New Medications, Social Support Can Help Schizophrenia Patients Work by Carolyn Cosmos The schizophrenia stereotype of an erratic bag lady raving in the subway reflects a reality that researchers say need not be the case. Although many people in the United States with this delusion-causing brain disease do live on public assistance, sleep in the streets, or are in prison for misdemeanors, recent studies show that a currently unknown percentage can recover from the devastating effects of schizophrenia and hold down normal jobs. The secrets of their success lie not only in good medicine and good counseling, but also in education and strong social support. And as this hidden group is brought to light, the hope is that more and more individuals may be able to join its ranks. Schizophrenia is not a “split personality,” a common misperception among many people. It is a genetically based mental illness that runs in families, strikes men and women alike, typically surfaces in young adults, and affect s about one out of every 100 people worldwide. It removes them from reality, causing them to become highly disorganized and apathetic. A few turn aggressive or violent. Medication is ordinarily needed for improvement. Between 1959 and 1991, several anti-psychotic drugs appeared on the market to help reduce hallucinations: Haldol, Mellaril and Thorazine. Side effects include jerking movements, choking, blunted emotions and motivational problems, often referred to as the “zombie effect.” Between 1991 and 2004, atypical or second-generation anti-psychotics appeared: Clozaril, Risperdal, Seroquel, Geodon, Zyprexa and Abilify. These have serious side effects but do not blunt motivation and allow for a greater recovery. A “third generation” of anti-psychotics is also in the works. New research is working to dispel the stereotypes associated with schizophrenia. “We have documented in one study that people with schizophrenia are able to hold high-level jobs, and in a second we show that they can keep them over time,” said Dr. Zlatka Russinova of the Massachusetts Center for Psychiatric Rehabilitation and an assistant professor at Boston University, who is conducting a national survey of work patterns in people with mental illness. In “Schizophrenia Research,” which was published in 2005, she identified 59 people with schizophrenia who had high-level employment, 65 percent of them full time, with 21 percent earning more than $40,000 a year. Nearly half had college or graduate degrees. A second study published in 2002 in the International Review of Psychiatry documenting 687 people with mental illness, including 109 with schizophrenia, was even more striking: It showed that the illness alone did not predict whether or not someone could keep a job. People in the larger study group said that taking medication was the most important reason why they kept their jobs, but social support from friends, family, mental health providers and co-workers was the other main reason for their success. In a third study, Russinova discovered four factors that make a difference when people with schizophrenia try to leave public assistance and get paying work: a good education, good overall health, the ability to look at adversity as opportunity, and the absence of stigma in the workplace. A study in the American Journal of Psychiatry in October 2005 by Judith Cook also showed the importance of social support. Looking at 1,273 patients with mental illness, it found that they were more likely to get and keep jobs if they had intensive vocational services linked to psychiatric help. The research of Russinova and Cook defies long-held beliefs about people with schizophrenia, who are typically believed to have a poor medical prognosis and assumed to be doomed to low-level, poor-paying jobs at best. “We don’t know how many people like this are out there,” Russinova said. “There’s a great potential, with the new self-help groups, new medications, more jobs for them. Times are changing.” Carolyn Cosmos is a contributing writer for The Washington Diplomat. Two People Who Defied Schizophrenia Stereotypes Below, two people with schizophrenia explain how they have led successful lives despite their illness: American artist and attorney “Robin Huntley” (not her real name) is an accomplished creator of publicly acclaimed work who previously practiced law. Her story: “Although I first started experiencing the symptoms of schizophrenia when I was 17—including hallucinations and withdrawal—I graduated in the top 12 percent of my class at one of the best law schools in the United States. I was receiving indifferent treatment at health centers and wasn’t able to generate an offer of permanent employment as a lawyer. I did begin clerking for a federal judge and was then able to pay for quality medical care. “At that point, I was first diagnosed as a schizophrenic and treated with anti-psychotics. I improved enough to be offered several positions at good law firms, was able to work as a lawyer for 10 years, and became a senior attorney. I’ve been on anti-psychotics and under psychiatric treatment for schizophrenia continuously. “I found that the autonomy of being a professional allowed me to manage my symptoms in a way that a low-level job would not have permitted. I had three therapy sessions a week, which few people with schizophrenia in the United States could afford. At my first law job, I worked 12- to 14-hour days, arriving early to have three quiet hours. That reduced symptoms. I also taught myself to distinguish hallucinations from reality. “However, I had seizures on one antipsychotic that couldn’t be controlled. Other medications caused potentially fatal reactions. I ran out of treatment options and lost my job. My doctors have not been able to find a drug combination—yet—that allows me to function, so I’ve not been able to practice law again.” Canadian Bill MacPhee, the recipient of several public service awards, is the publisher of Schizophrenia Digest. His story: “I want people to know there is life after mental illness. I was hospitalized six times with schizophrenia, lived in three different group homes, and had a suicide attempt. I heard voices, had depression. My life was a living hell. What was the turning point? Medication. It’s the foundation for recovery. “Another turning point was a new group of friends [without mental illness]. I decided to get work, tried and failed at seven or eight things, read a book on how to start your own business, said, ‘I can do a newsletter on schizophrenia.’ I now have four magazines. I’m married, have three children, and have recently started an advocacy group called Minds for Action. My life is very good.”

Would you like to become a WashDiplomat sponsor?