Alone In a Crowded Room: Mental Illness and Loneliness in the Workplace

Text of a talk for Experian UK’s “every Mind” Network for Mental Health Awareness Week. You can download slides here. You can find my book Our Dreams Make Different Shapes here.

Photo by Samantha Gades on Unsplash

Key points

• Living with mental illness can leave us least lonely when we are most alone, and most lonely when we are least alone.
• To be surrounded by people whose experience of moving through the world is so different from our own is both isolating and exhausting.
• Bringing those people who are currently on the edges of an organization in to the centre so that new ideas and fresh perspectives can flourish is crucial to that organization’s survival.
• By identifying and then removing the barriers that disable people with certain conditions, employers can empower their employees to flourish.
• It’s great to focus on wellness, but it’s also important to spend time and resources on illness
• It’s OK if you don’t understand what we are going through. It’s far more important that you believe us when we tell you.
• Don’t make assumptions about what people can do based on what they can’t; and don’t make assumptions about what people can’t do based on what they can
• The messages that you send when you aren’t talking about the important things will determine whether people trust that they can come to you with the things that matter

It is no coincidence that there is a large overlap between people who run ultramarathons and people with mental health conditions. Many of us feel as though we live in a world that doesn’t understand us. To be surrounded by people whose experience of moving through the world is so different from our own is both isolating and exhausting. So to be able to lose ourselves for hours, sometimes days, at a time in the presence of nothing but the trails, kept company only by a body that for once screams louder than our ever restless minds, feels like we have, for a moment, been given back our lives.

To put it at its most simple, living with mental illness can leave us least lonely when we are most alone, and most lonely when we are least alone.

I’ve been talking about mental health and mental illness in the workplace for many years. I usually begin by describing many of the most common forms of mental ill health reported in the workplace, trying to convey a sense of how each might affect an individual’s interactions with that workplace, and then offering practical advice for managers on how to make those interactions better, how to create a workplace in which everyone is able to flourish.

That aim — of empowering everyone through the creation of an inclusive workplace — remains. But whereas my emphasis often falls back repeatedly on the key point that everyone’s experience is different, this mental health awareness week’s theme of loneliness has given me the chance to approach things from a slightly different angle, and approach some of the more structural issues in the workplace and how to tackle them. Without ever losing sight of the fact that in terms of a manager’s relationship with any individual team member the most important thing to remember is that individual is the leading expert on their own experience, that their insights will trump those of any other expert or source of advice, and that if you only listen to one person when considering what to do, it should be them. In fact, you might bring these two sides — the structural and the personal — together by saying if there was one structural change an organization could make around mental illness, it would be for every manager to prioritize listening to, believing, and acting upon, the words of each individual team member.

What I really want to focus on here is why so many of us who have poor mental health experience that sense of being alone in a crowded room. I want to talk about why it matters — to us as individuals but also to the institutions for which we work. And I want to talk about how we can change those institutions, often in very small ways, to ensure we feel less alone, and as a result to improve people’s lives, to improve the effectiveness of teams, and to improve the performance of organizations.

Let’s start with some figures.

The first set is directly related to workplace loneliness and come from a ComRes poll for the BBC. They found that 49% of people would not tell their manager about their poor mental health, and 65% would not tell their peers.

Two things are striking here.

First, we are more likely to tell our managers than our peers. The research, sadly, doesn’t ask why that might be. But speculation gives a clear line of reasoning that makes a direct connection to the loneliness so many of us feel at work.

Our relationship with a manager is more likely to be transactional. We disclose something personal because a manager is the person who needs to know, who is in the position of being able to make adjustments.

Our peers in theory form a support network, but in practice, if we are struggling the6y are also in a difficult relation to us. Too often rhetoric can focus on the extra work other team members have to do when someone is unwell. And a request for an adjustment that we need in order to access work can be seen as getting special treatment.

We already put on a mask more than most in order to avoid judgement, and an environment that emphasises the burden we place on our peers intensifies a guilt we already feel for taking up resources.

It is this masking from one’s peers that’s the second key point here. One of the interesting questions on our staff experience survey here in Oxford is “To what extent do you feel you can be yourself at work?” For people with poor mental health, and for very many neurodivergent people, the best we can hope for is “somewhat, from time to time.”

Because workplaces evolved around the needs of people who are neurotypical and mentally well. And our lives look different. Our ways of being are different. The things that comfort us, the things that distress us, the things we need in order to function well — all are different. As I put it in the title of my book on creativity and neurodivergence, “our dreams make different shapes.”

