Workplace Mobbing: Are They Really out to Get Your Patient?

Workplace mobbing: Are they really out to get your patient?

Consider that coworkers’ hostile behavior could be causing paranoid symptoms

r. G, age 46, works for a large federal® Dowden govern- Health Media ment agency in a middle-management position. MHe presents seeking treatment for insomnia. He says, “I just need a sleepingCopyright pill. I haven’tFor been personal able to use only sleep for the last 3 months because everybody at work is talking behind my back and spreading rumors about how I’m crazy. My boss is in on it, too. She is always trying to undermine me and makes a big deal out of every little mistake I make.” Mr. G is suspicious, asking questions about the confi - dentiality of medical records. His speech is rapid, and he is anxious but exhibits a full range of aff ect and no pressured speech or fl ight of ideas. Mr. G describes early, middle, and late insomnia, decreased energy and interest, and gaining 10 pounds over the past 3 months. ALEX NABAUM FOR CURRENT PSYCHIATRY He admits owning a gun and having frequent thoughts of suicide and fantasies of killing his boss, although Mr. G James Randolph Hillard, MD repeatedly affi rms he would never act on these thoughts. A Professor Department of psychiatry week ago, his wife moved in with her parents because, he Associate provost for human health aff airs says, “she just couldn’t stand to be around me any longer.” Michigan State University East Lansing, MI I consider involuntary hospitalization for Mr. G. Ultimately I contact his wife, who agrees to pick him up, stay with him overnight, and return with him the next morning. Because the only medication Mr. G is willing to consider is sleeping pills, I prescribe fl urazepam, 30 mg qhs.

Mr. G was apparently paranoid, thinking of killing his boss, and had a gun. If his wife had not answered the phone and been willing to stay with him, he might have been involuntarily committed. As it was, further Current Psychiatry interviews with him revealed that Mr. G had been a tar- Vol. 8, No. 4 45

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45_CPSY0409 45 3/16/09 11:35:47 AM Box Workplace mobbing: How Mobbing, bullying, and harassment. The often does it occur? term “workplace mobbing” was coined by Leymann,3 an occupational psycholo- n 1990 Leymann3 estimated that 3.5% of gist who investigated the psychology of Ithe Swedish workforce had been victims workers who had suffered severe trauma. of signifi cant mobbing. Studies from various He observed that some of the most severe Workplace other European countries have estimated reactions were among workers who had prevalence of mobbing at 4% to 15% of the mobbing been the target of “an impassioned collec- total workforce.10 Studies from Europe have shown that tive campaign by coworkers to exclude, all age groups can be affected, but that punish, or humiliate” them. posttraumatic stress disorder among mobbing Many researchers use the term mobbing victims is more common in patients age >40. to describe a negative work environment 6 Both genders are equally at risk. created by several individuals working to- gether.1-3 However, some researchers such get of workplace “mobbing,” and that his as Namie et al4 use the term workplace Clinical Point insomnia and paranoia developed because bullying to describe the creation of a hos- An uninformed of a deliberate campaign by coworkers. tile work environment by either a single mental health This article discusses how to recognize individual—usually a boss—or a number symptoms of workplace mobbing, using of individuals. professional can Mr. G’s experience to illustrate the dynam- unwittingly make ics of this group behavior. An informed CASE CONTINUED a mobbing victim’s mental health professional can be of enor- Why I fi rst thought ‘paranoia’ situation much mous help to a mobbing victim, but an During our fi rst interview, Mr. G said that 6 uninformed professional can unwittingly months before he sought treatment he had worse make the situation much worse. reported misuse of government property by his supervisor’s boss. The case was investi- gated and dismissed. Mr. G’s supervisor never What is ‘mobbing’? confronted him about the complaint, but Initiated most often by a person in a po- shortly afterwards Mr. G started to notice dis- sition of power or infl uence, mobbing turbing changes in the workplace. has been described as “a desperate urge His supervisor avoided Mr. G’s phone calls to crush and eliminate the target…. As and e-mails and stopped meeting with him. the campaign proceeds, a steadily larger Instead, she met with Mr. G’s subordinates. range of hostile ploys and communica- The subordinates started to ignore Mr. G’s in- tions comes to be seen as legitimate.”1 This structions and would roll their eyes or be in- behavior pattern has been recognized in attentive when he spoke. Coworkers stopped Europe since the 1980s but is not well rec- talking when Mr. G approached, and he start- ognized in the United States. ed receiving anonymous e-mails questioning Davenport et al2 brought the phenom- his ability and sanity. He was reprimanded in enon and its consequences to the U.S. pub- writing for having made a $9 mathematical lic’s attention in 1999 with the publication error in an expense reimbursement request. of Mobbing: emotional abuse in the American Mr. G said when he approached his supe- workplace. Otherwise, little professional lit- rior about the work environment, she stated erature on workplace mobbing has been that he was “just paranoid” and needed to produced in the United States. see a psychiatrist. A PubMed search on the term “mob- When Mr. G’s wife accompanies him to bing” limited to 1982 through October 2008 the second interview, she confi rms his im- returned 95 listings, excluding those deal- pressions of ostracism and gossip at work. ing purely with ethology, but only 1 report She also relates her experiences with people from the United States. Studies from out- from Mr. G’s offi ce who previously had been side the United States indicate that mob- friendly but now were distant or hostile. Mr. Current Psychiatry 46 April 2009 bing is relatively common (Box). G shows me copies of harassing work e-mails

