Are Men Literally Working Themselves to Death? A Psychiatrist on What You Can Do to Manage Stress

By now, a lot of us know that being overworked can bleed into other parts of our lives, especially if work has become our entire identity.

But a new study published in American Heart Association's journal, Circulation: Cardiovascular Quality and Outcomes, found that being stressed at work isn’t just bad for our mental health or our social skills. The significant impact of stress on the heart means that people regularly dealing with work strain may be at risk for heart problems.

The study followed more than 6,000 white-collar workers without cardiovascular disease over an 18-year span, during which researchers observed a startling conclusion: Stress is a factor that contributes to heart disease risk—especially for men.

Men who were habitually stressed at work were 49% more likely to develop heart disease than those who weren’t. Left unaddressed, stress can lead to adverse health effects like increased blood pressure, and even a heart attack. 

So what’s a stressed man to do if winning the lottery doesn’t work out? Dr. Daniel Z. Lieberman, Clinical Professor of Psychiatry and Behavioral Sciences at George Washington University and SVP of Mental Health at Hims and Hers, shared some thoughts about how stress affects the body and how to manage job strain if you’re seeing signs that stress is affecting your heart or other parts of your physical health.

Dr. Lieberman: Stress has a negative connotation. It sounds like it's a bad thing, but in fact, it's not. It's only certain kinds of stress that are bad. 

So let's talk about the good stress first. Good stress is episodic stress, in which you are challenged and pushed to your limits on an occasional basis. And without that, we kind of stagnate; we don't grow. We really need that, and we need it not only psychologically, but also physiologically, biologically.

We need things that threaten us once in a while, because we evolved in an environment of stress. Our bodies are wired that way.

Let’s say you’re planning a vacation, and suddenly things go wrong. All of a sudden, you've got to scramble and make it right. 

I remember I was once giving a talk, and the AV equipment wouldn't work. And I was panicking, because I strongly rely on my slides when I talk. The talk was in a restaurant, where people were eating, and a bunch of people had laptops.

So I just copied my presentation to all the laptops, and they followed as I went along, and it turned out to be great. And I sort of felt like that initial stress added a certain amount of juice to the talk. 

These kinds of things that take us outside of our comfort zone can really enrich our lives. And another important aspect is that they don’t push us beyond what we can do—they’re doable challenges.

Bad stress differs from good stress in two ways: One is instead of being episodic, it's chronic. And the second is, we don't feel like we can overcome it. It feels like more than we're able to handle. 

When you have stress, the brain releases a chemical that stimulates the production of a stress hormone called cortisol.

Spikes of cortisol, like you get with episodic stress, are good for you. But chronically high levels of cortisol are very, very bad for you. It's actually neurotoxic and can lead to shrinkage of very important parts of the brain. 

When we get this stress that we feel like we can't deal with, over time, it erodes our resiliency. And ultimately, we are less and less able to cope with stress.

Bad stress can come from outside, like a job with unrealistic expectations that doesn't give you a good work-life balance, a job where you're being asked to do things without being given the adequate resources, or given responsibility without authority.

You have to make it happen, but you're not given the authority to have control over the situation.

Work stress for men is a lot about feeling competent and being recognized as somebody who does good work. And of course, it's also about money. 

Men define themselves very much by how much they earn—it’s really a fundamental way they construct their identities. So when you're in a situation where you're not given the tools to do it well or you're unfairly criticized for things that are outside of your control, it's not only stress about work. It really strikes deep into our very identity.

If I'm not a good worker, then what am I? What am I good for in this world?
For women, it tends to be different. For women, work stress is often more related to having to juggle multiple responsibilities—they may have to give up childcare activities sometimes to deal with work, or they may have to give up work activities to deal with childcare. 

Men are less likely to be able to positively define ourselves based on relationships, so we don't have that fallback to the same degree. When work threatens our view of ourselves as competent, it can be extremely disturbing.

Stress can cause a lot of negative health problems, the most obvious being depression and anxiety. It takes a toll on our mental stability. 

The brain is an organ, just like every other organ in the body. And when you push it too hard, when you put it in a very bad environment, it doesn't function well. 

But it's not just the brain. Stress releases fight or flight hormones. And so we always feel like something terrible is going to happen, and that can lead to increased blood pressure, which is sometimes deadly. Increased blood pressure caused by stress can lead to heart disease.

Stress hormones also suppress the immune system. So when you're stressed out, you're more likely to get little infections like colds or you might be more vulnerable to COVID. 

