Mental Illness at Work by Palgrave Macmillan Professional Business

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© Mary-Clare Race and Adrian Furnham 2014 Some sections of this book have been based on previous publications of Professor Adrian Furnham. All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted his right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2014 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN 978–1–137–27204–1 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. A catalog record for this book is available from the Library of Congress. Typeset by MPS Limited, Chennai, India.

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Contents List of Figures and Tables Preface

viii

1 Introduction

2 The Basics: What is Mental Illness? 3 The Personality Disorders

4 Alcohol and Other Addictions 5 Workaholism

107

6 Sector-Speciﬁc Illnesses

119

7 Illness at the Top: The Paradox of Managerial Success 8 Spotting Illnesses

133

148

9 Cultural Nuances and the Globalization of Mental Illness 172 10 Coping with Illness: Responding to and Managing the Situation Effectively 185 11 Creating a Healthy Workplace Environment References

223

236

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vi i

Index

199

ch ap te r

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Introduction

Would you recognize if a colleague at work was having a serious mental breakdown? You may be able to see signs of stress or depression, but can you detect schizophrenia or alcoholism? Are any of the top people in your organization psychopaths? And does anyone have full-blown obsessivecompulsive disorder? What should you do if you recognize symptoms of a major mental health problem? Is this essentially an HR issue? Do some workplaces make you psychologically as well as physically sick? Are there pathological organizations which almost require you to be disturbed in order to work in them: the paranoid or psychopathic organization? Do certain workplaces cause mental illness? And are people with a particular propensity towards certain disorders attracted to certain jobs and organizations? This book is about mental illness in the context of the modern workplace. It deconstructs the mythology and misconceptions surrounding mental illness and offers a useful taxonomy for understanding how the impact of mental illness in the workplace can be managed, mitigated and prevented. One aim is to help people recognize a range of psychological problems for what they are and offer appropriate help and advice before the problems become too serious.

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People are frequently physically ill at work. Over the course of a working life, people are likely to experience a wide range of physical illnesses such as the common cold, broken limbs resulting from accidents and chronic conditions like hypertension. Many are also likely to experience a range of ‘psychological issues’ and sometimes these may result in mental illness. Whilst physical

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O ch ne o sti alle f th as gm nge e b m soc a th s is igg pr ent iate at the est ob al is d lem he wi sti t a lth h ll s

health and mental health are closely related, it is much more difficult to identify and deal with mental health problems in the workplace. One of the biggest challenges is the stigma that is still associated with mental health problems. People suffering from mental illness are among the most stigmatized and marginalized in society, and although a lot has been done in recent years to address this, there is still a long way to go before mental illness is regarded in the same light as physical illness. The stigma of mental illness is consequently one of the biggest barriers that people with mental illness face as the social distance and exclusion that they often experience as a result of other people’s prejudices can make it very difficult for them to integrate successfully with other people and maintain a normal life. Another negative side-effect can be that people suffering from mental illness are reluctant to accept professional help until a late stage because of the fear of being labelled if people ﬁnd out they are receiving treatment. In the workplace this often means that employees will withhold information from their line manager, HR professionals or other decision makers because of the perceived impact on their career progression. As a result, the very people who are in a position to help them manage and cope with their illness at work are often the last to know. Depictions of mental illness in the media do not help, with a typically negative focus on the link between mental illness and violence, failure and unpredictable behaviour. The formation of these stereotypes is normal and to be expected in situations where we are basing our assumptions on often very limited personal contact with sufferers of mental illness. For example, a 2002 study of over 200 students in Malaysia highlighted the impact of stereotypes about mentally ill people, with the results showing that students with knowledge of, and contact with, mentally ill patients were less likely to have negative attitudes than students who had no prior exposure (Mas and Hatim, 2002). But what if we told you that most of us have more exposure to people with mental health than we think? Current estimates suggest that one in four people will experience some form of mental illness in any given year and yet awareness of, and attitudes towards, mental health would suggest otherwise. Proper education to dispel these myths and exposure to people with mental disorders is therefore an important step in overcoming these stereotypes, and later in this book we will explore this further.

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Introduction

1.1

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Deﬁning mental health

Mental health is a broad and complex topic and we will not seek to provide education on every disorder listed in DSM-V (the most recent psychiatric manual), but rather will focus on those conditions which can have the greatest impact on the business world. To a large extent, psychologists have thought about mental health as an absence of mental illness. Most psychologists accept that we are bio-psycho-social animals. Our health and welfare is not determined exclusively by our biology, our psychology or our social lives and networks, but by all of these. Abnormal and clinical psychologists are most concerned with mental health. However, the comparatively new discipline of health psychology is more interested in mental health and how it affects physical health (Seligman, Walker and Rosenhan, 2001). When a professional attempts to make an assessment of a person’s mental health, he or she tends to look at very specific features. Nevid, Rathus and Greene (1997) have listed 11 of these: Appearance: appropriate and clean. Behavioural characteristics: verbal and non-verbal. Orientation: knowledge of correct places, space and time. Memory: for recent and long-term past, people and events. Use of senses: concentration and awareness. Perceptual processes: sensing reality from unreality. Mood and affect: having an appropriate emotional tone. Intelligence: vocabulary knowledge. Thought processes: logic and coherence. Insight: self-awareness and psychological awareness of others. Judgement: rationality and decision making. It still seems rare for psychological textbooks to deal with mental health and wellness as not being anything more than an absence of signs of mental illness. On the other hand, there are lists of characteristics that epitomize mental health (Seligman, Walker and Rosenhan, 2001). These include the following: emotional stability and awareness; being able to initiate and sustain satisfying long-term relationships; being able to face, resolve and learn from day-to-day work, and personal and financial problems; being sufficiently self-confident and assertive; being socially aware, empathic and socio-centric; being able to enjoy solitude; having a sense of playfulness and fun; and showing signs of merriment, joy and laughter from time to time when appropriate.

