "the death of George Floyd," but curiously not specifically to the senseless violence and destruction we watched. The scope is broad than 2020, however, acknowledging our news-focused society, various economic challenges, foundational shifts in the way we work, and our old friend social media. I recently abandoned social media with the exception of a daily LinkedIn visit, and have found the move nothing but positive. I have experienced not a single bit of remorse regarding my absence from the toxic soup of social media.
There is a palpable suggestion in this book that we may subject ourselves to stress in the decisions that we make regarding subjecting ourselves to social media, livestreams, alerts, news services, and more. Do you find yourself longing for a period when there was less "instant" access to so much data, invective, and diatribe? Perhaps you are being subjected to stress merely by reading this review of stress? I can think of nothing more potentially stressful than having to listen to me.
The authors point us to the accepted "commonly mentioned personal stressors." We seem persistently worried about commonalities such as work, money, time management, other people, and doubts about our futures. Whatever our personal causation, the statistics support that most of us are experiencing stress; more than our grandparents did. The authors contend that stress is "universal." And, they suggest that we do not get the periodic relief from stress that was more common in a less-connected world. Our stress, they warn, is persistent and chronic.
And, it is affecting us mentally and physically. The authors contend that "75-90 percent of all doctor visits are due to stress related illness." They provide a laundry list of conditions to which "stress is intimately linked." The list is troubling and the maladies all too familiar. The impacts in terms of treatment, hospitalization, and lost productivity are discussed. The economic impact is said to be a productivity loss "to the tune of $300 billion each year." Combined with the medical treatment cost above, stress approaches half a trillion dollars annually.
The text provides definitions, legal attempts to categorize mental/emotional claims by state workers' compensation laws. The most challenging of these, the book says, is the "mental-mental stress claims that were virtually non-existent in the past," but which the authors see gaining a growing acceptance. Interestingly, this acceptance is specific to the "courts." But, there has also been legislative acceptance of such claims for special employees in recent years also.
We are reminded ot the existence of stress as a universal experience. It is not, it seems, an isolated experience of the "first responder" (or other special people); is is not, it seems, isolated to work, home, family or any such singular characterization. It is all around us, permeating, pernicious, and persistent. The authors coyly remind us of challenges in definition, likening our struggles with defining stress to the absurdly vague definition of obscenity foist upon us by the U.S. Supreme Court: "I know it when I see it." As a legal standard, that phrase is untenable, but in the context of personally understanding stress it is perhaps worthy of consideration. Stress, we might agree, is highly personal and subjective.
We are reassured by our guides here that stress may be "normal" and even positive. It is a natural human reaction any of us might experience (thus, the "flight" response). But, the authors warn, too much of this normal human reaction may be detrimental, damaging, and overwhelming. While the focus here is workplace, the authors concede that stress has many causes and that we may cross-contaminate, bringing our personal stress to the workplace and our work stress home.
An old friend of mine used to claim that he began each day eating a green frog, whole, from his garden. He said that way, no matter what, the day always got better as it proceeded. Perhaps stress is related as much to how our expectations are met as it it is to the actual occurrences we encounter? Might we be less stressed if we were better informed, less surprised, less frequently ambushed?
The book is replete with examples of what may cause stress both in and out of the workplace. As the experience of stress may be very individualized and subjective, these lists may or may not be of assistance to a particular reader. I would suggest, however, that it is also possible to experience generalized stress and anxiety without specifically identifying the source. For that purpose, it may be of benefit for the reader to review these lists and to ponder how one's personal feelings align with the potentials they suggest.
This lengthy book is divided into only three chapters. The first provides definitions, examples, constructs, and detail. However, there are familiarities and recurrences that help the reader to find identification with the topic. Chapter Two brings the focus back to the occupational arena, focusing on workers' compensation laws. Here, the reader may readily discern the influence of Judge Torrey. His style and prose are familiar to us after decades of reading. Chapter Three is focused upon our reaction to the challenges of stress. It provides some guideposts and channel markers for our consideration of our stress responses.
