Disclosure: This article was first published in the March, 2020 Edition of New Letter of Movement for Global Mental Health (MGMH)
The complex relationship between Work and Mental Illness
Let me begin with the role “work” has played in keeping me sane in the conundrum of roller coaster life laced with the severity of the bipolar disorder for decades.
Whenever, the pendulum has swung at the two extremes (the extremities of numbing depression or the flame out of mania), my inability to “work” has been most pronounced, looking back so much so that two of my early “mental breakdowns” in 1998 themselves were triggered by the high level of stressors present at the toxic workplace environment.
But this is only one half of the story.
Every time I have stumbled, my propensity to “work” with or without the “compulsion to work” for livelihood has decidedly improved my “coping strategy” to combat the travesty of mental illness and in turn has helped me emerge out of the rut.
Work indubitably has proved to be one of the two single most therapeutic agents in my life lived with insanity. The other such therapeutic agent has been the music.
Invariably, apart from its therapeutic value, “work” also has also brought the much needed money to run my family.
Moving beyond the narrow construct of my own life, in recent years I have closely examined the complex relationship between “work” and “mental health” of inmates lodged in various mental hospitals of the country.
In one hospital, I found the “nambardars” (drawn from the population of the inmates) were the one on the strength of whose labour the mental hospital was able to function. In another hospital, I found the entire work of the kitchen being managed by selected inmates particularly women. Still in another mental hospital I found that the entire farm of the mental hospital was tilled by the inmates.
I also found that all the work done by the inmates in the mental hospitals I visited was both “involuntary” and “unpaid”.
Nonetheless digging deeper, I found, much “higher level of esteem” and “appreciably better mental health” even in the case of those inmates who were forced to work involuntarily .Often I found them even eager to work even though, it brought no remuneration them ( Mental Health Care Act, 2017 makes it compulsory to pay remuneration for the work done by the inmates).
Some “intrinsic” motivation was definitely on play here amid the “therapeutic value” of even the forced work.
Couple of year back, as consultant to the “Udaan” program of Tata Trusts (which has been trying to bring transformative changes in the Regional Mental Hospital, Nagpur), I was majorly instrumental in getting one of the inmates work as a regular day worker in the Udaan Project office.
Let us call him Veer. He was deaf and dumb. As per hospital records, he was a long stay patient who was diagnosed chronic case of “Psychosis NOS”. Veer was selected from half a dozen short listed inmates, he was encouraged to wear normal clothing (not hospital dress) in the office, his lunch came daily in the lunch box from the hospital kitchen, he was promptly and properly remunerated for his work and most importantly he was treated as one amongst equal to otherwise normal workers of the team.
In short time “work” in a changed environment catapulted Veer to an effective and one of the most productive members of the team with high self- steam. Though I am no longer involved with Udaan program, Veer remained a “model worker” when I inquired last.
Veer was a perfect example of changing narrative around “work and even serious mental illness”
History suggests, work and mental health has been inexplicably linked in a rather complex manner.
Ancient Greco Roman, Hindu Ayurveda, Arabic Unani and Chinese medical doctrines all put work at the centre of improvement of “Mental Health” of even seriously mentally ill.
In the late eighteenth and early nineteenth century, as the new institutions named “lunatic asylums” took hold in Britain, other parts of Europe and America (even in colonies of South America, South Asia and Oceana) the work by patients (inmates) inside these institutions assumed altogether different meaning. At one level the “work” was considered from the lens of therapy and empowerment of patients but from another perspective, it was often found to be a part of coercion and punishment from authorities. Nonetheless whatever be the reason or rationale of the “work” by mentally ill in the asylums, these gave birth to the modern notion of “Occupational Therapy” practiced in mental hospitals or community settings.
Some front-line Non-Governmental Organizations in the country working at the cutting age of bringing transformations to the life of even most seriously mentally ill, have also mistakenly proved the criticality of “work” for improvement of mental health, and re-integration in society and workplace.
It is time now to look at other dimension of the complex interplay of “work” and “mental illness”.
Despite all the benefits of “work” even in the case of seriously mentally ill, the very incidence of mental illness is today laced with extreme stigma, profiling and discrimination at work place even in the most liberal of work settings -governmental, public sector corporate or non-governmental settings.
You announce “you have cancer” at workplace, you will get all ears, sympathy, empathy and accommodation. Flip the coin, and you announce the arrival in your life of even eminently curable common mental illnesses like depression and anxiety and there is every possibility, your bosses and colleagues will shun your company and unless luck is really on your side, losing the job is near certainty.
Reasonable accommodation is what is missing from the life of most mentally ill at the workplace.
Let me take a life out again from my personal experience. Despite being accursed with leading bulk of life ( including work life) with debilitating mental illness, except the periods of episodic extremes ( which arrive often unannounced and have been prolonged) with the support of medication, family and life style changes I have been rather well managed mentally ill person.
But to a large part my “mental wellness” is also attributable to the role played by “work” at my mental my worst (when I found it difficult to get out of bed and when my cognition was shredded ) thanks to the people who reposed confidence in my ability to do productive work in even such a situation.
The fact that I have faced much less stigma, have seldom lost job to mental illness or on occasions when I have done, others have made me productive again, does bring out one this categorically, if just Indian employers of all hues ( both informal and formal, in organized or non-organized setting) can change the narrative and make the work place more mental health friendly, the nation will gain handsomely at personal, familial and societal level.
Keeping mentally ill in workplace, giving them reasonable accommodation, providing flexible work hours and less threatening workplace to start with, only will do wonders to mental health of employees. It will also drastically improve the work-force productivity in general and organizational bottom-line in particular.
Make no mistake, serious mental illness is an “equal opportunity” disease.
Altruistic reason apart, the employers of all hues stand to gain handsomely by making the “work-place” mental health friendly. Else, the three trillion-dollar Indian economy, in mad rush to turn on its head to become five trillion-dollar economy, may brutally witness getting one trillion dollar getting knocked out of economy in medium term to mental illness.
It is time to make work therapeutic again- for the mentally ill and nation alike