Are men literally working themselves to death? A psychiatrist on what you can do to manage stress

By now, a lot of you know that being overworked can bleed into other parts of your life, especially if work has become your entire identity. 

But a new study published in the American Heart Association's journal, Circulation: Cardiovascular Quality and Outcomes, found that being stressed at work isn't just bad for your mental health or your 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.

According to Hims, 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? Here are some ways 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.

What's the difference between good stress and bad stress?

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. 

Good stress is episodic stress, in which you are challenged and pushed to your limits on an occasional basis. And without that, you kind of stagnate; you don't grow. You really need that, and not only psychologically, but also physiologically, biologically. 

You need things that threaten you once in a while, because you 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. 

These kinds of things that take you outside of your comfort zone can really enrich your life. And another important aspect is that they don't push you beyond what you can do—they're doable challenges.

What makes something a bad stressor?

Bad stress differs from good stress in two ways: One is instead of being episodic, it's chronic. And the second is, you don't feel like you can overcome it. It feels like more than you'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 you get this stress that you feel like you can't deal with, over time, it erodes your resiliency. And ultimately, you 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.

How can being stressed at work affect men and women differently?

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 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 your 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 themselves based on relationships, so they don't have that fallback to the same degree. When work threatens your view of yourself as competent, it can be extremely disturbing.

How does stress affect our physical health?

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

What are some other ways chronic stress affects the body?

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-19.

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

How do you know when the stress you're feeling has gone beyond episodic into chronic stress or burnout?

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 going to 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. 

What are some tips for managing work stress?

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 you're stressed out, you tend to have tunnel vision. This is related to the lack of creativity—your options contract, and you see only one way.

Your boss may have resources you are unaware of, or at least ideas due to more experience 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.

In situations where taking time off isn't an option, what kinds of treatments are available to help them address symptoms of the stress?

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."

Either psychotherapy or exploring the benefits of psychiatric medication can work. 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. 

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.

How else can people try to relieve work stress before it causes adverse impacts to their health?

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 you'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, communicating their distress, and asking for help. Sometimes men don't understand that simply talking about it is helpful.

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. You often have a vague feeling about what's important to you, 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 you evolved to use your hands and your body. And if you don't do that, you 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 therapeutic.