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Mental Illness on the Job

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from: Peter D. Kramer
to: Sally Satel

Posted Friday, June 6, 1997, at 3:30 AM ET

Dear Sally,

Yes, when you first give citizens a new civil right, you discover a backlog of past abuses, real or perceived. But I don't think the statistics you cite ought to dominate our discussion. The vast majority (one informant told me "99 percent") of the first flood of claims under the Americans with Disabilities Act haven't gone anywhere. The language and legislative history of the Act favor mediation. Companies are encouraged to establish procedures for addressing disputes, and judges mostly send cases back for internal resolution. Once the dust settles it will turn out that what the Act has created is a better means for the disabled to sit down with a supervisor and work out ways that they can continue to do their jobs. The latest clarification is meant to guide that process.
Your letter does point to a workplace problem, and it's not accommodation of the disabled; it's the behavior of lawyers. Attorney-initiated nuisance lawsuits are a plague on the nation--frivolous malpractice claims make doctors aware of that truth. Litigiousness demands a general solution: limits on contingency fees, limits on damages, and costs assessed to unsuccessful litigants have been proposed. But should progress in civil rights be held hostage to the mess in the legal profession? Yes, there are outlandish sexual harassment suits, but no one is suggesting that because lawyers are out of control we should return to the days when women had to suffer in silence.
I think we should focus our discussion on what we know best: the mentally ill, who they are and how they work. The typical patient I see is underemployed, in the sense that his (or her) position is lower than it would be if he were more self-confident and more consistent in his moods. In a different sense, he is fully employed: He has skills beyond those strictly required for his job, and the company makes good informal use of those extra talents.
My guess, based on the sorts of job problems I see in the consulting room, is that like past civil-rights legislation, the Americans with Disabilities Act will actually help the economy; it may even help employers. The Act will help the economy because the inability to hold a job that one can perform with dignity is devastating to those prone to mental illness, and mental illness is expensive. If there are immediate costs to workplace accommodation, the Act will spread them so that no one employer with generous policies is disadvantaged. But I suspect that in time the Act will do more: It will spread the benefits of making the careers open to the talents. Employers will find ways to make use of a wider range of workers; we will "cultivate our human resources." As James Fallows has written, opening opportunity is the characteristic source of strength in the American economy.
I worry that your "tough love" arguments about the workplace make the mentally ill seem especially strange or selfish. We all need accommodation. I have never had a job where I did not manage to negotiate the right to work some hours at home, skip a dull meeting, stretch the dress code, see patients as I want to see them and not as the institution prefers. Far from causing resentment, the ADA ought to get employees and employers alike to appreciate the benefits of a workplace that is tolerant of individual differences--a workplace that allows all sorts of people to do their jobs.

Peter

dialogues
entries
123456
from: Peter D. Kramer
to: Sally Satel

Posted Friday, June 6, 1997, at 3:30 AM ET
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Peter D. Kramer is clinical professor of psychiatry at Brown University. He is author of Listening to Prozac and the forthcoming Should You Leave? Sally Satel is a psychiatrist and a lecturer at Yale's School of Medicine.
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