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Mental illnesses can be caused by environmental, cognitive, genetic or neurological factors. Clinicians are concerned with the assessment, diagnosis and management of psychological problems. They are both scientists and practitioners who often specialize in the treatment of various disorders like anxiety disorders (anxiety, panic, phobias, post-traumatic stress disorder (PTSD)), mood disorders (depression, bipolar), substance disorders (alcohol, stimulants, hallucinogens, etc.) or complex problems like schizophrenia. Happiness is another widely discussed state that is essentially about mental wellness. However, it has been known for 50 years that happiness is not the opposite of unhappiness – the two feelings are unrelated (Bradburn, 1969). What this taught researchers was that absence of illness and unhappiness was not the key to understanding happiness, but that we need to know those factors that lead to stable happiness in an individual. The relatively recent advent of studies on happiness, has led to a science of well-being (Huppert, Baylis and Keverne, 2005). All the early researchers in this field pointed out that psychologists had long neglected well-being, while preferring to look at its opposites: anxiety, despair and depression. All the early writers in this area struggled with a definition. Eysenck (1990) noted telltale signs, both verbal and non-verbal. Argyle (2001) noted that different researchers had identified different components of happiness like life satisfaction, positive affect, self-acceptance, positive relations with others, autonomy and environmental mastery. Happiness also constitutes joy, satisfaction and other related positive emotions. Myers (1992) noted the stable and unstable characteristics of happy people, who tend to be creative, energetic, decisive, flexible and sociable. They also tend to be more forgiving, loving, trusting and responsible. They tolerate frustration better and are more willing to help those in need. In short, they feel good so do good. Diener (2000) has defined subjective well-being as how people cognitively and emotionally evaluate their lives. It has an evaluative (good-bad) as well as a hedonic (pleasant-unpleasant) dimension.

1.2 The incidence of mental illness The understanding and awareness of mental illness in society has improved dramatically in the last 15–20 years and at the same time there appears to have been an upward trend in its prevalence rate (Deverill and King, 2009), with the most commonly quoted statistic estimating that one in four

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people in the UK will experience a mental health problem in any given year (http://mind.org.uk). It is not clear if the rate of mental illness has truly increased or if the increase in understanding of the topic has led to more accurate diagnosis and therefore a greater frequency of reporting symptoms. Regardless, this increased prevalence of mental illness is quite alarming and particularly given the evidence that approximately three-quarters of adults with a common mental health problem are not in receipt of medication or counselling, including two-thirds of those who have been assessed as having sufficient a level of symptoms to warrant treatment (Deverill and King, 2009). The rate appears to be higher among women and in people in the 45–54 age bracket, and the prevalence rates are mirrored among working-age adults, with approximately one in six workers experiencing depression, anxiety or stress-related problems at any one time. This rate can increase to one in ﬁve when drug or alcohol dependence are included (Sainsbury Centre, 2007) and later in this book we dedicate a chapter to understanding the implications of drug and alcohol dependency.

1.3 Why we should care: the costs of mental illness to business We have all experienced the negative impacts when a colleague is off sick: increased workload for the rest of the team, disruption to the operations of the business, a drop in sales revenue, etc. Mental illness falls into this category and is a silent epidemic impacting the business world at an alarming rate. In the UK, for example, it is estimated that around 80 million days are lost every year due to mental illnesses, costing employers £1–2 billion each year, and in the USA, according to recent collaborative research by Harvard University Medical School and the World Economic Forum (Bloom et al., 2011), it is estimated that untreated mental illnesses costs the country at least $105 billion in lost productivity annually. The very nature of mental illness also means that absences from work are rarely characterized by the odd day here and there; instead, sufferers are likely to experience prolonged periods when they are not able to work, and when they do return to work, they can take some time to get back to their previous level of performance. Estimates for national spending in the USA on depression alone are $30–40 billion, with an estimated 200 million days being lost from work each year. Similarly, in the UK, depression is estimated to cost approximately £2 billion a year and, on top of absenteeism, can have a profound impact on reduced productivity, staff turnover, poor timekeeping and work-related accidents. In a study of US

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workers, Kessler et al. (2006) estimate that a single depressive disorder is typically associated with an average of over ﬁve weeks of lost productivity per person. Compared to other mental illnesses, depression would appear to be the most costly of all health problems to employers (Wang et al., 2003), although there is a vast amount of evidence to suggest that all mood disorders are associated with signiﬁcant costs, including absence from work and reduced functioning whilst at work. In addition, it is quite probable that a diagnosis of depression is often used as an umbrella term for some other mood disorders. Reduced functioning can take many forms, including poor cognitive performance, problem behaviour directed towards other colleagues, lack of attention to the core tasks of the job, poor interpersonal skills when dealing with clients and a greater need for frequent breaks and time off. In a recent study in the Netherlands, De Graaf et al. (2012) carried out extensive research to compare the effects of mental disorders on work performance. They found that drug abuse, bipolar disorder, major depression, digestive disorders and panic disorder were associated with the highest number of days of lost work (once co-morbidity had been taken out of the equation). At a wider population level, they found that depression, chronic back pain, respiratory disorders, drug abuse and digestive disorders contributed the most to lost productivity and days off work. Other research suggests that those with a psychiatric disorder (in comparison to the rest of the population) do not always have more days off work, but will certainly have a greater number of days during which they are either unproductive or unable to function at their full capacity (Boyle et al., 1996; Kessler and Frank, 1997). So, in other words, those with mental illness may be just as likely to show up for work as the rest of us, but they will need extra help in performing at the required level. This highlights the need for increasing the awareness of how to manage, mitigate and prevent mental health problems in the workplace. In order to get the most from workers who experience mental health problems, it is critical that managers and co-workers understand the nuances and respond appropriately.

