Employment Flexibility in Recovery
by Garth House

Recovery is a uniquely personal process. Each of us recovers
in our own way and in our own time. Nowhere is this truer than
in the area of work and employment.

If there is anything that proves deadly for healthy recovery and healthy
thinking about recovery it is the making of broad and sweeping generalizations
that create black and white, either/or extremes in conceptualizing about the categories
we use to describe the recovery process.

How many of us have heard that as consumers we are just dying to work, to get back into the workforce and be a productive member of society once more. It never seems to occur to anyone that some of us might have come to the conclusion, after many attempts at working and many, many consequent hospitalizations, that we have a serious mental illness and that we just might be seriously and actually disabled to the point that we cannot work.

Serious mental illnesses, serious brain disorders, are just that: they are serious and they are illnesses. They disable, they limit, and they narrow the capacities for achievement of the persons who have them.

This is not to say that many consumers do not return to full time work. Many do, but many don't. Again, it is the generalization that must be avoided. There is a whole spectrum, from not working at all at one end to total full time work at the other, along which consumers find themselves.

Because of reasons related to cultural heritage and values, much of the emphasis in recovery thinking so far has been placed on the need to return to work, to become productive again, where productivity is usually understood in its least creative and most narrow manner. As for the many consumers who have not been able or who have chosen not to return to work, less is heard about this population.

It may be inaccurate to state that "all consumers want meaningful employment." Perhaps what is really being expressed by such a statement is the truth that most consumers desire structure and purpose in their lives, and to realize that there are ways to find structure and meaning that have nothing to do with employment as we normally think of that term. Maybe our thinking needs to be broader and more creative with the term "employment."

Often family members of persons with serious mental illness will set the measure of full recovery at a point when the ill loved one can once again rejoin society as fully employed, tax-paying, "fully responsible" member, just as though recovery from serious mental illness were like recovery from any other illness, where one got sick, got well, stayed well, and went on to live a normal life. Yet for all our emphasis on how similar mental illness is to other medical illnesses, we must never forget the very important differences that distinguish serious brain disorders from heart disease, diabetes, etc., especially when it comes to the recovery process.

Serious mental illnesses are chronic. There are no cures. One has them for life. Symptoms may be allayed, and one may learn how to manage the illness, but the illness is always present. Relapse into active phases of the illnesses is common.

Even when recovery is very strong, when most symptoms have been allayed and the illness is being very effectively managed and the recovering individual has rendered his psychiatric disability "invisible", still the illness takes its toll.

For example, I once heard a medical doctor speak at a conference. He had a diagnosis of schizophrenia, and had battled with the illness for a number of years. He was still young, good looking, well dressed, extremely articulate and funny. If he hadn't told us of his diagnosis we would not have had a clue that he had any psychiatric problems at all, let alone something as serious as schizophrenia. He told us (with no little irony) that he was so recovered that some had leveled the charge that he had been "misdiagnosed." Otherwise how could he have recovered to such a state of well being? But what seemed really significant was that this medical professional, this doctor, was employed only part-time. How many doctors work part-time? The truth was that despite his high level of recovery, his illness still prevented him from full-time work, probably due to the limitations of stress.

As much as anything else, the initial battle of recovery is a battle to salvage the mind, the heart, and the psyche from destructive powers that would tear them apart and plunge them into oppressive darkness. This is a fierce struggle, requiring the best that modern science can offer and the utmost energy and dedication of the human spirit. When this fierce struggle is won, the fractured pieces of the human personality fitted together once again, and the deep wounds to the mind and heart sutured and on the way to healing, persons who have been forged in such a crucible of intense struggle and suffering possess great spiritual, emotional, and mental strength. Often, however, in relation to matters of those aspects of worldly life, like the stresses of daily living and the tensions of "just getting on with life," they find themselves quite fragile and vulnerable in regard to these latter categories.

The simple achievement of their own sanity, the healing of their broken minds and psyches, is such a triumph of the human spirit, that persons who attain this are sometimes baffled when their loved ones fail to recognize what they have attained and instead refuse to fully recognize recovery until full employment is achieved.

When one has spent months or years in mental hell, simple peace of mind can be one of the highest attainments of genius. To recover simple sanity and sheer tranquility of mind and spirit is a momentous achievement against which the significance of holding down a 40 hour a week job pales in comparison.

And the struggle to achieve such mental and emotional victory often exacts a great price, leaving the individual fragile and ill-suited for the weathering of the harsher realities of everyday life that go with the scramble and hurly-burly of modern living.

It should come as no surprise then to realize that there are many consumers who might choose to not return to work, or to work less than full time, or to work as volunteers, or to work in a self employed capacity in a non-traditional manner. Persons with serious mental illness must respond in creative ways to the limitations of their disease, and nowhere is this truer than in the area of employment. Each of the responses listed above, from choosing not to work to self-employment, is a creative response to the limiting realities of serious mental illness. They indicate that in the area of employment, when it comes to the issue of recovery there will always be a need for flexible thinking about the options open to consumers.