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The Burdens of Mental Illness in the Service Industry

Service workers across America are struggling with the pressures of balancing mental illness and retail jobs. In San Francisco, I learned what that felt like, the hard way.

By Linnie W. Greene


(Photo: plofiz/Flickr)

The scene opens with me on a bathroom floor in the first days of 2016, cradling a knife and threatening to kill myself, but it starts much earlier, months and months before, when I moved from North Carolina to the Bay Area and felt my small-town axis shift with the violence of an earthquake. Sometimes it takes a radical re-configuring of the landscape — the sorts of tremors that expose our tenderest parts — to show us what was really dormant all along. For those, like me, who have mental-health issues and work or worked in the Bay Area’s service industry, those fault lines are everywhere, ubiquitous as cracks in the sidewalk.

In a 2015 study sponsored by the Substance Abuse and Mental Health Services Association, substance use disorder among “accommodations and food services” ranked number one; retail trade came seventh after professions like mining and construction. In 2007, the Associated Press reported that “people who tend to the elderly, change diapers, and serve food and drinks have the highest rates of depression among U.S. workers,” with 7 percent of full-time workers battling the noonday demon (compare that to a national average of 6.7 percent in 2015, according to the National Association for Mental Health).

That may not sound statistically significant, but consider the ways in which constant interfacing with the demands of other people can ravage one’s psyche. Those, like me, predisposed to mental illness in a city this difficult can find retail work to be a dangerous tipping point, like dancing on the edge of a rooftop.

“The wealthy are able to afford good treatment options and those of low income are often able to get relatively good care through MediCal programs; the working class are in treatment limbo with services often out of reach.”

I started at Green Apple Books, San Francisco’s iconic 48-year-old independent bookstore, in March of 2015, freshly installed in a shoebox of an Oakland apartment where I often lay awake all night imagining a break-in. An hour and a half away from where I slept (by bike, then BART, then bus), the Inner Richmond establishment was a respite from the city’s most harrowing features: raised voices on the bus, leering men, reminders of how the simplest errands were sometimes impossible for me. My then-undiagnosed depression and anxiety rendered the city a land mine. Green Apple was, for the most part, supportive, helmed and staffed by like-minded book lovers looking for a slice of quiet amid the city’s hustle and bustle.

But no matter how supportive the staff and ownership, I found the job riddled with the same difficulties as any public-facing ordeal: managing the expectations of fellow humans while trying to preserve one’s own (often fragile) sanity and well-being.

On its most basic level, retail and industry work can exacerbate mental-health issues because they require resources that so many service employees can’t afford. As Rachel Del Rossi, managing director of Mental Health Association San Francisco, explains: “The wealthy are able to afford good treatment options and those of low income are often able to get relatively good care through MediCal programs; the working class are in treatment limbo with services often out of reach.” Del Rossi also observes that rates of mental illness increase with exposure to trauma, and trauma can correlate with low income brackets. In the gap between modest hourly pay and true financial stability, mental health care becomes a secondary concern after bodily medical emergencies and funds for basic expenses.

The average one-bedroom apartment rental in this city will run you $3,468 (via Zumper), while the minimum wage currently sits at $13.00 an hour. Ask me about how many stove-less efficiencies I’ve visited that run for $2,000 a month. Ask me about the restaurants that have sprouted in my Outer Richmond neighborhood, places which I can only now afford (and mostly still dodge like Whack-a-Mole). Add to that the particular pressures of a region where techies are titans, status can be measured in Teslas and Apple watches, and a crumbling hovel sells for a cool million, and you’ve got a potent recipe for disillusionment and self-doubt. How does one enjoy or profit from a world-class city when the things that make it notable — sweeping vistas, an apartment near public transit, quaint Victorians nestled in the hills — are as far from one’s own reality as the fog is from the Mission?

A friend who manages a café in the financial district says that finances were one of the chief issues that exacerbated pre-existing mental-health issues. “When you’re making minimum wage or even a little higher and trying to support yourself, it’s stressful as hell. Living paycheck to paycheck was when my depression was at its worst.”

But what of the masses of customers whose sheer numbers sent me periodically to the break room with an ill-timed panic attack? A desk job at $13.00 an hour would come with an entirely different — and, I would argue, lesser — set of stressors. As my café friend notes, “People treat service workers like dirt, even when they’re in management.” It was the same with everyone I polled — we, the hourly, are often someone’s easiest conduit to the rest of the world, and whatever the client’s frustrations, misgivings, or rage will become our problems too. Veterans and current service workers in the Bay share these horror stories with the beers swigged after a shift — the guy who relieved himself in the back of the store; the man who summoned me with the phrase “little girl” (I was 25); the micro- and macro-aggressions that accrue as fast as our bank accounts dwindle.

Then there’s the scheduling, the inconsistent workdays and body clocks set to a barista’s opening or a bartender’s closing time. Del Rossi cited many models of support in the city, from traditional clinical intervention to peer-to-peer phone and in-person counseling, but mentioned that one of the biggest challenges for service-industry employees is finding the time and resources to access this assistance. “In order to focus on mental wellness,” she says, “basic needs need to be met — food, shelter, social support — the extraordinary high cost of living makes this reality challenging to many.”

How does one enjoy or profit from a world-class city when the things that make it notable — sweeping vistas, an apartment near public transit, quaint Victorians nestled in the hills — are as far from one’s own reality as the fog is from the Mission?

The availability of care certainly hinges on health insurance, which many service industry workers forgo. I was lucky enough to get on Green Apple’s company insurance but spent the first few months of my Bay Area tenure paying $500 out of pocket for a shoddy plan that proved financially crippling.

For all the Bay Area’s faults, it might be easier to be open about one’s maladies here than in less progressive pockets of the country. At least, that’s Del Rossi’s view. “I think that San Francisco does a better job than most places on honoring an individual’s full life experience and may have slightly less associated stigma of mental health challenges which may allow more people to be ‘out’ about their illness,” she says.

I didn’t have that problem where I worked (see: the holiday party where I sobbed late into the night) but a long string of December overtime shifts led to the scene at the beginning of this piece, which eventually resolved with generous time off and a new regime of meds, little blue and pink pills with alchemical, life-saving properties.

I jumped ship on a job that I loved to pursue another career behind a desk, marketing books instead of selling them. I still have a bottle of anxiety pills I think of as pumping the brakes, but most days I spend eight hours without needing them, sitting behind a desk instead of a bustling cash register. My anxiety and depression ebb and flow, but there are fewer feverish spikes, shocks that register like Richter lines after a particularly unpleasant phone call or a confrontation over gift wrap. I visit the bookstore nearly every weekend.

From this new, less desperate place, I look back on my tenure in San Francisco retail like seeing a vista through leaded glass — the details get blurry with distance, and the feelings lose their sharpness. I think of this book-shelving, beer-swilling, table-bussing set as my people: the artists and dreamers who are hustling hourly to fund a life in a place that contracts like a fickle heart. They make their art on the side. They cope how they can, with the resources they have. They love what they do, when they don’t hate it.

My only regret is not getting help sooner, letting the cavalcade of anxiety and doom trample me like so many hooves. I see friends make time and save for their therapy and am inspired, because both of those things come at great cost. I know this firsthand. For those of you manning the storefronts, bussing the tables, shelving the books — find the help you need. You’re incandescent lights in this foggy city.