OVERWORK: THE NINETIES' DISEASE : HEALTH

DAVID BLACK realised that something was wrong when he began to fear that if he travelled home from work by Underground he might throw himself in front of a train. His thoughts had been revolving around the sea and mountains, not as havens of peace and tranquillity but as suitable places to kill himself. He saw the Underground as an accessible method close at hand. He decided to walk home instead.

What had happened to bring Black, a senior academic at London University, to the brink of suicide? He is a happily married man with two grown-up daughters, a comfortable home and a well-paid job in a respected academic institution. He is the author of six books, 50 articles and 20 published reports. He had worked at the university without one day's sick leave in 20 years.

The reason lay in the metamorphosis of his job. Like thousands of others in the slimmed-down, super-efficient, highly productive world of the 1990s, Black was being asked to do the work of two or three members of staff for much the same money with no extra support and no special thanks - a phenomenon that he calls the "intensification of work".

It has been described elsewhere as the 2:3:2 formula - half the people are now doing three times the work for twice the pay, compared to the early 1980s. As far as workload goes, the formula is accurate in universities, but the pay component does not hold good for academics, whose salaries have remained tightly controlled. But even where pay has kept up with workload, it is not clear the price is worth paying.

If overmanning was the disease of the Seventies, overwork is the disorder of the Nineties. Black's misery is replicated across Britain, among staff in hospitals, GPs' surgeries, schools and commercial companies. While many people despair of finding work at all, many professionals in the public and private sector simply cannot cope and, like Black, are cracking up.

Black who is 55, says his crisis developed slowly. "Up to the middle of 1992, I was producing some extra-ordinarily creative reasearch, where-as in the last two years I have produced some good things but they have been few in number.

"Student numbers in our department increased by about 100 over the last four years, with no increase in full-time staff, who shoulder the administrative burden. Assessments have gone up since everything now has to be double-marked and I seemed to be spending all my time either teaching or assessing. I kept trying to perform my job properly, carrying out research, preparing classes and doing the hellish administration, but it was an impossible task.

"I was waking up between two and three in the morning and worrying about some trivial administrative detail, turning it over and over in my mind until it assumed colossal proportions. I was also getting thinner.

"From 1993 I started thinking about early retirement. Then it moved to a stage last January when I thought I might leave in the next year or two, until a point came by the spring when I was really quite ill. I felt that I was killing myself or that I would kill myself."

Eventually his wife persuaded him to go and see his GP. "She told me that I should take sick leave immediately. My gloom started to lift when she said: `You are not the first person who has experienced this. You are ill and you are allowed to take time off. You are not letting people down, because it is not your fault.'

"My symptoms included a feeling of being overwhelmed by work, a loss of self-esteem, a feeling that my best days were behind me, oversensitivity to criticism, particularly from my family, and a sense of despair."

He was referred to a consultant psychiatrist and prescribed anti-dep-ressant drugs. "I have been on sick leave ever since the spring, and I am now trying to get early retirement on health grounds."

Black was the victim of two problems that are common in present-day professional and managerial life; he was subject to more "external pacing" than was the case 10 years ago (the growth of charters - student, patient and other varieties - has contributedto this, as well as increased government monitoring) and he suffered because of his efficiency.

"Ambitious people are often very efficient and they are punished for their efficiency," says Marilyn David-son, senior lecturer in organisation psychology at Manchester School of Management. "When managers want a job done well and quickly they will choose someone who is efficient. They will use the same people time and time again because they can rely on them to do the job.

"People have to learn to say no and explain why. Very often their bosses are totally unaware of the amount of work they are being given by others."

Apart from anecdotal evidence, are there any figures to support the view that people are working harder? And if we are working more intensively, does it do us any harm? Is Mr Black simply a wimp who should have pulled himself together?

Paul Gregg, a former senior researcher at the National Institute of Economic and Social Research, says there is strong evidence from the Household Survey that the hours of white-collar workers have increased. "Up to the late 1970s, the hours of white-collar workers had been falling for more than a century. But in the late 1970s and early 1980s the hours stabilised and then started to rise. Between 1982 and 1993 they rose from 41 to 43 hours a week, despite a huge increase in part-time workin g."

Gregg attributes the longer hours to increased pay inequalities and the fear of unemployment. The opportunities to make money rose and the penalties for falling off the ladder also escalated. "People worked longer hours to make sure they were among the winners," he says.