This is probably a good moment to say that I won’t talk about neurodivergence that much, but I’m very happy to answer questions. Neurodivergence — which covers for example autistic people, dyslexia, my own ADHD and dyspraxia — is often intimately connected with poor mental health. Often this is because of the trauma arising from not having a diagnosis and spending years being treated as lazy or difficult for something that is a fundamental part of how your brain is wired — treatment that often carries on into the workplace.

Not being able to be yourself leads to loneliness because no connection can be anything but shallow. And feeling that you can’t be yourself means you are less likely to disclose your condition — because you feel so utterly different that it is hard to trust that you would be understood — and the exhaustion and loneliness and pain of masking who you really are feels less than the pain and trauma of showing who you are and being rejected for it.

The second set of figures one might see as at least in part being a consequence of the first. The Money and Mental Health Policy Institute’s report “Mind the Income Gap” exposed a massive income disparity for those with poor mental health. For those with anxiety and depression, income was just 68% of the income of their peers. And people with mental health conditions are more likely to be in low paying work.

There are many reasons for this, of course. But they include the additional exhaustion of having to navigate a workplace in which one feels disconnected. And they include the assumptions that employers can make about us, which I want to talk about more later, as well as the ways they can manage us, which often mirror our experience of being told we are lazy or naughty in school, leading to a spiral of less rewarding work, more trauma, less capability to do the work we have, guilt, and even less rewarding work, and so on.

If we think of the key elements of Dan Pink’s famous triad of things that make work rewarding and workers empowered and high performing — autonomy, mastery, and purpose, all of the above combine to strip us of each of them.

So why does this matter? That’s a very stark question. It probably makes a lot of people feel very uncomfortable. From the most junior to the most senior in any workplace, it should go without saying that the impact of poor mental health on people at work should matter. And yet all too often it goes without saying not because everyone knows and is already pulling out every stop to mitigate that impact, but because no one really knows what to say; and because there is a general embarrassment — most of us know that things should be getting better. And most of us know they are not. So we avoid the subject. We certainly avoid any metrics. And we talk about the great work we are doing for wellness instead and most of the time we can pretend to ourselves that’s enough

The truth is that for most managers, the mental ill health of team members is just too difficult to think about — and tangled up with feelings of guilt on the one hand and helplessness on the other. A large part of what I want to help achieve through talks like this is to help managers get beyond those feelings — because only by facing this head on can we actually start to spend the quality thinking and action time we need taking practical measures to make the workplace better.

So let’s get this out of the way.

First. Most of the mental illness in any manager’s team is not their fault. Not all. But most. But it is your job to recognise that it’s there and to do something about it. Not to cure it. You’re not doctors. But to mitigate it. To empower your teams. To create spaces in which they can give their best, and be their best.

And that leads to the second point. You are not helpless. You can do often very simple things that can make very big differences. And many of those have to do with creating a workplace where we don’t feel lonely.

And this all leads back to that original question. Why the impact of mental illness in the workplace matters. It matters on the one hand because it is a human tragedy. Like any story of unfulfilled potential is a human tragedy. But it matters to companies, and to managers because you need us. Because even if it were legal to solve the problem by doing directly what all too often happens indirectly and simply removing us, that wouldn’t be the best solution for you. It’s an existential issue for many organizations to have the most creative and capable teams they can build. And that means having the most diverse set of perspectives on any issue — and not just having diverse perspectives but having them come from people who are empowered to nurture, express, pursue, experiment with, and implement those perspectives.

I would go so far as to say that for most companies, at an existential level, thinking about illness, about empowering those who are not well, is a far more crucial issue than thinking about wellness. Bringing those people who are currently on the edges in to the centre so that new ideas and fresh perspectives can flourish is far more likely to bring most companies the solutions they need than keeping at the centre those who are already there.

So what are the key drivers of workplace loneliness for those with poor mental health, and how can we mitigate them to benefit everyone?

To help frame this question, let me briefly talk about what disability means. Of course, not everyone with a mental health condition is disabled. But many are — the Equality Act’s definition of disability is a long-term (usually meaning 12 months) and substantial impact on day to day life.

And thinking about what it means to be disabled can help us understand how to improve the lives of everyone with poor mental health. I want to consider the social model of disability, as it is known. According to this model, rather than seeing us as “having a disability” which makes it hard for us to operate in the workplace, we are asked to consider the way we are disabled by the workplace so we cannot operate within it in the same ways, or by using the same amount of energy, as others can.

This is helpful, because it frames disability in the workplace as something that employers have the power to tackle. By identifying and then removing the barriers that disable people with certain conditions, employers can empower their employees to flourish.