46_CPSY0409 46 3/17/09 11:09:37 AM and memos. I tell Mr. G I believe his story and Table 1 diagnose him as suff ering from posttraumatic Mobbing syndrome: 10 factors stress disorder (PTSD). He begins supportive/ cognitive therapy and continues fl urazepam. Assaults on dignity, integrity, credibility, and competence

Negative, humiliating, intimidating, abusive, Mobbing syndrome malevolent, and controlling communication As it turns out, Mr. G was not paranoid; his Committed directly or indirectly in subtle or coworkers really were trying to get him. obvious ways Leymann5 divided 45 types of mobbing Perpetrated by ≥1 staff members* behaviors into 5 categories. These were or- ganized as attacks on: Occurring in a continual, multiple, and • self-expression and ability to commu- systematic fashion over time nicate (victim is silenced, given no oppor- Portraying the victim as being at fault tunity to communicate, subject to verbal Engineered to discredit, confuse, intimidate, attacks) isolate, and force the person into submission • social relationships (colleagues do not Clinical Point Committed with the intent to force the talk to the victim, victim is physically iso- person out Factors that might lated from others) Representing the removal as the victim’s increase one’s risk • reputation (victim is the target of gos- choice sip and ridicule) of being mobbed • occupational situation (victim is given Unrecognized, misinterpreted, ignored, include having a tolerated, encouraged, or even instigated by meaningless tasks or no work at all) management diff erent ethnicity, • physical health (victim is assigned *Some researchers limit their defi nition of mobbing to an ‘odd’ personality, dangerous tasks, threatened with bodily acts committed by >1 person or high achievement harm, or physically attacked). Source: Adapted with permission from Davenport N, Davenport et al2 distilled this list into Schwartz RD, Elliott GP. Mobbing: emotional abuse in the American workplace. Ames, IA: Civil Society 10 key factors of the mobbing syndrome Publishing; 1999:41 (Table 1); identifi ed 5 phases in the mob- bing process (Table 2, page 48); and de- fi ned 3 “degrees” of mobbing analogous Secondary morbidity. Victims of work- to fi rst-, second-, and third-degree burns place mobbing frequently suffer from: (Table 3, page 48). • adjustment disorders • somatic symptoms (eg, headaches or Mobbing risk factors. According to Ley- irritable bowel syndrome) mann,5 no specifi c personality factors • PTSD6,7 predispose workers to being mobbed. • major depression.8 Westhues1 and others, however, identify a In mobbing targets with PTSD, Ley- variety of social risk factors. These include mann notes that the “mental effects were any factors that make an individual differ- fully comparable with PTSD from war or ent from other members of his or her work prison camp experiences.”3 Some patients environment, such as: may develop alcoholism or other substance • different ethnicity abuse disorders. Family relationships rou- • an “odd” personality tinely suffer.9 Some targets may even de- • high achievement. velop brief psychotic episodes, generally Whistleblowers or union organizers with paranoid symptoms. also run a risk of stigmatization and mob- Leymann3 estimated that 15% of sui- bing. Organizations with unclear goals or cides in Sweden could be directly attrib- extensive recent turnover in senior leader- uted to workplace mobbing. Although no ship can be conducive to mobbing. Three other researcher has reported such a dra- industries identifi ed as at special risk for matic proportion, others have reported mobbing are academia, government, and increased risk of suicidal behavior among Current Psychiatry religious organizations.5 mobbing victims.10 Vol. 8, No. 4 47 continued

