In the 1968 the first online ATM was opened in Malmö. This was the start of something that would come to be a revolution, when money is concerned. However, it was not immediately accepted by the public, and the idea of getting cash from a machine was difficult to accept. ”I’d rather talk to a person, than using a machine to get my money.” was a commonly voiced opinion. However, the freedom that the machines provided was a very strong factor when it came to accepting the new modernity.

Among the problems people had initially, was of course the use of a PIN-code. Forgetting the PIN-code was a common problem, and luckily, the banks could still help you out manually when there was any problem. And, if you were still a bit reluctant, you could still get your money from a person behind the cashier. But people get used to new things quite quickly, and today the use of a machine for getting money is the default.

However, the introduction of the machine was of course not without problems. Apart from purely technical breakdowns, or disturbances on the connections (this was in the very early days of connectivity, the Internet was not even conceived of at that time) there was one recurring problem, however, that was labeled ”human factors”. It turned out that people tended to forget their cards in the machine. You might wonder how that could be, since you have to take your card before you get your money, and getting money was the whole reason for going there in the first place.

Well, the explanation is simple, it was simply not designed in that way in the beginning. When it was introduced, you would:

1. enter your card, and
2. then the PIN,
3. then request some money,
4. then you would get the money and,
5. finally you would get the card back (and the receipt, of course).

If you can see any problems with that sequence, you are already on the track. This was of course really a human factor, but a human factor that the system designers had forgotten! The reason that people did forget their cards was very simple. Getting money from the machine consists of two separate task, namely 1) to identify yourself and your account, and 2) get the money. The most important of these is of course the latter, to get the cash in your hand, since you have to buy something in a shop. No problem so far!

But, and this is a very big ”but”, the identification was wrapped around the primary task, in that it did not end until you had received your card back. But to the user, that task was not interesting in itself, and of course you had already identified yourself by entering the PIN code. Getting the card back, became a ”shadow task”, a task which was more or less hidden from the user’s mind. It was a human factor, but a human factor that we need to take into account in our designs.

Needless to say, after some iterations, the procedure was changed to the one we recognize today, where we have to take the card, before the main taks is finished (by getting the money). The designers had apparently learned their lesson.

Now, 50+ years later, I was seriously taken aback when I was about to park my car at the university parking space, after they had changed the old machines for the parking tickets, to new modern (and faster) ones. The new machine required me to leave the card in the slot during the whole transaction, and it even grabbed it, so that I could not pull it out. When was the transaction finished? You guessed it, when I had the parking ticket in my hand. Only then was my card released. Can you see the problem here now? Of course! If you are late to an appointment, the main task is to get the parking ticket into the car, so that you don’t get a parking fine (which was not unheard of, to say the least).

When I asked around a little, it turned out that there was a big increase in the number of cards, that had been forgotten in the slot (yes, I did it too!). Byt WHY did they repeat this unfortunate design? We already know from experience and research that this would happen. We even changed the pattern for this in the ATM machines, long time ago.

Well, I can see one reason that this happens. We have a short memory for design solutions. We don’t remember why we did the design as we did it, and even worse, we don’t remember the bad design choices that were made and discarded already. In a more and more complex world, we will repeat similar technical solutions over and over again. And we will most likely also continue to blame it on “Human Factors”.

And MAYBE, just MAYBE, it wouldn’t hurt that much to study old solutions and see why they were designed one way and not the other.

About security and safety

It has to be easy to do the right thing,
otherwise people will do the wrong thing.
(Minna) 

The more we depend on using computers and the Internet, the greater the risks for information leakage and information corruption become. However, it is relatively easy to protect the information that is being accessed over a network, and even easier to protect the information that is locked within a specific computer. “You only have to…” is a very common statement from computer experts when this kind of problems are brought up for discussion. The problem in that expression is the word “only”, which in most cases is not “only” for most general users.

So to protect your data that is transferred over the network you “only have to encrypt it”. And to prevent people from using all your accounts, you “only have to use good passwords that are different for all accounts”. And if you cannot remember all passwords, you “only have to use a password manager”. This might be easy for the more technically advanced users, but for the general public, the best password manager is most likely still a piece of paper beside the computer.

