Ash Fontana — 17 Jul 2011
Flat, hierarchy-free structures are both idealized and analyzed among those who think about work. Jason Fried of 37signals, at the top of our blogroll, recently wrote an article about why and how he keeps his company flat. Perhaps the primary argument against hierarchies, however, is that they actually induce stress, and stress kills. This blog has and will frequently refer to well-being and stress, so it’s worth taking time to outline the negative physiological effects of stress, how hierarchies cause stress, and offer ideas to eliminate or mitigate hierarchy-induced stress.
- Your body releases adrenaline and glucocorticoids when stressed.
- Adrenaline and glucocorticoids are useful when you're trying to 'fight or flight'; "you mobilize energy in your thigh muscles, you increase your blood pressure and you turn off everything that's not essential to surviving, such as digestion, growth and reproduction...you think more clearly, and certain aspects of learning and memory are enhanced. All of that is spectacularly adapted if you're dealing with an acute physical stressor — a real one." 
- Chronic psychological initiation of this endocrinological response can dramatically increase blood pressure, risk of heart disease, risk of diabetes, suppress the immune system, restrict blood flow to vital organs, kill brain cells in the hippocampus (i.e. affect memory), reduce dopamine secretion and accelerate the shortening of telomeres.
Hierarchies Induce Stress
The landmark Whitehall studies in Britain examine  mortality rates in British civil servants. This is a particularly useful group to study because of relatively consistent levels of access to health care, reduced variation in income (no one in the study was either very rich or very poor) and the absence of other drawbacks seen when using more general social class groupings.
The studies have shown an inverse association between level in the employment hierarchy and mortality, and linked this to stress. That is, those lower down the chain have a higher mortality rate than those higher up the chain, and it’s significantly higher – men at the bottom in the first Whitehall study had a mortality rate 4x higher than those at the top. This was true even after normalizing for established risk factors for coronary heart disease, such as smoking, BMI, leisure time and blood pressure . Something else was at play; and Marmot et al found that it was cortisol (our stress hormone); lower-level workers did not have higher cortisol levels than higher-level workers upon waking but did 30 minutes later, particularly if it was a work day .
How was work causing these biochemical changes in lower-level workers? Blood pressure at work was associated with ‘job stress’, including ‘lack of skill utilization’, ‘tension’, and ‘lack of clarity’ in tasks . Employment grade was strongly associated with work control and varied work (measures of decision latitude) as well as fast pace (a measure of job demands). Blood pressure at home, on the other hand, was not related to job stress level.
How to mitigate or eliminate the problem
The human world affords many opportunities to be a part of different hierarchies. We can create our own family and friendship structures, join community groups and change our work group by switching jobs. This, and the fact that we are no longer locked into social positions in any of these groups in our post-feudal world, affords us many opportunities to mitigate and eliminate the stress caused by being low in a hierarchy. Specifically, the creators of workplaces mitigate and eliminate the negative physiological effects of hierarchies and stress.
- Encourage 'horizontal ambition' - becoming better at all aspects of your work, in contrast to 'vertical ambition' which is a drive up a ladder on which the rungs are just corporate titles.
- Linked to horizontal ambition, help your employees have control over their work so that they can achieve flow. In a state of flow, employees absent many of the negative factors found in the Whitehall study, such as lack of skill utilization.
- Remove hierarchies in your work place by having teams manage themselves and cycling managerial responsibility (as they do at 37signals); with the hierarchy constantly changing no individual can control any other.
- Encourage your employees to participate in social groups outside of work where they can hold a high social status or upper part of a hierarchy. Afford them time to be captain of their basketball team, President of a community organization or even author of a popular Tumblr blog.
- Loudly call out anyone who revels in their rank.
-  http://news.stanford.edu/news/2007/march7/sapolskysr-030707.html. World-renowned neurobiologist and neuroendocrinologist Robert Sapolsky has conducted a number of studies on the structures within primate communities that both cause and enable stressful situations, as well as into the general biochemistry of stress. Baboons are good subjects for such research because, like us humans, they have to do very little work for their calories (just a few hours per day) and therefore have lots of time to generate psychological stress with others in their group as part of their attending to higher (Maslowian) needs.
-  The Whitehall studies are ongoing/longitudinal prospective cohort studies with Phase 10 being completed this year.
-  Marmot, M. G.; Rose, G.; Shipley, M.; Hamilton, P. J. (1978). "Employment grade and coronary heart disease in British civil servants". Journal of Epidemiology and Community Health 32 (4): 244–249. PMID 744814.
-  Kunz-Ebrect, S. R.; Kirschbaum, C.; Marmot, M; Steptoe, A (2004). "Differences in cortisol awakening response on work days and weekends in woman and men from the Whitehall II cohort". Psychoneuroendocrinology 29 (4): 516–528. PMID 14749096.
-  The Whitehall Study in Wikipedia.