Tuesday, January 18, 2011

Premature employment

The news media has revealed many details about Jared Loughner's mental state that resulted in the tragic scene in Arizona.

In addition to be dismissed from his community college, Loughner also was trying in vain to find work. He applied for, and never heard back from, sixty-five low level positions. You can only imagine what this did to his already deteriorating state of mind.

People who are psychotic or in the fledgling stages of recovery, by and large, are in no shape for the competitive job market. This simple observation doesn't seem to be widely appreciated. Mark Vonnegut wrote in The Eden Express that the person is too wrecked to do much of anything for at least one year, and Vonnegut appeared to be someone who recovered relatively quickly from his first bout with psychosis. One year is optimistic for a return to an educational facility or the job market. Medication or no medication, five or ten years or more is often more realistic for the time it takes to regain your bearings.

The family often fails to understand this need for time and begins to champ at the bit when they feel that enough time has elapsed. Parents, often in fear, anger and frustration, push their children to go out and bring in income. They think that it will help the child rediscover self-esteem and, more selfishly, it will make-up for the expense of keeping the child at home. Home life becomes more Darwinian the longer the adult child stays at home with nothing to do. Families' patience is taxed in the absence of understanding. One of the criticisms of NAMI is that it is said to lower people's expectations for their own recovery because it sees the person as chronic and in need of a lifetime of support. That's the low side of expectations. The high side of expectations may not be much better, because it pushes people to do things before they are ready.

There is a fine line between being realistic and crushing all hope. Conventional psychiatric care does a poor job of managing these expectations, no matter where you live. When someone has a breakdown, there is a huge negative impact on the dreams and aspirations of the parents for their child. As a parent, I wanted to see Chris return to "normal" as soon as possible, and to succeed at the benchmarks that his peers were setting. I wanted him to resume university and I was devastated when the doctors questioned all of this in a way that said to me his condition was chronic. The more negative they were, the more I fought against it, and pushed Chris to do things that he just wasn't ready for.

A better way to address expectations during the crisis of psychosis is to be of the mindset that recovery is expected, but just not now. This would go a longer way in curbing the panic of most parents and it would be truthful. Notice I said, expected, I didn't say "hoped for." "Hoped for" recovery introduces doubt. People will automatically translate "hope" in their minds as a long shot, something that happens to other people.

Faith healing doesn't work with hope or belief. It works with firm expectations that healing will happen because of faith that God's grace is taking place. Family members should be given a different story than the bleak story they are currently fed. The story should be uplifting.


  1. Rossa,
    You are so very right! The idea that a person must be in school or working to be considered worthy of respect--is a belief that permeates our culture. Recovery from extreme states is not like recovering from the flu or a broken bone. The attitude that only by being involved in producing, i.e. through work or educational endeavors is a person living a "quality" life is fallacious. The drugs that are used to treat psychosis limit a persons ability to think and act productively for many to whom they are prescribed. Yet, this is not taken into account. I have confidence in what my son tells me. I do not have confidence in mental health professionals who determine what is in his best interest without his input, or mine.

  2. "Nobody who is psychotic or is in the fledgling stages of recovery is in any shape for the job market."

    Not entirely true. Some people manage to hold down a job during their crisis. But it depends on the job, the working conditions. And I'd agree, that it is very unlikely that anyone experiencing extreme states of mind can do much else than continuing in a job they've some routine doing, and that, all in all isn't too "demanding". A job with some kind of OT-quality to it. Also I think, the smaller the work place, the fewer people around, and the more possibilities to "disappear" whenever needed, the better. Not many work places fulfil these criteria.

    Otherwise, I agree with Becky. Here in Denmark people talk a lot about that you ought to "function". If you can't "function", you need "treatment". Sounds to me like a broken machine that needs to be fixed. And, "function" -- in regard to what? I'd say, I was actually extremely well-functioning and (when I got some guidance) productive. In regard to working out what was going on inside me. But that kind of productivity, of course, doesn't increase the GNP...

