Presented at
Women's Health 2000: Creating New Models for Comprehensive care
Sacramento, California
January 21, 2000

Women in the Workplace: From Stress to Strength

These remarks are dedicated to five women in my life:

my wife - Lynn Lippin
my mother - Margaret Lippin
my daughter - Melissa Lippin
my sister - Lisa Cornelius
my mother-in-law - Esther Dienstman

This is my first presentation in the new millennium and nothing could please me more than it occurring at a conference on women's health because frankly women's health and leadership may indeed be the key to all of our success in the 21st Century. Certainly we could do better than the testosterone-dominated 20th Century. I thought to myself that it is more than irony that the name of the now worlds largest company "Microsoft" is also a urologic term- This paper will be fundamentally about our new millennium, a new world of health and a new world of work and its impact on stress in the workplace, especially as it relates to women. On the optimistic side, it will argue that, in these new worlds of work and health, working women are poised to transform stress into strength which will translate into individual success for working women and institutional and societal gains. When Marlene von Fredrichs Fitzwater asked me to speak at this conference, I began to ask myself why I had taken a particular interest in the issue of work stress in women in recent years. Since childhood I have had an interest in how "the mind bone was connected to the body bone" which has now become known as mind/body medicine. This was reinforced by my own personal experiences in medical school by the stress of my own medical education process and its impact on my own health and the health of my medical student colleagues especially the women in my class. Also, growing up as a child I observed how hard my own mother worked "without pay" in our home to raise me and my siblings. This observation has extended to my wife and my own home and family. As I began my career in the early 1970s at a multi-national chemical company where I remained until just a few weeks ago, it became very obvious to me as an occupational physician that stress was the most important factor in determining worker health and productivity outcomes and that without a doubt women in my particular company and industry were differentially stressed both personally and professionally. In this particular presentation I'm going to cover the following topics. The first is that work stress and its health and productivity implications represent a major public health problem that needs to be addressed soon. Furthermore, while I am not an authority on work stress among women in particular, the data demonstrate that working women are differentially impacted by this particular problem for many reasons which I will address. Thirdly I believe that there are indeed effective individual and institutional interventions that need to be brought to bear soon as it relates to managing this issue. Clearly, both individuals and institutions need to participate. Fourthly, as the world of work radically changes, especially in Western nations, as we speak, I believe women will have a differential capacity to succeed at work as leaders. Finally, these opportunities in the new world of work will help to transform stress for women into strength, stress management into stress competence.

So, to begin, what evidence do we have that workplace stress is epidemic -- for that matter, even a serious problem at all? One indication might be the number of published studies addressing this topic in recent years which has accelerated at a rate of 90 studies per year, far greater than many other fields in medicine and psychology. Workers compensation claims for stress related conditions have been rising steadily. An analysis by the Northwestern Mutual Life Insurance Company found that the % of stress related claims more than doubled from 1982 to 1988 (from 6-13% of total claims. And did you know that 70% of all persons receiving workers compensation claims have no demonstrable physical findings. Between 1990 and 1995 1 /3 rd of American Management Association (the other AMA) member companies reported downsizing of workers and the proportion of employees now working 49 hours or more has increased 20% since 1980 causing the US surpass Japan as the most "workaholic" nation on the planet. Even popular culture today reflects the magnitude of the work stress issues with movies such as 9 to 5, Working Girl and others you could think of I'm sure. Characterizing work in America the nineties someone said you know you've worked in the nineties when you've sat at the same desk for 5 years and worked for three different companies or where the definition of vacation is something you rollover into next year or is a check you receiver every January. And of course the ever popular ®filbert cartoon series with over 150 million readers and growing now appearing in over 1,500 newspapers in over 17 languages and 40 countries. I applaud cartoonist and social critic Scott Adams for using art as a means to both reflect and raise our awareness of the issue. I suppose laughter is a means of coping but it needs to energize us to action as well.