I want to look at four key areas of our interactions with the workplace. I’ll try to explain why they can lead to us feeling isolated in the workplace, entering a downward spiral of health and performance, and how some very simple adjustments can remove the barriers we face and make that spiral an upward one.

First is what you could call “well-meaning wellbeing. Let me explain

This is mental health awareness week, but like most awareness weeks, it’s a label that many of those affected don’t fully embrace. Because mental health and mental illness are different things. Just as wellness and illness are different. And often the focus in the workplace is on the former. And there is most definitely a vital place for that. The problem is that employers can then assume they have solved a different problem. More damaging still, they can assume they have spent all of their relevant budget!

The issue is that this feels as though more is being given to those who had more to start with, so we feel even more marginalised and alone. It feels as though we are not being listened to — because our needs are not met but we are told they are — and that makes us feel as though our voices “don’t count” and this introduces us to the theme of actions and words that we will come back to — when you are told something that actions suggest isn’t true it makes you doubt the sincerity; we are always scanning people’s words ; we are invited by words to put our heads above the parapet — only to find when we’re then not helped or actively hindered that it was unwise to do so but now it’s too late.

The problem with focusing on mental health and on wellness to the exclusion of talking about illness, is that it aims to keep well those who are fundamentally well to start. Obviously a good thing. But a very different thing from aiming to help those who are not well to nonetheless flourish and fulfil their potential. They are fundamentally different problems and need to be recognised as such.

Second is the connection between loneliness and empathy. Specifically the way that a lack of empathy can increase the feeling of loneliness. And this is something that many managers feel really uncomfortable talking about, because they like to think that empathy is a super strength of theirs.

But the fact is that if you are mentally well, there is a level of empathy that you will not feel with those of us who are mentally ill. And that is not only fine. It’s obvious. The problem again occurs when we are told in words that we are empathised with but shown in actions that we are not.

What it comes down to is this. We are not like you — in this respect at least. And it matters that you understand that. Being heard matters — because we are used to not being heard; because autonomy is the thing that’s most frequently stripped from us; and because listening and then acting on what you hear is the best way to preserve or restore our autonomy — when we tell you what adjustments we need; even just when we tell you how we feel.

We understand that people say “we all feel like that” because it seems empathetic but it is the worst response you can give. Far better to say “that sucks.” Stand alongside us in solidarity rather than claiming a stake in our space.

One of the things that makes it so hard for people to understand us in this way is what I call “the empathy gap.” This can be stated very simply as:

The easier it is for most people to perform a vital action, the greater the empathy gap they will experience with people who cannot (whom they will tend to characterise as unwilling not unable).

A further aspect, which has come to the fore during the pandemic is:

If you find an activity difficult or an inconvenience, you will tend to believe that you understand people who find it inaccessible or impossible. So, because you are able to carry out the activity despite finding it difficult, you will tend to believe that they could do the same, and that if they don’t it is the result of laziness at worst or obstinacy at best.

This is at the root of the trauma many of us experienced at school before we were diagnosed. So when managers adopt the same approach, it can trigger harmful episodes of PTSD as well as being ineffective.

The solution is again simple but hard. The “easier” you find something, the more you must remind yourself that there will be people who find it hard. And the more you think you understand something, the more you need to listen to what people are actually saying about there experience, because there is an increased danger you will interpret it in the light of your own experience.

Third, I want to talk about assumptions. Specifically the assumptions that are made about us generally from one aspect of our being.

One way in which most organizations disable us is by failing to account for what I call our “spiky profile.” To illustrate, let me take you back to the late Summer of 2017 though, to be honest, it could be pretty much any time because this is a story I have lived again and again. I’ve always loved being creative. During my doctorate I spent a long time looking at creative memory techniques in early modern England. I have taught creative thinking to everyone from school children to software programmers to intelligence analysts. I’ve also been competing at creative thinking for more than 2 decades, and in the late Summer of 2017 I won the second of 3 world championships.

Just two days later, our washing machine broke. For most people, ordering a new washing machine (we knew exactly which one we wanted) would take about 5 minutes, and an hour of someone’s time when it was delivered.

But my spouse and I are both bipolar. They are autistic; I have ADHD and dyspraxia. As a result of the impact of these conditions on our ability to plan and communicate, it took me 10 hours just to place the order. And I had to recount intimate medical details to more than 10 different individuals before I found a company that would allow me to have the delivery arranged in an accessible manner. It was distressing, humiliating, and left me wrung out, and temporarily broken to the extent I was able to do nothing but sit at my desk and stare at a blank screen for days after. It was the kind of episode that embodies so many of the reasons for the income gap I mentioned earlier.