A recent survey from Personnel Today shows that many managers work far longer than 43 hours a week, two out of five putting in more than 50 hours and one in eight more than 60 hours. A survey by the National Association of Teachers in Further and Higher Education showed that heads of departments in colleges worked on average 55 hours. A catering company, Compass, published a survey earlier this month showing that the lunch-hour is a thing of the past, the average time now taken being half an hour. Britain is recognised as having the longest working week in Europe (while still being one of the least productive countries).

What happens to people when they overwork? The 19th-century essayist Thomas Carlyle claimed that work was "the grand cure of all the maladies and miseries that ever beset mankind", but would he have talked the same way if he had lived in the age of the breakfast meeting, the mobile phone, e-mail and the fax machine? Many of the new communications methods have heightened the pace of decision-making by demanding an immediate response.

Days lost from stress-related illness have increased from 37 million a year in the 1980s to 230 million a year in the 1990s. Howard Kahn, A lecturer in organisational psychology at Heriot-Watt University, Edinburgh, predicts a "stress explosion" over thenext few years because many companies have shed too many staff.

"Heart attacks will increase. Already we are seeing more depression, anxiety, irritability and accidents in the workplace. Alcohol abuse is rising," he says. "People are taking less leisure time, less exercise and less time with their families.

"People overwork because there is more competition for fewer promotions: because so many grades have disappeared, there are fewer positions. There is more aggression in the workplace and more violence.''

According to Cary Cooper, professor of organisational psychology at the University of Manchester Institute of Science and Technology, downsizing - or rightsizing as some firms now call it - has led to a phenomenon he has termed "presenteeism". It is the opposite of absenteeism and consists in people coming early to work and staying late, to demonstrate their commitment.

"They also play more political games. They go to more meetings and call more meetings. They try to show that they are busy and indispensable.'' None of these stratagems increases productivity, but they do eat into family time and adversely affect the quality of life.

While thousands of professionals and managers are having to face these pressures, some clearly cope better than others. What helps one employee survive the jungle while another spirals downwards?

Stephen Palmer, a chartered psychologist, who runs the Centre for Stress Management in south-east London, believes it is our attitude to work that affects how well we cope with the demands. "All the research shows that it is how we appraise the situationwhich determines whether we get stressed or not," he says. "For example, if you are facing a deadline and believe that it is the end of the world if you do not meet it, you will become stressed. If you think that if you don't meet it, it is just too bad, you will not.

"People must learn to think more realistically. Many of those who suffer most from stress are perfectionists. Even if they do a job properly, it will never be good enough for them. They have too high a standard for themselves and others." Paradoxically, the perfectionist streak makes them less, not more effective. It can lead to more procrastination because of fear of failing, he adds.

According to an American psychologist, Suzanne Kobasa, those who survive are those with a "hardy personality". They believe in themselves and what they are doing, and think that they can influence the course of events (poor fools, I hear you say). They also regard change, rather than stability, as the normal mode of life and see it as a challenge rather than a threat.

But defining a hardy personality is easier said than done. Many victims of overwork would claim that they have nothing against changes in the workplace if they feel that those changes are improving their product or service, but not if they feel that the changes are for the worse.

Andrew Cane is someone who has suffered from work-related stress over the past six years and has had to resort to anti-depressants to keep going. He works an 87-hour week in a fast-growing branch of paediatrics at a large teaching hospital. He says his branch of medicine is changing rapidly and he can cope with that, but he objects to changes introduced for dubious motives (as was the case with the new working methods within the NHS), increasing everyone's work without improving the service.

"The NHS `reforms' have created a bureaucratic bog, which you have to wade through to get anything done. For example, we are using a new drug for some patients which is very expensive. I put in a report to the regional health authority requesting paymentfor it. They said I had to put it to the 14 district purchasers in the region separately.

"The purchasers are so inept and ignorant that you have to write a simplistic report for them, as if you were writing for Tomorrow's World. At 7pm, after a long day and often having been up much of the night, I do not want to start doing that.''

Cane is a victim of what Ben Fletcher, professor of business psychology and Dean of the Business School at the University of Hertfordshire, defines as the classic stressful situation - a job with high demands but low support.

"The route to reducing stress is not to reduce demand on people but to increase support. People want demanding jobs that provide interest and variety. The biggest predictor of ill-health is boredom and monotony. But they also need high support, both fromtheir boss and colleagues, and in feedback from the work itself.''

