Dealing with depression in the workplace

IMAGINE AN EXHAUSTION SO DENSE that it sucks in all your energy like a black hole. You wake up sluggish and you can’t get out of bed. A dark cloud follows you around, resting on your head. Everything is a blur. You can’t focus. You can’t function. Nothing makes sense. At night, your thoughts never settle. You cry. You pray. You plead to God to take away this lingering pain. The next morning, you wake up to the same. And the morning after. And the morning after… You badly want this to end. You want to die.

Psychiatrists have attached a word to this suffering: Depression.

Depression is defined by the World Health Organization (WHO) as a common mental disorder characterized by persistent sadness and a loss of interest in activities that one would normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. Depression is treatable with talking therapies and/or anti-depressant medication because depression involves a real chemical imbalance in the brain (such as lower levels of serotonin). Depression is also a leading cause of disability today, which prompted the WHO to launch a year-long campaign specifically for depression awareness. This week was Mental Health Awareness Week, and the global theme for the year is “depression in the workplace.”

As someone with high-functioning depression, I have had to answer this question at least once: Will I continue making a living when I don’t even have the vitality to live?

It is safe to say that I am not alone in confronting this dilemma. 

The WHO counts 300 million people in the world as living with depression. In the Philippines, there are 4.5 million people who live with depression. And because ours is a capitalist economic system, it is inevitable that people with depression will find themselves inside an office. 

SUBCATEGORIES 
In an interview last Sunday, my psychologist Cely D. Magpantay, PhD., who holds clinic at St. Luke’s Medical Center in Quezon City, described three common subcategories of depression that can be seen in the workplace.

The first is dysthymia or persistent depressive disorder, or “those who have been depressed for a long time but never really saw it as depression.”

The second subcategory is major depression: “those who have life events — like loss of a loved one, retrenchment, adjustment or co-worker difficulty — that triggers the depression.”

And then there is a third subcategory: “those who feel depressed for a month, and then suddenly, they feel very happy. Their mood seesaws. This is the bipolar category of depression.”

There is one commonality among all subcategories of depression: extreme sadness.

It is, admittedly, difficult to differentiate between sadness and depression. In fact, only last week, Eat Bulaga host Joey De Leon called depression — on national TV — “gawa-gawa (made up).” He has since apologized for his comment, but it shed light on how depression is still viewed in the country.

To this, Dr. Magpantay offers a basic metric: “If you are sad because of a certain situation, say you lost a pet or a loved one, it should last less than two weeks. But if it will persist and it will affect you socially, then you’re not just sad, you are depressed. If it’s two weeks or more and the intensity increases, and other areas of a person’s life are affected and revolving around it, then depression might be there.” 

But to best check, one has to seek a professional. “It’s not easy for a layman to understand the situation and to clinically declare depression because there are other factors,” she said.

SYMPTOMS 
They say that depression is an invisible disability. To a certain extent, this is true. However, there are clues that a person is suffering from depression which can be seen in an environment like an office.

According to Dr. Magpantay, the following are red flags that a colleague or a manager may notice in an employee with depression: a slowdown in productivity, absenteeism, social impairment, low energy, being too emotional or negative, and difficulty focusing. 

But perhaps the greatest “giveaways” are hygiene changes. “They used to be more sophisticated, they would be very particular about their outfit, and then suddenly, they don’t brush their hair or wear makeup,” she said.

And if you don’t separate your professional and social life, you may find clues online. “When you see people posting something with a tone that is suicidal or very sad and lonely, ask the person if they are all right or they need psychological intervention,” Dr. Magpantay said. Recently a New York Times article quoted a Harvard University research study in saying: “People… who [are] depressed [tend] to post photos that, on a pixel-by-pixel basis, [are] bluer, darker, and grayer on average than healthy people.”

Sometimes, however, depression could be masked. In this case, those who have prolonged depression are susceptible to forming habits that take their mind off the emptiness they feel inside: drinking, smoking, gambling, doing drugs, having too much sex, and — believe it or not — even working too hard.

“Workaholic people can have high-functional depression. They feel depression but they try to mask it with other things to make them productive, like being too workaholic, being too ambitious in work or what they want in life,” Dr. Magpantay said. “If you really look at them, it’s not normal. Because if you ask them, they feel empty when they don’t work. So the keyword ‘empty’ signals that there’s something that you want to fill in, and that’s actual depression in a different face. It’s like you are looking for something to fill a void in — work, relationship, or substance — when you take it away, you feel very, very down.”