1.4 The impact of the global ﬁnancial crisis on mental illness The report of the World Health Organization (WHO) in 1996 suggested that depression would emerge as the leading cause of disability by the year 2020 and the indicators seem to be that we are on trend for this to be true. One

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of the main catalysts contributing to this trend in the last decade has been the global financial crisis, with indicators that the economic crash of 2007 and the subsequent fallout has increased the prevalence of mental illness. The prolonged economic downturn has led to an increase in job insecurity, work stress and the helplessness associated with unemployment and redundancy. The mental health charity Mind found that one in ten workers in the UK visited their GP for support with mental health issues as a result of recessionrelated work pressure and in 2011 the BBC reported figures indicating that prescriptions for anti-depressant drugs such as Prozac rose by more than 40 per cent between 2006 and 2010. Economic recessions have numerous social and psychological consequences. Many people lose their jobs or are compelled to work part-time. Young people are often hit hard and struggle to find work. A sense of a lethargy and despair pervades many communities, industries and organizations. In some countries people take to the streets in protest, while in others they seem quietly resigned to their fate. There have been numerous studies of the psychological distress that unemployment brings (Bjarnsasson and Sigurdardotter, 2003), with the most extreme cases resulting in suicide. Redundancies in particular usually lead to two problems: first, affective or emotional consequences; and, second, cognitive consequences which impact an individual’s thought processes. Some of those ‘laid off’ from work genuinely experience all the symptoms of PTSD, experiencing anxiety and depression. Some cannot stop thinking about it (sensitizers), while others cannot bear to face reality (repressors), becoming withdrawn and soon falling into the vicious cycle of decline. Depression leads to withdrawal and low self-esteem, which lead to fewer attempts to find a new job or adjust, which in turn leads to a greater level of depression. Some see threats as opportunities, while others see them as disasters. Figure 1.1 below represents a typical, negative vicious spiral. People feel uncertain and anxious about their jobs. This distraction can lead to poorer performance as well as illness. This often leads to worse results for an individual, a group and a whole organization. This, in turn, threatens the individual’s work status which caused the problem in the first place. The most extreme impact of the recession is evidenced in the increasing rate of suicide amongst adults of working age in the hardest-hit countries. In 2011 the British medical journal The Lancet reported the results of a study from 10 European Union countries which indicated an increase in suicide rates in hardhit economies like Greece (up 17 per cent on figures before the recession) and Ireland (up 13 per cent). Research suggests that men may be more susceptible than women to suicide; a 2012 study published in the British Medical Journal

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Worsening results

Management warning

Ambiguity and uncertainty

Lower productivity

Anxiety

figure 1.1

The vicious cycle of job uncertainty

reported that each ten per cent increase in the number of unemployed men between 2008 and 2010 was signiﬁcantly associated with a 1.4 per cent increase in male suicides. Men may be more vulnerable to the adverse effect that unemployment and job insecurity can bring, particularly in households where they hold the traditional ‘breadwinner’ role. The nature of mental illness is such that symptoms can take many months to appear and so even though the signs of ﬁnancial recovery are there to be seen, the impact on human well-being is likely to be felt for many years to come. Indeed, at the time that The Lancet study was published in 2011, Bloomberg warned that increased suicides would be ‘just the tip of the iceberg’, alerting researchers to the likelihood of a mental health crisis and the spiralling incidence of depression across the world. This worrying trend highlights the need to invest in better systems to support people back into the workplace who may have lost their job as a result of the recession, to ensure that those in work who may be feeling vulnerable have the adequate support systems in place and to educate managers and the general workforce so that they are more able to spot the warning signs of mental illness.

1.5 A brief history of mental illness Attempts to understand and categorize mental illness can be traced back to ancient times where many cultures viewed mental illness as a form of

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punishment from the Gods. People were commonly assumed to have been possessed by demons and treatment included exorcism, physical punishment and treatment with balms and ointments. There was no clear distinction between physical and mental illness until the time of the early pioneers, including Hippocrates, who began to question this assumption. Hippocrates was one of the first people to start treating mentally ill people with techniques not rooted in religion or superstition and focused instead on making changes to the environment and administering specialist substances. Throughout the Middle Ages, the preoccupation with a religious connection persisted and priests and other figures of authority still thought of mental illness in terms of the person needing to be cleansed of evil spirits. Treatments during this era were of a harsh and brutal nature. These negative attitudes persisted into the eighteenth century in the Western world, following which a more enlightened and scientific approach began to emerge. In 1752 the first ‘lunatic’ asylum was opened in the USA at the Pennsylvania Hospital based on a model of care established at the famous Bethlehem Hospital in London (commonly known as Bedlam), where there are records as far back as 1403 of mentally ill patients being admitted. Treatment in these institutions was not much better than that doled out by priests in the Middle Ages and patients were often beaten, chained to walls and put in straitjackets for days at a time. Another cruel aspect of such institutions was that local people were often permitted to visit the asylum, pay an admission fee and subsequently observe patients and poke fun at them. Things began to change in the mid-1800s and activists such as Dorothea Dix lobbied for better treatment and living conditions for the mentally ill. Dix wielded considerable influence over state legislature and was eventually successful in persuading the US government to fund the building of 32 state psychiatric hospitals. During this time, new ideas about treating mental illness were also introduced and physicians became convinced that the act of physical confinement itself would go a long way towards treating the illness. Thus, the institutional inpatient care model, in which many patients lived in hospitals and were treated by professional staff, became accepted as the most effective way to care for the mentally ill. Asylums subsequently began to spring up in many countries in the Western world. By the mid-1950s, particularly in the USA, there was a push for deinstitutionalization as growing evidence had begun to show that this model was not working. Understanding of mental illness had progressed considerably and the focus at this time was on understanding and treating the psychosocial causes of mental illness. As a result, outpatient treatment began in many