The US federal agency responsible for occupational health research is known as NIOSH (The National Institute fir Occupational Safety and Health) This agency, incidentally headed by a remarkable woman, NIOSH's director, Dr. Linda Rosenstock, cites its own and others' data in a recent NIOSH publication, Stress at Work. A Princeton Research Associates survey states that 3/4 of employees believe that workers have more on-the-job stress than a generation ago. One fourth of employees view jobs as the number one stressor in their lives. Finally, from a health perspective, a St Paul Fire and Marine Insurance Company survey concludes that "problems at work are more strongly associated with health complaints than any other life stressor." Others might say that these data are simply employee response surveys representing a bunch of weak whiners whose expectations are unrealistic and are afraid of the good old fashioned hard work of previous generations. Well, I think not! A growing body of objective data would suggest otherwise. While we still need more work stress data, especially associated with women at work, there is abundant data that stress-related conditions in the psychological realm such as anxiety and depression are indeed epidemic and that stress-related illness and accident outcomes are growing. The data is especially robust in demonstrating the relationships of work stress to cardiovascular disease and musculoskeletal disease outcomes but is extending into many other areas such as infectious diseases and reproductive health. The relationship of stress to medical outcomes does indeed require acceptance of what I call a neuroscience-driven bio-psycho-social model of health care which posits that stress plays some contributory role in every condition each having its own attribution rate in all health outcomes, from acute illnesses and accidents to chronic diseases to wellness through peak performance. Clearly these health and stress-related accident outcomes could have a major impact on overall lost productivity, corporate success and even corporate imagine. With permission from Drug giant Smith Kline Beecham, I'd like to present two overhead slides which address stress-related outcomes related to psychiatric issues as well as medical outcomes. I applaud my friend and colleague Dr. Bob Carr, Corporate Medical Director at Smith Kline Beecham and his team for having the courage to begin to measure and manage this issue. We honestly don't know how much any of this is directly related to workstress per se versus personal stress at this time, but as we begin to tease out workstress data and differentiate it from home or other personal stress, we need to begin to act now. Also, in the new world of work, for good or for bad, there is an erosion of the barriers between what we call home and work. Hence, the personal versus workstress issues may become far less relevant. The head of NIOSH's Division of Applied Psychology and Ergonometrics, Dr. Steve Sauter, has collaborated successfully with the American Psychological Associations Dr. Gwen Keita Director of APA's Womens Program Office in co-chairing four major conferences on Work Stress beginning in 1991 which I urge you to attend in future years. It is probably the highest quality and most comprehensive conference on this important topic and you will learn a lot. One of the obvious needs in studies on women workers is the requirement to incorporate data on social factors such as income, marital status, household and child care responsibilities, amount of leisure time, hours of sleep as well as biological variables. Dr. Maureen Hatch from Mt. Sinai School of Medicine has recently documented an impact on menstrual function, for instance, among American and Italian nurses in high stress jobs including rotating shift work. Hatch also reports on a U.S. Bureau of National Affairs or BNA survey asking women to rate the seriousness of 11 hazards thought to affect women workers. In 1995 women respondents to the survey ranked stress as number 1. A leading expert in the area of work stress and coronary artery disease has argued that women's domestic responsibilities, the so-called "second shift," could prevent necessary biologic recovery time from job-related increases in blood pressure and other physiological factors leading to serious and chronic disabilities. My friend and colleague Dr. Jeanne Stellman Professor at Columbia University and an international authority on Women's workplace health issues has just completed the Herculean task of editing the 4th Edition of the International Labor Office (ILO) Encyclopedia of Occupational Health and Safety In a recent interview, in Occupational Health and Safety magazine, she stated that significantly more pages, 12 in 1983 and 87 in 1999, were dedicated to Behavioral and Organizational aspects of Occupational Health including work Stress and the much