47_CPSY0409 47 3/16/09 11:35:58 AM Table 2 he still thinks “almost every day” about what happened in his previous job but keeps telling Phases of mobbing himself “everything did work out OK after all.” Confl ict, often characterized by a ‘critical incident’ Mr. G experienced relatively mild, fi rst- Aggressive acts, such as those in Table 1, degree workplace mobbing, but it had a page 47 substantial effect on his quality of life and Workplace that of his wife for almost 1 year. If I had Management involvement mobbing followed my fi rst impulse and had Mr. G Branding as diffi cult or mentally ill involuntarily hospitalized after our fi rst Expulsion or resignation from the workplace interview, it would have confi rmed rumors

Source: Adapted with permission from Davenport N, at his offi ce and probably would have es- Schwartz RD, Elliott GP. Mobbing: emotional abuse calated the mobbing behavior. in the American workplace. Ames, IA: Civil Society Publishing; 1999:38

Table 3 Diagnostic recommendations Clinical Point Degrees of mobbing Consider the possibility that seemingly Major depressive paranoid individuals could be the target of disorder (often with First degree: Victim manages to resist, escapes mobbing at work, and don’t underestimate at an early stage, or is fully rehabilitated in the the psychological stress of being mobbed. suicide ideation) is original workplace or elsewhere Other forms of workplace harassment can frequently associated Second degree: Victim cannot resist or be extremely stressful but do not have the with being mobbed escape immediately and suffers temporary or “paranoidogenic” potential of mobbing. prolonged mental and/or physical disability and Patients may be so distressed that it is dif- has diffi culty reentering the workforce fi cult to fi gure out what is going on in their Third degree: Victim is unable to reenter the work environment. workforce and suffers serious, long-lasting Ask patients to present physical evi- mental or physical disability dence of conspiracy or harassment. Mob- Source: Adapted with permission from Davenport N, bing patients usually are willing to bring Schwartz RD, Elliott GP. Mobbing: emotional abuse in the American workplace. Ames, IA: Civil Society in large quantities of material. Keep in Publishing; 1999:39 mind that when subjected to mobbing be- havior over time, a person who is not ini- CASE CONTINUED tially paranoid is likely to develop some Redirecting energy into a job search secondary suspiciousness and even frank As I met with Mr. G over the next 3 months, paranoia. the pattern of malicious communication and Also consider the possibility of “pseudo- actions continued at his offi ce. For example, mobbing,” in which an individual falsely be- he received a written reprimand for being lieves he or she is a mobbing victim. Cases 10 minutes late after having overslept when of pseudomobbing have been reported in starting fl urazepam, which he continued to European literature11 and may represent a take for about 6 weeks without further tardi- negative side effect of greater public aware- ness. I encouraged Mr. G to withdraw energy ness of the mobbing phenomenon (and of from work by keeping a low profi le and trying legal remedies to mobbing available in var- not to react to provocations. Instead, I coun- ious European countries). seled him to put energy into family activities Mobbing is a serious stressor that can and try to fi nd a new job. lead to psychiatric and medical morbidity Within 3 months, Mr. G found a new posi- and even suicide. Major depressive disor- tion in the private sector at a similar salary, al- der—often with suicidal ideation—is fre- though with lower benefi ts. Six months later, quently associated with being mobbed.12 he was still with his wife, had been promoted A diagnosis of PTSD can be missed if at his new job, lost the 10 pounds he gained, the mobbing victim does not seem to have discontinued psychotherapy, and was sleep- been subjected to a severe enough stress to Current Psychiatry 48 April 2009 ing well without medication. He reported that meet PTSD criteria. continued on page 51