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countries, accelerated by the development of a variety of anti-psychotic drugs. This international move towards a more community-centric model of care was based on the belief that people with mental illness would have a higher quality of life if they were treated in their own communities.

1.6 Modern treatment and cures for mental illness Psychiatry has gone in and out of fashion. One of the most famous antipsychiatry studies was done in the early 1970s. Eight ‘normal’ mentally healthy researchers tried to gain admission, through diagnosis, to a number of American mental hospitals. The only symptom they reported was hearing voices. Seven were diagnosed as schizophrenic and were admitted. Once in the hospital, they behaved normally and were ignored when they politely asked for information. They later reported that their diagnostic label of schizophrenia meant they had low status and power in the mental hospital. They then decided to ‘come clean’ and admit they had no symptoms and felt fine. But it took nearly three weeks before they were discharged, often with the diagnosis of ‘schizophrenia in remission’. So, normal, healthy people could easily be diagnosable as abnormal. But could the reverse happen? The same researchers told psychiatric hospital staff that fake or pseudo-patients pretending to be schizophrenics might try to gain access to their hospital. They then found that 19 genuine patients were suspected as bring frauds by two or more members of staff, including a psychiatrist. The conclusion was that it is not possible to distinguish the sane from the insane in mental hospitals. Though this famous study has received considerable criticism on ethical and experimental grounds, it added great impetus to the anti-psychiatry movement. There were three main origins of the anti-psychiatry movement. The first started in the early 1950s and was a result of the war between Freudianinspired psychoanalytic psychiatrists and the new biological physical psychiatrists. The former favoured protracted, dynamic, talking cures, but were losing power and were being challenged by the latter, who saw this approach not only as costly and ineffective but also profoundly unscientific. The biological psychologist treatments were surgical and pharmacological, and they had some important early successes. The second attack on psychiatry began in the 1960s with famous figures like David Cooper, R.D. Laing and Thomas Szasz becoming highly vocal in different

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countries about the use of psychiatry to control those deviating from societal norms. Thus, people who were seen to be sexually, politically or morally deviant or different were subjected to psychiatric processing and control. The famous book The Myth of Mental Illness (Szasz, 1961) explains this position well. The third force were American and European sociologists, notably Erving Goffman and Michel Foucault, who saw the devious power of psychiatry and its effects on labelling and stigmatizing and hospitalizing people. The high point of this movement occurred at the time of the 1960s counter-cultural, challenging zeitgeist. Popular films (One Flew over the Cuckoo’s Nest) and radical magazines appeared that challenged the biological psychiatrists, state services and practices. The anti-psychiatry movement was always a loose coalition between social action groups who tended to focus on very specific problems like schizophrenia or sexual disorders. They talked of authenticity and liberation, of empowerment and personal management rather than pharmaceutical intervention. Many began to attack the pharmaceutical industry and, particularly, established psychiatric institutions like the great Victorian mental hospitals. The movements did share some fundamental beliefs and concerns. The first was that families, institutions and the state are as much a cause of illness as a person’s biological functioning or genetic make-up. Second, they opposed the medical model of illness and treatment. They believed those who were living by different codes of conduct were erroneously and dangerously labelled delusional. Third, they believed that certain religious and ethnic groups were oppressed because they were in some sense abnormal. They were pathologized and therefore were made to believe they needed treatment. The movements got and still get very concerned with the power of diagnostic labels. They see such labels as giving a bogus impression of accuracy and immutability. They have succeeded to a large extent such that ‘schizophrenics’ are now regularly described as ‘people with schizophrenia’ and ‘AIDS victims’ as ‘people with AIDS’. Diagnostic labels and manuals are rejected because people either meet none of the criteria or they meet multiple criteria and there is little agreement between experts. The movements against psychiatry also focused their opposition on very specific therapies, particularly drugs. This was especially the case with drugs designed to treat primarily childhood problems (like attention deficit hyperactivity disorder (ADHD)) and depression. They were attacked because of their cost and side-effects, but also because patients were not told the truth

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about them. Anti-psychiatry movement activists have focused on all aspects of pharmaceutical company behaviour, arguing that they fake their data and massively overcharge for their drugs. This in turn has led the industry to be carefully monitored and policed by legislation. Other targets have been electroconvulsive therapy (ECT) as well as very speciﬁc procedures like brain surgery (prefrontal lobotomies). Despite some evidence of success, critics argue they are ‘forced upon’ naïve patients and cause massive permanent side-effects. Although there are still a number of large inpatient psychiatric hospitals, particularly in Central and Eastern Europe, the deinstitutionalization movement has been fairly widespread and has changed the nature and perception of modern care. What was once the common has become the uncommon, with lobotomies being almost totally eradicated and the media branding psychiatry as a pseudo-science, not empirical and to many degrees a ‘sham’ (Kirk, 2013). Anti-psychiatric views such as these often focus on quantitative statistics rather than indepth rational inspection, e.g., that mental illness has grown, not shrunk, with about 20 per cent of American adults diagnosable as mentally ill in 2013 (Kirk, 2013).

