Psychopathology in the Workplace

Recognition and Adaptation

Jay C. Thomas, Michel Hersen, Jay C. Thomas, Michel Hersen

• Publisher: Routledge
• Year: 2004
• Print ISBN: 9780415933797
• eBook ISBN: 9781135953416
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This text provides students and professionals with the knowledge they need to treat work-related psychopathology and contribute to this new and growing aspect of clinical practice.

Part I
Overview

1
Introduction
JAY C. THOMAS
Pacific University

Henry¹ is a man in his mid-30s. He is a wine expert and works for a company that distributes fine wines. Henry’s job involves calling on customers, such as restaurants and caterers, delivering wines by the case, and having the customer sample wines for possible resale. He is expected to engage in a good deal of socializing with customers and others in the food and beverage industry and to attend charity auctions, golf tournaments, and similar events. Because Henry’s company is very small and he is involved with the management of the firm, he must attend several critical meetings each week. Henry is very good at his job except for one problem, which now interferes with his ability to perform most of his important work functions.

Sometimes Henry’s heart seems to race and he feels as if he is having a heart attack. He has been to the hospital emergency room (ER) several times, and he has had his coronary health thoroughly examined, with no finding of disease. Still, he panics whenever he feels his heart racing. He is so afraid of setting off an episode that he avoids all types of physical exertion. Consequently, he has gained a lot of weight, which, ironically, puts him at much greater risk of developing cardiac disease. In the past several months, Henry’s anxiety over his panic attacks has progressed to the point that he now frequently believes himself to be suffering from many other medical conditions. For example, one day he saw an advertisement on the side of a bus for a stroke medication. He immediately interpreted his slight headache as the beginnings of a stroke, so he went to the ER instead of going to work. An ache in his side or arm may be cancer and a cold may be pneumonia. Henry no longer finds it easy to call on customers, and carrying a case of wine is out of the question. Social events are too taxing, so he quit attending them. He actually left several business meetings to seek medical attention. His medical leave from work is long since exhausted, and the company’s health insurance rates are increasing because of his extreme overuse of benefits. Henry’s customers are complaining about poor service, and his co-workers and employer are tired of covering for him. Although a valued employee, Henry is about to lose his job because of his hypochondriasis and panic attacks.

Pat is a sergeant in the county sheriff’s office.¹ Two years ago Pat’s good friend and colleague Lieutenant Howard Brown was shot in the head while responding to a domestic disturbance. Lieutenant Brown is unable to speak clearly or walk without help and will never return to his job. Pat was supposed to take the call but was tied up in a traffic enforcement stop when the dispatch came. Lieutenant Brown covered the call as a favor. Now Pat and her spouse worry that the same thing could happen to her, and Pat feels guilty that Lieutenant Brown was wounded in her place. Now she has mixed feelings about responding to the dispatcher’s call: a heightened sense of duty and fear. Sometimes after a shift she goes home and shakes for an hour and finds it hard to talk to her husband about work. Pat’s husband wants her to leave her job and get out of police work.

Francesca works in an office supply store, part of a nationwide chain. She runs a small department that makes copies and performs simple printing jobs, such as business cards. She thought she was getting a “normal” job in which she would work 40 hours a week and leave her work behind when she was off duty.² She has three children, whose ages range from 3 to 11 years. Her ex-husband used to take care of their children on alternate weekends and would pick them up from day care or school and watch them on those days when she had to work late. He also was the one who took the older children to swimming lessons and to soccer and baseball practice. Four months ago, just as Francesca’s employer was facing increasing competition and requiring more and more overtime and weekend work, her ex-husband’s National Guard unit was called up for extended service in Afghanistan. He will be gone at least a year, and Francesca’s employer sees no end to the increased work demands. Her boss says she cannot hire additional workers without approval from the head office and there is not a chance of that happening. Francesca is making more money than she ever imagined, but the strain of overworking, plus caring for her children and her house, has her feeling depressed, anxious, and full of resentment.

