Health and Happiness From Meaningful Work (1606928201)

In: Health and Human Development Series
HEALTH AND HAPPINESS FROM MEANINGFUL WORK:

RESEARCH IN QUALITY OF WORKING LIFE
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HEALTH AND HUMAN DEVELOPMENT SERIES

Joav Merrick (editor)
Adolescent Behavior Research: International Perspectives Joav Merrick and Hatim A. Omar 2007 ISBN 1-60021-649-8 Disability from a Humanistic Perspective: Towards a Better Quality of Life Shunit Reiter 2008 ISBN 978-1-60456-412-9 Complementary Medicine Systems: Comparison and Integration Karl W. Kratky 2008 ISBN 978-1-60456-475-4
Health and Happiness from Meaningful Work: Research in Quality of Working Life Sren Ventegodt and Joav Merrick 2009 ISBN 978-1-60692-820-2
In: Health and Human Development Series
HEALTH AND HAPPINESS FROM MEANINGFUL WORK:

RESEARCH IN QUALITY OF WORKING LIFE
SREN VENTEGODT
AND
JOAV MERRICK EDITORS
Nova Science Publishers, Inc.

New York
Copyright 2009 by Nova Science Publishers, Inc.
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LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Ventegodt, Sren. Health and happiness from meaningful work : research in quality of working life / Soren Ventegodt, Joav Merrick. p. cm. Includes index. ISBN 978-1-61324-981-9 (eBook) 1. Quality of work life. 2. Work environment. I. Merrick, Joav, 1950- II. Title. HD6955.V45 2009 306.3'61--dc22 2008050567
Published by Nova Science Publishers, Inc.
New York
CONTENTS
Preface Acknowledgements Introduction Part I: Understanding Quality of Working Life How to Be Happy at Work Chapter 1 Chapter 2 Working Life Sren Ventegodt and Joav Merrick Quality of Life, Happiness and Meaning of Life Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Personal Quality of Life Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Mastery in your Work Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Working with Colleagues and Management Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Creating Value Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Up or Down in your Life? Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick How to Improve Working-life Quality, Quality of Life and Health Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel, Lars Enevoldsen and Joav Merrick vii ix 1 3 5 9
Chapter 3
23
Chapter 4
33
Chapter 5
43
Chapter 6
51
Chapter 7
59
Chapter 8
77
vi
Contents
Part II: Research in Quality of Working Life: Improving Value by Making your People Happy at Work Chapter 9 Working Life Quality and Value Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick Working Life Quality with the SEQWL Questionnaire Sren Ventegodt, Niels Jrgen Andersen and Joav Merrick Antonovsky Salutogenesis Related to Work Sren Ventegodt, Isack Kandel and Joav Merrick Mood Disorders and Suicide Jong-Min Woo and Teodor T. Postolache
109 111
Chapter 10 Chapter 11 Chapter 12
125 155 161 183 185 197 201 203 217 221 225 227 229
Part III: Travelling and Inspiration for Development as Leader Chapter 13 Chapter 14 Travel and Shift Work Tatiana Menick and Teodor T. Postolache Reflections Lars Enevoldsen
Part IV: Acknowledgements Chapter 15 Publications on Quality of Life 1994-2008 from an International Group of Collaborators Sren Ventegodt and Joav Merrick About the Quality of Life Research Center in Copenhagen About the National Institute of Child Health and Human Development in Israel
Chapter 16 Chapter 17
About the Authors About the Editors Index
PREFACE
Happiness at work.your quality of life and sometimes your life depends on it. Work is an important part of the life of the modern man, as it always has been, but work has become more complicated that before. Today what we do is often done as a part of a large organization. The work is often abstract manipulation of matter or information, and the value created by the single member of the organization has become increasingly difficult to measure. Organizations have become increasingly responsible for not only the physical work environment, but also for the mental working environment, and factors like stress and sexual harassment are becoming more and more regulated by company rules and culture. The health of the employees has become a major financial interest of the company as only healthy employees and leaders can perform optimally. Often the companies have health insurance for their people. Today employees and leaders also expect work to provide their life with meaning and stimulating experiences and developing challenges. Scholarly knowledge is substituted with experiential learning in a developing and dynamic environment. Society is developing fast and only companies with modern, well-oriented and culturally integrated employees can win the competition by offering costumers, clients or patients the best products and services. A strong association between quality of life, development of personal character, selfrealization, development of talents and skills, physical and mental health, meaning of life, sense of coherence and similar core concepts of modern medical and psychosocial sciences have in many studies now been strongly associated with work satisfaction, joy on the job and similar concepts. The scientific challenge we have taken upon our shoulders is to put the whole messy and chaotic area in order, and create a formula according to which the actual integrated status of worker can be calculated. We have decided to call the integrated concept of all above mentioned dimensions for working life quality, similar to the well-known global quality of life concept in medicine and social sciences. We are proud to present, in the present book, a mathematical formula from which the created value of an employee or leader can be known, if only the working life quality is known. We also provide a questionnaire for measuring the quality of working life, based on a theory of quality of working life. We have in a study on a random sample of the Danish population found a strong statistical association between the measured quality of working life and health.
viii
Preface
We started the research in quality of working life in 1994, and the first version of the QWL-theory was ready in 1996. In 1997 it was empirically tested in a study involving 1,500 persons and 30 companies. After adjusting the questionnaire and analysis of the data we further improved our understanding to the level that we are happy to present in this book, based on a number of published scientific papers.
ACKNOWLEDGEMENTS
The studies were supported by grants from the IMK Almene Fond in Denmark and the scientific papers published in the Int J Disabil Hum Dev 2008;7(2) and in the Int J Child Health Hum Dev 2008;1(2) and (3) issues. Staff from the National Institute of Child Health and Human Development, Office of the Medical Director, Jerusalem in Israel was supported by the Israel Foundation for Human Development in New York. We also thank Frank Columbus of Nova Science and his staff in New York for his support and guidance.
In: Health and Happiness from Meaningful Work Editors: Sren Ventegodt and Joav Merrick
ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.
INTRODUCTION
HEALTH AND HAPPINESS FROM MEANINGFUL WORK
Happiness at work your quality of life and sometimes your life depends on it. Work is an important part of the life of the modern man, as it always has been, but work has become more complicated that before. Today what we do is often done as a part of a large organization. The work is often abstract manipulation of matter or information, and the value created by the single member of the organization has become increasingly difficult to measure. Organizations have become increasingly responsible for not only the physical work environment, but also for the mental working environment, and factors like stress and sexual harassment are becoming more and more regulated by company rules and culture. The health of the employees has become a major financial interest of the company as only healthy employees and leaders can perform optimally. Often the companies have health insurance for their people. Today employees and leaders also expect work to provide their life with meaning and stimulating experiences and developing challenges. Scholarly knowledge is substituted with experiential learning in a developing and dynamic environment. Society is developing fast and only companies with modern, well-oriented and culturally integrated employees can win the competition by offering costumers, clients or patients the best products and services. A strong association between quality of life, development of personal character, selfrealization, development of talents and skills, physical and mental health, meaning of life, sense of coherence and similar core concepts of modern medical and psychosocial sciences have in many studies now been strongly associated with work satisfaction, joy on the job and similar concepts. The scientific challenge we have taken upon our shoulders is to put the whole messy and chaotic area in order, and create a formula according to which the actual integrated status of worker can be calculated. We have decided to call the integrated concept of all above mentioned dimensions for working life quality, similar to the well-known global quality of life concept in medicine and social sciences. We are proud to present, in the present book, a mathematical formula from which the created value of an employee or leader can be known, if only the working life quality is known. We also provide a questionnaire for measuring the quality of working life, based on a theory of quality of working life. We have in a study on a random sample of the Danish
Sren Ventegodt and Joav Merrick
population found a strong statistical association between the measured quality of working life and health. We started the research in quality of working life in 1994, and the first version of the QWL-theory was ready in 1996. In 1997 it was empirically tested in a study involving 1,500 persons and 30 companies. After adjusting the questionnaire and analysis of the data we further improved our understanding to the level that we are happy to present in this book, based on a number of published scientific papers. It is our sincere hope that our development and research in quality of working life will inspire many companies, leaders and employees to improve the meaning of life, sense of coherence, mental and physical health and happiness in life that can result from a wise and conscious use of yourself in the every day working situation.
PART I: UNDERSTANDING QUALITY OF WORKING LIFE HOW TO BE HAPPY AT WORK
Chapter 1
WORKING LIFE
Work can be one of the greatest pleasures in life. On the other hand, there is nothing worse than a job you are unhappy with. Work is such a vital part of life - such a constant companion - that if you do not feel at ease when leaving for work in the morning, your joy in life may be shattered. It is difficult to feel happy when you do not really feel committed to your work. If your work is not a place where you can thrive and be happy, but more like a prison with displeasing work, your life energy is drained. If you cannot see the point of what you are doing and you do not feel that you contribute anything valuable, your work wears you out. That kind of work may kill you slowly - bit by bit. Furthermore, if you do not consider your work valuable, the same will apply to your company, the customers and the environment in general. Without responsibility and commitment, quality and efficiency disappear into the blue.
He was lying with his eyes half open. Aha, like this! In his dream he had solved the problem, and he was now wondering if the solution could be applied to real life. Yes, it wasn't that bad his solution. He wondered how his colleagues would react? Blinking against the clear morning sun, Knud could hear the love of his life potter about in the kitchen. It was a lovely day. For a moment he felt completely happy.
According to a Quality-of-Life survey of 10,000 Danes, carried out by the Quality-ofLife Research Centre in Copenhagen, only one in every three employees is happy in his or her job [1,2]. This is catastrophic for society. We are convinced that an uninspiring and detached working life is one of the main reasons why people on average retire at the age of 61 years. And it may also be the reason why people in Denmark rate such a short average life span, as proven by several surveys and reports. Few human beings can cope with leading a meaningless life - all spent working in jobs that they do not really enjoy. It takes its toll because our health and wellbeing are dependent on our ability to renew ourselves and develop new expressions of our personality in order to use life properly.
Human beings are created to be active, to use their talents in the best possible way to the benefit of themselves and others [3-5]. That is what is meant by life. The meaning of life is found in all aspects of life: within the family, with friends in our spare time as well as on the job. Research showed [1,2] that people who feel useful are the ones who are happy. It seems that we all have a dream of contributing something to this world - in our private as well as our professional lives. Work can be exciting, it can be thrilling and, at best, it is not experienced as mere work. Instead it becomes the challenge of our life, becomes what we dreamed of doing, in private as well as professionally. There is nothing more exhilarating than an exciting job because work is about being useful to the world, as well as influencing and creating a world in accordance with our private dreams. There seem to be four basic conditions that determine the quality of working life: Personal quality of life Mastery of the working process Fellowship with colleagues and management Creating real value for both customers and environment.
Which is described in papers in this special issue and we would also like to take a closer look at personal development: How do you improve your life? What is it that makes it so difficult for us to develop? In order to develop and improve your life, it is essential to be aware of your attitudes and your way of doing things. This requires alertness and your best efforts. It may sound easy, but as a matter of fact it requires an immense amount of selfdiscipline, which very few possess at the outset. With your decision to make improvements, miracles may be waiting around the corner. At your company it should not be difficult to agree on commencing a project with the purpose of developing your working-life quality because an improvement in your work satisfaction will be in the interest of your company too. Employees and management who have gained more insight and a more profound sense of responsibility will be concerned to implement a production process that does not interfere with the delicate balance of the ecosystem.
REFERENCES [1] [2] Ventegodt S. Livskvalitet I Danmark. Quality of life in Denmark. Results from a population survey. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. The quality of life of 4,500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. Scientific World Journal 2003;3:1030-40.
[3]
Working Life
[4]
[5]
Ventegodt S, Merrick J, Andersen NJ. Quality of life theory II. Quality of life as the realization of life potential: A biological theory of human being. Scientific World Journal 2003;3:1041-9. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory III. Maslow revisited. Scientific World Journal 2003;3:1050-7.
Chapter 2
QUALITY OF LIFE, HAPPINESS AND MEANING OF LIFE

Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel and Joav Merrick
Good work is an activity that creates a strong sense of personal meaningfulness, because it is directly connected to the project of our personal development, what we want from life. We all want to become complete. To this end, we need to grow and achieve fulfilment. Good work challenges us to go beyond our limits and confront new and exciting aspects of life. Work should be a direct manifestation of life. Life is a simple and clear expression of what you do. Our love of life is revealed in what we do. The fine art of working and the secret of working are to be found in the intimacy of the intersection between our lives and the world around us. The secret of the extraordianry working life is the blossoming of all our human talents. Most interestingly it seems that we all have great gifts to give to the world, but only after many years of dedicated practice will these gifts reveal themselves fully.
INTRODUCTION Philosophers have through all ages been occupied with the immense questions and seemingly unsolvable problems related to the quality of human life. As life for most people have consisted of a professional and a private life, both of these have been subject to consideration. For half a century grand thinkers have been reflecting on the meaning of life and how to improve it and quite surprisingly, a sign of our time is that these problems are starting to soften up on the thinkers [1-3]. It is only natural, that we take these general solutions and apply them in relation to our worklife, and for that purpose we have constructed the word working-life quality or the quality of working life (QWL). For more that a decade, the Quality of Life Research Centre in Copenhagen, Denmark and its scientific international coworkers have walked the path to try to understand quality of life (QOL) and QWL, publishing books [4-11] and scientific papers [12-29] on the good life and the good work. Exept for a few books [4,5] and papers [12,30-37] our works have often
10
been discussing philosphy related to the concept of quality of life (QOL) and quality of working life (QWL), but without adressing the philosophical questions directly. But as philosophy is the basis of science, this is not wise. We need an explicit discussion of the philosophy behind the major aims and developments in our medical science and the related sciences making it possible for us to deliver the service to our patients and clients that we want; especially when it comes to large health care units, with all their to wellknown problems related to QOL and QWL. We need a specific research line in QWL also. In this book on QWL philosophy we take our offset in the Danish Quality of Life Survey, where we asked 10,000 people about their quality of life with the validated SEQOL questionnaire [16,17] with more that 300 questions on their quality of life, and the subsequent work done on QWL and the related 100 questions QWL-questionnare, SEQWL. How did they feel ? How content were they with their lives ? How happy were they ? Did they feel their needs were fulfilled ? These were part of the many questions asked. We asked the questions we believed to be important for the QOL. The results [8-11,22-27] forced us to contemplate deeply on the following philosophical questions, like what is QOL and QWL, what is human talent and how is it supported, what is personal mastery, fellowship and true creation of value? To argue that these philosphical questions, both related to QOL and QWL, were actually related to medicine and the providing of high standard health sevices, we needed to look at the consequesces of patients and co-workers being taught this philosophy layed out here. Quite surprisingly it seems like just assimilating the QOL and QWL philosophy already makes things feel better and more meaningfull. When we work with patients, we call this QOL as medicine [28,29] and this improvement of the patients personal philosophy of life seems to be the essence of holistic medicine, helping the patient to assume responsibility for his or her own life [30]. When we work with leaders and coworkers, the principles are not very different, but the focus is on using all their talents and obtaining joy of work and proficiency, hearthful relationships at the working place, and the expierience of creating real value to the community. Our series of QWL pilosophy papers will adress these items one by one. The quality of our QWL reflexions are soft and general pretty vague, if you are accustomed to the hard quality of natural science - as much philosophy is and even vague if you are accustomed to medical QOL science. Nevertheless we find such general perspectives of utmost importance, as all scientific and systemtical action is build on such general considerations of values, perspectives on reality, interpretations of life and production goals, and preferences of focus. So please bare with this vagueness and look for the abstract, QWLsupportive perspective, which materialise in our papers on QWL philosophy, as we believe that such a positive interpretation of life and reality can help many leaders and coworkers in the modern health service organisation.
TO WORK IS TO THRIVE AND PROSPER OR TO DIE SLOWLY The worst thing he knew was to wake up in the morning and go to work. He felt that his eyelids fought him on days like this and refused to open. He forced himself out of bed and got dressed. The day had started and he was already busy, trying not to be late for work.
Quality of Life, Happiness and Meaning of Life
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Do you look forward to going to work in the morning? Or is it a necessary evil? Does your work draw you or must you force yourself to leave home? Would you continue working if you had enough money? Or would you do something quite different - change professions, for instance, travel around the world, study, become an artist or make yourself comfortable and take it easy all day long? Many people daydream about not having to work. But, one day, they realise that maybe a lot of freedom and time off is not sufficient - maybe there was something special about working after all. Something that goes deeper than money, status and personal identity, which cannot hide the fact that human beings need to work. It is the meaning of life that we use ourselves for a purpose. It takes a lot of pain to experience life as a gift, if we consider ourselves useless creatures. And that is the secret of work: work is where our efforts can make a difference - and where our contribution can help to make this a better world to live in. The core of work is very close to our soul. We have to work simply because we cannot help it. It is in our nature as human beings to be active and creative. This, of course, does not mean that all work is good. Only work close to our soul is good, since it fulfils our need to develop ourselves to be useful and valuable. Consequently, using ourselves in constructive and useful ways gives us great experiences. Other ways will make us suffer from the wrongs we do. Work can build up something in life or tear it down. It can make us happy and healthy or it can corrode our souls and jeopardise everything. Most people feel fine on the job even though it is rarely superb. But this may be the essence of the problem: if you do not make further demands of your work, you will end up with a merely 'bearable' job and never obtain really rewarding work. According to statistics (Danish WorkingLife Quality project), only one in three people feels very much at ease with his or her job. Thus there are great possibilities for progress. What can we do to find a better job or improve our job? First of all, stop being so content, because we are content with far too little. We are too tolerant. A job that we do not really want is just not good enough. We really must make demands to feel fully alive at work. Life is too short for boring work. Get your fantasies going. What would you like to do? What do you feel like? What are your interests? What possibilities are offered by your present employer to get you where you want to be? Imagine that your physician has just passed you your death sentence: about three years left to live. Would you keep the job you are in? What would you do differently? To what would you say no? If you would not keep your job in this situation, maybe you should quit tomorrow. There is no guarantee that we will grow very old. We may die tomorrow. Life is far too short for meaningless work. It is important to understand that our body cannot endure the strain of doing things we consider meaningless. We must be alive on the job; we must be eager and keen and go full speed ahead! You will not become more alive from doing work that you consider routine, boring, monotonous and exhausting. This is not to say that all physical work - washing, cleaning up or sewing - is bad work. If you like it and you have good colleagues and if you consider it useful, then it might be the right job for you. But work that you do not consider good for you is not worth having. Do not take it for the sake of money. The world has grown too rich for that. To those people who insist on arguing that many people still have to work for their daily bread, we can only say that their attitude may be wrong. Of course, it is necessary to work to maintain a good standard of living - but is that standard necessary? Happiness does not depend on a car or a mobile telephone and electric toothbrush - nor the good claret and sirloin. Basically, happiness
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comes from your own wellbeing, your surroundings and from doing what you really like to do. If you can achieve such a state of wellbeing, there is no reason to be unhappy about a life without material goods. In that case, you are far better off than the average person is. Indeed - and this comes as something of a surprise - according to the previously mentioned study on quality of life - people with jobs they do not really like generally feel worse about life than those who are unemployed. The same research also showed that it is not unusual to be happy without a job. According to the survey, 55% of the jobless persons stated that they were happy or very happy compared to 66% of the persons in jobs, although those on social benefits were on average less happy. It is your own responsibility to get on with your life, if you are in a job that you do not like. Nobody will do the work for you. Your working life is your responsibility. You are the only person, who really knows what is good for you - and you are the only one who can change things. Our greatest enemy is resignation, indolence and laziness. Apathy flowing sluggishly through the veins and listlessness causing heavy eyelids all day long result in an almost dead person, who seemingly will not take the initiative in his or her own life. A person without dreams of life is a person who is only half-alive. To find out what to do with our working life is the great opportunity to do something about it. To what extent is our health endangered, when we are bored on the job? We do not know all the consequences yet. But we can assume that there is a severe health risk. As living creatures we are made for a whole range of lively activities. When we are wrapped up in old habits and comfortable wealth we lose our need to be alert and do our best. We so easily lose our clarity, our freshness and connection to life. We are able to renew our lives by demanding everything. Or we can let go and give up and gradually grow tired, sad, weak, old and desolate. Today we know for a fact that human beings, who have lost their joy in life are, in fact, people suffering from a wide range of weaknesses and health defects. It is as if we cannot live without feeling alive. Our body needs a commitment that is alive. It needs to feel excitement, fear, happiness and hope. If you feel that you are moving downhill, so to speak, and this is accompanied by a symptomatic and increasing number of days lost through sickness, forgetfulness as well as rather poor performance in your job, you need to give thought to what is wrong. Is it possible that your way of living is causing your deterioration? If we do not thrive and our body keeps telling us that we are unbalanced, then it is obvious that we suspect our working life of being too uninspiring, exhausting and destructive simply because work takes up such a big part of our life. Of course, your problematic relationship with your partner is worth a thought, and if you have no close friends that will not help you either, if you are to renew yourself. But everything in life fits together. If there is no commitment on your part towards your work, there will not be any enthusiasm either for your spouse, your children, your friends or your hobbies. Maybe there is no fire in you at all? If you can make a change by quitting a boring and monotonous job in favour of what you see as the challenge of your life, you have made an excellent bargain. And no matter whether you get half your former salary, your spouse gets infuriated or the whole world laughs at you - do not take any notice. Life is short and the chances are few - so take a chance while it is there. Today you may be young and vital; tomorrow you may be trying to recover from a cerebral haemorrhage. Life is shorter than you think. You have no time for fiddling about. A good job is
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one chance in a lifetime. Take the chance and go for it, be good to yourself. Create a job for yourself - get a job that you really care about. Good work is an activity that creates a strong sense of personal meaningfulness because it is directly connected to our personal development project, i.e. what we want from life. We all want to become complete. To this end, we need to grow and achieve fulfilment. Good work challenges us to go beyond our limits and confront new and exciting aspects of life. Work should be a direct manifestation of life. Life is a simple and clear expression of what you do. Our love of life shows in what we do. The fine art of working and the secret of working are to be found in the intimacy in the intersection between our lives and the world around us.
WHAT IS GOOD WORK AND HOW DO YOU ATTAIN IT?
The Bad Blacksmith

The work in the forge is hard. The hammers are heavy, the forge is hot and the noise from his constantly hammering the anvil is at times insufferable and always fatiguing. The work is grubby and the air inhaled is far from pure. At the end of the day, which anyway is much too long, the blacksmith always sighs a little. I should have done otherwise. But you have to stay alive and becoming a blacksmith was no problem.
The Mediocre Blacksmith

He shows a certain pride when delivering the finished product. It is quite well done, and the customer is usually content with what he gets. The work is good and the pay is not bad. Of course, the forge is very hot and dirty but he was lucky to get two apprentices to do the heavy work. One has to be flexible, he thinks. He always sees to it that they measure up to the professional standards. It is important to avoid too many errors even though things move fast at times. He is quite content with being a blacksmith, even though he takes no pleasure in handling the hammer.
The Good Blacksmith

The hammer hits the red-hot iron. The blacksmith is one with his hammer. The perfect mastery of the tool, the complete understanding of the qualities and properties of the iron, the right material, the perfect temperature, a total confidence in the red-hot iron, its workability as well as the slowness and precise movements of his body in full harmony with the purpose of his work. He has constant visions of the finished product, masters the creative process and is fully present in the situation. Of course, customers come from all over to ask for this blacksmith when they want the best, because this blacksmith's work is superb. Work was less complicated in the old days, before the computer. But imagine a modern open-plan office. Will you not find someone here mastering the forge hammer (the keyboard) with perfection and discipline, while others just fumble with the tool of their trade? Is it not common experience that under exactly the same conditions some thrive and prosper, whereas
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others whither and fall into decay? Why is it that human beings reach such different degrees of mastering their work and why do human beings display such different talents? Work can be a fantastic experience and a potential peak in a person's life. Such a state may be reached, when work is considered as a great personal fulfilment. You do it because it fits you perfectly; it is vital for you and just the thing to do. And you do the work not for the sake of others but for your own sake. You do it for the sake of the work itself, not as a means of obtaining something else, for instance money, prestige and identity. You do it because you cannot help doing it. Good work attracts you - not as a relaxing experience, but rather an intense one. And even if it is experienced as really good, it will not be regarded as comfortable. Good work entails much joy and happiness but also many challenges, problems and struggles. It may be a painful and difficult experience because it will take you right to your limits where you must make all your best efforts to handle the challenges. But still, it is not stressful, fatiguing or unpleasant. Stress in your life is when you cannot cope with external demands. It is the feeling of being burdened in a very unpleasant way. However, to be burdened in this way is being a mule on which others load their burdens. In good work your own inner demands direct you - not external demands. Even though your work is fine, there may still be lots of trouble. It takes time. Often you are quite tired when you get to the end of a job. But if you think that this specific piece of work just must be done and that you are the one to finish it, then it does not matter that you get tired. Think of your work. Does it really suit you? Do you feel like doing it? Are you given the freedom to carry out the work the way you want to? Are you good at your work? Is your working performance improving? If you can answer yes to these questions, then maybe you are one of those in a good job. That is what counts, even though other people perceive your job at the machine or the computer as mere routine. Please remember that what is important is your personal experience of doing your job. If you do not like your job, it does not help you to feel better about it, even though your social environment deems it a good job. A strange and interesting feature about work in general is that it develops. The piece of work that is felt as good and meaningful one day may very well be outworn and obsolete the next. For instance, how long will it be before sweeping, cleaning and floor washing will be carried out by crawling electronic night-time tortoises? Such robots may still have difficulties in observing the dirt as well as manoeuvring past doorsteps- but some day they will not. It will not be long either before a small scanner registers what is in your shopping basket in order to draw money from your bank right away, thus replacing the cashier in the supermarket. When the day comes, when electronic and mechanical devices can do the job just as well as human beings, work will lose its meaning. That is why there is no point in occupying the unemployed and receivers of social benefits by making them dig holes or produce pegs and pins. What if you are not the right person in the right place? Well, in that case you must get on with your life. It may be wise to change things right where you are or start looking for a new job. To be stuck in a place where you are not meant to be is quite dreadful. It is not to your advantage. Yet many people remain stuck where they are and do not look for alternatives. They do not make any demands. They do not start changing things and they do not complain about anything. They do nothing. They are fatalists and gradually they become almost
15
unnoticeable; they are going downhill. Year by year it goes from bad to worse - human relations, self-esteem, love life and health. How can you endure spending seven to eight working hours every single working day without feeling alive? How can you accept that what you are doing in your life does not make your happy? Do you seriously believe that you can return to your home after a long day of doing meaningless work and still be happy, enthusiastic and inspiring to your spouse, your children or your friends?
THE GOOD WORK HOW TO GET THERE? In order to feel at ease at your work it is necessary to understand which components in working life may contribute to improving your situation and which will not. Surprisingly enough, according to surveys carried out, pay is less important than job satisfaction. Similarly, it looks as if the social status derived from work is of less importance, as long as one's pay covers one's basic needs and the social status is not of a debasing nature. One likely explanation is that the salary and status may comfort you in your personal life, but while on the job - working - your pay does not really matter since you do not use your money there. In most of the western world there are few people who worry about whether they can afford a pair of shoes for their children, unless their mortgage is far too high. Nor is anyone likely to be attacked because his father is a garbage collector or a receptionist. The quality of life survey showed us that managers do not feel better than the man in the street and that professionals do not feel better than lower wage earners. It seems as if the common denominators of good work such as education, status, money etc. do not apply when it comes to the actual experience of the work as well as life as a whole. In this respect your relationship to your own self and your environment is far more important, which means that material comforts are given the lowest priority as compared to a good life and a good job. If we consider working life, there are four relevant conditions to be prioritised. These are your relationship to your own self, your relationship to what you are doing (the job/work), your relationship to the people with whom you work (your company) and your relationship to those you service (customers, clients, society, your environment). Your relationship to your own ego has to do with quality of life. Quality of life means that you like being the person you are and that, in general, you are a positive, constructive and well-balanced human being. In most everyday matters we operate only on the surface of life - and we operate in depth when we are in contact with our potential and talents while trying to fulfil our dreams. Our relationship to the job is all about mastery - which means that you are doing your job excellently and show true commitment as well as being the right person in the right place, improving and developing with the relevant challenges. Real life-mastery may be quite problematic as most of us are tempted to keep doing what we are good at. The development of mastery demands from us that we continue our process of learning by jumping into deep water. Our relationship to those we work with is about joint efforts. You may be part of a very creative team, be it as an expert or group manager. It is crucial that you understand your part and function and that you are where you want to be.
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Your relationship to customers, clients and so forth, to whom you give attention, is about genuine added value. It goes beyond just making money for your company. A certain amount of profit is a prerequisite for your company's survival, like the oxygen and blood sugar needed by your body. But - earning money is just as little the true meaning of work as metabolism is the true meaning of your life. A brain-dead person can also earn money. Life is about being valuable to yourself and one another and enterprises are created in order to make products or render services as a joint effort complying with the real needs of the environment. This requires employees who are genuinely valuable to their surroundings.
JOB SATISFACTION RELEVANT AND IRRELEVANT FACTORS Work could be something we love to do together with people we are fond of in a situation where we use our joint efforts to create something that is highly valuable. It is not that difficult to imagine good work. It is difficult to get there, but not impossible. To get there requires confrontation with the issues that we normally associate with work. How would you for instance answer the following twelve questions in connection with a new job? Is it important for you that: Your salary is good? (Yes/No) Your occupational status is attractive? (Yes/No) You have short working hours? (Yes/No) The job description matches your qualifications? (Yes/No) The job implies status at work and in society? (Yes/No) There are good possibilities of continuing education? (Yes/No) The prospects of promotion are good? (Yes/No) You have job security? (Yes/No) You are content with your work? (Yes/No) You have freedom to make your own job schedule? (Yes/No) There is no stress in the job? (Yes/No) You are not confronted with tasks that you cannot handle(Yes/No)
Did you mark all twelve with a yes response? At first sight, most people might think that if the above-mentioned issues are in order, the job must be a good one. The interesting thing is that these twelve issues are likely to have very little influence on working life quality. With regard to titles, salary and excellent opportunities for further training, it seems obvious that there is a poor correlation with job satisfaction (see figure 1, showing an inconsistency between annual income and job satisfaction).

Working-Life Quality
(on a scale 0-100)
80
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75
QWL-s cale 0-100
70
65
60
55
50 6,67 13,33 26,67 40 53,33 133,33
Income in thousand Euro (intervalse: 6,67 means 0-6,67)
Figure 1. Coherence between working-life quality and annual income. In a quality of life survey 2,500 Danes were asked to state their annual income as well as their level of job satisfaction. The height of each column corresponds to the average measured well-being at work (90% ='very good'), 70% ='good', 50%= 'neither good nor bad', 30% = 'bad' and 10% ='Very bad'). The diagram illustrates that well-being at work is unrelated to annual income, as all income groups feel equally well at work except for the highest income group, which shows an insignificantly higher degree of well-being than the other income groups.
Working-Life Quality
(On a scale 0-100)
75 70 65 60 55 50 Not interesting at all Of little interest Somew hat interesting Interesting Very interesting
How interesting is your work?
Figure 2. The correlation between working-life quality (well being at the job) and interesting work. In a pilot study of six medium-sized companies 60 employees filled in a questionnaire on their working-life quality ('How do you feel at work?') Answers: 90%:'Very good' to 10%:'Very bad', and how interesting they found their work (from 'very interesting' to 'very uninteresting'). Each column shows varying degrees of interesting or uninteresting work. The study included only three people who found their work uninteresting or very uninteresting, so we have not shown their two averages. The height of the columns shows the average working-life quality. It shows that working-life quality is closely correlated with how interesting the work is, as persons with interesting jobs show significantly greater workinglife quality than those not indicating an interesting job.
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Job satisfaction cannot be salvaged by course programs or prospects of promotion. Job security may be fatal if it blunts the professional nerve necessary to ensure your best efforts in order to make your own future. Besides, you might easily be in a fine job that is well paid and seemingly satisfactory but which bores you in the depths of your being. The freedom to do meaningless, senseless things when you choose to do them is not likely to make for much pleasure. Who wants a job that does not demand quality or deadlines, which cause stress if we cannot cope adequately with their demands? Another questionnaire can be compiled based on questions focusing more on the actual experience of work and including a number of factors related to feeling alive on the job. Please try to answer the following twelve questions in relation to a new job? Is it important for you to: Feel commitment to what you are doing? (Yes/No) To experience your job as the challenge of your life? (Yes/No) To feel that you create true value in the work? (Yes/No) To feel that you are applying yourself wholeheartedly with all your talents when on the job? (Yes/No) That your work is quite interesting to you, after all? (Yes/No) That you relate well to your surroundings through your work? (Yes/No) That you feel part of an entity - the joint efforts of your company?(Yes/No) Have a good working environment - physically and mentally? (Yes/No) To be so good at your job that you master it as well as being able to express yourself fully and creatively in the working process? (Yes/No) To forget yourself while working? (Yes/No) Be able to become deeply absorbed and concentrate so much that the distance between yourself and your work almost disappears? (Yes/No) Experience the degree of intensity, presence and attendance at work that you consider vital to feel really alive? (Yes/No)
How did you answer these twelve questions? These questions are related to our existence and devotion to our work. Various studies revealed that questions of this kind are far more important to working-life quality than the pay, for example (see figure 2) These questions concern the correlation between what we do at present and what we really want from our deep inner selves. When we are truly fit and adjusted to our inner life at work, we have the possibility of experiencing a genuine and thorough commitment. Good work is a natural extension of our true wants. This profound harmony is the only way of ensuring that our efforts will provide us with good and meaningful experience.
DISCUSSION The major critiques our philosophy of working-existentialism could invite is the argument that by focusing on jobs and work, we are strapping the human being to the production form of the industrial society. The informational society presumably coming in a few years will need people who are not working in the classical sense of this word, but continuously
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engaging themselves in all kinds of activities that will help them to develop and bring them joy. Another big problem with the presented view is that unemployed people are doomed not to develop or blossom; this means that when we have this kind of idealising idea about work in society we will keep a certain fraction of the citizens in the dark forcing them to risk behaviors in order to survive. How we collectively conceive work is to a very high degree giving birth to our collective values and understanding of the whole world actually our whole consciousness as already noticed by Karl Marx in his book Das Kapital. How we today organise the creation of value (money) in our society is determining which kind of behaviour will be rewarded and which type of personality will be seen as heroic. Today most people in the western world see work as the primary route of personal liberation, but that might lead to an unbalanced focus on action and materialistic wealth, and a lack of focus on being and spiritual wealth, which might give serous backfiring on the citizens of society and perhaps this will even lead to serious damage of the global ecosystem. To preserve the planet it might be that we collectively should abstain from work, moneymaking and all activities that transform the surface of planet earth and destroy nature. So maybe the whole focus on work also presented in this paper is leading mankind to Armageddon. These questions should be thoroughly explored as they might be of extreme importance. But this is not our mission here; our intention was to show that work can be great fun and of huge value, if developed consciously. Very few people know what they want from their working lives. Most people focus on the surface and miss the whole point of their working life. It is curious that human beings rarely have the courage to dream life differently from that defined by our materialistic and superficial culture. It is startling how many end up having an awfully meaningless, grey and boring working life. The questions above link up with the four conditions that are decisive for the quality of our working life. In the following papers we shall take a closer look at these four topics: the quality of life, mastery, joint efforts and creating true incremental value.
REFERENCES [1] [2] [3] [4] [5] [6] [7] [8] Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Franscisco: Jossey-Bass, 1987. Maslow A. Toward a psychology of being. Princeston, NJ: Van Nostrand, 1962. Frankl V. Mans search for meaning. New York: Simon Schuster, 1997. Ventegodt S. The quality of life. Seizing the meaning of life and becoming well again. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. The philosophy of life that heals. Copenhagen: Forskningscentrets Forlag, 1999. Ventegodt S. Working-life quality. To become valuable to yourself and your surroundings. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S. Measuring the quality of life: From theory to practice. Copenhagen: Forskningscentrets Forlag, 1996. Ventegodt S. Quality of life in Denmark. Results from a population survey. Copenhagen: Forskningscentrets Forlag, 1995. [Danish]
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Ventegodt S. The quality of life of 4,500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S. The quality of life and factors in pregnancy, birth and infancy. Results from a follow-up study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen 1959-61. Correlation between quality of life of 4,500 31-33-year-olds and data about their parents, birth and infancy. Copenhagen: Forskningscentrets Forlag, 1995 [Danish]. Ventegodt S. The quality of life and major events in life. Copenhagen: Forskningscentrets Forlag, 2000. [Danish] Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1):89-91. Ventegodt S, Poulsen DL, Hilden J, Frimodt V, Lohmann-Devantier E, Pruzan P. New tools to measure quality of life. Agrippa 1994;14(3-4), 210-5. [Danish] Ventegodt S, Hilden J, Merrick J. Measurement of quality of life I: A methodological framework. ScientificWorld Journal 2003;3:950-61. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life II: From the philosophy of life to science. ScientificWorld Journal 2003;3:962-71. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life III: From the IQOL theory to the global, generic SEQOL questioinnaire. ScientificWorld Journal 2003;3:972-91. Ventegodt S, Henneberg EW, Merrick J, Lindholt JS. Validation of two global and generic quality of life questionnaires for population screening: SCREENQOL and SEQOL. ScientificWorld Journal 2003;3:412-21. Lindholt JS, Ventegodt S, Henneberg EW. Development and validation of QOL5 for clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life. Eur J Surg 2002;168:103-7. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. ScientificWorld Journal 2003;3:1030-40. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory II. Quality of life as the realization of life potential: A biological theory of human being. ScientificWorld Journal 2003;3:1041-9. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory III. Maslow revisited. ScientificWorld Journal 2003;3:1050-7. Ventegodt S. Sex and the Quality of Life in Denmark. Arch Sex Behav 1998;27(3):295-307. Ventegodt S. A prospective study on quality of life and traumatic events in early life 30 year follow-up. Child Care Health Dev 1998;25(3):213-21. Ventegodt S, Merrick J. Long-term effects of maternal smoking on quality of life. Results from the Copenhagen Perinatal Birth Cohort 1959-61. ScientificWorld Journal 2003;3:714-20. Ventegodt S, Merrick J. Long-Term Effects of Maternal Medication on Global Quality of Life Measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 1959-61. ScientificWorld Journal 2003;3:707-13.
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[26] Ventegodt S, Merrick J. Psychoactive drugs and quality of life. ScientificWorld Journal 2003;3:694-706. [27] Ventegodt S, Merrick J. Lifestyle, quality of life and health. ScientificWorld Journal 2003;3:811-25. [28] Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine. A pilot study of patients with chronic illness and pain. ScientificWorld Journal 2003;3:320-32. [29] Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine II. A pilot study of alcoholics. ScientificWorld Journal 2003;3:320-32. [30] Ventegodt S, Merrick J, Andersen NJ. Holistic medicine III: The holistic process theory of healing. ScientificWorld Journal 2003;3:1138-46. [31] Editorial. Quality of life. Lancet 1991;338:350-1. [32] Diener E, Oishi C. Money and happiness: Income and subjective well-being across nations. In: Diener E, Suh EM, eds. Culture and subjective well-being. Cambridge, MA: MIT Press, 2000. [33] Shek DTL. Meaning in life and psychological well being: An empirical study using the Chinese version of the Purpose in Life Questionnaire. J Genetic Psychol 1992;153(2):185-200. [34] Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A qualityoflife instrument for use in international clinical trials in oncology. J Nat Cancer Inst 1993;85:365-76. [35] Testa MA, Anderson RB, Nackley JF, Hollenberg NK. The Quality-of-Life Hypertension Study Group. Quality of life and antihypertensive therapy in men. N Engl J Med 1993;328:907-13. [36] van Knippenberg FCE, de Haes JCJM. Measuring the quality of life of cancer patients: psychometric properties of instruments. J Clin Epidemiol 1988;41:1043-53. [37] McDowell I, Newell C. Measuring health: A guide to rating scales and questionnaires, 2nd ed. Oxford: Oxford Univ Press, 1996.
Chapter 3
PERSONAL QUALITY OF LIFE

Our viability and vigour in general is derived from our state of well being and life as a whole. Some people are harmonious. They thrive and prosper and have the energy to solve all the problems they encounter. These people are ready and willing to communicate and they are alert and attentive to life. They represent resources to be drawn upon. Often they are very valuable to themselves - they love life - and they are shown respect and appreciation. Human beings who communicate great joy in life and a reserve of strength, are those who easily rise to the occasion and quickly adapt to getting on with other people. Quality of life is something inside you and it accompanies you wherever you go. Many people think that it is a matter of chance whether or not there is quality of life and surplus energy. Some people are born under a lucky star, they say, while others had a bad start. By chance some humans have better genes and by nature they are the chosen few, the beautiful, the talented and the marvellous, while the rest of us must accept the twists of nature and accept being plain, a bit boring not possessed of the most brilliant minds. But no. Human beings are to a much greater extent the masters of their good or bad lives. Quality of life implies that you know and accept yourself. This is not as simple as it may sound. But you can shape the good life yourself. INTRODUCTION Peter feels best when he is on his own. It is as if other people are too much for him. He does not have the energy for them. When he is with people he feels something jarring, though he cannot figure out what might be wrong. It is as if they hurt him, as if their existence makes him uncomfortable. At work he easily flies into a temper and he is not capable of withstanding demands made upon him. It cannot be said that he is doing a poor job, but he is not really good at it and he keeps blaming himself for repeating the same mistakes. It is difficult for him to make a decision and keep his promises. He does not seem to have the potential to realise his goals. One cannot make him out really, because he has talent and in many ways he is a handsome man - tall and strong. However, there is something tormented
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about him, which makes other people prefer doing their job without him, leaving him out of the joint efforts. It is as if Peter's life will not allow him to succeed.
FEELING REASONABLY AT EASE Henrik is content with his work. He feels fine about his wife and children. In general, he is a happy man. He works well and he is reasonably good at his job. He functions well on all fronts. But Henrik tends to become bored. He is 45 years old and has the feeling that life has slowed down a bit too much. His love life has become a routine; it is not bad, but the excitement has gone. The work is good and that is it. The children are almost grown up - too grown up in fact, as if they are growing away from him. Of course, they are about to live their own lives, but still he often feels a stranger even though they are only 13 and 15. How will it be when they grow older? Anyway, Henrik is happy about life. He wakes up in the morning and looks forward to his newspaper and the smell of fresh coffee. But in idle moments he wonders what is missing. His life has lost its nerve, its spirit and passion. It is as if life has more in store for him but he cannot grasp that more.
FEELING GREAT ABOUT ONESELF Kristian cannot help being in high spirits. His humour without any vulgarity follows him everywhere. To put it plainly, he is always in a good mood. He always has a twinkle in his eye and he makes people smile. They cannot help it. Kristian feels fine. He does not feel superior or in any way put on airs. On the contrary, he is humble and has a modest bearing. He is well liked and supported by his fellow beings. Kristian understands how to live as well as getting the best out of almost any situation. He is like a breath of fresh air wherever he goes, with a scent of the forest, the pines, the resin and the magic secrets. He understands, he has the energy to lend others an ear. And his words are useful to others. Not that he is very talkative. But what he says makes sense. Kristian knows how to share his words in whatever situation he finds himself.
QUALITY OF LIFE Our viability and vigour in general is derived from our state of well being and life as a whole [1-22]. Some people are harmonious. They thrive and prosper and have the energy to solve all the problems they encounter. These people are ready and willing to communicate and they are alert and attentive to life. They represent resources to be drawn upon. Often they are very valuable to themselves - they love life - and they are shown respect and appreciation. Human beings who communicate great joy in life and a reserve of strength, are those who easily rise to the occasion and quickly adapt to getting on with other people. Quality of life is something inside you and it accompanies you wherever you go. If you want to check on your quality of life, the following questions are relevant: Are you where you should be in your life?
Personal Quality of Life

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Are you happy with the conditions of your life, including your work, your friends and your family life? Are your needs satisfied, including what you understand as a meaningful occupation? Do you feel happy and strong and free in your life as a whole and when at work? Do you feel fine - when it comes to the essentials? Is your life as such OK? Are you OK with your lover? Your friends? Your children? Yourself? Your surroundings? Do good experiences occur to you weekly that make you recover and renew yourself, at work and away from work? Do you know what to do with your life and are you willing to fight to realise your dreams?
Many people think that it is a matter of chance whether or not there is quality of life and surplus energy. Some people are born under a lucky star, they say, while others had a bad start. By chance some humans have better genes and by nature they are the chosen few, the beautiful, the talented and the marvellous, while the rest of us must accept the twists of nature and accept being plain, a bit boring not possessed of the most brilliant minds. But no. Human beings are to a much greater extent the masters of their own good or bad lives maybe best exemplified by the possibility of the human being to influence on his own good or bad health [23-43]. There are a number of reasons why some people have good quality of life while others squander it and we can go a long way in the influence we exert on these causes. You can shape the good life by: Respecting life Having good values Knowing what you want Listening to your inner wants and dreams Not wasting your energy Knowing that time is short and go for a life Taking responsibility
RESPECTING LIFE Quality of life implies that you know and accept yourself. This is not as simple as it may sound. Who are we and what are we really? If you ask people what and who they are, it is difficult to wrest from them anything but something like: Peter Jorgensen, Principal, 48 years old, married, two children and principal shareholder in Good Cucumbers Ltd. But we are not Peter Jorgensen or whatever our parents have chosen to call us. It is just a name, a label, so to speak. We are infinitely more than that. First and foremost, we are alive. We are living creatures with billions of years behind us, ancient beings from of old because life has been here almost endlessly and because the wisdom of life is passed on from one generation to the next. In common with all other beings, life is inherent in us, e.g. the happiness of living. We are in possession of intuitive knowledge
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of everything from sex and love via friendship and community to language and the intelligent use of tools. By nature we are magnificent creatures. Life has its own enchanting magic. If every single one of us does not feel alive and brilliant, it is because the magic has vanished and our life has become weak and fragile. We have stopped listening to it. We have stopped asking ourselves what to do with life and what it is about. Existentially, we have fallen into a deep dreamless sleep and we have failed to look for the meaning of it all. To respect life means to know as a human being that you are first and foremost alive and that life has its own deep regularities with which we must identify and to which we must conform. We have to give life space. If we do not, it will be strangled in common sense and formalities, vouchers, bad habits and every day routines. Discover the feeling of being alive. That is the first and crucial condition in order to be valuable to yourself and others.
HAVING GOOD VALUES Each of us has a set of values that consciously or unconsciously guides our actions and choices. The values are what we like, what we are looking for, what we consider serious, valuable and attractive. The values are the small number of central concepts that are our guiding principles. In our culture the important values are often extremely material, be it in the public or the political sphere. In short, we go for money, a residence, clothes, food, consumer goods, a good education and security. A minority group adds to this picture some confidence in a long life on earth because of a healthy life style. What made us choose these values? Could we not prioritise in favour of love and friendship, joint efforts, nature or the experience of feeling really alive while we are on this earth? We could have chosen otherwise but we did not. Typically we ask for materialism, which is not positively related to quality of life, annual income, educational level, housing, exercise, diet and so forth. However, we spend amazingly little time and energy on what could relate most fully to quality of life, namely the quality of our relationship to ourselves, our lover, friends, children, colleagues, the community, nature, etc. The values that we rate so highly today, as individuals and jointly, have little to do with quality of life. On the contrary, they are about money and things. With these kinds of values we set up for ourselves a life without joie de vivre, happiness and purpose. We fail to take account of our inner lives, and, in the long run, risk devastating effects on our health. This ought to shock us but it does not, because we know that it is so. Too often we are just too lazy to do something about it. We make a point of being tolerant with regard to others' values. 'All values are equal and everyone is free to choose', is our democratic line. Yet we know deep down inside of us that this is not true. Life has its own deep values that provide the key to the good life. We have an obligation to love life and live accordingly. We have an obligation to seek those values that accompany life: friendship, love, togetherness and to shun those values that are detrimental to life, for instance superfluous materialism, vanity and power without any purpose.

KNOWING WHAT YOU WANT
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We create our lives by making our dreams come true. Not knowing what we want makes us lose our lives. Most people walk around in a daze, not knowing what their lives are about. Not until death is near, do people wake up. By then it is often too late. Life is an arrow that points towards the future as well as towards death. We can do what we want if we are smart, ingenious and strategic - as well as efficient - for life is short. We have to be goal-oriented, energetic and persevering. We are offered such a wide range of possibilities to succeed but this necessitates us to be conscious of 'what' it is about. When you dream your life dream, it may be difficult to imagine it coming true. But if you show perseverance and patience, the right opportunity will present itself some day. The opening will present itself; you will see the way forward. The problem is not that the world does not offer any possibilities - there are many possibilities. The problem is rather that we do not know what we want. We make no demands. We are content with almost nothing. Right from the beginning we reject possibilities that seem, at first glance, to be out of our reach. We prefer to live with the smouldering pain of suppressed yearning, rather than the clear and obvious pain from dissatisfaction with the present state of things - which is, in fact, a prerequisite for change. It is not that difficult to find out what to do with your life. What is difficult is to live up to that knowledge because what is ahead of you is the difficulty of cultivating and refining your spirit; the pain of living with a feeling of yearning and loss; the strictness of waiting with patience; the harshness of living strategically, practising control and discipline. The knowledge of the meaning of life demands from you that you dust your morale and start fighting yourself for your life - against your apathy, ignorance, laziness and indolence in order gradually to re-conquer your life.
PAYING ATTENTION TO YOUR INNER WANTS AND DREAMS How do you find out what you really want? Listen to your longings and dreams. Trust yourself and listen to your heart. We all have frustrated dreams from the beginning of our adult lives. Dreams about friendship, about the love of your life, about the great job that will absorb us for years to come. About achieving something extraordinary in life. The colour of adult life is not a flashy one, but that is no excuse for throwing away all the dreams of your life and just resigning yourself and adapting to whatever comes your way. A typical feature of our greatest dreams is the happiness when the dream comes true. In your working life you may experience a strange kind of happiness after a real effort. You may gain the experience that life at this point is a success. You may experience that you are where you want to be and where you belong, that is to say that the higher meaning of your life is to do exactly what you are doing. Great professional accomplishments may be achieved. It is within your reach to achieve mastery. You may experience that the distance between what you do and what you are vanishes. You may reach the most intense and joyful state of mind - when you accept the greatest challenges and resolve the most trying problems. It starts with your life's dream. In the midst of a fantastic working-life - you do not find yourself, just like that. First you must find your vision and your imaginative concept of good
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work. Then, in the following thereof you materialise it by working laboriously through changes and adjustments taught by reality. Life is shaped by your self-expression. It is all there inside of us in the form of opportunities and potentials to be realised. When that happens we see our life blossoming. The potential reaches us in a strange and magic way, like a vision, an unexpected and surprising idea. But, without our true/proper inner spirit being involved, things will not work for us. The right spirit is the ability to sense the deeper meaning of life's way of being with us - to sense life's deepest purpose with us.
AVOIDING WASTING ENERGY Shaping your own life needs energy [1-22]. Where does this energy come from? From inside of us. Life is full of energy because life itself is the source of its inner meaning. The energy is drawn from life experienced as significance, by love, by importance. Those who really know what they want are willing to fight like lions to make their dreams come true. The world appears soft and malleable when we are in control of our selves and our personal energies. Right through the middle of our heart runs a 10,000-volt cable with unlimited energy on which to draw ad libitum. From here we can get all the energy needed. As long as we act in accordance with our love of life, there will be plenty of energy - until we have accomplished the measure of our days and death takes us away. However, it is possible to waste the immense energy of life in various ways. For instance by getting involved with matters that take more than they give. By quarrelling in vain. By frittering away our tasks and results due to lack of alertness to shortcomings. By expending our conserved energy on worthless entertainment. Lotteries like the State Lottery, the Pools etc. are good examples of wasting time and money. First you spend your money and energy on a ticket with artificially induced excitement and unrealistic hopes of winning a prize. Basic rules of profitability make it obvious that the lottery ticket is worth far less than the money paid for it. Many people apply this kind of lottery strategy as a common feature of their lives. With a bit of luck it works, and so forth. But there is no such luck in life - and we hear all too often: 'No luck this time'. People who try to justify their unhappiness with a fatalistic attitude are typically irresponsible people. By using our vital energy properly it is possible to conserve energy and consequently always have surplus energy. Quality of life will then be derived from our own efforts and wisdom, and we will not spend our time daydreaming about the quarter of a million prizes.
KNOWING THAT TIME IS SHORT AND LIVE ACCORDINGLY Life is shorter than we expect. One reason for this is that we finish our professional careers long before we shuffle off this mortal coil. The few years of work we have left may prove to be our most significant chance of achieving something of lasting value in life. This is our chance to leave our mark on the world in more ways than just providing the requisite couple of children that nature stipulates (which can be managed before you are 18 without too much trouble).
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Life is surprisingly short and time flies. The days come to an end too soon - one day ending the other. It is as if we are on a train. On board, all the more or less slow routines work according to the clock, signalling nothing unusual. But seen from the outside, it is obvious that the speed of the train is 160/kph and the trip is soon over. In order to grasp how short time and our working life is, it is necessary to take a look from the outside. Try to look through the windows of the train and watch the sluggish and torpid passengers inside, cut off from the real beauty of life and quite complacent while slurping up coffee and eating pastry while they are entertained by movies on the television. Do not waste your life like that! Time is far too short, and when you hear the voice of the engine driver telling you that your trip is coming to an end within a few minutes, it is too late to do anything about it.
ACCEPTING RESPONSIBILITY Accepting responsibility means that you see to it that things become the way you want them to be, no less [9-15]. We have far more freedom to shape our lives than is generally believed. When we start the fight for change the very first time, we often realise that the obstacles are not in the world out there but have their roots within us. This is not to say that there will not be grumbles and complaints from your environment when you fail to live up to others' expectations and start making demands and being troublesome. But other people rarely constitute a real obstacle. If you understand how to communicate and explain your motives clearly, it is often possible to induce change. To take responsibility for yourself means that you begin perceiving yourself as the acting cause of your life. It means that you realise how your words and actions have an impact on what your life is. Obviously, taking on responsibility is not tempting; it is like taking the first step into a cold shower. You are compelled to search out your personal attitudes to life in order to review your problematic situation. In general, it is far more appealing to pay attention to others faults. Accepting responsibility means changing your lifestyle and transforming yourself into a fighter. As a victim, you take things as you find them, as a fighter, you embark on a constant battle, fought with perseverance until you get what you want. What if your boss is a hopeless case? Will he become less awful and idiotic as a result of your taking responsibility and treating him in a strategic manner? Not really. But your problem with your superior is not that he is an idiot. He can be that, as long as you do not suffer from it. If you think it your responsibility to educate all the idiots of this world, you will have your job cut out. No, the moment you are in control of your attitude to the man as well as the way you treat him, he will start treating you far better in the future. Maybe he will even give you the freedom you so desperately want as a consequence of his sympathy for you as well as his confidence in you. In such a process where you take on a responsibility and clean up your own house, so to speak, most people discover unpleasant truths. Actually it was not just my dislike of my superior - it was about superiors in general. And maybe there are good superiors around who will wish us the best and provide us with maximum support and working conditions, so that we may carry out our jobs in the best way possible?
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Life appears to be like that all the way through. There are lots of excuses for leading a poor life but, at the end of the day, we may have to admit our own faults and prejudices. To take responsibility means trying to solve the problems.
DISCUSSION Sense of coherence and health seems to be dependent on contributing and creating value in life. This could be the most relevant scientific argument for a strong relation between working life quality and health. But sense of coherence is dependent on the person developing his purpose of life and character, including sex-character. Many kinds of work are severely limiting the individuals possibility to stem into character and using him- or herself. Much to often a job is about collecting money, not about thriving and personal development. It is a major challenge for every organization of our time to organise work in a way that it offers room for personal development and self-exploration that in the end leads to optimal job satisfaction and lasting health. Our viability and vigour in general is derived from our state of well being and life as a whole. Some people are harmonious. They thrive and prosper and have the energy to solve all the problems they encounter. These people are ready and willing to communicate and they are alert and attentive to life. They represent resources to be drawn upon. Often they are very valuable to themselves - they love life - and they are shown respect and appreciation. Human beings who communicate great joy in life and a reserve of strength, are those who easily rise to the occasion and quickly adapt to getting on with other people. Quality of life is something inside you and it accompanies you wherever you go. Many people think that it is a matter of chance whether or not there is quality of life and surplus energy. Some people are born under a lucky star, they say, while others had a bad start. By chance some humans have better genes and by nature they are the chosen few, the beautiful, the talented and the marvellous, while the rest of us must accept the twists of nature and accept being plain, a bit boring not possessed of the most brilliant minds. But no. Human beings are to a much greater extent the masters of their good or bad lives. Quality of life implies that you know and accept yourself [1-29].
REFERENCES [1] [2] [3] [4] [5] [6] [7] Jones E. The life and works of Sigmund Freud. Trilling L, Marcus S, eds. New York: Basic Books, 1961. Jung CG. Man and his symbols. New York: Anchor Press, 1964. Adler A. The individual psychology of Alfred Adler. Ansbacher HL, Ansbacher RR, eds. New York: Harper Torchbooks, 1956. Lowen, A. Honoring the body. Alachua, FL: Bioenergetics Press, 2004. Reich W. Die Function des Orgasmus. Kln: Kiepenheuer Witsch, 1969. [German] Horney K. Our inner conflicts: A constructive theory of neurosis., London: WW Norton, London, 1948. Rosen M, Brenner S. Rosen method bodywork. Accessing the unconscious through touch. Berkeley, CA: North Atlantic Books, 2003.