1.7 The categorization of mental illness The classification of mental disorders is essentially the holy grail of psychiatry. Creating a parsimonious, efficient and universal classification system is something that has only really begun to take shape in the last five decades. Pushed by the deinstitutionalization movement, the International Classification of Diseases (ICD) produced by the WHO and the Diagnostic and Statistical Manual of Mental Disorders produced by the American Psychiatric Association (APA) were the first comprehensive systems. Both systems list categories of disorders thought to be distinct types and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain. The ICD is an international standard diagnostic classification for a wide variety of health conditions. One chapter focuses on ‘mental and behavioural disorders’ and consists of ten main categories:

1. Organic (including symptomatic) mental disorders. 2. Mental and behavioural disorders due to the use of psychoactive substances.

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3. 4. 5. 6. 7. 8. 9. 10.

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Schizophrenia, schizotypal and delusional disorders. Mood (affective) disorders. Neurotic, stress-related and somatoform disorders. Behavioural syndromes associated with physiological disturbances and physical factors. Personality and behaviour disorders in adults. Mental retardation. Disorders of psychological development. Behavioural and emotional disorders with onset usually occurring in childhood and adolescence.

Within each group there are additional specific subcategories. The WHO is revising its classifications in this section as part of the development of the ICD-11, which is scheduled for 2014. The Diagnostic Statistic Manual – Version 4 (DSM-IV) consists of five axes (domains) on which disorder can be assessed. The five axes are as follows: Axis I: clinical disorders (all mental disorders except personality disorders and mental retardation). Axis II: personality disorders and mental retardation. Axis III: general medical conditions (must be connected to a mental disorder). Axis IV: psychosocial and environmental problems (for example, a limited social support network). Axis V: global assessment of functioning (psychological, social and job-related functions are evaluated on a continuum between mental health and extreme mental disorder). As with any competing enterprise, there are always ongoing scientific doubts concerning both validity and reliability (Baca-Garcia et al., 2007), but also and more importantly concerning boundaries of normality. Studies reporting insignificant validities and reliability, while having important implications, need to be considered in light of what these manuals represent. Often mistaken for ‘rule books’, it is important to note that these are guidelines. Each person will experience mental illness in a slightly different way, with mental illness often being a vast combination of things that will never be fully understood. Thus, such studies may not always show such manuals to be useful. Their generalizability is of more importance. That being said, because there are no ‘rules’ as it were, natural boundaries between related syndromes or between a common syndrome and normality have failed. Many practitioners find this unacceptable as labelling inappropriately

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cannot actually lead to mental illness, but can cause significant problems in all other areas of life. When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was released at the American Psychiatric Association’s Annual Meeting in May 2013, it marked the end of more than a decade of revising the criteria for the diagnosis and classification of mental disorders. DSM-V serves as the universal authority for the diagnosis of psychiatric disorders and most diagnosis and treatment of mental illness is based on the criteria and guidance set out in this manual. The publication of a revised and significantly altered version therefore has significant practical implications. The manual is divided into three major sections: 1) introduction and clear information on how to use the DSM; 2) information and categorical diagnoses; 3) self-assessment tools as well as categories that require more research. Whilst DSM-V has approximately the same number of conditions as DSM-IV, there have been some significant changes in specific disorders. A summary of these is as follows: Autism: there is now a single condition called autism spectrum disorder, which incorporates four previous separate disorders including autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder and not otherwise specified pervasive developmental disorder. Disruptive Mood Dysregulation Disorder (DMDD): childhood bipolar disorder has a new name, which is ‘intended to address issues of overdiagnosis and over-treatment of bipolar disorder in children’. ADHD: this disorder has been modified especially to emphasize that it can continue into adulthood. The one ‘big’ change is that you can be diagnosed with ADHD as an adult if you exhibit one less symptom than if you are a child. Bereavement exclusion removal: in DSM-IV, if you were grieving the loss of a loved one, technically you couldn’t be diagnosed with a major depression disorder in the first two months of your grief. This exclusion was removed in DSM-V for a number of reasons. First, the implication that bereavement typically lasts only two months has been removed as most practitioners recognize that the duration is more commonly one to two years. Second, bereavement is recognized as a severe psychosocial stressor that can precipitate a major depressive episode in a vulnerable individual, generally beginning soon after the loss. Third, bereavement-related major depression

