The Psychological Tolls of Leadership

Executives and leaders have always had severe stresses, but in a society in which one questions many issues that were formerly held as truths, leaders are subjected to special and extreme stresses. Today we are concerned about a wide variety of social issues. There’s an almost endless laundry list of them, but just to mention a few: pollution, population, the war, drugs, youth, poverty, racial discrimination, and our economic capacity. While we are concerned with these issues, we’re also involved with an ever-increasing technological society in which, by and large, organizations grow larger, more complicated, and less humanistic. There are tendencies toward fragmentation: that is, the performance of bits and pieces of activity without a feeling of being involved with anything that is complete or whole.

These factors can mix with personal and professional pressures to produce a painful state of stress, and I’d like to discuss a syndrome, or group of symptoms, some or all of which may be present in individuals under stress. These particularly affect people between 40 and 60, the years of maximum leadership expectation and very often of the greatest stress for individuals in executive positions.

What are these symptoms? Often the person under stress becomes irritable; he has a diminished tolerance for frustration; he gets angry easily; he frequently looks tired; he is sometimes fearful; and he startles easily. There may be symptoms of depression and anxiety. In depression there is an internal feeling of sadness, but there are also external signs, such as the individual’s attitude and behavior. He looks sad or depressed; his forehead is furrowed; his mouth corners are downturned; frequently his posture is stooped and he seems turned in upon himself. In anxiety there is a kind of internal uneasiness or dread, as if something distressing, even catastrophic, is about to happen. There may be tremulousness, sweating, disturbances in bowel function, and sleeplessness.

Anxiety may be helpful or it may be disabling. In many situations it is a motivating force that drives us to accomplish much of what we do. The question is not whether anxiety is present but rather, in a particular set of circumstances and at a particular point in time, what level of anxiety seems optimum for the adaptation of an individual. If there is too little, a person may produce less than expected and may not be comfortable or happy in her work. If there is too much, symptoms may appear that are disturbing and that may disrupt her capacity to do whatever job she wishes to accomplish.

Sleeplessness is common. If an individual is anxious, he tends to have difficulty sleeping early in the evening. If he is depressed, he tends to awaken later in the night or early in the morning. Frequently people who have trouble sleeping begin to use medications, often another warning sign.

Disturbing dreams, even nightmares, are common. Often they involve repetition of a situation that wasn’t quite mastered during the day. Many of us, reviewing the unsuccessful handling of a situation, will think, “Gee, I wish I’d said that,” or, “I wish I’d done that.” We may think about it again and again; it helps to resolve anxiety and also prepares us to manage future, similar situations more adequately. In a stress situation, however, that kind of repetitive reworking is not enough. The situation is relived during the night and is expressed in a variety of dreams, which typically are not identical with the disturbing situation but which relate to it.

This situation is often accompanied by certain physical symptoms and disease states. Gastric distress, indicating peptic ulcer, and high blood pressure—often the prelude to heart disease—are so common that they could almost be viewed as epidemic. If you observed a group of 100 men at age 40 and followed them through to age 60, you would find that 20 of those 100 had had heart attacks. In other words, in that 20-year span there is a 20 percent incidence of heart attack—almost an epidemic in its proportions.

Lessons from wartime

Some clues to treating stress may be derived from our military experience during World War II and the Korean War. In those conflicts, we discovered that when soldiers were in combat for prolonged periods of time, there was a sharp increase in psychiatric casualties. We called that syndrome a “traumatic neurosis.” In World War I we had called it “shell shock,” and in each previous war it had been known by a different name. It’s not a new phenomenon. It has to do with an external situation that is overwhelming to the individual and puts him under such stress that psychological decompensation occurs.

We occasionally see this disorder in civilian life. In its less-common form it can be precipitated by civilian disasters, such as airplane crashes or natural catastrophes. More commonly in civilian life this disorder occurs under conditions of chronic stress such as that to which the executive is exposed.

What safeguards against traumatic neuroses were developed by the US military? Many who were in military service will recognize some of the policies and procedures. When possible, personnel were trained in small groups where there could be depth and continuity of relationships. Again, when it was possible to do so, personnel were placed in situations where they continued to maintain the same relationships after training, even into combat.

All of us in military service become aware of how intense some of these relationships might be. In military units with high morale, the men form a relationship that is much like the relationship within a family. There seems to be some value in small groups: people trained in small groups get to know one another very well; they get to know their leaders; and they develop a kind of trust and confidence in one another, which offers the members of the group a great deal of support. Of course when that state is combined with the moral issue of having a highly valued purpose or cause, it is a powerful influence in shaping human behavior. The absence of that factor may be one of the problems in Vietnam; the sense of purpose or cause isn’t there, and some of the issues disturbing our troops may result from a lack of that shared ideal goal.