The authors concede that stress has been well covered, but remind us it remains debatable, despite being less-often debated of late. They focus us upon PTSD, and the paths by which some states seek to accommodate such complaints either on a population or special employee basis. In the inimitable Judge Torrey style, Chapter Two "features tables in which the laws of the state and federal programs are identified and specifically referenced." Judge Torrey is the Rembrandt of comparative law tables. That is all the more admirable considering that his subject (the various laws) seem sometimes to have been painted by Jackson Pollock with an attitude.
The authors help us with categorizing mental health claims, describing "three categories . . . crucial to the understanding of how mental injuries are treated by workers' compensation laws." These may not be all encompassing, but they are a framework for our comprehension. Despite the challenges of the topic, the authors suggest states have been successful in defining these claims with reasonably "bright lines" of definition.
There are definitions, history, and theories. There is then discussion of perceived arguments in favor and against compensability of mental injury claims. Many will find solace in those arguments, "pro and con, with regard to compensability," but may wonder whether one's personal solace is in the reinforcement (confirmation bias) of one's predispositions or in an academic analysis of the strengths or weaknesses of either argument. A careful reading of both sets of arguments, in a dispassionate perspective, is worthwhile (even if that requires repeated re-reading).
There is also an interesting discussion of the perceived rise of the mental injury claims in the 1970s, and the label of "crisis." The perceptions, judicial interpretation ("liberally allowing"), legislative reaction, and resulting further perceptions illustrates a pattern that some may perceive as all to familiar in statutory law. Though our topic is workers' compensation, many would argue that this community is an illustrative exemplar of statutory lawmaking writ large.
The context of this analysis in workers' compensation is also discussed in view of the larger complexity of mental health. There is acknowledgement here that mental health issues present challenges that are complex. The authors discuss "landmark cases" that began the consideration of mental workers' compensation. They are interesting and informative. Not the least of which harkens from Florida in 1954, involving the onset of "chest pain and other maladies" when an employee was "shocked when lightning struck the" workplace. Despite no visible wound, the Court reversed a denial of benefits, strictly construing the statute in which the court could find "no definition which limits the word to a visible wound."
It is likely fair to say that the state of mental injury compensability in 2021 remains complex. There are a variety of themes present in the various states. More intriguing, however, are the various interpretations and exceptions that are possible within a particular state based upon factual settings, or more generalized criteria.
The authors note that arguments for and against compensability abound. They note that "the most compelling argument favoring compensability is that mental injuries and their causes are no longer great mysteries." The pro argument also apparently takes solace in the conclusion of Arthur Lawson that "drawing a distinction . . . is simply 'unsound.'" In this conclusion, we have the solace of "modern science" (which gave us the Thermogram and more recently the assurance that no COVID vaccine could possibly be developed in less than 18 months). Science, it seems, is not infallible (just ask the "don't wear a mask," then "everyone wear a mask" scientists we've recently watched vacillating).
It is interesting also that Professor Larson's conclusions are cast in a criticism of "reluctance" regarding mental claims, which "contrasts markedly with their stated desire to liberally construe workers' compensation statutes." Of course, the "liberal construction" paradigm has been eroded in various jurisdictions and outright rejected by statute in others, including Florida. There is no discussion of this foundational erosion. When a fundamental premise changes, do we re-examine the results previously rendered on that premise?
A more compelling argument is perhaps the safety interrelationship of the workers' compensation equation. Many see liability for workplace injuries as a detriment to employers. They perceive the threat of that detriment as the encouragement for employers to strive for safe workplaces. Thus, they contend, if mental injuries are not not compensable then this "provides the employer with no incentive to work on reducing stresses that are hard to detect, or to create a more bearable or pleasant working environment." This argument pre-supposes that employers can diminish stress, and perhaps assumes that workplace stress in that two days per week we spend there is more predominant than what we all face outside of work?
