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Journal of Applied Rehabilitation
Counseling – January, 2000
Vocational
Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals.
Fischler, G. L., & Booth, N. (1999).
As indicated by the title, the purpose of
this book is to serve as a guide for rehabilitation professionals
on the vocational impact of psychiatric disorders. Although the
majority of common psychiatric diagnoses are reviewed, the authors
chose not to discuss the following: learning disorders, organic
disorders, and substance abuse disorders. The authors chose not
to include information on these diagnoses because “people
who have such disorders do not compose a homogeneous group and
cannot be described or understood as such” (p. xv). Yet,
even without the inclusion of the aforementioned subjects, Fischler
and Booth have produced a valuable reference for all levels of
vocational rehabilitation professionals.
Information on the various psychiatric disorders
is presented in the following format: A brief discussion on
the category of the disorders to be presented (e.g., mood disorders),
and specific diagnoses in the category (e.g., major depression)
are presented in separate sections. Each section includes morbidity
statistics as related to the general population, general sympto-
matology, the effects of the disorder on vocational activities,
and a brief character study of a person with the stated diagnosis
and his or her participation in vocational activities.
The review of each diagnosis is closed with a
summary of specific vocational strategies and accommodations.
The strategies are person-centered and the majority are behavioral
in nature. They are written in a simple format, have real world
applications, and appear to be easy to implement. These strategies
also include the implementation of outside support systems,
(e.g., psychotherapy, natural supports in the work place).
The book’s introduction offers a brief
discussion on the origins of the DSM-IV and its multiaxial system
of classification of mental disorders and the text is organized
with respect to this system. Information is in turn related
to the following areas of vocational functioning: cognition,
pace, persistence, reliability,motivation, interpersonal functioning,
honesty, stress tolerance, and job specific skills. Thus, the
frame- work is provided with which to examine the vocational
deficits that are often observed in persons with psychiatric
disorders.
Information on mental disorders is presented
in three parts, Part I, “Feeling Bad,” contains
Chapters 1-3. These chapters cover the classes of diagnoses
mood disorders, anxiety disorders, and somatoform disorders.
Part II, “Problems Getting Along,” includes Chapters
4-6. These chapters cover a wide variety of personality disorders.
Part III, “Problems with Reality,” has one chapter,
7. This chapter covers schizophrenia and other psychotic disorders.
Fischler and Booth conclude their book with a discussion on
psychological assessment, personality factors that affect job
satis- faction, supported employment, and the disclosure of
disability in relation to long-term job retention. According
to the authors, each of these must be considered when providing
vocational rehabilitation services to persons with mental disorders.
In conclusion, Vocational Impact on Psychiatric
Disorders provides information in a style that may
be read by a wide variety of rehabilitation providers. Definitions
of mental disorders symptoms are concise yet comprehensive.
The strategies offered for voca- tional accommodations have
real world applications. This book has the potential to be implemented
as an office reference or a text for vocational curriculums.
Kathy Morris-Ritz, MS, CRC (Candidate)
Wyoming State Hospital
© 2000 - Journal of Applied
Rehabilitation Counseling
Reprinted with permission
Journal of
Occupational Rehabilitation – July, 2000
Vocational
Impact of Psychiatric Disorders: A Guide for Rehabilitation Professionals.
Fischler, G. L., & Booth, N.
(1999).
Psychiatric disabilities are of growing significance
in the United States (U.S.) due to their increasing numbers and
negative impact on employee performance and productivity. These
disorders frequently become manifest at work through their impairing
effects on memory and understanding, concentration and persistence,
social interaction, and/or adaptation. Management of behavioral
dysfunction may become necessary based on the outcome of preplacement
examinations, employer drug testing programs, workers’ compensation
claims, return to work examinations following psychiatric illness,
workplace performance appraisals, psychiatric fitness for duty
examinations, or violence (real or perceived) in the workplace.
Psychiatric illnesses typically present unrivaled challenges to
several stakeholders besides affected employees and their families,
including coworkers, supervisors, employers, occupational health
professionals, case/disability managers, human resource professionals,
and rehabilitation professionals. Additionally, the management
team must also consider important U.S. federal regulations such
as the Americans with Disabilities Act (ADA) and the Family and
Medical Leave Act (FMLA) when resolving workplace issues arising
from employees with mental health disabilities.
Although the prevalence of psychiatric disorders
among the U.S. workforce is substantial, there are only a few
authoritative and pragmatic resources available to practicing
vocational rehabilitation professionals that focus on mental
health disorders and work. To partially fulfill this need, Fischler
and Booth coauthored Vocational Impact of Psychiatric Disorders:
A Guide for Rehabilitation Professionals to serve as a guide
to vocational rehabilitation professionals who periodically
encounter mental health disorders among their clientele. The
text is organized along three diagnostic decision matrices.
Part I addresses the neurotic disorders (i.e., depressive, psychosexual,
anxiety, and somatoform disorders), Part II addresses Axis II
personality disorders (i.e., the odd, dramatic, and anxious
clusters), and Part III addresses psychotic disorders (i.e.,
schizophrenia and other psychotic disorders). The authors routinely
discuss the psychological impact of these disorders on cognition,
pace, persistence, reliability, conscientiousness and motivation,
interpersonal functioning, honesty and trustworthiness, stress
tolerance, and other job-specific requirements.
The authors introduce the reader to each psychiatric
disorder by referring to case examples which are well-written,
concise, and illuminating. Each clinical vignette is followed
by a basic description of the disorder and a brief discussion
of their effects on the workplace. Their effects on vocational
abilities are assessed by applying an impairment scale to the
following psychological factors: understanding and memory, concentration
and persistence, social interaction, and adaptation. Discussions
conclude with a review of recommended vocational strategies
and accommodations for each disorder.
In summary, Vocational Impact of Psychiatric
Disorders: A Guide for Rehabilitation Professionals
offers a well-written and concise review of mental health disorders
that are commonly encountered in the workplace. The case-based
style used by the authors adds significantly to the reader’s
understanding of the various psychiatric disorders and their
propensity to impact work performance. The authors’ recommendations
for vocational strategies and accommodations are quite logical
and mirror ergonomists’ tactics of matching workplace
(mental) demands and worker (mental) capacity. Although this
book was published as a guide for rehabilitation professionals,
it should also prove to be a valuable resource to occupational
health professionals. Future editions of the book would be enhanced
by incorporating ADA, FMLA, and wrongful termination issues
into the discussions on strategies and accommodations.
Bruce A. Barron, M.D.
Division of Occupational and Environmental Medicine
University of Rochester School of Medicine and Dentistry
Rochester, New York
Copyright © 2000 - Journal of
Occupational Rehabilitation
Reprinted with permission
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