Information security has become more and more important, not least now when more and more information is available on the Internet. Now you can do almost anything on the net, even quite sensitive things, such as read your health documents online, handle your payments, and get information about people’s income. And now the security measures are getting more and more complicated to understand for the general user. They might be easy to handle, but we get more and more reports on how people are being tricked by imposters who have made up workarounds to cheat the security measures. Since people don’t know how the security software works, this is often an easy thing.

Here we have a printer used for “secret” documents. But since everybody tend to forget their key cards, we have to put them somewhere convenient. Why not hang them on the printer?

A chain is not stronger than the weakest link, and in most cases the weak link is… the nature of the security measures (!). Now, I guess that most of you who read this expected me to say that it would be the user, so maybe some explanations are necessary?

It is actually quite simple. Human behaviours are, by and large, based on economising resources (some would say that people are lazy instead). If we can do something in a simpler or more “efficient” way, we do so. So, if it takes too long to remember a password every time, it is of course time efficient to write it down somewhere, where it is easy to find. Even if someone tells us that it is not safe, we still let the economical considerations guide our activities.

Now, for example, at several web sites we are supposed to use two-step verification, which means that when you have entered a password, you will get an SMS with an extra code that you have to enter before you are completely logged in. If you have used it on a couple of web sites, you are very tempted to denounce using it at others. It is way too clumsy to be something to use everyday. What is the result? People will avoid using it, resulting in less secure connections.

But, of course, you only have to… and more and more often, “the only” gets to be just the little drop that is too much… Remember, humans are both “lazy”(*) and smart at the same time. Thus, if we can find a way to skip the awkward and inefficient procedures, we tend to do so. What does this mean? It means that we have to make sure that the means we have to use to secure our information will have to be easy to use. We cannot blame security breaches on the user who is only following his or her instinctive procedures. The blame should lie on the bad or insufficiently designed security solutions…

Footnotes:
(*) The word “lazy” in this context is a positive property, which has developed as a survival feature, conserving energy for the individual.

One of my absolute favorite expressions is the phrase: “You only have to…”. Even better is when it is preceeded by the next best expression: “It is very simple.” Why do I like it? Well, it is such a good example of when a bad interaction design has to be explained to someone who has been fighting a problem for hours, and is done so with a (not so) small hint of that the person asking for it does not know anything about what he or she is doing. “So, the text on the screen is too small to read? Well, that is easy, you only have to…”. Well, if it was so easy, why didn’t the person who asked about it find it already by him- or herself? Probably because it is only easy, as soon as you know how to do it already.

The two expressions above have been around since I started my work within the HCI area but from my experience, I can say that in my world, the “stupid user” does not exist. There might be some “unexpected” user’s who do things that we have not thought of. But they do it as a result of their background and the knowledge they have. So, if you as a software developer haven’t foreseen that these users do exist, the problem is yours, not theirs. To produce usable systems is, therefore, a matter of understanding the users, their needs and their backgrounds and then apply the technology needed in order to create the proper tools for them.

When people make errors, it is most of the time not because of their stupidity, it is because they think they are doing the right thing, and the system has fooled them sufficiently by encouraging this thought.

Footnote: In this article I am not discussing people who actively want to act in a stupid way, e.g., just to make a statement. If you try to not succeed, you will most likely also fail in the end (or succeed in failing, maybe).

During the last years there has been a number of incidents where the Swedish peer-to-peer money transfer system Swish has been down. There has also been a number of incidents where the Internet banking systems as well as ATM machines have been down, in some cases over more than a day. Now, when the Swedish banks are pushing for the cashless society, this should be a very strong alarm clock. If the electronic transfer systems are hit by a major function disturbance, people will not be able to pay, if there are no alternative payment options (such as cash money). Most interesting, however, is also that it seems that the banks do not have a plan B devised for a major breakdown of the transfer systems. 

https://www.svt.se/nyheter/inrikes/aterkommande-problem-pa-swish-mycket-olyckligt

https://www.expressen.se/dinapengar/problem-for-swedbanks-internetbank-alla-med-mobilt-bank-id-drabbade/

Now, the breakdowns in the money transfer systems have most of the time lasted less than 24 hours, causing mostly nuisances, rather than having disastrous consequences as a result. There are other areas where the plan B has to exist, and where a complete breakdown constitutes a life-threatening condition. You may probably guess one of those areas? 

