Many employees drag themselves to work even though they are feeling under the weather, suffer from insomnia and have aches and pains everywhere. They turn to medication for temporary relief.
Occupational health doctor and father to small children, Jani, 37, has suffered from depression, concentration problems and insomnia for several years. He has been to see a psychiatrist and tried depression medicines in various combinations to help him get through the day.
A couple of years ago he ended up misusing medicines usually prescribed for the treatment of ADHD because they were suggested to him by a private psychiatrist. Usually ADHD medication is used to manage hyperactivity and concentration problems but for people who do not suffer from these, the medicines act as pick-me-ups.
So the psychiatrist prescribed Jani ADHD medicines to help him cope with work, instead of giving him sick leave.
"I can get through the day at work without anyone being none the wiser but when I get home I'm all done in. After every stretch of holiday I have, I think I will cut my working hours but that never happens."
While he is usually able to offer employees who come to his office a chance to see a psychologist or to get some other form of medication-free therapy, Jani himself feels trapped.
"I've stopped taking medicines because they didn't help but I'm not really feeling any better."
When looked at over a longer period of time, working life and illnesses related to it have undergone a sea change. Employees need to have much more varied skills than in the past and their duties may be almost as demanding as those of their supervisors.
A specialist in occupational healthcare from themedical centre Aava, Marja-Terttu Lähteenmäki, says that while in the past people used to suffer from heart illnesses and physical strain caused by work, they now struggle with stress, mental health problems and substance abuse.
"Substance abuse has been on the increase in recent years. People self-medicate with alcohol to cope with insomnia and work stress. Use of drugs has also increased, particularly among young people."
According to Lähteenmäki, many employees say they use sleeping pills daily even though in light of some recent statistics use of sleep aids is on the decline. People coming to see Lähteenmäki also often ask for sleeping pills, to her surprise as these medicines should not be taken unless absolutely necessary.
"People come in expecting the doctor to prescribe strong medicines that work."
Jani has also come across this phenomenon, seeing every day at least one employee who suffers from depression, burn-out or insomnia.
"I renew at least one prescription for these problems every day. But the work does not change with the help of pills. Changing working conditions is the route we should be taking," says Jani.
One reason why so many people use medicines as a crutch to help them through the day is that employees are often left alone to cope with their problems. They turn to medication as a quick fix because in many workplaces duties have been divided in a way that means there is no one who is capable of helping a person drowning under an ever-increasing work load.
People may also expect more of themselves – they want to carry out their job to perfection.
Many feel they are irreplaceable at work, making it difficult for them to take a long sick leave as the longer they are away, the more daunting the idea of going back to work becomes.
"I often come across defensive behaviour and tendency to play down the problems when people talk to me about their duties and how demanding these duties are. They think that if they could cope in their 20s they have to cope now too," Jani explains.
Work and support
Jukka Vuori, a research professor at the Finnish Institute of Occupational Health, says that how well employees cope at work is directly linked to the work community and the support network it offers. Studies have shown that in the short term people are able to cope with even highly stressful situations if they get support from their work community.
Nowadays there are no informal occasions for sharing information the way there used to be as people do not have chats or talk about their jobs to a similar extent.
"There used to be a lot more chatting in workplaces. Now work communities with active social interaction are few and far between. Problems with exhaustion are prominent among self-employed people as they've got no one to turn to when tasks start piling up," Vuori explains.
Other factors explaining why people continue to work even when ill are shame and fear. People self-medicate and hide their problems out of fear of being shunned in the work community or even being fired.
Leena Kaila-Kangas, an expert from the Finnish Institute of Occupational Health, who has studied the connection between depression and musculoskeletal symptoms, says that prejudices against and faulty notions about mental illnesses are still common even though, along with musculoskeletal illnesses, mental problems are the most common cause of long sick leaves.
Kaila-Kangas says that there is also a strong link between the two causes: prolonged physical discomfort causes depression and, on the other hand, people suffering from depression are more sensitive to pain, while having no resources to look for treatment or manage the physical symptoms.
"Patients with depression or some other illness are often so tired that they have no energy left to try to make changes," says Kaila-Kangas.
Because of this, workplaces should foster an atmosphere that encourages people to get involved and intervene in problems instead of employees with depression being left to their own devices.
Lack of support
Riitta, who has worked in the care sector for a number of years, suffers from long-term depression. She left her previous job because of workplace bullying but feels she does not receive enough support from her supervisor in her current job.
"I told my current boss about my depression but I think they are taking advantage of my illness. Work meetings often take place when I'm away and decisions are made without me having a chance to have a say. And I'm not given any duties with a higher level of responsibility."
Riitta, who feels she is being discriminated against, has tried to stop taking medication for depression several times but finds it difficult.
When her boss is around Riitta feels anxious and tense.
"I have contacted the health and safety officer several times but they have not done much to help. We don't have a shop steward."
Riitta believes that the situation in her workplace would improve if the employees were offered more guidance, whereas at the moment all the stabs at improving working conditions seem to be directed at making the supervisor's work load lighter.
Jukka Vuori agrees that it is unfortunately very common for bosses to get support while employees are left to cope as best they can even though everyone is under a similar amount of pressure. The risk of burn-out skyrockets if employees feel they have been caught between demands from both clients and bosses.
Occupational health doctor Jani also feels under pressure for several reasons. Resources at his workplace do not allow the company to hire extra employees, and having high work ethics, Jani does all his work conscientiously.
"Of course it's ironic that I treat my patients and give them advice but don't look after myself. My work is affecting my whole life but when you have a hefty mortgage and a job you like it's difficult to make changes."
Usually the best way to improve wellbeing at work is to make changes to the job so that it is not too taxing to allow a normal life. In some cases, working can be beneficial to recuperation as long as the tasks are not too demanding.
Work should not leave employees feeling constantly tired, causing them to be forgetful, have concentration problems and view the future in bleak light.
"In the worst case scenario, burn-out can lead to long-term mental health problems and loss of ability to work. People often misguidedly think that an employee who needs to take long sick leaves cannot be fired," Jani sums up.
Jani's and Riitta's names have been changed.
Ida Roivainen – HS
Niina Woolley – HT
© HELSINGIN SANOMAT
Image: Klaus Welp