The other perspective, advocating against simple compensability of mental claims is largely based upon the challenges with verification of both existence and causation of such maladies. There are perceptions that diagnosis is difficult to objectively establish or verify. There is also a perception that given a wide path to compensability, such claims might "place an economic burden on the workers' compensation and occupational disease systems." The consensus in this perspective seems primarily the ultimate downside rather than the merits of inclusion or exclusion based upon principals of workers' compensation.
Admittedly, all people face stressors both in home and work environments. However, the onset of back pain while lifting a box at work is probably compensable to some extent (perhaps only as exacerbation or aggravation of a pre-existing condition, but that is a discuss ion of degree). Lifting a similar box at home is not compensable. Much of the compensability determination in such an event (without the more obvious, witnessed, sudden, trauma) may depend upon the chronology, credibility, and consistency demonstrated. Thus, some might argue that complicated and difficult evidentiary challenges are not isolated to mental injury claims.
Or, is the difference that there might perhaps be a greater volume of such credibility claims, or resultingly just more claims generally, and thus impacts upon resources? The authors note that "to blithely say that questions as to cause can simply be fought out in dispute resolution before compensation judges is not a satisfying answer to these concerns." They also note the impacts of lost time, "discovery of the most invasive kind," and the potential for animosity and friction between employer and employee in the litigation of such credibility-dependent claims.
The discussion of the competing perspectives and arguments is worthy reading.
Chapter Three of the book suggests paths toward addressing stress. It reemphasizes at the outset that stress is real, pervasive, and potentially "overwhelming and harmful" to us all. The fact that it may be chronic and persistent is also noted. The chapter returns to the opening discussion of causes, and encourages introspection.
Introspection is a path Americans seem to covet. The authors note that "the self help industry is valued at $10 billion." We are all striving to be a better something, somehow, someway. Might we address our stress by reading a book, gaining perspective, reflecting? That path has not been fruitful with our other challenges, but self-help books nonetheless abound. We are unique, different, and evolving. What is workable for one may be excruciating for others, in any context. That complicates any analysis of macro systems with a construction intended to accommodate our individualism while maintaining a overall consistency and predictability.
The authors focus us, in closing, on recognizing that stress may be aptly approached in either a remedial or preventative methodology, or perhaps both. There is a value, they stress, in recognizing the impact of stress regardless of the compensability potential, or workers' compensation context. There is value in recognizing and dealing with stress in the context of wellness or overall personal health, a necessary adjunct of which is occupational health.
In this moment, I digress for the professionals reading. You are literally employed for the purpose of shouldering the stress and challenges of others. Lawyers, doctors, nurses, case managers, adjusters, and more take on the impact of stressful situations that are not of their making nor of personal import. And, we nonetheless make those impacts personal. We empathize, sympathize, and allow others to offload their stress and anxiety upon us. We shoulder it, embrace it, and encourage it ("tell me how this affects you"). Despite our professional training or attempts to remain above circumstances, that stress can become crushing, debilitating, and darkening. As professionals, we owe it to ourselves and those around us to recognize the potential and to focus on our well being.
So, I close with my personal advice. Exercise daily, whatever that means to you. I find a way daily to be outside and to raise my heart rate. Find outlets to bring those periods of relief from the onslaught of this world. Disconnect from the feeds, streams, news, and other socially mediated stress. There is much in our lives which we cannot control, but finding daily moments of peace and respite are well within our control. If, that is, we choose to do so. Understanding our sources of stress, our most effective personal methodologies for mediating stress, and our personal path out of stress is critical.
This is in keeping with the themes in "Workplace stress: Past, Present, and Future." First, that stress can be understood and discussed. Second, that there are valid perspectives on stress that are worthy of consideration. And, finally, that despite the inevitability of stress we are capable of addressing stress in our lives, occupationally or personally.
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