Apr 12, 2017

Stress Induced Depression – An Illness of Epidemic Proportion

Vijay Sampath

The VUCA world is wreaking havoc on mental health
Change induced stress is appearing frequently
Depression is a major illness caused by change induced stress
Learning to cope with change will help people beat stress and depression
An epidemic of depression in the VUCA world?

During a recent visit to my dentist, I was waiting for my anesthetic to take effect and overheard her counseling a young man about his headaches.

She explained to me later that he was suffering from depression, was taking multiple anti-depressants, and essentially imagining his headaches were caused by physical issues.

This incident triggered some thoughts that had been bothering me for a while. I am increasingly coming across signs of depression, even among materially successful individuals. One very successful business owner recently confessed to having been treated for depression, caused by work setbacks. I have recently met several friends or former colleagues whose traumatic career experiences have set off acute depression that seems to have permanently disabled their functioning.

Grappling with work, family and social pressure is taking a heavy toll on one’s mental well-being. Sudden transfers, job loss, new technology or process, change of leadership, M&A situations, economic meltdown, commuting pressure, social pressure, pollution, the uncertain futures for our children….the list goes on.

The narcissistic parade of trivial successes and lux lifestyles on social media posts and pressure to perform in social media is adding to performance anxiety and loss of self-esteem.

At a global level, people have to cope with unexpected and unprecedented change, as nations and societies reinvent themselves. From the fallout of Brexit, the divisive US elections, the horrifying march of terrorism, the disappearance of balanced politics, to the growth of muscular nationalism and for us in India, the shock of demonetisation. The shrill and negative news of daily turbulence in our economic and social world, has everyone permanently rattled and on edge.

What connects all this is that change has become overwhelming and relentless, and the recovery time between change shocks is diminishing. In earlier times, as recent as the early 90’s, livelihoods were predictable and socioeconomic change infrequent and less disruptive. Today’s fast moving world, well defined by the term VUCA – Volatile, Uncertain, Complex, and Ambiguous, is like a machine gun spitting out change bullets.

Learning about change to beat Depression

The critical thing I notice in personal interactions and on social media is that people are unaware, unprepared and untutored in understanding how to cope with change.

Maybe, if we knew what to expect in the change process, we would be unafraid to express ourselves naturally, and come out of the change situation faster and healthier. Wouldn’t this ensure our performance levels are sustained?

The best model I have come across, and one that some have probably been exposed to, is the Kubler-Ross model of coping with change. Elisabeth Kubler-Ross propounded this model in 1969, in her book, On Death and Dying. Her study focussed on the emotions of terminally ill patients at the University of Chicago’s medical school.

There cannot be a bigger change stress than that of impending death. The ability of the subject to cope with this ultimate and irrevocable change is beyond doubt “the” benchmark of human emotion. Not surprisingly, this study has been extrapolated by behavioral scientists and applied to many life and work situations.

Kubler-Ross’ model describes five stages of coping or adjustment, popularly expressed in a sine curve. These five stages are Denial, Anger, Bargaining, Depression and Acceptance. These are presented in the diagram below. (I have presented them in beige color and have taken the liberty of adding in blue, a few intermediate emotions that I observed in adapted studies)

Her model begins when a sudden change causes a sense of “Denial” in the subject. This is characterised by a refusal to accept the fact that the change has occurred and the denial of the consequences. From this point it’s a short step to “Anger”, where the subject vents her negative emotions on some presumed causal factor or scapegoat. Often the anger is filled with self-pity: “Why me”? Anger is manifested both silently and vocally.

The subject then starts “Bargaining” with the situation- “Give me one chance to redeem myself”, “If I lived a few months longer I could settle my affairs in peace”. The bargaining is futile as the change event is irrevocable and only creates a sense of false optimism.

The reality and permanence of change sinks in finally and leads to depression. The mind becomes unbearably sad and hopeless. At work, the symptoms include lack of motivation or enthusiasm, low energy levels and distracted participation. In personal life, the symptoms include a withdrawal from social life and disinterest in any aspect of family life.

This is the tipping point. Here is where intervention and treatment (if necessary) have to kick in. Delay in recovery makes this a low that is then hard to climb out of. And when depression becomes clinical, it can have devastating consequences including suicidal tendencies.

Luckily, most of us climb out of this abyss of depression pretty soon. We start seeing the need to move on when we “accept” the new situation. The subject is still fragile and will be doubtful of the changed state. In the Acceptance phase, he will move gingerly, not knowing what lies ahead. At this point, people have to be treated with consideration, kindness and leniency for experimentation and mistakes. Otherwise, the slide back to depression is very likely and easy. Given the right mental conditioning and empowering conditions, the acceptance phase can rapidly lead to renewal and growth.

Though it is popular to explain this model in sequence, Kubler-Ross clarified that she didn’t intend for the five stages to be linear or comprehensive. Instead, she said, these were a set of “commonly observed behaviors” and all of these need not occur in a standard sequence.

While this theory remains untested by substantial research, it continues to provide a fascinating yet simple input to plan for change or while experiencing it.

Leaders of organisations or families will find the Kubler-Ross model helpful in preparing for impending change. I have found it to be useful in counselling people, who have been in career trauma situations, arguably the corporate equivalent of a terminal illness.

Some people never bounce back from negative situations because they get trapped in the quicksand of denial and depression. Their failure to rebound is a collective failure of society, in failing to address the grave mental health challenges in today’s fluid work and life. Given the rapidly mutating conditions of the modern world, it is imperative for leaders to address this condition and “teach” people to learn how to cope with change and its expected consequences.

So when we go to sleep today, let us wonder how prepared we are for tomorrow’s change.

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