But the immune system is also responsible for protecting us from cancer. And so even the risk of cancer is more likely to go up among people who have chronic stress.

I think it's really a question of how long it lasts and whether the person has the wherewithal to bounce back. With burnout, usually the answer is they don't have it alone and they're going to need some help. 

Stress is devastating for creativity. In order to be creative, you need to let your mind run free and you need to be willing to take chances.

If you're stressed out, neither one of those things are gonna happen. Instead of your mind running free, you're going to be ruminating on a negative loop: Can I get this done? I've got all this stuff hanging over my head.

So forget about the mind running free. If you're stressed out, you're also not likely to take chances since you're just barely keeping your head above water, which can lead to depression. 

The first thing you want to do is identify the source of the stress and see if something can be done about that. Before you think about treating the symptom, see if you can do something about the cause. 

Oftentimes, things that seem impossible to change are not. When we're stressed out, we tend to have tunnel vision. This is related to the lack of creativity—our options contract, and we see only one way.

Your boss may have resources you are unaware of, or at least ideas since they're probably more experienced in the company. Maybe you can even work with your boss to shift some responsibilities. Taking time off can also change your perspective as well.

I think the first thing a lot of people do is turn to self-help. But it doesn't work as well because people tend to wait so long before they finally admit they need help that they're usually beyond the point where it will be enough.

But if they really, really want to try self-help, they can try doing so with a set time limit, like I'll do this for a month or two, and if I'm not where I need to be, I'm going to work with somebody who has special training.
I would recommend either psychotherapy or exploring the benefits of psychiatric medication. In many cases, working with a therapist or coach can help give one a new perspective. 

Psychotherapy has the benefit of not having side effects of medication. And psychotherapy can often do a better job of identifying some of the root causes of chronic stress and bring about longer term changes.

The disadvantage of psychotherapy is that it does require a time commitment and it requires an emotional commitment to dig and go places that aren't necessarily comfortable. It can also be expensive. And it can also take work to find the right therapist.

When I was in training, one of my supervisors told me that finding the right therapist is like buying a car—you often have to test drive a few models.
The advantage of medication is that sometimes it will work when therapy does not. Therapy, including online therapy, and medication tend to work equally for mild to moderate conditions.

But if something gets severe, if those thoughts of death are starting to creep in, then either you want medication by itself or a combination of psychiatric medication and psychotherapy. Medication really needs to be in the mix when you have a more severe presentation.

Support from loved ones is very important. You want to communicate to people what you're going through. 

And this is sometimes difficult for men because it can feel like what they're saying is I'm not strong enough to deal with this on my own, I need help. And we’re told that men aren't supposed to do that, so it's very, very difficult. But it's absolutely important. Any time you do something that's both productive and hard, it's a sign of strength. 

Men need to really get that clear that it's not wrong. It's just scary. And they need to overcome their fears about that. So communicating their distress, and asking for help. Sometimes men don't understand that simply talking about it is helpful.

And I know I said that self-help is sometimes not enough, but there are some great things people can do on their own to address chronic stress in addition to daily practices like deep breathing. Exercise is enormously effective. It produces all kinds of great chemicals in the brain. But equally importantly, it gives people a sense of accomplishment and competence. 

Even just taking a walk around the block is a wonderful thing to do—and connected with that is getting out into nature. Even if you have a picture on your wall of a natural scene, studies have shown this will increase your productivity, increase your creativity, and decrease your stress.

If your office has a rooftop garden, see if you can have your lunch up there, even just spend a few minutes in between projects decompressing and letting your thoughts run free.

Another thing to do is to set aside some time to examine your values. We often have a vague feeling about what's important to us, but it can be very therapeutic to sit down and write them down. 

When you do that, often you will realize that maybe some of the things you're stressing about are things that really aren't essential to what you think are important.

You may also realize that you've been neglecting the things that are super important to you and it can help you rearrange your priorities in a way that will make you mentally stronger because you are meeting your psychological needs better.

There’s one more thing, and that’s having hobbies. A lot of people don't have hobbies—it's work and family responsibilities, and that's it. But hobbies are incredibly beneficial to living a full life. Many people nowadays do work that engages their brains exclusively, not their hands.

But we evolved to use our hands and our bodies. And if we don't do that, we will get sick. But creating things or being engaged in something you’re really interested in, whether that’s woodworking, gardening, sewing, knitting, cooking, biking, rock climbing or anything else that involves your body, can be very, very, very therapeutic.