Working Ourselves to Death: What is American Karoshi?

I’ve always worked hard. Sometimes, I’ve worked maybe a little too hard. Like the time in late 2021, with multiple deadlines looming, I fell asleep sitting in front of my computer screen, empty mint chocolate chip ice cream container and spoon by my keyboard, and woke with a start at 3 am. 

Not long after, I found myself in a cardiologist’s office with a strange and uncomfortable chest tightness and shortness of breath. I’d had a negative Covid test, so that wasn’t it. I wondered if I was having a strange, slow motion heart attack.

The doctor ran some tests. I wasn’t having a heart attack. Instead, I had something he called costochondritis, a painful inflammation of the cartilage that connects the ribs to the breastbone. So it just felt like a heart attack. He looked at me sternly. “Have you been under a lot of stress lately?”

A global pandemic. Long hours of shapeless, never-ending work, sitting on my rear in my home office, working longer and longer, “pushing through,” and feeling like I was getting less and less done. And then, anxious about how far behind I was, not sleeping well at night. And waking up to do it all again in the morning on another exhausted Groundhog Day. And I was one of the lucky ones. I wasn’t an essential worker risking my life and health just to go to work everyday. I hadn’t been furloughed, lost my job or spiraled into uncertainty and poverty. I didn’t have to thread the impossible needle of working while caring for or homeschooling young kids, like so many millions of women and caregivers experiencing one of the worst epidemics of burnout ever.

I snorted. “Well, yeah. Who hasn’t?”

I was one of the lucky ones, and I was breaking down.

When it comes to work stress — to which I am obviously no stranger — I’ve been intrigued by two things in particular: how little awareness we have of how widespread and damaging it is, and how we tend to think it’s all an individual problem, one that can be solved by individual self-helpy solutions, like lunchtime yoga, a meditation app, hot bath or wellness program. When in fact, work stress is the result of how public policy favors businesses over workers, how U.S. companies organize and manage work and how we’ve embraced a cultural norm that devoting oneself to work not only gives us identity and value, but is almost a sacred duty. And that’s what has to change.

That’s what led me to start hosting the Better Life Lab podcast a few years ago — reporting on the search to find a better way to work, so we can all live fuller, healthier lives. And this season, that need to transform work is what’s fueling our exploration of work stress and how we — businesses, policymakers, workers — can choose to create a better future of work and wellbeing, and the consequences we’ll face if we don’t.

Work stress is the result of how public policy favors businesses over workers, how U.S. companies organize and manage work, and how we’ve embraced a cultural norm that devoting oneself to work not only gives us identity and value, but is almost a sacred duty. And that’s what has to change.

My obsession with work stress started a few years ago, when I came across some research done by Stanford business professor Jeff Pfeffer. He and his colleagues did a meta analysis of more than 200 studies on work stress and, to my mind at least, released this bomb: work has become so stressful and leads to so much chronic ill-health that it is now the fifth leading cause of death in the United States! (Listen to a conversation with Pfeffer on the podcast’s first season here.) And that’s not from going down into coal mines or falling off ladders. That’s from the day-to-day experience of work-family conflict, high job demands, long work hours, feeling low social support or justice at work, job insecurity or being unemployed. 

Turns out what’s causing so much work stress is the growing power imbalance and inequality in the workplace. Workers have more and more job demands and less and less job control, which leads to higher and higher job strain. And that’s true not just for precarious hourly, contract or “essential” workers barely making enough money or given enough hours of work to survive, it’s true for the white collar professionals, too. They’re often taking on more work, worrying they’ll be let go if they don’t, as firms continue to squeeze labor in the name of “efficiency” and higher profits for shareholders.

But that management style is taking a real toll on workers. For instance, pre-COVID research has found that people working long hours are two and a half times more likely to experience depression than those who work an eight-hour day, and have a 60 percent increased risk of coronary heart disease. Up to 20 percent of all cardiovascular deaths among those of working age can be attributed to work. And work-family conflict— which has only ratcheted up for many women and caregivers during the pandemic— increases the odds of reporting poor physical health by 90 percent.

I’ve spent time reporting in Japan, where there’s a word — Karoshi — for working til you die. But I didn’t realize until I read Pfeffer’s work, and that of others who study occupational safety and health, that we have our own American Karoshi. We just don’t talk about it. Or even realize it exists here. Instead, we pride ourselves in overwork and busyness and hustle culture. We may scoff at workers who take work on vacation, or never take vacation, or answer emails or write LinkedIn posts in the hospital after having a heart attack, but our work culture also normalizes that behavior. Here in the United States, if you go to Workaholics Anonymous meetings (like I do), people say it’s hard to kick a habit that’s making them miserable, costing relationships, health, joy, time and may even cost them their lives, when it’s a behavior that’s rewarded, praised and can lead to pay raises and promotions.

This season, we’re looking at work stress now and what it will mean for humans in the future as automation and technology continue to rapidly and radically reshape work. 

