The sick workplace: how fear can drive up sickness absence
Uncover the surprising link between workplace fear and employee sickness rates, revealing how a psychologically unsafe environment can more than double absenteeism.
It is well known that medicines which have no active ingredient can nevertheless result in a positive outcome in patients, usually so long as the patient believes that they will be effective. The phenomenon of the ‘Placebo Effect’ is too well-documented to be dismissed and is widely accepted by scientists today. Countless studies have shown that while a placebo is typically not as effective as a genuine drug, it is often more effective than no treatment at all.
Less famous is the ‘Nocebo Effect’. Studies have shown that if patients have negative expectations about a given medicine, then they will sometimes experience worse outcomes than if they felt positive about it, even with a genuine medical treatment.
It is not immediately obvious why any of this should happen. If an illness were all in the mind, then it would be no surprise if the cure were found there also. But the placebo effect works on the symptoms of all kinds of malady, including real, physical ailments that are down to bacterial infections or viruses.
In 2002, the Cambridge neuropsychologist Nicholas Humphrey proposed a remarkable explanation.[1]
He observed that the body has a variety of methods for dealing with illness, from vomiting and diarrhoea to expel toxins to raising its temperature to create an inhospitable environment for pathogens. The drawback with vomiting, high fevers and the like, is that they can weaken and damage us in their own right. They involve a high expenditure of energy, with no guarantee that they will work. The body must make a judgment call, based on the information it has to hand, on whether to let the pathogen do its worst, or fire up its defences at the cost of incapacitating us. And even if running a high fever drove out an invading bacterium, that would be no use to our ancestors if their delirium rendered them easy pickings for any passing sabre-toothed tiger. Humphrey theorised that the body would only pull out all the stops if it felt safe to do so — for example, if it found itself swaddled in furs in a warm cave, surrounded by loved ones watching over it in the night. In this case it might decide the gamble was worth taking. The Placebo Effect manifests when we feel we are in safe hands.
Only then does the body feel that it is worth pulling its weight by, for example, cranking up the immune system to the maximum, the high calorific cost be damned. The effect is so strong that it can operate even when we know we are receiving a placebo, so long as the physician goes through the motions of giving care.[2]
Feeling unsafe really can make us ill, or make us feel the symptoms of illness more intensely. And it can keep us there, unable to shrug off ailments we ought to be able to cope with. But in a more supportive environment where we feel safe, we are able to shake these very same maladies more quickly, or function with symptoms that seem to be milder than they appeared when we lived in fear.
Humphrey’s theory is borne out by the team Ipsos Karian and Box and research they conducted in the last 2 years.
It has shown that the employee sickness rate in businesses where employees work in fear is 4.2%, which is more than double the rate of 1.9% boasted by low-fear workplaces. In a higher-fear environment within the retail industry, large stores suffer an average absence rate of 7.5%. This is worth 16% of their total salary bill — almost three quarters of which is the price of fear.[3]
‘Don’t worry about things you can’t influence,’ goes the old saw. The problem is that the more we are able to influence, the more we have to worry about, and these days we are able to influence a great deal.
Mental and emotional health concerns were given short shrift in the days when we had little understanding of these matters and few tools for dealing with them.
Since Prozac opened the door to a new arsenal of pharmaceutical treatments for anxiety and depression, and since post-Freudian psychotherapy brought evidence-based counselling to an analyst’s couch previously dominated by charlatans, there has been more reason to dwell on psychological issues rather than trying to ignore them. Employers cannot pretend that they do not live and operate in this new world. Neither should they complain about it. Ignoring the problem never did make it go away. We need to acknowledge it and recognise that it has a solution. Not only a solution, but also preventative measures.
Consider how many employees would question their organisation if their physical safety was not guaranteed. Now, with the same premise, how many employees would challenge their employer if they felt their mental wellbeing was not protected? When employees are psychologically well, then they are able to operate effectively and without fear of reprimand. This has a positive impact on both their morale and their overall performance – including whether they show up to work at all.
Research shows that outcomes for chronically ill employees are better the earlier they declare their illness. So, it makes sense that many workplaces now encourage employees to be open about their mental health. It is important to create an environment where employees take positive action before poor wellbeing leads to absence and/or attrition.
As the researchers Pieter Van Dijk and Andrea Kirk Brown put it, ‘enhancing perceptions of trust and respect which then leads to higher levels of positive affect towards the employing organisation are likely to create an environment where chronically ill employees feel confident in declaring, discussing and managing their condition at work.’[4]
Every single piece you publish I think, how can I remember all this to build in to a business case for my work. And, I wish I could have written that.
👏 again