You may think holding down a job is too much for someone with schizophrenia. But with treatment, many people can -- and should -- stay in the game.
"People feel better about themselves if they're doing something productive," says Steven Jewell, MD, associate professor of psychiatry at Northeast Ohio Medical University. "It's critical to recovery to move forward with your life, whether it's at school or at work." Jewell advocates a team approach to providing patients the treatment, skills, and support they need to get back on track. And there is evidence to support this idea.
In a 2006 study of 1,400 patients with schizophrenia, three-quarters were unemployed. The other quarter, who did have jobs, tended to have milder symptoms, a higher level of education, and greater access to rehabilitation.
Timely treatment of schizophrenia is critical to becoming and staying employed. "If you can deliver intensive coordinated care early in the course of the illness, the likelihood of avoiding long-term disability is much higher," Jewell says. Essential to the treatment plan: antipsychotic medication as well as counseling for the patient and family.
While medicines are needed, side effects can cause problems.
"In general, they tend to impair concentration and may reduce drive or motivation," Jewell says. "This can be a real impediment in the workforce and in college."
Most psychiatrists aim for the lowest possible dose that will control symptoms. "It's important to find the right medication and dose as quickly as possible to stabilize the patient," Jewell says. After a minimum of 6 to 12 months of stability, the dose can sometimes be lowered gradually. Smaller doses will be prescribed in baby steps, with a psychiatrist on guard for a return of psychotic symptoms, which would require increasing the dose again. The goal is to find the smallest dose that provides a consistent suppression of symptoms. "People with a reduced dose tend to do better long-term than those who stay on the initial full dose."
Going Back to School
Schizophrenia usually appears between ages 18 and 35, just when people are in college or laying the foundations of their careers. A psychotic episode can interrupt someone’s plans, and they may never receive the education or training needed for success. But if symptoms are brought under control quickly, going back to school or a job is realistic and encouraged.
Frederick J. Frese III, PhD, was in the Marine Corps when he developed schizophrenia. "I had the delusion that the enemy was brainwashing higher-ranking officials, and that was preventing us from winning the Vietnam War," he says.
After 5 months of intense treatment, Frese was able to continue on his path to success. "I immediately went back to school in business and then worked at a Fortune 500 company in management," he says. When a second episode landed him in the hospital again, he didn't give up. Once he was stable, he found another job and pursued his PhD in psychology.
Today, Frese is an associate professor of psychiatry at Northeast Ohio Medical University. He attributes his success to a combination of his own commitment to recovery and a strong support system. "I take medication and see a psychiatrist regularly," he says. "It would have been easy to throw up my hands and say, 'I can't do this' … but I had this determination to have a career in mental health even though I had this condition."
Rehabilitation and Job Training
Rehabilitation for people with schizophrenia can range from learning to use public transportation and manage money to career counseling and job training. Therapy to improve thinking skills is important to gain long-term employment.
A 2008 study found those who got these services were more likely to work than patients with schizophrenia, depression, or bipolar disorder who didn’t get the help.
What to Tell the Boss
A tricky decision is when and how to let an employer know about this illness. It’s a good question to ask your doctor.
"It depends on the individual and how well they have responded to medication," Jewell says. "If symptoms have essentially disappeared, there's really no need to tell an employer. Some people who have a less than complete response to medication may well need to [tell.]" If active symptoms get in the way of work duties, it might be a good idea to have a conversation with the boss about needs, such as doctor’s appointment times.
Frese offers similar advice. "It's a good idea not to advertise or tell people if you don’t have to," Frese says, especially at the beginning of your career. If you're older or nearing the end of your career, Frese encourages you to tell your co-workers. More openness about schizophrenia will help reduce the stigma.
Frese rejects the idea that certain types of work might be best for people with schizophrenia. While routine, low-stress jobs may be beneficial for some, others thrive in more demanding posts.
Elyn Saks, JD, PhD, is a professor at the University of Southern California Gould School of Law with joint appointments in law, psychology, and psychiatry. She is also the author of a memoir called The Center Cannot Hold: My Journey Through Madness.
"Work is one of my best defenses against my mental illness," Saks says. "It keeps me stable." Despite hospitalization three times during young adulthood, Saks graduated from Yale Law School and later received a MacArthur Foundation Genius Grant. To keep her schizophrenia symptoms at bay, she stays on medication and sees a therapist four or five times a week.
"I have occasional delusional thoughts, but I tell myself, 'It's just your illness,' and I dismiss those thoughts."
Saks says her success is not as rare as people might think. "There are others like me. It's just the stigma that keeps people from coming forward."
A schizophrenia diagnosis doesn’t rule out a successful career, Jewell says. "Everything is a possibility depending on the person," he says. With a successful response to treatment, "there's a chance they might be able to do just about anything."