The Humanity of Mortals
Indications that people have long suffered transient and chronic incapacitating psychological states can be found as far back as the classical period in history. These include conditions of anxiety, addiction and melancholia. While certain attributes of these conditions have varied over time and across cultures, core features remain remarkably recognizable today and cut across geographical regions and economic strata. Specific problems such as anxiety, chemical dependence and depression may even be more prevalent now and emerging data suggest elevated rates of occurrence in individuals from higher socioeconomic levels.
While early studies focused on the epidemiology of mental health issues in the general workforce, increasingly we are appreciating the distinctive vulnerabilities of principal leaders. These include extended work hours, unremitting pressures to meet deadlines and financial goals, feelings of personal responsibility for the welfare of employees and shareholders, increased risk-taking, making unpopular decisions and over-commitment to name a few. When compounded by the inevitable universal life stressors such as death of a loved one, loss of a personal relationship, family problems or medical illness and it is not hard to understand when the psyche finally says “enough.”
The Hidden Burden
The World Health Organization reports that one in four people will experience a diagnosable mental health condition sometime during their lifetime and cites Depression as the leading cause of disability worldwide in terms of total years lost to the disorder. Unfortunately, estimates are that only one-third of individuals seek out effective, even life-saving diagnosis and treatment. Depression can be an insidious process and just different enough from person to person to go unidentified for extended periods. Reasons for this include poor understanding of depression, problems accessing care, and stigmatizing attitudes towards the illness. Even when identified as a potential reason for malaise and decreased ability to function, the tendency is to ignore supporting evidence and acceptance of the diagnosis can take time. Psychological health concerns themselves may be denied, due to incomplete understanding which may be further reinforced by community stigma. This stigma does not help prevent the effects of excess stress on the mind, but tragically prevents many individuals from seeking proper diagnosis, treatment and attaining full recovery.
The Myth of Invincibility
C-level executives operate under chronically high levels of stress which have direct and indirect negative effects on physical and emotional health over time if not offset by regular stress-relieving activities. While this seems an intuitive concept, it is surprising how many hard-charging leaders neglect their own well-being. Yet a crucial aspect of leadership competency is self-awareness. In my experience as a psychiatrist, being self-aware can distinguish exceptional from merely capable leaders and manifests in understanding one’s strengths, challenges, needs and motivations, as well as their impact on those around them. Top level leaders are becoming more and more proficient in taking care of their employees and implementing programs which emphasize employee wellness, yet they are very apt to exclude themselves from the directives given relating to their own health. Whether born out of healthy narcissism or habitual self-neglect, it is a functional denial of vulnerability. Denial is not an attractive feature of executive character, because someone eventually bears the burden of another’s blind spot.
The Many Faces of Proteus
Top-flight professionals and executives struggle with debilitating depression at least at the same rate as the general workforce. Whether it occurs as new onset at the peak of their career or intermittently through chronic relapsing and remitting illness over many years, depression impacts personal, financial, physical health and emotional well-being. Those high-functioning executives who find their way into a mental health specialist’s office generally do so at the request of a loved one or on referral from a general medical clinician. They frequently cite concerns about memory problems or unremitting fatigue, sometimes thoughts of suicide. On further questioning it emerges that the person no longer experiences pleasure from previously enjoyed activities, libido is marginal or non-existent and they are prone to bouts of irritability, anger or tearfulness. They may also describe any combination of exhaustion, lack of motivation, feeling stressed or burnt out, unremitting sadness, anxiety, insomnia, relationship problems, poor concentration, inability to make decisions, drinking too much alcohol or taking pills to get through the day, or night. There are high levels of overlap between depression and other common conditions, including anxiety and drug and alcohol problems.
Born out of Chaos
There is no single underlying cause of depression. Biological, psychological and social risk factors may contribute to development of the illness and the specific constellation of risk factors varies between people. Biologic risk factors include having a family history of depression, experiencing physical illness or injury, chronic pain, alcohol abuse, illicit or prescription drug use, chronic sleep problems, or pregnancy. A prior episode of depression is a risk factor for a subsequent depressive episode. Psychological risk factors for depression include low self-esteem, being overly self-critical, and feelings of having little control over life events. Social influences include stressful life events such as relationship conflict, caring for someone with an illness; experiencing a difficult or abusive childhood and unemployment. People differ greatly in the amount or type of risk factors they experience, and having several risk factors alone is not enough to trigger depression. A combination of risk factors and stressful life events may prompt the onset of depression. The greater the number of risk factors that a person experiences, the more vulnerable they are to developing depression when stressful life events occur. Any combination of personal or financial losses seems to make for the perfect storm, especially if they come in rapid succession to each other, over months to several years. In addition to the inciting loss, the nature of clinical depression is such that it can set in so deeply that it invites still further monetary, personal and career loss if it remains untreated.
Asclepius and the Return to Mt Olympus
Regardless of whether a person seeks help out of fear, desperation, first instinct or last resort, courage and trust are critical components of recovery. C-level executives generally have an abundance of courage and trust in themselves, but may struggle with trust outside their areas of expertise. However, once they realize that there is nothing to be lost by submitting to an evaluation, they can be well on the way to healing. The clinical evaluation will involve meeting with a clinician, such as a psychiatrist, psychologist or primary care physician who will perform a clinical interview. The results of that may lead directly to discussion of a proposed treatment plan or recommendation for further medical, neurologic or psychological testing. The time it takes to get back to normal may vary, and can involve medication and/or individual psychotherapy. Tincture of time is an essential element. Even the most capable people should know that a series of untoward events can overwhelm them to a degree they never thought possible. But if they seek help they can still come back and have a meaningful life and career.