  3. Interesting comment.

    "Also I think, the smaller the work place, the fewer people around, and the more possibilities to "disappear" whenever needed, the better."

  4. Marian - I rewrote this a bit and introduced the word "competitive" into job market, which I think reflects what we are talking about.

  5. "Five or ten years or more is often the time it takes to regain your bearings"

    For some perhaps and not for all. I suggest this is highly variable from one person to the next and has a relationship with what the individual is willing to take on and in some cases whather they feel working is a necessary requirement in their life situation.

  6. Rossa,

    I think it's important to take small steps sometimes, and for a person not to kick themselves for any "failures" along the way, especially when it comes to an attempt to enter, or re-enter the workforce.

    The keyword here is "competitive"... Community-based jobs are competitive by nature, and can add stress to a person who is doing their best to get through each day.

    In a perfect world, employers would be able to help modify jobs, duties, etc, and to some extent this happens, but not often enough unfortunately.

    The difficulty with asking for accommodations at a worksite, is in the "disclosure" of the difficulties, due to the misperception of "mental illness", the fears, stereotypes, etc.. which have only been fueled by many mental health professionals and "advocacy" groups.

    I look forward to the day when more people begin to really appreciate recovery, and not simply give lip-service to the movement.

    The psychiatric labels, drugs, and "treatment" can be lot to recovery from... Providing support can be of great value in helping someone have the courage to attempt to work, and for being there for them emotionally and otherwise.

    I like what Zig Ziglar has to say about this subject -

    "Failure is an event, not a person."

    We need to remind each other of this truth...

    My best,

    Duane Sherry

  7. Duane - Good comment. The idea of a non-competitive work situation sounds so sensible, yet, there are so many undercurrents that go on in mental health treatment that the basics of the recovery message aren't usually conveyed very well. Since the book I've written in a memoir, it is easier to show just what I was up against and hard to explain properly on my blog. Chris was in an "ideal" day program for two years (music and art therapy, cooking, group dynamics) and then after that the program arranged for community supported work. (That's another story . . .) The problem was that the tone of the message didn't get through to me that this was a temporary step. The pervading tone of the doctors and the program was of lost hope. I'm a quite skeptical of institutions with good intentions.

  8. "If a man does not keep pace with his companions, perhaps it is because he hears a different drummer. Let him step to the music which he hears, however measured or far away." -

    Henry David Thoreau

  9. Rossa, the keyword here is "competitive", as Duane says, yeah. My own working conditions were widely non-competitive. Also I think it was important, at least to me, and I'd imagine I wasn't an exception, that I wasn't expected to team-work, actually on the contrary. So I wasn't in a situation where I had to relate to others. And I didn't work in any limited, easy to oversee environment. Most of the time I was on my own, and out of others' sight. So there was very little, if any, reason for me to feel watched, I could talk to myself, i.e. back at the voices, without anybody listening, and thinking 'how weird!', if, by accident, someone came along and heard me, I was talking to the horses, of course, and every afternoon I spent more or less entirely away from the farm, checking up on the horses in the fields, the fencing, etc. Perfect. But how many work places can offer such conditions? I wouldn't have lasted a day in a job, let's say as a check-out assistant at the supermarket, in an office, at a factory, whatever of that kind. As it happened, I didn't have as much as one single day of absence from work during crisis. That said, I also wonder what gave me the strength to pull through. And superhuman strength was needed, perfect working conditions, or not. Probably it was my fear of what might happen, if. One of the first questions at each therapy session: "How's work? Are you still attending work? No absence? How's it going? Has anybody noticed?" etc.etc. I had no doubt that it was my ability to drag myself to work each and every day that kept me out of the system, out of hospital, undrugged. No sensible therapist would want to ruin employment for their clients, and of course she knew that there was a good chance that putting me into the bin, even for a short period, would have got me sacked.


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