broader category known as Organization of Work or "OOW" a term you will hear more about in the future. Stellman also believes that there is significant official undercounting of women workers and citing that there is almost "universal" employment of women as home makers and child care and elder care givers or workers. We have the shocking statistic from the Federal government that homicide is the number one cause of female deaths at the U.S. workplace, accounting for 40% of deaths at the workplace. This is indeed a commentary not only on work but violence against women in our society. The notion that so-called "women's work" is safe compared to so called high risk "macho jobs" must be abandoned. Women's work, both paid and unpaid, is indeed work and much of it is exhausting and unsafe. Stellman calls for a closer look at the Leeweenhak scheme of classifying work which permits the incorporation of work at home as an objective measure. In some developing countries there is not even the pretense of gender equality yet ironically it is often the brawn and endurance of women that is prized. In regard to stress in the work place for women, there are many intuitive reasons why women should suffer more stress including the inherently more stressful jobs, greater difficulty in achieving work/family balance, barriers to career advancement and others. In the early art of this c nt~iry in th5 count on!y 2 bout one in seven women (or 14%) were employed outside the home. Today, women contribute to about half or @46% of the civilian work force. 73% of married women with children under the age of 18 and 85% of women without children under the age of 18 are employed either full or part-time. Employed women have reported nearly twice the rate, of stress-related illnesses along with the higher likelihood of "burning out" on the job than employed men. Certain job conditions are well-established stressors. These include among others, heavy workload demands combined with little control over work, the so-called "Demand Control Model first defined by Robert Karasak at the University of Massachusetts, Lowell. Unfortunately, this model is far too prevalent in many predominantly female occupations such as clerical workers, garment workers and care givers. Another classical stress is poor relationships with supervisors which again women seem to be more vulnerable to. Many women report supervisors as nonsupportive, disrespectful, and/or engaging in blatant harassment and surely these result in psychological and physiological symptoms. The number of supervisors that an individual woman reports to is also increasing thus resulting in more problem role ambiguity "what do I do?" and role conflict-"who is my boss?" So to reiterate on-the-job stressors that may be particularly geared toward women or so-called gender-specific stressors include sexual harassment, work/family balance, erosion of work life and home life and workplace violence to name a few. It is estimated for example that 50% of women will be harassed at some point during their career and that in predominantly male occupations like Medicine for example, this figure may be as high as 80%. Make no mistake about the fact that women still have predominant responsibility for household work despite their numbers increasing in the so-called "paid workplace." There is evidence of some sharing of home responsibility by males but it is still a small factor. Also while flex time and day care centers have provided some relief in so-called "family-friendly" companies, there are clearly not enough companies establishing these policies. Many employees still demand 110% while spouses and children still need clean socks in the draw, food on the table and a ride to the doctor or dentist. And in many cases if policies do exist , policy rhetoric often belies the true practice the underground or real corporate culture. There is conflicting data about the overall health benefits of work. Working wives contributed 23% of the 25% increase in family income adjusted for inflation since 1969. Women may achieve increased income and self-esteem in well designed work but many would say that this health benefit is more than offset by poor work design and workload issues associated with job/family conflicts. The role of the workplace physical environment also is a contributor and often combines with stress to induce psychological and physiological symptoms and diseases. Musculoskeletal problems in particular in poorly designed workstations such as computer operations, supermarket cashiers and other jobs which are predominantly populated by women. Imagine the physiological, environmental, psychological stress that the typical female flight attendant must endure in a commercial airline might experience in the year 2000 given the air quality issue and most especially the increasingly uncivil nature of overcrowded aircraft cabins.