“This is a signal that they’re coping, and it’s a red flag that they have depression,” Dr. Magpantay added.

The ways in which employees cope with depression in the workplace vary, depending on the severity of their mental illness. “Others can go to work while medicating, but others are not functional anymore,” the doctor said. “Sometimes they could be sleeping because they’re on anti-depressants. Others I know they become less communicative. Before they were the clown of the workplace, then they suddenly isolate themselves. Some couldn’t work at all. They want to quit the job because they feel that everything becomes hard. It used to be easy but because of depression, they couldn’t handle it anymore. In a way, it makes them more depressed so they will really quit.”

But things could be worse: “According to research, if depression is not managed properly, the end result is suicide. That’s 90% risk,” said Dr. Magpantay. “When you are severely depressed, it can also lead to violence. Those who shoot people at random, they could be depressed for a long time — they don’t derive meaning in their life. Others would be highly functional, they would create poor relationships, they can damage their families when they get married. There are a lot of bad things that can happen.”

TRIGGERS
A close friend of mine — a writer who refuses to be named — has been struggling with bipolar disorder. Since her first job in 2011 (after we graduated) that lasted four months, she has never returned to an office setup, taking online jobs as a freelancer, because she’s been “traumatized.”

“I was undiagnosed and unmedicated when I started working,” she recalled about her copywriting job at an advertising firm. “I think I’d always have known that I had problems dealing with stress, but I guess I didn’t expect that my first job would be that stressful, and I soon realized that I was terrible at it, or at least that the industry wasn’t the right match for me. We often worked late nights, unpaid, and they never really trained us fresh grads. So there was a pretty steep learning curve, on top of dealing with the new environment, the new interpersonal professional relationships.

“I only lasted about four months on the job, but it felt a lot like four years. I was very idealistic and wanted so badly to be good at my job, but towards the end, I just grew more and more depressed, which affected my mood, which affected my work.

“I was suicidal by the time I quit. I think I gave a couple weeks’ notice, but I couldn’t even manage to last that long. If memory serves, I’m pretty sure I ended up leaving earlier than planned.”

Stress, according to Dr. Magpantay, is the number one workplace trigger for depression. “When you feel that you are stressed and you cannot do anything about it, you will feel helpless and then depression will seep in,” she said.

Inside an office, there are particular causes of stress. These were enumerated by Rene M. Gener, the executive director of the People Management Association of the Philippines or PMAP, and someone who has encountered a number of clinical depression situations in his previous workplaces.

“Management might not even admit it, but minsan, sila din ang reason (sometimes, they’re also the reason),” he said.

According to Mr. Gener, an employee’s depression could be caused by: “too many assignments or required output, unrealistic targets, job insecurities,” and even the company’s financial standing. “If the company is seen as unstable or in the red, the employee can feel insecure about how long he can keep his job,” he said. Likewise, “being a contractual employee could also be a stressful condition that can lead to depression or anxiety.”

“Manager or supervisor-employee relationship is also another point,” he said. “If the manager is kind of drastic, wala nang ginawa kundi manakot sa trabaho nya (does nothing but terrorize an employee for his work) then the employee becomes fearful that he will be suspended anytime.”

Personal problems, such as family and financial situations, can also affect how an employee feels. And while work is not the major reason, it still adds to the burden. “I’ve seen many employees who find it hard to concentrate because they can’t find money to pay debts, and it rebounds in unfinished assignments,” he added.

PREVENTION
Given the role of the workplace in triggering or contributing to an employee’s depression, what, then, can be done to prevent its occurrence or to help an employee through a bout of depression?

For Mr. Gener, the first line of prevention involves managers and supervisors. “Day-to-day, we are together. Day-to-day you will notice my behavior. That should raise a red flag. If a supervisor’s communication with his subordinate is open, then intervention will come in easier.”

The performance management system can also be used as a venue to handle depression, he added. “For example, if you are my subordinate and I notice a dip in your performance, I will dwell on it and explore what are the reasons for it. If I see depressing reasons, maybe I can help you. The manager can have a good feel on his employee. Ano ba talaga ang kaya nito? (How much can he really handle?) Baka mamaya (for all you know) he is only capable of doing level 1 to 3 jobs, but you’re giving him level 10 jobs.”

