“Many Italians Choose Suicide” – People Need to Work

Overview

• The essence of healing is feeling safe. Your body regenerates and heals.
• Not being able to support yourself or have access to basic resources is incredibly damaging to your mental and physical health.
• Medicine must look at a patient in the context of their whole environment – especially work.
• Acute interventions in the face of unrelenting stress have limited to no impact on health.

Few physicians possess sufficient training in the nuances of occupational medicine; however, we all can remove a patient from the workforce. I have observed that when a person is confined at home, their pain tends to worsen.

• Without the distractions of work, pain is more noticeable.
• It’s usually not known when the patient can return to work is often unclear, which can be anxiety-inducing.
• Being labeled a “chronic pain patient” by everyone, including the medical profession, begins early.

 

 

NBC News Post

NBC News in 2012 reported that with the recent economic downturn, many Italians were committing suicide. Here are excerpts from the notes left by the victims:

• “I decided to end it because I am a failure. I can’t live without work.”
• “I can’t live without a job.”

This sense of failure and loneliness lies at the core of the desperate actions taken by the Italian business community. The messages left reflect the same mantra echoed by workers and entrepreneurs who either attempted suicide and survived to share their stories or those who contemplated it but found other reasons to continue living.

Another excerpt:

• “My business is like my family. I feel responsible for each of my employees. If my business fails, I fail with it.”

(This article was called “In debt or jobless, many Italians choose suicide,” by  Claudio Lavanga. NBC News World Blog, May 9^th, 2012)

Mental health and work

My early perspective

I can only speak for myself when referencing some of my past perspectives. Nevertheless, it is the way I was trained. I had the impression that many patients wanted to stop working.

• Only a few wanted to be taken off work.
  • Most did not.
  • Dependency on a complex disability system is miserable. It is like being stuck in quicksand.
• I did not understand how devastating it was to a patient and their family to lose a job.
• The mental health consequences of being home and disabled are severe.
  • Social isolation creates the same symptoms as chronic pain
• It was often more manageable for me to take a person off of work.
  • It’s time-consuming to go into the details of light duty, etc.

My approach changed

• There are significant implications of losing a job.
• Being out of work creates further health problems.
• Any time off work should be as short as possible, with specific dates for returning to work.
• If a patient is already off work, quickly broach the subject of returning to work.
• If they have no intention of returning to work, the issue must be discussed early and an alternate plan implemented.

One of the many papers on the connection between mental health, disability, and not working comes from Australia. They documented that almost 50% of people not working had issues with their mental health, while those who were working experienced significantly fewer issues.¹ It was noted that returning to work is an essential healing aspect, but mental health must be addressed. Unfortunately, in the Workers’ Compensation system, mental health interventions are not covered, and mental pain is often more disabling than physical pain.² Regardless of whether the unpleasant sensory input comes from a mental or physical source, the danger signal originates in similar brain regions. You cannot resolve physical pain without addressing mental pain.

People inherently desire to be part of society and make contributions. Actively participating in the workforce is a crucial aspect of fulfilling that need.

 

 

Social determinants of health

Social determinants of health account for a significant percentage of a person’s chronic illnesses and diseases, while doctors can only contribute a small portion, as their training is more focused on acute care. Factors include poverty, lack of opportunity, oppressive work environments, ongoing physical, emotional, or sexual abuse, societal instability, homelessness, bullying, social media, overexposure to social media, inadequate police protection, and authoritarianism.³ If a person’s annual income is less than $40,000 in the US, the incidence of a diagnosable anxiety disorder reaches 100%.⁴

Helping people heal while ignoring their environment is challenging, if not impossible. Mainstream medicine has failed to tackle this issue with a comprehensive public health approach. Return to work is just one of the concerns. As long as we only treat symptoms without addressing the root causes, our nation will continue to struggle under the burden of chronic disease, which currently consumes over 20% of our gross national product.⁵

Without a widespread focus on expanding health and human services, homelessness will rise, chronic diseases will continue to grow with reduced access to treatment, preventive care will receive less emphasis, and the mental health of individuals and our nation will be significantly compromised. How will current mental health resources tackle this massive challenge? I have not yet mentioned the issues stemming from the opioid epidemic, alcoholism, and domestic abuse.

What do you want?

What does our nation desire?  Unrelenting threats to our well-being lead to illness and disease, resulting in tremendous costs compared to maintaining health. Healing occurs when you feel safe. How are your society and the medical world assisting you in achieving that sense of safety?

Canada has a national initiative known as “CASCH” (Canadian Alliance for Social Connection and Health). Its efforts focus on promoting the adoption and implementation of social prescribing.⁶ The medical field must collaborate closely with the government to effect this necessary change on a broad scale. It is time for the medical community to address the whole person and embrace a public health approach.

References

1. Devine A, et al. ‘I’m proud of how far I’ve come. I’m just ready to work’: mental health recovery narratives within the context of Australia’s Disability Employment Services. BMC Public Health (2020); 20:325. https://doi.org/10.1186/s12889-020-8452-z
2. Lane RD, et al. Biased competition favoring physical over emotional Pain: A possible explanation for the link Between early adversity and chronic pain. Psychosomatic Medicine (2018); 80:880-890. DOI: 10.1097/PSY.0000000000000640

3. World Health Organization; Commission on Social Determinants of Health. Closing the gap in a generation. 2008 summary report. WHO REFERENCE NUMBER: WHO/IER/CSDH/08.1
4. Rose, Mark. Anxiety Disorders. NetCE (2022); Sacramento, CA.
5. O’Neill Hayes, Tara, and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americaactionforium.org; September 10^th, 2020.
6. Simran L, Hoverman A, Allison S, and Kiffer Card. What is Needed to Promote the Uptake and Implementation of Social Prescribing? Canadian Alliance of Social Connection and Health – Research Report, 2024.