On August 24, the hospital in Nyköping suffered a complete blackout that lasted for several hours, and three patients in intensive care had to be evacuated immediately. Another 106 patients were about to get evacuated, when finally the power was restored. However, even when the power was restored, the computer systems were not online until quite some time afterwards. During the blackout, no patients could be admitted and all the activities had to be suspended.. This lasted from lunch time until 21.30 in the evening, i.e. almost 9 hours. 

Now, this was “only” a Power blackout and there were no direct casualties from the event. But, and this is the crucial question, where was plan B? Where were the alternative power sources; where was the backup for the information systems? In the event of a prolonged event, what will happen then? 

Now, if you say that this never, happens, we can just go back a few years in the history.  In 2003 a large part of the eastern USA and Kanada suffered a major blackout, in some areas for almost two weeks, when the complete power grid apart from one main line lost power. If the last power line had also failed, the blackout would have lasted even longer than it did. This was during midvinter, and people found themselves without the possibilities to heat their apartments, and unless they had planned ahead, no ability to cook their food. 

https://en.wikipedia.org/wiki/Northeast_blackout_of_2003

Of course, you can’t predict everything that can happen. But on the other hand, if a whole hospital stops working for almost a day due to one single cause, then something is very wrong in the planning for emergencies. And, when we start looking around, this seems to be a major problem with the large electronic/electric infrastructures. The society depends more and more on that they do work, and flawlessly so, because there are no plans for a likely case of a breakdown. 

If organisations are to go fully digital in the future, there will also be a need to make sure that the general infrastructures can handle emergency cases, when something happens. We need to make sure that journals are accessible, even when the computers show black screens. We need to make sure that people can go shopping even if the banking systems don’t work any more. We need to make sure that communications work, even if the computerised logistics systems capsize.

Whenever we go digital in critical organisations, we may not only need a plan B, but maybe, just maybe, we need to create a plan Omega, which will make the society run even when all of our power plants and not least all computers are all down, maybe for a longer period of time, and not just for a few hours. We need a thorough planning for even small disasters, and this planning has to be very pessimistic, and not rely on  that things will work out in the end. 

The big question is: How long can we manage without our computer systems? Without a plan B, or Omega, probably only a few hours at best.

Sometimes when we make studies on a work environment, e.g., as a preparation for software development, there seems to be a tendency to overlook the smaller things; things that actually have a greater effect on the work situation than we might think at a first glance. There is, of course, never any doubt that big software systems will play a big role in a person’s work over the day. When there are problems with these, this often causes large breaks in the workflow and are (hopefully) sorted out fairly quickly. But there are also many small things; those annoying nuances that might not be causing disasters, but merely make a person frustrated in the long run. These smaller inconveniences are often not detected or considered in the cognitive workspace design.

The idea of a cognitive, ergonomic work context was widely discussed in the 1980’s. (c.f., Hagert, Hansson and Oestreicher, 1987, Wærn 1988) . However, the overall combination of software systems as a work environment seems today to be stressed mostly as an issue of incompatibility, e.g. causing unnecessary copying and processing of data and similar issues. Even if we manage to make the systems compatible and exchanging the data between themselves there are many other environmental factors that will still be affecting the cognitive work context negatively. These factors are sometimes well hidden in the work procedures and may be difficult to assess for software designers, and sometimes they are actually not even software issues but rather involving advanced hardware solutions.

During our previous study visits at the hospital, there were many small things happening that were hardly noticeable, but which at the same time constituted important factors in the work situation. In some cases, these small things were not directly concerned with the software systems used (although it is possible to see some of them as relevant to the overall software systems design), but proper workspace design might actually include these parts in the larger software network.

Just after Easter, in 2018, I was hospitalised for a week with an evil strand of pneumonia. Apart from being sick it also meant an interesting and close view of the nurses’ work context and the tools that they used. Since I was actually a real patient (albeit of an observing kind) I think that the nurses were more relaxed than during the earlier study visit. So, I started to observe several things that happened all around me and in this and some following articles I will go through some of the ideas that fell well into the work context situation.

One thing that was quite apparent, both in the study visits and during my longer stay at a clinic, was the fragmented workflow. Among the ordinary work tasks, there were many local interruptions, from alarms for a certain patients medical condition (mostly false ones, but more about this later), to calls for non-urgent requests from patients for water, tending or other less acute matters. Also, there were incoming medical transports and phone calls which, although part of the work, often tended to interrupt the nurse in the work. This is very difficult to catch in a work design study since it more or less requires a longer period of study in order to properly judge its significance for the work. In this way, we tend to see the forest (of tasks) as a single unit, whereas the nurses instead are working on all the small trees that actually constitute it.

