High Achievement and Schizophrenia
The perception that schizophrenia and unemployment go hand in hand is rooted in terrible statistics: 80% of diagnosed individuals are unemployed, and their loss of wages and benefits is the single greatest indirect cost of the disease.
Yet people with schizophrenia are employed, including at the highest professional levels. Nobel Prize-winning mathematician John Nash’s battle with psychotic symptoms and paranoia were the basis of the book and movie A Beautiful Mind. Psychologist Fred Frese, a member of the Treatment Advocacy Center board of directors and sometimes described as “the most famous schizophrenic in America,” is a professor of psychiatry at an Ohio medical school and a high-profile public speaker and advocate.
Gainful employment is considered a hallmark of stability and recovery in serious mental illness. To learn how individuals with schizophrenia who achieve occupational success manage their symptoms, a team of researchers interviewed 20 men and women with the disease who had completed a master’s or doctoral degree or were enrolled in a master’s-level program and reported their findings.
Common Coping Strategies
Five coping strategies were common among the study participants, all from the Los Angeles area:
Avoidance behavior – Actively avoiding situations and behaviors they had found in the past made their symptoms worse
Reliance on supportive others – Connecting with family, friends or colleagues who would provide objective feedback on symptoms and nonjudgmental support
Medication adherence – Taking medications to support stability even when it did not eliminate all symptoms
Cognitive techniques – Using specific thought strategies when experiencing symptoms, such as challenging the likelihood that a driver in a car on the other side of a highway could be talking to them
Environmental control – Adjusting surroundings to prevent, minimize or address impacts on symptoms, whether by seeking a calm setting to minimize distraction or creating a noisy environment to drown out voices
Three additional strategies were identified by some interviewees:
Spiritual engagement – Seeking support in religious or spiritual communities
Focus on well-being – Building exercise, diet or other wellness routines into everyday life
Employment or education – Finding distraction or satisfaction from an intellectually absorbing activity
The latest estimate of the total cost of schizophrenia to US society was reported at $155 billion in 2013 – $44,773 per individual with the disease. Unemployment was the single biggest contributor to cost impact at $59 billion, 38% of the total cost. Unemployment additionally produces significant personal and social costs to individuals with the disease and those around them.
The study by Amy N. Cohen and colleagues (including best-selling author and professor Elyn Saks, who has schizophrenia) was limited to 20 individuals in a single city. Nonetheless, the authors said the interviews “revealed unique perspectives on how individuals cope with symptoms of schizophrenia while maintaining occupations that require a high degree of responsibility, productivity and accountability.” The coping strategies participants in the study identified could be used to “reconceptualize and advance what is possible in mental health recovery,” the authors said.
Most of the participants reported using multiple strategies to manage their symptoms. Typically, they used the strategies to management positive symptoms (hallucinations and delusions) rather than negative ones (motivation and social engagement). Symptom control was not complete, and interviewees continued to experience challenges related at least in part to their schizophrenia.
Nonetheless, they were succeeding by the common definition of occupational success. “These findings highlight the fact that having ongoing symptoms and struggles does not mean that individuals cannot pursue occupational and educational goals that are important to them,” the authors concluded.