Dear all, 

A while ago a friend of mine told me about a new book called “Selling 
Sickness” that reveals how normal personality traits and common medical 
symptoms are being portrayed as frightening conditions. For instance; 
· shyness is “Social Anxiety Disorder” 
· boisterously active children now have ADHD 
· PMS is now a psychiatric illness called PMDD 
He told me that a critique of this book is available on the web at; 
http://www.allen-unwin.com.au/exports/product.asp?ISBN=1741145791 

I have noticed a similar phenomenon in relation to my ageing mother. A few 
years ago she broke her hip and (as she was in her eighties and suffering 
from severe osteoporosis) she became bed-ridden. Naturally after a very 
active life that had (until then) included many outdoor activities (such as 
gardening) she became somewhat despondent. She was taken aback when they 
offered her medication for depression. Her response was; in my condition 
what sane person wouldn’t be despondent? 

A friend of mine happens to be a professor of community medicine who has a 
strong interest in geriatrics – and in particular the treatment of 
depression and senility in the elderly. Naturally I mentioned this to her. 
She told me that basically there are two types of depression; “reactive 
depression” (which is a rational despondency to saddening events or 
circumstances) and endogenous depression (irrational depression that is not 
related to external causes). She told me that the drugs are designed to 
combat the endogenous depression or the symptoms of depression and that 
many doctors did not bother to make a distinction when treating elderly 
people as the causes (bereavement et cetera) are usually beyond control. 

However, she did make the point that for rational despondency (“reactive 
depression”) it is better in the first instance to find the social or 
medical causes and treat those before treating the patient with drugs for 
depression. She remarked that they are often related to work or 
relationships (or workplace relationships!) and lifestyle factors. There 
is, of course, another side to this coin; by some strange coincidence a co-
worker mentioned that Ian Dury (the English pop star) wrote a book 
called “Reasons to Live” while he was dying of cancer where he said that 
work was his best therapy because it diverted his mind from contemplating 
his mortality. 

Given the huge focus on overuse injuries, chronic pain and workplace 
bullying I am surprised that there is not more discussion in forums like of 
the role of work and the workplace as a cause of depression. I have heard 
that even colour schemes and décor can affect mental conditions – the white 
walls of cells and cheap bed-sitters sometimes get mentioned in relation to 
suicides for instance. (I don’t know that ergonomists ever deal with such 
extreme outcomes but I have often wondered whether bare walls cause 
any “sensory deprivation” effects on either moods or performance; my 
workstation is heavily decorated, I might add– I'm not taking any chances! )

When I first trained in ergonomics someone gave a presentation on this 
model of ergonomics where the outer layers were the social dimension of 
work, private life and public health. This “onion skin view” of ergonomics 
placed a lot of stress on emotional states and social relationships in the 
workplace in addition to the more traditional physical design aspects. Owen 
Evans very kindly supplied me with a reference for the “Onion-skin” model 
of ergonomics. It is in “Evaluation of Human Work” (Wilson and Corlett, 
1995) as Figure 1.2 on page 10 of that textbook; it is based on an earlier 
publication (Grey, Norris and Wilson, 1987). It shows the following layers 
(proceeding from the inside to the outside);

· People
· Tasks
· Equipment and machines
· Personal workspace
· Wider workspace
· Physical environment
· Work organization and job design.

      Plus the factors that impinge on the outer layer;
· Technical 
· Social
· Legal
· Financial

It also contains a vector diagram (figure 1.3 on page 11) that shows the 
inter-relationships between the following factors;
· The well-being of the employees, 
· The well-being of the organization, 
· Health, safety, comfort, satisfaction
· Productivity and quality

It is the inclusion of the “Social” factor and the “well-being of the 
employees” in these models that interests me. I have been wondering whether 
codes concerning the inner layers of the onion should contain motherhood 
statements about these factors given the increasing awareness of the need 
for stress management for risk control. It might also be possible to 
increase motivation of employers by referring to both well-being and 
productivity.

I had been hoping that the outer layers might make mention of the 
usefulness of preventive medicine life-style factors (nutrition, physical 
exercise, mental activity, habits, social activity, mental health et 
cetera) for well-being given the growing popularity of “corporate health” 
programs. However, if they are included (possibly they are part of “well-
being”) the mention is not very explicit.

I had been looking for this aspect of our professional work because I have 
noticed a boom in the areas of “corporate health”, and training in 
wellbeing and wellness. They often cover (or attempt to cover) virtually 
all lifestyle factors - exercise, diet, leisure activities, mental 
stimulation and so on. Are ergonomists getting involved in these areas? 
Does anyone else feel that it might be useful (not to mention entertaining) 
to discuss lifestyle issues as well as the more run-of-the-mill stuff? I 
cannot help thinking that a broader scope would attract a wider audience 
and perhaps (only perhaps!) a little more on-line debate. 

From what I am hearing the creation of a “virtual community” might take a 
lot of time and money. However, I don’t know how anyone else feels, but I 
would like to receive the occasional “news bulletin” about the latest 
research papers being published in journals and conferences around the 
world. Surely publishers have people on their staff who could take the time 
to do this (and indirectly provide their employers with a bit of free 
advertising!).

Regards, 

David McFarlane 
Ergonomist, 
WorkCover Authority of New South Wales 

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