[8] [9] [10] [11] [12] [13] [14] [15]
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[16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29]
Grof S. LSD psychotherapy: Exploring the frontiers of the hidden mind. Alameda, CA: Hunter House, 1980. Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1):89-91. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II: The structure of the life purpose and the ego. ScientificWorld Journal 2003;3:1277-85. Ventegodt S, Andersen NJ, Merrick J. The life mission theory III: Theory of talent. ScientificWorld Journal 2003;3:1286-93. Ventegodt S, Merrick J. The life mission theory IV. A theory of child development. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. A theory of the antiself and explaining the evil side of man. ScientificWorld Journal 2003;3:1302-13. Ventegodt S, Andersen NJ, Merrick J. The life mission theory VI: A theory for the human character. ScientificWorld Journal 2004;4:859-80. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Life Mission Theory VII: Theory of existential (Antonovsky) coherence: a theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy: when life sparkles or can we make wisdom a science? ScientificWorld Journal 2003;3:1160-3. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy I: Quality of life, happiness, and meaning of life. ScientificWorld Journal 2003;3:1164-75. Ventegodt S, Andersen NJ, Kromann M, Merrick J. QOL philosophy II: What is a human being? ScientificWorld Journal 2003;3:1176-85. Ventegodt S, Merrick J, Andersen NJ. QOL philosophy III: Towards a new biology. ScientificWorld Journal 2003;3:1186-98. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy IV: The brain and consciousness. ScientificWorld Journal 2003;3:1199-1209. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy V: Seizing the meaning of life and getting well again. ScientificWorld Journal 2003;3:1210-29. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy VI: The concepts. ScientificWorld Journal 2003;3:1230-40. Ventegodt S, Merrick J. Clinical holistic medicine: Applied consciousness-based medicine. ScientificWorld Journal 2004;4:96-9. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Classic art of healing or the therapeutic touch. ScientificWorld Journal 2004;4:134-47. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine III: The holistic process theory of healing. ScientificWorld Journal 2003;3:1138-46. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine IV: Principles of the holistic process of healing in a group setting. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Global quality of life.Theory, research and methodology. New York: Hippocrates Sci Publ, 2005.
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[30] Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Induction of Spontaneous Remission of Cancer by Recovery of the Human Character and the Purpose of Life (the Life Mission). ScientificWorld Journal 2004;4:362-77. [31] Ventegodt S, Solheim E, Saunte ME, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Metastatic cancer. ScientificWorld Journal 2004;4:913-35. [32] Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch. ScientificWorld Journal 2004;4:571-80. [33] Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Problems in sex and living together. ScientificWorld Journal 2004;4: 562-70. [34] Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Treatment of physical health problems without a known cause, exemplified by hypertension and tinnitus. ScientificWorld Journal.2004;4:716-24. [35] Ventegodt S, Merrick J. Clinical holistic medicine: Chronic infections and autoimmune diseases. ScientificWorld Journal 2005;5:155-64. [36] Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: Holistic treatment of rape and incest traumas. ScientificWorld Journal 2005;5:288-97. [37] Ventegodt S, Morad M, Andersen NJ, Merrick J. Clinical holistic medicine Tools for a medical science based on consciousness. ScientificWorld Journal 2004;4:347-61. [38] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine: Psychodynamic short-time therapy complemented with bodywork. A clinical follow-up study of 109 patients. TSWHolistic Health Med 2006;1:256-74. [39] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced impaired sexual functioning. ScientificWorld Journal 2007;7:324-9. [40] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) improves quality of life, health, and ability by induction of Antonovsky-salutogenesis. ScientificWorld Journal 2007;7:31723. [41] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced physical illness and chronic pain. ScientificWorld Journal 2007;7:310-6. [42] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced mental illness. ScientificWorld Journal 2007;7:306-9. [43] Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Self-reported low self-esteem. Intervention and follow-up in a clinical setting. ScientificWorld Journal 2007;7:299-305.
Chapter 4
MASTERY IN YOUR WORK

Mastery in the process of work is one of the four dimentions developing the quality of work life. Mastery is about developing our potential, and our potential is all we might be and do in life. It consists of all potentially achievable skills, including personal qualities. To master something means to do it brilliantly and to be among the best in what you do. But a master is not preoccupied with comparing himself with others. He prefers comparisons with his personal visions and life dreams about the best way of improving. People who seek mastery live with a dream of ultimate professionalism and then go for it. Slowly and systematically it is done. They will gradually master a profession to perfection. A master loves his work intensely. He finds the greatest challenges at work and confronts them. The master develops professionally and mentally at the same time. In mastery life is unfolded more freely, more perfectly. Every human being can develop towards mastery. It is a fact that most people are prepared to make an effort in their working life. This is not just about the salary, but also about providing the world with a valuable and personal contribution which gives a strong sense of personal meaningfulness. Developing mastery is one of the four conditions besides quality of life, joint efforts and creating true incremental value, that are decisive for the quality of our working life. Today almost all human beings have both the potential and the opportunities to develope their mastery. In this paper we shall take a closer look at what mastery really is about and how it is developed.
INTRODUCTION Every human being can develop towards mastery [1-7], and it is a fact that most people are prepared to make an effort in their working life. Almost all human beings have an unlimited potential of what we might be and do in life. Our potential is all we might be and do in life. It consists of all potentially achievable skills, including personal qualities [6,7]. At first glance it might not seem as if humankind is well equipped with possibilities and potentialities. But we
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are indeed. It is quite easy to live one's life without ever realising it. That is, in fact, what happens to most of us. The brain is to be used according to your preferences and you may increase or decrease your demands on its functioning. If you really find the challenge of your life and make the most of your cerebral capacity, it may be possible to make the brain answer even the most complicated questions. We all have this possibility. But only a few of us seize this opportunity. We hold back, thinking 'I am no genius, not even in my field of activity'. However, people who have not developed mastery are still needed, those who are on the way towards mastery. But those who achieve a great mastery will prove valuable according to a different scale. In this article we will examine the four aspects of developing mastery: Finding the potential for your mastery: Your gifts and talents Realising that potential in the form of skills, which requires: A deeply felt commitment that will not show until the day: When you find and grasp the challenge of your life.
We all have an invitation and a possiblity to develop our mastery in the process of work when we grasp the sense and content in ourselves, our life dreams and what we really want to do with our life.
MASTERY IN THE PROCESS OF WORK
The Bad Secretary

Tove has been on the way out for a long time. Each month she costs her company a fortune due to mismanaged sales appointments, letters not mailed, deadlines not met - not to mention her depressed voice on the phone, business letters filled with little faults such as double spacing and punctuation errors. She can barely make the word processor run a spell check. She thinks that she is too old to learn such skills. Curiously enough she and everyone else seems to live with 'that is how Tove is'. Even when she makes serious mistakes, no one really bothers about correcting her. 'It is unfortunate that we were so busy that we had to let her take care of it' and -'She is growing old; you have to bear with her'. Old? Tove is only 51 years old!
The Good Secretary

Ellen, however, is more energetic. She is a lively and cheerful presence in the office. Her voice on the phone is brisk and she keeps her promises and deadlines. She is good at dictation and drafts. She is efficient and competent and makes only the occasional error. She is a good and thoroughly reliable secretary who keeps up with new word-processing packages. Often she makes jokes and becomes difficult only when under too much pressure because handling stress is not her strong point.
Mastery in your Work
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The Brilliant Secretary

Then there is Jill, mysterious Jill. She is a genius. She knows all that is going on in the company. She can lay her hands on all letters, order books, files, customers' lists etc. Even though the files contain thousands of documents, it will take her less than one minute to find any of them. She writes letters based on minimal drafts because she knows the ins and outs of procedures. She is on good terms with secretaries in dozens of client companies and they do each other favours. She comes up with suggestions to promote efficiency and quality assurance in sections that she only knows from the correspondence. Jill ought to be covered in three layers of gold. She is 54 years old and has hardly had a day off sick in her nine years with the company. Nobody remembers having seen her stressed or confused. She is the only one who can manage three phones simultaneously. She has rescued the firm many times, because she is alert and attentive to errors committed in the company. How does she manage?
MASTERING YOUR WORK To master something means to do it brilliantly and to be among the best. But a master is not preoccupied with comparing himself with others. He prefers comparisons with personal visions and life dreams about the best way of improving. People who seek mastery live with a dream of ultimate professionalism and then go for it. Slowly and systematically it is done. They will gradually master a profession to perfection. A master loves his work intensely. He finds the greatest challenges at work and confronts them. The master develops professionally and mentally at the same time because work has become fully integrated with his personality. As mastery develops so the distance between the person and the mastery diminishes until the two have fully merged. The distance disappears. The master is completely absorbed: 'Oh, what time is it? It is dark already.' In mastery life is unfolded more freely, more perfectly. Try considering how things stand with regard to your own mastery. Please try to answer the following questions: How competent are you at your job? How good are you compared to the best in your field? How good are you compared to the full realisation of your potential? How well developed is your sense of quality, and how ambitious are you in respect of your work and its quality? How fast and efficient are you compared to how efficient you could be? Do you develop the skills necessary for your profession? Do you experience work as a challenge? Are you doing your best to succeed? Are you preoccupied with matters that really interest you? Do you fully understand the purpose of your work and do you agree with this? Do you feel that work builds you up, or is it breaking you down?
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Do you realise your full potential at work?
Developing mastery has to do with four aspects: Finding the potential for your mastery: Your gifts and talents Realising that potential in the form of skills, which requires: A deeply felt commitment that will not show until the day: When you find and grasp the challenge of your life.
Let us take a look at each of the four consecutive points.
YOUR UNLIMITED POTENTIAL Our potential is all we might be and do in life [8-14]. It consists of all potentially achievable skills, including personal qualities. At first glance it might not seem as if humankind is well equipped with possibilities and potentialities. But we are indeed. It is quite easy to live one's life without ever realising it. That is, in fact, what happens to most of us. Life is not easy for all of us. We are just human beings and it is hard to believe that we possess special features and talents, until we have used these talents and become really good. We are not in the habit of believing that we are likely to become brilliant. But when, for some reason or another, we are forced to do our best, our vast potential suddenly comes to the fore. It is almost unlimited. We can do what we want to do, provided that we train persistently in spite of the difficulties encountered in the protracted learning process involved in mastering a new field of activity. It would not be true to say that we are sufficiently gifted to learn anything. We are predisposed to a certain degree but we can all grow better in relation to how nature has shaped us. If we do not possess the necessary physical strength, agility and speed, hard physical work will not be tempting. Playing a game of tennis requires a well-trained body. Try to think of your potential as flower seeds to be sowed in good soil to germinate and grow. The good soil is a prerequisite of mastery. It is not that easy to become brilliant. In order to develop, the plant must set its root properly into the ground - and touch the soul where the happiness and joy are to be found. The leaves must reach the light. Somewhere out there is a need for our development.
SKILLS Why are we not normally geniuses within our field of activity, but just reasonably competent at what we do? Why do we so rarely reach the zenith in our working life? It hardly comes as a surprise to anyone that mastering one's working life is difficult if one cannot master life in general. That was why quality of life is an important issue. Those who cannot yet understand the necessity of involving life as part of the discussion, we would like to convince in the following way. How can we use proper professional language in our working life if we have a poor command of our language in ordinary situations? If we cannot express our ideas precisely and
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concisely? Reading and writing is more than reading a tabloid and leaving notes for one's spouse. Expressing yourself is an art. And life is an art in itself. There is so much to learn and to master. To achieve something great is tied up with our physical and mental well being. Fortunately, it is a fact that when you decide to become very good at what you are doing, your well-being increases. One might say that the reason for your troubles during this process is that you are carrying your basic existence with you, and this is hard work. But there is no alternative really. Each profession requires an extensive knowledge. If you work with materials, you may derive your knowledge from the science of engineering and building materials. There is so much to learn about iron and glass, for instance, that you could go on forever. No matter what your occupation, you will have to acquire professional know-how. A person who is deeply committed to his or her profession may acquire an incredible amount of professional knowledge. Nothing is boring when it fits into an overall objective. We have to do our best and train systematically to improve. Not until we master a lot of tiny technical details can it all merge into a functional entity. That is to say that mastery makes you very happy - happiness derived from your ability to express yourself fully. Everything in life fits into a whole. Can you achieve a professional mastery if you are not in control of your private and social life? No, it is not possible to be a master behind your desk or in production if you have severe problems with the one you love. Likewise, mastery involves your ability to laugh and become absorbed in playing with your children. Mastery encompasses life. The choice to focus on the development of working-life quality is based on the fact that most people are prepared to make an effort in their working life. It is not just about the salary but also about providing the world with a valuable and personal contribution.
A DEEPLY FELT COMMITMENT A true commitment is something that makes you direct all your attention and energy to the matter in hand. It is as if what really interests you - and exerts pull and push on you - is the need to become deeply immersed in order to experience yourself as a fully alive person. Thus matters that really interest you will wake you up and make you happy too - and in the end you will be renewed, happy and lively. Maybe you remember how you were once caught up in a good book or a movie - or maybe what someone told you about his life fascinated you. When life is right, a situation of glowing intensity may arise with its eternal magic so difficult to put into words. Think of your first experience of falling in love and the desperate need you felt to be with the other person. It is the same quality, a wild and profound commitment. Is it possible to experience this kind of interest at work? Yes it is. Very few humans feel this way about work, but there are no obstacles if you want to change the circumstances as the possibilities are just beneath the surface. Can you fall in love with your wife once more? Is it possible to discover new, fantastic traits in your friends? Can you take up new hobbies at an advanced age? Can one keep finding hidden sides of one's personality to exploit and develop? Of course one can, but they do not appear just like that. In contrast to our first falling in love - which we get for free - our adult life requires quite a lot from us if we want specific experiences to be part of our everyday life. Commitment cannot be expected to be a common feature of your day - your employer does not offer you a job with commitment on a
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plate. As adults we are responsible for adding energy, significance and meaning to life. This means that our contribution is like sawing knotty wood: we have an invitation to find the challenge of our life.
FINDING THE CHALLENGE OF YOUR LIFE Can work become a challenge? The same piece of work may, as you know, be considered either as a challenge or as a nuisance, depending on who you are. My definition is as follows: A challenge is something that you feel you have to seize but offhand do not know how to handle. In fact, you cannot handle it until you have done it, because a challenge is a challenge precisely because it requires you to make moves and learn more in order to accomplish your task. A challenge is a necessary task to be accomplished because a challenge is something very personal; something that is very important to you and which for personal reasons you must take on. Challenge is strictly personal because it is about one's personal development towards mastery. It is one's development towards accomplishing one's essential task. This destination is defined by one's nature, by one's personality and by one's situation in a community. It is experienced as a vocation. Something calls us. One might say that any small challenge derives energy from the great challenge that we basically see in our lives. A human being who is incapable of experiencing his or her life as fundamentally a challenge will not consider his/her work and private sphere as a challenge either. Such a person will find it very hard to develop towards true mastery. If you fail to perceive work as an exciting and fascinating challenge that demands great efforts, you will lose your way. Challenge is the basic prerequisite for becoming good at something since it is challenge that propels us beyond our own limits. Many people wrongly think that challenges appear from the outside and that the employer will provide them with challenges. So too it is believed that some work provides challenges while other does not. Nothing could be further from the truth. Challenges are something we find for ourselves - amidst a tangled world of opportunities. If it is in our nature to interpret the world as a place full of challenges, we will find challenges everywhere. There is always a tiny chance of heading in the right direction. People who see challenges everywhere are pursued by good luck; those who fail to see challenges are pursued by back luck. Of course, all people experience both good and bad luck. But those who do not see a challenge when it is there may miss their chance. Challenges are found in one's private as well as one's professional life. In general, one's love life is quite a challenge. What you can learn here is generally related to your experiences with regard to professional challenges. You are forced to develop your personality, self-discipline and patience - not to mention decisiveness, shrewdness and clarity. But many fail to see their complete relationship as a challenge and try to make peace with their partner. If peace at home is attempted and finally achieved, the final and completely senseless phase of a private relationship has begun. Normally, this stage lasts for the rest of your life. A partner or spouse is a worthy opponent and an immense challenge, which you will have to cope with until the situation changes due to death, a new partner etc. You cannot take drama and wildness away from love without killing it.
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In the same way, you may enter into a passionate relationship with your work. The day you start making peace with it, you stop fighting and start being contented. To be content with something is to accept things as they appear to be, renouncing your expectations of changes, as well as letting go of your will and your responsibility for creating change. This is the way to lead your personal development into a deadlock. Apparently, few people consider work a challenge. Short working hours and high pay is the norm. So one finds oneself a well-paid job from 8 a.m. to 4 p.m., but what kind of life is that? Where is the spark? Where is the commitment? Where is the excitement? Many people would be able to improve their lives considerably if they accepted a lowering of their salary in favour of devoting their time to work that makes their commitment prosper. But this requires you to consider work as a situation in which to be challenged. Also, you must dream your personal life dream of becoming a master. When you find your challenge and accept it, it will probably bring about supreme skills.
EVERY HUMAN BEING CAN DEVELOP TOWARDS MASTERY The word genius is applied to very few human beings. We often think of geniuses as fellowbeings with innate special talents. However, these geniuses were not born brilliant. Albert Einstein did not do well in primary school, for instance. His first job as an adult was an ordinary one at a Patent Bureau. But he kept developing and today he is considered a genius of our time. The brain of Einstein was thoroughly examined after his death. It was widely believed that his brain would be different, but it was not. No particular features were found. The brain, yours for example, is to be used according to your preferences and you may increase or decrease your demands on its functioning. It is a way of 'beating' your brain. If you really find the challenge of your life and make the most of your cerebral capacity, it may be possible to make the brain answer even the most complicated questions. We all have this possibility. Only few of us seize this opportunity. We hold back, thinking 'I am no genius, not even in my field of activity'. Why must we always be so small and modest? Ask for more! Trust yourself. Make heavy demands on yourself and at work. Take the best from your working life. Ask for the necessary freedom to make your own working schedule as well as solving problems your way. Ask for influence on the stated goals and targets, standards of quality, working procedures - all of it. It is naive to believe that your company will immediately grant you the privileges you want in order to develop your mastery. Speak out for yourself! Make you superior understand where you are heading and make him or her understand the potential of your future value and commitment to your company. Go for it - and accept the risk. Show your will power. Seize the opportunity and become brilliant. It may be that you will be considered peculiar, but that is not your problem. It is possible that your ambitions are considered as slave work. You will also have to accept that your communication with your superiors may cause some gossip about your buttering up'. But you are the only one who knows your reasons, which is why it will be wise to ignore what others think about you and your development project. The person in the company who succeeds in achieving mastery will change his or her status notably. He or she will become one of a kind and make a significant difference. This brilliant person will make a considerable contribution to making a company locally, nationally and
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internationally. The masters are the truly valuable employees. There is no denying it. A secretary, an engineer or a welder can do things nobody else can. He or she will leave a unique stamp on the environment. A master is practically irreplaceable. He or she calls down to earth the spirit and makes significant moves forward. It is the master who makes our world develop through the realisation of his or her life dreams and through fighting the biggest challenges. However, people who have not developed mastery are still needed, those who are on the way towards mastery. But those who achieve a great mastery will prove valuable according to a different scale.
DISCUSSION People who seek mastery live with a dream of ultimate professionalism and then go for it. Slowly and systematically it is done. They will gradually master a profession to perfection. The master finds the greatest challenges at work and confronts them. He develops professionally and mentally at the same time, because work has become fully integrated with his personality. Is a life without challenges and commitment less worthy? In fact, the answer is affirmative, because if you do not have any challenges or feel deep commitment, you are about to loose yourself. To feel that you are developing your self towards mastery you have to meet your challenges and that requires your commitment. A challenge is a necessary task to be accomplished, because a challenge is something very personal; something that is very important to you and which for personal reasons you must take on. Those people who achieve a great mastery will prove valuable according to a different scale. And that is a personal thing, call it a personal gift which follows each one of us. When you stop fighting and start being content, watch out! To be content is to accept things as they appear to be, renouncing your expectations of changes, as well as letting go of your will and your responsibility for creating change. This is the way to lead your personal development into a deadlock. Many people wrongly think that challenges appear from the outside and that the employer will provide them with challenges. So too it is believed that some work provides challenges, while other does not. Nothing could be further from the truth. Challenges are something we find for ourselves - amidst a tangled world of opportunities. If it is in our nature to interpret the world as a place full of challenges, we will find challenges everywhere. Challenges are found in one's private as well as one's professional life, where you are forced to develop your personality, selfdiscipline and patience - not to mention decisiveness, shrewdness and clarity. Many people would be able to improve their lives considerably if they accepted a lowering of their salary in favour of devoting their time to work that makes their commitment prosper. But this requires you to consider work as a situation in which to be challenged. Also, you must dream your personal life dream of becoming a master. We all have an invitation to find the challenge of our life and to develop mastery in the process of work. When you find your challenge and accept it, it will probably bring about supreme skills when you do your best and train systematically to improve. Not until we master a lot of tiny technical details can it all merge into a functional entity. That is to say that mastery makes you very happy - happiness derived from your ability to express yourself fully.
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Life is not easy for all of us. We are just human beings and it is hard to believe that we possess special features and talents, until we have used these talents and become really good. We are not in the habit of believing that we are likely to become brilliant. But when, for some reason or another, we are forced to do our best, our vast potential suddenly comes to the fore. It is almost unlimited. We can do what we want to do, provided that we train persistently in spite of the difficulties encountered in the protracted learning process involved in mastering a new field of activity.
REFERENCES [1] [2] [3] [4] [5] [6] [7] Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1):89-91. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II: The structure of the life purpose and the ego. ScientificWorld Journal 2003;3:1277-85. Ventegodt S, Andersen NJ, Merrick J. The life mission theory III: Theory of talent. ScientificWorld Journal 2003;3:1286-93. Ventegodt S, Merrick J. The life mission theory IV. A theory of child development. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. A theory of the antiself and explaining the evil side of man. ScientificWorld Journal 2003;3:1302-13. Ventegodt S, Andersen NJ, Merrick J. The life mission theory VI: A theory for the human character. ScientificWorld Journal 2004;4:859-80. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Life Mission Theory VII: Theory of existential (Antonovsky) coherence: a theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy: when life sparkles or can we make wisdom a science? ScientificWorld Journal 2003;3:1160-3. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy I: Quality of life, happiness, and meaning of life. ScientificWorld Journal 2003;3:1164-75. Ventegodt S, Andersen NJ, Kromann M, Merrick J. QOL philosophy II: What is a human being? ScientificWorld Journal 2003;3:1176-85. Ventegodt S, Merrick J, Andersen NJ. QOL philosophy III: Towards a new biology. ScientificWorld Journal 2003;3:1186-98. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy IV: The brain and consciousness. ScientificWorld Journal 2003;3:1199-1209. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy V: Seizing the meaning of life and getting well again. ScientificWorld Journal 2003;3:1210-29. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy VI: The concepts. ScientificWorld Journal 2003;3:1230-40.
[8] [9] [10] [11] [12] [13] [14]
Chapter 5
WORKING WITH COLLEAGUES AND MANAGEMENT

The job has become the modern man's bridge to the world. It is first and foremost our joining an organization (company) that provides man with actions that confront us with the outer world. There is enormous potential in the development of the joint energy of an organization and of groups. The groups that manage to handle all conflicts and conflicting interests turn into regular small combat units that perform miracles none would ever think of. Fellowship is something in life that contains immense potential, and fellowship is the third aspect of working life quality besides quality of life, mastery and creating real value. If you open up and let things happen, a group may turn into an incredibly intense and creative unit. Cooperation and management gradually disappear in favour of group members' increasing ability to act intuitively and directly. Much time is wasted and valuable energy lost in internal disputes. Instead of fighting our personal limitations and ourselves, many of us fight others. A section of a company may end up being unproductive and without profit if the classical pattern of complaints, envy, cliques and arguments prevails. Through this article we shall have a look at what creates and builds fellowship, the role of the leader and the workers.
INTRODUCTION The brilliant leader does not acquire his or her dominance and power by obstructing the employees. Rather, the brilliance of leadership originates from the leader's ability to inspire the group. A group has a natural leader, who may be characterised as the person who most clearly is able to understand the common objective as well as to express the collective intention and will of the group. His or her task is to secure the group's common interests. This includes being authorised by the group to organise the work so that everybody contributes his best efforts to solve the group's common task. You not only have a right to, you have an obligation to enter into dialogue with your superior, if you disagree with him or her.
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In this chapterarticle we shall have a further look at co-operation, management and public relations (public or private) as an entity. Ideally, these three aspects converge into an overarching entity uniting employees and managers in a sense of fellowship within the organisation - in order to carry out its goals.
CO-OPERATION WITH COLLEAGUES AND MANAGEMENT
Bad Co-operation
Anders does not thrive at work. He often feels exploited when asked to carry out extra work. He rarely benefits from doing this. He is not particularly proud of working for this company. The manager and the chief executives decide and define which tasks are to be carried out. Whether the company sells its products and survives, Anders sees merely as a management problem. 'It can never be my problem if the company is doing badly', he thinks, 'I am not the one who makes more money when the company has a high turnover.' When they speak about him, his colleagues sometimes adopt quite an acrimonious and sarcastic tone. For his part, Anders considers them idiots in varying degrees. Anders does not think highly of the head of the section, since Anders is not 'understood'. Actually, Anders tries to work as little as possible, to get as much money as possible and to avoid his superiors and colleagues to the greatest possible extent.
Normal Co-operation
Thomas feels all right at work. He gets on well with his colleagues at lunchtime, but when he works he minds his own business and rarely notices the presence of his colleagues. He is in good standing with his superior and they communicate politely. The head of section knows best and Thomas is confident in leaving his superior with all the administrative and planning matters. Thomas has no real reasons to complain although he is not very content and Thomas does not feel any true commitment to his company. He might as well be employed by a competitor. He considers it a coincidence that he is working for this firm and not another.
Good Co-operation
Bjarne has a good feeling each morning on arriving at the company's main entrance. He feels good here. He is always happy to meet his colleagues and he is highly regarded by his superior. He feels embraced by his section. Even when he is a bit tired and worn out after a period of long working hours and lack of sleep, he likes to join his team for ten minutes in the morning to make plans for the day. Bjarne considers the company his own even though he is not a partner. The management does its best to back him up as well as to support his development. He experiences his company as a good opportunity to make a valuable contribution to his surroundings. He does not distinguish strictly between work and spare time, since he considers his work meaningful and more than his money's worth. The work is also done for the sake of his pleasure and personal
Working with Colleagues and Management
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development. If he were to become redundant, which is most unlikely, he would continue with something similar. Bjarne is a very loyal and conscentious employee. He works late if needed and gives of his best all round including in his relationship with colleagues, managers and customers. Management appreciates his efforts and considers him a future key person in the company.
FELLOWSHIP The advantage of co-operation is that work may be divided up in a way that is tailor-made to suit each member of the group. Consequently co-operation is a great advantage that makes for great achievement. Thus things are done, which would have proved impossible the individual way. A group needs a leader to promote unity and to co-ordinate individual contributions into a powerful whole. Think once more of your present perception of fellowship and your own cooperation by answering the following questions: Do you experience yourself as a perfect part of your group? How good is the co-operation? How good is management? Do you like your superior, your colleagues and your subordinates, or are your personal relations cool and formal? Have you chosen the right organisation to work for? Are you comfortable with the organisation's mission statement? Does your organisation show proper values? Is the organisation alive or is it 'half dead'? Is your heart and soul in it when you enter the company premises? Do you take any responsibility for the internal and external affairs of the organisation?
Fellowship is something in life that contains immense potential. If you open up and let things happen, a group may turn into an incredibly intense and creative unit. Co-operation and management gradually disappear in favour of group members' increasing ability to act intuitively and directly. There is enormous potential in the development of the joint energy of a group, and the groups that manage to handle all conflicts and conflicting interests turn into regular small combat units that perform miracles none would ever think of. Humans who join together in well functioning communities may experience a closeness and intensity that is hard to put into words for outsiders. Unfortunately, joint energies are immensely vulnerable and experience shows that even the best groups do not survive for long. It may be that it is part of the essence of life that joint efforts for a collective purpose, a joint project or a united statement of objectives will survive only for as long as there is a reason to keep the group intact. Only a united challenge keeps the group together. Although, for example, Danes see themselves essentially as friendly people, they often experience problems with regard to co-operation and a sense of community in their
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companies. Often there will be considerable distance among the workers themselves and between management and the workers. Various professional groups may develop into factions or cliques and manifest considerable difficulty in adjusting to an overall sense of community in the company. Some people may be on friendly terms with a few colleagues, albeit very few, and it is a fact that people rarely establish friendships with their superiors. This is not really an astonishing feature in cultures where, (according to Quality-of-Life survey results), only one in two people has a close friend in whom they can confide and with whom they can discuss anything. The fact that people are not as sociable at work as they could or should be might be considered a private matter. However, it is clear that organisations, departments and companies will suffer in the long run as a result of imperfect communication. Much time is wasted and valuable energy lost in internal disputes. Instead of fighting our personal limitations and ourselves, many of us fight others. A section of a company may end up being unproductive and without profit if the classical pattern of complaints, envy, cliques and arguments prevails.
THE GOOD ORGANIZATION The job has become the modern man's bridge to the world. It is first and foremost our joining an organisation (company) that provides man with actions that confront us with the outer world. It is difficult to define an organisation but basically it is about a group of people who join together for a common purpose. In the good organisation all employees solve their tasks efficiently and well. Management's objective is co-ordination of the work in order to maximise the value of the overall efficiency. In a good organisation, the leader is part of the group. Even though he or she is authorised with the power to define tasks, to lay off some members and welcome others, the good leader does not serve his personal interest in doing this. Rather, he or she serves the overall objective of the organisation. In the good organisation the leader is considered a valuable and appreciated person who deserves to be held in high esteem. People live, thrive and prosper in the organisation. It operates efficiently and develops quality. It is, so to speak, an extension of life and does not function in opposition to life; it does not go against our nature as human beings. Unfortunately, the good organisation is rare, but in principle it is not out of reach. There is no need for conflict between employee and manager or between people and their organisations. The good organisation provides us with opportunities to perform tasks that we are fit for. The organisation sees to it that we develop within our professions, placing mastery within our reach. The good organisation enables people to co-operate and make joint efforts to solve tasks that might otherwise be difficult to deal with alone. It is a natural thing for people to join this kind of community. This development dates back to when man started walking the earth. The organisation is, at its best, a modern version of humankind's natural community. The deeper meaning of organisations, i.e. the reason for their existence, may be found in the diversity of humankind. Even though we are all provided with the same basic features and preferences with regard to food and drink, clothes and a place to live, love, friendship, community and togetherness with the world, nature and society, there are in our personalities a few quite distinctive diversities that shape our preferences.
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Some people show a strong preference for acting and doing things; others prefer leadership and organizing. Some prefer knowledge and wisdom. Others take up the classical attitude of assisting and helping. Again, some people have preferences for science and technology whereas others cannot possibly take an interest in the periodic system or complicated software diagrams but instead concentrate on linguistic, communicative and humanistic matters. Some people take an interest in selling and doing business. Others prefer to minimise the role of commercialism in their lives. The above-mentioned diversities of preference are useful when we try to match them to our personalities in real life. An important symmetry of this kind is the relationship between the leader and the group members. Some people consider it a vocation to manage and spend all their energy on superior levels while others prefer to become absorbed in detail. These people appreciate a co-ordinated and overall direction of goals in order to make the details fit into the total context. Some people prefer a tangible reality whereas power and the broad overview attract others. My point is that the brilliant leader has not acquired his or her dominance and power by obstructing the employees. Rather, the brilliance of leadership originates from the leader's ability really to inspire the group. The company may suffer from lack of confidence in managers and immediate superiors in cases where the executives have been employed without paying adequate attention to the employees, their conditions and wishes. Instead of becoming the group's representative, the leader may end up being a stranger who never gets close to the group. This situation leads to a range of communication problems and conflicts between managers and employees that could have been avoided. A manager who has no confidence in his associates easily creates a barrier to the individual initiative, freedom and independence at work instead of supporting his associate in these respects. Similarly, the associate who has no confidence in the leader will not accept his or her help and support. In many large companies there are several hierarchies of heads of sections and this may serve to slow down the work process as well as preventing greater efficiency. To avoid these effects, many large modern companies dismiss part of their managerial staff and develop a flatter organizational hierarchy. Interdepartmental projects that cut across traditional structures (e.g. affiliated sections) may strengthen the independence of the employees as well as more or less spontaneous group formations. Often the project group may choose its leader from the group. However, it is still not clear whether this type of solution has a great future but the idea is good in theory.
THE GOOD LEADER A group has a natural leader, who may be characterised as the person who most clearly is able to understand the common objective as well as to express the collective intention and will of the group. His or her task is to secure the group's common interests. This includes being authorised by the group to organise the work so that everybody contributes his best efforts to solve the group's common task.
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In this way the leader takes a position vis--vis the individuals of the group. In other respects the leader subordinates himself to the group. The good leader abandons his or her personal interests, so to speak, in favour of servicing the unit and the community. The leader supports each individual member of the group and finds out the best way of combining the given tasks with preferences and needs within the group. This joint task must be accomplished along with the personal and professional development of the members of the group. To be a good leader requires a highly developed understanding of what is needed 'out there' - which means quite a cultivated sense of human potential as well as knowledge about the way it operates in life, including personal development. Apart from insight into human or personal development, leadership requires knowledge about our complex society. The leader must be courageous and visionary. He or she must be able to articulate the group's project in comprehensible terms that can be agreed upon. A leader who gets no support for defined projects does not have a chance. If he or she is unable to communicate the basic ideas to the employees and make them share the vision of the good values in future projects to be carried out by the group, the prospects are none too good. The leader's duty is to collect all ideas, impressions and opinions for a clear and precisely expressed vision of the relevant project, be it the creation of a new product or a new way of servicing customers. The leader's vision and creative mind must guide the employees into collectively creating value. Not until the leader understands himself or herself as ultimately the primary and most important supporter of the employees will the organisation flourish.
GOOD CO-OPERATION When carrying out different tasks necessary for the organisation to create its products or provide services, we are engaged in joint efforts with colleagues and management. Properly speaking, we co-operate. The idea of co-operation is to supplement one another. In order to co-operate we need communication, including an open-minded and friendly way of speaking. It is important to take on the responsibility and to carry it through in the face of difficulties. You must also be able to cope with honest criticism of yourself and put up with your colleagues' strengths and weaknesses. Experience shows that we all have our flaws and imperfections and these cause us to jar against each other and to collide with each other. The precondition of co-operation is that we manage to ignore each other's imperfect personalities and instead try to develop a more profound and basic confidence in and sympathy for other people. A prerequisite for cooperation is that we like each other. If we do not like each other, we cannot find a reasonable way of communicating. Criticism will be understood as unfriendly and manifestly hostile intentions rather than as assistance to improvement and development. When joining in close teamwork people get to know each other intimately. It is always easier to find fault with your neighbour, which is why co-operative endeavours can lead to unpleasantness when a person's behaviour is commented on. There are two ways to cope with criticism: One is to defend oneself and put a distance between oneself and one's critic, to take offence and put on a sour look. The other way, which is a far better one, is a more humble and open-minded attitude where criticism is not taken as an offence but rather as a mirroring of
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yourself. This way the critics show which points should be relevant for further personal development. The art of co-operation is particularly difficult when it is a matter of co-operating with your superior. If, for instance, you know that your colleague rarely meets an appointment on time, writing to the colleague instead of waiting for him in vain can solve the problem. If you know that your colleague is very good at accounting whereas you dislike this job, switching tasks might solve problems. To be able to say 'yes' and 'no' is essential for good teamwork. Unfortunately, in such situations most of us have trouble with emotions because they remind us of events in our personal life when we may have experienced the pain of rejection. In the old days the authoritarian executive style held sway. Nowadays, modern IT-companies cannot function without dialogue. Employees of the late 20th century must be well informed and conscious of what is going on. Thus modern employees tend to hold views that are fully valid vis--vis their superiors. You not only have a right to, you have an obligation to enter into dialogue with your superior if you disagree with him or her. Only on very rare occasions will a competent modern chief executive force through his own point of view, as today it is of the utmost importance that we engage with each other properly and that all points of view are respected. The employee may often be right and great value may be achieved, if the manager can overcome his or her pride and recognise this. In case of long-term problems in regard to teamwork it is still not an acceptable solution to suppress a colleague's point of view. Here we are up against fundamental differences in points of view that ought to be sorted out. The disagreements might very well focus on views on the stated objectives and values of the organisation, and this is the very situation where any modern leader should be particularly observant and attentive.
DISCUSSION The largest challenge in creating a well-functioning organisation is the development of the physical, mental and existential health of its employees. Most unfortunately many people in the world today is in a state of chronic stress; it can be described as a state of severe psychoform and somatoform dissociation. The person is not really there; neither through mind or body can he or she be contacted. The behaviour is often quite mechanical, and reflections are not deep, quality of life is often low, and ability of functioning in all areas from sexuality to social life are often low. Such people are in severe need of existential healing. But healing must happens in a sound environment with full support and acceptance for the individual. A company culture with love, respect and understanding is encouraging sub-environmental initiatives for creating groups and departments able to support its members and letting people heal and grow. We human beings are social beings. We are all gifted with different talents [1-7] and only together can we do great and complicated things like sending men to the moon or developing science and technology. We need to see and acknowledge the talent in every person, and only when we can do that, and support each one and facilitate the need for personal development of talents and self-insight, can we create the company and the society, that provides us all with our needs and longings.
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A company is in many ways like a living organism, where every employee and leader corresponds to a living cell. Only when all the cells are happy, healthy, oriented and fully informed about what is going on everywhere in the organization can do an optimal job. Only when everybody is connected to the world and giving their gift to the world though the work, can we have an optimal performance in an optimal organization. The key to all this is fellowship, for only through fellowship can man be nourished and supported enough to grow and heal existentially. The team must support personal and professional growth. Only in the soil fertilised with human respect and unconditional love can geniuses and masters grow.
REFERENCES [1] [2] [3] [4] [5] [6] [7] Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1):89-91. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II: The structure of the life purpose and the ego. ScientificWorld Journal 2003;3:1277-85. Ventegodt S, Andersen NJ, Merrick J. The life mission theory III: Theory of talent. ScientificWorld Journal 2003;3:1286-93. Ventegodt S, Merrick J. The life mission theory IV. A theory of child development. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. A theory of the antiself and explaining the evil side of man. ScientificWorld Journal 2003;3:1302-13. Ventegodt S, Andersen NJ, Merrick J. The life mission theory VI: A theory for the human character. ScientificWorld Journal 2004;4:859-80. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Life Mission Theory VII: Theory of existential (Antonovsky) coherence: a theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89.
Chapter 6
CREATING VALUE
Creating real value is one of the four dimensions of developing the quality of work life besides the quality of life, mastery and fellowship. The organisations is our chance to become valuable to a much wider circle than the one closest to us. By being part of a valuable organisation we create genuine value, not just market value. This article is about how we can create real value and how organisations become valuable to customers, clients, patients and the environment. In order to create real value, it is necessary to adhere to good and viable values which allows us to create clear preconditions for quality of life instead of wasting these preconditions. The transition towards creating proper values requires a profound rethinking of our attitudes. To this end, customer satisfaction will be subordinate to a more global perspective on production. It may well be better to remain in your job and change a bad company than fleeing to another job. This must be considered an emergency solution. The world needs competent people exactly where change is needed. We can all grow and develop, thus becoming more valuable. Every one of us can be useful by contributing our individual skills to the environment. Consider this a personal obligation. Put in another way, if we do not put our uniqueness and best talents to proper use, we betray ourselves as well as others.
INTRODUCTION You can question wether a company really creates value with its product or services or not. It earns money, of course, but does it create genuine value? How beneficial are the product and the activities? Do they contribute to making this world a better place to live in? In order to create real value, it is necessary to adhere to good and viable values. These values are about satisfying people's real needs, maybe also those of animals and plants, without destroying the world we inherited and which our children will inherit from us in the future. If we live up to values that respect these conditions, we build up instead of breaking
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down. We support other people in their self-expression instead of wasting global resources on superfluous consumption. We create clear preconditions for quality of life instead of wasting these preconditions. A person may be more or less valuable. Some people are not of great value to themselves or in their personal relationships. Others know how to gain from life as well as being pleasant company for others. We can all grow and develop, thus becoming more valuable. Every one of us can be useful by contributing our individual skills to the environment. How valuable are you in relation to your potential value? Could you grow to be twice as valuable to your spouse? Your children? Your friends? Could you become twice as valuable to your organisation? Your customers?
It feels good to be useful. Quality-of-life surveys have shown that people who feel useful, also as a group, are happy, whereas those who do not feel useful are unhappy. You can contribute to a shift in attitudes and practice. In this way you will make a significant change not only for yourself but also for your place of work and your environment.
CREATING REAL VALUE FOR CUSTOMERS AND THE ENVIRONMENT In this article we shall have a look at how organisations become valuable to customers/clients/patients/users and the environment. Let us start this difficult subject with an example from the world of health care in order to illustrate how much value can be created.
A hospital Department with Poor Ability to Create Value

This department has specialised in treating breast cancer. The physicians do all they can to fight the cancer with all means available: chemotherapy, radiation and surgery. A considerable amount of money is spent on research and the physicians often participate in conferences abroad to present their results. They are proud that over the past thirty years science globally has succeeded in doubling the lifetime of cancer patients (even though critics argue that it is because the diagnosis is made at an earlier stage, which makes women aware of their cancer for a relatively longer period). However, a new type of 'troublesome and critical' patient has appeared on the scene. She asks questions about the customary treatment or refuses to accept it. Some nurses are becoming aware that patients must be involved much more in the decisions made about their treatment. But since patients lack professional knowledge, physicians consider this proposal a problematic one. Patients who undergo the prescribed treatment often feel very bad physically during the course of the treatment (often for the rest of their lives). The physicians hope for a breakthrough with new products and focuses on molecular research rather than involving
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psychological and social events in the treatment. Women do not think that they obtain much help from the cancer department.
A Hospital Department Creating Great Value

The department has specialised in treating breast cancer. It has become evident over the past ten years that, according to statistics, traditional treatment of advanced breast cancer with chemotherapy, radiation and surgery prolongs the patient's life by only a few months. Furthermore, the treatment often ruins the patients' quality of life. In this department experiments are initiated - where ordinary treatment is being offered to all patients (but not always accepted) and supplemented with a clearly articulated request to the patients to take very good care of themselves. The department runs different projects to enhance the women's self-esteem and self-confidence to make them act more constructively in life. The physicians were surprised at preliminary results showing that patients can do far more for themselves than could have been hoped for. Some of the otherwise doomed women join groups of twenty persons. They exchange views on their joys and sorrows, values and goals in life for about one and a half hour per week. Quite often they succeed in gaining deeper insight as well as improving their quality of life. They not only get better but also live twice as long as patients who do not join an existential group. The experiment leading to this surprising result was carried out by David Spiegel and associates at Stanford University, USA and reported on in the Lancet in 1989 [1]. Many of the women consider the cancer department a most valuable experience.
The Good Car Factory Bad in the Old Days the 1990s
Not many years ago this car factory let its product burn off a considerable amount of leaded petrol and diesel oil which polluted the environment. In those days cars transformed a large quantity of valuable raw materials into gigantic quantities of worthless waste. For a while it looked as if the factory would continue contributing to global environmental deterioration, but then a niche appeared on the market, created by the political consumer. Far-sighted leaders seized the opportunity and arranged for the production to become viable. Today the factory creates real significant value. Customers are more content with the cars now, since their conscience is clear. Technological advances that led to this improvement were, first and foremost, good rechargeable and re-usable batteries. After that came the durable and efficient electrometer. The very best thing to happen was the new effective generation of solar cells that keep the car recharged all day. The car proved fully viable when re-usable panels and spare parts became available. Nonpolluting chemicals are now used to produce water-based paints. Not to mention the car's various built-in computers now made of fibre-optic materials that do not waste energy. Thus neither nature nor we will be contaminated in the future. These materials are fully degradable in ordinary sea sand. Will this car be for sale? Give it twenty to thirty years - and a bit of help. Fortunately it is on its way. Ecology and advanced technology supplement each other wonderfully.
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WHAT DOES IT MEAN TO CREATE REAL VALUE?
Companies create value when they produce products or services for sale. At the same time they consume energy, water and raw materials and produce direct and indirect pollution, contributing to the transformation of natural resources into waste deposits. It is debatable whether the consumers are better off after all. They will not become healthier or happier. Maybe they merely waste their time, energy and money on the product. It is questionable whether a company really creates value with its product or services. It earns money, of course, but does it create genuine value? How beneficial are its product and its activities? Does it contribute to making this world a better place to live in? In order to create real value, it is necessary to adhere to good and viable values. These values are about satisfying people's real needs, maybe also those of animals and plants, without destroying the world we inherited and which our children will inherit from us in the future. If we live up to values that respect these conditions, we build up instead of breaking down. We support other people in their self-expression instead of wasting global resources on superfluous consumption. We create clear preconditions for quality of life instead of wasting these preconditions. The organisation is our chance to become valuable to a much wider circle than the one closest to us. By being part of a valuable organisation we create genuine value, not just market value. Often the demand for goods is not grounded in genuine and profound needs. It may derive from more or less artificial needs such as cultural trends, fashion whims, commercials and materialism have imposed upon us. We eventually realise that these are status symbols or masks that we could really do without. There are many perceptions of quality. Today several companies are content with a standard of quality expressed by customer satisfaction: if the customers get what they expect, the supplier has measured up to expectations. A well-known example is the concept of Total Quality Management (TQM). The problem is, however, that the standard of quality does not call for a further investigation into the quality of the demand, that is to say, which part of the demand for goods may be detrimental to the environment, the local area and its quality of life, etc. In order to create real value, more is needed than just customer satisfaction. A company would have to evaluate whether it is actually creating value (other than employment) by means of its products and services. The good organisation usually creates far more value than customers do, simply by demanding more. In this respect, managers and employees use comprehensive internal standards of quality which help customers increase their knowledge about products, materials, services and so on. The transition towards creating proper values requires a profound re-thinking of our attitudes. To this end, customer satisfaction will be subordinate to a more global perspective on production. Our culture is said to be materialistic, short-sighted and therefore often quite stupid. It may be a fact that we take less interest in existential values, such as love of life and the environment, than in power, money, status, consumer goods, and comfort - which are superficial and culturally determined values. If you think about it, there are private and public organisations which, for various reasons, clearly do not exist in order to create genuine value. Perhaps you work for such an organisation. If you do, it is time to take responsibility and start improving your organisation.
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It may be your opening to find the challenge of your life and to make a contribution to a better world. It may well be better to remain in your job and change a bad company than fleeing to another job. This must be considered an emergency solution. The world needs competent people exactly where change is needed. Try reconsidering how value is created in your organisation. Please try to answer the following questions: How good is the quality of the products/services? How resource-conscious and viable is the production process? How successful is the organisation measured in terms of its stated objectives for the future? How efficient is the organisation? How well prepared is your company to take a lead and to pioneer new paths? How beneficial is the organisation to the employees? How useful is the organisation to the local environment?
Becoming a Valuable Human Being

A person may be more or less valuable. Some people are not of great value to themselves or in their personal relationships. Others know how to gain from life as well as being pleasant company for others. Things fit together. If you do not like yourself and your life, it is difficult for you to contribute to the world. We can all grow and develop, thus becoming more valuable. Every one of us can be useful by contributing our individual skills to the environment. Consider this a personal obligation. Put in another way, if we do not put our uniqueness and best talents to proper use, we betray ourselves as well as others. How valuable are you in relation to your potential value? Could you grow to be twice as valuable to your spouse? Your children? Your friends? Could you become twice as valuable to your organisation? Your customers? 'Well, maybe I could' you think, 'but why should I'? The answer to this question is very simple: Because you are no more valuable to yourself than you are to others, and vice versa. It feels good to be useful. Quality-of-life surveys have shown that people who feel useful, also as a group, are happy, whereas those who do not feel useful are unhappy. We are more closely tied to the world than we think. Our freedom not to be useful is limited. We are obliged to be useful and resourceful beings. This is dictated by our basic nature as human beings. A valuable person is one who leads a life in accordance with good and stable values. A valuable organisation also manifests good and enduring values. But why is it that people often adhere to two sets of values, one for private life (with love a dominant feature), another set of values for professional life, primarily concerned with power and money? How does it impact on a person's life when the two sets of values do not harmonise? Is it likely that such a person can become really valuable to himself/herself and to others?
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Make your Organisation Valuable

When you have found out who you are personally and professionally, and when you have grown professionally, the time has come for you to make a difference to the whole. If you understand what is going on in your organisation, you will quickly gain understanding as to how to increase your influence. If the organisation wants to create more genuine value for customers, a change to better values is needed. What are the good values? Let us make a distinction between our personal values at work and the shared values formulated in an organisation's mission statement. Good personal working values refer, for the most part, to commitment, mastery and management. They are about the experience of creating value. In principle these values might also carry the organisation, but it is not as simple as that. An organisation has its own values. They focus on survival and growth, making a profit for the owners and satisfying the employees, economically and otherwise. These values are about achieving a goal, for instance a new product or a service that is unique. A healthy organisation takes an overall and global view: We want to participate in creating the future the way we like it. We must all accept our share in that responsibility. It is urgent that we make suitable investments in research that will secure the company's profitability in the long run. We must not make do with short-sighted solutions. However, it is not an easy task to determine the company's values. Often, one thing is proposed and something entirely different is carried out. It takes great individual efforts to determine what the values of the organisation really are in respect of its overall philosophy, its view of people as well as of itself, its conventional wisdom, its position and responsibility. Often the values have not been formulated. They may very well be conflicting. Companies often practise double standards. The working environment, for instance, is considered important until that environment requires expenditure. Nature must be preserved and protected, until the day production is interfered with. Today, there are many good things to be done if you want to make sure that good values are implemented. Environmental concern, life-cycle analysis and projects add to the development of zest. Furthermore, there are innovative workshops for management combined with dialogue with the industrial council. If you have a clear perception of where you are heading, action is possible. Lots of good tools are marketed at a reasonable prize, enhancing the possibility of sustaining a process of development directed to employees and managers becoming more alert and more oriented to value. If you believe in fighting to make the difference, the door will be open for deriving knowledge and strength from the great hidden reserve of human potential. Awareness of the company's values puts you in a powerful position. It would be very hard for anyone within the company to reject criticism of values which are basically hostile to people or nature. You can develop values within the company if you really believe that you are able to make a difference by seeing what is wrong and acting to put it right. This is an enormous challenge that requires all of us to raise our level of awareness. Our central conviction with regard to humanity is that you can make the difference, if you want to. You can contribute to a shift in attitudes and practice. In this way you will make a significant change not only for yourself but also for your place of work and your environment. People who fight for their personal values to be implemented in the company
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contribute to making a difference. It is people like this who make the world a better place. Why should you not become one of them?
Technology and Value

Today a good machine can easily do the work of 100 employees. In a modern IT-company work is not so much about your personal initiative but rather about letting technology do the work. All processes must be carefully and precisely managed with a view to the complex realities within each section, the company and the environment. Work is no longer oil stains and sweat but an alert handling of energy and information. Our present society has turned into an awfully efficient but also very complex world and we have seen just the beginning of the IT revolution. The immense power gained from technology means that contemporary employees and managers must be highly conscious and alert. Fortunately, consciousness and alertness are original features of the human character. This is all we long for, deep inside. Our feelings of being present, fully alive and in line with reality will not manifest themselves fully until we grow fully conscious and alert. Most people are aware of the potential of science and technology. The most efficient machines available these days may cause world-wide pollution. We can waste global raw materials in no time and before knowing it we may have ruined nature and thus the basis of our existence. We simply have to get technological development under control. Our last chance is to change the values and attitudes within organisations to assure that what we produce contributes to creating appropriate values.
DISCUSSION Real value might be more strongly connected to our common survival on the planet than most people realise. We are in the middle of a technical revolution and explosive population growth; we are completely transforming the surface of the planet. We suggest that real value very soon will be about contributing to the global eco-system, more than anything. This demands a highly developed consciousness and maybe the development of human consciousness itself is the next area we need to focus on for man to create value and the human race to survive. Most interestingly, the development of consciousness and self-insight is closely connected to development of sexual ability and the ability to love others and function socially. Medicine might very well be about developing the human consciousness as well, as health and happiness is highly dependent on this [2-16]. Our central conviction with regard to humanity is that you can make the difference, if you want to. You can contribute to a shift in attitudes and practice. In this way you will make a significant change not only for yourself, but also for your place of work and your environment. People who fight for their personal values to be implemented in the company contribute to making a difference. It is people like this who make the world a better place. Why should you not become one of them?
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REFERENCES
[1] [2] [3] [4] [5] [6] [7] [8] [9]
[10] [11]
[12] [13]
[14] [15] [16]
Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2(8668):888-91. Ventegodt S, Merrick J. Clinical holistic medicine: Applied consciousness-based medicine. ScientificWorld Journal 2004;4:96-9. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Classic art of healing or the therapeutic touch. ScientificWorld Journal 2004;4:134-47. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine III: The holistic process theory of healing. ScientificWorld Journal 2003;3:1138-46. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine IV: Principles of the holistic process of healing in a group setting. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Global quality of life.Theory, research and methodology. New York: Hippocrates Sci Publ, 2005. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Induction of Spontaneous Remission of Cancer by Recovery of the Human Character and the Purpose of Life (the Life Mission). ScientificWorld Journal 2004;4:362-77. Ventegodt S, Solheim E, Saunte ME, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Metastatic cancer. ScientificWorld Journal 2004;4:913-35. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch. ScientificWorld Journal 2004;4:571-80. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Problems in sex and living together. ScientificWorld Journal 2004;4: 562-70. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Treatment of physical health problems without a known cause, exemplified by hypertension and tinnitus. ScientificWorld Journal.2004;4:716-24. Ventegodt S, Merrick J. Clinical holistic medicine: Chronic infections and autoimmune diseases. ScientificWorld Journal 2005;5:155-64. Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: Holistic treatment of rape and incest traumas. ScientificWorld Journal 2005;5:288-97. Ventegodt S, Morad M, Andersen NJ, Merrick J. Clinical holistic medicine Tools for a medical science based on consciousness. ScientificWorld Journal 2004;4:347-61.
Chapter 7
UP OR DOWN IN YOUR LIFE?