48_CPSY0409 48 3/17/09 11:09:42 AM continued from page 48 Treatment recommendations First, do no harm: Do not allow yourself to Related Resources be used by the mob. This process can be di- • Leymann H. The Mobbing Encyclopaedia. www.leymann.se. rect—as in the Mr. G’s case, where the pa- • Westhues K. Workplace mobbing in academe. http://arts. uwaterloo.ca/~kwesthue/mobbing.htm. tient was almost involuntarily committed— • Namie R, Namie G. The Workplace Bullying Institute. or subtle. For example, a person you know www.bullyinginstitute.org. may describe the behavior of “someone at Drug Brand Name work,” and you may be tempted to respond, Flurazepam • Dalmane “Well, I have not examined this person, but Disclosure from what you say, it sounds like maybe…” Dr. Hillard reports no fi nancial relationship with any company You could then be quoted as a psychiatrist whose products are mentioned in this article or with manufacturers of competing products. who agrees that the person is paranoid. Giving your patient a name for what is happening to him or her may be the most therapeutic intervention. Generally, pa- time, encourage him or her to grieve losses tients have not heard of mobbing. They experienced as a result of the mobbing. typically are confused about what is hap- Clinical Point pening and may blame themselves. References 1. Westhues K. At the mercy of the mob: a summary of research Giving patients Treat the patient’s family. Giving a pa- on workplace mobbing. Canada’s Occupational Health and a name for what tient’s spouse or partner a name for what is Safety Magazine. 2002;18:30-36. 2. Davenport N, Schwartz RD, Elliott GP. Mobbing: emotional is happening to happening is almost always helpful. One- abuse in the American workplace. Ames, IA: Civil Society third of mobbing victims suffer breakup of Publishing; 1999. them may be the 3. Leymann H. Mobbing and psychological terror at workplaces. their marriages or relationships during the Violence Vict. 1990;5:119-125. most therapeutic course of a mobbing, which can create a vi- 4. Namie G, Namie R. The bully at work: what you can do to intervention cious cycle of stress, leading to isolation, stop the hurt and reclaim your dignity on the job. Naperville, IL: Sourcebooks, Inc; 2003. 3 leading to more stress. Encourage the pa- 5. Leymann H. The content and development of mobbing tient not to subject the spouse to repeated at work. European Journal of Work and Organizational Psychology. 1996;5:165-184. ruminations about insults at work. 6. Leymann H, Gustafsson A. Mobbing at work and the Treat secondary symptoms of depres- development of post-traumatic stress disorders. European Journal of Work and Organizational Psychology. 1996;5:251- sion, anxiety, PTSD, or other sequelae with 275. pharmacotherapy, psychotherapy, or a 7. Bonafons C, Jehel L, Coroller-Bequet A. Specifi city of the links between workplace harassment and PTSD: primary results combination as appropriate. Refer patients using court decisions, a pilot study in France. Int Arch Occup with somatic symptoms to primary care if Environ Health. 2008 Oct 25 (Epub ahead of print). 8. Girardi P, Monaco C, Prestigiacomo C, et al. Personality you feel that they need further evaluation. and psychopathological profi les in individuals exposed to Encourage your patient to visualize mobbing. Violence Vict. 2007;22:172-188. choices and ways to escape the situation. 9. Duffy M. Workplace mobbing: individual and family health consequences. The Family Journal. 2007;15:398-404. Frequently, patients will be locked into 10. Pompili M, Lester D, Innamorati M, et al. Suicide risk and “fi ghting for justice” or putting up with exposure to mobbing. Work. 2008;31:237-243. 11. Jarreta BM. Medico-legal implications of mobbing. A false the situation because they see no options. accusation of psychological harassment at the workplace. Encourage your patient to withdraw en- Forensic Sci Int. 2004;146(suppl):S17-S18. ergy from work and invest it in family, so- 12. Girardi P, Monaco E, Prestigiacomo C, et al. Personality and psychopathological profi les in individuals exposed to cial life, or anything else. At the appropriate mobbing. Violence Vict. 2007;22(2):172-188.

Bottom Line Consider the possibility that a seemingly paranoid patient is a victim of workplace mobbing. Mobbing victims are subject to severe stress and may develop adjustment disorders, depression, or posttraumatic stress disorder. Treat these disorders symptomatically, and encourage patients to withdraw energy from the workplace Current Psychiatry and invest it in family, job searching, or other activities. Vol. 8, No. 4 51

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