When Gary was 20 years old, his symptoms were diagnosed as schizophrenia. His personal appearance is slovenly (his hair is matted into dreadlocks and he wears dirty clothes), and he often has a vacant stare. He experiences auditory delusions and sometimes talks back to them. He is employed as a groundskeeper in a park. His duties involve mowing the lawn, raking leaves, emptying the garbage, and performing similar chores. So far, his performance on these tasks has been satisfactory. However, sometimes while working he stops and stares off for minutes at a time. Other times young children think that his talking is directed to them and they get scared. His appearance makes him seem threatening. Gary is not aggressive or assertive, and his response to aggression is to back off. His psychiatrist prescribed medication, and when Gary takes it as prescribed his most obvious symptoms disappear. However, Gary dislikes the medication because of the side effects (including gaining a great deal of weight) and because he wants people to know “the real me.” Many families with young children use the park, and Gary's strange appearance and mannerisms scare some away. Parents have been complaining about him, and some worry that he will hurt the children because he is “obviously crazy.”

These four cases illustrate some of the issues of psychopathology in the workplace; similar cases can be found in any industrialized country in the world. Work can be stressful, and employers can be very demanding because of the demands of the marketplace. In such an environment people with mental disabilities, cognitive or emotional strain, or other impairments are at an extreme disadvantage. Historically, the employer’s solution was simply to terminate the employee, if possible. Certainly, people with a history of psychopathology would not be hired if the employer could find any other alternative. Times, however, have changed and are continuing to change rapidly. Laws, such as the Americans with Disabilities Act of 1990 (ADA), limit the employer’s ability to discriminate against those people with disabilities who can perform the essential functions of a job. Highly trained employees such as Henry and Pat may be too expensive to replace, unless as a last resort.

Demographers and labor economists believe that, in spite of many companies moving jobs overseas, there may be a shortage of workers in the U.S. economy over the next several years (Fullerton, 1997, 1999; Olsen, 1994). The country cannot afford to have people, who can be productive, being idle because of an accommod-able or treatable mental condition. Such conditions are common in U.S. society, with National Institute of Mental Health (NIMH) data indicating that more than 22 percent of Americans older than age seventeen years have a diagnosable mental disorder in any given year (NIMH, n.d.). Throughout the world mental illness is second only to cardiovascular disease in disease burden (NIMH, n.d.). It is also well established that people with mental disorders have lower rates of participation in the workforce, with rates for people with psychoses, such as schizophrenia, being among the lowest and rates for people with anxiety disorders being somewhat below that of the general population (Yelin & Cisternas, 1997). There are many barriers to getting people experiencing psychopathology into the workforce. Moffitt and Winder (2003) examined data from the Three-City Study, a large longitudinal project concerned with welfare-to-work transition, and found that, compared with other study participants, those participants with identifiable mental health concerns were more likely to enter welfare rolls and less likely to leave welfare by finding a job. There is a large pool of potential workforce entrants among those people experiencing psychopathological conditions, and it may be to the advantage of employers and society to find methods of effectively tapping it.

Integrating people with mental disorders into the workplace is apt to be difficult without due consideration of the work environment, particularly of the social environment. Jeff Hite and I have argued that research in the past half century of organizational theory has resulted in organizational designs and practices in which people with psychopathological conditions are unlikely to be either successful or comfortable (Thomas & Hite, 2002). Modern organization design, with its flat hierarchies, team emphasis, goal setting, fast pace, accountability, the need for flexibility and continual change, and high-stress conditions puts a premium on the possession of excellent interpersonal skills and coping strategies, initiative, and other characteristics that often are muted by psychopathology. The need for employees with these skills creates a challenge for those people who are responsible for managing organizations, therapists, job coaches, and individuals with mental disorders who wish to hold or retain a responsible job. They must find creative ways to achieve the objectives implied by system and organizational design and to minimize the environmental factors that encourage failure. Job accommodation cannot be a cookie-cutter approach but must be accomplished by using an understanding of the individual’s condition, the working situation, and the organizational environment.

The common saying “This job is driving me crazy” should be a reminder that sometimes it is the work environment or conditions that contribute to a person’s mental distress. “Job stress” has entered the popular lexicon, and it is popularly considered to be at fault for many problems faced by individuals, including depression, violent behavior, heart disease, divorce, and, in Japan, karoshi, or death from overwork. A recent MSNBC series presented examples and expert opinions supporting these ideas (Weaver, n.d., with links to other episodes of the series). Professionals need to go beyond popular portrayals and examine the scientific bases for these assertions. In later chapters in this book we will present some of the research that can sustain or reject such claims.