Initially, I planned ten episodes, one to explore each of the ten “psychosocial stressors” that Pfeffer and others have researched. But the more I talked to workers, the clearer it became that no one experiences just one stressor. We usually experience a combination of them at one time or another. And the more I read, reported and thought, the clearer it became that just as power imbalance and inequality is what drives work stress, power and inequality are also the real danger we need to address in thinking about the future of work.

So much of the future of work debate has focused on robots, or, more precisely, fears that robots will come and take our jobs. But, as MIT economist David Autor helps explain on episode one, along with warehouse worker Joe Liebman, robots aren’t what we need to worry about. 

Automation will certainly destroy some jobs — or even entire industries. Liebman once had a great middle class life —a house with a white picket fence for his wife and 5 kids in St. Louis — because he had a good job as a manager in newspaper distribution. But technology — the internet and Craigslist — not only “disrupted” the classified and advertising revenue that fueled the newspaper industry, but nearly destroyed it. Newspapers have shrunk or shuttered in communities all across the country. There was no place for Liebman to go in the industry he knew.

But automation will also create new jobs that we can’t even imagine yet. Not long ago, who knew there would be such a thing as a content moderator to scan through and remove all the hateful content posted on social media? Who knew that warehouse pickers like Liebman would be in high demand as e-commerce and the ease of shopping online has exploded in recent years? But Liebman’s in-demand job only pays him $17 an hour. His health insurance deductible is so high, $7,600, as to be laughable. His marriage broke up, and he’s living in an 800-square foot apartment. He thinks this is as good as it’s going to get.

So the real future of work question is — will these new jobs technology and robots create be “big enough” to support human life? 

And if Joe’s experience and the recent past is any guide — jobs have become increasingly worse over the last 40 years, with lower wages, fewer benefits if any, less security or predictability, more contract and involuntary part-time work — the answer is no. What we now risk, Autor argues, is that, unless we make different choices, we are setting ourselves up for a future of grotesque inequality of the “servers and the served.” A dynastic country. Not a country of equal opportunity and the promise of a better life for all.

This week, we told the story of caregivers Brittany and Danielle Williams. They are quite literally servers— they find meaning, joy and dignity in caring for and serving others. But there’s a huge “dignity gap” that most caregivers — many of them women, women of color and immigrants suffer — they earn poverty wages and struggle to make a living for themselves. 

Danielle lives in Arkansas, a right to work state, earns $11 an hour, has no benefits, works seven days a week and can’t imagine ever retiring. 

But there’s hope in her daughter Brittany’s story. Brittany lives in Washington state, where she was able to join SEIU 775, a home care workers union, and bargain with the state for decent wages, better benefits like health care and retirement, training, and pathways to advance. Making care jobs better jobs in Washington state has also made the care better — more people are able to age in place and stay in their homes, like they prefer, rather than be sent to nursing homes. And that saves the state and taxpayers money. It works for everyone.

As guest Ai-jen Poo tells us on the podcast, “It is completely and entirely within our power to make every care job a good job in this country with living wages, benefits. If we can do it in Washington state, we can do it anywhere. And this is a country where we have so much in the way of resources, creativity, brilliance, caring. My God. Danielle and Brittany. I mean, if they are  any indication, there’s a lot of heart in our country. What we’ve lacked so far is the political will to make these jobs good jobs. And one hopeful note is that I actually believe that that’s started to change, and that COVID has catalyzed a national awakening about the need to value and invest in care and caregivers in a whole new way.”

We’ve got work to do.

The fourth episode airs on Tuesday, April 12: Where have all the women gone? We’ll cover what’s happening to the two million women, like Kari McCracken and Kiarica Shields, still missing from the workforce — largely because of the lack of childcare, paid leave and the unwillingness of companies to provide workers, particularly those with care responsibilities, with more control over when, where and how they work.

KARI MCCRACKEN: I enjoy working. I’m almost a workaholic at times.
BRIGID SCHULTE: I hear you.
KARI MCCRACKEN: But I was almost what you would call supermom. I was able to have a successful career and then also be a parent as well. I’ve worked in a male-dominated industry, and I never felt at any point in time that I was any different than anyone else.
BRIGID SCHULTE: Were there others who were furloughed who were able to come back because they did not have those same kind of care responsibilities?
KARI MCCRACKEN: Yes. Yes.
BRIGID SCHULTE: And were they mostly men?
KARI MCCRACKEN: Yes.
BRIGID SCHULTE: What do you think about that?
KARI MCCRACKEN: It tells a story.

I hope you'll listen in and join the conversation! 

The podcast is a co-production of New America and Slate and sponsored by the Robert Wood Johnson Foundation. You can find the podcast — and transcripts and additional resources —on our Better Life Lab website, on Slate, Apple, or wherever you get your podcasts. Leave a review on Apple podcasts if you like the show. And email me with ideas and stories: schulte@newamerica.org