It is amazingly rare for people to succeed in creating really good lives through their work and making the big dream come true. Surveys carried out by The Quality-of-Life Research Centre showed that only one Dane in three is really happy in his work. Few people burn for their work, they just burn themselves out. We all have the option of revising what we think of ourselves, life and the world around us. Likewise we can make adjustments to our habits and our way of life in general. We can all do a lot to feel better, in private and on the job. For some reason we do not do anything about it until we are forced to. But we could easily do something if we decided to do so. There is nothing more delightful than discovering that nature actually created us wonderful, intelligent, attractive, talented and humorous etc. We must stop preventing ourselves from being so. The four issues necessary for a company to really succeed and create real value in the world are; quality of life and job satisfaction, mastery within each individual field of activity, a sense of community with respect to cooperation and management, and finally creating real value. This is an ongoing process that affects revising of values, working procedures and goals. The company or organisation with these qualities will be successful both from the perspective of employees and customers. Such an organisation will go one step further and also prove to be valuable to the environment: nature and society. It is this type of development, which will carry companies forward into the 21st century.
INTRODUCTION Most of us do not grow old gracefully, we become sad and decrepit. What is it that makes some people develop and systematically improve their lives year by year? What are the characteristics of people who understand how to develop? The basic principles of personal development can be studied thoroughly in a rather special situation, which is when a life-threatening condition becomes terminal. In this
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situation most of us suddenly experience an immense love of life as well as a very strong motivation to improve life radically while we still can. The fantastic thing about this is that it seems to be possible. It does not even take long to improve life significantly when we are terminally ill - maybe a few weeks or months. We all have great hidden resources. Nothing is as sensitive to attitudes and conduct as our dealings with others. We are able to create for ourselves most favourable circumstances provided that we know how to bring to the surface the best in people, if we consider them delightful, talented, constructive etc. Often we can inspire to personal development by observing fine traits in people who have not yet themselves discovered their good points. This is one of the best ways to interact with your friends and colleagues. Now and then we meet a very happy person - and they do exist. A feature of very happy people is that they do precisely the work they want to. Look closer and you will find that these people consider themselves hunters or warriors. They fight to make their dreams come true. They are very different from the majority since their efforts are not motivated by duty and mere necessity but by love of life. This love provides an indomitable will to make life come true. In a flash of profound insight, a lucky moment in which we sense very intensely what life has in store for us, we suddenly decide to change our lives. When made wholeheartedly, the decision to change our lives is an extremely effective one. Unfortunately, our existence is often so unconnected that the decision is not made in our existential centre, in our inner integrity, but in a far corner of the brain. Such a decision has no great and pervasive effect. It can be compared with a decision to stop smoking where you start again after a fortnight. On the other hand, this is what we have to make do with. The missing discipline must be developed gradually through perseverance. As long as we do our best and a little more, we cannot blame ourselves. What does it matter if we fall back into less fortunate patterns? If we eventually realise what is wrong, we can escape once more. This is exactly the struggle we are involved in, all of us. Such are the tough conditions of life. Very few people ever develop enough discipline to experience the full strength of a decision made by the whole person. This kind of decision simply changes life from one moment to the next. But again, people who are that disciplined rarely have anything to improve. They have achieved mastery. They have put their life in complete order. It is often an advantage when a coach can keep you at it and prevent you from taking the easy way out. A coach can observe you from the outside and he or she has excellent opportunities of keeping an eye on you and finding out how you prevent yourself from creating true progress in your life. The ideal coach is a person who is not necessarily a close friend but he or she is somebody you trust and like.
ARE YOU ON YOUR WAY UP IN LIFE OUR DOWN?
When you Cannot Find any Challenge in Work: Stress and Lack of Development
Tanya works in the marketing department. She thinks that her work is strenuous and stressful. Her superior keeps making demands of her and she has difficulty keeping up with these demands. She feels inadequate. Often she doubts whether she has found her niche though she
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cannot think of something else to do. She wonders why she is always so busy and she can tell from her superior's looks that he thinks she works too slowly and does not do her job properly. Sometimes she believes she is going to wear herself out.
Taking up the Fight of Life: Developing

Gertrud is developing well in her job and her life. She thrives and grows and has changed completely. It appears that she gets better year by year. She is in full bloom, laughing and joking. She is alive. Gertrud has made a strange leap. Her posture has changed from a stooped to an erect carriage. Mentally she has changed her attitude towards life to a positive and constructive belief in survival. She is coping. Each day she practises living. And she makes astonishingly good progress.
Developing Personal Challenges: Developing a Great Deal

Tea is part of an interesting team in the marketing department. She experiences life as a great personal challenge. Her work is also her hobby. She knows that she does what she is best at and that it corresponds exactly with what she wants to do. Often her work absorbs her for days. Each day brings her something new. She is not worried about working at full speed all day as well as working overtime. She lives for using her life and she loves her work. If she is made redundant, she will continue to fill her life with meaning. Her colleagues look at her with a wry expression. They say she works like a horse. But Tea does not work for compliments. She works because she is convinced that this work is her purpose in life. People think they develop because life's panorama changes and because they gradually rearrange their values in accordance with current trends. But the crucial point is that the experience of life as such does not change for the better in most people's lives. If it changes, it usually goes gradually downhill. On the other hand, people rarely become radically happier with living as they grow older. Nor do they radically improve their experience of their working life - although it does happen.
GROWTH AND DEVELOPMENT There is much evidence to indicate that it is possible to become happier [1]. Most of us know of some people who have done it, have improved their lives, and acquired a new and more fulfilled working life, leisure life, etc. Rather few people achieve a better working life without improving their life in general. It happens that people find a new job and say without hesitation: I feel so much better at work now. Now the problems, the conflicts and the bad experiences vanish for a while. But they will resurface if one suffers from such tendencies. It is amazingly rare for people to succeed in creating really good lives through their work and making the big dream come true. It is very important to keep in mind that change itself is not human development. A great deal of change is often superficial whereas the tough reality at the depth of life offers only
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stagnation and adaptation. Development takes more than that. It demands a goal-oriented and disciplined effort. It requires us to really want to change. We must want a better life before we start improving our life at work. In order to succeed we must be truly motivated. When we embark on growth and development as human beings, whether in our private lives or at work, we come against strong, conservative forces. We have developed into egos through a long personal history which has confirmed our perception of reality as taught by parents, teachers and all other adults explaining what reality looks like. We were given a set of attitudes, a set of habits and behaviour patterns drummed into us. Now these more or less permanent attitudes form the backbone of our lives. Such a backbone has to be quite stable, rather rigid, so to speak; otherwise we are too impressionable and dependent - soft as molluscs. Unfortunately this rigidity makes it difficult for us to develop because development requires certain softness and flexibility, as well as a basic openness to the views of others.
Developing as a Human Being - Improving the Experience of Life

To push it to its logical conclusion, one could say that what really needs to be developed in us is our somewhat half-finished, coarse and less refined perception of ourselves, of life and of the world around us: This is what gives us unpleasant personalities. Human development is largely focused on being able to accept oneself as a human being with flaws and weaknesses that we would like to correct. This is followed by years of hard work trying to correct these flaws and weaknesses. When we do not develop, it is because we much prefer to justify ourselves instead of acknowledging our shortcomings and trying to correct them. Our experience of living, that is to say our joy in life, needs to be developed further since quality of life is a function of this joy. Life experience manifested by good or bad quality of life covers two issues: our perception of reality and the things we do in life. Our perception of reality embraces our attitudes to life and what it brings us. What we do in life is our practice of life, all we do and say, our habits, decisions etc. Our practice of life mirrors our attitudes and ends up confirming them, be they conscious or unconscious. If we dislike somebody, for instance, we behave accordingly, showing distance and reservation. Such a behaviour pattern provokes repulsion. It makes us believe that there are numerous reasons for not liking the person, despite our own initial bad behaviour. Or maybe we were trained in inept behaviour during our childhood by not being taught actively to search for knowledge, etc. and are now in trouble in our adult life because we have come to regard ourselves as untalented. Or we feel that we are not good-looking, intelligent, admirable, courageous or whatever. We have learned to picture ourselves in terms of the number of words available to us in our language. To each quality or feature is attached a detailed behaviour. We contain a huge amount of behaviour patterns, taught by vocation and thousands of repetitions. Our concept of the state of things is confirmed by experience during a lifetime, even though we were the underlying reason for what happened. We create our own experiences through our attitudes and life practice, often without knowing it! We suffer from a dreadful tendency to be unaware of what is happening in our lives.
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But logically, the solution is within reach. When we become attentive, we overcome many of the barriers that keep us fixed at a certain level through life. An increasing awareness of our personal likes and dislikes makes us reconsider our motives. Not until we realise that we do have an opinion on life, may we discover the wide range of alternative attitudes. Furthermore, we discover that our behaviour is an expressed attitude, which leads to different ways of doing things, some of which may be better than others. In fact, comprehensive development is not compatible with a wish to achieve development within a few areas, privately or professionally. It is our whole attitude to life and our corresponding behaviour that creates our lives. All the way through life we must be attentive and do our best. We must take up life's challenges and train ourselves, be totally attentive and do our best. To be attentive and make an effort corresponds to a solution where you act according to your true convictions. Bear in mind that being attentive is not something you do; it is something you are. In a way you have to change something deep inside your existence in order to start developing. This is a barrier that deserves respect and must be overcome through persevering, active and goal-oriented effort. Most people find it hard to believe that inside of us we possess all the wisdom needed to lead a good life. To most people it sounds preposterous that we just need to surrender to life and trust it. To modern western Europeans it seems naive and romantic to listen to the soul hidden beneath the busy and confused surface. To improve your life is quite complicated when you try. When taking up the challenge, try testing the simple idea that life is full of wisdom which can be located and expressed in many ways, provided that you have faith in yourself while you listen to your inner self. It requires courage to recognise and live out your innermost dreams and longings. But we will not become harmonious and happy beings until the day we start asking for and doing what we really want to do [2-6].
Ability to Function and Age

There is a sinister curve regarding the state people find themselves in. It is the curve showing the correlation between peoples age and their ability to function. This ability to function comprises issues such as ability to manage one's job and one's social obligations and is directly related to health. Research results show that people reach their peak activity between 20 and 40 years. After this they decline, at first very slowly, then faster later on. Around 60 years of age most people have deteriorated to such an extent that they are of very little value on the job. At present, the average retirement age is 61 years. At this age most people have acquired their first chronic disease. Normally it is not a harmful disease, just a slight attack of arthritis or dementia. But the decay accelerates and around the age of 75 most have reached the end of the road. Results of research done in Denmark (Quality-of-Life Survey, 1995) has revealed interesting but worrying facts and patterns that seem to relate strongly to our ability to function in relation to age. The results revealed that most Danes do not really feel very good or very bad during their lives - they live in a lukewarm middle-group' revealing the following characteristics:
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Almost every other Dane does not have a close friend. Every fourth Dane does not have a girlfriend or boyfriend. Of those with a partner, one in three women and one in four men have sex problems. Only one Dane in three feels very good at work. 94% of the population suffer from a health defect. Half of the population suffers from chronic conditions. One in twenty contemplates suicide from time to time. There is no correlation between happiness and annual income. Happiness is clearly and closely connected with the quality of personal relationships. Those who feel bad on the job feel worse in life than unemployed people do.
The surveys have also shown that the Danes are one of the most contented populations in Europe. At the same time they have the second highest suicide rate in Europe as well as one of the lowest life expectancies. The most interesting feature about this curve is that a small proportion of the population does not seem to follow the curve. A few percent get better year by year and become rounded, soft, warm, valuable and highly appreciated human beings. They are the ones who end up as wise, old people who are highly esteemed and vital until their last day. They often die within 24 hours at a very advanced age. These exceptions do exist. Could this picture of the Danish culture be true of other western cultures too? However, most of us do not grow old gracefully, we become sad and decrepit. What is it that makes some people develop and systematically improve their lives year by year? What are the characteristics of people who understand how to develop? The basic principles of personal development can be studied thoroughly in a rather special situation, which is when a life-threatening condition becomes terminal. In this situation most of us suddenly experience an immense love of life as well as a very strong motivation to improve life radically while we still can. The fantastic thing about this is that it seems to be possible. It does not even take long to improve life significantly when we are terminally ill - maybe a few weeks or months. We all have great hidden resources.
Apprehension and Life Practice

For a long time Lisa felt she was ailing. It seemed as if her life would not work out properly. She thought of life as hard, painful and weak. As if it contained no value - and it was useless to start fighting. In a way, she felt life a bit unreal. Nor was she content with the world around her. It did not seem to offer her the proper opportunities, it was hard and unyielding; you could not even scratch it with a nail. She could not help feeling that she did not comply with life's demands. She did not feel bright and attractive; at times she felt ugly and unloved. She thought, all in all, that she was rather useless and tired of life. Her life had gradually turned into a routine. She had come to terms with quite a few symptoms from stomach-aches to insomnia. She had come to accept that things would not work out for her at work, where she felt excluded when colleagues chatted among themselves
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and left her out of it, even maybe behind her back. She refrained from confronting executives and colleagues, her friends and her boyfriend with her opinion of the situation. Instead she chose, not really wanting to, the role of the victim. Understandably, no one really liked her. She was not an easy person to care for. Try to plot Lisa in the attitudinal questionnaires below: We know from research that statistically quality of life correlates strongly with answers in the left-hand column. How do you perceive life, yourself and your environment? Put a circle around a number in each line - between the two statements. The numbers mean: 1: You agree 100% with the statement to the left 2: You agree more with the statement to the left 3: You agree or disagree with both statements 4: You disagree more with the statement to the right 5: You agree 100% with the statement to the right
Perception of Life
Life is full of joy Life is full of meaning Life is enhanced through fighting 12345 12345 12345 Life is full of pain Life is meaningless It is useless to fight
Self-Perception
I am Loved Extroverted Headstrong Competent Courageous 12345 12345 12345 12345 12345 Unloved Introverted Weak-willed Incompetent Cowardly
Perception of Environment
The world is soft and malleable 1 2 3 4 5The world is hard and unyielding The world contains all I need 1 2 3 4 5 The world cannot satisfy my needs My personal achievements matter to the world 1 2 3 4 5 My personal achievements are unimportant to the world Then Lisa gets breast cancer, like innumerable other women. The prognosis is bad. Feeling the pressure of the short time left to her, she discovers a new love of life that changes her attitude and mental outlook. Now she finds that life is valuable and good and full of meaning and fighting spirit. She gives the matter a great deal of thought and reaches the conclusion that everything important in life is caused by something and that nothing happens
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by chance. She is forced to improve her marriage and her working life as well as the way she is using her friends. She discovers, finally, a great freedom to shape her life and her reality the way she wants. The opportunities are far more extensive than she ever imagined. Lisa finally experiences a new love for herself. She accepts herself as she is, weak and vulnerable. In the midst of this openness she discovers life itself to be strong and that she has far more strength than she thought. She experiences an intense blossoming accompanied by many declarations of love. She opens up to life and people around her in a touching whirl of events that change her life completely. At one point she can say honestly and in the middle of disease and misery: 'I never felt so good in all my life'.
Perception, Behaviour, Experience

Our experience of life is defined by two basic parameters in life: our perceptions or attitudes and what we do and say to express these perceptions. A complicating feature in human beings is that we find confirmation of our initial attitudes and opinions in the reactions that come to us from life and our surroundings. Figure 1 depicts the situation.
Perception Experience Behaviour
Figure 1. Our behaviour (Life practice) is defined by our conception (Sense of reality), which is again confirmed through the response from life and the surroundings caused by our conduct. We end up being caught in a self-affirmative bubble, the truth and value of which we are quite sure of, even though it may be in deep conflict with life inside us. The whole construct, the life we have created, can only be valued by a single parameter, which is our experience of life, our quality of life.
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Awareness Perception (1) Experience (1) Perception (2) Experience (2)
Development
Behaviour (1) Exercise State of being 1
Behaviour (2)
State of being 2
Figure 2. Human beings develop when they become attentive to attitudes which are more in accordance with life and when life simultaneously is restructured and rearranged in favour of expressing more constructive and positive attitudes. You can either jump from one state to another, or you can develop by making a decision to improve your life, practising alertness and making your best efforts at living.
Our perception and our behaviour provide us with our experiences. Furthermore, our perception gives us an attitude, which leads to a response from our surroundings, which in turn inevitably confirms us in our beliefs. What happens to Lisa, when she is confronted by the death sentence is that she experiences her life structure, all she believed in and her way of life, as a failure. Put together, her attitudes and behaviour have not caught up with life and expressed love of life. She becomes attentive to a whole new set of beliefs and a whole new perception of life, which corresponds to a new practice of life. Concurrently with rearranging her life, she achieves a far better experience of life. She stops opposing life and finally finds herself close to life and alive according to the original meaning of her life as illustrated by figure 2.
Do I Have a Talent for this Task?

Rasmus is trainee clerical assistant and not very good at his job. The secretaries perceive him as somewhat misplaced. He does not think of himself as talented. In general, he appears lazy and unmotivated. He does not have the curiosity towards the profession, which is typical of good trainees and he prefers to avoid the difficult tasks. At a particular point, the head of section makes it clear to Rasmus that he has to change his attitudes if he wants to stay with the company. Rasmus experiences a crisis in which he finds himself in serious doubt as to whether he really wants to work in an office or whether he should try manual work. Pressed by circumstances, he is in doubt as to whether he has a talent for office work at all. He ends up concluding that he does have talent but is not good at utilising it. As he does not try and does not do his best, he cannot expect to get better at his job. Rasmus radically
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changes his attitude to the job and decides to remain in the profession and give it all it needs. Soon after he begins to make progress and in time he becomes very valuable to the office and very happy in his job. Try to plot in Rasmus' attitudes before and after the crisis according to the list below:
Attitudes towards Becoming Really Good

I have many important talents 1 2 3 4 5 I have no specific talents When I work on improving my skills, they improve quickly 1 2 3 4 5 When I work on improving my skills, they improve only slowly I love challenges and continually look for new tasks that will force me to develop 1 2 3 4 5 Challenges stress me. I try to hold on to what I am used to do I am a person who succeeds, in general 1 2 3 4 5 I am a person who does not really succeed I have big dreams of mastering my profession and create genuine value.1 2 3 4 5 I have no dreams about mastering my profession to become really valuable
Meeting People
Anders was very fond of his small favourite bar. He did not go there all that often but when he did, he really let go. One day, when dropping by, he met a big nasty guy. The big guy was the kind of person who hit people for no cause and carry a gun in their inside pockets, Anders thought. He ordered a beer, but had not had a drop before the stranger started bothering him with stupid remarks. Anders was very fond of his small favourite bar. One day at the bar he met a customer he had not seen before, a big, strong guy with square features. He ordered a beer and after a while he was talking to the stranger. It appeared that he had just moved into town and did not yet have any friends. Anders could provide the stranger with useful information and they ended up getting on fine. The way we meet people, our attitudes and prejudices as well as our behaviour will always decide the quality of our human relations. Some people are incredibly good at meeting other people whereas others systematically make trouble for themselves. Nothing is as sensitive to attitudes and conduct as our dealings with others. We are able to create for ourselves most favourable circumstances provided that we know how to bring to the surface the best in people, if we consider them delightful, talented, constructive etc. Often we can inspire to personal development by observing fine traits in people who have not yet themselves discovered their good points. This is one of the best ways to interact with your friends and colleagues.
Attitudes towards others, towards Co-operation and Management

I like other people 1 2 3 4 5 I do not like other people I believe that otherpeople like me 1 2 3 4 5I do not count on other people liking me
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I am sure that my colleagues can perform just as well as I can 1 2 3 4 5I do not have confidence that my colleagues can do the job as well as I can The best thing is to create results together with others 1 2 3 4 5 The best thing is to create something on your own Managers are a steady help and support in my development 1 2 3 4 5 You cannot make friends with your manager - there are too many differences At times things are not perfect and we are obliged to change the situation because we are the best placed to do so. Our place of work, for instance, is managed by an authoritarian and out of date board, which acts as a barrier to any development, including creating genuine values. In this situation it is important to start fighting in order to create order. This fight is the ultimate test. Only when we are involved in confronting challenges of this size can we see the direct benefit of personally developing into a better and more influential person. You only develop when you are forced to. To accept the big challenge is to place yourself in a situation which leaves you with no choice but to do your best and to do it quickly.
Attitudes towards Creating Real Value

At work I get the good feeling that I create value for others and myself 1 2 3 4 5I do not give much thought to how valuable my work is to customers and others I feel that I realise some of my most significant values and dreams within the organisation 1 2 3 4 5I do not feel that I can realise my true values within the organisation My values are in line with those of the organisation 1 2 3 4 5 My values are very different to those of the organisation The purpose of the exercises above is to draw your attention to your own attitudes and the way these attitudes are expressed. By paying attention to your attitudes and continually trying to develop and train these, you may ensure a better experience of life and a more valuable existence. The above lists are examples found in the tools for improving working-life quality. The tools are organised in such a way that it makes it easy for you to analyse your attitudes and find out what problems you cause for yourself in various situations at work. Everyday examples, like those provided by Lisa and a lot of other people, show that human beings have within them many more hidden resources than we think. We all have the option of revising what we think of ourselves, life and the world around us. Likewise we can make adjustments to our habits and our way of life in general. We can all do a lot to feel better, in private and on the job. For some reason we do not do anything about it until we are forced to. But we could easily do something if we decided to do so. There is nothing more delightful than discovering that nature actually created us wonderful, intelligent, attractive, talented and humorous etc. We must stop preventing ourselves from being so. Now and then we meet a very happy person - and they do exist. A feature of very happy people is that they do precisely the work they want to. Look closer and you will find that these people consider themselves hunters or warriors. They fight to make their dreams come true. They are very different from the majority since their efforts are not motivated by duty
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and mere necessity but by love of life. This love provides an indomitable will to make life come true. Happy people squeeze all they can get out of life. They fight to make life succeed. The willpower to fight uncompromisingly provides them with a special capacity for living and they develop a certain competence in life. When we meet people of this kind, we often think they were privileged by birth. Unfortunately it seldom occurs to us that they may have developed and shaped their lives individually and finally achieved mastery.
Get started - Personally and within the Company

The Churchill Dairy's bottom line is in the red. Employees seek jobs elsewhere and everybody has a feeling that the company is a sinking ship, though this is not obviously the case. Milk, butter and cheese are always in demand and the dairy's products are not significantly poorer than those of other companies. Still, sales are declining. It has proven difficult to contact the customers. There are cliques; there is trouble and quarrelling. The employees blame the situation on management, who respond by pointing to shortcomings and lack of efficiency as well as lack of flexibility among the workers, many of whom are elderly. They are poorly educated and have problems handling the latest technology. In general, the bad and uninspiring atmosphere makes it hard to attract young people. An attempt to understand what is wrong is made by measuring the level of job satisfaction at the dairy. The evaluation shows that all four dimensions of working-life quality are low: personal quality of life, mastery, sense of community and the creation of genuine values. There is no particular point of failure but generally the dairy's working-life quality is 50-60% of its potential - in the so-called red area, the consultant says. Such a company runs at only half speed or less and is hardly able to compete. The consultant recommends quick implementation of a radical cure to raise the company to the orange area (60-70%). The green area, above 70%, will take a few years to attain. However, the dairy may succeed, provided the trend of development takes a turn for the better. Management presents the analysis at a staff meeting where the connecting principles are discussed concerning the bottom line and working-life quality. Agreement is reached that lack of information and lack of responsibility and commitment to the company are the main reasons for poor efficiency. Furthermore, poor communication between sections, lack of team spirit among the employees and conflicts between management and employees are other reasons for inefficiency. The cheese and some of the other products could be better, too. The customers complain about lack of consistency as well as fluctuating quality. Though it is not clear how production is supervised, it is obvious that improvement is needed through a better working environment, personal commitment and job satisfaction. When you have improved your skills in solving problems on the job, you will discover a general upgrading of your skills in troubleshooting. This may benefit your private life as well. It works both ways: if you try hard to solve private problems, the effects will be positive on the job as well. We have now examined the four issues necessary for a company to really succeed and create real value in the world: quality of life and job satisfaction, mastery within each individual field of activity, a sense of community with respect to co-operation and
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management, and finally creating real value. This is an ongoing process that affects revising of values, working procedures and goals. The company or organisation with these qualities will be successful both from the perspective of employees and customers. Such an organisation will go one step further and also prove to be valuable to the environment: nature and society. It is this type of development, which will carry companies forward into the 21st century.
How to Start Developing

We all have resources, hidden as well as obvious, to improve our lives. We have the resources to ameliorate our actions. But how do we get started? Traditionally there are two ways. The first and ordinary way is the most difficult one to implement: we discover that we are to die within a short time and that we love life immensely and this makes us rearrange our limits. This is the method for those given a death sentence by their doctor. The situation is highly effective if you confront it properly, although naturally this situation could never arise artificially. Consciousness about death and the fighting spirit to remain alive are gifts we receive unexpectedly and often undeservedly. The second method is always at hand. In a flash of profound insight, a lucky moment in which we sense very intensely what life has in store for us, we suddenly decide to change our lives. When made wholeheartedly, the decision to change our lives is an extremely effective one. Unfortunately, our existence is often so unconnected that the decision is not made in our existential centre, in our inner integrity, but in a far corner of the brain. Such a decision has no great and pervasive effect. It can be compared with a decision to stop smoking where you start again after a fortnight. On the other hand, this is what we have to make do with. The missing discipline must be developed gradually through perseverance. As long as we do our best and a little more we cannot blame ourselves. What does it matter if we fall back into less fortunate patterns? If we eventually realise what is wrong, we can escape once more. This is exactly the struggle we are involved in, all of us. Such are the tough conditions of life. Very few people ever develop enough discipline to experience the full strength of a decision made by the whole person. This kind of decision simply changes life from one moment to the next. But again, people who are that disciplined rarely have anything to improve. They have achieved mastery. They have put their life in complete order. It is easier to decide if more people want the same thing. Joint inspiration and support is an advantage when running a development project in the company in order to improve life. It is often an advantage when a coach can keep you at it and prevent you from taking the easy way out. A coach can observe you from the outside and he or she has excellent opportunities of keeping an eye on you and finding out how you prevent yourself from creating true progress in your life. The ideal coach is a person who is not necessarily a close friend but he or she is somebody you trust and like.
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ABOUT WORKING-LIFE QUALITY: A TOOL FOR EMPLOYEES AND EXECUTIVES
The Working-Life Quality tool has been developed in order to help you acquire the inspiration and discipline needed to develop personal working-life quality. It is not very difficult to use this tool but it commits you to being alert and effecting changes. The tool attends to the four aspects of good work: quality of life, mastery, sense of community, and creating authentic value. Furthermore, the tool comprises an understanding of what is needed for people to develop and grow, i.e. the perception and practice of life that must be developed analogously and brought in harmony with our inner lives. Finally, it supplies a form (including a chart for checking yourself) for exercises that may motivate the discipline needed. If you do not try, you will not improve. Our attention to positive attitudes as well as proper behaviour is what opens us up and gives us access to our hidden resources. The tool is an instrument to help make a difference in your working life. A combination of disciplined effort and understanding of the principles of development, a focus on better attitudes plus adjustment of less satisfactory conduct, which acts as an impediment, may lead to significant development.
WORKING-LIFE QUALITY THE TOOL The tool itself guides you through a course lasting 15 weeks during which you improve the four central issues at work: your relationship to yourself, to the tasks you work with, to those you work with and to those you work for, customers and your environment. It is a workbook of 160 coloured pages with exercises and various examples. The material is collected in a folder including a 12-page questionnaire about working-life quality, as well as an inspirational brochure, which informs you about the basic ideas. The folder also contains a floppy disc with a programme (Windows operating system) showing your personal profile of working-life quality, which will help you to realise what particular efforts may be required on your part in order to improve. You can use the tool on your own. It may, however, be a good idea to ask your company to take initiative and to start a development project with the purpose of improving the working-life quality of the employees and the executives. Supplementary to the individual folder, you can get a company analysis programme (QOL Working-Life Quality - Company Profile) which provides you with a profile of the whole department or organisation with regard to its working-life quality. At the moment reference values from six Danish companies and their employees are included in the programmes in order to give you an idea of your company's standing or rating. If your company reaches the conclusion that they want to address working-life quality, they should earmark 1-2 hours weekly for 15 weeks for each employee (spread over 4-8 months, for instance) to train and do the exercises. In appendix A you will find references and addresses of public information centres, consultants as well as the Danish Research Centre in Copenhagen that can provide help and support for measuring working-life quality and quality development projects based on working-life quality. You will also find information on where to purchase the tools and questionnaires.
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Today, most company executives have come to realise that job satisfaction and commitment are significant parameters for quality assurance and efficiency. To an increasing extent companies need people who can find individual challenges on the job. More than ever independent-minded, creative, conscientious and resourceful employees are needed. Such people are rare and the companies will have to develop such capabilities themselves. To this end, projects of this type may be applied. It is no secret that the general unofficial retirement age of 61 constitutes an increasing drain on the cost of keeping the labour market going. It is hardly natural for most people to become so decrepit at the age of 61 that they are mainly a burden on the job. On the contrary, many people are still active, very much alive, loved, respected and visited at the age of 87. But let us face it: They are not the ones who for thirty solid years went on doing things they did not like, or take an interest in what they were doing. They are not the ones who were bored with their work from the age of 30 to the age of 60. Such a way of living is a prelude to a life of mental decline, cancer and heart attacks at an early age. Many companies may be interested because of a wish to retain their employees for the company and keep them healthy. If you can succeed in starting a developing process, which makes people grow and prosper and have fewer accidents, instead of becoming worn-out and decrepit slowly but surely, your company will gain an incredible advantage. Furthermore, it would be to everyone's advantage if management and employees were equally convinced of the benefit involved in embarking on the exercise. This will make the organisation a forum for the discussion of ideas, in respect of their substance and their viability. Another suggestion is to let management take the lead in the development process in order to build up consecutive steps of motivation and guidance for the employees. But one must beware of romanticising the project of improving working-life quality. There are many obstacles to initiating the process. However, once the basic idea of human development is accepted and the necessary self-discipline is established, the exercises will be much easier to cope with. When we are about to embark on personal development, the greatest challenge is believing that we are in fact able to make a change for the better in our lives. We have to convince ourselves. But we do not believe it until we see it. And we do not start until we believe. Consequently, we are faced with a dilemma that necessitates a firm decision. A decision such as, 'I will do it, for I intend to improve my life as well as my working life' cuts through the doubt and uncertainty. Once this decision has been taken, we need no longer wait for a life-threatening situation to impel us forward. We can start our development process right away, either within the community of the organisation or alone. We can also do it together with a friend or a coach. It is much more pleasant to do it together with someone else. But when it comes to our personal development, we must always realise that when engaged in the most significant struggles we are on our own. As individuals we are our own greatest and most dangerous enemies in the process of development. But when love of life is with us we have a fair chance of success. We wish you good luck with the improvement of your working-life quality.
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DISCUSSION
There are many ways stating to improve the quality of working life in the company. But every improvement starts with yourself. It is almost impossible to change other people; just reflect on the sad fact that it is very hard to change yourself. To change and develop you needs a strategy that immediately pays off. Hard discipline in combination with doubtful results is only for the few God have chosen to be great examples for the rest of us. We need to walk a path that is immediately rewarding. And personal development of quality of life, mastery and fellowship can be that path. If only the project is managed well. Self-leadership is for the inspired ones, and development without pain for the prophets and saints. The rest of us needs to be pushed by suffering to change our attitudes and become self-reflective. The leader or employee that wants to introduce the concept of quality of working life and personal development in his company most therefore be extremely aware that everybody will resist development. Even the best of ideas will receive fierce resistance. So bring your idea forward, but do not despair, when the people around you do not follow. Just continue to say and do what you find appropriate. Speak the truth, keep your heart warm and open; do good and serve your friends, colleagues, costumers and mankind. When we are about to embark on personal development, the greatest challenge is believing that we are in fact able to make a change for the better in our lives. We have to convince ourselves. But we do not believe it until we see it. And we do not start until we believe. Consequently, we are faced with a dilemma that necessitates a firm decision. A decision such as, 'I will do it, for I intend to improve my life as well as my working life' cuts through the doubt and uncertainty. Once this decision has been taken, we need no longer wait for a life-threatening situation to impel us forward. Surveys carried out by The Quality-of-Life Research Centre showed that only one Dane in three is really happy in his work. Few people burn for their work, they just burn themselves out. But work is our great chance to develop our quality of life; it calls for personal development and a critical revision of our attitudes, as well as a change of our daily routines. You have working-life quality when your work is an extension of what you want in life, when you develop and become master of your particular field, when you experience fellowship with colleagues and managers, when you are proud of your place of work, and when you are useful to the world and able to deliver products and services of high quality in a responsible manner.
REFERENCES [1] Ventegodt S, Flensborg-Madsen T, Andersen NJ, Nielsen M, Mohammed M, Merrick J. Global quality of life (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991-2004. Soc Indicator Res 2005;71:87-122. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine III: The holistic process theory of healing. ScientificWorld Journal 2003;3:1138-46. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine IV: Principles of the holistic process of healing in a group setting. ScientificWorld Journal 2003;3:1294-1301.
[2] [3]

[4] [5] [6]
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Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Global quality of life.Theory, research and methodology. New York: Hippocrates Sci Publ, 2005.
Chapter 8
HOW TO IMPROVE WORKING-LIFE QUALITY, QUALITY OF LIFE AND HEALTH

Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel, Lars Enevoldsen and Joav Merrick
We present a complete package of know-how and tools for improving quality of working life (QWL) in an intermediate to large, public or private, organization. Using the concepts of quality of life, mastery, fellowship and creation of value, we demonstrate how the companies revenue can be developed by helping the company to use its employees and leaders in a better way, leading to a happier, healthier and more productive working life. The QWL-tool box is today complete with QWL-questionnaires, QWL-software for measurement of employees, leaders and divisions; and developmental tools (exercises books and intervention programs). We believe that a company unaware of the idea of human capital can increase its value over a few years by implementing the concept of QWL as a policy tool.
INTRODUCTION The scope and complexity of change at all levels of our society - especially in the world of work - have placed a heavy burden on employees and leaders alike to ensure that they attain the necessary skills and understanding to survive and thrive in this new reality. Some people feel insecure and threatened by the speed, vastness and insecurity of the changes that they have to keep up with. Fear of losing their jobs because of downsizing, restructuring and affirmative action have put employees under tremendous pressure and stress and thrown many in crisis. Uncertainty about how to react to cultural differences as well as bad economic times is claiming its toll. The impact on the employees of our companies manifests itself in rising health problems and tremendous rises in claims for depression and stress-related medicine. It seems that people do not have the skills or right attitudes to deal with and handle all the pressures of current times. As the use of more traditional medicine can and will not stop the causes for its use (symptomatic treatment), it is becoming more and more clear that we will have to focus
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Sren Ventegodt, Niels Jrgen Andersen, Isack Kandel et al.
our effort on prevention of illness rather than cure. This can only be done if we can develop values and skills in our employees that will enable them to take control of their own future and health. As this is a huge task, leaders as well as employees on all levels of the organisation will have to take individual as well as shared responsibility for this effort. Consciousness and understanding about the fact that we can change our health by changing our attitudes about life and developing the right abilities and skills to handle uncertainties, must be created everywhere in the organisation. Information and openness how to obtain these should be widely promoted. Open minds are needed to accept the fact that in order to solve our problems in respect of our health crisis we have to begin to care about our people in order to help them help themselves. We have to teach them to practice self-management of their health and life.
FOCUS ON QOL, QWL AND HEALTH Some time ago it was thought that ill health was a simple function of poor genes, hard living and old age. Today we know - although we still do not understand it completely - that a major cause of health problems is poor living style, especially negative attitudes and nonconstructive behaviour. But what is so surprising is that it seems possible for everybody to improve their living style and radically improve their experience of life and working-life. And when they do this, they also usually get healthier. Science has shown that even if you have a life threatening disease, like disseminated breast cancer [1], you can improve your quality of life (QOL) and live longer. If you have heart-problems due to atherosclerosis, science has recently shown that you can reverse the deadly decay of your vessels, if you improve your living style [2]. But we do not need to suffer from a deadly disease in order to improve our QOL and health. Research has shown that the statistical connection between the number of health problems and QOL is so strong that for example headache and sleeping disorders are likely to disappear, if people understood themselves and their lives better [3-9]. This is where focus on QWL (quality of working life) becomes important [10,11]. People spent a lot of their personal energy and effort in and around their work. According to research, to thrive on the job seems to be one of the most important sources for a general good QOL. And it is surprisingly easy to improve the QWL - you just have to improve your relations in your work, the relation to your colleagues, to your boss, to the customer and to yourself (see appendix E: basic theory and concepts). All it takes is a change of attitude and a change of habits. Of cause it takes a lot of effort to do that, but that is all it takes (see statistical connections between QWL and health in appendix I). When you want to change your QOL or QWL (and through that your health) you first of all need some self-discipline. As most people are lacking self-discipline it is of great help to do things together. This can be done by running a QWL project in the company. Here people can get the support, the comfort, the help, and the moral back up that is needed. Practically, they can get a reminder to practise; they can get an invitation to join in. The limitations of practising by yourself in order to make a difference in your personal and professional life can thus be lowered immensely.
How to Improve Working-life Quality, Quality of Life and Health
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Understanding Quality of Life: The Experience of Life as a Function of our Attitudes and our Personal Philosophy of Life
QOL has for centuries been a mystery to mankind. It seemed quite unfair that some people materially have everything, while others had virtually nothing. It seemed very unfair and strange that two people in exactly the same physical conditions could have very different lives, when it came to mood and happiness. For no obvious reason some people lead a good life, healthy through-out life and most of the time without a single worry, while others seem to be tortured by pains, worries and ill fortune all through their lives. For the last 100 years, starting with Freud and psychoanalysis, QOL has been a research area in the western world. But only recently science came closer to a rational answer in this regard. It seems that QOL is greatly a function of the person's personal philosophy of life and his/her attitudes towards life. And since Rensis Likert (1903-1981) made his brilliant Likert scale for psychometric measurement in 1932, it has been possible to measure the strength of an attitude and rate the colour of an evaluation: the degree of positivity and negativity. By comparing peoples attitudes, it can been shown [7-9,12-17] that some attitudes are good for your life, while other attitudes are actually quite harmful. The scheme is quite simple: if your attitude expresses something positive and constructive towards life, then it is of good value, because it allow you to find good things in yourself and express it. On the other hand: if your attitude denies life and expresses negativity and destructiveness it will hardly do you any good. It will be a hindrance for you to find the good things in yourself and it will definitely inhibit you when you want to express yourself and the life you contain. The good life is a life where we grow and use all the enormous potentials we carry within us, all the talents, all the abilities, all the dreams, needs and wants. The good life is about expressing lifes potentials. And only a loving, supporting, containing and allowing attitude can make that possible. The fantastic thing is however that the personal philosophy of life can be developed. It cannot really be changed. People cannot really be taught a new philosophy, because the personal philosophy of life is in a way a simple function of their personal history. But as people reconsider their personal history and their fundamental attitudes and confront them with their intuition about life, the personal philosophy of life can fairly easy be developed. All it takes is a willingness to open up and learn and a safe environment in which to partake in the most important experiment in life, namely learning to look at the world and on life itself in a different manner.
A Need for an Integrated Approach towards QOL, QWL and Health

In recent years the term quality of life almost became a household word in the domestic language of layman and professionals alike. The concept has also been widely referred to by health and social services, as well as in the political arena. Reference to terms such as happiness, well-being, the good life, health and standard of living has lend itself to a host of subjective and one-sided definitions and interpretations of the concept by all interested parties alike - medical, social, economic, psychological and political. They all claim to have the individual welfare foremost in their minds.
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This in term led to fragmented and limiting research approaches and ways to measure the quality of individual lives. Lots of efforts and money spend to enhance quality of life have consequently failed or were found not really to have had an impact on optimizing life quality, improving health or personal circumstances. All of the above pointed towards an urgent need to search for a global, holistic concept of the quality of life, which focuses on the totality of life aspects of the individual. It must be theoretically sound and common to people everywhere irrespective of age, sex, ethnic group, culture, income and state of health. Within such an approach we then need to do research in order to determine and understand what constitutes quality of life for all people. How is it the same and how does it differ from that of other cultures, if at all. Such an approach will allow us to investigate, examine, explore and scrutinise all efforts and domains that claim to determine, measure and improve the quality of life, of work-life and of health in a scientific and controlled way. We believe that the research done in Denmark has laid the groundwork for such an approach. This research developed a meta-theory for studying the concept of QOL, which is philosophically and methodologically sound (see appendix I). On the basis of the integrative theory on quality of life and health this research evolved into a theory on working-life quality (see appendix E). Generic and scientifically constructed questionnaires were further developed in order to measure the dimensions that constitute QOL, QWL and health, as well as the development of training programs and interventions to improve these and hopefully in the future even prevent illness. Although their questionnaires still must be validated in truly multicultural and multiethnical societies, their basic philosophy and methodology of a generic concept of QOL and QWL seems sound and worthwhile exploring in any context.
A Strategy for the New Millennium: Hard Value from Soft Values
All individuals have resources, hidden as well as obvious, to improve their lives. But how do we get started on this road? We work from the premise that individuals are able and willing to tell us, how they feel about themselves and their circumstances and that they can learn, because we all have the potential for personal growth. The answer thus lies in dialogue (effective measurement) and the continuous practice of personal development. However in order to ensure the wanted outcomes (see features and benefits, appendix A) for the individual and organisation it makes good sense to structure such efforts in a practical, controlled and cost effective way within the organisation. Thus a QWL-Health intervention process should be planned in such a way that it continuously and systematically guides the company through preventative QWL-Health interventions and at the same time teach people to help themselves. It is however not good or cost effective practice to start with any intervention, if you do not know what the state of current affairs in respect of QOL, QWL and health in the organisation is. In the interest of both cost-effectiveness as well as creating new knowledge and understanding about the interrelatedness and development of these variables, it is wise to follow a scientific and controlled approach.
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A Scientific Approach: Using Knowledge to Create Knowledge

Science has given us our wealth, ample food, breathtaking technology, computers, paintings, new materials, machines and life saving medication. It allows us to master the universe, to get freedom and control. Science also allows us to develop tools to change the world. Basically science is nothing but knowledge structured in such a way, that it can be used in practice. It is about knowing what to do and how to do it, when you want to make a difference. When it comes to QOL, QWL and health, science has suffered greatly from methodological problems. This is because one of the basic features of science always has been its need to define its boundaries. Science only works within narrow borders and when it comes to existence and survival many scientists - medical doctors, psychologists, sociologists - have believed that science should and could not cope with it. Because of this, QOL for many years, remained a subject for religion and philosophy only. Medical science has put an end to that. At present more than a thousand papers yearly are published on quality of life, which has been shown to be easy to measure, as soon as you know what it is. QOL can be many things - the different ways you can feel, good or bad; the different dimensions of well being, existence and functionality; lifestyle; etc. The problem therefore is to pick the right dimension to measure and improve, which is the same as to pick the right questionnaire and there are virtually a thousand questionnaires available to choose from. Very few of these questionnaires are what you call generic and global. Generic means that it can be used on everybody in spite of age, gender, health, socio-economical status, culture etc. As soon as you want that kind of questionnaire you are limited to choose from a handful. If you also want to focus on the dimensions of QOL that are related to health and development of diseases your choices are narrowed down once again. If you want to look at quality of the work-life the situation is very much the same. Many branches of industrial psychology that deal with the domain of work-life have there own questionnaires, but a questionnaire which can be used on all employees and managers from all different cultures is seldom found. Furthermore very few, if any, are developed with relation to QOL and preventative health-care intervention. The QWL-health questionnaire (developed in Denmark at the Quality of Life Research Center) seems to be such a questionnaire. A questionnaire can be valid, just as every other measuring instrument can be valid, this mean you must know what it measures and show that it measured precisely and reliably. This is done by constructing the questionnaire according to sound principles; ideally a good theory for QOL or QWL. Thereafter it can be checked by comparing the questionnaire with some external standard, which is generally acknowledged to measure the same. The degree of reliability is measured by a test-retest procedure. Sensitivity is given by the standard deviation. (For these aspects of the QWL questionnaire, see appendix E). When you have a validated and sensitive questionnaire you can measure a difference. If you for example intervene on the QWL, you can examine the test-group before and after the intervention to see, if the state of QWL and health have improved and to what extent. This makes it possible to learn from your experiences and to see if it works or not. When you do different things you can see which alternative works the best for the changes you want to achieve. If you measure with the combined QWL-health measuring instrument you can follow QWL, QOL and health. You can see how improvement of health follows improvement
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of QWL and QOL, when it does. This may be difficult to detect, when you look at a single individual only. Statistical science however functions as a magnifying glass, where you look at many people together (see sensitivity statistics for QWL-health studies, appendix J) and can easily detect the difference. Scientific research on the QOL-QWL-health connection however does much more than allow us to measure. It helps us to make a change. It helps us to identify the variables and dimensions to work with - e.g. conflict-resolution, self-esteem, stress - therefore assuring that we most likely get the change we aim for (see table-works on the QWL-QOL-health connections in appendix J). A scientific approach also gives us practical and reliable tools with which to make the difference. The science of QOL, QWL-Health is a promising new science, but already advanced enough to give us promises of success with QOL-interventions in the future.
Bridging Cultural Differences: Valuing Diversity and Creating a New Society

According to world wide research and scientific studies, as underlined by Thomas Blakeslee (he called it the attitude factor in 1997) it seems more and more that people do not differ from one another in terms of their basic need for the experience of quality of life and quality of work-life. From our integrated theory of QOL [10,18-28] and the derived QWL-theory [11] we know that the essence of both these experiences are our satisfaction with the relationships we have with other people in our lives and environment, our work-process (colleagues and leaders) and ourselves. We also know that this satisfaction depends greatly on our philosophy of and attitudes towards life. For any multicultural society this holds immense promise. For what can be more useful than developing attitudes and a philosophy of life that allow us to value other people around us, but at the same time feel good about ourselves. The accompanying development of lifeskills, such as conflict-resolution and stress-management will help us to resolve problems and difficulties that might arise, but also make us more aware and understanding of the immense richness in possibilities the various cultures offer for experiencing QOL and learning from one another. Determining peoples experience of quality of life and quality of working-life is done by asking them about their deep-felt opinion of the quality of their relation with others, the workprocess and themselves. It is therefore important to give them the opportunity to do so in a language they feel comfortable with. This is especially important for people with lower levels of education. Questionnaires to do so should therefore be available in the persons preferred language.
A Practical Solution: Measurement, Education, Learning and Personal Development (QOL-health and QWL-health Interventions)
Even though the principles are fairly simple, the practical implementation of the ideas and processes explained can be done in many different ways. To a large extent the choice of approach is an empirical question (i.e. what works). But there is a significant element of taste
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and art in it to. A special situation, a special work environment, a special group of people or maybe a special company might need a very different approach than others. The principles behind development of QWL-health are really simple. It is about improving the relations in the work-situation. This is done by letting the employees and leaders/managers identify bad attitudes and destructive behaviour and then consequently create their own exercises to make a change happen. Because resistance against change is normal and this process is aimed at changing old comfortable attitudes and beliefs, the intervention design is very important. Carefully designed activities and exercises that is fun, but at the same time unobtrusively raise awareness about the reality of the participant's conception of there own life and the fact that a lot of their attitudes and beliefs are not appropriate any more, will facilitate learning and change. Based on the above rationale, the implementation process can therefore successfully be guided by tools and instruments with face validity (acceptable appearance) such as to be acceptable to participants, but also good construct and content validity in order to educate and train employees and leaders in the basic concepts of the good working life, as well as the skills needed to achieve good working life quality. The first education begins with a measurement, the QWL-questionnaire itself. Its construction has been well considered: 100 questions on the central aspects connected to QWL e.g. How much do you develop professionally? How do you feel at work? How stressed are you at work? How interesting is your work? By filling in the questionnaire people learn the basic concepts, but they are also forced to evaluate their present work/job situation from a QWL perspective. This confront them with the real nature of QWL and raise awareness regarding the problems and aspects of their QWL that they are not satisfied with at present and create a need and will to change. Please beware that the QWL-score obtained at the second (retest) measure is very often lower than the first measure. This seems to be the consequence of higher awareness by the individual of the reality of his/her real situation regarding QWL. If personal development is continued the consequent QWL-scores should be higher. Hereafter the process is guided by interventions/tools (seminars, courses, workshops, awareness campaigns, lectures and programs) designed to address various needs and specific problems. QOL, working life quality and health seminars confront people with a very optimistic and positive philosophy of life and working life: "Your life can be better! You have lots of hidden resources! Deep down you are a joyful, knowing, skilful, playful and capable being. The real purpose of life is to create value for yourself and others! Useful people are most often happy people!" Although this may seem innocent, it is a direct provocation of the negative set of attitudes most of us carry around unconsciously: "Work means suffering and is a necessary evil; big companies are abusing their employees and managers, draining them of energy and leaving the burnout victim to a hopeless destiny and struggle for survival; life sucks; etc. Even if taken lightly, everybody with a serious desire to learn and understand will be a little different thereafter. A 16-week QWL training program lets people search in their souls for the right answers and attitudes necessary to obtain good quality of working life. Awareness-exercises cast light on limiting beliefs and change-exercises induce real changes in the old habits until now, expressed negativity towards life. Everybody who does his or her exercises will be changed little or much - according to the exercise. No one is forced to do anything that seems or feels
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wrong. The concept is one of ultimate freedom. The only thing you are obliged to do is to be aware and practise your own exercises. If you need help to create the exercises you can get it. But nobody forces any specific drill unto anybody. The course also makes people aware of the connection between the quality of their working-life and their health. As soon as people have been measured for QWL-health it is very easy to identify the persons with specific problems i.e. health problems, QOL-problems, QWL-problems, problems with stress or problems as a result of lack of skills in conflict-resolution. Due to the screening-process people can be offered exactly the intervention, which match their specific problems. If they have problems with health a unique course in health management (heal yourself) is offered. This provides a unique opportunity for the company to really enhance and practice preventative health care/medicine. During the course people are taught how to listen to their body and follow its messages. This is accomplished by lessons in the philosophy of life, some classical therapeutic procedures and through bodywork i.e. exercises with specific focus on the body. The QWL-questionnaire-personal profile is available in an electronic version to be run under Windows. This provide participants with a personal profile of their present QWL, whilst saving previous profiles, thus allowing them to continuously follow their own development, as they progress due to courses, exercises and other interventions. An inspirational book, ''Working-Life Quality" will give employees and leaders with a deeper interest in QWL a chance to understand the background and the concepts in more detail. It should be given to everybody in the company who wants a copy. Teaching QWL to the employees may in the long run prove to be the best investment the company ever made, as understanding is the road to joy and freedom at work and only the joyful and satisfied worker will eventually do an excellent job.
CONCLUSIONS There are so many uncontrollable factors in a company that everybody seems to agree that human thriving and health is too complex and farfetched to be the companies responsibility. We think that the research in human development, quality of life and healing during the last decades has indicated that thriving at work and productivity are most intimately connected. Only the companies who understand this connection and use it in the development of the whole organisation, from mission to daily management, will be successful in the new millennium. We have developed a theory of quality of working life, and according to this all the tools for measuring and developing the company, that its leaders needs for taking the challenge. We hope that this work will be of value to all involved.