A majority of clinicians are interested in treating psychopathology and, to a much lesser extent, in adapting environments that allow their clients the best chance of success. The “client’s work” refers to something that goes on in the treatment session, not what the client does for a living. For some reason the notion that clients may have or wish to have a job not only as a means of survival but also as a way to establish relationships with others, a sense of self-esteem and self-efficacy, and meaning in their life has not received the attention it deserves in the clinical literature. For example, a recent, comprehensive, four-volume compendium of psychotherapy does not contain index references to terms such as job, employment, or work (Kaslow, 2002). The same is true of Barlow’s (2002) comprehensive and authoritative book on anxiety, although Beckham and Leber’s (1995) Handbook of Depression includes one chapter that considers some aspects of the workplace and their influence on the development and maintenance of the disorder (Brems, 1995). Programs in clinical and counseling psychology often include education and training about the family, schools, and other important milieus but rarely cover the workplace. There are many therapies that have been shown empirically to result in positive changes, but even in the best of studies one-fourth to one-third of clients fail to improve (Thomas, 2002). In preparing this book, we had the objective of training therapists to be better prepared to understand the client’s work life and to be more able to use that understanding to effect change on the job.

Managers and human resource professionals are less concerned with treatment of mental disorders than clinicians are. Their attention is concentrated on having a smoothly operating, productive workplace. In recent years there has been a reawakening of interest in dysfunctional behavior in the workplace (e.g., Giacalone & Greenberg, 1997; Lowman, 1993; Vardi & Weitz, 2004). Lowman’s book, in particular, is an excellent resource for the clinician, although it concentrates on changing the individual rather than including adaptation and accommodation as other treatment options. Often, authors are interested in personality processes, as they may result in undesirable behavior at work—an important perspective but one that necessarily leaves out the purposeful or inadvertent dysfunctional behavior related to other forms of psychopathology. We have found it helpful for people in management positions to obtain an understanding of the more common forms of psychopathology and their genesis and treatment and their potential impact at work. So armed, these managers can participate more meaningfully in recognizing the need for adapting a mentally disabled employee’s work in appropriate ways.

In conclusion, it is a priority that people with mental disorders be able to work successfully, to hold a job, and to contribute economically to society and to their own support. At the same time employers need to be able to change the organizational systems whose design works against people with mental disorders to an environment that allows for success while keeping up with productivity demands and competing effectively against other organizations. These goals are to a large degree antagonistic and meeting them requires that clients, therapists, and management work together to understand each other’s situation, objectives, and presses. Few areas of psychology and management require the breadth of knowledge, critical thinking, and creativity that working with psychopathology in the workplace does. The reader is invited to enter this challenging and potentially rewarding arena.

References

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford.

Beckham, E. E., & Leber, W. R. (Eds.). (1995). Handbook of depression (2nd ed.). New York: Guilford.

Brems, C. (1995). Women and depression: A comprehensive analysis. In E. E. Beckham & W. R. Lever (Eds.), Handbook of depression (2nd ed., pp. 539-566). New York: Guilford.

Fullerton, H. N. (1997). Labor force 2006: Slowing down and changing composition. Monthly Labor Review, 120(11), 23-38.

Fullerton, H. N. (1999). Labor force participation: 75 years of change, 1950-98 and 1998-2025. Monthly Labor Review, 122(12), 3-12.

Giacalone, R. A., & Greenberg, J. (Eds.). (1997). Antisocial behavior in organizations. Thousand Oaks, CA: Sage.

Kaslow, F. W. (Ed.). (2002). Comprehensive handbook of psychotherapy (Vols. I-IV). New York: John Wiley.

Lowman, R. L. (1993). Counseling and psychotherapy of work dysfunctions. Washington, DC: American Psychological Association.

National Institute of Mental Health. (n.d.). The impact of mental illness on society. Retrieved from http://www.nimh.nih.gov/publicat/burden.cfm.

Moffitt, R., & Winder, K. (2003). The correlations and consequences of welfare exit and entry: Evidence from the Three-City Study (Three-City Working Paper 03-01). Baltimore: Johns Hopkins University. Retrieved from www.jhu.edu/~welfare.

Olsen, R. J. (1994). Fertility and the size of the U.S. labor force. Journal of Economic Literature, 32 (March), 60-100.

Thomas, J. C. (2002, November). Understanding non-r...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• ABOUT THE EDITORS
• LIST OF CONTRIBUTORS
• PREFACE
• PART I: OVERVIEW
• PART II: CATEGORIES OF DYSFUNCTION
• PART III: ENVIRONMENTAL AND MANAGERIAL INTERVENTIONS