In the career and advancement area, much has been documented as it relates to gains women have made in breaking the so-called "glass ceiling" but there continues to be a lack of parity of women in leadership positions in many companies. Of the Fortune 500 companies 11.2% of the board seats are held by women up from 8.3 in 1993 but 27% of the nations largest corporations have no women directors. We need to do much better Thus career advancement frustration clearly remains a stressor. A woman friend of mine who fought her way up to an Assistant Dean position at a Southern Medical University refers to a thick plastic lexan ceiling saying at least glass can break.

Well, what we do about workplace stress, especially its impact on Women? One thing for sure is that we need to emphasize both individual as well as institutional approaches. One without the other is not a comprehensive stress management program so biodots, relaxation tapes and motivational signage while helpful just don't "cut it". While there are traditional individual stress management techniques such as relaxation, cognitive restructuring and formal psychotherapy and psychotropic medications when indicated and a host of other effective individual stress management techniques, one contribution in particular that I have made in individual stress management relates to stress releasing techniques such as weeping, laughing, hitting and kicking exercises, responsible sexuality, writing, and engaging in the arts. I defined these in 1985 with apologies to relaxation response expert Herbert Benson as the mirth response, the weep response, the strike response, the orgasm response, the scribe response and the creativity response. Dr Angela Patemore of Essex England has also challenges "the relaxation gurus" by promoting a new and refreshing approach to stress suggesting that the most effective methods of gaining mastery over stress is to practice handling it, what she calls stress competency and others might refer to stress immunization rather than practicing relaxation thus avoiding what Martin Seligmen from University of Pennsylvania would call "learned helplessness". One stress releasing technique in particular that I have become increasingly interested in is the work of Dr. Jim Pennebaker of Texas who tells us that the very act of writing or as he calls it "disclosing one's emotions" is indeed health-enhancing. Dr. Pennebaker has documented clear improvements in health in terms of fewer visits to doctors and self-reported symptoms in people who "disclose." Several studies have shown increased immunocompetance and disclosing college students improved their grades in one study and a group of disclosing unemployed engineers were much more likely to find new jobs than were nondisclosing out-of-work associates.

However important the individual interventions, a much greater opportunity lies in institutional interventions or changes. We need Corporate Policies with teeth in them or where policies do not come forward we need regulations which are family and woman friendly, enough inspectors to enforce such policies where companies do not voluntarily comply, must be budgeted. Leonard Silverman, VP of Human Resources at Hoffman La Roche has been quoted as saying that "happy children plus happy parents equals happy employees, equals happy stockholders" We need swift and harsh punishment for sexual harassers. We also need career advancement based on true merit and properly designed and engineered work environments, workspaces and work took which protect worker health and safety. But there is reason to be optimistic and this optimism is based on the profound and dramatic changing nature of work in America and on new paradigms which I believe will favor women. As usual it will be the forces of the open marketplace which will drive the most dramatic change. First, in the new information age economy there will be increasing emphasis on innovation, creativity and intellectual capacity favouring brain, heart and gut over muscle. So l would ask that you not strive to become like men lest stress hormone related facial and chest hairs begin to sprout. Rather leverage your innate abilities because we are moving from industries based on muscles and testosterone to those requiring creativity, quickthinking, collaboration and rapid communication. Thus in a new information-based economy, computer skills and creative collaboration will has as much to do with success as physical effort and extreme competitiveness had in the past. Also, on a very fundamental level, we are slowly adapting principles and paradigms such as team-building sustainability, open communications, creativity and intuition where women may have perhaps a physiology-based temperamental edge over men. Thus, quick wit and nimble fingers where small muscled intelligent athletes rather than muscle-bound big-muscled athletes dominate the world of work. We will be replacing "road warriors" with "keyboard warriors" as Bell Telephone says: "Let your fingers do the walking."