Another factor that has appeared is that while the design of the main computer systems often is very thoroughly prepared, both in terms of requirements on the software and the hardware, much less effort seems to be spent on the personal software and hardware(!). This means that even if we get very advanced software systems on the ward, the personal equipment is pretty left out of the equation. Essentially, this is very much similar to working hard on defining a forest, but lacking the ability to see all the trees that make up the forest.

In the next blogs, I will try to disseminate these issues into some more concrete examples and even make some suggestions for how to proceed and also enhance the situation at a hospital ward with these observations as a base.

Exposing ramp.

To access a building or other places where there is a difference in height it is often necessary to walk up a set of stairs. This, of course, becomes very difficult when you are using a rollator or a wheel chair, or as a parent with a pram. So, in order to simplify the process of accessing the building by adding a ramp! A ramp is a flat surface with a suitable incline and surface. This makes it much easier, no? Well, if you have tried to do some inline skating you know that to skate uphill and downhill is much worse than skating on the flat surface. Skating uphill is very tiring, and for skating downhill, well, imagine the speed you can get in a long downhill run. It is the same thing when in a wheel chair. If the ramp becomes too steep or too long, there will be a difficulty to access the building also with a ramp. Also, going uphill is a difficult feat since it will change the point of balance in the wheel chair, increasing the risk for people who are new to the use of a wheel chair.

By trying to fit the material to the building, the architect selected to use “cobble stone” as the surface material. However, that is about the worst surface you can have in a wheel chair.

 

But there are other things to consider. A ramp that is added to a staircase will also expose the person using it. It becomes clear that the ramp (such as the one in the picture to the right) is not the main entrance, but an added extra. Apart from that it is not designed to look good, but gives a generally ugly impression, clearly showing that it does not really belong.

Thus the wheel chair ramp is clearly stigmatising the person using it. He or she will be clearly visible as going a different path than the “normal” people. Thus it should be a strive for more integrated solutions, where the solutionbecomes a part of the building, where we want to have a public access

Even if we try to make things all right, there are other traps in the issue of minimising the stigmatisation. In the figure to the right, the architects chose to use cobble stones as a surface for the ramp, quite likely with an ambition to integrate the ramp in the building style. However, the ramp is the only place in the area where you need to traverse a surface with cobble stones. The rest of the area is laid out with asphalt (which is nice to drive over with cars).

What most people who are using wheel chairs know by heart, is that uneven surfaces, such as cobble stones, is the worst kind of surface you can have when using a wheel chair. The shaking of the vehicle that is caused by the stones does give the person a difficult ride. And it is also pretty sure that it has not been tested by any person who is using a wheel chair as an everyday tool. My students, during the practical sessions where they are allowed to try out wheel chair driving for a few hours, immediately recognized the problem with this surface. It should not be difficult for anyone to realize that this solution does not work well. So how come that this ramp was built at all?

Combining ramps and stairs is very common. But why do we need the stairs?

Such a solution is shown in the figure to the left. It shows the combined approach. When rebuilding the entrance, a ramp was added, using the same material as the general entrance of the building. Stone and black iron fit in well with the existing materials. So this approach is much better from the point of view of stigmatisation. However, there is still one problem. Now both the stairs and the ramp become very narrow, and this complicates the usage. Both the people on wheels and those on foot will have to wait for a meeting person.

So, the next thought that comes to mind is: Who needs the stairs? The slope of the ramp is very small, which means that people should have little problems of walking up the ramp instead. The stairs are also designed partly as so called “donkey stairs” (stairs with intermediate smooth surfaces, which is where the donkey could make a pause when going up the stairs). These stairs are rather difficult to walk up and down, since they do not allow for a rythm in the walking. They also increase the risk of stumbling, since people do often not focus on the walkway. So, who needs the stairs? If we make the whole entrance into a large ramp, then we have all the space we need, and people will not have to choose which way to go. And above all, there is no difference made between different categories of people. Anyone can use the whole entrance.

There are two things that I think are showing in this blog. One is that we still seem to think that good enough is the same thing as good. But it isn’t, which is very clear in these examples. All these solutions do work, in the sense that the person can access the building, although while being exposed, shaken and competing with other people about the space. However, neither of the examples are good, in the sense that they do not provide a good feeling in the person using the artefact.