APPENDICES APPENDIX A. DETAILED PROPOSAL FOR THE IMPLEMENTATION OF A PREVENTIVE QWL-HEALTH INTERVENTION PROCESS WITH COMPANIES
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Rationale
There is a direct connection between Quality of Life (QOL), Quality of Working Life (QWL) and Health Quality of Life is a function of our philosophy of and attitudes towards life, which can be developed thereby improving health Quality of Working-life arises from good relations in the work situation, namely your relation to: Yourself The work-process Those you work with and The customer, community and environment (nature)
which can be improved through education, training and personal development, thus empowering people to take responsibility for their own QWL, QOL and health?
Strategy
Implement a continuous preventative Health Care process within the company based on QOL-QWL-Health connection rationale Determine current status re quality of life, working-life and health in the company, using the QWL-Health Questionnaire? or QOL-Health Questionnaire? Provide and implement intervention processes for individuals with problems after scientific screening, using the QOL, QWL and health programs, tools and instruments or other applicable sources as appropriate Analyse and evaluate outcomes through retest measures and correlation with external health audit data Align and integrate efforts with other company health care efforts Create a culture of awareness about the connection between QOL, QWL and health Promote personal life and health management
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Features and Benefits of the QOL, QWL and Health Programs, Tools and Instruments
Features
Accurate, immediate analyses of QOL, QWL and health situation of individuals and the organisation as a whole Quick and user friendly measurements Accommodates all levels Independent of income, culture, gender, age, state of health, etc Establish a preventative health care approach Identify individuals who need treatment Pinpoint appropriate choice of intervention needed Equip employees and leaders with attitudes and skills to handle problems, change, personal and inter-personal relationships and crises Allow for comparison with other companies (benchmarking) as well as between branches, departments, etc. Methodologically and philosophically sound
Benefits
Features Accurate, immediate analyses of QOL, QWL and health situation of individuals and the organisation as a whole Quick and user friendly measurements Accommodates all levels Independent of income, culture, gender, age, state of health, etc Establish a preventative health care approach Identify individuals who need treatment Pinpoint appropriate choice of intervention needed Equip employees and leaders with attitudes and skills to handle problems, change, personal and inter-personal relationships and crises Allow for comparison with other companies (benchmarking) as well as between branches, departments, etc. Methodologically and philosophically sound Benefits Direct Benefits Lowered absenteeism Improved health Less stress Better ability to solve conflicts Improved personal development Higher efficiency Improved commitment to work Better co-operation Improved communication Better leadership Improved organisational image Individual life and health management Indirect Benefits Lowered medical costs Higher productivity Healthier retirees and older workforce Higher value to society More innovation Improved competitiveness
See Appendix I for tables on statistical connections and Appendix B for estimation of immediate financial value gained .
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Proposed Process for Implementation

Step 1: Initial Project (Include the Executive Management Group)
Purpose: Launch preventative QWL-Health intervention process within the company Conduct qualitative interviews to validate and explore the processes Evaluate the value of the QWL-Health programs, tools and instruments for preventative Health Care Determine success of various interventions Analyses for possible effects of multicultural realities Process: a) Establish a QWL-Health project team to co-ordinate, plan and execute project b) Obtain support and commitment from senior management for the process c) Launch QWL-Health awareness campaign through internal company media d) Distribute inspirational brochure to everybody in the company e) Make inspirational book - Working-Life Quality - available to everybody who participate in the process. f) Communicate QWL-Health-project and process to the people involved written communiqu One hour inspirational lecture /session g) Administer QWL-Health Questionnaire as well as the QWL- questionnaire (paper or diskette) to all involved h) Collect data (questionnaires or diskettes) for analyses i) Provide each participant with his/her personal profile, explaining results and possible solutions to problems (Users of PC-version get his/her profile immediately but borrow diskette to company consultant in order to compile company profile) j) Compile company-profile and give feedback to the executive team. k) Invite executive members to attend 2-day seminar on Quality of Life, working life and health and eventually the 16-week course l) Screen rest of participants for specific health problems - high stress rating, low psychological health rating, low ability to solve conflicts, general problems with QOL and QWL - and offer appropriate courses and interventions to those in need m) Retest all participants with QWL-Health Questionnaire after six months n) Retest all intervention participants every 3 months after intervention for 1 year o) Report results: Analyses of QWL-Health situation within the company Evaluation of QWL-Health project-interventions and outcomes for the pilot project Results of QWL-Health standardisation and validation process Project management Budget
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Step 2: Continuation of QWL-Health Project

Purpose: To sustain the benefits of implementing the process it is important to: continue with the preventative QWL-health process as a permanent strategy for Health Care management in the years to follow Change the company culture towards one of understanding the implications of the connections between QWL, QOL and health for personal well being and happiness as well as organisational performance, and financial growth. implement yearly screening of employees to detect problems with health, stress, poor QWL and QOL, poor conflict-resolution abilities and unhealthy lifestyle timeously make self-help tools available to everyone who needs and want it ( 16-week QWL-programme ) empower the company through selection, training and licensing of internal trainees to run the 16-week QWL-program internally under supervision provide intervention programmes (QWL-, Health-, resilience-learning (stress) and conflict-resolution courses) on a yearly basis employees empower managers to manage the QWL-Health situation in their departments, divisions etc. by letting them attend the QWL-course and the 16-week program themselves continue scientific approach through (1) continuously mapping and analysing changes in the companies QWL-Health situation and the effects of interventions and (2) continuing qualitative interviews to validate and explore the process, thus gaining and creating new knowledge for the future continuously calculate the impact on the bottom line
APPENDIX B. AN ESTIMATE OF IMMEDIATE VALUE GAINED AS A RESULT OF QWL-HEALTH INTERVENTIONS It is predicted that QWL can be raised with 1% yearly as a result of QWL-health interventions. As seen in the previous appendix - Features and Benefits- this will influence a wide variety of variables directly as well as indirectly. The hard value of some of these aspects is difficult to estimate, e.g. that of higher efficiency, value to society quality of services etc. The value of better and more stable client-customer relationships as a result of employees who are happy and satisfied with their work should also not be underestimated. The value of other aspects are however much easier to calculate, for instance that of 1% lower absenteeism, 1% better health and 1% less stress and depressive related illnesses and the accompanied lower medical costs. On the basis of the statistical connections achieved in research studies so far, the following can be expected:

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A lowering in one day absenteeism for employees attending one of the courses and A lowering of 3-day absenteeism for the subordinates of leaders who attend the 16week QWL-course At least 1% fewer bad health symptoms can follow from attending one of the courses, which is likely to result in 1% better performance as well as accompanied lowering in direct expenses to medical costs and insurance, disability pensions etc. A 1% improvement in personal efficiency if a person lowers his/her stress level by 3%, is expected from participation in one of the courses; this equals 1% of the salary of these individuals.
These estimations are only for one year, but as QWL development continues similar contingencies can be expected in the years to follow. It is suspected that improvements because of participating in interventions will last for 10 years.
APPENDIX C. LEGAL ASPECTS
Intellectual Rights
The Quality of Life Research Center (QOLRC) in Copenhagen, Denmark owns the intellectual rights and copyright on all the developmental tools and measuring instruments on QOL-QOW-Health, the books mentioned in this document as well as the software on QOL, QOW and Health that accompany these. All new versions of the QWL-QOL-Health tool, QWL-QOL-Health courses and the QOL-QWL-Health concepts belong to the QOLRC. New QWL-QOL-Health tools developed in prolongation of the old tools also belongs to the QOLRC. The QOLRC supervise all measurements in companies and elsewhere with the QOL, QWL and Health Questionnaires and preserve the data in order to protect the rights of individuals against misuse or identification by companies or the state.
Right of Use
Special permission (in writing) can be granted to individuals who want to use the questionnaires for research purposes on signing an agreement that the questionnaires will not be copied and or modified. Everybody who is trained and licensed to use the questionnaires or products owned by the QOLRC must sign the same agreement.
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APPENDIX D. LIST OF MATERIAL AND COURSES
The Material
QWL-Health Questionnaire QWL-Questionnaire PC Questionnaires: QOL Working-Life Quality - a Personal Profile QOL Working-Life Quality - a Company Profile Book: Working-Life Quality by S?ren Ventegodt Inspirational Brochure QWL-Tool: Working-Life Quality - A tool for employees and leaders Tabelworks + graphs (Statistical and validation information)
The Courses
1. A Five-day Workshop. Heal Yourself QOLRC, Copenhagen, All Rights Reserved
Change your course in life and mobilise your hidden resources and you will improve your health and your quality of life.
Introduction In the course of five days, working intensely with our philosophy of life, our personal history and our feeling of being present in our own bodies, we shall try to examine why we become ill, tired, low on energy and burned out etc. and find out what we can do to help ourselves. The purpose of the seminar is to point the participant in a new direction in life, the direction that is a consequence of taking responsibility for your own personal development. The seminar is directed at people with bad health and a poor quality of life who want to realise their hidden potentials and help themselves to a better life. The seminar is for people who want to discover and surmount limits, both personal and in relation to other people and the surrounding world. It is for people who want to experience more connection and concord between intention and action. Purpose To provide the participants with the possibility of re-discovering and experiencing hidden resources for personal progress and strength. To identify bad attitudes and inappropriate behaviour and change these. To inspire the participants to become responsible for their own lives, their relationship with their partners, friends, work, nature and the community and, most of all, their relationship with themselves. To enable the participants to discover lifes deeper meaning, to re-discover and develop a greater correlation between our own inner self and our ego - our inner world and the external reality we live in.
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To provide the participants with the possibility of discovering their original source, to find the essence of their own existence, to clarify own values and prioritise values and to develop agreement between values, attitudes and action.
Contents What is illness? Why do we get sick? What can we do ourselves to become well? What is illness? Feeling burned out? Decay of the body? What is quality of life? What is life? What are cells? How do cells communicate? What is the connection between body and mind? What is the placebo effect? How can we improve our health through our consciousness? A New Model for Understanding Illness From material to spirit through life, feelings and mind. What is material? What is spirit? What are your attitudes to life? Your personal philosophy of life? What do you do when life becomes painful? To close off life events with a lie to escape from the pain. Why does a bad quality of life disturb the body? About being present in the body and the importance of not being present. Working with your body. Working with your Body To become present in your body and to like being there. What is the connection between body and feelings? What happens when we touch the body? How does the body remember events in life? How can we rid the body of bad memories, which bind the energy for life? The hidden source of the energy of life. About chronological and physiological age. The Medicine Wheel About feeling and reason, action and growth. What are feelings? What is reason? What is action? What is personal growth? To Create Confidence and Openness: Your life just now. Where are you now?
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What is your life like just now? Do you get out of life what you want? Do you experience the world with all your senses? Do you thrive in all aspects of life? Why do you do what you do - and how do you do it?
To Experience all Possibilities and Re-discover your Own Resources: Personal history. What are your greatest talents? What are your greatest achievements? Where are you heading? What do you want? When have you tried being yourself? To Re-discover the Meaning of Life: Your soul. When do you let people limit you? Who limits you? What lies do you tell yourself in order to limit your own self-expression? Do you take responsibility for yourself, your words and your actions? What is the basic cause of your limits, guilt, fear of love, dependency, desire and ignorance? To become oneself means to grow wonderful. The Change: To find the source of your existence and being. Who are you when you are you? The essence of life: love and strength, to be, peace, continuity, clearness and bodily comfort.
The connection between your inner self, your values and attitudes to life and what you do, your behaviour and your habits. What is important to you? When will you live the life you want and deserve? What is holding you back?
To Create Energy and Movement: Your future. How do you want your life to be in the future? What will you do, how will you think? How will you attain your new purpose? How will you become valuable to yourself and your surroundings? Methods: Dialogue between philosophy of life, processing of personal history and working with the body in order to re-establish the inner connection, the coherence. Ten (10) circles of presentations, exercises and discussions. The combination of presentations by instructors and exercises both individually and in groups, as well as joint discussions will provide the
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participant with a personal experience of attention, insight and change. The seminar presupposes the willingness to change and personal commitment.
Form: The seminar will be held over five days and includes accommodation. It starts Monday morning and finishes Friday afternoon. Attendance throughout the course is obligatory. During the seminar the participants will be presented with challenging and demanding exercises and tasks. Timetable: Monday: Tuesday: Wednesday: Thursday: Friday:
09.00 approx. 24.00 09.00 approx. 24.00 09.00 approx. 24.00 09.00 approx. 24.00 09.00 approx. 16.00
Other: The atmosphere during the seminar is happy, free, supportive and confrontational and is ones own responsibility. Use of medicine and other medical or psychological treatment must be reported prior to commencing the seminar. 2. A Two-day Seminar on Quality of Life, Working Life Quality and Health QOLRC, Copenhagen. All Rights Reserved Purpose: The purpose of the seminar is to inspire participants to a more positive and optimistic philosophy of life as well as a more constructive way of living and working. The seminar illustrates the connection between quality of life, health and personal responsibility for one's own future health. Contents: During the seminar we shall try to find answers to life's great questions. What is quality of life? How do we improve our own quality of life? How do we form our own lives through our attitudes and behavior? How do we become really happy with our work? Why do we let our brain and consciousness fool us into believing things that are wrong and contrary to life? Why do we become ill? Can we cure ourselves by improving our quality of life? Form: The seminar will consist of lectures, exercises, group work and general discussions. The seminar covers the Research Center's philosophy and theories on the good life, the good work, health and illness. Results from The Quality-of-Life survey and other scientific surveys will be presented and discussed. Participants must not expect adequate answers to all
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questions, as the whole purpose of the seminar is to teach people to ask their own questions and supply their own answers. Thus the seminar is first and foremost an inspiration to a better quality of life.
Time Schedule: 9 a.m. -4 p.m. on both days Target group: The seminar is targeted at anyone interested in quality of life, working-life quality and health. Material: Lecture book 'Working-Life Quality' with loose-leaves of exercises and tasks regarding attitudes and behavior. Requirements: No professional requirements are necessary to participate in the seminar. Openness to new ideas and personal courage and honesty would be an advantage. This program is only meant as a guideline as the day will largely be based on the subjects brought up and the questions asked by the participants.
APPENDIX E. QWL-QUESTIONNAIRE
Basic Theory and Concepts

The QWL-questionnaire was developed on basis of the integrative theory of QOL. According to this theory a good quality of life is not just about personal functioning or immediate subjective well-being, but basically about good relations to self, other people and what you do for a living. Relationships with the surrounding world, nature and culture are also of great importance. The derived theory of working life says that a good QWL arises from good relations in the working situation. The theory (explained in Working Life Quality, the book) states that there are basically 4 important relations in the working-life: The relation to yourself The relation to the work process The relation to other people in the work group, i.e. colleagues, managers and subordinates The customer and the surrounding world These four relations that the QWL aims to improve, sum up to the four keywords or basic concepts of the QWL theory: 1) QOL 2) Mastery 3) Fellowship and 4) Creation of real value.
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QOL (Quality of Life)

QOL refers to the person's state of living. It is basically and surprisingly a function of the level of inner harmony and balance. You can say that QOL is about expressing the basic qualities of life: Joy (pleasure-pain axis), knowledge (information-structure axis) and awareness (consciousness-unconsciousness axis) in your daily living. Inner conflicts and lack of knowledge and understanding of yourself make this difficult for a majority of mankind.
Mastery
It is the purpose of human life to be active and to create value. This is done through our understanding and behaviour. Personal and professional development leads to a state of being where ideas and intentions can be freely expressed in the work-process. This is the ideal but seldom achieved state of mastery. The reason why mastery is seldom achieved is that most people stop in their personal development before they reach perfection. Development of mastery can only be achieved through challenge, which most people seem to avoid for safety and personal security. A working culture focusing on challenge and personal development can be of tremendous value to the employee personally and to the company. For there is nothing as satisfying as personal development and there is nothing as valuable for a company as mastery among its employees and leaders.
Fellowship
Man as a social being has a deep-rooted need for being a part of a social whole, an accepted and appreciated member of the group. But unfortunately, many people do not develop the social skills necessary for communication, conflict solving, co-operation, leadership and personal responsibility in a group and so forth. As these social qualities are with us all the time as hidden resources, processes that take them into use are of huge value for the individual as well as for the organisation.
Creation of Real Value

Work is about creating value, and not really about money, although most people who have not reflected deeply on this might think it is. Real value is about helping other people improve their lives. It is about experiences. It is about fulfilling real needs for individuals and for society. It is in the end about creating a better world and taking development and evolution a step further. It is rather surprising when studies of happiness are done, that happiness and life satisfaction are so closely related to being useful and only remotely connected to yearly income. This at least appears true for rich countries such as Denmark where material wealth has been striven for long, but now that everybody is rich, nobody seems to be happy. It seems that human beings have a need for being useful and not for material wealth in itself. This does
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not imply that we should not take care of things like clean water and basic standard of living, but this in itself does not make people happy. Where this has been obtained people need more.
Development of the QWL-Questionnaire

Based on the above theoretical foundation the QWL-questionnaire seems to be valid when it comes to its basic construction. Amongst 500 items originally proposed by a workgroup with professors, company directors, MDs, PhD's in organisational theory development, as well as industrial psychological experts, 100 questions were selected. The criteria for the selection was that they together should show the broadest possible picture of the working-life situation, redundancy should be minimised, and they had to be meaningful and linguistically sound to maximise communication i.e. the obtained level of information.
Validation of the QWL-Questionnaire

The QWL-questionnaire, which gives a number for the calculated QWL as a mean of the rating of the four basic dimensions, has been validated when it comes to internal consistency (focus) by the Cronbach-alfa method, external validity (criteria validity) by its correlation to the self-evaluated QWL and some international questionnaires on health; its reliability has been tested through test-retest procedures and its sensitivity has been found through its statistical variation. All of the parameters were found to be satisfactory compared to internationally accepted standards.
APPENDIX F. THE PERSONAL QWL-PROFILE AND ITS DIMENSIONS As discussed in appendix E - The Quality of Working-life: Basic theory and concepts, working-life quality can easily be divided into four main issues impacting strongly on people's experience of satisfaction with the process of work, namely Quality of life Mastery Fellowship Creating real value
The hundred questions of the QWL-Questionnaire have been constructed to measure these four aspects of the work process by attending to important dimensions of each domain. These dimensions provide a practical and useful way to give feedback to the individual about his/her experience of their working-life and allow for easy identification of areas that can and should improved.
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Feedback is given in the form of a QWL-Personal Profile, which gives a graphic picture of personal performance in respect of experience of working-life quality, but also shows how the personal profile compare to those of the other employees in the company. The dimensions covered within each domain of the questionnaire are provided in the table below, whilst an example of a profile can be found on the next page.
Quality of Working-Life: The Four Domains and their Dimensions QOLRC, Copenhagen. All Rights Reserved
Quality of Life: Relation to self Experience of life Satisfaction with life Needs fulfilment Mastery: Relation to your work Skills competence Character of work Influence re own work Experience of work Commitment to work Salary and status Personal development Fellowship: Relation to the Organisation Commitment to organisation Information flow Teamwork Working environment Management Interpersonal relations Influence Creating real value: Relation to environs Organisational mission Quality of products/service Efficiency Creating proper values
APPENDIX G. INSPIRATIONAL AND MOTIVATIONAL RESOURCES Work can be one of the greatest pleasures in your life. On the other hand there is nothing worse in life than a job you are unhappy with. Work is such a vital part of a life such a permanent companion that if you do not feel at ease when leaving for work in the morning - your joy of life may be shattered. It is difficult to feel happy when you do not really feel committed to your work. If your work is not a place where you can thrive and be happy, but more like a prison with displeasing work your lifes energy is being drained. If you cannot see the point of what you are doing and you do not feel that you contribute with anything valuable your work wears you out. That kind of work may kill you slowly bit by bit. Furthermore, if you do not consider your work valuable the same will apply to your company, the customers and the environs in general. Without responsibility and commitment, quality and efficiency disappears into the blue. According to The Quality-of-Life survey of 10,000 Danes carried out by The Qualityof-Life Research Center in Copenhagen, only every third citizen who is working is happy in his or her job which is catastrophic for the society. Personally, I am convinced that a uninspiring and detached working life is one of the main reasons people on average retire at
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the age of 61. And that may also be the reason why people rate such a short average life as proven by several surveys and reports. Only few human beings can cope with leading a meaningless life lives spent working in jobs that they do not really like. It takes its toll because our health and well being are dependent on our ability to renew ourselves and develop new expressions of our personality in order to use life properly. Every human being is created to be active, using his or her talents the best possible way to the benefit of oneself and others this is what is meant by life. This meaning of life we find in all dimensions of our life: Within the family, with friends in our spare time as well as on the job. Research shows that people who feel useful are the ones who are happy. It seems that we all have a dream of contributing something to this world in our private as well as our professional lives. Work can be exciting, it can be thrilling and at best it is not experienced as mere work. Instead it becomes the challenge of our life becomes what we dreamt of really doing, in private as well as professionally. There is nothing more exhilarating than an exciting job because work is about being useful to the world as well as influencing and creating a world in accordance with our private dreams. This book was written in connection with a project Working-Life Quality, which resulted in a simple and useful kit of tools, easily applicable for developing working life quality ( i.e. Working life quality. A tool for employees and leaders, appendix I). There seem to be four basic conditions, which determine the quality of working life: 1) Personal quality of life 2) Mastery of the working process 3) Fellowship with colleagues and management 4) Genuine improvement for both customers and environment. A closer look should be taken on personal development: How do you improve your life? What is it that makes it so difficult for us to develop? In order to develop and improve your life, it is essential to be aware of your attitudes and your way of doing things. This requires alertness and your best efforts. It may sound easy, but as a matter of fact it requires an immense amount of self-discipline which only a very few possess at the outset. The above mentioned tools will inspire you as well as support your selfdiscipline. With your decision to make improvements, miracles might be waiting around the corner. At your company it should not be difficult to agree on commencing a project with the purpose of developing your working-life quality because an improvement of your job satisfaction will be in the interest of your company, too. Employees and leaders who have gained more insight and a more profound sense of responsibility will in future encounter a more viable production, which does not interfere with the delicate balance of the ecosystem.
Reference
Ventegodt S. Working life quality. Copenhagen: Quality Life Research Center, 1996

APPENDIX I. THE QWL-TOOL: INTRODUCTION AND CONTENTS
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Working-life quality is a new concept meaning 'The quality of life you experience at work.' It is about job satisfaction, about excitement, enthusiasm and commitment at work. It is about the feeling of being alive when working. The Working-Life Quality tool was developed in order to help employees as well as leaders to acquire the inspiration and discipline required to develop the quality of their working life. It attends to the four aspects of good work, namely quality of life, mastery of the work process, a sense of community with colleagues and management and creating real value for the customer and environment. It also comprises an understanding of what is needed for people to develop and grow namely awareness and practice or change. These must be developed analogously and brought in harmony with the life inside us. Finally it supplies the user with exercises to motivate discipline because only if you try new behaviour will you improve. Throughout the book attention is focused on positive attitudes and behaviour for this is what opens us up and give us access to our hidden resources.
Description and Contents of Package

The tool consists of a folder with a workbook of 160 coloured pages with exercises and examples that guides the user through a 16-week course to improve the four central issues of work namely: 1. Your relation to yourself, which is about Quality of Life 2. Your relationship to the tasks you work with - the working process, which is about Mastery 3. Your relationship to those you work with and the organisation, which is about Cooperation and 4. Your relationship to the customer and the environment, which is about creating real value and obtaining proper values. Furthermore, it includes a 12-page questionnaire on quality of working life as well as an inspiring brochure, which informs you of the basic ideas of QWL. The folder also contains a floppy disc with a programme: QOL Working-Life Quality - a Personal Profile (Windows operating) showing the user his or her personal profile of working life quality, helping them identify which particular aspects will require effort on their part in order to improve their personal quality of working life. Supplementary to the individual folder, a company PC analysis-programme (QOL Working-Life Quality - a Company Profile) is also available. This programme correlates the keyed answers from several Personal Profile disks and then provides a total profile of a company's or a department's working-life quality. At the moment reference values from six Danish companies and their employees are included in order to allow you to benchmark your rating. Eventually the program will allow you to benchmark your company to the best in your own country as well as in the world.
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Overview of Program Contents and Form

Understanding the role and value of awareness and practise (exercise) in the forming and changing of attitudes and beliefs
Module 1 - 5. Quality of Life Living the life you deep down experience
Discover what quality of life means to you personally and how you can achieve it Develop an understanding of the relation between your attitudes towards life and being healthy Discover your own attitudes towards yourself and your life
Module 6 - 9. Mastery of the Work-process To become really good at your work and love it. Experiencing work satisfaction and joy
Understand the function of your potential and challenge in becoming a master of your work Discover the role or your attitudes and personal beliefs in the experience of mastery Discover your boundless and unused potentials and resources Create energy Develop your skills and abilities Commit yourself to your work Grasp your challenges
Module 10 13. Sense of Community within the Organisation The experience of teamwork and working together to obtain results for yourself and the organisation through joined effort and shared purpose
Understanding community within the organisation The function of communication and the role of your attitudes and beliefs The art of co-operation and teamwork Leadership and co-operation - to lead and be lead
Module 14 -15. Creating Real Value Producing products and providing services, whilst at the same time preserving the environment and adding value to the community
To be valuable to the customer and society Meeting the real needs of people Feeling useful in the world Developing valuable values Apprehension of the connection between attitude and perception in developing values and creating value
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Implementation of 16-week Program

1. Inform selected employees about aim of intervention and distribute inspiration brochure 2. Screen everybody with QWL-Health Questionnaire 3. Give feedback to all about their questionnaire results and invite participation in intervention 4. Distribute QWL-Workbook to participants and explain process to them 5. Individuals work alone and in small groups trough the first 5 weeks 6. 2-Day group seminar 7. Individuals work on their own and in small groups for the next 5 weeks 8. 2-Day group seminar 9. Individuals complete rest of modules 10. After 2-months: QWL-Health measurement 11. After 3-months: QWL-Health measurement 12. Report on results of intervention
Teachers
Trained psychologists of the QOLRC and assistants
Reference
Working Life Quality: A tool for employees and management. Copenhagen: QOLRC, 1996.
APPENDIX J
QWL Tables
2,500 Danes from the Central Person Register (CPR) where mailed a QWL questionnaire with 500 items including questions on QOL, QWL and health. 700 persons returned the huge questionnaire in a usable form for the QOL-QWL-Health analysis. 16 dimensions were chosen as core dimensions: QOL Mastery Fellowship Creating value Estimated QWL (calculated as a mean of the former 4 dimensions) Own rating of QWL Own rating of psychological working condition Immediate subjective well-being at work (Feeling good at work) Own rating of physical working condition
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Stress factor Number of days off sick Own rating of psychological health status Own rating of physical health status The amount of health difficulties Own rating of own efficiency.
60 dimensions were then plotted against these 16 core dimensions to map the central statistical co-variations.
Major Findings
We will show some major findings and the results as documentation. These connections are not analysed according to causality, but it is our research hypothesis that they will change dynamically according to their statistical connections. This is the subject for the intervention study. The following categorisation of the size of the connections (according to prior test) are used in the descriptions below: 0-5%: 5-10%: 10-15%: 15-30%: 30%+: Very small connection Small connection Intermediate connection Large connection Very large connection
We found the following statistical connections (selected findings): 1. 2. A large connection between being good at work and QOL (1) A very large connection between being good at work and "own estimate of physical health (10) 3. A very large connection between being good at work and amount of health problems (11) 4. An intermediate connection between being good at work and "stress (13) 5. An intermediate connection between being good at work and own estimate of physical working condition (14) 6. A large connection between being good at work and commitment to your work (15) 7. A large connection between being good at work compared to the best and QOL (17) 8. An intermediate connection between being frustrated because work is to difficult and fellowship (131) 9. A very large connection between stress and feeling good at work (152) 10. An large connection between ability to influence the goal of the work and the number of days off sick (171)
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11. A large connection between ability to influence how to do your work and the amount of health problems" (178) 12. A large connection between feeling good at work and QOL (209) 13. A large connection between feeling good at work and Mastery (210) 14. A large connection between feeling good at work and fellowship (211) 15. A large connection between feeling good at work and Creating value (212) 16. A very large connection between feeling good at work and Estimated QWL - a criteria validation (213) 17. A very large connection between feeling good at work and Number of days off sick (OBS only two respondents in 5. category) (219) 18. A large connection between feeling good at work and number of days off sick" (220) 19. A large connection between feeling good at work and stress" (221) 20. A large connection between feeling good at work and own estimate of psychological health" (222) 21. A large connection between feeling good at work and commitment to your work" (223) 22. A large connection between doing what you like the best and commitment to your work" (239) 23. A large connection between experience of joy in work and QOL (241) 24. A very large connection between experience of joy in work and mastery (242) 25. A large connection between experience of joy in work and fellowship (243) 26. A large connection between experience of joy in work and creating value (244) 27. A very large connection between experience of joy in work and feeling good at work (248) 28. A large connection between experience of joy in work and own estimate of psychological health" (250) 29. A very large connection between experience of joy in work and amount of health problems" (251) 30. A very large connection between experience of joy in work and commitment to your work" (255) 31. A large connection between interesting work and mastery (258) 32. A large connection between interesting work and fellowship (259) 33. A large connection between interesting work and creating value (260) 34. A large connection between interesting work and own estimate of psychological health" (266) 35. A large connection between interesting work and amount of health problems" (267) 36. A large connection between interesting work and own estimate of physical working condition" (270) 37. A very large connection between interesting work and commitment to your work" (271) 38. A large connection between time spent in flow and mastery (306) 39. An intermediate connection between time spent in flow and amount of health problems" (315)
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40. An intermediate connection between time spent in flow and commitment to your work" (315) 41. A large connection between challenges and mastery (370) 42. A large connection between challenges and Own estimated QWL (374) 43. An intermediate connection between challenges and own estimate of psychological health" (378) 44. An intermediate connection between challenges and amount of health problems (379) 45. A large connection between challenges and commitment to your work" (383) 46. A large connection between professional development and mastery (386) 47. An intermediate connection between professional development and own estimate of physical working conditions" (398) 48. A large connection between professional development and commitment to your work" (399) 49. A large connection between personal development and mastery (418) 50. A large connection between personal development and creating value (420) 51. A large connection between personal development and commitment to your work" (431) 52. A large connection between responsibility towards the organisation and fellowship (435) 53. A large connection between responsibility towards the organisation and creating value (436) 54. A intermediate connection between responsibility towards the organisation and amount of health problems" (436) 55. A large connection between responsibility towards the organisation and commitment to your work" (447) 56. A very large connection between how well are your treated by the organisation and creating value (452) 57. A large connection between how well are your treated by the organisation and amount of health problems" (459) 58. A very large connection between how well informed are your by the management and fellowship (467) 59. A large connection between how well informed are you' by the management and own rating of psychological working conditions (471) 60. A large connection between how well informed are your by the management and feeling good at work (472) 61. A very large connection between teamwork and own estimate of QWL (502) 62. A very large connection between teamwork and amount of health problems" (507) 63. A large connection between teamwork and own estimate of physical working condition" (510) 64. A large connection between ability to resolve conflicts and QOL (529) 65. A large connection between ability to resolve conflicts and fellowship (531) 66. A very large connection between ability to resolve conflicts and Own rating of QWL (534)
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67. A large connection between ability to resolve conflicts and feeling good at work (536) 68. A very large connection between ability to resolve conflicts and own estimate of psychological health" (538) 69. A large connection between ability to resolve conflicts and amount of health problems" (539) 70. A large connection between ability to resolve conflicts and number of sick days off" (540) 71. A large connection between level of responsibility and QOL (561) 72. A large connection between level of responsibility and fellowship (563) 73. A large connection between level of responsibility and own estimate of psychological health" (570) 74. A large connection between level of responsibility and own estimate of physical working condition" (574) 75. A very large connection between level of responsibility and commitment to work" (575) 76. A large connection between psychological working environment and QOL (593) 77. A large connection between psychological working environment and own estimate of physical working condition" (606) 78. A large connection between how good is the management and QOL (609) 79. A large connection between how good is the management and estimated QWL (613) 80. A large connection between how good is the management and own rating of QWL (614) 81. A large connection between how good is the management and feeling good at work (616) 82. A large connection between how good is the management and own estimate of physical health" (617) 83. A large connection between how good is the management and amount of health problems" (619) 84. A large connection between how good is the management and own estimate of physical working condition" (622) 85. A very large connection between how good is your boss and fellowship (627) 86. A large connection between how good is your boss and creating value (628) 87. A large connection between how good is your boss and feeling good at work (632) 88. A large connection between how good is your boss and amount of health problems" (635) 89. A large connection between how good is your boss and own estimate of physical working condition" (638) 90. A large connection between possibilities of taken new initiatives and estimated QWL (645) 91. A intermediate connection between possibilities of taken new initiatives and amount of health problems" (651)
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92. A vary large connection between possibilities of taken new initiatives and commitment to your work" (655) 93. A very large connection between importance of the mission and creating value (660) 94. A large connection between importance of the mission and own estimate of psychological health" (666) 95. A large connection between importance of the mission and amount of health problems" (667) 96. A large connection between ethical organisation and fellowship (803) 97. A very large connection between ethical organisation and creating value (804) 98. A large connection between being of value to the organisation and own estimate of psychological health" (826) 99. A large connection between being of value to the organisation and amount of health problems" (827) 100. A very large connection between thinking the organisation is a success and fellowship (851) 101. A very large connection between thinking the organisation is a success and creating value (852) 102. A large connection between thinking the organisation is a success and own estimate of psychological health" (858) 103. A very large connection between thinking the organisation is a success and creating value (852) 104. A large connection between thinking the organisation improves the customers QOL and creating value (868) 105. A very large connection between thinking the organisation helps the development of society and creating value (916) 106. A very large connection between thinking the organisation helps the development of society and estimated QWL (917) 107. A very large connection between thinking the organisation helps the development of society and own estimated QWL (918) 108. A very large connection between own estimated QWL and own estimate of psychological health (938) 109. A very large connection between own estimated QWL and own estimate of physical working condition" (942) 110. A very large connection between own estimated QWL and commitment to your work" (943)
REFERENCES [1] [2] [3] Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2(8668):88891. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336(8708):12933. Ventegodt S. Quality of life in Denmark. Results from a population survey. Copenhagen: Forskningscentrets Forlag, 1995. [Danish]

[4]
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[5]
[6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18]
[19] [20] [21] [22] [23] [24] [25] [26]
Ventegodt S. The Quality of Life of 4500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S. The quality of life and factors in pregnancy, birth and infancy. Results from a follow-up study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen 1959-61. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. The quality of life and major events in life. Copenhagen: Forskningscentrets Forlag, 2000. [Danish] Frankl V. Mans search for meaning. New York: Pocket Books, 1985. Antonovsky A. Health, stress and coping. London: Jossey-Bass, 1985. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Francisco: Jossey-Bass, 1987. Ventegodt S. Measuring the quality of life. From theory to practice. Copenhagen: Forskningscentrets Forlag, 1996. Ventegodt S. Working life quality, 2nd ed. Copenhagen: Forskningscentrets Forlag, 1999. Csikszentmihalyi M. Flow. The psychology of optimal experience. New York: Harper Collins, 1991. Fromm E. The art of loving. New York: Harper Collins, 2000. Goleman DL. Destructive emotions. New York: Mind Life Inst, 2003. Tolle E. The power of now. Novato, CA: New World Library, 1999. Buber M. I and thou. New York: Charles Scribner, 1970. Nordenfelt L. Quality of life and health. Stockholm: Almqvist Wiksell, 1991. [Swedish] Ventegodt S, Flensborg-Madsen T, Andersen NJ, Nielsen M, Morad M, Merrick J. Global quality of life (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991-2004. Soc Indicator Res 2005;71:87-122. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy: when life sparkles or can we make wisdom a science? ScientificWorld Journal 2003;3:1160-3. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy I: Quality of life, happiness, and meaning of life. ScientificWorld Journal 2003;3:1164-75. Ventegodt S, Andersen NJ, Kromann M, Merrick J. QOL philosophy II: What is a human being? ScientificWorld Journal 2003;3:1176-85. Ventegodt S, Merrick J, Andersen NJ. QOL philosophy III: Towards a new biology. ScientificWorld Journal 2003;3:1186-98. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy IV: The brain and consciousness. ScientificWorld Journal 2003;3:1199-1209. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy V: Seizing the meaning of life and getting well again. ScientificWorld Journal 2003;3: 1210-29. Ventegodt S, Andersen NJ, Merrick J. QOL philosophy VI: The concepts. ScientificWorld Journal 2003;3:1230-40. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. ScientificWorld Journal 2003;3:1030-40.
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[27] Ventegodt S, Merrick J, Andersen NJ. Quality of life theory II. Quality of life as the realization of life potential: A biological theory of human being. ScientificWorld Journal 2003;3:1041-9. [28] Ventegodt S, Merrick J, Andersen NJ. Quality of life theory III. Maslow revisited. ScientificWorld Journal 2003;3:1050-7.
PART II: RESEARCH IN QUALITY OF WORKING LIFE: IMPROVING VALUE BY MAKING YOUR PEOPLE HAPPY AT WORK
Chapter 9
WORKING LIFE QUALITY AND VALUE

When job satisfaction and functional ability is to be measured and improved, it is necessary to assess and quality assure the intervention of company consultants on the soft assets of a company, however for many years it was believed that the scenario of a common worker is far too complex and that factors that makes him or her valuable to a company could not be agreed upon. It seems that the new concept of quality of working life (QWL) could be a key concept in the description of the employee making, enabling, for the first time possible, a simple way to determine the value or potential value to be realised under good leadership of an employee. Working-Life-Quality (QWL) is easily measured by the SEQWL questionnaire. By measuring with SEQWL before and after an intervention on employees, created change in QWL, can be documented, hereby enabling the documentation of the gain of value for the company by the intervention. This paper aims to find a simple formula by which the value for an improvement in QWL easily can be calculated. We found the following formula useful: V total for a QWL project = N S T QWL, where V is the potential additional value gained more for the company under good leadership, N is the number of participants, is a psychobiological constant for human beings 10, S is the average salary, T is the duration of the improvement and QWL is the difference in quality of working life.
INTRODUCTION Thriving at work is statistically strongly associated to quality of life (QOL) [1,2], selfassessed health, physical and physiological (measured by SEQOL [3]) and quality of working life (QWL) [4], as we present it in this paper and measured by SEQWL [5]. In addition to these statically findings, a number of projects have successfully been carried out in Denmark and Norway leading to the general conclusion that it is possible to improve both thriving at work, general health and the quality of life of employees.
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Just as evident as it seems to many modern managers, that relations as QWL and wellbeing at work are fundamental to the qualitative and quantitative output of employees, (i.e. too the benefit to the employee and the organisation), just as difficult is it for organisations to value the benefit of soft values to hard numbers. The difficulty is caused by the lack of credible numbers for QWL that could have been used as a basis for proper mathematical calculations of the profit. Calculations showing a positive outcome of interventions on QWL and prosperity are a precondition for the willingness of company leaders to prioritise projects meant to improve QWL, QOL and health. The arguments against an overly focus on the employee thriving on the job are often derived form an economic perspective and from the wish to secure efficiency through a certain degree of authority and control. In order to meet such requirements, measurements have been limited to hard facts, such as consumption of time and materials and production. Soft values such as the employees experience of his own thriving, mastery, sense of community and productivity have not previously been taken into consideration. There seems to be a growing awareness of the concept of QOL in society and the business world has also seen the benefits. This article aims to render probable the benefit of an organisation by improving quality of working life for the employee and managers of the company. On the basis of existing empiric data we will try to establish the formula for the connection between improved QWL and increased profit for the company, calculated on the individual employee.
WHAT IS QUALITY OF WORKING LIFE (QWL)? Work can be one of the greatest pleasures in your life [1,2,4]. On the other hand there is nothing worse in life than a job you are unhappy with. Work is such a vital part of a life, such a permanent companion, that if you do not feel at ease, when leaving for work in the morning, your joy of life may be shattered. It is difficult to feel happy when you do not really feel committed to your work. If your work is not a place, where you can thrive and be happy, but fells more like a prison, your life energy is being drained. If you cannot see the point in what you are doing and you do not feel that you contribute with anything valuable, your work wears you out. That kind of work may kill you slowly, bit by bit. Furthermore, if you do not consider your work valuable the same will apply to your company, the customers and the environment in general. Without responsibility and commitment, quality and efficiency disappears into the blue. According to the Quality of Life survey of 10,000 Danes carried out by the Quality of Life Research Centre in Copenhagen [1,2], only every third Danish citizen was happy in his or her job, which is catastrophic to Danish society. Personally, we are convinced that the uninspiring and detached working life is one of the main reasons Danish people retire at the age of 61 years. Only few human beings can cope with leading a life as meaningless as ours all our lives spent working in jobs that we do not really like. It takes its toll, because our health and well being are dependent on our ability to renew ourselves and develop new expressions of our personality in order to use life properly. Every human being is created to be active, using his or her talents the best possible way to the benefit of self and others this is what is meant by life. This concept of meaning of life we find in all stages of our life: within the family, with
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friends in our spare time as well as on the job. Our research showed that people, who feel useful, are the ones who are happy. It seems that we all have a dream of contributing something to this world in our private as well as our professional lives. Work can be exciting, it can be thrilling and at best it is not experienced as mere work. Instead it becomes the challenge of our life becomes what we dreamt of really doing, in private as well as professionally. There is nothing more exhilarating than an exciting job, because work is about being useful to the world as well as influencing and creating a world in accordance with our private dreams. There seem to be four basic conditions, which determine the working life quality [4]: 1) 2) 3) 4) Personal quality of life Mastering of the working process Fellowship with colleagues and management Genuine improvement for both customers and environment.
QWL determines the quality and efficiency of both the employees and the leaders work in the company. Roughly speaking you can say that the value of an employee or leader for a company depends on his or her ability to create value by him- or her or in co-operation with colleagues and the leader and subordinates. Or in other words the persons influence on the surroundings in a positive or negative direction together with the ability to perform with efficiency and quality in the broadest sense of these two difficult concepts. In our studies of QWL we have noticed that there is a huge connection between "objective quality" (the concrete ability to function i.e. make a selling exhibition or keep a tight budget and "subjective quality" - the experience of the work. A survey of the selfassessed QWL for the Danish population showed the following distribution: 23% said their QWL was very good, 57.5% said "good", 15.9% said neither nor, 3.2% said bad and 0.4% said very bad (see table 1). We found an average for the Danish companies of 70%, the score equal to the expression good on the above-mentioned five-point scale [6]. Table 1. Selfassessed QWL in Denmark [1]
Self-assessed QWL 1. Very good 2. Good 3. Neither good nor bad 4. Bad 5. Very bad Total number of respondents, Overall average No 159 397 110 22 3 691 % 23.0 57.5 15.9 3.2 0.4 69.9 Meas. QWL 76,1 69,7 63,0 55,2 42,0 69,5
When calculated from the 100 questions in the QWL-health questionnaire the distribution was narrowed and only 3.8% of the employees get 80-100% (very good) on average. 72.9% scored between 80% and 60% in measured QWL, 22.5% between 60% and 40%, and less than one percentage below 40% in measured QWL (see table 2). From these numbers it seems fair to conclude that you cannot function in a job with a QWL below around 50%. Most people score around 70%. Terrible employees score below 55%. Bad employees get 55-65%.
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Average scores 65-75. Good employees score 75-85% and the extremely good (1:50) scores 85-100% in measured QWL (see table 2). A lot of very important factors seem to follow the measured QWL closely: Self-assessed physical health, self-assessed mental health, stress, number of sick days and working environment, thus implying some of the reasons why a low measured QWL is incompatible with working efficiently and happily. The value of a worker can be negative if he or she significantly disturbs the work environment and destroys co-operation and other vital company relations, for example to the customers. A bad employee can easily destroy the value that equals one other worker. A good employee can inspire good work.
ECONOMICAL INTEREST IN IMPROVED QWL Let us address the companys direct and indirect economic interests in the employees QWL. Improvement of QWL, primarily seems to be of benefit to the employee himself, but also benefits the company. Table 1 lists the expected benefits for the company. It has been confirmed by a series of practical intervention examples conducted by Niels Jrgen Andersen, where it was found that these benefits normally follow such a QWL improving intervention. Table 1 also lists some of the features experientially needed in a good QWL-improvement project. Table 1. Expected benefits for the company Features Accurate, immediate analyses of QOL, QWL and health situation of individuals and the organisation as a whole Quick and user friendly measurements Accommodates all levels Independent of income, culture, gender, age, state of health, etc Establish a preventative health care approach Identify individuals who need treatment Pinpoint appropriate choice of intervention needed Equip employees and leaders with attitudes and skills to handle problems, change, personal and inter-personal relationships and crises Allow for comparison with other companies (benchmarking) as well as between branches, departments, etc. Methodologically and philosophically sound Benefits Direct Benefits Lowered absenteeism Improved health Less stress Better ability to solve conflicts Improved personal development Higher efficiency Improved commitment to work Better co-operation Improved communication Better leadership Improved organisational image Individual life and health management Indirect benefits Lowered medical costs Higher productivity Healthier retirees and older workforce Higher value to society More innovation Improved competitiveness

TO THRIVE BETTER
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People who are not thriving in their job have a tendency to burn out and sooner or later become only of modest value for the company. Employees who are developing through their working life, however, will become of increasing value for the company. It is important for a company to keep employees in the company instead of constantly needing to recruit new employees. If you want to keep employees with the present labour market, then you need to make sure that they are thriving in their job, i.e. developing personally and professionally. The reason the job is important to the person, is its importance to his general QOL and it seems that creating value is inherently the meaning of life [7-13].
Fewer Days Lost through Sickness

Since there is a significant correspondence between QOL and the number of days lost through sickness, an improved QWL most probably will also result in fewer days lost through sickness. If the project results in fewer days lost through sickness per employee per year, then the project will soon have proved profitable. Presumably more engaged employees would also be less likely to report sick.
Higher Quality and Larger Efficiency

Employees who are engaged and developing in their job will also be more efficient and deliver work of a better quality. When communication is improved, the distance not only between employees and leaders is reduced, but also between colleagues on the same level and between employees and customers. Different teams of the organization will become able to make a better and more coherent effort. Expensive waste of time due to common confusion about the tasks to carry out, unproductive double work, and unprofitable attempts to solve problems will be avoided.
Better Innovation
Development of quality products demands a large personal reserve of energy within the employee. The innovative employee must be courageous, visionary and willing to go all the way for his idea. That personal surplus arises, when the employee masters his field of work, when he/she really masters it. The growth of this mastery in the work process is one of the main aims of the QWL project. Those employees who achieve real mastery within their field of work will become the experts, who are vital for the company and driving its development.
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Environment-friendly Image
There are many image related benefits, when conducting a project in order to improve QWL. It is very valuable for the company that the employees are thriving, but it is perhaps just as important to make it public. That makes it not only easier to keep valuable workers, but also to attract attractive new manpower. It seems logical that a company, which is able to take care of its employees thriving and health also will be able to make sound decisions on a larger scale. People with a high QOL and a large personal reserve of energy have better possibilities to consider external dimensions, such as sustainability, life time cycles and more, even if they are not directly profitable. The importance of an environmental-friendly image to the still more numerous political consumers cannot be underestimated.
FORMULA FOR QWL AND VALUE TO THE COMPANY How is it practically possible to measure the economical worth of an employee? The traditional way has been to look at manpower as a commodity you can buy on the market. It is supply and demand, which is determining the value and price of a commodity. Establishing such a formula is connected with a lot of ethical thoughts, because a human being is certainly not a thing, but a person, a subject, and as such the human being must be respected and its integrity hold sacred. However, it is well known from the realm of psychology that people have different value to us, just as our own life differs in value at different times and states. When we are improving our self-esteem and increasing our selfcare by being better towards ourselves, our QOL and joy of life is being improved and thus also the value we hold for others and ourselves. Even if the value of a human being cannot be completely settled and we are all equal before God, it is therefore in the context of a company reasonable to allow the perception that two employees in the same job function hold very different values for the company, due to their skills and experience, ability to cooperate and width of view. When you as a leader are looking at the employee from the outside, you wish to see exactly those resources, the good spirit, health and professional stability and the personal reserve of energy that are connected with a good QOL, exactly that mastery which comes from engagement, commitment and personal development in the job, exactly that ability to cooperate which comes from being a well integrated and generally liked part of a professional cooperative and exactly that real productivity that comes from broad point of view, general orientation towards and understanding of the totality on all levels. Thus, it is a probable hypothesis which of course is to be proven empirically that the value of an employee corresponds directly with the four fundamental dimensions of QWL [4]. The first question is whether there is a simple and linear relation between productivity and QWL. Presumably there are linear relations between the quality of the four fundamental human conditions and the productive functions of the company, which they support and relations between QOL dimensions and other conditions of life, like self estimated QWL are just linear [1,2]. In research we normally find those correspondences surprisingly linear within the normal range [1,2,15] and accordingly, we find the following simple relation, which is the formula for a straight line: V = k QWL +
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where QWL is measured with SEQWL [5] or a corresponding form based on the QWL theory, k is the slope (multiplied with a constant, depending on the units) and b is the intersection point with the y axe that determines when an employee holds no or negative value to the company. Using S for the average salary, we have: V = S ( QWL + ) Where S is the average salary for a worker in this function.
Determination of and
When an employee scores around 60% QWL (measured with SEQWL) we know from experience (compare the numbers above) that he often does not function well enough to keep his job. If the score is around 70%, he is stable and a good working power. 50% QWL means that he is a considerable burden to the company, while 80% would mean that he is a fast advancing star worker. Accordingly it is possible to establish the following table (table 1) which shows that must be around 10 and be around 0,6. We have: V = S ( QWL + ) = S (10 QWL 0,6) And V = V (t2: QWL 2) - V(t1: QWL 1) = S (QWL) = 10 S QWL Table 2. Connection between value of the worker (expressed in the units of salary) for the company and measured QWL (rough estimate)
QWL 10% 20% 30% 40% 50% 60% 70% 80% 90% Close to 100% Value of employee to the company (s = average salary) not able to work not able to work not able to work not able to work severe strain -1s worthless 0s worth his salary (average/normal) 1s especially well functioning employee 2s best practice 3s unique genius 4-1000 s
Example 1 An employee with a QWL measured to 65% and an average salary of 50,000 $ for his type of job will create the following value for his company (OBS: If you use the corrected formula below you will find a negative value):
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V (QWL 65%) = V = S (QWL + ) = 50,000$ x 10 x (0,65 0,6) = 50,000$ x 10 x 0,05 = 25,000 $ If his QWL is raised only 5%, the value gained on a yearly basis (given 10, which must be empirically conformed) will be: V = V (t2: QWL 70%) - V(t1: QWL 65%) = S (QWL) = 50,000$ x 10 x 5% = 25.000 $ So his value of this employee to the company will be doubled.
DISCUSSION When you see this formula and table 1, then as a leader you would spontaneously feel like firing all employees with a QWL ranging under 65%. However, the valuable thing by measuring QWL as a leadership tool is not the inhumane dismissal of people, who are not thriving for the time being, because the QWL of the individual employee is varying considerably through time, i.e. it is well known that the best worker of one month is not the one of the following month. The clever leader consequently supports the development of QWL within the company, thus contributing to the increasing value of all employees to themselves and each other. In that way, the company also makes a valuable contribution to society instead of just picking people from the top and just unethically wearing them down for final discard. This practice, which has been used in the high-tech business in the last two decades should be stopped and replaced by a more decent human resource philosophy. Such a change would also be of benefit for the companies themselves, improving their ability to keep workers and supporting them in their ongoing development instead of putting them under constantly higher pressure finally resulting in their burnout. The difference in productivity per employee at a certain time thus is: V = 10 S QWL where QWL is the QWL measured with SEQWL, S is the salary and is a constant (estimated 10). However, this is not enough to determine the value of a QWL intervention, because the crucial question is how the employee will do in the long run. It has to be integrated over a longer period: V total for a participant = t2-t1V = S t2-t1QWL, 10 The value created trough time for a participant is (ten) times the difference in quality of working life (mQWL) though time (t) times the average salary (S) For the QWL intervention project as a whole is the formula: V total for QWL project = P t2-t1V = PS t2-t1QWL, 10
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The value created trough time for an intervention group is (ten) times the number of participants (P) in the intervention times the difference in Quality of Working Life (mQWL) though time (t) times the average salary (S). Will he continue to develop after i.e. a QWL course or will the improvement only be temporary? The answer to this very important question is that it completely depends on how the QWL project is conducted and how well it is anchored within the organization. It turns out to be of outmost importance that even after the closure of the project, there continues to be setters and holders of perspective maintaining the vital, down-to-earth and existentially orientated development perspective, which is the basis of the complete QWL theory. That good QWL first of all is about having good relations, both internally and externally. Do you succeed in involving all workers and leaders in the project and in anchoring this philosophy in the company? The experience from Niels Jrgen Andersens lifelong practice seems to show stable improvements within a time span of ten years, even if some employees leave and new ones join the company. A lasting change has been created in the very culture of the company, and thus also the QWL in the company as a whole. Thus, when the project is well conducted in the whole company (or a well-defined, independent part of it), we can simplify the formula above as follows, when B is the number of years the QWL improvement lasts: V total for QWL project = PBV = P S B QWL, where P= number of members in the organisation, 10, B10years The value created trough time for a QWL intervention project is (ten) times the number of participants (P) in the company/division times the difference in Quality of Working Life (QWL) though time (B) times the average salary (S)
Example 2: Improving QWL in the Company Improving QWL 10 % in a company which we some times see in QOL and QWL projects with 100 employees with an average QWL measured to 65% and an average salary of 50,000 $, will in 10 years create the following value for its owners:
V total for QWL project = P S B QWL = 100 x 10 x 50.000 $ x 10 x 0,1 = 100 mill. $ where P= number of members in the organisation, S the average salary for that kind of work, 10, B10 years.
DISCUSSION When QWL projects are conducted successfully in companies, large negative results can be turned into large positive results. This has occurred many times, and it always seems like a miracle for the company. Interestingly, the health of the employees in several of the projects we have participated in often undergo such a radical improvement that the days lost through sickness during the intervention period of 6-12 months decrease from 10 and 20% to only 23%. The QWL concept thus seems to have such a great impact that it, correctly applied in
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companies and society, can restore not only the companys own economy, but also the general health and economy of society. The importance of leadership for productivity and a formula for the leaders productivity: A generalised formula for the value the leader can create for his company, based on his QWL. Let us finish with turning our attention towards a fact that it is very important, but for which it at the same time is very difficult to establish a formula, namely the productivity of the leader. The leader has crucial importance for the possibilities of the employee to make the most of his potential in order to create value. This reflection is about the leader as a limiting factor and the potentials of the employees must be exploited, which is the responsibility of the leader. Potentials can be visible or hidden, and it is evident that the good leader helps his employees to develop themselves by recognizing hidden potentials and talents and using them. This is a promising and rich perspective and it gives the leader a very large responsibility for the fate of his subordinates. The skilled management consultant or physician is delivering just that service to respectively his costumer or patient. A more common and neutral view upon leadership is that the employees hold merely those resources that are visible, and that the leader has to manage them as he or she best can. That perspective, to which we will stick, means that bad leadership simply waste the resources of the employees, just in the same way as excellent leadership makes the best of them. The numbers we have seen in the calculated examples above implicitly implied optimal leadership. If the employee improves his QWL, he is potentially increasing his value for the company, but that does not necessarily mean that he actually creates more value. That would imply the cooperation with a leader seeing him and his new, released potentials and helping him to exploit them for the common good. The leader is of crucial importance for the effort and QWL of his subordinates. Most workers are able to work much smarter and better. Actually, a good leader is able to make people thrive, just as a bad leader makes his employees not thrive. As mentioned at the beginning, it is very common that people are working efficiently in their job and are holding large, visible and not exploited resources. This implies that the problem of low productivity very much is a matter of bad leadership. Therefore, you should normally focus on the leader and the leadership, if you want to improve the productivity of the company as a whole. An investigation of QWL and the quality of leadership showed almost linear correspondence between these two factors. It seems to be reasonable to propose a formula showing the created value as a function of leadership quality and as a function of QWL. It is sufficiently general to embrace all members of an organization, since every employee also has to lead him- or herself. But in order to be meaningful you have to start at the highest level of leadership. Because top leaders should let intermediate leaders flourish so that their employees in return use themselves optimally. Thus, this formula tells nothing about the potential productivity as the formulas above have done, but about the actual productivity for which the leader is responsible. The number of subordinates, N (including the leader), is a simple expression of the empowerment of the leader function. Under normal conditions and if he is not somehow completely unfit for his job and thus in one way or another predestined to ruin everything, the leader will create the following value: V (leader) = N S ( QWL + )

and V total for a participant leader = N t2-t1V = N S t2-t1QWL, 10
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The interesting thing is that the result turns out to be exactly the same, whether you develop the management level or the whole organization. The explanation is, of course, that a skilled management department always would optimise the employment of the workers in the very same ways as a QWL project would. V total for a QWL project in the company = V total for a QWL project in the management = NTV = N S T QWL, where V is the potential value the employees can create for the company under good leadership QWL is the measured Quality of Working Life (in percentage) calculated as a mean of the four dimension: "QOL", "Mastery", "Fellowship" and "Creation of real value" according to the QWL-theory S is the average salary N is the number of participants in the project T is the duration of the created improvement
CONCLUSIONS How can the gained value of a QWL-project be calculated when intervening on a group of employees in a company? We recommend the use of this simple formula: V total for a QWL project = N S T QWL where V
is the potential value the employees can create more for the company under good leadership N is the number of participants in the project is a psychobiological constant for human beings 10 S is the average salary T is the duration of the created improvement often 10 years in good project QWL is the difference in Quality of Working Life, measured with SEQWL before and after the intervention
FUTURE RESEARCH AND DIRECTIONS It is important to stress that the established formulas have to be proved empirically, which is a task is for continued scientific work. The formulas are not likely to have found their final
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shape. Expectation based on calculations with that formula has to be held with reservations. Most of todays consultants are not able to create large successes as seen in the best cases. It is recommended to pick your consultants with outmost care and through good references secure, that they actually have delivered what they are promising. Measurements and improvement of QWL have to be conducted by independent units in order to secure objectivity. As a final remark it can be stated that development of QWL gives a person both external and internal empowerment. The more conscious you get in your job the more QWL you will develop and the more power and potential success you will have. The development of QOL, QWL and health is actually happening, when an employee or leader takes responsibility for his own professional life and this is basically self-empowerment. Responsibility is the door to success in private life as in professional life and a company and society always needs employees and leaders that is responsible for being, doing and having which is basically what QWL is all about. The collective development of QWL in companies and society at large might be a very important issue in the future. As QWL is so closely linked to QOL and health, it will be for the benefit of not only our people and society, but for our whole global community. Its simplicity and clarity and the large statistical background material from the QOL investigation of 10.000 Danes [1,2,15] vouch for the value of the QWL concept. The great challenge for industrial healthcare, health politicians, and trade unions is to make public and private organizations interested in focusing on the thriving of their employees. In the future it will perhaps be relevant for trade unions to demand better conditions for the pleasure of work, instead of higher wages and other advantages.
REFERENCES [1] [2] Ventegodt S. Quality of life in Denmark. Results from a population survey. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. The quality of life of 4500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S, Henneberg EW, Merrick J, Lindholt JS. Validation of two global and generic quality of life questionnaires for population screening: SCREENQOL and SEQOL. ScientificWorld Journal 2003;3:412-21. Ventegodt S. Working life quality. To become valuable to yourself and your surroundings. Copenhagen: Forskningscentrets Forlag, 1999. Ventegodt S. Quesionnaire for working life quality (SEQWL). Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S. Measuring the quality of life. From theory to practice. Copenhagen: Forskningscentrets Forlag, 1996. Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1):89-91. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II: The structure of the life purpose and the ego. ScientificWorld Journal 2003;3:1277-85.
[3]
[4] [5] [6] [7] [8]