Workers also need to have some control over the demands made on them, according to Shirley Fisher, professor of health and occupational pyschology at Strathclyde University. "The problem for both academics and doctors is that they have little control over demand. Whether it is from students or patients, the demand will not go away. It has to be dealt with. It becomes like assembly- line work.''

What can be done to reduce overwork? Under the Health and Safety at Work Act, companies have an obligation to provide a safe environment for staff, and the recent case in which a social worker successfully sued his employer for damaging his health (John Walker v Northumberland County Council) should make them more conscious of their legal duties. Some provide what are called Employee Assistance Programmes (EAPs), which are stress management schemes for their staff, while others carry out stress audits or employee satisfaction surveys.

But many companies only pay lip service to the idea that their staff are their most valuable commodity and consider that counselling is strictly for losers. Where bosses are not interested, what can employees do? Howard Kahn recommends that they make sure they have a social life and interests outside work; take exercise and make time for the family. Where people are showing signs of anxiety or depression, they should seek medical help or counselling.

Cary Cooper recommends all employees keep their skills up to date by going on as many courses as they can. That way, they will either make themselves indispensable to their employers or attractive to other companies.

"If you keep your skills up to date, and your company overloads you, you can say to them: `Thank you very much, but I am going to work for an organisation that treats me like a human being.'"

That presupposes, of course, that you can find one.

How to cope with stress l Recognise you have a problem l Seek help from a doctor, counsellor, partner or friend l Be determined and patient in facing truths about yourself and in making changes l Make time for exercise, social life and family l Learn to set sensible deadlines and say "no"

l Dwell on the positive rather than the negative l Give up perfectionism. Fear of failing can lead to procrastination l Remember that low levels of stress are actually desirable Useful reading: Living with Stress, Cary L Cooper, Rachel D Cooper and Lynn H Eaker, Penguin Books; Counselling for Stress Problems, Stephen Palmer and Windy Dryden, Sage Publications.

TWO CASES OF WORK ABUSE Andrew Cane, aged 45, paediatrics consultant in a teaching hospital.

"For the first eight years I was a consultant, I was working single-single-handed in my speciality, with the result that I was on call every night and every weekend. It was ludicrously busy. I was working 87 hours a week during the day, and often had to go into the hospital at night to deal with difficult cases.

"I put in endless papers to the administration, requesting a second consultant in my speciality. But no one took any notice. I got profoundly depressed, and sought help from my GP. He sent me to a consultant psychiatrist, who put me on anti-depressants.

"Then finally, one Monday morning, I had had enough. I reached a state of total desperation. I had worked most of the previous weekend and missed a lot of sleep. We had also lost a baby (a patient). I was starting my out-patients' clinic on Monday morning, but after seeing my first patient, I just walked out. I went to the hospital's chief executive and said that unless I had a written guarantee that day that they would appoint another consultant, I would resign. By 5pm, they had come up with a written commitment.

"Things improved somewhat after they made that appointment, but my working life is still extremely busy. I have three children, but I see little of them. We rarely have anyone to dinner and if we go out to the cinema, I have to take my air-call bleep andpray that it does not go off. I am still taking quite hefty quantities of anti-depressants.

"I have always regarded myself, and been regarded by others, as positive and optimistic, but after a while the pressure grinds you down. I am pleased that none of my children have decided to go into medicine."

Elizabeth Smith, aged 42, magazine publishing executive.

"I was working for a young, growing publishing company with few resources. In my line of business, whatever the client says goes. Even if a client's ideas are loony, you have to carry them out. It was my job to liaise between the clients and the publishing staff. I was fatigued, had headaches, smoked too much.

"I was brought to the brink of collapse by one particular project which was good in itself, but which the client wanted carried out in six weeks. I was in the office by 7am every day and did not leave until 10pm. At the end, I was physically and emotionally exhausted. I was as snappy as hell at home with my husband and impossible to live with.

"My boss's attitude was: `Staff are like fuses. When one burns out, I just get another.'

"I was saved by Transcendental Meditation. I do it for 20 minutes when I get up in the morning and 20 minutes when I get home in the evening. It dissolves the stress. You almost feel the steam coming out. It made me realise that I had to make more time for myself, instead of letting everything get sucked into the company. It helped me balance my life. I no longer smoke.

"I now run my own company, in part-nership with someone. It has its own pressures, but they are not as bad."

All names have been changed.