The second observation is the lack of including the real users in the development and evaluation processes. It should be compulsory to involve the users of the tools in the development from the beginning, even during the planning and design phase, as well as involving the final users in the testing of the result (or prototypes). This is something that has quite likely not been done in these cases. And the result is useable, but not good.

In the previous posts I have touched back on the problem of stress-related Exhaustion Syndrome. A frein of mine got hit, much worse than I did. But when I heard about his first days I could very well relate to what I heard. The sad and bad truth is that a person who has run into this syndrome will have changed afterwards, both in short and in a long term perspective. So what happens? Well, in some cases it appears almost as the aftereffects of a stroke. I am not sure whether it is a physical change to the brain, but according to the way it affects a person, it may well be.

Short-term effects
The short-term effects are often the ones that people see, and which are of a more explicit kind. It is important, however, to note that the profile is individual. Different people display different effects in varying strengths, and I think it might be very difficult to be exhaustive in the descriptions. But the most common ones are:

• Extreme Fatigue – Here the important keyword is “extreme”. It is not like any ordinary tiredness, and you can’t sleep it away, no matter how much you sleep. The degree of fatigue might vary over time, but it is very unpredictable, also for the person affected by it. Different activities may trigger the fatigue, such as social gatherings, big or small, going shopping, or even very loud of visually intensive situations.
• Loss of memory – Most of the memory functions will be affected, to some extent, such as:
• Short-term memory – It is difficult to remember things that are kept in the immediate memory. People tend to forget what they were about to do. I have even opened a kitchen cupboard to take out a cerial package for breakfast five times, without getting the package on the table in the end.
• Long-term memory – There is a great tendency to miss meetings and appointments. Unless they are in a calendar or in the cell phone, appointments don’t exist. The main long-term memory is seldom affected (in contrast with dementia). However, names or faces, even well-known ones,may be difficult to remember and recognize.
• Semantic memory – The semantic memory may also be affected, resulting in what I have myself called “Associative aphasia”. You have difficulties finding the right term, and it was in my case many times not the right word that appeared, but rather an associated term. I heard myself, e.g., telling the passengers in the car, that I was going to put the trailer in the trunk of the car, rather than the garage.
• Episodic memory – The episodic memory is also affected sometimes. There are difficulties remembering the context of activities and events afterwards. The time of the events are also confused, not only in terms of hours and minutes, but also in terms of week days and even weeks.
• The memory of often-used knowledge is also affected. The remembering of pin codes, passwords, important telephone numbers and other simple (but easy to confuse) pieces of information becomes an increasingly difficult task.
• Unfocused activity – this is probably to do with short-term memory, in that people tend to either not start or not finish things they do. It might be that while cleaning up the room, you start by cleaning the table, and then suddenly see some other cleaning task that needs doing. This means that you start on the new task, forgetting about the previous one you started. Associativity plays a large roll in this difficulty.
• Decreased social competence and activity level – Social situations are very hard to handle after a stressrelated Exhaustion Syndrome (even positive ones). This can take on many shapes, such as not responding even to social invitations from close relatives or friends. Parties may cause days of fatigue, even if they were great. Initially, it might even be too much with family, which leads to a kind of isolating behaviour.

This is a very depressing list of symptoms, and the worst part of it is that the healing process is long (≈ years). Even when a person is considered to be healthy again, many of these symptoms will appear now and then in different situations. A person with a stressrelated exhaustion syndrome will probably never be a party popper afterwards, because the environmental stress from the social situations will be too hard to handle.

But now comes the real difficulty. What happens to people in the immediate social context? In many cases the efforts are focused on the person who is ill. The wife, husband, partner, children, etc. are very seldom addressed, despite the fact that they are equally affected by the illness of their relation. The people around the person who has fallen ill, are very likely to feel very lonely and isolated, since the person who is ill needs their constant attention, and of course the social activities will also be removed from the agenda. There remains (often a single) a person who is responsible for everything that happens, where there used to be more people around.

I think it is very important that we also acknowledge those who are affected around the person who has fallen ill. They need to talk! They need to talk much about their situation, and they need to do it often. So one of the important things to do is to lend the person an ear. Helping out with simple things can also be very supportive in this situation. But the most important thing is to be there for the person.