[9] [10] [11] [12] [13]
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[14]
[15]
Ventegodt S, Andersen NJ, Merrick J. The life mission theory III: Theory of talent. ScientificWorld Journal 2003;3:1286-93. Ventegodt S, Merrick J. The life mission theory IV. A theory of child development. ScientificWorld Journal 2003;3:1294-1301. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. A theory of the antiself and explaining the evil side of man. ScientificWorld Journal 2003;3:1302-13. Ventegodt S, Kromann M, Andersen NJ, Merrick J. The life mission theory VI: A theory for the human character. ScientificWorld Journal 2004;4:859-80. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Life Mission Theory VII: Theory of existential (Antonovsky) coherence: a theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89. Ventegodt S. The quality of life and factors in pregnancy, birth and infancy. Results from a follow-up study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen 1959-61. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. The quality of life and major events in life. Copenhagen: Forskningscentrets Forlag, 2000. [Danish]
Chapter 10
WORKING LIFE QUALITY WITH THE SEQWL QUESTIONNAIRE

Sren Ventegodt, Niels Jrgen Andersen and Joav Merrick
We have constructed a self evaluation of working life quality questionnaire (SEQWL). It was developed on the basis of the philosophy and theory of quality of working life (QWL), strongly inspired by recent quality of life theories, especially the integrated quality of life theory (the IQOL theory) with a focus on the quality of human relations. The QWL-theory considers four fundamental domains of working life: quality of life, mastery, fellowship and creation of real value. These dimensions arise from four fundamental relations at work: the relations to one self (quality of life), to the job function (mastery), to other members of the working team (fellowship), and to what extend the individual contributes to the surrounding world (creation of real value). Thus good quality of working life is about much more than job-satisfaction, stress, the working environment, personal functioning, performance, health and immediate subjective well-being at work, although these factors are also covered by the QWL-concept, and measured by the SEQWL questionnaire. The SEQOL measure is an objective and valid measure, which together with good leadership will determine companies of value.
INTRODUCTION The philosophy of QWL (quality of working life) aim to empower the leader or employee to improve his subjective QWL-dimensions like joy of work, job-satisfaction and improve health and performance. The theory of working life is based upon the idea that good QWL arises from good relations in the working situation [1]. The theory states that there are basically four important relations to the working life: The relation to yourself, the relation to the work process, the relation to other people in the work group, i.e. colleagues, managers and subordinates and the customer and surrounding world. The four relations each define its specific domain: 1) quality of life 2) mastery 3) fellowship and 4) creation of real value. The theory defines that these four domains are of equal importance to the perception of quality of
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work life, leaving QWL as an average of 1-4 (Find the scoring formula attached below the SEQWL questionnaire).
Quality of Life (QOL)

QOL refers to the person's state of living, which is a function of the level of inner harmony and balance. QOL depends on basic qualities of life as joy (pleasure vs. pain), knowledge (information vs. appearance) and awareness (consciousness vs. unconsciousness) in your daily living. Inner conflicts and lack of knowledge and understanding of your self will make a good life difficult for the majority of mankind today. It is known that QOL is closely related to health [2,3]. QOL has been investigated scientifically for two decades using the IQOL theory [4-8].
Mastery
As it is the purpose of human life to be active and to create value, perfection of our talent and behaviour are essential elements of the achievement of mastery. Personal and professional development leads to a state of being, where ideas and intentions can be freely expressed in the work-process. This is the ideal, however seldom achieved, state of mastery. The reason for this is to be found in the personal search, or lack of such, for self-actualisation. Most people stop in their personal development before they reach the state of transcendence and perfection, so well described by Maslow [9]. Development of mastery can only be achieved through on-going challenges, which most people seem to avoid in return for safety and personal security. Nowadays business consultants predict a working culture focusing on challenge and personal development as tremendous valuable to both the company and its employees.
Fellowship
As a social being, mankind has a deep-rooted need for being a part of a social whole, an accepted and appreciated member of the group. However, many people do not develop the social skills necessary for communication, conflict solving, co-operation, leadership and personal responsibility in a group. As these social qualities exist as hidden resources, processes that take them into use are of great value for the individual as well as for the organisation as a whole.
Creation of Real Value

It is rather surprising, when studies of happiness are done, that happiness and life satisfaction are closely related to being useful, and only remotely connected to yearly income [4,5]. This at least appears true for rich countries such as Denmark, where material wealth has been
Working Life Quality with the SEQWL Questionnaire
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striven after for a long time. Material life has been attained, citizens are wealthy, however not many seems to be happy. Work is about creating value, and not really about making money, although most people who have not reflected deeply on this, might think it is. Real value is about helping other people improve their lives. It is about experiences. It is about fulfilling real needs for individuals and for society in general, and it seems that human beings have a need for being useful and not for material wealth in itself [10].
NOTHING IS AS PRACTICAL AS A GOOD THEORY Consciousness is tricky and it is very easy to fool one self. Although consciousness and the very depths of human existence are difficult to reach by the quantitative methodology, we believe it to be a more feasible starting-point than the qualitative methodology. When we are striving to improve our state of being, it is very important to have some hard benchmarks to compare with during time and to measure our improvements. To do this we need to measure though the period of intervention both of the group or person we want to evaluate, and of the population we want to benchmark against. Subjective dimensions are best measured psychometrically by a questionnaire and the measurement must be generic and global [11]. We have constructed the self evaluation of working-life quality questionnaire (SEQWL) according to the seven criteria, which was originally set up for the generic measuring of global QOL [11]. These criteria range from the most abstract, a philosophy of working life, to the most factual, like 5 point Likert scales. Qualitative surveys rely on the respondents subjective judgment. The interpretation process of the collected data itself requires a deep understanding of the nature of human consciousness and must follow strict methodological criteria as outlined. The seven construct criteria have already been shown to be of value in practical use as demonstrated in [11,12,13]. The criteria as they are when applied to the QWL are presented in table 1. Table 1. Methodological requirements for quantitative, questionnaire-based research on the global quality of working life
A clear definition of the quality of working life A philosophy of working life on which the definition of the quality of life is based A theory that operationalize this philosophy by a) deducing questions that are unambiguous, mutually exclusive and comprehensive as a whole and b) establishing the relative weights of each question. A number of response options that can be interpreted quantitatively on a fraction scale Technical quality in terms of reproducibility, sensitivity and well-scaled- ness (appropriate scale characteristics) The survey must be meaningful to both researchers, respondents and those who use the results (including criterion validity) An appreciation of the aesthetic dimension
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The SEQWL Questionnaire: The Domains and the Sub-domains and their Definitions
To make the questionnaire it was important to create the correct number of sub-dimensions. Ideally a theory was made for each sub-domain if these were not given by the main theory. We have not been able to do that in a convincing way and have chosen to be practical about it instead. We collected the hundred most popular questions in each domain and selected the 2030 that a working group found to be the most relevant, most in accordance with the basic philosophy of QWL, and most helpful for the development of QWL in a company using information technology. The 20 sub-domains, which have been chosen, illustrate the complexity of the four domains (see table 2; the principle for Scoring the QWL-questionnaire is also given here). Table 3 states the chosen definitions of the sub-domains. Table 2. The SEQWL questionnaire has three levels: level 1: Global QWL, level 2: the 4 QWL domains, level 3: the 20 sub-domains (each domain is scored as an average of its sub-domains, and QWL is score as an average of the domains)
Quality of working-life: The four domains and their dimensions QOLRC, Copenhagen. All rights reserved. Quality of Life: Fellowship: Relation to self Relation to the Organisation Experience of life Commitment to organisation Satisfaction with life Information flow Needs fulfilment Teamwork Working environment Mastery: Management Relation to your work Interpersonal relations Skills competence Influence Character of work Influence re own work Creating real value: Experience of work Relation to environs Commitment to work Organisational mission Salary and status Quality of products/service Personal development Efficiency Creating proper values
Tabel 3. Definitions of the QWL sub-domains

Level 1: QWL Total Working-Life Quality, Estimated is the calculated value of QWL as a mean of QOL, Mastery, Fellowship and Creation of value. Working-Life Quality, Self-Assessed is your self-assessed well being at work - a very important dimension of QOL. We use it as a control and compare it with the calculated QWL.
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Level 2: the 4 QWL - domains Quality of Life is a name for all the different ways life can be good and bad. In this survey QOL indicates your experience of life, your satisfaction with life and your actual state of fulfilling your needs. Mastery indicates your present state of mastery in your work - and so it also reflects your hidden potentials. Fellowship indicates your present state of fellowship with the organisation and everybody in it. Creating real value indicates your present situation when it comes to contribute to the world through your job. Level 3 the sub domains Quality of Life (QOL) Life experience refers to your subjective QOL - your rating of such factors as life satisfaction, happiness and well-being at home. Satisfaction means satisfaction with all your personal relations, i.e. to your partner, your friends, your children and your society. Needs means fulfilment of your needs, i.e. your physical and social needs and your need of self-realization. Mastery Skills is about your present state of professional development - how good are you at present compared to the best and to your own potential? Character of work is about variation, boredom, stress and workload and the influence of your work on your health. Influence (mastery) is about freedom to determine what to do and how to do it. Experience of working is about joy and meaningfulness of - and well being at your work. Commitment (mastery) refers to your passion for and interest in your work as well as the priority it has in your life. Salary and status refers to yearly income as well as your status at work and in your society. Development is about your experience of personal and professional development as a result of your work. Fellowship Commitment (fellowship) refers to your relation to your company, i.e. your passion for and interest in your organisation. Information is about the richness and quality of the information flow to the employee from the organisation and vice versa. Teamwork is about your present ability to cooperate, solve conflicts and assume responsibility. Working environment is about your experience of your physical and psychological working environment.
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Table 3. Continued
Management is about your experience of the quality of the leadership of the company at present, including the management skills of your manager and yourself. Relations is about the quality of your relationships to your colleagues, your boss and your subordinates. Influence (fellowship)is about your ability to influence the goals and decisions of your organisation. Creating real value The Mission is about your understanding and personal support of the company mission i.e. the major goals of your organisation. Quality is about your pride of being part of the organisation and your judgement of the quality of its products. Efficiency is about how efficient the organisation uses its resources - human, material and technological and the total impression of the efficiency of the organisation. Ethics reflects your judgement of the ethical standard of the organisation and the degree it pollutes its environment. Creating real value might be the most important dimension reflecting your value for the organisation and the surrounding world and your experience of the organisation as creator of value for its customers/users i.e. by taking a leading role in developing man and society.
DEVELOPMENT OF THE SEQWL-QUESTIONNAIRE
Amongst 500 items originally proposed by a workgroup with professors, company directors, physicians, consultants in organisational development, 102 questions (+9 controls) were finally selected in total, about 25 from each domain. The selection criteria was the following: The questions should together show the broadest possible picture of the working-life situation, risk of redundancy should be at a minimum and the questions should be meaningful and linguistically sound, in order to maximise communication.
VALIDATION OF THE SEQWL-QUESTIONNAIRE
The QWL-questionnaire, which gives a number for the calculated QWL as a mean of the rating of the four basic dimensions, has not yet been sufficiently validated, when it comes to internal consistency (focus) by the Cronbach-alfa method. However the external validity (criteria validity) has shown to be validated by its correlation to the self-evaluated QWL (see table 4) and SEQOL. Its reliability has not been sufficiently tested through test-retest procedures, but its sensitivity has been found through its statistical variation. All of the investigated parameters are found to be satisfactory compared to internationally accepted standards. We believe though, that SEQWL is valid as it is constructed and developed exactly like the validated SEQOL and QOL5 questionnaires [12,13].
Table 4. External validation of the SEQWL questionnaires is defined by its correlation with self-assessed QWL and calculated QWL value. The correlation coefficient is 0.69, and the statically covariation is measured to 75.0%, and calculated to 48,1%, using the method of modified regression (ref: measuring the QOL). As we find these numbers satisfactory, we have an external validation of the SEQWL questionnaire
How good is your quality of working life (as you understand it)? Table of frequency 1. Very good 2. Good 3. Neither good nor bad 4. Bad 5. Very bad Total number of respondents Corr.(r), Signif.(p), Total resp. (n) Table of average Group average; Number of respondents in group Test 1. Very good 2. Good 110 3. Neither good nor bad 4. Bad 5. Very bad Overall average; total numbers 691 Resp. 159 397 15,9 57.9 22 3 100 66.0 (p-value) 73.7 ** 0.0001 66.2 0.5014 1.1 ** 0.0001 3.2 49.3 ** 0.0001 0.4 44.5 0.6 % 23.0 57.5 Calc. WLQ 1.1 0.6 ** 0.0001 -12.3 2.2 11.5 No. Resp. 159 397 110 22 3 691 Score 90 70 50 30 10 Calculated WLQ 10 30 50 0 0 0 0 0 0 0 1 0 1 1 3 6 56 73 21 2 158 0,0001 70 132 339 37 0 0 508 90 21 1 0 0 0 22 691 Deviation from survey average as a percentage thereof Test Calc.
-0,6872
(p-value) WLQ 11.7 ** 0.0001 0.4 0.5014 110 3. Neither good nor bad 4. Bad 5. Very bad Overall average; total numbers 691
Table 4. Continued
VARIATION IN WORKING-LIFE QUALITY ACROSS THE MEASURING INTERVAL Total Variation Variation Uncertainty 44.3 37.1 3.9 Numbers in percent
[ 1 is the measured max-min difference. D2 is the variation calc. by weighted linear regression, e being the measurement error at a=0.05 ]

90
133
80
70
60
50 You The company 40
30
20
10
0 Self-assessed QWL Working-Life Quality Quality of Life Mastery Fellowship Creation real value
Figure 1. Quality of working life (QWL).
The Personal QWL-profile and its Dimensions

The hundred questions of the QWL-Questionnaire have been constructed, in order to measure the four domains of the work process, by attending to important dimensions of each domain. These dimensions provide a practical and useful way to give feedback to the individual about his/her experience of their working-life, and further allow for easy identification of areas, that can and should be improved. Feedback is given in the form of a personal QWL-profile, which 1) gives a graphic picture of subjective experience of working-life quality 2) shows how the personal profile compare to those of the other employees in other companies (the benchmark). Figure 1 illustrates an example of this.
APPENDIX 1. SELF-EVALUATION OF WORKING LIFE QUALITY QUESTIONNAIRE (SEQWL) 2008 Quality-of-Life Research Center, Classensgade 11C, 1th, DK-2100 Copenhagen O, Denmark. This SEQWL questionnaire is hereby released for non-commercial, scientific use. Please apply for written permission for all commercial or non-scientific use to the Quality of Life Research Center.
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About this Questionnaire

You experience quality of work when your work life suits you well. This questionnaire takes the pulse of the quality of working life. The inquiry form comprises about 100 questions that throw light on various aspects of working life. The concept Quality of working life comprises 4 main subjects: 1. 2. 3. 4. Your concept of yourself: Which is about Quality of Life Your relation to your job: Which is about Mastery Your relation to the organization: Which concerns cooperation and community Public relations and the customer: Creating proper values
The questionnaire is structured according to the above-mentioned four main domains. At the end of the questionnaire you will find a few questions concerning assessment. We kindly ask you to state your opinion of the questionnaire in case a total of quality of work is summed up for your company. Furthermore, at the back of this form please find a score sheet for your answers in order to give you an overview of your quality of work. This questionnaire is a part of the product series Working-life Quality A Tool for employees and managers.
How to Complete the Questionnaire?

Please mark the answer you choose with a circle: How do you feel at work? 1 2 3 4 5 Leave out questions that you cannot answer.
Very good Good Neither good nor bad Bad Very bad
You Yourself: Quality of life. How do you Feel about Your Life?
Q1 1 2 3 4 5 How are you at the moment? Very good Good Neither good nor bad Bad Very bad
Working life Quality with the SEQWL Questionnaire

Q2 1 2 3 4 5 Q3 1 2 3 4 5 Q4 1 2 3 4 5 Q5 1 2 3 4 5 Q6 How happy are you with your life right now? Very content Content Neither content nor displeased Displeased Very displeased How happy are you at present? Very happy Happy Neither happy nor unhappy Unhappy Very unhappy How do you feel at home? Very good Good Neither good nor bad Bad Very bad How do you feel in your spare time? Very good Good Neither good nor bad Bad Very bad
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How is your present quality of life (as you understand it) Very good Good Neither good nor bad Bad Very bad
Satisfaction with Relationships

Q7-16 How content are you at present with: (Please note, for instance, that it is possible to feel satisfied in spite of a poor health)
Very content 1 1 Content 2 2 Neither nor 3 Displeased 3 Very displeased 4 5 4 5
Your health? Your material and economic conditions?
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Table. Continued
Very content Content Neither nor Displeased Very displeased 5
Your intimate relationship? Your parents? (Please answer even though your parents have passed away) Your situation concerning children? (Please answer even though you have no children) Your relationship with your friends? Your relationship with acquaintances? Society your environment? Nature around you? Your work?
1 1 1
2 2 2
3 3 3
4 4 4
5 5 5
Needs
Q 17 How well are your basic needs fulfilled at the moment? (This means physical needs such as food, clothes, temperature, dwelling, sleep, private life and safety.) 1 Very well 2 Well 3 Neither very well nor well 4 Badly 5 Very badly 6 I do not have these needs
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Q 18 How well are your social needs fulfilled for the time being? (For instance your need for human warmth, recognition, friendship and social togetherness.) 1 Very well 2 Well 3 Neither good nor bad 4 Badly 5 Very badly
Q 19 How well realized is your need to prove useful at present? (For instance a need to help others, to keep the world going or make it better.) 1 Very well 2 Well 3 Neither well nor badly 4 Badly 5 Very badly 6 I do not have this need Q 20 1 2 3 4 5 6 How well realized is your need for an exciting and varied life at present? Very well Well Neither well nor badly Badly Very badly I do not have such a need
Q 21 How well realized is your need to unfold your true potential at present? (For instance, a need to develop your insight and your drive, in order to live in conformity with yourself to a greater extent.) 1 Very well 2 Well 3 Neither well nor badly 4 Badly 5 Very badly 6 I do not have this need
The Job: Mastery Skills

Q 22 How good are you at your work? 1 2 3 Very good Good Neither good nor bad
138 4 5

Bad Very bad
Q 23 How good are you within your field of activity, if you compare yourself with the best people? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad Q 24 How good a professional are you, compared to how good you could be? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad Q 25 To which extent are you using all your skills? 1 2 3 4 5
To a very large extent Very much Average Below average Far below average
The Character of your Work

Q 26 How varied is your work? 1 2 3 4 5 Q 27 How many hours a week do you work? _________ Q 28 How many hours are you paid for weekly? _________ Q 29 How often are you bored, because there is too little to do? 1 2 3 4 5 Very varied Varied Neither varied nor monotonous Monotonous Very monotonous
Very rarely Rarely Part of the time Most of the time Almost always

Q 30 How often are you frustrated about too much to do? 1 2 3 4 5
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Q 31 How often time are you bored because your work is too easy? 1 2 3 4 5
Q 32 How much of the time are you frustrated about your work being too difficult? 1 Very rarely 2 Rarely 3 Part of the time 4 Most of the time 5 Almost always Q 33 How stressed are you at work? 1 2 3 4 5
Not at all stressed Partly stressed A bit stressed Very stressed Almost dying from stress
Q 34 How is your work affecting your health, physically? 1 It is very beneficial 2 It is beneficial 3 It is neither beneficial nor harmful 4 It is harmful 5 It is very harmful Q 35 How does work affect your mental well-being? 1 2 3 4 5
It is very beneficial It is beneficial It neither beneficial nor harmful It is harmful It is very harmful
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Influence
Q 36 How clear is the goal of your work? 1 2 3 4 5 Very clear Clear Neither clear nor unclear Unclear Very unclear
Q 37 To which extent do you exert an influence on the goal of your work? (Do you make your own decisions as to what you want to do?) 1 To a very large extent 2 To a large extent 3 Average 4 Below average 5 Far below average Q 38 To which extent can you decide how to do your work? (freedom to accomplish your tasks the way you want it) 1 To a very large extent 2 To a large extent 3 Average 4 Below average 5 Far below average
The Experience of Working

Q 39 How are you at work? 1 2 3 4 5 Very good Good Neither good nor bad Bad Very bad
Q 40 To which extent do you work with what you like best? 1 To a very large extent 2 To a large extent 3 Neither high nor low extent 4 Below average 5 Far below average Q 41 How much job satisfaction do you experience at work? 1 2 3
Very much Much Neither much nor little

4 5 Q 42 How much meaning do you experience at work? 1 Very much 2 Much 3 Neither much nor little 4 Little 5 Very little
141 Little Very little
Commitment
Q 43 How interesting is your work? 1 2 3 4 5 Q 44 How committed are you to your work? 1 2 3 4 5 Q 45 How much do your burn for your work? 1 2 3 4 5 Very interesting Interesting Neither interesting nor uninteresting Uninteresting Very uninteresting
Very committed Committed Average Hardly any commitment No commitment at all
I burn I am hot I am warm I am cold I am ice-cold
Q 46 How much of your time spent at work are you in flow (Thats to say that can you forget yourself and vanish into concentration)? 1 Almost always 2 Most of the time 3 Part of the time 4 Rarely 5 Very rarely Q 47 How is work prioritised in your life? 1 2 3 4 5
Work is the most important thing in my life Work is more important than my private life Work and private life are equally important Private life is most important Work is a necessary evil
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Salary and Status

Q 48 How much do you earn annually before tax? 1 2 3 4 5 More than 40.000 Euro. 30.001 - 40.000 Euro. 20.001 - 30.000 Euro. 10.001 - 20.000 Euro. 0 10.000 Euro
Q 49 Which status do you have at work? 1 Very high status 2 High status 3 Neither high nor low status 4 Low status 5 Very low status Q 50 Which status have you acquired off work due to your position at work? 1 Very high status 2 High status 3 Neither high nor low status 4 Low status 5 Very low status Q 51 How sure are you to keep your job? 1 2 3 4 5
Very sure Sure Neither sure nor unsure Unsure Very unsure
Q 52 How promising does your future at work appear to be? (Prospects of promotion, a good career, a company of your own etc.) 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad
Professional and Personal Development

Q 53 How many good challenges do you find at work at present? 1 There is nothing but challenges 2 Many 3 A few 4 Few 5 None
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Q 54 How much do you develop professionally? 1 I am developing tremendously 2 I do develop a lot 3 I develop a bit 4 I develop very little 5 I do not develop at all Q 55 What are the prospects for you as to further professional training on the job? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad Q 56 How much do you develop as a human through your work? (your personal character) 1 I am in the midst of a tremendous development 2 I develop a lot 3 I develop a bit 4 I develop very little 5 I do not develop at all
Organization: Fellowship
(Organization does not mean union, but private or public enterprise.)
Attachment
Q 57 How important is your person to the organization? 1 Very important 2 Important 3 Neither important nor unimportant 4 Unimportant 5 Very unimportant Q 58 How important is this particular organization to you? 1 Very important 2 Important 3 Neither important nor unimportant 4 Unimportant 5 Very unimportant
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Q 59 How much responsability do you feel towards your organization? 1 2 3 4 5
Very much Much Average Little Very little
Q 60 How well are you treated by the organization? 1 2 3 4 5
Very good Good Neither good nor badly Badly Very badly
Information
Q 61 How well are you informed by management as to what happens within the organization? 1 Very well informed 2 Well informed 3 Neither well nor badly informed 4 Badly informed 5 Very badly informed Q 62 How well do you keep up with events within the organization (except from gossip)? 1 Very well 2 Well 3 Neither well nor badly 4 Badly 5 Very badly Q 63 How good are you at informing management on what agitates you? 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad
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Q 64 How is the reaction from management on your input?(for instance proposals for improvement, briefing on personal matters) 1 Very good 2 Good 3 Neither good nor bad 4 Bad 5 Very bad
Cooperation
Q 65 How are you at cooperating? 1 2 3 4 5 Q 66 How often are you praised for your work? 1 2 3 4 5 Q 67 How thoroughly is your work evaluated? 1 2 3 4 5 very good good neither good nor bad bad very bad
very often frequently neither often nor frequently not often very rarely
very thoroughly thoroughly neither thoroughly nor superficially superficially very superficially
Q 68 How are you at solving your own conflicts at work? 1 2 3 4 5
very good good neither good nor bad bad very bad
Q 69 Do you think your colleagues take enough responsibility when you cooperate? 1 very much 2 frequently 3 average 4 little 5 very little
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Q 70 Do you think you take enough responsibility when you cooperate? 1 2 3 4 5
very much frequently average little very little
Working Environments
Q 71 How is your physical working environments? 1 2 3 4 5 Q 72 How is your psychological working environment? 1 2 3 4 5 very good good neither good nor bad bad very bad
Management
Q 73 As a whole, how is the management in your organization? 1 2 3 4 5 Q 74 How is your immediate superior as a manager? 1 2 3 4 5 Q 75 How are you at cooperating with your manager? 1 2 3 4 very good good neither good nor bad bad very bad
very good good neither good nor bad bad

5 Q 76 How are you at managing yourself, i.e. self-discipline? 1 2 3 4 5 Q 77 How are you at managing others? 1 2 3 4 5
147 very bad
very good good neither good nor bad bad very bad very good good neither good nor bad bad very bad
Relations
Q 78 How is your relationship with your colleagues? 1 2 3 4 5 Q 79 How is your relationship with your boss? (If you have one) 1 2 3 4 5 very good good neither good nor bad bad very bad
Q 80 How is your relationship with the organizations executive management? 1 very good 2 good 3 neither good nor bad 4 bad 5 very bad Q 81 How is your relationship with your subordinates, if any? 1 2 3 4 5
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Influence in the Organization

Q 82 What are your possibilities of influencing the organizations objectives? 1 very good 2 good 3 neither good nor bad 4 bad 5 very bad Q 83 What are your possibilities of influencing decisions in the organization before they are made? 1 very good 2 good 3 neither good nor bad 4 bad 5 very bad Q 84 What are your possibilities of taking new initiatives? 1 2 3 4 5
Customers/surroundings: Creating Proper Values

(By Creating proper values we mean producing values that cover real needs, not artificial ones.)
The Mission
Q 85 How clear is the organizations mission (by mission we are talking about overall objective)? 1 very clear 2 clear 3 neither clear nor unclear 4 unclear 5 very unclear Q 86 How well do you understand the organizations mission? 1 2 3 4
very well well neither well nor badly badly

5
149 very badly
Q 87 How important do you think the organizations mission is? 1 very important 2 important 3 neither important nor unimportant 4 unimportant 5 very unimportant
Quality
Q 88 How proud are you of being a member of this organization? 1 very proud 2 proud 3 neither proud nor embarrassed 4 embarrassed 5 very embarrassed
Q 89 How do you rate the quality of the organizations product/service? 1 very good 2 good 3 neither good nor bad 4 bad 5 very bad
Efficiency
Q 90 How efficient do you think your organization is? 1 2 3 4 5 very efficient efficient neither efficient nor inefficient inefficient very inefficient
Q 91 How well does the organization utilize the new technology? 1 2 3 4 5
very well well neither well nor badly badly very badly
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Q 92 How well does the organization utilize its human resources (employees talents and abilities)? 1 very well 2 well 3 neither well nor badly 4 badly 5 very badly Q 93 How well does the organization utilize material resources (think of waste of time, materials, packaging etc.)? 1 very well 2 well 3 neither well nor badly 4 badly 5 very badly
Ethics
Q 94 How much does the organization pollute the environment? 1 2 3 4 5 Q 95 How ethical do you think the organization is? 1 2 3 4 5 very little pollution a little pollution some pollution much pollution very much pollution
very ethical ethical neither ethical nor unethical unethical very unethical
Creating Proper Values

Q 96 How valuable are you to the organization? 1 2 3 4 5 very valuable valuable neither valuable nor worthless rather worthless totally worthless
Q 97 What is your relationship with customers/users/clients? 1 2 3 4 5
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Q 98 To what extent do you think the organization is a success? 1 to a very great extent 2 to a great extent 3 to neither a great nor a small extent 4 to a small extent 5 to a very small extent Q 99 To what extent do you think that the organizations product/service improves the customers quality of life? (maybe as a sub-contractor) 1 to a very great extent 2 to a great extent 3 to neither a great nor a small extent 4 to a small extent 5 to a very small extent Q 100 How useful is the organization to the community? 1 2 3 4 5 Q 101 How well is the organization doing economically? 1 2 3 4 5
indispensable very useful of some use not very useful useless
very well well neither well nor badly badly very badly
Q 102 In your opinion, to what extent is the organization helping to develop people and the community in a positive direction? 1 to a very great extent 2 to a great extent 3 neither to a great nor a small extent 4 to a small extent 5 to a very small extent
Personal Evaluation of Quality of Working Life

Q 103 How is your quality of working life (as you understand it)? 1 2 3 4 5 very good good neither good nor bad bad very bad
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Assessment and Critique of the Questionnaire (Q 1-103)

Q 104 How easy was it to complete the questionnaire? 1 2 3 4 5 very easy easy neither easy nor difficult difficult very difficult
Q 105 How long did it take you to complete the questionnaire? 1 less than a quarter of an hour 2 l/4 - 1/2 hour 3 1/2 - 1 hour 4 1 - 2 hours 5 more than 2 hours Q 106 What do you think of dividing quality of working life into four main subjects (quality of life, mastery, solidarity, creating proper values)? 1 very good 2 good 3 neither good nor bad 4 bad 5 very bad Q 107 How safe do you feel taking part in this survey? 1 2 3 4 5 Q 108 How honest were your answers? 1 2 3 4 5
very safe safe neither safe nor unsafe unsafe very unsafe
very honest honest neither honest nor dishonest dishonest very dishonest
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Q 109 While answering did you find there were questions that would cause ethical problems at your place of work?
1 yes
2 doubtful
3 no
Q 110 Do you think the questionnaire covers all relevant subjects necessary for your quality of working life? 1 yes 2 doubtful 3 no
Q 111 If no or in doubt, write the subjects missing:

QWL Rating Scale (Please See Table 2 for the Principle of Scoring) SCORING of SEQWL: QWL= (QOL+ Mastery + Fellowship + Creation of real value):4= (((Q1+Q2+Q3+Q4+Q5+Q6):6 + (Q7+Q8+Q9+Q10+Q11+Q12+Q13+Q14+Q15):8 (Q17+Q18+Q19+Q20+Q21):5):3 + ((Q22+Q23+Q24+Q25):4 + (Q26+Q29+Q30+Q31+Q32+Q33+Q34+Q35):8 + (Q36+Q37+Q38):3 (Q40+Q41+Q42):3 + (Q43+Q44+Q45+Q46+Q47):5 + (Q48+Q49+Q50+Q51+Q52):5 (Q53+Q54+Q55+Q56):4 ):7 + ((Q57+Q58+Q59+Q60):4 + (Q61+Q62+Q63+Q64):4 + (Q65+Q66+Q67+Q68+Q69+Q70):6 (Q71+Q72):2 + (Q73+Q74+Q75+Q76+Q77):5 + (Q78+Q79+Q80+Q81):4 + (Q82+Q83+Q84)):7 + ((Q85+Q86+Q87):3 + (Q88+Q89):2 + (Q90+Q91+Q92+Q93):4 + (Q94+Q95):2 (Q96+Q97+Q98+Q99+Q100Q+10Q1+1Q02):7):5 ):4 CONTROL: Self-assessed QWL: (Q16+Q39+Q103):3
+ +
REFERENCES [1] [2] [3] [4] [5] Ventegodt S. Working life quality. Copenhagen: Quality Life Researchy Center, 1996. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 1989;2(8668):888-91. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336(8708):129-33. Ventegodt S. [Quality of life in Denmark. Results from a population survey]. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. [The quality of life of 4,500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen]. Copenhagen: Forskningscentrets Forlag, 1996. [Danish] Ventegodt S. [The quality of life and factors in pregnancy, birth and infancy. Results from a follow-up study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen 1959-61]. Copenhagen: Forskningscentrets Forlag, 1995. [Danish] Ventegodt S. [The quality of life and major events in life]. Copenhagen: Forskningscentrets Forlag, 2000. [Danish]
[6]
[7]
154 [8]

Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. ScientificWorld Journal 2003;3:1030-40. Maslow AH. Toward a psychology of being. New York: Van Nostrand, 1962. Frankl V. Mans search for meaning. New York: Pocket Books, 1985. Ventegodt S. Measuring the quality of life. From theory to practice. Copenhagen: Forskningscentrets Forlag, 1996. Lindholt JS, Ventegodt S, Henneberg EW. Development and validation of QoL5 for clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life. Eur J Surg 2002;168(2):107-13. Ventegodt S, Merrick J. Long-term effects of maternal medication on global quality of life measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 195961. ScientificWorld Journal 2003;3:707-13.
[9] [10] [11] [12]
[13]
Chapter 11
ANTONOVSKY SALUTOGENESIS RELATED TO WORK

Sren Ventegodt, Isack Kandel and Joav Merrick
40 patients with low or very low self-assessed working ability were treated with psychodynamic short time therapy complemented with body-work. They received in average 20 sessions at a prize of 1,600 EURO. The Body Work was inspired by Marion Rosen and helped the patients to confront old emotional pain from childhood trauma repressed to the body-mind. Results: 52.5% (95% CI: 36.1% - 68.5%) of patients recovered their self-assessed working ability (from 4.2 to 2.4 up the five point Likert scale (p<0.01)). From this we have NNT = 1.46-2.77. We estimate the Number Needed to Harm to be NNH>500. The responders improved their self-assessed physical health (from 3.3 to 2.6; 0.6 step up the five point Likert Scale, p=0.01), self-assessed mental health (from 3.8 to 2.5, p<0.01), self-esteem (from 3.4 to 2.5, p<0.01), self-assessed quality of life (QOL1) (from 3.7 to 2.4p<0.01), QOL measured by QOL5 (from 3.3 to 2.6p<0.01), the quality of relations (from 3.2 to 2.6p<0.01), general ability of functioning (from 3.5 to 2.5; p<0.01). Combining quality of life, health, and ability showed large improvements of the patients whole life (p<0.01). The simultaneous improvement in all aspects of life can be explained as caused by existential healing (Antonovsky salutogenesis). The patients of this study have been strongly motivated, and willing to endure the strong emotional pain provoked by the therapy.
INTRODUCTION The experience of having lost the ability to work is to many people a destiny worse than death; quite surprisingly we have found that this condition is often easily curable with psychodynamic short time therapy [1-6] complemented with bodywork. The key to recovery of working ability seems to be rehabilitation of the patients character [7] and purpose of life [8], as already Hippocrates knew [9]. The basic idea of the therapy is that what limits our performance is not knowing our own talents and not understanding the joy of using these gifts to create value for others. Modern psychodynamic theory states that the lack of personal power primarily is caused by a lack of insight in self, which originally was caused by the patients childhood traumas
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(gestalts) [10-12]. These traumas carry both painful emotions and negative life-denying, decisions, which materialize a negative philosophy of life, which again limits the patients self-confidents, self-esteem, sense of coherence, and willingness to accept lifes challenges. This becomes a major hindrance to the personal development, and shuts the patients life down. OUR STUDY In this study we included the 40 patients that entered our Research Clinic for Holistic Medicine 2004 and 2005, and before starting therapy rated their own ability to work as bad or very bad. In average these patients (from 20 to 60 years, both gender) had about 20 sessions of clinical holistic therapy [10-12] for 1,600 EURO. Most patient paid for their own treatment, indicating a strong motivation to receive the treatment. The clinic was build with financial support from the IMK Almene Foundation, which is a non-for profit organisation supporting research in complementary medicine. The patients approached the clinic themselves, mostly because of recommendation from former patients. The mission of the clinic is to improve psychodynamic short term therapy to make it more efficient and useful for patients with physical, mental, existential, sexual, and working-ability issues. The Body Work was inspired by Marion Rosen and helped the patients to confront old emotional pain from childhood trauma repressed to the body-mind[13], thus accelerating therapy, and making it less painful [11]. See Ventegodt et al 2006 [14] for more details on the study.
SOME OF OUR FINDINGS After the treatment we found that 21 patients (52.5%, 95%CI: 36.1% - 68.5% [15]) rated their working ability as very good (1 patients), good(11 patients), or neither good nor bad (9 patients); 7 completed the treatment but did not improve, and 12 patients dropped out of the study. Table 1 shows the results. We found that the 21 patients who improved their working ability (from 4.2 to 2.4; a radical improvement 1.8 step up the five point Likert scale (p<0.01)) also statistically and clinically significantly improved their self-assessed physical health (from 3.3 to 2.6; 0.6 step up the five point Likert Scale (p=0.01)), self-assessed mental health (from 3.8 to 2.5; 1.3 step up the five point Likert Scale (p<0.01)), self-esteem (from 3.4 to 2.5; 0.9 step up the five point Likert scale (p<0.01)), and their self-assessed quality of life (measured by QOL1[16]) (from 3.7 to 2.4; 1.3 step on the five point Likert Scale p<0.01)). We also found large improvements of QOL (measured by QOL5[16]) (from 3.3 to 2.6; 0.8 step on the five point Likert Scale (p<0.01)), the quality of relations (mean of relation to self, friends, and partner) (from 3.2 to 2.6; 0.7 step on the five point Likert Scale (p<0.01)), general ability of functioning (mean of ability to love, sexual ability, social ability and working ability) (from 3.5 to 2.5; 0.9 step on the five point Likert Scale p<0.01)). Combining quality of life, health, and ability in a measure called QOL10 showed large improvements of the patients whole life (from 3.4 to 2.6; 0.9 step on the five point Likert Scale p<0.01)) (see table 2). This over-all improvement is the indication of the phenomena of holistic healing that Antonovsky predicted and called salutogenesis the inverse process of pathogenesis. A one-year follow up indicated the therapeutic benefits to be lasting [14].
Antonovsky Salutogenesis Related to Work

Table 1. Charateristics of sample
Before After treatment treatment 40 7 0
157
Low or very low self-assessed working ability Self-assessed working ability
Non-responders or dropouts Low or very low self-assessed working ability, non-responder or dropout
40
21; 21/40 = 52.5% (95%CI: 36.1% 68.5%) [15] Fully recovered (good or very good): 12 Improved (neither good nor bad): 9 12 19
Table 2. The 21 patient who improved working ability also improved QOL, relations, and ability in general (p<0.01). They also improved the whole life (QOL10, which is an average of QOL, self-assessed health, and self-assessed ability) Paired T-Test Paired Std. 95% interval of mean difference Lower Upper .1950 .228 1.041
.1865 .1618 .1493 .551 .444 .537 1.329 1.122 1.162
df
Mean
Std.
Significance (2 tailed)
Relations before/after Ability beore/after QOL5 before/after QOL10 before/after
.634 .940 .783 .850
.8938 .8547 .7236 .6680
3.25 5.04 4.84 5.69
20 20 19 19
.00 .00 .00 .00
COMMENTS We have seen 21 patients of 40 recover self-assessed working ability though clinical holistic medicine. Quality of life, health and ability were regained at the same time. We suggest that this happened because the therapy healed the patients existence as a whole. Antonovsky predicted that this dramatic event of total recovery could happen, when sense of coherense was recovered, which is what we are noticing happening; he called this process of healing the patients total life for salutogenesis [17,18]. We find that the present study strongly indicates that Antonovskys concept of salutogenesis might be a key to solve one of the most important problems of our time: how to help people recover their working ability when this is lost to pour health, low self-confidence and self-esteem, and pour quality of life. The secret seems to be to find the patients inner resources and help him set these free.
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We were told that several of the patients actually got full-time work after the treatment, but unfortunately this objective side of the improvement was not well documented in the study, which primarily had an existential focus. Further research is needed to document that improved self-assessed working ability is also actually making the patient regain his job.
CONCLUSIONS Antonovsky predicted that man could heal his whole existence and called this salutogenesis. Clinical holistic medicine seems to be efficient in inducing salutogenesis, and lost working ability seems to be regained in 52.5% (36.1% - 68.5% of the patients, p=0.05). The patients are motivated for human development and engage in existential therapy in spite of this being highly emotionally painful at times where old trauma are confronted and integrated. The study was a non-controlled, non-blinded prospective intervention study. We found that the 21 patients who improved their working ability (from 4.2 to 2.4; a radical improvement 1.8 step up the five point Likert scale (p<0.01)) also statistically and clinically significantly improved their self-assessed physical health (from 3.3 to 2.6; 0.6 step up the five point Likert Scale (p=0.01)), self-assessed mental health (from 3.8 to 2.5; 1.3 step up the five point Likert Scale (p<0.01)), self-esteem (from 3.4 to 2.5; 0.9 step up the five point Likert scale (p<0.01)), and their self-assessed quality of life (measured by QOL1) (from 3.7 to 2.4; 1.3 step on the five point Likert Scale p<0.01)). We also found large improvements of QOL (measured by QOL5) (from 3.3 to 2.6; 0.8 step on the five point Likert Scale (p<0.01)), the quality of relations (mean of relation to self, friends, and partner) (from 3.2 to 2.6; 0.7 step on the five point Likert Scale (p<0.01)), general ability of functioning (mean of ability to love, sexual ability, social ability and working ability) (from 3.5 to 2.5; 0.9 step on the five point Likert Scale p<0.01)). Combining quality of life, health, and ability in a measure called QOL10 showed large improvements of the patients whole life (from 3.4 to 2.6; 0.9 step on the five point Likert Scale p<0.01). This over-all improvement is the indication of the phenomena of holistic healing that Antonovsky predicted and called salutogenesis[17,18] the inverse process of pathogenesis.
REFERENCES [1] [2] [3] [4] Anderson EM, Lambert MJ. Short term dynamically oriented psychotherapy: A review and meta-analysis. Clin Psychol Rev 1995;15:503-14. Crits-Cristoph P. The efficacy of brief dynamic psychotherapy: A meta-analysis. Am J Psychiatry 1992;149:151-8. Svartberg M, Stiles TC. Comparative effects of short-term psychodynamic psychotherapy: A meta-analysis. J Consult Clin Psychol 1991;59:704-14. Leichsenring F, Rabung S, Leibing E. The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiatry 2004;61(12):1208-16
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[7] [8] [9] [10] [11] [12] [13] [14]
[15] [16]
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Leichsenring F. Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data. Int J Psychoanal. 2005;86(Pt 3):841-68 Abbass AA, Hancock JT, Henderson J, Kisely S. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2006;(4):CD004687. Ventegodt S, Andersen NJ, Merrick J. The life mission theory VI: A theory for the human character. ScientificWorld Journal 2004;4:859-80. Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1): 89-91. Jones WHS. Hippocrates. Vol. IIV. London: William Heinemann, 1923-1931. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Global quality of life.Theory, research and methodology. New York: Hippocrates Sci Publ, 2005. Rosen M, Brenner S. Rosen method bodywork. Accessing the unconscious through touch. Berkeley: North Atlantic Books, 2003. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine: Psychodynamic short-time therapy complemented with bodywork. A clinical follow-up study of 109 Patients. ScientificWorld Holistic 2006;6:2220-38. Diem K, ed. Documenta Geigy. Scientific tables. Basel: Geigy, 1962. Lindholt JS, Ventegodt S, Henneberg EW. Development and validation of QoL5 clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life. Eur J Surg 2002;168:103-7. Antonovsky A. Health, stress and coping. London: Jossey-Bass, London, 1985. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Franscisco: Jossey-Bass, 1987.
Chapter 12
MOOD DISORDERS AND SUICIDE