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Introduction

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is most likely to occur in individuals with past personal and family histories of major depressive episodes. It is genetically influenced and is associated with similar personality characteristics, patterns of co-morbidity and risks of chronicity and/or recurrence as non-bereavement-related major depressive episodes. Finally, the depressive symptoms associated with bereavementrelated depression respond to the same psychosocial and medication treatments as non-bereavement-related depression. PTSD: more attention is now paid to behavioural symptoms that accompany PTSD in DSM-V. It now includes four primary major symptom clusters: re-experiencing, arousal, avoidance and persistent negative alterations in cognitions and mood. The condition is now developmentally more sensitive in that diagnostic thresholds have been lowered for children and adolescents. Major and mild neurocognitive disorder: major neurocognitive disorder now subsumes dementia and amnestic disorder, but a new disorder – mild neurocognitive disorder – has also been added. Other new and notable disorders: both binge eating disorder and premenstrual dysphoric disorder are now official diagnoses in DSM-V (they were not prior to this, although there were commonly diagnosed by clinicians). Hoarding disorder is also now recognized as a real disorder separate from obsessivecompulsive disorder (OCD), ‘which reflects persistent difficulty discarding or parting with possessions due to a perceived need to save the items and distress associated with discarding them. Hoarding disorder may have unique neurobiological correlates, is associated with significant impairment and may respond to clinical intervention’. There are and will remain many criticisms of this manual, and the psychology and psychiatry community has come out in unison to highlight concerns about the changes. In a blog post in Psychology Today (2 December 2010), Frances lists the ten ‘most potentially harmful changes’ to DSM-V: DMDD being used to describe temper tantrums. Major depressive disorder being used to for normal grief situations. Minor neurocognitive disorder being used for normal forgetfulness in old age. Adult attention deficit disorder, which could lead to greater psychiatric prescriptions of stimulants. Binge eating disorder being used to describe excessive eating. Changes to autism diagnoses, thus reducing the numbers diagnosed. A risk that first-time drug users could be grouped with addicts. Behavioural addictions, making a ‘mental disorder of everything we like to do a lot’.

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Generalized anxiety disorder being used to describe everyday worries. Changes to PTSD opening ‘the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings’. These criticisms are not new and are certainly not unique to DSM-V. Is the reliability of diagnosis improved? In other words, do psychiatrists and psychologists agree upon diagnoses? Is all this medicalization mainly for the beneﬁt of the big pharmaceutical companies? There is also the serious issue of cultural bias. It is argued that national culture affects the experience, expression, generation and management of symptoms. It also affects the management of symptoms. People in different cultures use different words and idioms to express their psychological distress and pain. National culture also reﬂects shame in different ways. Many cultures accept supernatural explanations for mental illness, while others try hard to medicalize it as soon as possible. What place does a universal diagnostic manual have in a multicultural and diverse world? And does it help to improve the mental health literacy of the general public?

1.8 Summary Many groups have called for a change in attitude towards and an understanding of mental disorders which cost individuals, families and organizations a great deal. It seems that we have been much more successful at changing attitudes towards physical illness than mental illness. The sooner we are able to increase mental health awareness, the sooner we can help people in distress. There are a large number of self-help groups and societies dedicated to helping people and their relatives with a large range of psychological and physical problems. Each calls for the better education of the general public, particularly those in educational and organizational settings. This is not only a humanitarian but also a business issue. The more mental health-literate manager should be able to make better hiring and managing decisions about people who are often the greatest asset but also the greatest cost to an organization.

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Index Note: italic page numbers indicate tables; bold indicate figures. 4Ds 19–20 50 Great Myths of Popular Psychology 186–7 360 degree feedback 165–6

Aakster, C. 180 abnormal psychology 17 abnormality and context 18 criteria 19–20 defining 17–18 vs. normality 18–19, 20 actor-observer difference 20 addictions addictive personality 88–9 alcohol use see alcohol dependence criteria for substance dependence 89 definition and scope 87–8 harm 93 overview 87–8 summary 106 theories of 88–90 work-induced illness 127–9 addictive personality 88–9 age, and alcohol dependence 91 agoraphobia 40–2 Alarcon, G. 113

alcohol dependence 5 alcohol consumption 100–3 associated problems 93 causes 94 consequences in workplace 103–5 cultural factors 96–100 culture, age and gender 91 demographics 94 diagnostic criteria 92 familial pattern 92 health costs 101 managing 105–6 occupational health 105 prevalence 91–2 reasons for drinking 95–6 recommended limits 101–2 units of alcohol 100–2 workplace legislation 105 alienation 33 American Express 216 American Psychiatric Association (APA) 12 Ames, G.M. 129 Andreassen, C. 114 anorexia, cultural definitions 174–5 anti-psychiatry movement 10–12 anti-social personality disorder 50, 61–4, 134–5

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Index

anxiety disorder not otherwise specified 38 anxiety disorders 37–42 agoraphobia 40–2 generalized anxiety disorder (GAD) 38–9 overview 37 physiological arousal 41 signs and symptoms 167 social phobia 39–40 types 37–8 anxiety disorders due to a known physical cause 38 Argyle, M. 4, 207 Arup briefing 216–18 asylums 9 at-risk occupations addictions 127–9 depression 126 exposure to trauma 129 suicide risk 127–8 attitude formation 204–6 attitude theory 205 attraction-selection-attrition (ASA) 122 atypical depression 34 avoidant personality disorder 51, 72–4 awareness 2, 16 Aziz, S. 112 Babiak, P. 134, 135–6, 139–40 Baca-Garcia, E. 13 back to work transition 196–7 Bakker, A. 113 balance 218–20 Baron, Frank 27 Baylis, N. 207 behaviour, noticing and reporting changes 165 behavioural indicators, of illness 164 Benning, S. 134, 137 Bernstein, D.P. 49

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Bethlehem Hospital (Bedlam) 9 binge drinking 93, 94, 102–3 biological physical psychiatrists 10 biomedical approach 21 biopsychosocial perspective 20–2 bipolar disorder 34, 140–3 Bjarnsasson, T. 6–8 Bloom, D.E. 5 Bochner, S. 182 Bonde, J.P.E. 125 borderline personality disorder 51, 64–7 boundaries of normality 13 Boyle, M.H. 6 brain surgery, opposition to use of 12 Brewer, G. 123 British Household Panel Survey (BHPS) 131 British Medical Journal 7–8 Brohan, E. 203 Burke, A.E. 38 Burke, R. 112, 113, 114 burnout 32–3, 113 Burton, A.K. 193 business, costs of mental illness 5–6 business shock 184 Buskist, W. 204 Cairo, P. 138, 144, 146–7 Camaraza, Doria 216 Care, Robert 216–18 career selection 122–4 means of public and private sectors showing dark side trait and higher-order factors against population norms 124 Carlson, N.R. 204 Carver, C. 169–70 case studies, schizophrenia 27 catatonic depression 34 catatonic schizophrenia 24