I wrote in the previous post about a friend of mine that I heard of had fallen into the trap of stress-related syndrome. I guess I should have read through that checklist as I was writing them. Especially the item number 8. Denial of being stressed. No I am not stressed, I just have lots of things to do, and I am really feeling good about my situation right now. I can’t be on the way to that famous wall again…

Well, so wrong I was. Reading the checklist today scored me around 8 on the scale.

If you didn’t read that post, I can tell you that the list contained eight items. And this morning I just couldn’t get out of bed. I have slept 14 hours tonight, and still feel completely exhausted. Just thinking about taking a short walk is too much. I have booked myself for two parties tonight and tomorrow, two parties I have looked forward to very much, especially since one of them is to celebrate a good friend of mine who really deserves it. But I will not be able to make it. I am too exhausted even before the party, and since social meetings drain me, even if they are positive experiences in themselves. After any larger social event, I always get drained. But I have learned to handle this fatigue. (Did you see that word? Fatigue – warning sign 4 in my list). But in those cases I am reasonably alert before the party.

To make a long story short. This morning I realised that it is necessary to pull the emergency brake, and I just hope that I will be able to stop the train in time. Like with a train the stopping stretch is long. That is why it is important to have clear signals to follow. And to start braking when the signs are there. I guess (and hope) that this was the final sign before the wall, and not the wall itself. I hope that I have some petrol left in my spare tank, on which I am running now.

So, what is the point in this post? Well, the point is twofold, one is of course to help raising the warning flag for others, but the second is also to try to explain myself towards my social environment. I don’t act in the usual way, and I don’t act as I would like to. I forget things, I forget names of people I know well, and I have big difficulties in focusing. This can cause much discomfort among people in my surroundings. I don’t want that. I don’t want to behave the way I do when this happens. So what will I do about it?

As I feel currently, I have decided to start by cutting down on my social activities, that is hard enough. I know that may disappoint some of my friends, but I hope they are more happy to have me around later, even if I don’t attend some social things now. I still have a few work tasks to do before I go for summer. So why not go on a sick leave and leave that? Well, there are some things that cannot wait, and if someone else would do them for me, they would have to ask me about it all the time, which means that I am not able to put them away. Course reporting is one such thing. Other things will be on my mind even if I would postpone them until I get better again. Such things just need a relaxed pace, and doing away with them will actually make me feel much better. So I will continue with my work doing those things that cannot wait, or that will relieve me of stress. This will help me to reload my batteries. The social events are easier to remove (albeit with a bad conscience towards other people). In social events, you are most of the time possible to replace, that is the hard truth. You are of course possible to replace in the work context too, but with much more problems to other people.

But, you may wonder, isn’t that still to continue along the stress path. Yes and no, the most stressing things in life are often those things you don’t do. If it is possible to get a few undone things unloaded, it will remove a large amount of stress. But, if I feel that even this will not work, then I will drop it. I have seen the warning signal (a bit too late, but still) but I think I will be perceptive about this.

Just to round up my post today, I hope that you who read this will understand more about this impairment (because it is an impairment, and an impairment that is chronical to some extent). Hopefully you will be able to avoid it, but also that you will understand the problems it causes to both the person who is affected, and to this person’s social environment, wife, husband, children etc. It is often so that we concentrate on the person who is affected, while the people around him or her are left aside.

I will write more about this in a later post. It may take some time until it appears, but it will, I assure you.

Today I got some knowledge about another friend of mine who has reached the end of his bodily petrol tank, running out of gas. I met him at the end of April, and it was difficult to realise that this would happen, because nothing could be noticed, at least not directly. In afterthought there were small signs, but it is much easier to make post-fact-observations.

So, now he has joined the club of burned-out people, or the club of people with stressrelated exhaustion syndromes. This group of people is constantly growing, it seems, and nobody seems to really care about any preventive actions. People with this syndrome are really impaired for a long time after the events that caused it, and even thinking in economical terms, it is really a waste. But what could be done to prevent this type of illness? Isn’t it, as I said, always easy to see afterwards, but much more difficult to see the warning signs in advance? Actually, I think there are plenty of possible warning signs, that should lead to a preventive consultation with a psychologist or someone educated in stress therapy (I know that this is not a formal term, but I think the intention is clear).