Jong-Min Woo and Teodor T. Postolache
This chapter reviews the evidence estimating an impact of occupational factors on mood disorders and suicide, and the efficacy of interventions. This review is based on literature searches using Medline and Psych INFO from 1966 to 2007 (keywords: work stress, job insecurity, job strain, shift work, violence, occupational health, mood disorders, depression, and suicide). To establish the relationship between occupational variables and mood disorders, we focused on clinically significant disorders rather than depressive symptoms. During the last decade, prospective epidemiological studies have suggested a predictive association between the work environment and mood disorders. Recently, increasing numbers of clinical trials have shown favorable effect size of intervention and suggested preferable return-on-investment (ROI) results. However, low awareness and social stigma still decrease workers access to treatment. Mental health professionals in conjunction with employers have to devise a creative system to make employees more accessible to the quality care being offered. In addition, further outcomes data is needed to evaluate the benefit of managing mood disorders in the workplace, and to foster awareness of positive implications for employees, employers, their families, and the society at large. In addition, the work environment, with its chemical (e.g. chemosensory factors, pollutants), physical (e.g. lighting, noise, temperature, outdoor views and activities), biological (e.g., chronobiological factors, allergens, infectious agents), psychological (e.g. demand-control, effort-reward balance), social (e.g. cohesiveness, support), and organizational (e.g. leadership styles) component should meet minimal standards, and may improve with striving towards the optimum.
INTRODUCTION Work and love are two major domains of our lives from which most people get satisfaction and find meaning; at the same time these can act as life-threatening stressors. Rapid economic change is one of the most significant aspects of our times. Behind the curtain of world economy globalization, the occupational environment is delivering increasing stress, such as job insecurity, increasing workload, and the burden of lifelong learning. Larger proportion of
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employees became involved in service- and knowledge-based industries which require heavy technological preparedness and mental stress. If the pace of change exceeds the capacity of the workers to cope, negative stress reactions can occur. These include psychosomatic reactions (e.g. depression, insomnia) as well as vocational consequences (e.g. job dissatisfaction, decreased organizational commitment, reduced job performance, and absenteeism) [1]. Negative stress reactions are not limited to the individual worker, but also the workers family, and the community in which they live. More attention is required to psychosocial impact of psychosocial work environment than to physical impact of physical environment. It is well-known that mood disorders cause the largest disease burden in general population and loss of work productivity in working population [2]. It seems that at least 5 % of the workers are affected by mood disorders. Using the National Comorbidity Survey Replication, Kessler and coworkers [3] reported that 1.1% of the workers met criteria for bipolar disorder (I or II) and 6.4% for major depressive disorder (MDD). A study of 24,000 working Canadians also reported that 4.6 % met criteria for major depressive episode (MDE) in the past year [4]. The Office of Applied Studies (OAS) of Substance Abuse and Mental Health Services Administration (SAMHSA) also reported that an annual average of 7.0 % (10.1% for female vs. 4.7% for male) of full-time adult workers experienced a MDE in the past year [5]. Some researchers propose that increasing work stress can be associated with the increasing prevalence of depressive disorder and suicide [6-8], but whether it is just a coincidence or any causal relationship has yet to be defined. Therefore, while the effect of depression on functioning has received substantial attention, we have to obtain a greater understanding of the impact of the work environment on mood disorders in order to prevent significant losses to both the individual and society. How many social resources have to be invested in this area? Who has to take care of these problems? In what areas do we have to intervene first? Given the multiple potential variables proposed to be related in this matter, we would like to clarify the terms and concepts to answer to those questions.
CLARIFICATION OF THE DIAGNOSIS Most of the past researches have focused on psychological distress symptoms (depression, dysphoria, and burn-out) showing elevated rates in workers with higher job stress [9-11]. Yet solid studies on clinically significant psychiatric disorders have not performed until very recently [5,7,12]. There are some important differences between subclinical symptoms and clinically significant psychiatric disorders. On the individual level, differences between psychological symptoms and clinical conditions seem to be marked by symptomatic constellations, duration of symptoms and functional impact. As subclinical mood symptoms are by far the common in everyday lives of workers, it is reasonable to use those concepts in occupational research. However, the severity and impact on health care system and productivity are much more detrimental in mood disorders compared to symptoms. Furthermore, if we try to manage these problems, medical implications are quite different. Subject population has to be clearly categorized to define the amount of loss from direct medical cost and to compare it with other conditions. Thus, using definite diagnostic categories like such as those from the Diagnostic
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and Statistical Manual of Mental Disorders (DSM) [13], although having their own imperfections, are preferable in performing health economics studies, such as costeffectiveness analysis, cost-benefit analysis, and the return-on-investment (ROI) analysis. These studies are essential to decide how much investment is required to address a certain problem and who has to take care of this new social epidemic. The community knows that work can be stressful and cause distresses including a few depressive symptoms. Based on this empirical knowledge, we can easily decide to put public revenue into management of depressive symptoms. However, what about clinically significant depressive disorders? Can the working environment directly cause a depressive disorder which requires intensive clinical attention and cost a lot of money? If then, the risk is placed on the employers. However, if the work environment can only trigger the onset or aggravate mood disorder of a vulnerable worker who is destined to get it, it is more likely that the burden should belong to an individual employee. This may potentially result in huge political and economic ramifications. In this article, we will put more importance on mood disorders rather than symptoms based on their unique health outcome and medical concerns. Depression can be re-classified into three forms - MDE, depressive syndrome, and dysphoria and examined their differential association with occupational variables [6]. Depressive syndrome (which is equivalent to a subsyndromal major depression) shows some symptoms of DSM-? MDE criteria A, but does not fulfill all criteria for MDE. Dysphoria signifies having feelings of sadness or unhappiness. We differentiated previous studies according to the diagnostic methods which were used (see table 1).
RELATIONSHIP BETWEEN OCCUPATIONAL ENVIRONMENT AND MOOD DISORDERS In general, there is a consensus that acute and chronic life stressors can lead to psychological and physical responses. Workplace can also make manifest latent mood disorders, destabilize, and aggravate symptoms and courses of mood disorders among workers. The relationship between occupational environment and mood disorders seems to be reciprocal, creating vicious cycles in many cases (see figure 1). For example, depressive episodes resulting from work-related stress can impact vocational performance by presenteeism (reduced work productivity while present at work) due to decreased concentration, reduced motivation, and decision errors, as well as absenteeism (lost productivity from absence, e.g. non-attendant workdays, arriving late or leaving earlier than usual). Negative feedback from the organization, decreased self-esteem, and reduced salary may follow and add on the stress level of depressed workers. If these impacts persist or get worse, more serious mental health outcomes, such as chronic disability and suicide attempt, as well as vocational consequences including repeated job loss can threaten the identity as a working people. Unemployment and job loss have been consistently reported to raise the risk for depression and suicide attempt, especially in young workers [14,15]. Depressive workers may perceive their environment more desperate and frustrating, so they can lose motivation for problem solving and have a tendency to rely on unhealthy habits. These can lead to more frustration in real life, making them more depressed. Methodological limitations can cause controversies in assessing the relationship between work stress and mood disorders. Self-report method can influence a reporting bias, as
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common perceptual set influences the reporting of both the causal and outcome variables. In addition to acute loss of income and overall socioeconomic status, overwhelming financial stress, inability to support oneself and ones dependants, narcissistic frustration to unwanted change in career can contribute to the association between job loss, or being demoted, and depression [16]. The effects of low occupational status can be confounding variables intermingled with the effects of work stress [11]. Childhood depression can increase the risk for psychiatric disorders in adulthood which can lead to more stressful jobs [17]. Moreover, having a personality disorder comorbid with mood disorders may increase troubles at work, which could elevate work stress. As randomized studies are not feasible in this domain, large scale longitudinal cohort studies are necessary to understand the direction of causality. However, we can keep in mind that workplace can function as a secure base for promoting mental health. It is desirable to focus on how to get rid of any potential risk rather than who is more responsible to it. Most of the workers spend more time at work than at home when they are awake. Therefore, it is quite reasonable to manage their health problems at the workplace, regardless of the cause. Table 1. Diagnostic methods for three levels of conditions related with mood disorder
Psychological Well-Being Self-rating scale Symptoms Self-rating scale Disorder Clinical Diagnosis with/without structured interview Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) National Institute of Mental Health Diagnostic Interview Schedule (DIS) Structured Clinical Interview for DSM Disorders (SCID) The World Health Organizations Composite International Diagnostic Interview (CIDI)
General Health Questionnaire (GHQ)
The Center for Epidemiological StudiesDepression (CES-D) Beck Depression Inventory (BDI) Hamilton Rating Scale for Depression (HAM-D) The Profile of Mood States (POMS) Zung Self-Rating Depression Scale (ZDS)
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Figure 1. A mModel of oOccupational stressors and mood disorder. Absenteeism: sickness absence, early leaving, late arrival; Presenteeism: reduced performance while present at work; MDD: Major Depressive Disorder; PTSD: Post-traumatic Stress Disorder; CVD: Cardiovascular Disorder
ARE CERTAIN OCCUPATIONS MORE DANGEROUS? From the public health perspective, it is very important to define the risk for mood disorders by occupational categories. This is also important in regard to workers mental health claims and compensation issues. We have to explore and target the dangerous trades to establish priorities in policy making and to set up an effective primary intervention system [18]. Many studies have established a connection between occupations and depressive symptoms [5,8,19]. Some professions and their occupational characteristics are suggested to have association with diagnosable mood disorders and suicide. Employment in human service occupations (e.g. health care, education, and social work) is consistently reported to display high risk for mood disorders [20]. Some occupations (e.g. lawyers, dentists, artists, machinists, auto mechanics, and carpenters) are suggested to have higher risk for suicide, while others (e.g. clerks, elementary school teachers, and cooks) are reported to have lower risk [8]. SAMHSAs recent report [5] also demonstrates that the rate of depression varies by occupation and industry. Among the 21 major occupational categories, the personal care and service occupations (10.8 %) followed by the food preparation and serving related occupations (10.3 %) recorded the highest. Engineering, architecture and surveying (4.3%), life, physical, and social science (4.4%), and installation, maintenance, and repair (4.4%) recorded the lowest rates of the past year MDE. It is not yet clear whether the alleged risk of certain occupations is due to the occupational stressors associated with them or due to the sociodemographic factors of the workers in those occupations [21]. However, poor work conditions (e.g. physico-chemical environment, shift work, jet lag, and long working hours) and high job stress (e.g. high demand with low control, insufficient reward) are suggested to be the common cause of risk in some occupations in many studies [7,12,22]. For example, excessive exposure to
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occupational toxicants, irritants, odors, extremely hot or cold temperature, and severe noise, as well as inadequate lighting can contribute to the poor response to treatment of and exacerbation of psychiatric conditions, including mood disorders.
CHEMICAL ENVIRONMENT Acute and toxic exposure can definitely lead to organic brain damage with cognitive and behavioral impairment. Chronic exposure to low-to-moderate dose can cause anxiety and mood disturbances [23]. Specifically, lead exposure with increased blood lead level can contribute to depression and anxiety [24,25]. One study has found that even low levels of lead exposure can overstimulate protein kinase C [26] which is involved in dysregulation of affect and behavior, which can be a feature of many psychiatric disorders including bipolar disorder. Exposure to lead can give more impact to people who are genetically predisposed to mood disorders. Neurotoxic levels of organic mercury also contribute to high prevalence of depression and anxiety among chemical workers after acute exposure as well as chronic exposure to high levels [27,28]. Organophosphate (OP) pesticides are widely used in agriculture. They are rapidly absorbed and exert their toxic effects. Acute and moderate OP poisoning has been reported to induce depression, anxiety, and irritability [29,30]. Beseler and his colleagues reported nearly six times risk for depression after OP pesticides poisoning among farmer applicators. They also reported the increased odds of having depression (odds ratio (OR) = 3.26; 95% confidence interval (CI) 0.91-1.31) in the presence of a history of pesticide poisoning among farm women who are not themselves applicators [31,32]. In United Kingdom, there have been social debates on the effects of sheep dip on farmers depression and suicide. Sheep dip is a kind of OP compounds which is used to protect sheep from external infestation. Anecdotally, use of sheep dip has been linked with flu-like syndrome, such as headache, limb pains, fatigability, sleep disturbance, poor concentration, mood change and suicidal thoughts [31,33]. However long-term health effect to long-term low-level exposure is not clear. Some researchers report probable association between chronic low dose exposure and depression [31], but others suggest that this relation is only temporary, nonspecific, and involves psychological mechanism rather than physical [33,34]. Exposure to organic solvents has been consistently reported to be associated with depression [35,36]. Rayon manufacturing workers can suffer depression as well as other neurological disturbances due to chronic exposure to carbon disulfide [37]. Prevalence of mood and anxiety disorders is significantly higher among workers who used organic solvents [22]. Chronic low-level exposure to substances in modern ordinary environment can also cause mood disturbances with many somatic complaints, so called idiopathic environmental intolerance or multiple chemical sensitivity (MCS), which involve mood symptoms and syndromes [38]. Odors can also alter mood, cognition, and behavior. Some kinds of odors can elevate the level of mood and activity, while aversive odors can make depressive patients more depressed. For example, exposure to pleasant odors elevate mood both in healthy adults [39] and in depressed patients with seasonal affective disorder (SAD) winter type [40], who have been reported to have a greater olfactory acuity than control subjects [41]. Olfactory neurons
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are only two synapses away from the amygdala, which is known to be a part of the neuronal circuitry of anxiety and depression, and can be activated by olfactory aversive stimuli [42]. Workers can be exposed to various levels of odors, aromas and irritants at workplace. For example, workers in the swine industry or at slaughter houses can be exposed to extreme pungent odors for a long period. On the other hand, excessive odors of any hedonic valence can be difficult to bear and fragrances can also act as irritants when present in very intense concentration. People who are more sensitive to odorants than others can suffer from MCS [43]. It is important to note that some chemicals may cause irritation at levels below which their odor can be detected. Therefore, setting occupational exposure limits (OELs) for odorous or irritating chemicals is needed to promote safety at work [44]. Positive environmental interventions using odors to improve mood are difficult, except in relatively confined work spaces which allow individualized approaches, as peoples individual sensitivities, preferences, and behavioral effects vary. We strongly believe that affecting even a few negatively to affect many positively is not an ethically acceptable approach for an occupational environmental consultant.
PHYSICAL ENVIRONMENT In humans, light has potent biological and therapeutic effects. Light also suppresses melatonin secretion [45], modulate the release of serotonin [46], shifts the circadian rhythms according to a phase response curve [47] and is necessary to synchronize circadian rhythms in humans [48]. Bright light and the deprivation of it can affect the internal biological clock, sleeping patterns, and energy levels [49]. Sensitive individuals may notice changes in their mood associated with the doses of sunlight exposure, such that they may feel gloomy during long stretches of cloudy winter days and experience mood improvement on sunny summer days. Poor lighting conditions at work represent a factor that may be conducive to depression, especially in patients with syndromal or subsyndromal SAD, which together reach 15% to 20% prevalence at temperate latitudes [50]. Prolonged reduction of exposure to light in winter can affect the mood status of an individual vulnerable to seasonal changes or who already has spent too much time indoors. Especially for, but not confined to, this population, bright lighting at workplace can improve mood status of workers. Bright light therapy is supported by the American Psychiatric Association for the treatment of patients with major depression [51], as it has demonstrated its effectiveness not only for SAD but also as an adjunct in MDD or dysthymia with seasonal exacerbations. Bright light might be also beneficial for mood in healthy people [49]. Beyond usage of an artificial light treatment device, it is important to mention that in one study of patients with SAD, a one hour walk outside each day for one week significantly reduced depressive symptoms, with no significant relapse after withdrawal. The response rate of 65% was similar to the results of previous studies with bright light treatment by the same group [52]. In general, increasing outdoor activities on weekends, being exposed to morning light during winter, and taking outdoor breaks can be recommended to workers. With a consideration for a personalized space, a location near a window would be strongly recommended for individuals with SAD. In the absence of a window, workers with SAD should be encouraged to use a light treatment device close to their workspace during the fall and winter. Obviously, for those individuals, the treatment should be supervised by a qualified professional.
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The temperature conditions, as well as humidity and air flow, which greatly affect thermoregulation, of outdoor and indoor work are also important for patients with mood disorders, as thermoregulatory neurotransmitter and neurotransmitters of mood regulation overlap, and weather and individual mood may be related [53]. Exposure to heat was suggested to be a triggering mechanism in vulnerable individuals of summer SAD, which shows depression during the summer and spontaneous remission in the fall [54]. This would suggest that air conditioning may be an important preventive intervention for these individuals, but recent research failed to confirm this hypothesis. In Romania, a country with hot summers and relatively few microenvironments with air conditioners, those who possess an air conditioner have a higher, rather than lower, rate of summer SAD [55]. Hot temperatures can also be associated with increased perspiration, dehydration, and increased toxicity risks from psychotropic medications used in mood disorders. Exposure to noise can be a particular stressor and predict irritability, somatic complaints, anxiety, and depression [56]. While intense noise is difficult to bear for practically anyone, even mild or intermittent noise may affect certain vulnerable subjects with noise annoyance (the emotional reaction to noise at exposure). Noise annoyance is associated with noise sensitivity (the physiological reaction to noise), which is an individual trait quite stable over time and may predict depression [57].
BIOLOGICAL FACTORS The discussion of occupational parasitic and bacterial infections is beyond the scope of this article. However, we will mention that, in a routine working environment, infectious agents, pollutants which contain endotoxin of bacterial origin, and aeroallergens are commonly encountered. As upper respiratory infections have a very high incidence, allergies have a very high prevalence [58]. Changes in allergic symptom severity correlate with changes in depression symptom severity in patients with mood disorders exposed to environmental peaks in aeroallergens [59]. Additionally induction of inflammation in the upper airway results in increased cytokine gene expression in the brain and depression-like behaviors in laboratory animals [60]. Therefore, efforts to reduce exposure to viruses, pollutants, allergens, and bacteria cannot be overemphasized.
SHIFT WORK AND JET LAG Sleep disturbance is a very important risk factor for depression, bipolar disorder, and suicidality [61,62]. Sleep impairment can be a common factor in mood disorders which could be aggravated by work environments either as sacrificed duration of sleep to catch up with work or as a consequence of mood disorders. Modern society is by and large sleep-deprived. In addition to impaired sleep, the timing of sleep and activity is essential for both performance and well being. Lets look around us. Doctors, nurses, police, emergency services, gasoline stations, pharmacies, grocery stores and many others work on a 24 hours schedule. On interstate highways, huge tractor trailers are driving mainly at night to avoid roadblocks related to rush hours, and train and airport operators work many night hours.
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Shift work is suggested to increase the risk of developing or aggravating mood disorders at least in vulnerable individuals [63]. High incidence of MDD was observed during and after shift work experience and this risk is associated with the duration of exposure [64]. Some researchers deny direct effect of night shift on mood disorders and suggest that job characteristics or other organizational factors are related to the association between them [65,66]. Further examination of these issues is needed with improved research designs including consideration of particular shift work rotation schedules. Treatment of shift work sleep disorders involves institutional, micro-environmental, and individual approaches. Institutional intervention includes the shift protocol and the occasional medication focusing on circadian rhythm sleep disorder, jet leg type. Micro-environmental intervention includes the lighting and rest/nap schedule at work. Individual approach includes informed allocation of time and timing for personal needs vs. work and scheduling sleep and wake. Factors to promote sleep and wake at adverse timing includes bright light, avoidance of light, and wake promoting agents in more severe or refractory cases. Treatment and prevention of jet lag includes elaborated schedules of light exposure and avoidance, creating portable microclimates to promote sleep in adverse conditions, timed administration of melatonin, and sleep promoting or wake promoting pharmacological agents. Use of bright light to alleviate mood disturbances associated with shift work needs extensive empirical testing [63]. The in depth discussion of these interventions is beyond the scope of this article. However, shift work and jet lag should always be a consideration for clinicians treating patients with recurrent mood disorders, or at risk for suicide. In certain cases of high risk (e.g. bipolar I disorder), the physician should advocate medical leave or even vocational change.
PSYCHOLOGICAL WORK ENVIRONMENT AND MOOD DISORDERS There are established correlations between high level of occupational stress and a wide range of mental health problems [7]. Recently, several longitudinal studies reported the important role of work stress in developing clinically diagnosable mood disorders. An epidemiological study revealed that work stress can be an independent risk factor for the development of MDE [67]. Workers presenting scores of work stress above the 75th percentile had an elevated risk for MDE (7.1%) and work stress was significantly associated with the risk for MDE in multivariate analysis (OR = 2.35, 95% CI 1.54-3.77). In addition, high job demands (excessive workload, extreme time pressures) increased the risk for MDD or generalized anxiety disorder (GAD) twofold and were associated with the onset of new MDD and GAD in previously healthy young workers [7]. However, work stress may only play an additive role in the manifestation of a preexistent condition among vulnerable individuals, e.g. having a chronic pain condition [68]. Two models have long been proposed to explain the job characteristics and health implications of work stress; the Demand-Control (DC) model by Karasek and the EffortReward Imbalance (ERI) model by Siegrist [69,70]. Some studies have reported that ERI and low control at work are both associated with depressive symptoms [71]. The DC model is based on the very simplified assumption that the characteristics of the job itself, rather than the perception of an individual worker, induce job strain that can predict a broad range of health and behavioral outcomes [69]. This model characterizes the job according to the combination of two basic dimensions: job demand and control. Control, or
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decision latitude, includes the two factors of skill use and decision authority. According to this model, high strain - a combination of high demand and low control - at work will lead to psychological stress, which can eventually lead to chronic disease, including depression [34]. Lack of control, in particular, is a relatively consistent predictor of depression [72,73]. Overall, the proportion of variance in depression explained by job strain factors varies from approximately 10% to 50%, with a wide percentage margin, due to the difference in measures used [11]. The ERI model is based on the broader concept of the job, including work role, and reflects the individual workers emotional needs and characteristics. This model proposes that insufficient reward (income, esteem, occupational status control) compared to workers effort (demands and obligations) can lead to adverse health effects. Most of the studies using Siegrist's ERI questionnaire suggest a positive relationship between ERI and depression [71,74]. An extensive review of the ERI model concludes that employees working in a higheffort- low-reward situation had a significantly elevated risk for psychosomatic symptoms including depression [75]. As these two models examine broader societal and economic outcomes, as well as medical outcomes, most of the studies using these models have discussed only general symptoms rather than clinical disorders. However, a series of recent reports have demonstrated that these models can be validly applied to clinically diagnosed mood disorders [4,6].
SOCIAL ENVIRONMENT AT WORK Every worker has relationships with others, whether or not these are supportive, neutral, or full of conflicts. The social environment at work can predict the prevalence and severity of depression in most occupational groups. The level of social support can modulate the effect of work stress on depression [72]. Karaseks DC model is extended to include the degree of social support and thus becomes the Demand-Control-Support model [76]. A socially isolated status means neither supportive co-workers nor supervisors present. On the other hand, too much interaction with others can be also troublesome [77]. Interpersonal conflicts at work predicted an increased risk for psychiatric morbidity. Violence, threatening, bullying, and sexual harassment can be some of the most severe cases of stress from other workers. Employment in occupations involving exposure to work-related threats and violence is a strong risk factor for depression and stress-related disorders in both genders [78]. Recently, a group of European researchers raised the concept of justice at work to represent the organizational climate and social relations [79,80]. The components of justice at work are consistent and sufficient information from the line manager, the line managers listening to problems about work and praise, as well as the absence of unfair criticism. The relevant research suggests that employees who perceive that they are treated unfairly by their supervisors are at increased risk of poor mental health. In addition, workplace bullying is a significant risk factor for incident depression in employees. On the other hand, an increase in fair treatment reduces the risk of mental health problems [80].

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We can assume biological, psychological, psychosomatic, and behavioral mechanisms contribute to the influence of work stress on the risk for of mood disorders. While the effects of the discussed physico-chemical factors pertinent to the work environment have multiple mechanisms which would require a discussion with a length which will surpass the scope of this article, we focus here only on the effects of social and psychological factors associated with work. Any intense of sustained stress elevates corticosteroids, and persistently elevated corticosteroids can directly affect brain structure [81] and can induce down-regulation of the glucocorticoid receptors, thereby impairing affect regulation [82]. Rydmark [83] reported that the cortisol response to corticotropin-releasing hormone (CRH) showed significantly dampened response in patients with job-stress related depression. However, prefrontocortical and hippocampal volumes were not changed. This contrasts to what has been described in MDD and suggests the difference between endogenous depression and reactive depression due to environmental change. High job demands and lack of decision latitude implies an inability to influence ones own condition and may induce feelings of helplessness and hopelessness. If this continues for a long time, an individual can be conditioned to learned helplessness, which is a well known psychological cause and manifestation of depression. Work stress can result in psychosomatic symptoms, such as fatigue, sleep disturbance, and concentration difficulty, all of which can be both symptoms and risk factors for mood disorders. Finally, behavioral difficulties, such as inability to engage in leisure activities and to maintain strong social networks, can lead to mood disorders [76].
GENDER IMPLICATIONS Certain work related risk factors and triggers for mood disorders and suicide are different in men and women. For example, a recent Canadian survey showed that men with high strain jobs and women with low decision authority had elevated odds of incident depression, while lack of social support was related to depression in both gender. This result may reflect the difference in the types of jobs held, as many women tend to take less-strained jobs to balance work and family [4]. The fact that women are absent from work more often than men is a very often reported finding [84], but there is very limited explanation as to why this is so [85]. An often suggested explanation is that womens high rates of absence are related to them bearing the majority of the load in childcare and family responsibilities. However, despite the face validity of this double burden (childcare and work) hypothesis, it is not supported empirically [85]. In fact, more recently, it appears that there is no difference between absenteeism for childcare reasons between men and women. Also, having more children is a factor reducing rather than increasing absenteeism in women [86]. In fact, women with multiple roles have better health, stronger relationships, and less depression [87]. As such, one very likely explanation for an increased absenteeism in women is their poorer health, including physical symptoms, insomnia, migraine headaches, and depression [88]. It is well known that depression and anxiety disorders are more prevalent in women. Many biological, psychological and social factors have been proposed to explain this difference in prevalence. Among occupational factors which could add to a potential increased vulnerability of women
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to depressogenic factors, we mention implicit and explicit work discrimination, such as lower salaries, more difficult promotion, and an increased risk to be bullied or harassed. In regard to suicide, it is well known that women attempt suicide more often, often with overdoses, but that men commit suicide more often. However, certain occupational considerations may increase the risk of completed suicide in women, such as availability of lethal poisons, or professional knowledge to use them to lethal ends. For instance, older generation pesticides, more lethal in overdose, are responsible for the greater rate of suicide completion in women than in men in China as compared to the rest of the world [89,90]. In the hands of doctors and nurses, means of self-poisoning, which otherwise would result only in suicide attempt, result in suicide completions because of professional knowledge to use them more effectively and increased access to lethal doses [91].
JOB INSECURITY AND UNEMPLOYMENT There is no guarantee that high-caliber professionals or the most profitable company of this year will survive some years later in this era of globalization. Tougher competition, organizational restructuring, and abrupt lay-offs can cause negative affect, such as feelings of insecurity, inferiority, and uncertainty about the future. Job loss can damage ones self-esteem and cause feelings of helplessness which can continue for some years. Job loss and unemployment can trigger the chain of adversity: financial and relational strain, being trapped in worries of another job loss, and loss of personal control, and these can lead to depression and even suicide [92,93]. Suicide risk is strongly associated with unemployment, lack of job security, and sickness-related absence from work especially in male subjects [94,95]. On the other hand, some jobs might be as bad for mental health as no job at all. The unemployed reported worse health when compared to all employees, but poor quality jobs (i.e. those featuring high job insecurity, low marketability, and high job strain) were also associated with worse health when compared to jobs with fewer or no stressors. And bad jobs with combined psychosocial stressors were as bad for ones health as having no job [14]. Nonstandard employment, such as part-time work, temporary work, and daily work, were shown to lead to increased depression and suicidal ideation [96].
WORK-RELATED SUICIDE Workplace suicide is the most severe outcome of mental health problems at the workplace. Whether it is associated with work-related stress (e.g. karo jisatsu - suicide from overwork) or just takes place at the victims workplace (e.g. on-the-job suicide), it signifies detrimental loss to the victim and his/her family members, colleagues, and workplace as a whole. Some occupations have more suicide risk than others. The data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) indicated the highest relative risk (RR) of on-the-job suicide among police and detectives in public service (RR 6.99) and workers in military occupation (RR 5.39) [97]. Access to lethal weapons can be an occupation-specific risk factor for suicide in the police and military personnel [98], as well as accessibility and knowledgeable use of poisons increases the risk of overdose suicide in medical personnel [91]. Total number of workplace suicide victims was the highest in
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managerial and professional specialty occupations. On-the-job suicide may not be related to work-related issues or exposures, but this result can be applied to devise suicide prevention strategies for professions at risk. Severe work stress can be an important risk factor for suicide, especially when combined with individual characteristics and poor social support [15,94]. A prospective study investigated the association between psychosocial job characteristics and the risk for completed suicide among Japanese male workers. The result showed that low control at work increased the suicidal risk more than fourfold [99]. A psychological autopsy also showed that most of the suicide victims had suffered from low social support, high psychological demand, low decision latitude, and long working hours [100]. Even though half of them saw a general practitioner because of unspecified somatic complaints, none of them had a psychiatric consultation and effective treatment of job stress or depression. This result calls for appropriate countermeasures, including job redesign aimed at increasing workers control and psychiatric quality care to treat workers under stress. Systemic interventions to increase awareness and destigmatize mental health, and regular monitoring for high-risk populations are also in urgent need. Listing telephone numbers with suicide crisis hotlines in every directory, with confidential telephone calls and also availability of referral networks are expected to also contribute to a reduction of work related suicides. Reducing access to suicide means, such as high places from where one can jump, firearm policies, ceilings fixtures which would not be able to support a human body in case of hanging, and work flows which encourage human contact and reporting concerns to a supervisor immediately might be beneficial. Identifying temporal windows of possible increased risk, such as recent hire, being demoted or promoted, being transferred, being laidoff, and offering free counseling may also represent positive steps.
TOWARD THE HAPPIER, HEALTHIER, AND MORE PRODUCTIVE WORKPLACE As the occupational factors involved in mood disorders are various and complicated, interventions can be devised at multiple levels of approaches. Interventions can be classified into individual approaches and organizational approaches. Individual approaches can include traditional psychiatric/psychological interventions in a clinical setting, such as cognitivebehavioral treatment and pharmacotherapy. Stress reduction programs, such as teaching effective coping skills and relaxation techniques, may help workers to manage work stress better and reduce their risk of depression [101]. An extensive review reported a moderate effect from cognitive-behavioral interventions and multimodal interventions, and a small effect from relaxation techniques [102]. Pharmacotherapy with psychiatric quality care to the clinical population has consistently proven the cost-effectiveness and cost-benefit to both employers and employees [103,104]. However, some investigators are quite skeptical towards the long-term benefits of these individual approaches, because they usually will not change the root cause. The organizational approach focuses on an assessment of hazardous work conditions and a mobilization of organizational resources to support workers mental health. Though this could be theoretically ideal, the feasibility requires testing. It is very difficult to tell which specific occupational factors contribute to the development and/or worsening of mood
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disorders. It is also more difficult for an individual worker to change the nature of his workplace and occupation. Only a few reports showed the efficacy of the organizational approach towards general symptoms [105]. The authors could not find such a report on clinically diagnosed psychiatric disorders. The irony that some workers can do even more harm to the organization while present at work suggests the need of more active intervention at the organizational level. For example, more and more executives are affected by stress from an unpredictable economy, increasing responsibility, and pressure to keep up profitability. If some executives have a vulnerability of or already suffer from mood disorders, work stress may wreak more havoc on his or her mental health over time. Emotionally unstable executives can cause disturbances in the company and make an irrevocable loss to the whole organization. In those cases, it is quite clear that unstable executives had better to take a few weeks leave of either personal or medical, make more personal time, and take proper evaluation and management in order to get back to normal performance level. It is beneficial both for the individual and the organization to develop a more accessible system which can provide practical solutions with timely referral to professional care. At some point of treatment, psychiatrists and other health professionals can recommend the worker to take leave of absence. Educational efforts need to take place at the level of the organization to help the management keep in mind the greater negative effects of presenteeism as compared to absenteeism on the organization as a whole. We should not wait until the workers become aged and suffer from chronic problems. Rather, long-term interventions must be started from young adulthood or even adolescence. Significant numbers of new cases of depression can be attributable to work stress and younger workers with depression are suffering from even more severe absenteeism [106]. Adequate interventions may significantly improve employment outcomes and reduce workplace conflicts in depressed employed persons [107]. Preventing and managing mood disorders among workers is the ultimate issue. Organizational concern and effort can save money while creating a healthier, happier, and more productive workplace. If a worker in the service industry is not happy by any means, he or she cannot smile at the customers, cannot be kind enough, can ruin the relationship with them, and cannot keep the sales record as a result. If a researcher in the information technology industry is emotionally neither healthy nor stable, he or she cannot generate creative and feasible ideas and thus cannot be productive.
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What, in our opinion, is an ideal work environment for the workers with mood and anxiety disorders? We summarize the requirements for the optimal mood-friendly, and thus more productive, workplace in table 2. Considering the enormous impact of mood status on the performance level, more comprehensive professional consultation service, requiring medical, psychological, and organizational knowledge and experience, is urgently needed. This
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sophisticated specialty can presumably be called thymo-ecological consultation which focuses on optimizing affective status of workers by manipulating various environmental conditions, both at an individual and an organizational level. Psychiatrists with occupational or organizational experience and occupational physicians with proper psychological training can be candidates for this new professional area. For example, shorter working hours, monitoring the environmental risks on mood status, using noise canceling headphones, allowing one to take outdoor walks or naps (in a nap space) during the workdays, access to a window based on vulnerabilities, and managing behavioral risks are several examples of recommendations from a thymo-ecologically minded occupational consultant.
CONCLUSIONS Mood disorders have a close relationship with occupational environment in a working population. Depressive disorders cause more severe functional impairment than any other illness; suicides, as well, cause great loss. These losses are not confined to the individuals they directly affect, but are substantial in our society. However, the government and companies have little awareness of and, thus, limited investment in them. Considering the Table 2. Checklist for an ideal work environment. SAD: Seasonal affective disorder robust evidence proving efficacy of treatment for depression, the investment and unprejudiced attention of employers would be very helpful to their employees' mental health and business productivity. These efforts are expected to reduce suicide risk factors such as depression, hopelessness, and sleep impairment. Finally, adequate efforts for increased awareness, education, early detection and referral, help hotlines, availability of counseling, as well as asking about suicide ideation/intent/attempts during routine medical checkups, may contribute to a reduction of work-related suicide and suicide in general, a public health priority.
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[91] Agerbo E, Gunnell D, Bonde JP, Bo Mortensen P, Nordentoft M. Suicide and occupation: the impact of socio-economic, demographic and psychiatric differences. Psychol Med 2007;37(8):1131-40. [92] Price RH, Choi JN, Vinokur AD. Links in the chain of adversity following job loss: how financial strain and loss of personal control lead to depression, impaired functioning, and poor health. J Occup Health Psychol 2002;7(4):302-12. [93] Claussen B, Bjorndal A, Hjort PF. Health and re-employment in a two year follow up of long term unemployed. J Epidemiol Community Health 1993;47(1):14-8. [94] Johansson SE, Sundquist J. Unemployment is an important risk factor for suicide in contemporary Sweden: an 11-year follow-up study of a cross-sectional sample of 37,789 people. Public Health 1997;111(1):41-5. [95] Lewis G, Sloggett A. Suicide, deprivation, and unemployment: record linkage study. BMJ 1998;317(7168):1283-6. [96] Kim IH, Muntaner C, Khang YH, Paek D, Cho SI. The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Soc Sci Med 2006;63(3):566-74. [97] U.S. Department of Labor, BoLS. An Analysis of Workplace Suicides, 1992-2001 [Web Page]. 28 January 2004; Available at http://www.bls.gov/opub/cwc/ sh20040126ar01p1.htm. (Accessed 15 October 2007). [98] Mahon MJ, Tobin JP, Cusack DA, Kelleher C, Malone KM. Suicide among regularduty military personnel: a retrospective case-control study of occupation-specific risk factors for workplace suicide. Am J Psychiatry 2005;162(9):1688-96. [99] Tsutsumi A, Kayaba K, Ojima T, Ishikawa S, Kawakami N. Low control at work and the risk of suicide in Japanese men: a prospective cohort study. Psychother Psychosom 2007;76(3):177-85. [100] Amagasa T, Nakayama T, Takahashi Y. Karojisatsu in Japan: characteristics of 22 cases of work-related suicide. J Occup Health 2005;47(2): 157-64. [101] Mino Y, Babazono A, Tsuda T, Yasuda N. Can stress management at the workplace prevent depression? A randomized controlled trial. Psychother Psychosom 2006;75(3):177-82. [102] van der Klink JJ, Blonk RW, Schene AH, van Dijk FJ. The benefits of interventions for work-related stress. Am J Public Health 2001;91(2):270-6. [103] Lo Sasso AT, Rost K, Beck A. Modeling the impact of enhanced depression treatment on workplace functioning and costs: a cost-benefit approach. Med Care 2006;44(4):352-8. [104] Wang PS, Patrick A, Avorn J, Azocar F, Ludman E, McCulloch J, Simon G, Kessler R. The costs and benefits of enhanced depression care to employers. Arch Gen Psychiatry 2006;63(12):1345-53. [105] Mikkelsen A, Saksvik PO. Impact of a participatory organizational intervention on job characteristics and job stress. Int J Health Serv 1999;29(4):871-93. [106] Druss BG, Rosenheck RA, Sledge WH. Health and disability costs of depressive illness in a major U.S. corporation. Am J Psychiatry 2000;157(8):1274-8. [107] Smith JL, Rost KM, Nutting PA, Libby AM, Elliott CE, Pyne JM. Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added? J Ment Health Policy Econ 2002;5(1):43-9.
PART III: TRAVELLING AND INSPIRATION FOR DEVELOPMENT AS LEADER
Chapter 13
TRAVEL AND SHIFT WORK

Tatiana Menick and Teodor T. Postolache
Jet lag, a circadian rhythm sleep disorder associated with transmeridian travel, is the result of many factors, the most important ones being misalignments between the light-dark cycles of origin and of destination, and between the social demands at the place of destination and internal, biological, representations of day and night which govern our abilities to fall asleep, stay alert and perform. Most of the time, sleep deprivation compounds the misalignment effects. The demands and the duration of the trip, as well as the direction and number of time zones crossed, and prior vulnerability to jet lag should determine if and how to treat jet lag. Treatment options include simple measures involving bright light exposure and avoidance, bright light treatment, timed meals, and exercise, and, sometimes, melatonin, short acting hypnotics, and alertness promoting beverages and pharmacological agents. Given the longterm health implications of circadian rhythm sleep disorder, and their impact on individuals and society, further research and more effective treatments are needed.
INTRODUCTION The past is a foreign country; they do things differently there. The words of novelist Leslie Poles Hartley (1895-1972), described the folkways of rural England at the turn of 20th century, but equally true of our more distant forebears. They spent more time outdoors than we do, had little in the way of artificial illumination and traveled at the speed of the march, the horse and the sail. Rapid transmeridian travel, unknown 100 years ago, is now a common experience. We may travel faster these days, but our physiologies are rooted in our ancestors world. Our contemporary environment, characterized as it is by microclimates with artificial light and temperature control, is a novelty in human experience; and we have learned that living in a 24-hour society, with a round-the-clock economy with shift work and frequent jet travel, has its price. Both jet lag and shift work are highly prevalent in industrialized countries and have health and safety implications for both the individuals involved and for the public. Jet lag
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syndrome and shift work sleep disorder are circadian rhythm sleep disorders resulting in a constellation of symptoms such as sleepiness, difficulty initiating and maintaining sleep, and peaks and troughs of alertness and mental performance, all of which become out of sync with the environmental demands. The overall clinical presentation is influenced by a combination of physiological, behavioral, and environmental factors. The long-term health implications of shift work and, in particular, jet lag are not widely recognized.
THE CIRCADIAN SYSTEM
Circadian Rhythms
Biological rhythms having a period of approximately 24 hours are called circadian (from the Latin words circa, meaning about, and dies, meaning day). The human circadian system orchestrates rhythmicity in the human body and drives normal sleep-wake and rest-activity phases. Circadian rhythms are part of normal human physiology and behavior, and almost every bodily function has been shown to exhibit a circadian rhythm. Many human health parameters show a circadian variation: body temperature has an evening maximum and late night-early morning minimum. The blood levels of hormones can also change, depending on the time of day. Cortisol and testosterone are highest in the morning, while insulin, gastrin, and renin are highest in the early evening. Growth hormone, prolactin, and melatonin are at their highest at night [1]. The suprachiasmatic nuclei (SCN), located in the hypothalamus above the optic chiasm, are generators of normal circadian rhythmicity and are known as the circadian or biological clock. The pineal gland, retina, and retinohypothalamic tract also influence the circadian rhythm [2]. Also known as the master oscillator, the SCN serves as pacemaker, setting electrophysiological neuronal activity and hormonal rhythms. These, in turn, send information to peripheral, so-called slave, oscillators in the organism. Under constant conditions, circadian rhythms are consistent and have a period slightly longer than 24 hours, with the result that certain physiological and behavioral rhythms occur at a later clock time each day. Is circadian rhythmicity produced by the SCN neurons or the network of those neurons? Strong evidence supports the former. In each of the SCN neurons, the transcription/translation of clock genes and the complex feedback from their protein products generate a rhythm with a period of approximately, but not equal to, 24 hours. The circadian rhythm in gene transcription/translation is converted into a rhythm in neuronal firing by tying the levels of ion channels, receptors, or transmitters to the rhythmically transcribed genes [3]. Downstream from the SCN, information about internal day (rapid firing) or internal night (slow firing) is transmitted to the paraventricular nucleus of the hypothalamus. Then, via multisynaptic pathways, the SCN inhibits the melatonin secretion in the pineal gland via a adrenergic receptor. Melatonin closes the feedback loop, activating, via blood and cerebrospinal fluid (CSF), its receptors in the SCN.
Zeitgebers or Time Givers

The SCN also times circadian rhythms to the environment. The most important aspect of this external synchronization is the entrainment, or synchronization of the SCN-generated
Travel and Shift Work
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rhythms to the 24-hour period of rotation of the Earth. Environmental factors that influence the SCN are known as zeitgebers or time givers.
LIGHT IS THE MAIN ZEITGEBER Various rhythmic environmental stimuli are known to entrain circadian clocks [4]. Light-dark cycles are the most important environmental entraining agents for circadian rhythms because they are the most consistent from day to day. However, other environmental stimuli, such as temperature, physical activity, or feeding, may also play important roles for entrainment. Human circadian clocks adjust internal time to the external time primarily by way of light input through the retina [5]. Input for entrainment comes primarily through specialized retinal ganglion cell photoreceptors, which connect via the retinohypothalamic tract to the SCN. The neural pathway that extends from the SCN to the pineal gland involves a multisynaptic link via the superior cervical ganglion (SCG). Melatonin, secreted by the pineal gland, closes the feedback loop by acting on melatonin receptors in the SCN. Light as a circadian phase shifting agent. The effect of light on the human circadian clock depends on the time at which it is presented. The relationship between the time of light exposure and the direction of magnitude of phase shift can be quantified and analyzed by deriving a phase response curve (PRC). For PRC studies, a demanding protocol called constant routine is necessary to minimize the masking effects of sleep, food and water intake, and posture on circadian rhythms. In a room with dim light, and under the direction of an attending technician, the subject is kept awake in half supine position for as long as 50 hours. Food, water and any medications are given day and night at short even intervals. In majority of entrained individuals, the point of minimum body temperature occurs at 45am. Bright light prior to the minimum body temperature phase delays circadian rhythms and after the minimum of body temperature minimum phase advances circadian rhythms [6]. For more detailed information on PRC, the reader is directed to the review by Postolache and Oren [4]. Melanopsin and blue light. Melanopsin, present in the majority of retinal ganglion cells, is an important novel circadian photoreceptor. Melanopsin photosensitive to short-wavelength or blue light, which, according to several studies, appears to have stronger circadian effects [7].
PATHOPHYSIOLOGY OF JET LAG Acute jet lag. Jet lag is caused by a misalignment between the circadian clocks internal timing and the new external, environmental light-dark, day-night cycle. The exact symptoms of jet lag, and their severity and duration, depend on the individual, the direction of travel, and the number of time zones crossed. Symptoms may include sleep impairment, general malaise, poor mental concentration, loss of motivation, and increased incidence of headache, irritability, and gastrointestinal disturbance.
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Sleep impairment usually manifests itself as an inability to fall asleep or maintain sleep at the destinations local nighttime. Sleep impairment adds another component to daytime sleepiness, already present due to misalignment. Jet lag is typically worse when traveling east than when traveling west [8]. The unadjusted rhythm is phase-delayed relative to local time after an eastward flight, and phaseadvanced after a westward flight [1]. Since the circadian clock has a period slightly longer than 24 hours [9], it has a natural tendency to phase delay. Thus, phase delays proceed easier and more rapidly than phase advances and this is one important reason why it is more difficult to adjust for eastward travel. As the body contains multiple oscillators, one hypothesis of jet lag is based not on the desynchronization between the SCN and the external light-dark cycle, but on the desynchronization between central and peripheral oscillators [10]. In other words, while the central oscillators are adjusting somewhat faster to the timing of the destination using local zeitgebers, the peripheral oscillators take a significantly longer time. This might explain why the symptoms of jet lag often persist beyond the duration necessary for the entrainment of common circadian markers such as melatonin, cortisol, or temperature rhythms. Chronic jet lag. Many people, such as pilots and flight attendants, are exposed chronically to changes in meridian time. Temporal lobe atrophy and spatial cognitive deficits have been associated with a short recovery period after transmeridian flights in flight attendants [11]. Specifically, the volume of the temporal lobe and hippocampus-dependent memory deficits were compared in two flight attendant groups (each composed of 10 healthy, 22-to-28-yearold women with five years in service). One group had recovery periods of fewer than five days, while the other was given 14 days or more to recover. Magnetic resonance imaging (MRI) revealed that the group with the short recovery period (fewer than five days) had smaller right temporal lobe structures. Visual spatial memory tests identified impairments in hippocampus-dependent memory. In addition, the reduction in the right temporal lobe volumes was associated with higher cortisol levels [11]. . LIGHT AND JET LAG TREATMENT Compared to naturalistic models, which involve a lot of variability due to the heterogeneity of travel-related behavior, jet lag is much easier to study in the laboratory, where the sudden change in light exposure can be easily simulated, circadian markers monitored, and treatment interventions tested. In the lab, an appropriately timed light exposure, combined with light avoidance or melatonin administration, accelerates adaptation to the new time zone [12]. In a study of 15 healthy young men in a laboratory simulation of a trip from Montreal to London (an eastward flight across five time zones), light exposures scheduled during the advancing portion of the PRC were effective in synchronizing the biological night and day to the sleepwake rhythms in the new destination [13]. In a recent laboratory study by Eastman et al [14], circadian rhythms were advanced at home by light exposure before an eastward flight as a strategy to prevent or reduce jet lag. The sleep schedule of 26 young healthy adults was gradually advanced one or two hours per day for three days, with intermittent morning bright light exposures (one-half hour of approximately 5000 lux and one-half hour of less than 60 lux) for 3.5 hours. According to this proactive approach, a large-enough phase advance before flight, close to the number of time zones to be crossed can, theoretically, eliminate jet lag.
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Instead, the traveler would arrive with circadian rhythms already set to the new zone. The goal of the preflight schedule, then, is to advance circadian rhythms as much as possible, while keeping them aligned with the advancing sleep schedule. However, for the great majority of us, such preflight gradual adjustment is not practical. Field studies of light exposure after flights are few and inconclusive. Exposure and avoidance of light. Both light exposure and light avoidance are effective circadian shifters. Appropriately timed light exposure and light avoidance are crucial in the treatment and prevention of jet lag. One common mistake transmeridian travelers make is to get indiscriminate exposure to light at the destination in order to adapt to the new time zone rapidly. In fact, knowing when to avoid light at certain times is important to prevent worsening of the jet lag. For instance, if someone travels from New York to Paris and arrives at 8 AM in Paris, there is a six-hour lag between the internal biological clock and the external clock time in Paris. If one is exposed to bright light at 8 AM in Paris, that light is not a stimulus for the SCN at 8 AM (Paris time) but rather at 2 AM (the internal time). According to the light PRC, this is the region of maximum phase delays, and now, one can experience an eight-hour jet lag instead of a six-hour jet lag. To avoid this, light exposure should be avoided or minimized before the temperature minimum (between 10 AM and 11 AM Paris time). After that period, bright light exposure is highly recommended and it will cause circadian phase-advance. Light can be avoided by the use of eyeshades, window shades, or sunglasses [4]. The sunglasses should be dark (but not so dark as to make driving more dangerous) and should filter out or reflect blue light, which is the most potent stimulating spectral band of melanopsin receptors. There is a schedule of recommended times for avoidance of and exposure to bright light when crossing time zones, eastbound or westbound, that can be useful, although the schedules are often difficult to apply in general conditions. For more complete schedules one can consult Postolache et al [10]. For simplicity, one can remember that bright light should be avoided before Tmin with eastern travel and after Tmin with Western travel and then estimate the temperature minimum on the first day at the new destination (Tmin2) as Eastward travelTmin2=Tmin (of origin) +number of time zones crossed Westward travelTmin2=Tmin (of origin) -number of time zones crossed. Natural light. Natural sunlight contains the blue-green wavelengths that may be optimal for the chronotherapeutic effects of light. Hazards include ultraviolet radiation, which can cause skin cancer and cataracts, and blue wavelengths, which can cause retinal damage. Artificial light treatment. Light boxes, light visors, sunrise clocks, dawn simulators, and face masks have all been used to treat jet lag. Mini light boxes, which are small and portable, use light-emitting diodes (LEDs). Currently, narrow-spectrum, short-wavelength blue-green and blue light devices provide more potent melatonin suppression and circadian shifting and shorter periods of exposure compared to the more traditional light boxes, which produce white cool or full spectrum light. Bright light treatment is considered as generally effective and a safe intervention. The most commonly reported side effects are headache, eyestrain, feeling wired, and nausea. If these symptoms are moderate or severe, and persist after decreased duration of light exposure, discontinuation is recommended. Initially, it was believed that only bright light could shift circadian rhythms in humans. Now we know that even room light has shifting potential especially with extended exposure. Thus, the traveler should be mindful of the potential detrimental exposure to room light at the
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place of destination. In contrast, one should brighten the room when the exposure to brighter light is adequate.
MELATONIN FOR JET LAG In humans, as in most vertebrates, melatonin is synthesized primarily from serotonin in the pineal gland. It is often called the hormone of darkness since it is secreted during the internal nighttime. Melatonin has a role in diverse physiological functions: it is centrally involved in sleep regulation, it is considered the bodys chronological pacemaker, and it has potential antioxidant, oncostatic, and immunomodulatory properties. As a chronobiotic molecule, melatonin has shown to be valuable in treating various circadian rhythm sleep disorders, including jet lag or shift-work sleep disorder. As mentioned earlier, when melatonin is given during the evening, it phase-advances the circadian clock; when administered during the sleep period or in the morning, it shows maximal phase delays of the circadian clock. The timing of melatonin administration is critical for the optimal treatment of jet lag. One study by Waterhouse et al [12] proposed a schedule for use of melatonin on the first day after time-zone transitions. Arendt et al [15], in a review of 10 years of studies using melatonin, found that subjective assessments of jet lag symptoms declined by half with melatonin treatment, compared to placebo. The recommended regime was 5 mg melatonin taken in the evening three days before traveling and upon arriving using the same dose taken at local bedtime for four days after a flight [15]. In a laboratory study by Revell and Eastman [16], preflight melatonin and light administration were shown to phase-advance circadian rhythm by 2.5 hours. Smaller doses (0.5 mg) were recommended, since doses of 3 mg resulted in increased sleepiness. Takahashi et al [17] studied six subjects who took eight-hour eastward flights from Tokyo to Los Angeles. Entrainment by phase advancing was seen in all subjects under a regime of 3 mg melatonin for three days after the flights. Five days after the flights, entrainment was almost complete. Melatonin is sold and marketed as a dietary supplement in the United States and it is not approved for the treatment of any disorder by the US Food and Drug Administration. The most common mistakes made in melatonin utilization include consuming it at the wrong time and using higher doses, more adequate for sleep induction rather than circadian shifting. If melatonin is taken indiscriminately as a sleep inducer, it can cause circadian shifts in an unwanted direction. Smaller doses (0.5-1 mg) are recommended and sufficient for phase shifting in jet lag.
SYMPTOMATIC INTERVENTIONS In addition to the interventions specifically targeting the pathophysiology of jet lag, additional interventions target symptomatic improvement. The most common symptoms patients complain of are insomnia and daytime sleepiness. For insomnia, melatonin, synthetic melatonin receptor agonists (which are awaiting clinical studies for jet lag), and short-acting hypnotics at regular doses are often used. For improved alertness, caffeine, as beverage or pill, and modafinil are interventions that are sometimes recommended.
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Hypnotics
For the majority of patients the inability to fall asleep at the adequate time when traveling eastward is the most salient symptom of jet lag, the most bothersome and the one for which they seek treatment. A successful restoration of the ability to sleep equates for those patients a successful treatment of jet lag, even if alertness deficits and other jet lag symptoms persist after treatment with hypnotics. In addition, in patients with bipolar disorder, one night of sleep loss represents a major potential trigger for an upward switch, increased cycling, and loss of therapeutic control. In a recent study, travelers crossing five to nine time zones during transatlantic flights were given 10 mg of zolpidem (non-benzodiazepine hypnotic) or placebo for three consecutive nights, starting with the first nighttime sleep after travel. Zolpidem resulted in improved sleep quality, longer total sleep time, and a reduced number of awakenings compared to placebo. The most common side effects were headaches [18]. Other hypnotics that are not expected to work beyond 8 hours of sleep include temazepam (15 mg at bedtime), zaleplon (10 mg at bedtime), or eszopiclone (3 mg at bedtime). It is important to keep in mind that all hypnotics can have adverse effects and are recommended only for short-term symptomatic treatment. We discourage the use of hypnotics with longer duration of action for the treatment of jet lag, such as trazodone (Desyrel), or those like older generation antihistamines (diphenhydramine) which could affect cognitive functioning. In addition, a very important consideration is to think about the expected duration of sleep. If the remaining duration of sleep is less than 8 hours, we recommend to not use eszopiclone or zolpidem extended release, but the regular, non-extended release zolpidem. For the induction of very short sleep of several hours and for sleep maintenance difficulties after eastward travel, we often recommend zaleplon, considering its very short half time. With the newer generations of hypnotics, cognitive side effects represent areas of concern, and the individual response of a particular patient needs to be determined prior to prescribing these agents to be self administered for jet lag in a remote location.
Caffeine
Caffeine is one of the most frequently used psychostimulant drug worldwide and has been reported to improve subjective alertness and alleviate the deleterious effects of sleep deprivation. The actions of caffeine, a naturally occurring methylxantine most commonly found in coffee, tea, cola, and chocolate, have effects on various physiologic systems. The effects of caffeine on sleep and circadian rhythm are most likely mediated through the antagonism of adenosine A1 and A2a receptors [19]. Caffeine is often consumed at different times of day and night to alleviate the consequences of sleep deprivation, jet lag, and shift-work. In a recent study by Beaumont et al. [20], a new slow-release formulation of caffeine (SRC), at a dosage of 300 mg twice a day, was shown to maintain performance and alertness during 32-hour sleep loss after rapid eastward transmeridian travel, with no side effects. Nevertheless, this alerting effect of SRC seemed to have residual effects on recovery sleep: feeling of sleepiness and sleep latencies were higher than in baseline conditions, and subjects who took SRC woke up earlier, slept less, and experienced more awakenings compared to subjects who took melatonin during the
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first night. Further studies on jet lag and administration of SRC will be required to elucidate its effects on recovery sleep. Reported side effects of caffeine include increased anxiety, locomotor agitation, diuresis, and tachycardia. The use of the new slow-release formulation of caffeine can reduce these adverse effects.
Modafinil (Provigil)
Modafinil is currently FDA approved for excessive daytime sleepiness secondary to shift work, and as an add-on in obstructive sleep apnea. In one recent study, treatment with 200 mg modafinil resulted in a decrease in extreme sleepiness and a modest improvement in sustained-attention performance in patients with shift-work disorder [21]. However, patients treated with modafinil continued to show evidence of excessive sleepiness and consequently impaired performance during the night shift. Headaches were the most common side effect. Another laboratory study examined modafinils effects on sleep, cognitive performance, and mood during simulated shift work [22]. Participants received a single oral modafinil dose (0, 200, or 400 mg) one hour after waking following a day shift, and one hour after waking following a night shift, for three days. The shifts were alternated three times. Therapeutic doses of modafinil showed an attenuation of mood and cognitive performance impairments during night shift, while the larger dose administered during day-shift work caused sleep disruptions. These findings may have some significance in possible treatments of individuals in occupations where abrupt changes in work shifts are common. There have been no reports on treating jet lag with modafinil. Modafinil is a forbidden medication for competitive athletes due to its performance enhancing properties.
Exercise
It is not exactly known if and how exercise can cause chronobiological effects in humans. However, there is convincing evidence to suggest a phase shifting effect of exercise, especially confirmed for phase delay, rather than phase advance. Factors such as the intensity, specific kind and duration of exercise, as well as interaction between exercise and light, have to be studied in order to provide any evidence-based approach or recommendation to travelers [23].
DISCUSSION Research directions may include a) testing light, melatonin, and light avoidance in naturalistic paradigms, b) studying light of different wavelengths for jet leg, allowing exposure to smaller intensities of light, and also filtering certain wavelengths using adequate sunglasses, c) using melatonin receptor antagonists and wake promoting agents for jet leg, d) understanding interaction between multiple pace makers in creating jet lag, and e) understanding vulnerability to jet lag, that is, why some people report a lot of symptoms and others very few.
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Patients with mood disorders: are particularly vulnerable to the effects of sleep loss, which may exacerbate symptoms of depression and hypomania/mania, increase mood lability and cycling, and precipitate episodes of major mood disorders. Also, many patients with mood disorders have preexisting circadian abnormalities [24] that can compound the effects of jet lag. Consulting for jet lag in patients for mood disorders, when anticipating transmeridian travel in a patient with preexisting psychiatric illness the context is very important, as well as his/her history of prior response to transmeridian travel. Individuals with a tendency to phase advance, will do well traveling eastward, while those with a phase delay will adjust better when traveling west. Patients with bipolar disorder, especially those with rapid cycling and poor therapeutic control, are at increased risk. A written recommendation for the employer to assist the employee with minimize transmeridian travel is a first step. If frequent travel is currently an occupational imperative for those patients, a recommendation for change in job or profession may be required. Bipolar patients and those with recurrent major depression should be counseled against becoming flight attendants, and obviously against becoming commercial pilots. If the planned stay is short, the schedule at the destination flexible and the performance upon return essential, trying to keep the schedule of activity and of dark and light exposure of the place of origin is desirable. Window shades and/or sunglasses (dark or orange, i.e. filtering blue light) and alternation of bright light are recommended to avoid adjusting to the new time zone. When adjusting rest activity to local time is imperative or impossible to avoid, and the trip itself very important, shifting light-dark exposure, sleepwake, and rest-activity by one hour per day before the trip is recommended, when feasible. For that purpose, 30-minute exposure to bright light is useful for eastward travel upon awakening and for westward travel in the late afternoon or evening. In most cases, however, the treatment of jet lag starts on the day of departure. To fast-start entrainment in the majority of patients who are neither phase delayed or advanced (thus having their temperature minimum between 4 and 5 AM) traveling east, we recommend melatonin 0.5-1 mg in the afternoon of the departure (4-6 PM time of departure). At destination, on the first day, we strongly recommend bright light avoidance before (4 AM + number of time zones crossed AM) and bright light exposure after (4 AM + number of time zones crossed), then moving the time separating light avoidance and exposure earlier every day. Traveling west, we recommend bright light in the afternoon of departure (4-5 PM departure time) and, at the location of destination, avoidance of bright light in the early morning upon awakening for several days. Short acting hypnotics are useful for sleep induction for eastward travel, and ultrashort acting hypnotics may be useful for sleep maintenance with westward travel. Alerting medications may be useful in patients with a severe mismatch between occupational demands and alerting resources, and may include caffeine and modafinil. All these interventions are off-label, as the treatment of jet lag awaits larger and more definitive trials, which is well-deserved considering the increasing number of individuals exposed to transmeridian travel. All alerting medications may add to the potential mania inducing capacity of sleep deprivation in patients with bipolar disorder. We recommend purposeful timing for exercise and meals, in the direction of the desired adjustment. Independent of crossing meridians, general air travel advice includes: wearing loose clothes and shoes, drinking plenty of fluids, avoiding alcohol and caffeinated beverages, investing in a noise reduction headset, having eye shades available, walking for 10 minutes every 90 minutes, and moving legs for three minutes every 15 minutes when awake. In
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addition, we would advise traveling patients with mood disorders to reduce tasks and expectations during the first several days of the trip and using a decongestant if symptoms of rhinitis are present prior to travel, in order to avoid an obstructive sleep impairment factor secondary to cabin environment. Patients are reminded not to forget their medications, and to put needed medications in carry-on luggage, in case flight schedules are altered. Bipolar patients should be advised to not sacrifice sleep duration under any circumstance and use short-term hypnotics more readily to secure the regular duration of sleep. Finally, we recommend that the treating psychiatrist be available for brief phone consultations, anticipating possible time windows of contact, as well as clearly discussing the patient concrete situations when the patient will have to seek local professional attention.
REFERENCES [1] [2] [3] [4] [5] Dunlap JC, Loros JJ, DeCoursey PJ. Chronobiology: Biological timekeeping. Sunderland, MA: Sinauer, 2004. Richardson GS. The human circadian system in normal and disordered sleep. J Clin Psychiatry. 2005;66 Suppl 9:3-9;42-3. Ko CH, Takahashi JS. Molecular components of the mammalian circadian clock. Hum Mol Genet 2006;15(2):R271-7. Postolache TT, Oren DA. Circadian phase shifting, alerting, and antidepressant effects of bright light treatment. Clin Sports Med 2005;24(2):381-413, xii. Czeisler CA, Richardson GS, Zimmerman JC, Moore-Ede MC, Weitzman ED. Entrainment of human circadian rhythms by light-dark cycles: a reassessment. Photochem Photobiol 1981;34(2):239-47. Khalsa SB, Jewett ME, Cajochen C, Czeisler CA. A phase response curve to single bright light pulses in human subjects. J Physiol 2003; 549(Pt 3):945-52. Rea MS, Bullough JD, Figueiro MG. Phototransduction for human melatonin suppression. J Pineal Res 2002;32(4):209-13. Boulos Z, Campbell SS, Lewy AJ, Terman M, Dijk DJ, Eastman CI. Light treatment for sleep disorders: consensus report. VII. Jet lag. J Biol Rhythms 1995;10(2):167-76. Czeisler CA, Duffy JF, Shanahan TL et al. Stability, precision, and near-24-hour period of the human circadian pacemaker. Science 1999;284(5423):2177-81. Postolache TT, Hung TM, Rosenthal RN, Soriano JJ, Montes F, Stiller JW. Sports chronobiology consultation: from the lab to the arena. Clin Sports Med 2005;24(2):415-56, xiv. Cho K. Chronic 'jet lag' produces temporal lobe atrophy and spatial cognitive deficits. Nat Neurosci 2001;4(6):567-8. Waterhouse J, Reilly T, Atkinson G. Jet-lag. Lancet 1997; 350(9091):1611-6. Boivin DB, James FO. Phase-dependent effect of room light exposure in a 5-h advance of the sleep-wake cycle: implications for jet lag. J Biol Rhythms 2002;17(3):266-76. Eastman CI, Gazda CJ, Burgess HJ, Crowley SJ, Fogg LF. Advancing circadian rhythm before eastward flight: a strategy to prevent or reduce jet lag. Sleep 2005;1:3344. Arendt J, Skene DJ, Middleton B, Lockley SW, Deacon S. Efficacy of melatonin treatment in jet lag, shift work, and blindness. J Biol Rhythms 1997;12(6):604-17.
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[16] Revell VL, Eastman CI. How to trick mother nature into letting you fly around or stay up all night. J Biol Rhythms 2005;20(4):353-65. [17] Takahashi T, Sasaki M, Itoh H et al. Re-entrainment of circadian rhythm of plasma melatonin on an 8-h eastward flight. Psychiatry Clin Neurosci 1999;53(2):257-60. [18] Jamieson AO, Zammit GK, Rosenberg RS, Davis JR, Walsh JK. Zolpidem reduces the sleep disturbance of jet lag. Sleep Med 2001; 2(5):423-30. [19] Fredholm BB, Battig K, Holmen J, Nehlig A, Zvartau EE. Actions of caffeine in the brain with special reference to factors that contribute to its widespread use. Pharmacol Rev 1999;51(1):83-133. [20] Beaumont M, Batejat D, Pierard C et al. Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. J Appl Physiol 2004;96(1):50-8. [21] Czeisler CA, Walsh JK, Roth T et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder. N Engl J Med 2005;353(5):476-86. [22] Hart CL, Haney M, Vosburg SK, Comer SD, Gunderson E, Foltin RW. Modafinil attenuates disruptions in cognitive performance during simulated night-shift work. Neuropsychopharmacology 2006; 31(7):1526-36. [23] Atkinson G, Edwards B, Reilly T, Waterhouse J. Exercise as a synchroniser of human circadian rhythms: an update and discussion of the methodological problems. Eur J Appl Physiol 2007; 99(4):331-41. [24] Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar disorders and recurrent depression, 2nd Ed. New York: Oxford Univ Press, 2007.
Chapter 14
REFLECTIONS
Lars Enevoldsen
I would like to describe in short my personal development as a leader or manager. Ten years ago I was the classical, quite authoritarian, leader of a private company with 20 employees, but through a personal development process turned into a much more contemporary, democratic leader, strongly inspired by the holistic concepts of spiritual leadership, as expressed by Dalai Lama and Deepac Chopra. In this development my interest changed to leadership in science and research projects instead of business. I believe that personal development with a holistic approach will allow us to increase the strength and quality of our impact.
INTRODUCTION During the plast 15 years I have developed my own personal style of leadership, very much inspired by the concepts of emotional intelligence as formulated by Daniel Goleman [1,2], the native Americans, and the philosophy of kindness as expressed by the Dalai Lama [3]. I have had the great blessing to be involved in many different circumstances, where my leadership was welcomed. I have noticed that the organizations, scientific and human development projects always have succeeded the best, when I have been relaxed and coming from my authenticity and heart. I have very often thought about what quality and competency makes a great leader. After many years of reflection I have finally set my mind on the capacity of intuition.
Problem of Method
The problem of method concerned intuition is that it is very hard to define. It is very personal and not rational in the intellectual understanding of the word. Intuition is much more connected to the concept of common sense in the original meaning of sensis communis
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the faculty of intelligence resting behind the words that makes the world as we know is from our own creative consciousness and source of life. I have often noticed a certain laziness of people depending much on their minds in their living, a kind of lack of spiritual sharpness and presence. I have observed too much dependency on the past and already learned knowledge and principles that gives a strong alienation and mechanical attitude to the world. This will reduce it to just the expected, not living in the known and using all the information and resources available to create the unique and extraordinary. In the intuitive approach is an orientation towards the surrounding world, not the internal much more limited representation of reality. Intuition comes from within - of course we are connected to the world but we contain all the wisdom within our self, but on a hidden level. As Carl Gustav Jung (1875-1961) said [4]: Everything is present in our collective unconscious. Not everybody is connected to this deep and subtle dimension of existence. I have often wondered from where my own gift of intuitive leadership has come. It has been a second nature, which has given me very severe difficulties in expressing it to my world, because how can you put words to things you just know for no reason at all? Another problem I have had is my own appreciation of this gift, because when it has not been expressed and not been strived for, then what is it worth? But people around me have always appreciated my gift of taking control, when everything were chaotic and intuitive leadership most definitely creates order and fine result.
Intuitive Leadership of Organizations

