Balancing Work, Medication And Mental Illness

By NPR Staff

Published February 28, 2013 at 6:04 PM EST

With a proper balance of medication and therapy, some people diagnosed with mental illness can succeed in the workplace.

Thirty years ago, when Elyn Saks was diagnosed with schizophrenia, her doctors told her she would never be able to hold a job.

"The idea was that I should lower my expectations," she tells NPR's Neal Conan. "I was advised to be a cashier for a year or two and then think about another job or possibly going back to school."

She didn't listen.

Despite hospitalization, years of psychoanalysis and continued delusions, Saks discovered that work was essential to managing her psychosis. She is now a professor at the University of Southern California Gould School of Law.

"When I'm constructing an argument or responding to an argument and focusing on that, that's where my mind goes, and the kind of crazy stuff recedes to the sidelines," says Saks, who specializes in mental health law. "So it's not one size fits all, and I think it's a mistake prematurely to tell people to lower their sights, lower their expectations."

In a piece for The New York Times, Saks argues that mental illness imposes real limitations, like medication, but says it can also spur creative thinking.

Dr. Richard Friedman, a professor of clinical psychiatry and director of the Psychopharmacology Clinic at Weill Cornell Medical College, says, "Physicians, psychiatrists often have inappropriately low expectations after somebody gets a diagnosis of a serious mental disorder like schizophrenia or bipolar disorder, and settle for function which is much, much lower than the person's actually able to achieve."

He explains that having a social network and a sense of purpose can be just as essential to controlling symptoms as taking medication.

"At the same time," Friedman adds, "I think we should recognize that there probably are a proportion of people who — even with all the encouragement, all the support — may not be able to achieve exactly what they expect or what we think that they should. And we should not push people beyond the point where they're comfortable and capable of actually functioning."

Though Saks still has some symptoms, she says they are not as long-lasting or intense. Finding the right balance of medication was key.

"I think I only really came to terms with having the illness and being careful about how I structured my life, ironically, when I got on really good medication," Saks says. "It made me realize that, you know, these chaotic and violent thoughts weren't things that everybody had."

Saks says the support of friends and family has also been essential to controlling her triggers.

"If I start losing it, my husband and my closest friends usually see what's happening and rally around to try to help me. And I'll talk to my psychiatrist more, and I'll take more medication," she says.

There are times, Saks says, when she's so unwell that she can't work. "Then I just try to lower stimulation in my life, kind of sit in a bare room, listen to quiet music, maybe talk on the phone with friends, but just kind of give myself a bit of a break, a bit of a time to rest and reconstitute."

Saks, author of the memoir The Center Cannot Hold: My Journey Through Madness, spent many years struggling with the stigma of mental illness.

When actress Glenn Close asked her to be on the board of her nonprofit Bring Change 2 Mind, Close gave her a shirt that says "Schizophrenia."

"And then I thought, 'Do I really want to wear a T-shirt that identifies me as having schizophrenia?' " Saks says.

"And then I thought, 'But people wear bracelets and ribbons and shirts identifying themselves as cancer survivors with pride, without shame, with camaraderie with others.' And we're just not there yet with mental illness."

"The more I admitted that I had a mental illness," she says, "the less it defined me."