So what are the warning signs? Well, there are many different ones, and I will write down those that I can see should have given me a warning, apart from the major indicator: the constant feeling of being stressed:

1. Keeping many things going at the same time. This is of course not a problem, as long as you are not in the risk zone. Often this is regarded as an important skill. But if you are continuously forced to juggle many tasks in order to keep them up and running, then this is a high risk factor.
2. Loosing the control and overview. When you now and then feel that you are no longer in control of your work or personal life, and that you have lost the overview over all things that you have to do, then that is also a warning sign. If it happens once, there is of course not a problem, but if it reoccurs, then you need to check what is going on.(*)
3. Forgetting things and missing meetings. One of the first things that fail under stress, is the memory mechanisms. Most affected is the short term memory, and a person who has kept most things in his memory, will soon discover that he cannot do so any more. One of my first signs, was actually when I missed having a full class waiting for me to give a lecture, while I was happily skiing.
4. Fatigue Being unexplainably tired is a late warning sign. If you are unable to sleep the tiredness away regardless of how much you sleep, this is also an indicator. The body is trying to avoid the burnout by shutting down, the only way it knows. Unfortunately, this will most of the time result in an even greater stress, during the waking hours.
5. Problems talking. Stress does affect our oral output. If you start to stutter or realise that you are sometimes saying things without thinking, that is also a very strong indicator. Our speech system is very sensitive to stress, and gives us away immediately.
6. Losing of focus or having difficulties reading. When we are too stressed, the mind tends to sprint between many different things that are wirling around in the head. It becomes difficult to stay focused on one topic for a longer period of time. Reading texts is also one of those skills that are affected by stress. If the reading gets to slow for the stressed mind, it gets bored, and skips reading.
7. Mood changes. Getting angry or upset without any reasonable cause, or having large mood swings is one of the indicators of that something is out of balance. This can of course have many causes, but is one of the indicators.
8. Denial of being stressed. Many people who are on the edge do not admit to the problem. And even if they admit to a stressful situation, they still maintain that they cannot change the situation now, or that “when I have only finished this”, things will get better. But the situation never changes, and the stressfulness continues.

There are several other symptoms, I presume, but these are the ones that I can more or less easily see in my own pre-burnout history. And towards the end, I had most of these at the same time, and did still not understand… We are very good at denying our own weaknesses, and many times we need other people to help us in detecting the problems enough to make something of it. I think we need to be aware of this, all of us, because we need to help our friends colleagues in understanding that something is wrong, and that something has to change.

This is difficult, and we are often scared of intervening in other peoples lives, but I think it is completely necessary, in todays society with all requirements that meet us everywhere… So my only advice is to look around you, and be aware of the warning signs. And maybe we can help other people to regain their health.

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(*) People with very stressing work situations, such as flight controllers, can report “loosing the picture” when they have been in the business for a long time. This is a warning sign as well, since it is a signal telling that the mental mechanisms are not coping at the same rate any more.

In case of fire, don't use the lift.

During the course on Universal design that I have given before Christmas, we came to discuss the issue in this post. Where is the emergency exit when you have an impairment? It is very simple to say a thing such as: “In case of fire, do not use the lift”. But what are the implications? How is a person in a wheel chair supposed to get down? Taking the stairs is definitely not an option. Part of the problem is of course the actual instance, where the suggested solution is not a possible alternative.

But part of the problem is also of the more general kind: Why are there so few solutions for emergency exits for people with impairments? In a normal lecture room at the university, there is exactly one entrance and exit. If the corridor gets filled with smoke and fire, the only exit is through the windows. But how is a person in a wheel chair supposed to get up to the window? The window ledges is so high that it is bad enough for a person who can use both legs.

After the lecture, I have started to look at emergency exits for people with impairments. There are virtually none. Steel spiral staircases? Window exits? Staircases instead of lifts? The sad but true fact is that the emergency solutions are designed for people without impairments. How can you find the exits if you are blind? How can you notice the fire, if you can’t hear the alarm bells (actually, in some places they are difficult to hear even with normal hearing).

How can we change this? By developing new evacuation tools. Why not try to invent a way to allow a wheel chair to get down a stair case in an emergency. Why not provide good instructions for blind people at the entrance of a room. We might even print the instructions in Braille on the walls close to the door. And why only use sound as warning sounds. A flashing light together with a warning sign would help many more attend to the warning signs.

But the most important thing is, maybe, to increase the awareness of this problem. Opening the eyes of architects and designers might be another way to start a process of preventive design.

The picture in this blog is by Garrick Tremaine, and is used with his kind permission. Please don’t copy it without permission.