I had my first experience with intuitive leadership, when I as a young man was working in my own sandwich shop. I employed at that time 14 people without any formal training in management and leadership. People advised me to go to business school, but for some reason I resisted. I had good fortune with my business it grew and grew over the years and at last, it grew completely over my head. I found myself in the middle of a spiritual learning crisis and caught by holy madness, I went to the library. Here I became strongly inspired by the book The seven spiritual laws of success [5] and broke through to a new level of intuitive leadership. After succeeding as a businessman, I longed for new challenges. I therefore started my training as a holistic therapist mastering both bodywork and psychodynamic therapy. I chose an education based on experiential learning and this turned out the natural frame using my intuitive leadership related to people.
Intuitive Leadership of People in Personal Development

I was thrown into the deep waters of existential despair. This new field of exploring human consciousness was so overwhelming, that I was in no way able to cope with it only by using the rational mind. Once again, I was forced to turn inwards in order to find answers. I learned that only by insisting on doing good for myself and other people I was able to move forward in a constructive way. I learned that, in every situation, there is something that must be done in order for healing to take place and lift the person in question to a better version of him- or
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herself. Through my work with people I slowly realized that what was important was not what I did, but merely that I supported the person in developing trust in his or her intuitive truth. The key to this turned out to be the patient recovering his own sense of coherence. The work of Aaron Antonovsky (1923-1994) on salutogenesis finally shed light and made me understand [6,7].
Intuitive Leadership of Scientific Projects

According to these experiences and learning it was a natural step for me to take over the responsibility for the research projects in the center where I was being trained. 109 patients were treated by holistic therapy in the aim of inducing salutogenesis [8-12]. Dozens of complex leadership tasks were shouldered by me using intuitive leadership. First, I took care of the team spirit by researching the local bars. It did not take me long to find our favorite bar. And inspired by the doubtful rooming, many valuable scientific discussions took place here. The excellent beer helped us to find and grow fellowship among team members. In composing the crew, human qualifications and real competency were more important than formal education and academic degrees. During the two years of the research project we produced several scientific papers that finally were published in a peer reviewed international journal [8-12].
CONCLUSIONS Very often in this complex world decisions must be made on the basis of limited information. Our rational mind can only make a guess, but if we dare to look deeper into ourselves for the answers we can actually foretell the future destiny of organizations, projects and people. Know thyself have been the keywords for success for all human endeavors since the Oracle of Delphi in ancient Greece. And so it will be for millennia to come.
REFERENCES [1] [2] [3] [4] [5] [6] [7] Goleman DL. Emotional intelligence. New York: Bantam, 1995. Goleman DL. Destructive emotions. New York: Mind Life Inst, 2003. Goleman D. Healing emotions: Conversations with the Dalai Lama on the mindfulness, emotions, and health. Boston: Mind Life Inst, 1997. Jung CG. Man and his symbols. New York, Anchor Press, 1964. Chopra D. The seven spiritual laws of success: A practical guide to the fulfillment. New York: Bantam, 1996. Antonovsky A. Health, stress and coping. London, Jossey-Bass, 1985. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Francisco, Jossey-Bass, 1987.
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Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) improves quality of life, health, and ability by induction of Antonovsky-salutogenesis. ScientificWorld Journal 2007;7:317-23. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced impaired sexual functioning. ScientificWorld Journal 2007;7:324-9. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced mental illness. ScientificWorld Journal 2007;7:306-9. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced physical illness and chronic pain. ScientificWorld Journal 2007;7:310-6. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Self-reported low self-esteem. Intervention and follow-up in a clinical setting. ScientificWorld Journal 2007;7:299-305.
[9]
[10]
[11]
[12]
PART IV: ACKNOWLEDGEMENTS
Chapter 15
PUBLICATIONS ON QUALITY OF LIFE 1994-2008 FROM AN INTERNATIONAL GROUP OF COLLABORATORS

INTRODUCTION Our research over the past years has taken the form of several books, book chapters and peerreviewed scientific papers (see also the website: www.livskvalitet.org). The research papers have been arranged according to several systematic categories according to the following headlines and topics: QOL Methodology describes the method used to measure quality of life used with the Quality of Life Survey Study at the University Hospital (Rigshospitalet) in Copenhagen, Denmark. QOL Philosophy describes the philosophy behind our work with quality of life presented in the books Quality of life. To seize the meaning of life and get well again (1995), Life philosophy that heals. Quality of life as medicine (1999), Consciousness-based medicine (2003) and Principles of Holistic Medicine. Philosophy behind quality of life (2005). This is publications describing the philosophy on which the entire project is based. QOL Theory covers the related life and human points of view described theoretically. QOL Questionnaires are the questionnaires used in the Quality of Life Survey Study and later studies (see also chapters 15 and 17 in this book). QOL Results are results from the Quality of Life Survey Study. Theories of Existence are new theories on quality of life and the human nature described coherently and concisely.
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Holistic Medicine describes our research program for the holistic-medical project ? a new research paradigm for researching alternative and holistic medicine and a theory for process of holistic healing. QOL as Medicine describes results from the treatment of patients suffering from various chronic diseases, like chronic pains, alcoholism and Whiplash Associated Disorders. Clinical holistic medicine describes how to deal with the variety of problems presented by the patients in the medical clinic using holistic medicine. Human development is a series of papers to address a number of unsolved problems in biology today. First of all, the unsolved enigma concerning how the differentiation from a single zygote to an adult individual happens has been object for severe research through decades. By uncovering a new holistic biological paradigm that introduces an energetic-informational interpretation of reality as a new way to experience biology, these papers try to solve the problems connected with the events of biological ontogenesis from a single cell involvement in the fractal hierarchy, to the function of the human brain and adult human metamorphosis. Sense of coherence papers where we have used the concept of salutogenesis developed by Aaron Antonovsky (1923-1994) to help people heal. Research summary papers for the scientific community to present and discuss our work over a longer time period. Discussion papers or shorter reviews in the public debate. We believe it is important to participate in the public debate from the point of view of holistic health and medicine and have therefore used the opportunity to join in the debate, whenever the occasion arise.
Books Published
1. Ventegodt S. Quality of life in Denmark. Results from a population survey. Copenhagen: Forskningscentrets Forlag, 1995. [Danish and English] 2. Ventegodt S. Quality of Life. To seize the meaning of life and become well again. Copenhagen: Forskningscentrets Forlag, 1995. [Danish and English] 3. Ventegodt S. The quality of life and factors in pregnancy, birth and infancy. Results from a follow-up study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen 1959-61. Copenhagen: Forskningscentrets Forlag, 1995. [Danish and English] 4. Ventegodt S. The quality of life of 4500 31-33 year-olds. Result from a study of the Prospective Pediatric Cohort of persons born at the University Hospital in Copenhagen. Copenhagen: Forskningscentrets Forlag, 1996. [Danish and English] 5. Ventegodt S. Measuring the quality of life. From theory to practice. Copenhagen: Forskningscentrets Forlag, 1996. 6. Ventegodt S. Measuring the quality of life. Copenhagen: Forskningscenterets Forlag, 1996. [Danish] 7. Ventegodt S. Working-life Quality. To become valuable to yourself and your surroundings. Copenhagen: Forskningscentrets Forlag, 1996. [Danish]
Publications on Quality of Life 1994-2008
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8. Ventegodt S. Working-life Quality. A tool for employees and leaders. Copenhagen: Forskningscentrets Forlag, 1999. 9. Ventegodt S. Philosophy of life that heals. Copenhagen: Forskningscenterets Forlag, 1999. [Danish] 10. Ventegodt S. The quality of life and major events in life. Copenhagen: Forskningscentrets Forlag, 2000. [Danish and English] 11. Ventegodt S. Quality of life as medicine. Copenhagen: Forskningscenterets Forlag, 2001. [Danish] 12. Ventegodt S. Consciousness-based medicine. Copenhagen: Forskningscenterets Forlag, 2003. [Danish] 13. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Philosophy behind quality of life. Victoria, BC: Trafford, 2005, 228 pages. 14. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Quality of life and health. New York: Hippocrates Sci Publ, 2005, 378 pages. 15. Merrick J, Zalsman G. Suicidal behavior in adolescence. An international perspective. London/Tel Aviv: Freund, 2005, 372 pages. 16. Ventegodt S, Kandel I, Merrick J. Principles of holistic medicine. Global quality of life. Theory, research and methodology. New York: Hippocrates Sci Publ, 2006, 262 pages. 17. Shek DTL, Merrick J, eds. Positive youth development program in Hong Kong. London, Tel Aviv, Freund, 2006, 259 pages. 18. Shek DTL, Ma HK, Merrick J, eds. Positive youth development. Development of a pioneering program in a Chinese context. London/Tel Aviv: Freund, 2007, 400 pages. 19. Kandel I, Schofield P, Merrick J. Aging and disability. Research and clinical perspectives, Victoria, BC: Int Acad Press, 2007, 441 pages.
Chapters in Books
1. Ventegodt S. Quality of life and disease. The need for a new medical model. In: Lund AB, ed. Health Services in the 21th Century. Copenhagen. Committee Health Information, 1994:81-3 2. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Nielsen M, Morad M, Merrick J. Global quality of life (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991-2004. In: Shek DTL, Chan YK, Lee PSN, eds. Quality of life reearch in Chinese, Western and global contexts. Dordrecht, Netherlands: Springer, 2005:87-122. 3. Ventegodt S, Merrick J. Philosophy of life and suicide. In: Merrick J, Zalsman G, eds. Suicidal behavior in adolescence. An international perspectice. London, Tel Aviv: Freund, 2005:9-17. 4. Ventegodt S, Merrick J. Concept of self in holistic medicine: Coming from love, freeing the soul, the ego and the physical self. In: Prescott AP, ed. The concept of self in medicine and health care. New York: Nova Sci Publ, 2006:163-71.
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5. Ventegodt S, Merrick J. What is the most efficient way to improve health: Changing your lifestyle or improving your quality of life? In: Kinger LV, ed. Focus on lifestyle and health research. New York: Nova Sci Publ, 2005:1-22. 6. Ventegodt S, Merrick J. What is a good death? In: Kandel I, Schofield P, Merrick J. Aging and disability. Research and clinical perspectives. Victoria, BC: Int Acad Press, 2007:241-52. 7. Ventegodt S, Merrick J. Suicide in holistic medicine. In: Kandel I, Schofield P, Merrick J. Aging and disability. Research and clinical perspectives. Victoria, BC: Int Acad Press, 2007:259-68.
Peer-reviewed Scientific Papers (See also www.livskvalitet.org)

Quality of Life (QOL) Methodology
1. Ventegodt S, Hilden J, Merrick J. Measurement of quality of life I: A methodological framework. ScientificWorld Journal 2003;3:950-61. 2. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life II: From the philosophy of life to science. ScientificWorld Journal 2003;3:962-71. 3. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life III: From the IQOL theory to the global, generic SEQOL questioinnaire. ScientificWorld Journal 2003;3:972-91. 4. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life IV: Use of the SEQOL, QOL5, QOL1 and other global and generic questioinnaires. ScientificWorld Journal 2003;3:992-1001. 5. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life V: How to use the SEQOL, QOL5, QOL1 and other and generic questionnaires for research. ScientificWorld Journal 2003;3:1002-14. 6. Ventegodt S, Merrick J, Andersen NJ. Measurement of quality of life VI: Qualityadjusted life years (QALY) is an unfortunate use of quality of life concept. ScientificWorld Journal 2003;3:1015-9. 7. Ventegodt S, Merrick J. Measurement of quality of life VII: Statistical covariation and global quality of life data. The method of weight-modified liniar regression. ScientificWorld Journal 2003;3:1020-29. 8. Ventegodt S, Andersen NJ, Merrick J. The square curve paradigm for research in alternative, complementary and holistic medicine: A cost-effectice, easy and scientifically valid design for evidence-based medicine and quality improvement. ScientificWorld Journal 2003;3:1117-27.
QOL Philosophy
1. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy: when life sparkles or can we make wisdom a science? ScientificWorld Journal 2003;3:1160-3. 2. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy I. Quality of life, happiness and meaning in life. ScientificWorld Journal 2003;3:1164-75.
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3. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy II. What is a human being ? ScientificWorld Journal 2003;3:1176-85. 4. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy III. Towards a new biology: Understanding the biological connection between quality of life, disease and healing. ScientificWorld Journal 2003;3:1186-98. 5. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy IV. The brain and consciousness. ScientificWorld Journal 2003;3:1199-1209. 6. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy V. Seizing the meaning of life and becoming well again. ScientificWorld Journal 2003;3:1210-29. 7. Ventegodt S, Andersen NJ, Merrick J. Quality of life philosophy VI. The concepts. ScientificWorld Journal 2003;3:1230-40. 8. Ventegodt S, Merrick J. Philosophy of science: How to identify the potential research for the day after tomorrow? ScientificWorld Journal 2004;4:483-9.
QOL Theory
1. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. ScientificWorld Journal 2003;3:1030-40. 2. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory II. Quality of life as the realization of life potential: A biological theory of human being. ScientificWorld Journal 2003;3:1041-9. 3. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory III. Maslow revisited. ScientificWorld Journal 2003;3:1050-7.
QOL Questionnaires (SEQOL, QOL5)

1. Ventegodt S. Questionnaire for self-assessing quality of life. Copenhagen: Forskningcenters Forlag, 1994. [Danish] 2. Ventegodt S. Questionnaire: Quality of life and life events. Copenhagen: Forskningcenters Forlag, 1995. [Danish] 3. Ventegodt S. Questionnaire: Working-life Quality. Copenhagen: Forskningcenters Forlag, 1996. [Danish] 4. Ventegodt S. Software for quality of life: Personal profile. Copenhagen: Quality Life Res Center, Disk version, 1996. [Danish] 5. Ventegodt S. Questionnaire: Health, quality of life and working life, Copenhagen: Quality Life Res Center, 1997. [Danish] 6. Ventegodt S. Questionnaire on quality of working life and health. Copenhagen: Quality Life Res Center, 1999. [Danish] 7. Lindholt JS, Ventegodt S, Henneberg EW. Development and validation of QoL5 for clinical databases. A short, global and generic questionnaire based on an integrated theory of the quality of life. Eur J Surg 2002;168(2):107-13. 8. Ventegodt S, Henneberg EW, Merrick J, Lindholt JS. Validation of two global and generic quality of life questionnaires for population screening: SCREENQOL and SEQOL. ScientificWorld Journal 2003;3:412-21.
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QOL Results
1. Ventegodt S. [Sexuality and quality of life. Results from the quality of life study of 4,626 Danes aged 31-33 years born at Rigshospitalet 1959-1961]. Ugeskr Laeger 1996;158(30):4299-304. [Danish] 2. Ventegodt S, Hilden J, Zachau-Christiansen B. [Phenemal to pregnant women and children's intelligence and quality of life 31-33 years later]. Ugeskr Laeger 1997;159(24):3799-800. [Danish] 3. Ventegodt S. Sex and the quality of life in Denmark. Arch Sex Behaviour 1998;27(3):295-307. 4. Ventegodt S. A prospective study on quality of life and traumatic events in early life 30 year follow-up. Child Care Health Dev 1998;25(3):213-21. 5. Ventegodt S, Merrick J. Psychoactive drugs and quality of life. ScientificWorld Journal 2003;3:694-706. 6. Ventegodt S, Merrick J. Long-term effects of maternal medication on global quality of life measured with SEQOL. Results from the Copenhagen Perinatal Birth Cohort 1959-61. ScientificWorld Journal 2003;3:707-13. 7. Ventegodt S, Merrick J. Long-term effects of maternal smoking on quality of life. Results from the Copenhagen Perinatal Birth Cohort 1959-61. ScientificWorld Journal 2003;3:714-20. 8. Ventegodt S, Merrick J. Lifestyle, quality of life, and health. ScientificWorld Journal 2003;3:811-25. 9. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Factors during pregnancy, delivery and birth affecting global quality of life of the adult child at long-term follow-up. Results from the prospective Copenhagen Perinatal Birth Cohort 1959-61. ScientificWorld Journal 2005;5:933-41. 10. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. The health and social situation of the mother during pregnancy and global quality of life of the child as an adult. Results from the prospective Copenhagen Perinatal Cohort 1959-61. ScientificWorld Journal 2005;5:950-8. 11. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. Events in pregnancy, delivery and infancy and long-term effects on global quality of life. Results from the Copenhagen Perinatal Birth Cohort 1959-61. Med Sci Monit 2005;11(8):CR357-65. 12. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Morad M, Merrick J. Quality of life and events in the first year of life. Results from the prospective Copenhagen Birth Cohort 1959-61. ScientificWorld Journal 2006;6:106-115. 13. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. What influence do major events in life have on our later quality of life? A retrospective study on life events and associated emotions. Med Sci Monit 2006;12(2):SR9-15.
Theories of Existence
1. Ventegodt S. [Awareness-oriented (holistic) medical theory: the purpose of life theory (the life mission theory)]. Ugeskr Laeger 2003;165(6):590. [Danish] 2. Ventegodt S, Andersen NJ, Merrick J. Editorial: Five theories of human existence. ScientificWorld Journal 2003;3:1272-6.
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3. Ventegodt S. The life mission theory: A theory for a consciousness-based medicine. Int J Adolesc Med Health 2003;15(1): 89-91. 4. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II. The structure of the life purpose and the ego. ScientificWorld Journal 2003;3:1277-85. 5. Ventegodt S, Andersen NJ, Merrick J. The life mission theory III. Theory of talent. ScientificWorld Journal 2003;3:1286-93. 6. Ventegodt S, Andersen NJ, Merrick J. The life mission theory IV. Theory on child development. ScientificWorld Journal 2003;3:1294-1301. 7. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. Theory of the antiself (the shadow) or the evil side of man. ScientificWorld Journal 2003;3:1302-13. 8. Ventegodt S, Kromann M, Andersen NJ, Merrick J. The life mission theory VI. A theory for the human character: Healing with holistic medicine through recovery of character and purpose of life. ScientificWorld Journal 2004;4:859-80. 9. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. The life mission theory VII. Theory of existential (Antonovsky) coherence: A theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89.
Holistic Medicine
1. Ventegodt S, Becker P. [Quality of life and disease]. Ugeskr Laeger 1994;156(11):1661. [Danish] 2. Ventegodt S, Andersen NJ, Merrick J. Holistic medicine: Scientific challenges. ScientificWorld Journal 2003;3:1108-16. 3. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine II: The square-curve paradigm for research in alternative, complementary and holistic medicine: A costeffective, easy and scientifically valid design for evidence based medicine. ScientificWorld Journal 2003;3:1117-27. 4. Ventegodt S, Andersen NJ, Merrick J. Holistic medicine III: The holistic process theory of healing. ScientificWorld Journal 2003;3:1138-46. 5. Ventegodt S, Andersen NJ, Merrick J. Holistic medicine IV: Principles of existential holistic group therapy and the holistic process of healing in a group setting. ScientificWorld Journal 2003;3:1388-1400. 6. Ventegodt S, Thegler S, Andreasen T, Struve F, Jacobsen S, Torp M, Aegedius H, Enevoldsen L, Merrick J.A review and integrative analysis of ancient holistic character medicine systems. ScientificWorld Journal 2007;7:1821-31.
QOL as Medicine
1. Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine: A pilot study of patients with chronic ilness and pain. ScientificWorld Journal 2003;3:520-32. 2. Ventegodt S, Merrick J, Andersen NJ. Quality of life as medicine II: A pilot study of a five-day quality of life and health cure for patients with alcoholism. ScientificWorld Journal 2003;3:842-52. 3. Ventegodt S, Clausen B, Langhorn M, Kromann M, Andersen NJ, Merrick J. Quality of life as medicine III. A qualitative analysis of the effect of a five day intervention
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with existential holistic group therapy or a quality of life course as a modern rite of passage. ScientificWorld Journal 2004;4:124-33. 4. Ventegodt S, Merrick J, Andersen NJ, Bendix T. A combination of gestalt therapy, Rosen body work, and cranio sacral herapy did not help in Chronic WhiplashAssociated Disorders (WAD). Results of a randomized clinical trial. ScientificWorld Journal 2004;4:1055-68.
Clinical Holistic Medicine

1. Ventegodt S, Merrick J. Clinical holistic medicine: Applied consciousness-based medicine. ScientificWorld Journal 2004;4:96-9. 2. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Classic art of healing or the therapeutic touch. ScientificWorld Journal 2004;4:134-47. (CHM-1 in our terminology) 3. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: The new medicine. The multiparadigmatic physician and the medical record. ScientificWorld Journal 2004;4:273-85. (CHM-2) 4. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Holistic pelvic examination and holistic treatment of infertility. ScientificWorld Journal 2004;4:14858. (CHM-3) 5. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Use and limitations of the biomedical paradigm. ScientificWorld Journal 2004;4:295-306. (CHM-4) 6. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Social problems disguised as illness. ScientificWorld Journal 2004;4:286-94. (CHM-5) 7. Ventegodt S, Morad M, Andersen NJ, Merrick J. Clinical holistic medicine: Tools for a medical science based on consciousness. ScientificWorld Journal 2004;4:34761. (CHM-6) 8. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: When biomedicine is inadequate. ScientificWorld Journal 2004;4:333-46. 9CHM-7) 9. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Prevention through healthy lifestyle and quality of life. Oral Health Prev Dent 2004;2(Suppl 1):239-45. (CHM-8) 10. Ventegodt S, Morad M, Vardi G, Merrick J. Clinical holistic medicine: Holistic treatment of children. ScientificWorld Journal 2004;4:581-8. (CHM-9) 11. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Problems in sex and living together. ScientificWorld Journal 2004;4:562-70. (CHM-10) 12. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Holistic sewxology and treatment of vulvodynia through existential therapy and acceptance through touch. ScientificWorld Journal 2004;4:571-80. (CHM-11) 13. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: A psychological theory of dependency to improve quality of life. ScientificWorld Journal 2004;4:638-48. (CHM-12) 14. Ventegodt S, Morad, M, Kandel I, Merrick J. Clinical holistic medicine: Treatment of physical health problems without a known cause, examplified by hypertention and tinnitus. ScientificWorld Journal 2004;4:716-24. (CHM-13)
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15. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Developing from asthma, allergy and eczema. ScientificWorld Journal 2004;4:936-42. (CHM-14) 16. Ventegodt S, Merrick J. Clinical holistic medicine: Chronic infections and autoimmune diseases. ScientificWorld Journal 2005;5:155-64. (CHM-15) 17. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Morad M, Merrick J. Clinical holistic medicine: A pilot study on HIV and quality of life and a suggested cure for HIV and AIDS. ScientificWorld Journal 2004;4:264-72. (CHM-16) 18. Ventegodt S, Merrick J. Clinical holistic medicine: Chronic pain in the locomotor system. ScientificWorld Journal 2005;5:165-72. (CHM-17) 20. Ventegodt S, Gringols M, Merrick J. Clinical holistic medicine: Whiplash, fibromyalgia and chronic fatigue. ScientificWorld Journal 2005;5:340-54. (CHM-18) 21. Ventegodt S, Merrick J. Clinical holistic medicine: Chronic pain in internal organs. ScientificWorld Journal 2005;5:205-10. (CHM-19) 22. Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: Holistic treatment of rape and incest trauma. ScientificWorld Journal 2005;5:288-97. (CHM20) 23. Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: The existential crisis life crisis, stress and burnout. ScientificWorld Journal 2005;5:30012. (CHM-21) 24. Ventegodt S, Gringols M, Merrick J. Clinical holistic medicine: Holistic rehabilitation. ScientificWorld Journal 2005;5:280-7. (CHM-22) 25. Ventegodt S, Morad M, Press J, Merrick J, Shek DTL. Clinical holistic medicine: Holistic adolescent medicine. ScientificWorld Journal 2004;4:551-61. (CHM-23) 26. Ventegodt S, Andersen NJ, Neikrug S, Kandel I, Merrick J. Clinical holistic medicine: Mental disorders in a holistic perspective. ScientificWorld Journal 2005;5:313-23. (CHM-24) 27. Ventegodt S, Andersen NJ, Neikrug S, Kandel I, Merrick J. Clinical holistic medicine: Holistic treatment of mental disorders. ScientificWorld Journal 2005;5:427-45. (CHM-25) 28. Ventegodt S, Merrick J. Clinical holistic medicine: The patient with multiple diseases. ScientificWorld Journal 2005;5:324-39. (CHM-26) 29. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Induction of spontaneous remission of cancer by recovery of the human character and the purpose of life (the life mission). ScientificWorld Journal 2004;4:362-77. (CHM-28) 30. Ventegodt S, Solheim E, Saunte ME, Morad M, Kandel I, Merrick J. Clinic holistic medicine: Metastatic cancer. ScientificWorld Journal 2004;4:913-35. (CHM-29) 31. Ventegodt S, Clausen B, Nielsen ML, Merrick J. Clinical holistic medicine: Advanced tools for holistic medicine. ScientificWorld Journal 2006;6:2048-65. (CHM-30) 32. Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: The case story of Anna. I. Long-term effect of childhood sexual abuse and incest with a treatment approach. TSW Holistic Health Med 2006;1:1-12. (ScientificWorld Journal 2006;6:1965-76). (CHM-31) 33. Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: The case story of Anna. II. Patient diary as a tool in treatment. TSW Holistic Health Med 2006;1: 4270. (ScientificWorld Journal 2006;6:2006-34). (CHM-32)
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34. Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: The case story of Anna. III: Rehabilitation of philosophy of life during holistic existential therapy for childhood sexual abuse. TSW Holistic Health Med 2006;1: 102-13. (ScientificWorld Journal 2006;6:2080-91). (CHM-33) 35. Ventegodt S, Clausen B, Omar HA, Merrick J. Clinical holistic medicine: Holistic sexology and acupressure through the vagina (Hippocrates pelvic massage). TSW Holistic Health Med 2006;1:114-27. (ScientificWorld Journal 2006;6:2066-79). (CHM-34) 36. Ventegodt S, Clausen B, Merrick J. Clinical holistic medicine: Pilot study on the effect of vaginal acupressure (Hippocratic pelvic massage). TSW Holistic Health Med 2006;1:136-152. (ScientificWorld Journal 2006;6:2100-16). (CHM-35) 37. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine: Psychodynamic short-time therapy complemented with bodywork. A clinical follow-up study of 109 patients. TSWHolistic Health Med 2006;1:256-74. (ScientificWorld Journal 2006;6:2220-38). (CHM-36) 38. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Self-reported low self-esteem. Intervention and follow-up in a clinical setting. ScientificWorld Journal 2007;7:299-305. (CHM-37) 39. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced mental illness. ScientificWorld Journal 2007;7:306-9. (CHM-38) 40. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced physical illness and chronic pain. ScientificWorld Journal 2007;7:310-16. (CHM-39) 41. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) improves quality of life, health and ability by induction of Antonovsky-Salutogenesis. ScientificWorld Journal 2007;7:317-23. (CHM-40) 42. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) in the treatment of experienced impaired sexual functioning. ScientificWorld Journal 2007;7:324-9. (CHM-41) 43. Ventegodt S, Kandel I, Merrick J. Clinical holistic medicine: How to recover memory without implanting memories in your patient. ScientificWorld Journal 2007;7:1579-80. (CHM-42) 44. Ventegodt S, Kandel I, Merrick J. A short history of clinical holistic medicine. ScientificWorld Journal 2007;7:1622-30. (CHM-43) 45. Ventegodt S, Kandel I, Merrick J. Clinical holistic medicine (mindful short term psychodynamic psychotherapy complimented with bodywork) in the treatment of schizophrenia (ICD10-F20) and other psychotic mental diseases (ICD10-F2/DSMIV-code 295). ScientificWorld Journal 2007;7:1987-2008. (CHM-44)
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46. Ventegodt S, Kandel I, Merrick J. First do no harm. An analysis of the risk aspects and side effects of clinical holistic medicine compared with standard psychiatric biomedical treatment. ScientificWorld Journal 2007;7:1810-20. (CHM-45) 47. Ventegodt S, Kandel I, Merrick J. Biomedicine or holistic medicine for treating mentally ill patients? A philosophical and economical analysis. ScientificWorld Journal 2007;7:1978-1986. (CHM-46) 48. Ventegodt S, Kandel I, Merrick J. Clinical holistic medicine: Factors influencing the therapeutic decision-making. From academic knowledge to emotional intelligence and spiritual crazy wisdom. ScientificWorld Journal 2007;7:1932-49. (CHM-47)
Human Development
1. Hermansen TD, Ventegodt S, Rald E, Clausen B, Nielsen ML, Merrick J. 1. Human development I. Twenty fundamental problems of biology, medicine and neuropsychology related to biological information. ScientificWorld Journal 2006;6:747-59. 2. Ventegodt S, Hermansen TD, Nielsen ML, Clausen B, Merrick J. Human development II. We need an integrated theory for matter, life and consciousness to understand life and healing. ScientificWorld Journal 2006;6:760-6. 3. Ventegodt S, Hermansen TD, Rald E, Flensborg-Madsen T, Nielsen ML, Clausen B, Merrick J. Human development III. Bridging brain-mind and body-mind. Itroduction to deep (fractal, poly-ray) cosmology. ScientificWorld Journal 2006;6:767-76. 4. Ventegodt S, Hermansen TD, Rald E, Flensborg-Madsen T, Nielsen ML, Clausen B, Merrick J. Human development IV. The living cell has information-directed selforganization. ScientificWorld Journal 2006;6:1132-8. 5. Ventegodt S, Hermansen TD, Flensborg-Madsen T, Nielsen ML, Clausen B, Merrick J. Human development V: Biochemistry unable to explain the emergence of biological form (morphogenesis) and therefore a new principle as source of biological information is needed. ScientificWorld Journal 2006;6:1359-67. 6. Ventegodt S, Hermansen TD, Flensborg-Madsen T, Nielsen M, Merrick J. Human development VI: Supracellular morphogenesis. The origin of biological and cellular order. ScientificWorld Journal 2006;6:1424-33. 7. Ventegodt S, Hermansen TD, Flensborg-Madsen T, Rald E, Nielsen ML, Merrick J. Human development VII: A spiral fractal model of fine structure of physical energy could explain central aspects of biological information, biological organization and biological creativity. ScientificWorld Journal 2006;6:1434-40. 8. Ventegodt S, Hermansen TD, Flensborg-Madsen T, Nielsen ML, Merrick J. Human development VIII: A theory of deep quantum chemistry and cell consciousness: Quantum chemistry controls genes and biochemistry to give cells and higher organisms consciousness and complex behavior. ScientificWorld Journal 2006;6:1441-53. 9. 9. Ventegodt S, Hermansen TD, Flensborg-Madsen T, Rald E, Nielsen ML, Merrick J. Human development IX: A model of the wholeness of man, his consciousness and collective consciousness. ScientificWorld Journal 2006;6:1454-9.
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10. Hermansen TD, Ventegodt S, Merrick J. Human development X: Explanation of macroevolution top-down evolution materializes consciousness. The origin of metamorphosis. ScientificWorld Journal 2006;6:1656-66.
Sense of Coherence Papers

1. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Merrick J. The life mission theory VII. Theory of existential (Antonovsky) coherence: A theory of quality of life, health and ability for use in holistic medicine. ScientificWorld Journal 2005;5:377-89. 2. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and physical health. A review of previous findings. ScientificWorld Journal 2005;5:665-73. 3. Flensborg-Madsen T, Ventegodt S, Merrick J. Why is Antonovslys sense of coherence not correlated to physical health? Analysing Antonovskys 29-item sense of coherence scale (SOC-29). ScientificWorld Journal 2005;5:767-76. 4. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and health. The construction of an amendment to Antonovskys sense of coherence scale (SOC II). TSW Holistic Health Med 2006;1:169-75. (ScientificWorld Journal 2006;6:2133-9). 5. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and physical health. A cross-sectional study using a new scale (SOC II). TSW-Holistic Health Med 2006;1:236-47. (ScientificWorld Journal 2006;6:2200-11). 6. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and physical health. Testing Antonovskys theory. TSW-Holistic Health Med 2006;1:248-55. (ScientificWorld Journal 2006;6:2212-9). 7. Flensborg-Madsen T, Ventegodt S, Merrick J. Sense of coherence and physical health. The emotional sense of coherence (SOC-E) was found to be the best-known predictor of physical health. TSW Holistic Health Med 2006;1:183-93. (ScientificWorld Journal 2006;6:2147-57). 8. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, Torp M, Merrick J. Clinical holistic medicine (mindful, short-term psychodynamic psychotherapy complemented with bodywork) improves quality of life, health and ability by induction of Antonovsky-Salutogenesis. ScientificWorld Journal 2007;7:317-23.
Research Summary Papers

1. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Nielsen M, Mohammed M, Merrick J. Global quality of life (QOL), health and ability are primarily determined by our consciousness. Research findings from Denmark 1991-2004. Social Indicator Research 2005;71:87-122. 2. Ventegodt S, Kandel I, Merrick J. Quality of life and philosophy of life determines physical and mental health: Status over research findings from the Quality of Life Research Center, Copenhagen, 1991-2007. ScientificWorld Journal 2007;7:1743-51.
Publications on Quality of Life 1994-2008 Short Reviews in the Public Debate
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1. Merrick J, Ventegodt S. What is a good death ? To use death as a mirror and find the quality of life. BMJ 2003 October 31 online at http://bmj.com/ cgi/eletters/327/7406/66#39303 2. Ventegodt S, Merrick J. Medicine and the past. Lesson to learn about the pelvic examination and its sexuality suppressive procedure. BMJ 2004 February 20 online at http://bmj.com/cgi/eletters/328/7437/0-g#50997 3. Ventegodt S, Morad M, Merrick J. If it doesnt work, stop it. Do something else! BMJ 2004 Apr 26 online at Http://bmj.com/cgi/eletters/328/7446/1016-a#57718 4. Merrick J, Morad M, Kandel I, Ventegodt S. Spiritual health, intellectual disability and health care. BMJ 2004 Jul 16 on-line at http://bmj.bmjjournals.com/ cgi/eletters/329/7458/123#67434 5. Merrick J, Morad M, Kandel I, Ventegodt S. Prevalence of Helicobacter pylori infection in residential care centers for people with intellectual disability. BMJ 2004 Jul 23 on-line at http://bmj.bmjjournals.com/cgi/eletters/329/7459/204#68360 6. Ventegodt S, Morad M, Kandel I, Merrick J. Maternal smoking and quality of life more than thirty years later. BMJ 2004 Jul 30 on-line at http://bmj.bmjjournals.com/ cgi/eletters/329/7460/250#69316 7. Merrick J, Morad M, Kandel I, Ventegodt S. People with intellectual disability, health needs and policy. BMJ 2004 Aug 20 on-line at http://bmj.bmjjournals. com/cgi/eletters/329/7463/414#71560 8. Ventegodt S, Morad M, Merrick J. Chronic illness, the patient and the holistic medical toolbox. BMJ 2004 Sept 15 on-line at http://bmj.bmjjournals.com/ cgi/eletters/329/7466/582#74372 9. Ventegodt S, Merrick J. Academic medicine must deliver skilled physicians. A different academic training is needed. BMJ 2004 Oct 09 on-line at http://bmj. bmjjournals.com/cgi/eletters/329/7469/0-g#77606 10. Ventegodt S, Merrick J. Placebo explained: Consciousness causal to health. BMJ 2004 Oct 22 on-line at http://bmj.bmjjournals.com/cgi/eletters/329/7472/927#80636 11. Ventegodt S, Flensborg-Madsen T, Merrick J. Evidence based medicine in favor of biomedicine and it seems that holistic medicine has been forgotten? BMJ 2004 Nov 11 on-line at http://bmj.bmjjournals.com/cgi/eletters/329/7473/987#85053 12. Ventegodt S, Merrick J. Philosophy of science: How to identify the potential research for the day after tomorrow? ScientificWorld Journal 2004;4:483-9. 13. Ventegodt S, Vardi G, Merrick J. Holistic adolescent sexology: How to counsel and treat young people to alleviate and prevent sexual problems. BMJ 2005 Jan 15 online at http://bmj.bmjjournals.com/cgi/eletters/330/7483/107#92872 14. Ventegodt S, Kandel I, Merrick J. Medicine has gone astray we must reverse the alienation now. BMJ 2005 Mar 10 on-line at http://bmj.bmjjournals.com/cgi/ eletters/330/7490/515#99806 15. Ventegodt S, Morad M, Merrick J. Challenge of chronic disease is the challenge of understanding life. The social medicine of our time. BMJ 2005 Mar 18 on-line at http://bmj.bmjjournals.com/cgi/eletters/330/7492/657#100776
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16. Ventegodt S, Merrick J. The consensus paradigm for qualitative research in holistic medicine. BMJ 2005 November 24 on-line: http://bmj.bmjjournals.com/cgi/ eletters/331/7526/0-d#122164 17. Ventegodt S, Andersen NJ, Merrick J. Rationality and irrationality in Ryke Geerd Hammers system for holistic treatment of metastatic cancer. ScientificWorld Journal 2005;5:93-102. 18. Ventegodt S, Merrick J. Suicide from a holistic point of view. ScientificWorld Journal 2005;5:759-66. 19. Ventegodt S, Merrick J. Psychosomatic reasons for chronic pain. South Med J 2005;98(11):1063. 20. Omar H, Ventegodt S, Merrick J. Holistic adolescent medicine. Ital J Pediatr 2005;31:284-7. 21. Ventegodt S, Merrick E, Merrick J. Clinical holistic medicine: The Dean Ornish Program (Opening the Heart) in cardiovascular disease. TSW Holistic Health Med 2006;1:13-20. (ScientificWorld Journal 2006;6:1977-84). 22. Ventegodt S, Morad M, Merrick J. The problem of consciousness. BMJ 2006 February 03 on-line at: http://bmj.bmjjournals.com/cgi/eletters/332/7536/0-f#127464 23. Ventegodt S, Kandel I, Merrick J. CAM is tested unfairly against placebo CAM is offering highly efficient placebo cures that should be tested with respect for its nature. BMJ 2007 Oct 14 On-line: http://www.bmj.com/cgi/eletters/335/ 7623/743#178119
Chapter 16
ABOUT THE QUALITY OF LIFE RESEARCH CENTER IN COPENHAGEN

INTRODUCTION The Quality of Life Research Center in Copenhagen was established in 1989, when the physician Sren Ventegodt succeeded in getting a collaboration started with the Department of Social Medicine at the University of Copenhagen in response to the project Quality of life and causes of disease. An interdisciplinary Working group for the quality of life in Copenhagen was established and when funds were raised in 1991 the University Hospital of Copenhagen (Rigshospitalet) opened its doors for the project. The main task was a comprehensive follow-up of 9,006 pregnancies and the children delivered during 1959-61. This Copenhagen Perinatal Birth Cohort was established by the a gynecologist and a pediatrician, the late Aage Villumsen, MD, PhD and the late Bengt Zachau-Christiansen, MD, PhD, who had made intensive studies during pregnancy, early childhood and young adulthood. The cohort was during 1980-1989 directed by the pediatrician Joav Merrick, MD, DMSc, until he moved to Israel. The focus was to study quality of life related to socio-economic status and health in order to compare with the data collected during pregnancy, deliverty and early childhood. The project continued to grow and later in 1993, the work was organized into a statistics group, a software group that developed the computer programs for use in the data entry and a group responsible for analysis of the data.
QUALITY OF LIFE RESEARCH CENTER

AT THE UNIVERSITY MEDICAL CENTER
The Quality of Life Center at the University Hospital generated grants, publicity with research and discussions among the professionals leading to the claim that quality of life was significant for health and disease. It is obvious that a single person cannot do much about his/her own disease, if it is caused by chemical defects in the body or outside chemicalphysical influences. However, if a substantial part of diseases are caused by a low quality of life, we can all prevent a lot of disease and operate as our own physicians, if we make a
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personal effort and work to improve our quality of life. A series of investigations showed that this was indeed possible. This view of the role of personal responsibility for illness and health would naturally lead to a radical re-consideration of the role of the physician and also influence our society.
INDEPENDENT QUALITY OF LIFE RESEARCH CENTER In 1994, The Quality of Life Research Center became an independent institution located in the center of the old Copenhagen. Today, the number of full-time employees have grown. The Research Center is still expanding and several companies and numerous institutions make use of the resources, such as lectures, courses, consulting or contract research. The companies, which have used the competence of the reseach center and its tools on quality of life and quality of working life, include IBM, Lego, several banks, a number of counties, municipalities, several ministries, The National Defense Center for Leadership and many other management training institutions, along with more than 300 public and private companies. It started in Denmark, but has expanded to involve the whole Scandinavian area. The centers research on the quality of life have been through several phases from measurement of quality of life, from theory to practice over several projects on the quality of life in Denmark, which have been published and received extended public coverage and public impact in Denmark and Scandinavia. The data is now also an important part of Veenhovens Database on Happiness at Rotterdam University in the Netherlands.
NEW RESEARCH Since The Quality-of-Life Research Center became independent a number of new research projects were launched. One was a project that aimed to prevent illness and social problems among the elderly in one of the municipalities by inspiring the elderly to improve their quality of life themselves. Another a project about quality of life after apoplectic attacks at one of the major hospitals in Copenhagen and the Danish Agency for Industry granted funds for a project about the quality of work life.
QUALITY OF LIFE OF 10,000 DANES There is a general consensus that many of the diseases that plague the Western world (which are not the result of external factors such as starvation, micro-organisms, infection or genetic defects) are lifestyle related and as such, preventable through lifestyle changes. Thus increasing time and effort is spent on developing public health strategies to promote healthy lifestyles. However, it is not a simple task to identify and dispel the negative and unhealthy parts of our modern lifestyle even with numerous behavioural factors that can be readily highlighted harmful, like the use of alcohol, use of tobacco, the lack of regular exercise and a high fat, low fibre diet. However there is more to Western culture and lifestyle than these factors and if we only focus on them we can risk overlooking others. We refer to other large parts of our life, for
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instance the way we think about and perceive life (our life attitudes, our perception of reality and our quality of life) and the degree of happiness we experience through the different dimensions of our existence. These factors or dimensions can now, to some degree, be isolated and examined. The medical sociologist Aaron Antonovsky (1923-1994) from the Faculty of Health Sciences at Ben Gurion University in Beer-Sheva, who developed the salutogenic model of health and illness, discussed the dimension, sense of coherence, that is closely related to the dimension of life meaning, as perhaps the deepest and most important dimension of quality of life. Typically, the clinician or researcher, when attempting to reveal a connection between health and a certain factor, sides with only one of the possible dimensions stated above. A simple, one-dimensional hypothesis is then postulated, like for instance that cholesterol is harmful to circulation. Cholesterol levels are then measured, manipulated and ensuing changes to circulatory function monitored. The subsequent result may show a significant, though small connection, which supports the initial hypothesis and in turn becomes the basis for implementing preventive measures, like a change of diet. The multi-factorial dimension is therefore often overlooked. In order to investigate this multifactorial dimension a cross-sectional survey examining close to 10,000 Danes was undertaken in order to investigate the connection between lifestyle, quality of life and health status by way of a questionnaire based survey. The questionnaire was mailed in February 1993 to 2,460 persons aged between 18-88, randomly selected from the CPR (Danish Central Register) and 7,222 persons from the Copenhagen Perinatal Birth Cohort 1959-61. A total of 1,501 persons between the ages 18-88 years and 4,626 persons between the ages 31-33 years returned the questionnaire (response rates 61.0% and 64,1% respectively). The results showed that health had a stronger correlation to quality of life (r= 0.5, p<0.0001), than it had to lifestyle (r=0.2, p< 0.0001). It was concluded that preventable diseases could be more effectively handled through a concentrated effort to improve quality of life rather than through n approach that focus solely on the factors that are traditionally seen to reflect an unhealthy life style.
COLLABORATIONS ACROSS BORDERS The project has been developed during several phases. The first phase, 1980-1990, was about mapping the medical systems of the pre-modern cultures of the world, understanding their philosophies and practices and merging this knowledge with western biomedicine. A huge task seemingly successfully accomplished in the Quality of Life (QOL) theories, and the QOL philosophy, and the most recent theories of existence, explaining the human nature, and especially the hidden resources of man, their nature, their location in human existence and the way to approach them through human consciousness. Sren Ventegodt visited several countries around the globe in the late 1980s and analysed about 10 pre-modern medical systems and a dozen of shamans, shangomas and spiritual leaders noticing most surprisingly similarities, allowing him together with about 20 colleagues at the QOL Study Group at the University of Copenhagen, to model the connection between QOL and health. This model was later further developed and represented in the integrative QOL theories and a number of publications. Based on this philosophical breakthrough the Quality of Life Research Center was established at the University hospital.
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Here a brood cooperation took place with many interested physicians and nurses from the hospital. A QOL conference in 1993 with more than 100 scientific participants discussed the connection between QOL and the development of disease and its prevention. Four physicians collaborated on the QOL population survey 1993. For the next 10 years the difficult task of integrating bio-medicine and the traditional medicine went on and Sren Ventegodt again visited several centers and scientists at the Universities of New York, Berkeley, Stanford and other institutions. He also met people like David Spiegel, Dean Ornish, Louise Hay, Dalai Lama and many other leading persons in the field of holistic medicine and spirituality. Around the year 2000 an international scientific network started to take form with an intense collaboration with the National Institute of Child Health and Human Development (NICHD) in Israel, which has now developed the concept of Holistic Medicine. We believe that the trained physician today has three medical toolboxes: the manual medicine (traditional), the bio-medicine (with drugs and pharmacology) and the consciousness-based medicine (scientific, holistic medicine). What is extremely interesting is that most diseases can be alleviated with all three sets of medical tools, but only the bio-medical toolset is highly expensive. The physician, using his hands and his consciousness to improve the health of the patient by mobilising hidden resources in the patient can use his skills in any cultural setting, rich or poor.
CONTACT PERSON Director Sren Ventegodt, MD, MMedSci, MSc Quality of Life Research Center, Classensgade 11C, 1 sal, DK-2100 Copenhagen O, Denmark E-mail: ventegodt@livskvalitet.org Website: http://www.livskvalitet.org
Chapter 17
ABOUT THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT IN ISRAEL
INTRODUCTION The National Institute of Child Health and Human Development (NICHD) in Israel was established in 1998 as a virtual institute under the auspicies of the Medical Director, Ministry of Social Affairs in order to function as the research arm for the Office of the Medical Director, but also as a national research and policy institute on child health and human development. In 1998 the National Council for Child Health and Pediatrics, Ministry of Health and in 1999 the Director General and Deputy Director General of the Ministry of Health endorsed the establishment of the NICHD.
MISSION The mission of a National Institute for Child Health and Human Development in Israel is to provide an academic focal point for the scholarly interdisciplinary study of child life, health, public health, welfare, disability, rehabilitation, intellectual disability and related aspects of human development. This mission includes research, teaching, clinical work, information and public service activities in the field of child health and human development. The Institute should eventually be the obvious resource to turn to for professionals, politicians, the general public and the media concerned with the care of children, the disabled and the intellectually disabled in our society.
SERVICE AND ACADFEMIC ACTIVITIES Over the years many activities became focused in the south of Israel due to collaboration with various professionals at the Faculty of Health Sciences (FOHS) at the Ben Gurion University of the Negev (BGU). Since 2000 an affiliation with the Zusman Child Development Center at the Pediatric Division of Soroka University Medical Center has resulted in collaboration
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around the establishment of the Down Syndrome Clinic at that center. From 2002 a full course on Disability was established at the Recanati School for Allied Professions in the Community, FOHS, BGU and twice a year seminars for specialists in family medicine. From 2005 collaboration was started with the Primary Care Unit of the faculty and disability became part of the master of public health course on children and society. From the academic year 2005-2006 a one semester course on aging with disability was started as part of the master of science program in gerontology in collaboration with the Center for Multidisciplinary Research in Aging. In 2007 a collaboration with the Center for Womens Health Studies and Promotion was started around the issue of home visitation for young pregnant mothers and their children. Academic activity has also taken place within the Ministry of Social Affairs for medical and allied health professionals in collaborations with most universities in Israel and relevant academic colleges.
RESEARCH ACTIVITIES The affiliated (volunteer) staff has over the years published work from projects and research activities in this national and international collaboration (about 1,000 publications since 1998). In the year 2000 the International Journal of Adolescent Medicine and Health and in 2005 the International Journal on Disability and Human development of Freund Publishing House (London and Tel Aviv), in the year 2003 the TSW-Child Health and Human Development, in 2006 the TSW-Holistic Health and Medicine of the Scientific World Journal (New York and Kirkkonummi, Finland) and in 2008 the International Journal of Child Health and Human Development, International Journal of Child and Adolescent Health and the Journal of Pain Management all published by Nova Science, New York), all peer-reviewed international journals have been affiliated with the National Institute of Child Health and Human Development. This collaboration with seven international journals has resulted in further projects worldwide and the possibility to publish the research in special peer-reviewed issues or other publications.
NATIONAL COLLABORATIONS Nationally the NICHD works in collaboration with the Faculty of Health Sciences, Ben Gurion University of the Negev; Department of Physical Therapy, Sackler School of Medicine, Tel Aviv University; Autism Center, Assaf HaRofeh Medical Center; National Rett and PKU Centers at Chaim Sheba Medical Center, Tel HaShomer; Department of Physiotherapy, Haifa University; Department of Education, Bar Ilan University, Ramat Gan, Faculty of Social Sciences and Health Sciences; College of Judea and Samaria in Ariel and recently also collaborations has been established with the Division of Pediatrics at Hadassah, Center for Pediatric Chronic Illness, Har HaZofim in Jerusalem.
About the National Institute of Child Health and Human Development in Israel 223
INTERNATIONAL COLLABORATIONS Internationally with the Department of Disability and Human Development, College of Applied Health Sciences, University of Illinois at Chicago; Strong Center for Developmental Disabilities, Golisano Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, New York; Centre on Intellectual Disabilities, University of Albany, New York; Centre for Chronic Disease Prevention and Control, Health Canada, Ottawa; Chandler Medical Center and Childrens Hospital, Kentucky Childrens Hospital, Section of Adolescent Medicine, University of Kentucky, Lexington; Chronic Disease Prevention and Control Research Center, Baylor College of Medicine, Houston, Texas; Division of Neuroscience, Department of Psychiatry, Columbia University, New York; Institute for the Study of Disadvantage and Disability, Atlanta; Center for Autism and Related Disorders, Department Psychiatry, Childrens Hospital Boston, Boston; Department of Paediatrics, Child Health and Adolescent Medicine, Children's Hospital at Westmead, Westmead, Australia; International Centre for the Study of Occupational and Mental Health, Dusseldorf, Germany; Centre for Advanced Studies in Nursing, Department of General Practice and Primary Care, University of Aberdeen, Aberdeen,United Kingdom; Quality of Life Research Center, Copenhagen, Denmark; Nordic School of Public Health, Gottenburg, Sweden, Scandinavian Institute of Quality of Working Life, Oslo, Norway; Centre for Quality of Life of the Hong Kong Institue of Asia-Pacific Studies and School of Social Work, Chinese University, Hong Kong.
CONTACT PERSON Joav Merrick, MD, MMedSci, DMSc. Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs and Social Services, POB 1260, IL-91012 Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net.il; Website: www.nichd-israel.com
ABOUT THE AUTHORS

Niels Jrgen Andersen, MSc. Professor, Department of Innovation and Economic Organization, Norwegian School of Management, Friisebrygga 2, 501, N-3921 Porsgrunn, Norway. E-mail: niels.j.andersen@bi.no; Website: www.bi.no/ users/fgl93013/ Lars Enevoldsen. Quality of Life Research Center, Classensgade 11C, 1 sal, DK-2100 Copenhagen O, Denmark. E-mail: larsenevoldsen2@msn.com Isack Kandel, MA, PhD. Senior lecturer, Faculty of Social Sciences, Department of Behavioral Sciences, Ariel University Center of Samaria, Ariel and National Institute of Child Health and Human Development, Jerusalem, Israel. Address: Maaleh Shomron, IL44852, Lev Shomron, Israel. E-mail: kandelii@zahav.net.il; Website: http://www. ariel.ac.il/ba/Faculty.asp?n=Kandel_I Tatiana Menick, MD. Psychiatrist, St. Elizabeths Hospital Psychiatry Residency Training, St. Elizabeths Hospital, Barton Hall, 2700 Martin Luther King Junior Ave SE, Washington DC, 20032 United States. E-mail tmenick@yahoo.com Joav Merrick, MD, MMedSci, DMSc. Professor of Pediatrics, National Institute of Child Health and Human Development, Office of the Medical Director, Division for Mental Retardation, Ministry of Social Affairs, Jerusalem and Kentucky Childrens Hospital, University of Kentucky, Lexington, United States. Address: Medical director, Ministry of Social Affairs, POBox 1260, IL-91012 Jerusalem, Israel. E-mail: jmerrick@internetzahav.net; Website: www.nichd-israel.com; Home-page: http://jmerrick50. googlepages.com/home Sren Ventegodt, MD, MMedSci, EU-MSc. Director, Quality of Life Research Center, Classensgade 11C, 1 sal, DK-2100 Copenhagen O, Denmark. E-mail: ventegodt@ livskvalitet.org; Website: http://www.livskvalitet.org Teodor T. Postolache, MD. Associate Professor and Director, Mood and Anxiety Program (MAP), Department of Psychiatry, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF Building Room 502, Baltimore, MD 21201 United States. Email: tpostolache@psych.umaryland.edu Jong-Min Woo, MD, PhD. Department of Psychiatry, Inje University College of Medicine, Seoul Paik Hospital, 85 Jurdong-2-ga, Jung-gu, Seoul, Korea 100-032. Email: jongmin.woo@gmail.com
ABOUT THE EDITORS

