Working it out
Mental illness survey defies popular myth
By Hope Green
Thirteen years ago, Bill Lichtenstein's manic-depressive condition triggered episodes of delusion and paranoia so severe that he was hospitalized for weeks at a time. But after a lengthy rehabilitation process, the former ABC News producer went on to launch an award-winning independent production company in New York, where he manages a staff of 10, juggles multiple radio, video, and television documentary projects, and is responsible for raising and spending $1 million a year.
It is possible that Lichtenstein's underlying condition will never go away. But by keeping a flexible work schedule and acknowledging his disorder, he has been able to continue pursuing the career of his choice.
The story of the producer is not an unusual case, according to a recent survey conducted at Boston University's Center for Psychiatric Rehabilitation. Researchers say their study of 500 professionals with ailments such as bipolar disorder, schizophrenia, major depression, and post-traumatic stress disorder demonstrates how talented individuals can overcome the limitations of severe psychiatric illness and fulfill their potential in the workforce.
"I live with this illness and take medication just as somebody with diabetes takes insulin," says the president of Lichtenstein Creative Media and coproducer of The Infinite Mind, National Public Radio's weekly program that explores issues of the human psyche. "I don't have to be so overwhelmed by my symptoms that I can't lead a full life."
Besides Lichtenstein, survey respondents included nurses, administrators, lawyers, and even corporate CEOs. A majority of the group, 62 percent, had held their current position for more than two years, and 73 percent worked full-time. Many had been hospitalized within the past three years.
Although the researchers were unable to poll a random, statistically representative sample of such professionals, they say their findings help to shatter myths commonly held by the public, employers, and even psychotherapists.
"While past studies have focused primarily on dysfunction, this is the first study of its kind to open a window on a previously unexplored area: how people, despite a disabling mental illness, have fashioned an enduring, well-paying, and meaningful professional or managerial career," says Zlatka Russinova, codirector of the study and a senior research associate at the center, a wing of BU's Sargent College of Health and Rehabilitation Sciences. "This research provides hope for others who are combating personal and societal barriers as well as stereotypes about the impact of serious mental illness on careers."
An estimated 2.6 percent of Americans, or 5.5 million, have a serious and persistent mental illness, according to the National Institute of Mental Health. Despite the introduction of increasingly effective drugs during the last decade, the BU researchers say, many psychologists and psychiatrists still take a traditionally pessimistic attitude toward their patients' prognosis for recovery, and steer even those with high intelligence and education toward repetitive, low-skill, low-wage jobs. But as the study participants can attest, such typecasting is out of date.
"It is true that we conducted our study with the goal of changing people's attitudes," says Marsha Langer Ellison, the project's director and a SAR adjunct assistant professor, "but we did not know how many people we would find or what kinds of challenges they were facing in the workplace. There is plenty of suffering, but the astonishing thing about this group is that they have succeeded in their careers nonetheless."
"We don't want to present this as a garden of roses," adds Russinova. "These people still have to be in treatment, and they still have to cope with their illness. But we were struck by their unusual resilience. They really are heroes to be able to do this."
Survey respondents most frequently cited psychotropic drugs, regular talk therapy, and the support of a spouse or partner as factors that help them cope with daily pressures. Many also benefit from a flexible work schedule and the ability to take short breaks. Often such flexibility is part of company policy. But in many cases, employees find it necessary to disclose a psychiatric condition to supervisors and colleagues, as did 86 percent of those surveyed.
Respondents were asked what factors of their illness present them with the greatest job-related challenge. A large number reported feeling uncomfortable about asking supervisors for adjustments in their routine, and said they worried about fitting in with the prevailing office culture. One survey participant, a senior technical editor in San Jose, Calif., who asked that her name not be used, says that she is "extremely lucky" that her boss allows her to work at home when her manic-depressive symptoms flare.
"Most people with this condition become sleepy. I have atypical symptoms -- I get extremely angry and hostile," says the editor, who has worked at her company for 10 years. "Sometimes I need to leave or I'm going to yell at somebody." Often she finds that a walk around the block is sufficient, and she can calmly return to her desk.
Lichtenstein says it would be impossible for him to function if he could not be candid about his illness. "This is an issue that the mental-health community has not explored: it's phenomenally stressful to feel you have to stay in the closet," says Lichtenstein, a Brookline native and son of Bernice Lichtenstein (SON'59). "The fear of what would happen if you were discovered is enough to make you sick."
Russinova and Ellison, whose project is funded by research grants from the National Institute on Disability and Rehabilitation Research and the Center for Mental Health Services, plan to conduct a second, larger phase of the study, which will track participants for two years. They expect to produce evidence that gainful, intellectually challenging employment can help to keep chronic psychiatric ailments under control.
"The recovery process tends to stimulate one's ability to work," Russinova says, "but returning to work also helps people with mental illness get better. These things are definitely interconnected."