The military also attempted to deploy the troops in such a way that only a part of them were in combat at any point in time, with perhaps two-thirds in and one-third out. Part of the military’s reason for this is that they need reserves, which have to be mobile and ready to move in or out at times of military crisis. There is also a sound psychological principle, the “rest and rotation” idea: troops should be moved out of immediate danger regularly. They should be provided with physical and psychological supports that they lack in combat, including good food and an adequate and safe place to sleep, to give them some relief from combat stress.

We also learned that when soldiers with psychological symptoms were treated close to where the symptoms occurred (typically, this was the divisional level), 95 percent were returned to duty and into combat. If they were evacuated to farther points, then, as the distance grew, the capacity to return to combat was sharply reduced. Removal to even 50 or 100 miles from the front lines resulted in decreasing the incidence of return to duty from approximately 95 percent to 50 percent.

What was actually done for those casualties at the divisional level? They needed safety, physical comforts and supports, and, importantly, someone to talk to. Occasionally hypnosis or sodium pentothal—truth serum—were used, but more often the therapist simply listened and talked. This conversation brought psychological relief; something tightly bound inside the individual was released. Fairly soon, perhaps in 48, 72, or 96 hours, there was relief from the symptoms and the soldier was ready to return to his unit.

Strategies for confronting civilian stress

Some of the principles observed in military settings have relevance in other contexts as well. Individuals in positions of leadership and responsibility need relief from time to time. There must be rotation of authority and depth in command, so that a single individual does not endlessly have to cope with decision making and the kinds of stresses that go with leadership. Periods of relief may be arranged in a recurring way, or they may be made available at certain critical times.

The occasional brief holiday is valuable. However, it can take more than just a quick break to allow the executive under stress to unwind; the condition is chronic and relief may require a week or 10 days. In a situation of continual fatigue, the weekend off or the Sunday free of responsibility isn’t enough to bring the person back on Monday feeling rested. The inability to recuperate with a day off is the warning signal that an individual ought to be thinking about a longer period of time away from work responsibilities and the leadership situation.

It becomes important, therefore, to have small groups of people who occupy leadership positions, who know each other quite well, who recognize their own capacity as well as their fellows’, who feel closely involved with one another, and who respect and have trust in one another. This can provide both alternative leaders and opportunities to develop small-group supports.

There is something to be learned out of the small-group process and the interrelationships and interactions that develop—something that is worth duplicating at staff leadership levels. It is important that there be the kind of openness in communication that permits a person to talk with her fellows about what is happening. A comparable outlet in the military was the opportunity to discuss the terrible things that had happened with someone who was willing to listen. It is also important to all of us, in our everyday situations, to build the degree of openness among our fellows that will allow us to talk about frustrations and difficulties.

And it becomes important for an individual to recognize and understand the symptoms of stress. Alcohol abuse and problems in marriage and family life are typical. The recognition of these symptoms in ourselves or others serves a diagnostic function. Willingness to be open and to allow other people to know what you’re feeling under situations of stress, to recognize the need for assistance or for a brief vacation, relief from responsibility, support of one sort or another—these are important.

When treatment is called for, we can apply what we know about treating patients close to where their symptoms occur: psychological maladaptations ought to be detected and treated as early as possible, and the individual should be treated as close to his usual activities and supports as possible. The treatment system attempts to get the disabled individual back as quickly as possible to his everyday functioning.

The trouble with intervention

There may be difficulties when a person observes stress in a colleague, particularly if he’s a superior. The question then arises as to how open she can really be. Help must be suggested with some tact and sensitivity. With some individuals it is difficult to do so any time, with others it becomes a matter of timing. If a man is obviously disturbed, under great stress, and needs relief, but has no self-recognition of it, the situation can be very difficult, almost impossible to deal with. But if people have developed that availability to one another and the willingness to be open, it is surprising how often they can be helped.

The primary point of all of this is the willingness to recognize the potential difficulty in oneself and in others. If a woman is in touch with herself in relation to stress, then her own capacity for executive action, for leadership, is greater. She may leave potentially damaging situations for periods of time before the stress becomes too great.

I have identified for you some of the telltale symptoms. Certainly you can recognize the times when stress is most likely to occur. It’s clear that we can build in certain safeguards. Appropriate leadership, supervision, and training as people grow into executive positions are important. The potential for group-process training, and also the development of group cohesiveness and relatedness, are safeguards.

Each corporation should have a response system available. With recognition in oneself and others that there is a constructive way to manage this set of problems, stress should not come as a surprise or as something unexpected, and its effects can be contained, with minimum damage to the individual and loss to the organization.

Robert S. Daniels was professor of administrative medicine and director of the Center for Health Administration Studies at Chicago Booth, where he served on the faculty from 1968 to 1971.