Sren Ventegodt, MD, MMedSci, EU-MSc in Complementary, Psychosocial and Integrated Health Sciences is the director of the Nordic School of Holistic Health and Quality of Life Research Center in Copenhagen, Denmark. He is also responsible for a Clinical Research Clinic for Holistic Medicine in Copenhagen and used as a popular speaker throughout Scandinavia. He has published numerous scientific or popular articles and a number of books on holistic medicine, quality of life and quality of working life. His most important scientific contributions are the comprehensive SEQOL questionnaire, the very short QOL5 questionnaire, the integrated QOL theory, the holistic process theory, the life mission theory, and the ongoing Danish Quality of Life Research Survey, 1991-94 in cooperation with the University Hospital of Copenhagen and the late professor of pediatrics, Bengt ZachauChristiansen, MD, PhD. E-Mail: ventegodt@livskvalitet.org Website: www.livskvalitet.org
Joav Merrick, MD, MMedSci, DMSc, is professor of pediatrics, child health and human development affiliated with Kentucky Childrens Hospital, University of Kentucky, Lexington, United States and the Zusman Child Development Center, Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel, the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, the founder and director of the National Institute of Child Health and Human Development. Numerous publications in the field of pediatrics, child health and human development, rehabilitation, intellectual disability, disability, health, welfare, abuse, advocacy, quality of life and prevention. Received the Peter Sabroe Child Award for outstanding work on behalf of Danish Children in 1985 and the International LEGO-Prize (The Childrens Nobel Prize) for an extraordinary contribution towards improvement in child welfare and well-being in 1987. E-Mail: jmerrick@internet-zahav.net.il Website: www.nichd-israel.com
INDEX
A
abnormalities, 193 academic, 199, 213, 215, 221, 222 access, 72, 98, 161, 173, 176 accessibility, 172 accidents, 73 accommodation, 92 accounting, 49 achievement, 45, 126 activation, 179 acute, 163, 164, 166, 178 adaptation, 62, 188 adenosine, 191 adjustment, 72, 189, 194 administration, 169, 188, 190, 192 administrative, 44 adolescence, 174, 205 adult, 27, 37, 39, 62, 162, 204, 208 adulthood, 164, 174, 217 adults, 38, 62, 166, 177, 188 advocacy, 227 affective disorder, 176 affirmative action, 77 African-American, 178 afternoon, 92, 193 age, 5, 37, 63, 64, 73, 80, 81, 86, 91, 97, 112, 114 agent, 187 agents, 161, 168, 169, 185, 187, 191, 193 aging, 178, 181, 222 agricultural, 178 agriculture, 166 AIDS, 211 air, 13, 24, 168, 194 air travel, 194 alcohol, 177, 194, 218 alcoholics, 21 alcoholism, 204, 209 alertness, 6, 28, 57, 67, 98, 185, 186, 190, 191 alienation, 198, 215 allergens, 161, 168, 180 allergic, 168 allergy, 211 alternative, 37, 63, 81, 204, 206, 209 alternatives, 14 alters, 178 American Psychiatric Association (APA), 167, 177, 179 American Psychological Association, 181 amygdala, 167, 179 animals, 51, 54, 168 antagonism, 191 antagonists, 193 antidepressant, 194 antihistamines, 191 antioxidant, 190 anxiety, 166, 167, 168, 171, 175, 177, 225, 192 anxiety disorder, 166, 171, 175 apathy, 27 appendix, 72, 78, 80, 81, 82, 88, 96, 98 argument, 18, 30 arthritis, 63 artificial, 54, 148, 167, 185 assessment, 134, 173, 176, 177 assets, 111 asthma, 211 atherosclerosis, 78 athletes, 192 atmosphere, 70, 93 atrophy, 188, 194 attacks, 218 attention, 16, 29, 37, 47, 69, 72, 92, 98, 120, 162, 163, 176, 192, 194 attitudes, 6, 29, 51, 52, 54, 56, 57, 60, 62, 63, 66, 67, 68, 69, 72, 74, 77, 79, 82, 83, 85, 86, 90, 91, 92, 93, 94, 98, 99, 100, 114, 218 authenticity, 197 authority, 112, 170, 171 autoimmune, 32, 58, 211
230
autoimmune disease, 32, 58, 211 autoimmune diseases, 32, 58, 211 autopsy, 173, 181 availability, 172, 173, 176 avoidance, 169, 185, 188, 189, 192, 193 awareness, 56, 63, 83, 85, 87, 94, 98, 99, 112, 126, 161, 173, 176
Index
breast cancer, 52, 53, 58, 65, 78, 106, 153 bullying, 170 burn, 53, 59, 74, 115, 141, 162 burnout, 83, 118, 177, 211 business, 34, 44, 47, 112, 118, 126, 176, 197, 198 butter, 70
C
caffeine, 190, 191, 192, 193, 195 caliber, 172 CAM, 216 campaigns, 83 cancer, 21, 32, 52, 53, 58, 73, 211 candidates, 176 capacity, 34, 39, 70, 162, 193, 197 carbon, 166, 178 cardiovascular, 216 cardiovascular disease, 216 cast, 83 causal relationship, 162 causality, 101, 164 cell, 50, 187, 204, 213 census, 172 cerebrospinal fluid, 186 cervical, 187 CES, 164 chaotic, vii, 1, 198 chemical, 161, 165, 166, 171, 178, 179, 217 chemicals, 53, 167 chemistry, 213 chemotherapy, 52, 53 child development, 31, 41, 50, 123, 209 child welfare, 227 childcare, 171 childhood, 62, 155, 156, 211, 212, 217 childhood sexual abuse, 211, 212 children, 12, 15, 24, 25, 26, 28, 37, 51, 52, 54, 55, 129, 136, 171, 208, 210, 217, 221, 222 Chinese, 21, 205, 223 chocolate, 191 cholesterol, 219 chronic, 21, 32, 49, 63, 64, 163, 166, 169, 170, 174, 176, 180, 200, 204, 209, 211, 212, 215, 216 chronic disease, 63, 170, 204, 215 chronic diseases, 204 chronic illness, 21 chronic pain, 32, 169, 180, 200, 204, 212, 216 chronic stress, 49 chronobiology, 194 circadian, 167, 169, 179, 185, 186, 187, 188, 189, 190, 191, 193, 194, 195 circadian clock, 187, 188, 190, 194
B
bacteria, 168 bacterial infection, 168 banks, 218 barrier, 47, 63, 69 barriers, 63 basic needs, 15, 136 batteries, 53 beating, 39 Beck Depression Inventory (BDI), 164 beer, 68, 199 behavior, 93, 94, 166, 179, 186, 188, 205, 213 behavioral difficulties, 171 behavioral effects, 167 beliefs, 67, 83, 99, 100 benchmark, 99, 127, 133 benchmarking, 86, 114 benchmarks, 127 benefits, 44, 80, 87, 112, 114, 116, 173, 182 benzodiazepine, 191 beverages, 185, 194 bias, 163 biochemistry, 213 biological, 6, 20, 107, 161, 167, 171, 185, 186, 188, 204, 207, 213 biological form, 213 biology, 31, 41, 107, 204, 207, 213 biomedical, 210, 213 bipolar, 162, 166, 168, 169, 179, 180, 191, 193 bipolar disorder, 162, 166, 168, 179, 191, 193 birth, 19, 20, 70, 106, 123, 153, 204, 208 blame, 60, 70, 71 blaming, 23 blindness, 195 blood, 16, 166, 178, 186 blood lead levels, 178 blue-collar workers, 179, 180 body temperature, 186, 187 bone, 178 boredom, 129 brain, 16, 31, 34, 39, 41, 60, 71, 93, 107, 166, 168, 171, 195, 207, 213 brain damage, 166 brain structure, 171 breast, 52, 53, 58, 65, 78, 106, 153
Index
circadian rhythm, 167, 169, 179, 185, 186, 187, 188, 189, 190, 191, 194, 195 circadian rhythm sleep disorders, 186, 190 circadian rhythmicity, 186 circadian rhythms, 167, 179, 186, 187, 188, 189, 194, 195 circulation, 219 citizens, 19, 127 classical, 18, 43, 46, 47, 84, 197 classified, 163, 173 cleaning, 11, 14 clients, vii, 1, 10, 15, 16, 51, 52, 150 clinical, 20, 21, 32, 154, 156, 157, 159, 161, 162, 163, 170, 173, 186, 190, 200, 205, 206, 207, 210, 212, 213, 221 clinical disorders, 170 clinical presentation, 186 clinical trial, 21, 161, 210 clinical trials, 21, 161 clinically significant, 156, 158, 161, 162, 163 clinician, 219 clinicians, 169 closure, 119 coffee, 24, 29, 191 cognition, 166 cognitive, 166, 173, 181, 188, 191, 192, 194, 195 cognitive deficit, 188, 194 cognitive function, 191 cognitive performance, 192, 195 coherence, vii, 1, 2, 30, 31, 41, 50, 92, 123, 156, 199, 204, 209, 214, 219 cohesiveness, 161 cohort, 164, 177, 178, 182, 217 collaboration, 217, 220, 221, 222 collective unconscious, 198 colleges, 222 combat, 43, 45 commercial, 133, 193 commercials, 54 commodity, 116 common symptoms, 190 communication, 39, 46, 47, 48, 70, 86, 95, 96, 100, 114, 115, 126, 130 communities, 45 community, 10, 26, 38, 45, 46, 48, 59, 70, 72, 73, 85, 90, 98, 100, 112, 122, 134, 151, 162, 163 compensation, 165 competence, 70, 97, 128, 218 competency, 197, 199 competition, vii, 1, 172 competitiveness, 86, 114 competitor, 44 complementary, 156, 180, 181, 206, 209
231
complexity, 77, 128 components, 15, 170, 194 compounds, 166, 185 computer, 13, 14, 217 computers, 53, 81 concentration, 141, 163, 166, 167, 171, 187 conception, 66, 83 conditioning, 168 confidence, 13, 26, 29, 47, 48, 69, 166 confidence interval, 166 conflict, 46, 66, 82, 84, 88, 95, 126, 182 conformity, 137 confounding variables, 164 confrontation, 16 confusion, 115 consciousness, 19, 20, 31, 32, 41, 50, 57, 58, 74, 91, 93, 107, 122, 126, 127, 159, 198, 205, 207, 209, 210, 213, 214, 216, 219, 220 consensus, 163, 194, 216, 218 construction, 83, 95, 214 consultants, 72, 111, 122, 126, 130 consulting, 218 consumer goods, 26, 54 consumers, 54, 116 consumption, 52, 54, 112 continuing, 16, 88 continuity, 92 control, 27, 28, 29, 37, 57, 78, 81, 112, 128, 161, 165, 166, 169, 170, 173, 177, 179, 180, 181, 182, 185, 191, 193, 198 controlled, 80, 158, 182 conviction, 56, 57 coronary heart disease, 106, 153 correlation, 16, 17, 18, 63, 64, 85, 90, 96, 130, 131, 219 correlation coefficient, 131 correlations, 169 cortical, 178 corticosteroids, 171 corticotropin, 171 cortisol, 171, 188 cost-benefit analysis, 163 cost-effective, 80, 163, 173, 209 costs, 34, 86, 88, 89, 114, 182 counsel, 215 counseling, 173, 176 countermeasures, 173 coupling, 179 coverage, 218 CPR, 101, 219 creative process, 13 creativity, 213 CRH, 171
232
Index
desynchronization, 188 detection, 176, 179 diagnostic, 162, 163 Diagnostic and Statistical Manual of Mental Disorders (DSM, DSM-IV), 163, 164, 177, 212 diesel, 53 diet, 26, 218, 219 dietary, 190 differentiation, 204 diphenhydramine, 191 disability, 89, 163, 182, 205, 206, 215, 221, 222, 227 disabled, 221 discipline, 13, 27, 60, 71, 72, 74, 78, 98 discrimination, 172 diseases, 81, 212, 217, 218, 219, 220 disorder, 163, 169, 185, 186, 190, 192, 193, 195 disputes, 43, 46 dissatisfaction, 27 dissociation, 49 distress, 179 distribution, 113 disulfide, 166 diversity, 46, 181 division, 119 doctors, 71, 81, 172 dominance, 43, 47 doors, 217 dosage, 191 down-regulation, 171 downsizing, 77 dream, 5, 6, 19, 27, 33, 35, 39, 40, 59, 61, 97, 113 drinking, 194 dropouts, 157 drug abuse, 177 drugs, 21, 208, 220 duration, 111, 121, 162, 168, 169, 185, 187, 188, 189, 191, 192, 194 dust, 27 dynamic environment, vii, 1 dysphoria, 162, 163 dysregulation, 166 dysthymia, 167
criticism, 48, 56, 170 cross-sectional, 181, 182, 214, 219 cross-sectional study, 214 CSF, 186 cultural, 54, 77, 220 cultural differences, 77 culture, vii, 1, 19, 26, 49, 54, 64, 80, 81, 85, 86, 88, 94, 95, 114, 119, 126, 181 curable, 155 curiosity, 67 customers, 5, 6, 13, 15, 16, 35, 45, 48, 51, 52, 54, 55, 56, 59, 69, 70, 71, 72, 97, 98, 106, 112, 113, 114, 115, 130, 150, 151, 174 CVD, 165 cycles, 116, 163, 185, 187, 194 cycling, 179, 191, 193 cytokine, 168
D
daily living, 94, 126 dairy, 70 death, 11, 27, 28, 38, 39, 67, 71, 155, 206, 215 death sentence, 11, 67, 71 decay, 14, 63, 78 decisions, 52, 62, 116, 130, 140, 148, 156, 199 decongestant, 194 defects, 12, 217 deficits, 191 definition, 38, 127 degree, 17, 18, 19, 36, 79, 81, 112, 130, 170, 219 dehydration, 168 delays, 187, 188, 189, 190 delivery, 208 demand, 18, 54, 70, 116, 122, 161, 165, 169, 173, 177 dementia, 63 demographic, 182 Denmark, ix, 5, 6, 9, 19, 20, 63, 74, 80, 81, 89, 95, 106, 107, 111, 113, 122, 126, 133, 153, 177, 203, 204, 205, 208, 214, 218, 220, 223, 225, 227 dentists, 165 Department of Education, 222 deposits, 54 depressed, 34, 163, 166, 174, 178 depression, 77, 161, 162, 163, 164, 165, 166, 167, 168, 170, 171, 172, 173, 174, 176, 177, 179, 180, 181, 182, 193, 195 depressive disorder, 162, 163, 176, 177 depressive symptomatology, 177 depressive symptoms, 161, 163, 165, 167, 169, 177, 178, 180, 181 deprivation, 167, 182 desire, 83, 92
E
earth, 19, 26, 40, 46, 119 eating, 29 ecological, 176 economic, 77, 79, 112, 114, 135, 161, 163, 170, 176, 182, 217 economic change, 161 economic status, 217 economics, 163 economy, 120, 161, 174, 185
Index
ecosystem, 6, 19, 98 eczema, 211 education, 15, 16, 26, 82, 83, 85, 165, 176, 198 EEG, 178 efficacy, 158, 159, 161, 174, 176 ego, 15, 31, 41, 50, 90, 123, 205, 209 elderly, 70, 218 electrical, 180 electronic, 14, 84 electrophysiological, 186 electrostatic, iv elementary school, 165 emotional, 155, 156, 168, 170, 197, 213, 214 emotional intelligence, 197, 213 emotions, 49, 107, 156, 199, 208 employees, vii, 1, 2, 5, 16, 17, 40, 43, 44, 46, 47, 48, 49, 54, 55, 56, 57, 59, 70, 71, 72, 73, 77, 81, 83, 84, 86, 88, 90, 95, 96, 98, 99, 100, 101, 111, 112, 113, 114, 115, 116, 118, 119, 120, 121, 122, 126, 133, 134, 149, 161, 162, 170, 172, 173, 176, 177, 180, 181, 197, 205, 218 employers, 161, 163, 173, 176, 182 employment, 54, 121, 172, 174, 182 empowerment, 120, 122 endangered, 12 endocrine, 178 endocrine system, 178 endogenous, 171 endogenous depression, 171 energy, 5, 23, 24, 25, 26, 28, 30, 37, 38, 43, 45, 46, 47, 53, 54, 57, 78, 83, 90, 91, 97, 100, 112, 115, 116, 167, 213 engagement, 116 engineering, 37 enterprise, 143 entertainment, 28 enthusiasm, 12, 98 environment, vii, 1, 5, 6, 15, 16, 18, 29, 40, 49, 51, 52, 53, 54, 55, 56, 57, 59, 65, 70, 71, 72, 79, 82, 85, 97, 98, 99, 100, 104, 105, 112, 113, 114, 125, 128, 129, 130, 136, 146, 150, 161, 163, 165, 166, 168, 176, 185, 186, 194 environmental, 49, 53, 116, 166, 167, 168, 169, 171, 176, 178, 186, 187 environmental change, 171 environmental conditions, 176 environmental factors, 186 environmental stimuli, 187 epidemic, 163 epidemiological, 161, 169, 179 estimating, 161 ethical, 105, 116, 130, 150, 153 Euro, 141, 142
233
Europe, 64 European, 21, 63, 170, 178, 181 Europeans, 63 evening, 186, 190, 193 evidence, 61, 161, 176, 177, 186, 192, 206, 209 evil, 11, 31, 41, 50, 83, 123, 141, 177, 209 evolution, 95, 214 excitement, 12, 24, 28, 39, 98 excuse, 27, 29 exercise, 26, 73, 83, 99, 185, 192, 194, 218 existentialism, 18 expert, 15 experts, 95, 115 explosive, 57 exposure, 165, 166, 167, 168, 169, 170, 177, 178, 179, 185, 187, 188, 189, 192, 193, 194 external validation, 131 external validity, 96, 130 eye, 5, 24, 60, 71, 194
F
face validity, 83, 171 factorial, 219 failure, 67, 70 faith, 63 family, 6, 25, 97, 112, 162, 171, 172, 180, 181, 222 family history, 180 family life, 25 family medicine, 222 family members, 172 farm, 166, 178 farmers, 166, 178 fatalistic, 28 fatigue, 171, 211 faults, 29, 34 fear, 12, 92 feedback, 87, 96, 100, 133, 163, 186, 187 feeding, 187 feelings, 57, 91, 163, 171, 172 fibromyalgia, 211 financial support, 156 fire, 12 firearm, 173 flexibility, 62, 70 flight, 188, 190, 193, 194, 195 flow, 96, 103, 128, 129, 141, 168 focusing, 18, 95, 122, 126, 169 food, 26, 46, 81, 136, 165, 187 Food and Drug Administration (FDA), 190, 192 forgetfulness, 12 formal education, 199 freedom, 11, 14, 16, 18, 29, 39, 47, 55, 66, 81, 84, 129, 140
234
Freud, 30, 79 friendship, 26, 27, 46, 136 frustration, 163, 164 fulfillment, 199 funds, 217, 218
Index
harmful, 63, 79, 139, 218, 219 harmony, 13, 18, 72, 94, 98, 126 head, 44, 67, 198 headache, 78, 166, 187, 189 healing, 21, 31, 49, 58, 74, 84, 155, 156, 157, 158, 198, 204, 207, 209, 210, 213 health care, 10, 52, 84, 85, 86, 114, 162, 165, 205, 215 health care system, 162 health effects, 170, 180 health insurance, vii, 1 health problems, 77, 78, 84, 87, 102, 103, 104, 105, 164, 170 health status, 219 healthcare, 122 heart, 27, 28, 45, 73, 74, 78, 197, 216 heart attack, 73 heat, 168 hedonic, 167 height, 17 Helicobacter pylori, 215 helplessness, 171, 172 heterogeneity, 188 high fat, 218 high-risk, 165, 169, 173 high-risk populations, 173 high-tech, 118 hippocampal, 171 hippocampus, 188 Hippocrates, 31, 58, 74, 75, 155, 159, 205, 212 HIV, 211 holistic, 10, 21, 31, 32, 41, 50, 58, 74, 75, 80, 123, 156, 157, 158, 159, 197, 198, 199, 200, 204, 205, 206, 208, 209, 210, 211, 212, 213, 214, 215, 216, 220, 227 holistic approach, 197 holistic medicine, 10, 31, 32, 41, 50, 58, 74, 75, 123, 157, 158, 159, 200, 204, 205, 206, 209, 210, 211, 212, 213, 214, 215, 216, 220, 227 honesty, 94 hopelessness, 171, 176 hormone, 171, 186, 190 hormones, 186 hospital, 52, 219 hospitals, 218 host, 79 household, 79 housing, 26 human brain, 204 human capital, 77 human condition, 116 human development, 61, 73, 84, 158, 197, 221, 227 human experience, 185
G
ganglion, 187 garbage, 15 gasoline, 168 gastrin, 186 gastrointestinal, 187 gender, 81, 86, 114, 156, 171, 181 gene, 168, 186 gene expression, 168 General Health Questionnaire (GHQ), 164 general practitioner, 173 generalized anxiety disorder, 169 generation, 25, 53, 172, 191 generators, 186 genes, 23, 25, 30, 78, 186, 213 genetic defect, 218 gerontology, 222 gestalt, 210 gift, 11, 40, 50, 198 gifted, 36, 49 gifts, 9, 34, 36, 71, 155 gland, 187 glass, 37, 82 global resources, 52, 54 globalization, 161, 172 glucocorticoid receptor, 171 goals, 10, 23, 39, 44, 47, 53, 59, 71, 130 God, 74, 116 gossip, 39, 144 grants, ix, 217 group therapy, 209, 210 group work, 93 groups, 17, 43, 45, 46, 49, 53, 92, 100, 188 growth, 56, 62, 80, 88, 91, 115 guidance, ix, 73 guiding principles, 26 guilt, 92 gynecologist, 217
H
handling, 13, 34, 57, 70 hands, 35, 172, 220 hanging, 173 happiness, 2, 11, 12, 14, 21, 25, 26, 27, 31, 36, 37, 40, 41, 57, 64, 79, 88, 95, 107, 126, 129, 206, 219 harm, 13, 18, 72, 94, 98, 126, 174, 213
Index
human nature, 203, 219 Human Resource Management, 181 human resources, 149 human subjects, 194 humanity, 56, 57 humans, 23, 25, 30, 37, 167, 178, 179, 189, 190, 192 humidity, 168 humorous, 59, 69 hypertension, 21, 32, 58 hypnotic, 191 hypothalamus, 186 hypothesis, 101, 116, 168, 171, 181, 188, 219
235
I
IBM, 218 ice, 141 id, 39 identification, 89, 96, 133 identity, 14, 163 idiopathic, 166, 178 IL-4, 225 Illinois, 223 illumination, 185 imaging, 181, 188 immunomodulatory, 190 impairments, 188, 192 implementation, 70, 82, 83 incest, 32, 58, 211 incidence, 168, 169, 177, 178, 181, 187 income, 16, 17, 26, 64, 80, 86, 95, 114, 126, 129, 164, 170 increased access, 172 independence, 47 indication, 156, 158 individual character, 173 individual characteristics, 173 inducer, 190 induction, 32, 168, 179, 190, 191, 193, 200, 212, 214 industrial, 18, 56, 81, 95, 122 industrialized countries, 185 industry, 165, 167, 174 inefficiency, 70 infancy, 20, 106, 123, 153, 204, 208 infection, 215, 218 infections, 32, 58, 211 infectious, 161, 168 inferiority, 172 infertility, 210 inflammation, 168 information technology, 128, 174 inherited, 51, 54 injustice, 181 innovation, 86, 114
Innovation, 115, 225 inorganic, 178 insecurity, 77, 172 insight, 6, 48, 49, 53, 57, 60, 71, 92, 98, 137, 155 insomnia, 64, 162, 171, 190 inspiration, 71, 72, 93, 98, 100 institutions, 218, 220 instructors, 92 instruments, 21, 83, 85, 87, 89 insulin, 186 insurance, 89 integrity, 60, 71, 116 intelligence, 198, 199, 208 intensity, 18, 37, 45, 192 intentions, 48, 95, 126 interaction, 170, 192, 193 interdisciplinary, 217, 221 internal biological clock, 167, 189 internal consistency, 96, 130 internal time, 187, 189 international, 9, 21, 96, 199, 205, 220, 222 internet, 223, 225, 227 interpersonal conflict, 181 interpretation, 10, 127, 204 interstate, 168 interval, 157 intervention, 77, 80, 81, 83, 84, 85, 86, 87, 88, 100, 101, 111, 114, 118, 119, 120, 121, 127, 158, 161, 165, 168, 169, 174, 182, 189, 209 interview, 164 interviews, 87, 88 intimacy, 9, 13 intuition, 79, 197 investment, 84, 161, 163, 176 ion channels, 186 iron, 13, 37 irrationality, 216 irritability, 166, 168, 187 irritation, 167
J
jet lag, 165, 169, 185, 187, 188, 189, 190, 191, 192, 193, 194, 195 job dissatisfaction, 162 job insecurity, 161, 172 job loss, 163, 164, 172, 180, 182 job performance, 162 job satisfaction, 15, 16, 17, 30, 59, 70, 72, 98, 111, 140 jobless, 12 jobs, 5, 12, 17, 18, 29, 70, 77, 97, 112, 164, 171, 172, 177 judgment, 127
236
justice, 170
Index
longitudinal studies, 169 long-term, 49, 166, 173, 174, 185, 186, 208 losses, 162, 176 love, 5, 9, 13, 15, 16, 23, 24, 26, 27, 28, 30, 37, 38, 46, 49, 50, 54, 55, 57, 60, 64, 65, 66, 67, 68, 70, 71, 73, 92, 99, 156, 158, 161, 205 lover, 25, 26 low-level, 166 LSD, 30 luggage, 194 lying, 5
K
killing, 38 kinase, 178
L
labour, 73, 115 labour market, 73, 115 lack of confidence, 47 language, 26, 36, 62, 79, 82 laughing, 61 laws, 198, 199 lawyers, 165 lead, 19, 39, 40, 48, 55, 63, 72, 73, 79, 100, 120, 163, 164, 166, 170, 171, 172, 178, 182, 218 leadership, 43, 47, 48, 74, 86, 95, 111, 114, 118, 120, 121, 125, 126, 130, 161, 197, 198, 199 leadership style, 161 learned helplessness, 171 learning, vii, 1, 15, 36, 41, 79, 82, 83, 88, 198, 199 learning process, 36, 41 leisure, 61, 171 liberation, 19 licensing, 88 LIFE, 132 life quality, vii, 1, 6, 9, 16, 17, 18, 19, 30, 37, 43, 69, 70, 72, 73, 74, 80, 83, 94, 96, 98, 99, 106, 113, 122, 125, 127, 133, 153 life satisfaction, 95, 126, 129 life span, 5 life stressors, 163 life style, 26, 219 life-cycle, 56 lifelong learning, 161 lifestyle, 29, 81, 88, 106, 153, 206, 210, 218, 219 lifestyle changes, 106, 153, 218 lifestyles, 218 life-threatening, 59, 64, 73, 74, 161 lifetime, 13, 52, 62 light-emitting diodes, 189 Likert scale, 79, 127, 155, 156, 158 limitations, 43, 46, 78, 163, 210 linear, 116, 120, 132 linear regression, 132 linguistic, 47 linguistically, 96, 130 linkage, 182 listening, 26, 170 location, 167, 191, 193, 219 long period, 167 long work, 44, 165, 173
M
machines, 57, 81 maintenance, 165, 191, 193 major depression, 163, 167, 177, 179, 181, 193 major depressive disorder, 162, 177 malaise, 187 males, 178 management, 6, 43, 44, 45, 46, 48, 56, 59, 70, 71, 73, 82, 84, 85, 86, 87, 88, 98, 101, 104, 105, 113, 114, 120, 121, 130, 144, 146, 147, 163, 174, 182, 198, 218 mania, 193 manipulation, vii, 1 manpower, 116 manufacturing, 166, 178 mapping, 88, 219 market, 51, 53, 54, 116 market value, 51, 54 marketability, 172 marketing, 60, 61 marriage, 66 masking, 187 mastery, 10, 13, 15, 19, 27, 33, 34, 35, 36, 37, 38, 39, 40, 43, 46, 51, 56, 59, 60, 70, 71, 72, 74, 77, 95, 98, 100, 103, 112, 115, 116, 125, 126, 129, 152 material resources, 150 materialism, 26, 54 maternal, 20, 154, 208 maternal smoking, 20, 208 mathematical, vii, 1, 112 MCS, 166, 167 meals, 185, 194 measurement, 77, 79, 80, 83, 100, 127, 132, 218 measures, 81, 85, 170, 185, 219 mechanical, 14, 49, 198 mechanics, 165 media, 87, 221 medication, 81, 154, 169, 192, 208 medications, 187, 193, 194
Index
medicine, vii, 1, 10, 20, 21, 31, 41, 50, 58, 77, 84, 93, 122, 156, 159, 203, 204, 205, 206, 209, 210, 211, 213, 215, 216, 220 Medline, 161 melatonin, 167, 169, 179, 185, 186, 187, 188, 189, 190, 192, 193, 194, 195 melatonin receptor agonists, 190 memory, 188, 212 memory deficits, 188 men, 21, 49, 64, 171, 172, 177, 178, 181, 182 mental disorder, 159, 177, 211 mental health, vii, 1, 114, 155, 156, 158, 163, 164, 165, 169, 170, 172, 173, 174, 176, 182, 214 mental illness, 32, 200, 212 mercury, 166, 178 meridian, 188 messages, 84 meta-analysis, 158, 159 metabolism, 16 metamorphosis, 204, 214 metastatic, 58, 106, 153, 216 metastatic cancer, 216 microenvironments, 168 micro-organisms, 218 middle-aged, 181 midlife, 178 migraine, 171 migraine headache, 171 military, 172, 182 military occupation, 172 Millennium, 80 minority, 26 mirror, 215 MIT, 21 Modafinil, 192, 195 models, 169, 170, 179, 180, 181, 188 modules, 100 money, 11, 14, 15, 16, 19, 26, 28, 30, 44, 51, 52, 54, 55, 80, 95, 127, 163, 174 mood, 24, 79, 161, 162, 163, 164, 165, 166, 167, 168, 169, 170, 171, 173, 174, 175, 176, 178, 179, 192, 193, 194 mood change, 166 mood disorder, 161, 162, 163, 164, 165, 166, 168, 169, 170, 171, 173, 174, 176, 193, 194 morale, 27 morning, 5, 10, 11, 24, 44, 92, 97, 112, 167, 186, 188, 190, 193 morphogenesis, 213 mortgage, 15 mothers, 222 motivation, 60, 64, 73, 156, 163, 187 motives, 29, 63 MRI, 188 multicultural, 80, 82, 87 multi-ethnic, 80 multivariate, 169
237
N
N-acety, 179 narcissistic, 164 natural, 9, 10, 18, 43, 46, 47, 54, 73, 188, 198, 199 natural resources, 54 natural science, 10 nausea, 189 negative attitudes, 78 negativity, 79, 83 nerve, 18, 24 nervous system, 178 network, 186, 220 neuroendocrinology, 181 neurons, 166, 186 neuropsychology, 213 neurotransmitter, 168 neurotransmitters, 168 New World, 107 NNT, 155 Nobel Prize, 227 noise, 13, 161, 166, 168, 176, 179, 194 normal, 83, 116, 117, 120, 174, 186, 194 normal conditions, 120 novelty, 185 nurses, 52, 168, 172, 220
O
OAS, 162 objectivity, 122 obligation, 26, 43, 49, 51, 55 obligations, 170, 181 obsolete, 14 obstructive sleep apnea, 192 occupational, 16, 161, 162, 163, 164, 165, 167, 168, 169, 170, 171, 172, 173, 176, 178, 179, 193 occupational groups, 170 occupational health, 161 odds ratio, 166 odorants, 167 odors, 166, 167, 178 oil, 53, 57 old age, 78 olfaction, 179 olfactory, 166, 178, 179 oncology, 21 online, 215, 216 ontogenesis, 204
238
Index
70, 72, 73, 74, 78, 79, 80, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 98, 99, 100, 103, 114, 115, 116, 125, 126, 129, 130, 133, 143, 144, 155, 165, 169, 172, 174, 182, 197, 217 personal achievements, 65 personal control, 172, 182 personal history, 62, 79, 90, 92 personal identity, 11 personal life, 15, 39, 40, 49, 85 personal meaningfulness, 9, 13, 33 personal qualities, 33, 36 personal relations, 45, 52, 55, 64, 86, 114, 129 personal relationship, 52, 55, 64, 86, 114 personal responsibility, 93, 95, 126, 218 personal values, 56, 57 personality, 5, 19, 35, 37, 38, 40, 97, 112, 164, 177 personality disorder, 164 personality traits, 177 pesticide, 166, 178 pesticides, 166, 172, 178 pharmacies, 168 pharmacological, 169, 185 pharmacology, 220 pharmacotherapy, 173 philosophical, 10, 213, 219 philosophy, 10, 18, 19, 20, 31, 41, 56, 79, 80, 81, 82, 83, 84, 85, 90, 91, 92, 93, 107, 118, 119, 125, 127, 128, 156, 197, 203, 206, 207, 212, 214, 219 phone, 34, 194 photoreceptor, 187 photoreceptors, 187 physical activity, 187 physical environment, 162 physical health, 2, 32, 58, 101, 102, 105, 114, 155, 156, 158, 180, 210, 214 physicians, 52, 53, 130, 176, 215, 217, 220 physiological, 91, 111, 168, 186, 190 physiology, 178, 186 pilot study, 17, 21, 209, 211 pilots, 188, 193 pineal, 179, 186, 187, 190 pineal gland, 179, 186, 187, 190 placebo, 91, 190, 191, 216 plague, 218 planning, 44 plants, 51, 54 plasma, 195 play, 169, 187 pleasure, 13, 18, 44, 94, 122, 126 poisoning, 166, 172, 178 poisons, 172 police, 168, 172 policy making, 165
openness, 62, 66, 78 operating system, 72 opposition, 46 optic chiasm, 186 optimal performance, 50 oral, 192 organic, 166, 177, 178 organic solvent, 166, 177, 178 organic solvents, 166, 177 organism, 50, 186 organization, 1, 30, 43, 50, 77, 115, 119, 120, 121, 134, 143, 144, 146, 147, 148, 149, 150, 151, 163, 174, 213 organizations, 122, 197, 199 orientation, 116, 198 oscillations, 179 oscillator, 186 overtime, 61 oxygen, 16
P
pacemaker, 179, 186, 190, 194 packaging, 150 pain, 11, 21, 27, 49, 65, 74, 91, 94, 126, 155, 156, 209, 211 paints, 53 parameter, 66 paraventricular, 186 paraventricular nucleus, 186 parents, 20, 25, 62, 136 pathogenesis, 156, 158 pathophysiology, 181, 190 pathways, 186 patients, 1, 10, 21, 32, 51, 52, 53, 58, 106, 153, 155, 156, 157, 158, 166, 167, 168, 169, 171, 178, 179, 190, 191, 192, 193, 194, 199, 204, 209, 212, 213 pediatrician, 217 peer, 199, 203, 222 peer review, 199 pelvic, 210, 212, 215 pensions, 89 percentile, 169 perception, 45, 56, 62, 67, 72, 100, 116, 125, 169, 218 perceptions, 54, 66 performance, 14, 88, 96, 125, 155, 165, 168, 174, 175, 176, 186, 191, 192, 193 periodic, 47 peripheral oscillators, 188 perseverance, 27, 29, 60, 71 personal, 1, 6, 9, 10, 11, 13, 14, 15, 19, 28, 29, 30, 33, 35, 36, 37, 38, 39, 40, 43, 45, 46, 48, 49, 50, 51, 52, 55, 56, 57, 59, 60, 61, 62, 63, 64, 65, 68,
Index
political, 26, 53, 79, 116, 163 politicians, 122, 221 pollutants, 161, 168 pollution, 54, 57, 150 poor, 12, 16, 23, 29, 36, 70, 78, 88, 90, 135, 165, 166, 170, 172, 173, 182, 187, 193, 220 poor health, 135, 182 poor performance, 12 population, vii, 2, 6, 19, 20, 57, 64, 106, 113, 122, 127, 153, 162, 167, 173, 176, 177, 180, 182, 204, 207, 220 population growth, 57 positive attitudes, 67, 72, 98 positive relation, 170 positive relationship, 170 posture, 61, 187 power, 26, 39, 43, 46, 47, 54, 55, 57, 107, 117, 122, 155 predictors, 181 preference, 47 pregnancy, 20, 106, 123, 153, 204, 208, 217 pregnant, 208, 222 pregnant women, 208 preparation, 165 preparedness, 162 pressure, 34, 65, 77, 118, 174 prestige, 14 prevention, 78, 169, 173, 189, 220, 227 preventive, 168, 219 primary care, 182 primary school, 39 priorities, 165 private, 6, 9, 37, 38, 40, 44, 46, 54, 55, 59, 62, 69, 70, 77, 97, 113, 122, 136, 141, 143, 197, 218 proactive, 188 problem solving, 163 procedures, 35, 39, 59, 71, 84, 96, 130 production, 6, 10, 18, 37, 51, 53, 54, 55, 56, 70, 98, 112 productivity, 84, 86, 112, 114, 116, 118, 120, 162, 163, 176, 181 profession, 33, 35, 37, 40, 67, 68, 193 professional careers, 28 professional development, 48, 95, 103, 126, 129 professional growth, 50 professionalism, 33, 35, 40 professions, 11, 46, 165, 173, 177 Profile of Mood States (POMS), 164 profit, 16, 43, 46, 56, 112, 156 profitability, 28, 56, 174 prognosis, 65 program, 83, 88, 94, 99, 204, 205, 222 prolactin, 186
239
promote, 35, 45, 167, 169, 218 prosperity, 112 protein, 166, 186 protein kinase C, 166 protocol, 169, 187 provocation, 83 psychiatric disorder, 159, 162, 164, 166, 174, 177, 179 psychiatric disorders, 159, 162, 164, 166, 174 psychiatric illness, 193 psychiatric morbidity, 170, 178, 181 psychiatrist, 194 psychiatrists, 174 psychoanalysis, 79 psychological, 21, 53, 79, 87, 93, 95, 101, 102, 103, 104, 105, 106, 129, 146, 161, 162, 163, 166, 170, 171, 173, 175, 178, 179, 181, 210 psychological distress, 162, 179 psychological health, 87, 101, 102, 103, 104, 105, 106 psychological stress, 170 psychologists, 81, 101, 178 psychology, 19, 30, 81, 107, 116, 154 psychometric properties, 21 psychophysiological, 179 psychosocial, 1, 58, 106, 153, 162, 172, 173, 181 psychosocial stress, 172 psychosomatic, 162, 170, 171 Psychosomatic, 216 psychotherapy, 30, 32, 158, 159, 200, 212, 214 psychotic, 212 psychotropic medications, 168 PTSD, 165 public, 26, 44, 54, 72, 77, 116, 122, 143, 163, 165, 172, 176, 185, 204, 218, 221, 222 public health, 165, 176, 218, 221, 222 public relations, 44 public service, 172, 221 pulse, 134 pulses, 194
Q
QLQ-C30, 21 QOL, 9, 10, 31, 41, 72, 74, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 94, 99, 101, 102, 103, 104, 105, 106, 107, 111, 112, 114, 115, 116, 119, 121, 122, 126, 127, 128, 129, 131, 153, 155, 156, 157, 158, 203, 204, 205, 206, 207, 208, 209, 214, 219, 220, 227 qualifications, 16, 199 qualitative research, 216 quality assurance, 35, 72 quality improvement, 206
240
Index
156, 158, 159, 162, 168, 169, 170, 178, 185, 197, 199, 203, 204, 205, 206, 207, 209, 214, 215, 217, 218, 221, 222 research design, 169 researchers, 127, 162, 166, 169, 170 reservation, 62 residential, 215 resilience, 88 resin, 24 resistance, 74, 83 resolution, 82, 84, 88 resources, 23, 24, 30, 60, 64, 69, 71, 72, 80, 83, 90, 95, 98, 100, 116, 120, 126, 130, 158, 173, 193, 198, 218, 219, 220 responsibilities, 171 restoration, 191 restructuring, 77, 172 retina, 186, 187 retinohypothalamic tract, 186, 187 retirees, 86, 114 retirement, 63, 73 retirement age, 63, 73 revenue, 77, 163 reward conditions, 180 rhinitis, 194 rhythm, 185, 186, 188 rhythmicity, 186 rhythms, 167, 186, 187, 188 rigidity, 62 risk, 12, 19, 26, 39, 130, 163, 164, 165, 166, 168, 169, 170, 171, 172, 173, 176, 177, 180, 181, 182, 193, 213, 218 risk behaviors, 19 risk factors, 171, 176, 177, 182 risks, 168, 176 roadblocks, 168 ROI, 161, 163 routines, 26, 28, 74 rural, 185
quality of service, 88 quality of working life, vii, viii, 1, 2, 6, 9, 10, 73, 77, 78, 83, 84, 98, 99, 111, 112, 118, 125, 127, 131, 134, 151, 152, 153, 207, 218, 227 quantum, 213 quantum chemistry, 213 questionnaire, vii, viii, 1, 2, 10, 17, 18, 20, 72, 81, 83, 84, 87, 94, 95, 96, 99, 100, 101, 111, 113, 125, 126, 127, 128, 130, 131, 133, 134, 152, 153, 154, 159, 170, 207, 219, 227 questionnaires, 20, 21, 65, 72, 77, 80, 81, 87, 89, 96, 122, 130, 131, 203, 206, 207
R
race, 57 radiation, 52, 53, 189 radical, 70, 119, 156, 158, 218 range, 12, 27, 47, 63, 116, 127, 169 rape, 32, 58, 211 rating scale, 21, 164 raw materials, 53, 54, 57 reading, 37 reality, 10, 27, 47, 57, 61, 62, 66, 77, 83, 90, 198, 204, 219 receptors, 181, 186, 187, 189, 191 recognition, 136 reconstruction, 181 recovery, 155, 157, 188, 191, 209, 211 reduction, 167, 173, 176, 188, 194 redundancy, 96, 130 refining, 27 reflection, 120, 197 refractory, 169 regression, 131, 206 regular, 43, 45, 173, 182, 190, 191, 194, 218 regulation, 168, 171, 178, 190 rehabilitation, 155, 211, 221, 227 rejection, 49 relapse, 167 relationship, 12, 15, 16, 26, 38, 39, 45, 47, 72, 90, 99, 136, 147, 150, 161, 163, 174, 176, 180, 182, 187 relationships, 10, 82, 88, 130, 170, 171 relaxation, 173 relevance, 181 reliability, 81, 96, 130 religion, 81 remission, 168, 211 renin, 186 repair, 165 repetitions, 62 research, viii, 2, 10, 12, 31, 52, 56, 58, 63, 65, 75, 78, 79, 80, 82, 84, 88, 89, 101, 113, 116, 127,
S
sacred, 116 sacrifice, 194 SAD, 166, 167, 168, 176 sadness, 163 safety, 95, 126, 136, 167, 185 salaries, 172 salary, 12, 15, 16, 33, 37, 39, 40, 89, 111, 117, 118, 119, 121, 163 sales, 34, 70, 174 sample, vii, 1, 157, 176, 182 sand, 53
Index
satisfaction, vii, 1, 6, 16, 18, 51, 54, 82, 96, 99, 125, 129, 161 scheduling, 169 schizophrenia, 212 science, 10, 20, 31, 32, 37, 41, 47, 49, 52, 57, 58, 78, 79, 81, 82, 107, 165, 197, 206, 207, 210, 215, 222 scientific, vii, viii, ix, 1, 2, 9, 10, 30, 80, 82, 85, 88, 93, 122, 133, 197, 199, 203, 204, 220, 227 scientific community, 204 scientists, 81, 220 SCN, 186, 187, 188, 189 scores, 83, 114, 117, 169 search, 19, 29, 62, 80, 83, 106, 126, 154 searches, 161 seasonal affective disorder, 166, 179 secret, 9, 11, 13, 73, 158 secretion, 167, 179, 186 secrets, 24 security, 16, 18, 26, 95, 126, 172 seeds, 36 self, 32, 65, 74, 113, 114, 128, 133, 153, 157, 163, 164, 200, 212 self-care, 116 self-confidence, 53, 158 self-discipline, 6, 38, 40, 73, 78, 98, 146 self-empowerment, 122 self-esteem, 15, 32, 53, 82, 116, 155, 156, 158, 163, 172, 200, 212 self-expression, 28, 52, 54, 92 self-help, 88 self-management, 78 self-organization, 213 sensitivity, 82, 96, 127, 130, 166, 168, 179 series, 10, 114, 134, 170, 204, 217 serotonin, 167, 179, 190 services, 1, 16, 48, 51, 54, 55, 74, 100, 168 severity, 162, 168, 170, 187 sex, 26, 30, 32, 58, 64, 80, 210 sexual harassment, vii, 1, 170 sexuality, 49, 215 SH, 179 shape, 23, 25, 29, 46, 66, 122 sheep, 166, 178 short-term, 32, 158, 159, 191, 194, 200, 212, 214 side effects, 189, 191, 192, 213 sign, 9, 89 signalling, 29 simulation, 188 skills, vii, 1, 33, 34, 35, 36, 39, 40, 51, 52, 55, 68, 70, 77, 82, 83, 84, 86, 100, 114, 116, 130, 138, 173, 220 skin, 180, 189 skin cancer, 189
241
sleep, 26, 44, 136, 166, 168, 169, 171, 176, 180, 185, 186, 187, 188, 190, 191, 192, 193, 194, 195 sleep deprivation, 185, 191, 193 sleep disorders, 169, 194 sleep disturbance, 166, 171, 180, 195 sleep-wake cycle, 194 smoking, 60, 71, 215 SOC, 214 social, vii, 1, 12, 14, 15, 37, 49, 53, 63, 79, 95, 126, 129, 136, 156, 158, 161, 162, 163, 165, 166, 170, 171, 173, 185, 208, 215, 218 social benefits, 12, 14 social environment, 14, 170 social events, 53 social factors, 171 social life, 37, 49 social network, 171 social obligations, 63 social problems, 218 social relations, 170 social resources, 162 social sciences, vii, 1 social services, 79, 223 social skills, 95, 126 social status, 15 social support, 170, 171, 173 social work, 165 socially, 57, 170 society, 5, 15, 16, 18, 19, 46, 48, 49, 57, 59, 71, 77, 82, 86, 88, 95, 97, 100, 106, 112, 114, 118, 120, 122, 127, 129, 130, 161, 162, 168, 176, 185, 218, 221, 222 socioeconomic status, 164 sociologist, 219 sociologists, 81 software, 47, 77, 89, 217 soil, 36, 50 solar, 53 solar cells, 53 solidarity, 152 solutions, 9, 56, 87, 174 solvents, 166, 178 somatic complaints, 166, 168, 173 sounds, 63 spatial, 188, 194 spatial memory, 188 specialists, 222 spectrum, 189 speed, 11, 29, 36, 61, 70, 77, 185 spiritual, 19, 197, 198, 199, 213, 219 spirituality, 220 spouse, 12, 15, 37, 38, 52, 55 stability, 116
242
Index
symbols, 30, 54, 199 symmetry, 47 sympathy, 29, 48 symptom, 168, 191 symptomatic treatment, 77, 191 symptoms, 64, 88, 162, 163, 166, 170, 171, 174, 178, 179, 186, 187, 188, 189, 190, 191, 193, 194 synapses, 167 synchronization, 186 syndrome, 163, 166, 186 synthetic, 190 systematic, 203 systems, 191, 209, 219
stages, 112 standard deviation, 81 standard of living, 11, 79, 95 standards, 13, 39, 54, 56, 96, 130, 161 starvation, 218 statistics, 11, 53, 82, 217 stigma, 161 stimulus, 189 stomach, 64 strain, 11, 117, 161, 169, 171, 172, 180, 182 strategic, 27, 29 strategies, 173, 218 strength, 23, 24, 30, 36, 56, 60, 66, 71, 79, 90, 92, 197 stress, vii, 1, 16, 18, 19, 34, 68, 77, 82, 84, 86, 87, 88, 89, 102, 106, 114, 122, 125, 129, 139, 159, 161, 162, 163, 165, 169, 170, 171, 173, 174, 176, 177, 180, 181, 182, 199, 211 stress level, 89, 163 stress reactions, 162 stressors, 161, 165, 172 stress-related, 77, 170 students, 179 subjective, 21, 79, 94, 101, 113, 125, 127, 129, 133, 178, 190, 191 subjective experience, 133 subjective well-being, 21, 94, 101, 125 substances, 166 suffering, 12, 74, 83, 174, 204 sugar, 16 suicidal, 166, 172, 173 suicidal ideation, 172 suicide, 64, 161, 162, 163, 165, 166, 169, 171, 172, 173, 176, 177, 180, 181, 182, 205 suicide attempters, 180 suicide rate, 64 summer, 167, 168, 179 sunlight, 167, 189 supervision, 88 supervisor, 173 supervisors, 170 supply, 93, 116 suppression, 189, 194 suprachiasmatic, 186 suprachiasmatic nuclei, 186 suprachiasmatic nuclei (SCN), 186 surgery, 52, 53 surplus, 23, 25, 28, 30, 115 surprise, 12, 36 survival, 16, 56, 57, 58, 61, 81, 83, 106, 153 sustainability, 116 sweat, 57 switching, 49
T
tachycardia, 192 talent, 10, 23, 31, 41, 49, 50, 67, 123, 126, 209 tangible, 47 targets, 39 taste, 82 tea, 61, 191 teachers, 62, 165 teaching, 173, 221 team members, 199 technician, 187 technological, 57, 130, 162 technology, 47, 49, 53, 57, 70, 81, 149 Tel Aviv, 205, 222 telephone, 11, 173, 179 television, 29 temperature, 13, 136, 161, 166, 168, 185, 187, 188, 189, 193 temporal, 173, 188, 194 temporal lobe, 188, 194 terminally ill, 60, 64 testosterone, 186 theoretical, 95 theory, vii, viii, 1, 2, 6, 7, 19, 20, 21, 30, 31, 41, 47, 50, 58, 74, 78, 80, 81, 82, 84, 94, 95, 96, 106, 107, 117, 119, 121, 122, 123, 125, 126, 127, 128, 154, 155, 159, 181, 204, 206, 207, 208, 209, 210, 213, 214, 218, 227 therapeutic, 31, 58, 84, 156, 167, 191, 193, 210, 213 therapeutic benefits, 156 therapy, 21, 32, 58, 155, 156, 157, 158, 159, 167, 198, 199, 210, 212 thinking, 34, 39, 51, 54, 105, 106 threatened, 77, 180 threatening, 78, 170 threats, 170, 181 thresholds, 179 time pressure, 169 timing, 168, 169, 187, 188, 190, 194
Index
tinnitus, 32, 58, 210 tobacco, 218 top-down, 214 toxic effect, 166 toxicity, 168 trade, 13, 122 trade union, 122 trainees, 67, 88 training, 16, 80, 83, 85, 88, 143, 176, 198, 215, 218 training programs, 80 traits, 37, 60, 68 transatlantic flights, 191 transcendence, 126 transcription, 186 transformation, 54 transition, 51, 54 transitions, 190 translation, 186 trauma, 155, 156, 158, 211 traumatic events, 20, 208 travel, 11, 185, 187, 188, 189, 191, 193, 194, 195 trend, 70 trial, 182 triggers, 171 troubleshooting, 70 trust, 60, 63, 71, 199 turnover, 44 variance, 170 variation, 96, 129, 130, 132, 186 vertebrates, 190 vessels, 78 victims, 172, 173 Victoria, 31, 58, 74, 159, 205, 206 violence, 161, 170, 181 viruses, 168 visible, 120 vision, 27, 28, 48 vocational, 162, 163, 169 vocational performance, 163 voice, 29, 34 vouchers, 26 vulnerability, 171, 174, 185, 193 vulvodynia, 32, 58, 210
243
W
wages, 122 waking, 192 walking, 46, 194 waste, 28, 29, 53, 54, 57, 115, 120, 150 water, 15, 53, 54, 95, 187 wavelengths, 189, 192 wealth, 12, 19, 81, 95, 126, 127 weapons, 172 wear, 61 welfare, 79, 221, 227 wellbeing, 5, 12 well-being, 17, 21, 37, 79, 112, 129, 139, 227 western culture, 64, 218 windows, 29, 173, 194 winning, 28 winter, 166, 167, 179 wisdom, 25, 28, 31, 41, 47, 56, 63, 107, 198, 206, 213 withdrawal, 167 women, 52, 53, 64, 65, 166, 171, 172, 181, 188 wood, 38 work environment, vii, 1, 83, 114, 161, 162, 163, 168, 171, 175, 176, 177 workability, 13 workers, 10, 43, 46, 70, 116, 118, 119, 120, 121, 161, 162, 163, 164, 165, 166, 167, 169, 170, 172, 173, 174, 175, 176, 178, 180 workforce, 86, 114 working conditions, 29, 103, 104 working hours, 15, 16, 39, 176 working memory, 178 working population, 162, 176 working women, 177 worklife, 9 workload, 129, 161, 169
U
ultraviolet, 189 uncertainty, 73, 74, 172 unemployment, 172, 177, 182 unfolded, 33, 35 unhappiness, 28, 163 unions, 122 universe, 81 universities, 222 upper respiratory infection, 168 users, 52, 130, 150, 178, 225
V
vaginal, 212 valence, 167 validation, 20, 87, 90, 102, 131, 154, 159, 207 validity, 83, 96, 127, 130 values, 10, 19, 25, 26, 45, 48, 49, 51, 53, 54, 55, 56, 57, 59, 61, 69, 70, 71, 72, 78, 90, 92, 97, 99, 100, 112, 116, 128, 134, 148, 152 vapor, 178 variability, 188 variable, 180 variables, 80, 82, 88, 161, 162, 163, 164
244
workplace, 161, 164, 167, 170, 172, 174, 175, 182 work-related stress, 163, 172, 182 workspace, 167 World Health Organization, 164 worry, 15, 79 writing, 37, 49, 89
Index Y
young men, 188
Z
zygote, 204

Health and Happiness From Meaningful Work (1606928201)

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In: Health and Human Development Series

HEALTH AND HAPPINESS FROM MEANINGFUL WORK:

HEALTH AND HUMAN DEVELOPMENT SERIES

In: Health and Human Development Series

HEALTH AND HAPPINESS FROM MEANINGFUL WORK:

JOAV MERRICK EDITORS

Nova Science Publishers, Inc.

Copyright 2009 by Nova Science Publishers, Inc.

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Published by Nova Science Publishers, Inc.

Chapter 10 Chapter 11 Chapter 12

About the Authors About the Editors Index

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

Sren Ventegodt and Joav Merrick

PART I: UNDERSTANDING QUALITY OF WORKING LIFE HOW TO BE HAPPY AT WORK

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

Sren Ventegodt and Joav Merrick

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

QUALITY OF LIFE, HAPPINESS AND MEANING OF LIFE

Quality of Life, Happiness and Meaning of Life

Quality of Life, Happiness and Meaning of Life

WHAT IS GOOD WORK AND HOW DO YOU ATTAIN IT?

The Bad Blacksmith

The Mediocre Blacksmith

The Good Blacksmith

Quality of Life, Happiness and Meaning of Life

Quality of Life, Happiness and Meaning of Life

QWL-s cale 0-100

50 6,67 13,33 26,67 40 53,33 133,33

Income in thousand Euro (intervalse: 6,67 means 0-6,67)

How interesting is your work?

Quality of Life, Happiness and Meaning of Life

[11] [12] [13] [14] [15] [16]

[21] [22] [23] [24]

Quality of Life, Happiness and Meaning of Life

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

PERSONAL QUALITY OF LIFE

Personal Quality of Life

Personal Quality of Life

Personal Quality of Life

Personal Quality of Life

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

MASTERY IN YOUR WORK

MASTERY IN THE PROCESS OF WORK

The Bad Secretary

The Good Secretary

Mastery in your Work

The Brilliant Secretary

Let us take a look at each of the four consecutive points.

Mastery in your Work

Mastery in your Work

Mastery in your Work

[8] [9] [10] [11] [12] [13] [14]

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

WORKING WITH COLLEAGUES AND MANAGEMENT

CO-OPERATION WITH COLLEAGUES AND MANAGEMENT

Working with Colleagues and Management

Working with Colleagues and Management

Working with Colleagues and Management

ISBN 978-1-60692-820-2 2009 Nova Science Publishers, Inc.

A hospital Department with Poor Ability to Create Value

A Hospital Department Creating Great Value

Becoming a Valuable Human Being