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categorical versus dimensional debate 49 categorization 12–16, 22–4, 46–7 see also anxiety disorders; depression; post-traumatic stress disorder (PTSD); schizophrenia; stress challenge and support 29–30 charity work 212–13 Chatman, J. 122 Chen, H. 149 CIPD 124 civil servants study 131 Clark, M. 113–14 Cleckley, H. 137 clinical psychology 17 clinical viewpoint 19 clinicians, range of practice 4 co-workers, training for 198 cognitive behavioural therapy (CBT), for agoraphobia 40–1 compulsive organizations 120–1 control, and depression 131 Cooper, David 10 coping strategies 169–70 depression 194 stress 31, 195 corporate psychopaths 135 Corrigan, P. 203 costs, to business 5–6 creativity and madness 140–7 bipolar disorder 140–3 histrionic personality disorder 145–7 lifetime prevalence of mental disorders in 1004 eminent subjects classified by profession 142 schizotypal personality disorder 144–5 crisis response 168–9 Csikszentmihalyi, M. 116–17 cultural differences depression 180–2

health beliefs 177–8 in mental health 176–8 overview 172–4 pathways to treatment 178–80 schizophrenia 176 spread of Western viewpoint 174–5 summary 184 theories of health and illness 178 cultural viewpoint 19 culture, alcohol dependence 91, 96–100 culture-bound syndromes 184 culture shock 182–4 cyclothymia see bipolar disorder Daoud, J. 150 De Graaf, R. 6 definition, problems of 17–18 deinstitutionalization 9–10, 12 demand-control theory 29–30 dependent personality disorder 51, 74–6 depersonalization 33 depression 33–7 at-risk occupations 126 consequences in workplace 35–7 and control 131 costs to business 5–6 cultural differences 180–2 managing at work 193–4 overview 33 signs and symptoms 33–4, 167, 193–4 types 34 work-induced illness 125 depressive organizations 121–2 Deverill, C. 4–5 deviance, as mental illness 10–11 Dewhurst-Savellis, J. 131 Diagnostic and Statistical Manual of Mental Disorders (DSM) 12, 13–16, 91–2 diathesis-stress model 34

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Index

Diener, E. 4, 207 disclosure, reluctance 2 discrimination 192, 203, 204 disorganized schizophrenia 24–5 Dix, Dorothea 9 Dotlick, D. 138, 144, 146–7 dramatic organizations 121, 145 drug dependence 5 drug treatment for agoraphobia 41 opposition to use of 11–12 drug use see addictions Duxbury, L. 123 dysthymia 35

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formal screening 170–1, 186 Foucault, Michel 11 Frank, R.G. 6 Frese, Fred 28 Freudian theories, personality disorders 85 Frohlinger-Graham, M.J. 219 Furnham, A. 50, 123–4, 150, 177, 180–1, 182, 187

economic recessions, impact 6–8 education, of workforce 200–2 egocentric cultures 177 electroconvulsive therapy (ECT), opposition to use of 12 elevation 208 Elton, C. 216 emotion-focused coping 169 Employee Assistance Programmes (EAPs) 185, 206, 217 employment, benefits to mental health 193 endogenous depression 35 energy and personality 116 types of 115–16 engagement, and burnout 113 Engel, C.C. 129 Equality Act 2010 192, 193 exogenous depression 35 Eysenck, H. 4, 143, 207

gender alcohol consumption 102–3 alcohol dependence 91 and work-induced illness 125 gender differences, personality disorders 49 General Health Questionnaire 186 12-item version (GHQ-12) 165–6 generalized anxiety disorder (GAD) 38–9 genetic theories, personality disorders 85 Gini, A. 112 global financial crisis, impact 6–8 globalization dimensions of 173 overview 172–4 summary 184 symptom repertoires 174–5 of Western viewpoint 174 Goffman, Erving 11 Golub, R.M. 38 Gorgievski, M. 113 Gostick, A. 216 Grant, M. 97, 99 Greene, B. 3

familial pattern, alcohol dependence 92 feedback 130 Feldman, D.C. 112 Fiksenbaum, L. 113, 114 flow 116–17, 208, 210

Hackman, J.R. 130 happiness 4 achieving 211 features 211–12 importance of 209–10 myths 210

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happiness – continued and personality 212 positive psychology 208–9 promoting 212–13 tips for 209–10 and well-being 206–8 hardiness 31 Hare, P. 134, 135–6, 139–40 harmonious passion 114–15 Harpaz, I. 113 Hatim, A. 2 health beliefs 177–8 health, definitions 172–3 health insurance 28 health literacy 149 health psychology 3 health resources, global inequality 176 healthy work environments attitude formation 204–6 balance 218–20 barriers to 214–21 dealing with stigma 202–4 executive-level commitment 216–18 happiness and well-being 206–8 monitoring 220–1 organizational culture 214–15 overview 199 promoting positive attitudes 200–4 removing hazards 218–19 steps to take 200 summary 221 work engagement 213–14 workforce education 200–2 see also happiness; well-being Heath, D. 95–6 Helman, C. 179, 181 Hetland, J. 114 Higgins, C. 123 Hippocrates 9 history, of mental illness 8–10

