Not what the doctor ordered

10th January 2003 at 00:00
Stress can be a byword for dissatisfaction and anger, says GP Mike Fitzpatrick

As a GP I see a lot of teachers. Whether it's an inspection, problems with the head, another badly behaved child - or a badly behaved parent - teachers often come to the surgery complaining of symptoms of stress.

After offering a tissue and listening to the story, I explore the options. Would a sick-note for a week or two be helpful? How about some medication to relieve the symptoms of anxiety and depression? Perhaps a referral for counselling might be suggested.

The number of teachers I sign off from work, or prescribe Prozac, or refer for therapy seems to have risen dramatically. So I have increasingly wondered whether any of these approaches is really beneficial.

Sick leave might give some respite, but it may compound a teacher's loss of confidence. Drugs may relieve despair, curb panic attacks and improve sleep, but they are unlikely to effect a long-term solution.

The price of counselling is an acceptance of the identity of stress victim. This implies a surrender of control over the inner self to some external agency. Far from empowering, it diminishes individual autonomy.

The problem of work-related stress is not peculiar to teachers. Academic authorities endorsed by government have diagnosed an epidemic of work-stress afflicting between a quarter and a third of the workforce. Doctors too are victims of stress: a helpline set up by the British Medical Association in 1996 recorded 6,000 calls in its first two years.

Strikingly similar themes recur for teachers and doctors. They both complain of unreasonable workloads, unsupportive working environments and increasingly unsustainable demands from those they serve.

There is a powerful consensus that working circumstances have drastically deteriorated in both schools and surgeries in recent years. But can this be true?

Both my parents were teachers. I seem to recall that things were not so easy in the schools of the past. They had bigger classes, less support in the classroom and far fewer resources. My predecessors in general practice had bigger lists, longer surgeries, did more home visits and much more "out-of-hours" work - all without the benefit of practice nurses, administrative and secretarial staff, not to mention computers and mobile phones. Yet neither my parents nor my former colleagues came down with stress.

A new book* provides some insights into the contemporary malaise. The authors, sociologists David Wainwright and Michael Calnan, emphasise the importance of the political and cultural climate created by the seismic shifts of the late 1980s: the ending of the polarities of East and West, left and right, and the defeat of trade union power. Unions now provide personal services rather than organising action in defiance of aggressive management. Instead of tackling grievances through traditional trade unionism, employees tend to internalise them and re-interpret them as personal problems.

The reorientation of the trade unions towards issues of health and safety is a key factor in the stress epidemic. Oppressive management is now perceived in terms of bullying and harassment. Employees experience boredom as despair, dissatisfaction as depression, anger as anxiety. Instead of taking action together, workers individually complain of stress and go to their doctors or lawyers in search of therapy or compensation (or both).

All these trends are evident in the schools as in other workplaces.

Wainwright and Calnan are critical of the redefinition of the problems of the workplace in medical terms. They also criticise the therapeutic influence that has created the identity of the work stress victim. They suggest that employees reject the work-stress label and resist the pressures from all sides that encourage them to adopt this way of dealing with difficulties at work.

What does this mean for teachers? For some, the subjective experience of stress has reached such intensity that some form of therapeutic intervention may be necessary. But for many, it would be better to refuse the label of stress victim and cling to the identity of autonomous social agent.

An important step forward would be for the teacher unions to abandon their individualistic focus on health and safety issues, which encourage even higher levels of awareness of stress - and hence higher levels of morbidity.

Instead of colluding in the promotion of victimhood, doctors could encourage their patients to reject it and seek alternative strategies to resolve workplace problems. On a wider level, teachers and doctors could work together in questioning mystifying notions of stress - and also in challenging the culture of control, through specious performance indicators which is doing such damage to morale in both education and health.

Mike Fitzpatrick is a GP in east London*Work Stress: the making of a modern epidemic (Open University Press) Stress factor 451, page 59

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