Management-induced distress syndrome.

Abstract

‘The three deceits of bureaucracy’ editorial1 in the June issue was a curious one. Why would an editor of a neurology journal write an article on a subject that has nothing to do with neurology? I suppose the obvious answer is because he can, and, quite frankly, I would be writing precisely the same content were I an editor of a scientific journal. Everything in Husain’s editorial rings true—at least in the English-speaking parts of the world—but an important point was missed that actually makes the problems he discusses particularly appropriate for publication in Brain. The crisis he describes in the university system (and which, I would argue, is equally true in education more generally and the hospitals) has spawned a new disorder of the nervous system. This new syndrome first started appearing in my cognitive neurology clinic 10–15 years ago. The first wave were typically middle-aged primary school teachers, but I have since observed it in a range of skills-based occupations, including those working in higher education/research and healthcare. The core features of the syndrome are as follows: there is a dissonance between what the sufferer thought was their job (e.g. research, teaching, delivery of healthcare etc.) and an ever-increasing range of new tasks that take them away from this role (mandatory online and in-person trainings; forms to be filled out; permissions to be obtained; appraisals; setting of ‘key performance indicators’ and other goals etc.). This dissonance gives way to feelings of inability to manage the demands of the job and to a sense of being constantly judged; not trusted; or even to feelings of being at risk of some kind of punitive action. The sufferer becomes overwhelmed with a sense of helplessness and stress. At this point the cognitive syndrome develops. As with other situations of extreme psychological stress, the brain’s ability to focus, or sustain, attention breaks down manifesting clinically as perceived memory impairment and an inability to concentrate. Work performance may then decline in reality and actual punitive action may ensue (some of my early school teacher referrals were instigated at the behest of their managers).