I believe that the future belongs to those companies and organizations who possess the following characteristics: Almost all experts believe that innovation is critical. Business guru Peter Drucker says that speed of innovation is the most important variable in global competitiveness and creative demands double every generation or twenty years. We are truly entering a business age where environmental sustainability becomes a business imperative lest we destroy our planet and the resources in and on it, including ourselves. Thus innovative companies who recognize and act on this will have a competitive edge. In order for companies to be creative they must enhance their employees' intuitive abilities and work as much from the gut and from the heart as much as they do from the their minds and their genitals thus echoing the emphasis Daniel Goleman has made on the importance of what he calls Emotional Intelligence. Another friend of mine has proposed a course called qualitative thinking for the quantitatively impaired. In order for companies to move fast, they must maximize communication and collaboration by developing and empowering small and effective mission-oriented teams which de-emphasize outmoded hierarchical and bureaucratic corporate models. People Soft uses the ad you may have seen on television, "Employees want 'missions, not "jobs." I personally believe this is true. Given the awesome growing economic power of corporate multi-national giants, there must be new emphasis on corporate responsibility, especially in local communities where they operate or have their headquarters. Corporations must recognize their deep interconnectedness to their communities. It does indeed take a village or should I say "I village" to secure a healthy future for all of us. In the new economy the worn-out cliché phrase, "People are our most important asset" becomes an economic imperative. Where what I call the three "M's" of human assets management which have health, safety and productivity implications include measuring our human assets bases, managing them and maximizing them. Some economists are convinced that this capacity to leverage our human assets will be the constraining variable to economic success in any company in the future. In a more philosophic vein all of the above in essence relates to a love of life, love of our planet and a love of our fellow human beings which biologist E. B. White refers to as Biophilia. I must conclude that perhaps by biological temperament, perhaps by conditioning or by sheer free will and courage, woman are differentially capable of advancing these concepts in business, hence their increasing capacity and obligation to lead. Futurist Faith Popcorn calls this megatrend "femalethink" which is a new trend that reflects a new set of business and societal values encouraging us to shift marketing consciousness from traditional goal oriented hierarchical models to the more caring and sharing familial ones . My friend State Senator John Vasconcellos from this state of California cites in his seven historic revolutions a revolution in gender wherein women are encouraged to think and govern and men are encouraged to feel and become more vulnerable. Deepak Chopra says we are now re-entering a great age of Feminism. Recently I have been thinking about some of the great historic and contemporary role models of women business leaders and it is building on these role models, celebrating them and learning from them that sustains my hope. Actually we have had a pretty good year in 1999 with the appointment of Carly Fiorina who broke the cyber-glass ceiling in the worlds second largest computer maker in Hewlett Packer by becoming its CEO where I might add that 1/4 of its managers are women. I might also cite Andrea Jung as CEO of cosmetics giant Avon and Jane Friedman CEO of the huge publishing firm Harper Collins. And of course we would be remiss not to cite the courageous and competent performance of our nation’s first woman Secretary of State Madeline Albright. Moving to other arenas Astronaut Eileen Collins became the 1st woman to command a space shuttle and a US soccer team , thanks in part to title 9 kicked their way onto a Wheaties box and into the hearts of little girls and their parents all over America. And on the international tennis courts in acts of awesome athletic talent and filial support sisters Venus and Serena Williams excelled. And I just read in the paper yesterday that for the first time in the 16 year history of the highly regarded Sundance Film Festival that 26% of the 115 feature films are directed by women, twice the number shown last year. Finally I viewed it as a good omen that my jumbo jet flight from east to west coast on my way to this conference was piloted by Captain Deborah McHendry one of @150 female pilots in whom United Airlines and its passengers places its complete confidence.

In more recent years on a more philosophic note as we approach the end of the millennium I realized what a profound crisis our society seems to be in, despite unprecedented economic wealth we all are experiencing a sense of collective unease. Something at a very fundamental level is wrong. The age of anxiety truly has become manifest, part of the problem, I believe, can be attributed to the excesses of the masculine psyche and the male models of leadership. Perhaps by default, women should be given the opportunity to do better. On a more positive note, I had always observed, sometimes with awe, the power of women, especially in my own home and in social arenas. This translated not only into respect and admiration but also into love. This love has been reinforced and translated recently into a deep gratitude for women, recently reinforced by the aging of my own mother, age 82 this month and my own need to be grateful for her and other women in my life. My friend Psychiatrist John Diamond says that this love of women may be the key to humanities survival.

I'd like to close with two quotes not from women but from two great black men who like women in our country and elsewhere endured similar struggles. Martin Luther King said that "the arc of History is long but it bends toward justice" and Nelson Mandela said in his inaugural address to the Presidency of South Africa that "our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light not our darkness that frightens us. If, however, we let our own light shine we unconsciously give other people permission to do the same. As we are liberated from our own fear our presence automatically liberates others. So I wish each of you the courage to become in the world of work and through meaningful work your true selves. Thank you for your attention.

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