I posted about the experience on Facebook and got a very interesting comment back — “genuinely interested, do you have any idea what it is about the difficult stuff that means you can do it when you can’t do the easy stuff”. It took me completely aback because the answer is obvious — I can’t do the difficult stuff, like answering a telephone call, I can do the easy stuff, solving puzzles. And then of course it clicked. As a society we have objectified our definitions of easy and difficult rather than accepting that the terms are relative. If you can do “difficult things” therefore, you must be able to do all things with no help at all, and if you can’t do “easy” things then there must be nothing you can do.

The problem always seems to boil down to the fact it is so easy to see one side of a person and then draw conclusions about the rest of them from that.

This happens a lot in the workplace. When I ask for adaptations in order to help me do my job, the level of work I am given is lowered, the amount of work reduced, the opportunities I am given lessened because “we don’t want to put pressure on you” or “we know you struggle” — as though what I struggle with is delivering presentations of performing complex calculations or seeing the deep implications of policy and strategy and not, let’s see, having to work fixed hours despite fluctuating health and being forced to use the telephone. And so I end up with tasks I cannot perform well and because I cannot perform them well I am given tasks that are so-called “easier” which I can do less well, and the spiral continues

But when I stay silent about the adaptations I need, I find that work at which I would otherwise excel comes with sets of procedures, utterly irrelevant to the task at hand, such as the clothes you should wear to carry it out, a deadline not for the final work but for every stage it is assumed you will take along the way, the form of communication any collaborations are to take, and the linear medium in which everything related to the task is to be delivered. And so I fail at that too.

In both cases, people end up unable to do what they are capable of doing, and the organisations that employ them end up losing out on their potential.

The answer falls into that tricky category of “simple but hard.” It is simple because all it involves is not judging us in one area based on our performance in another. But it is hard, because we are often very good at things at which most people struggle and very bad at things which most people don’t even consider tasks. It can be almost impossible for a manager to understand that someone may be capable of carrying out the highest level of strategic planning, but not of sitting in an office with fluorescent lighting.

It might sound encouraging to say “focus on what people can do, not what they can’t” but that’s unhelpful. Far better to say, “provide people the support they need with the things they can’t do so that you empower them to flourish at the things they can.”

Finally let me talk about messaging. By that I mean specifically what we say about mental illness when we’re not talking about mental illness. Let me illustrate with a story about a purple paperclip.

It starts with a manager, Steve, sitting at his desk shaking his head. He has just had to send a final email to Jem, After months of escalating procedures through Jem’s sickness, he has finally let them go. What more could he have done? “If only you’d come to me earlier, I could have done something,” he wrote. But, he thinks to himself as he closes his laptop, shrugs, and gets on with his day, “How could I have known?”

Now our story takes us back in time, to that first day in the new office as Jem excitedly arranges their things on their new desk — their purple journal and pen, the purple photoframe, and the purple letter trays they’ve had since student days. “Are you all set up?” asks their new boss, Steve, “Anything you need, you can order up from supplies.” “Well,” says Jem enthusiastically, “I just need some paperclips. I saw the catalogue has some purple ones. It’d be epic if I could have some of those.” It’d really make my desk feel like home, they think.

“Sorry,” says Steve. “We have a supply of plain metal clips in the cupboard. Help yourself. You know what they say, ‘watch the pennies.’” Jem smiles, knowing that’s the correct reaction to the first thing your new boss says to you. Inside they shrink a little, a light dims, something begins to die, a familiar wall goes up. That night they take their purple journal back to the sanctuary of home. It’s nothing they haven’t been through before they reflect as they stare at the ceiling, unable to sleep. They’d hoped it would be different this time, but if that’s how Steve reacts when they ask for something as small as a purple paperclip, there’s no way he’s going to listen to what they need to make the workplace work for their depression.

In short, if you want to make it safe for your team to talk to you about their mental health, what matters most is how you behave long before they ever need to approach you. The way you talk about and act around things that might seem really trivial tells such an important story about how you would respond to someone coming to you to talk about things that really matter.

None of these changes is complicated. But each of them is deep. It requires actions. But more than that it requires those actions to become intuitive, because real change comes not from individual good actions but from understanding what good practice means so that whatever action is taken, and in whatever context, it is likely to succeed. That means individuals, and institutions, ingesting what people need, and making it part of their fabric. It means listening in the most intentional way. Not always trying to empathise, not trying to understand what it is like to be us — but understanding what we need, and committing to delivering it.