On a higher level: “top management should build a culture of resilience,” Mr. Gener said. “It is the leaders who should build that culture who should show how we stand in times of crisis. ‘We will cut down on costs, pero ang huling ika-cut down namin ’yung tao (the last thing we will cut down are the people).’ That builds resilience with his employees,” he said.

“Management should address depression because they’ve invested in the employee, in their payslips. Likewise, the employee already delivered for the company,” he added. “All organizations are deeply dependent on their employees — and these employees are supposed to be strong and excellent.”

He also believes that management should identify the causes of work-related health problems: “Are our deadlines reasonable? Are our strategic plans achievable or are we pushing ourselves too much?”

Another point to be looked at by management is their strategy on mental health: physical, mental, spiritual programs which include sports activities, hobby clubs, and team building activities that can “take away the mental stress and divert it somewhere.”

Allowing an employee to take a sick leave after a mental breakdown also won’t hurt. “Perhaps grant an extension of vacation leaves, sick leaves, or employee leaves for them to recharge,” he said. 

But it all boils down to communication. “There must be some counseling,” he said, referring to how a manager might act as a mentor going beyond tackling just professional skills to actual life issues.

But when this still isn’t enough, “in our case, when the depression comes when you’re already a regular employee, we bring them to our professional doctors for proper care.”

CONFRONTATION
While these scenarios seem positive, few actually give it a shot. The reality remains that most people with depression choose to keep silent, lurking in the workplace’s cubicles with the burden on their heads.

According to Dr. Magpantay, most of her patients choose to keep their condition from their superiors. “It will take some time, unless the company voluntarily asks them for reasons for absenteeism. However, they won’t declare it easily because there are stigma and shame,” she said.

In my case, when I divulged to my bosses that I was suffering from depression, I was met with understanding and compassion that made me see the organization in a brand new light. And while I continue to struggle with this mental illness, the support from the organization — in addition to that of my family and friends — has become a part of my recovery. It is liberating to know that you are not keeping a secret that is too heavy for you to bear. It gives you a jolt of confidence and boosts your morale that despite your condition, you know that there are people who believe that you are not defined by your depression.

“As a manager, allow them to open up,” Dr. Magpantay says. “A person is a whole person. When you see that the person is absent, etc., explore the reasons. If you see that their family situation is chaotic, ask. Observe them, if there’s a sudden change that’s going on, then talk to them first. If you know that it’s beyond their control, then refer. That’s the best way. As a manager, you also have to know what are the emotional susceptibility that the people under you — especially if the nature of the job is very stressful, there’s always time pressure and quotas, the more that the individual may have a hard time to catch up. There are those who are very strong, whatever you throw at them they can manage, but there are those who are not resilient. You just need sensibility, sensitivity, openness, explore their needs, and referral.

“[It is b]etter to have a routine psychological assessment,” she added. “We usually have a psychological test at the beginning, for recruitment or promotion, but there’s no routine psychological checkup. They can have counseling or therapy inside the office, it could be very helpful. I know some big companies who do that, but only for retrenchment.”

She added: “If emotions are addressed, then performance is also addressed. They are not machines, by all means — they are people. When we look at their needs, they also need to be addressed psychologically, not just physically,” she noted.

“When they know that when they accept the condition and they are more open for adjustment and compromise, they can go back to the routine,” Dr. Magpantay said.

“Remember this is just a state in a person’s life. It doesn’t mean that they will be like this for the rest of their lives. The openness, the warmth, the atmosphere, and the sensitivity to the condition are really helpful.”

If you are in need of mental health support, you may call the following hot lines:

• 24/7 HOPELINE: (02) 804-4673; 0917-558-4673 or 2919 (toll Free for all Globe and TM subscribers).

• To schedule an appointment with Cely D. Magpantay, PhD, call her secretary at +63908- 353-4862; (+632) 723-0301 loc. 2912.

• In-Touch Foundation crisis Line: Landline: (02) 893-7603; Globe Duo: 0917-8001123 / 0917-5067314; Sun Double Unlimited: 0922-8938944 / 0922-3468776; www.in-touch.org

• Center for Family Ministries: Landline: (02) 426-4289 to 92; www.cefam.ph

• Manila Lifeline Center: (02) 896-9191; 0917-854-9191