histrionic personality disorder 51, 67–9, 145–7 Hogan, J. 55, 56, 58, 60, 63, 66, 67–8, 70, 73, 75, 76, 77, 80 Hogan, R. 55, 56, 58, 60, 63, 66, 67–8, 70, 73, 75, 76, 77, 80, 134 holistic model 180 Horney, Karen 54 Houlfort, N. 114 Huppert, F. 207 Hyde, G. 123–4, 187 integrational model 180 intellectual energy 116 International Classification of Diseases (ICD) 12–13 International Monetary Fund (IMF) 173 invasion shock 183–4 Iscan, C. 49 Ishikawa, S. 136 Jamison, K.R. 142–3 Janes, C. 129 job characteristics, work-induced illness 130–2 job insecurity impact of 7–8 vicious cycle 8 Jorm, A. 149, 198, 206 Joyce, C. 122 Judge, T.A. 134 Karasz, A. 180 Kessler, R.C. 6, 37, 41, 150 Kets de Vries, M. 119–22, 145 Keverne, B. 207 King, L. 93 King, M. 4–5 Kirk, S.A. 12 Kitchener, B.A. 198, 206 Kivimäki, 125 Kraepelin, Emil 23 Krupa, T. 203

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Index

labelling 10, 11, 202–3 Laing, R.D. 10 Langner 22 model 166 learning theories 90 personality disorders 85 Lee, Sing 174–5 Lelchook, A. 113–14 lifetime prevalence of mental disorders in 1,004 eminent subjects classified by profession 142 Lilienfeld, S. 186–8 Linley, A. 211 Ludwig, A.M. 140–2 Lundin, R. 203 Lyons, S. 123 Machlowitz, M. 109–11 Magraf, J. 37 major depression 34 maladaptive behaviour 18 Malik, R. 180–1 managerial success overview 133 psychopathy 134–7 summary 147 see also creativity and madness managers attitudes and beliefs 199 awareness of behaviour changes 165–6 managing mental illness confronting myths 186–91 depression 193–4 employers’ role 186 getting back to work 196–7 identifying possible problems 186 overview 185 roles and responsibilities 191–3 schizophrenia 195–6 stress 195 summary 198 training for co-workers 198

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Mandell, W. 128 manic depression 34 marginalization 2 Martin, G.N. 204 Mas, A. 2 Maser, J. 49 The Mask of Sanity (Cleckley) 137 Matthiesen, S. 113 McGruder, J. 176 meaningfulness 130 means of the public and private sectors showing dark side trait and higher-order factors against population norms 124 media representations, unhelpful 2 medical model global adoption of 175–6 subtypes 180 melancholic depression 34 mental health defining 3–4 features 3 as psychological well-being 17 Mental Health First Aid (MHFA) programmes 198 Mental Health Foundation 219 guidelines for managers 191–3 mental health issues, responsibilities in workplace 168 mental health literacy 149–63 increasing 175 test 150–60 mental health screening 170–1, 186 mental illness 221 causes 4 cultural definitions 174–5 history 8–10 as possibly beneficial 123 recognizing 1–2 risk of 150 spotting see recognition of illness Merikangas, K.R. 37 Michael, T. 37

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Miller, D. 119–22 Miller, L. 138–9, 145, 147 Mind 5, 7 moral insanity see anti-social personality disorder Morris, L. 54, 57, 59, 61, 64, 66–7, 68–9, 71, 74, 76, 78, 80–1, 82–4, 136 Motivating Potential Score (MPS) 130–1 Mugford, S. 198 multi-rater feedback 165–6, 166 Myers, D. 4, 207, 209–10 mythlets 187 The Myth of Mental Illness (Szasz) 10 myths 186–91 narcissistic personality disorder 51, 69–72 National Council on Alcoholism and Drug Dependence (USA) 104 National Institute of Mental Health 38 National Office for Statistics 128 Nazroo, J. 181 Netherlands, costs to business 6 Netterstrøm, B. 125 Nevid, J. 3 Newman, J.P. 136 Ng, T.W. 112 non-criminal psychopaths 136–7 normality boundaries of 13 vs. abnormality 18–19, 20 normative viewpoint 18–19 Nutbeam, D. 149 Nutt, D. 93 Oates, W. 108–9 obsessive-compulsive disorder (OCD) 38 obsessive-compulsive personality disorder 51, 78–81

obsessive passion 114–15 occupational health 105 Occupational Health Services 185 Oldham, G.R. 130 Oldham, J. 54, 57, 59, 61, 64, 66–7, 68–9, 71, 74, 76, 78, 80–1, 82–4, 136 opponent-process theory 90 optimism 208 and stress 30–1 organization responding to crises 168–9 responsibilities for mental health 168 organizational culture, healthy work environments 214–15 organizational neuroses 119–22 Osler, William 21 Pallesen, S. 113, 114 panic disorder with or without agoraphobia 37 paranoid organizations 120 paranoid personality disorder 50, 55–7 paranoid schizophrenia 24 Parker, G. 131 passion, for work 114–15 passive-aggressive personality disorder 51, 76–8 Paterniti, S. 125 pathways to treatment, cultural differences 178–80 Peele, S. 99 Pennsylvania Hospital 9 personality career selection 123–4 and energy 116 and happiness 212 and workaholism 113–14 personality disorders alternative typologies 51–5, 52–3 anti-social personality disorder 50, 61–4

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Index

avoidant personality disorder 51, 72–4 borderline personality disorder 51, 64–7 dependent personality disorder 51, 74–6 diagnostic criteria 50 as distinct from mental illness 49–55 effects of 54 gender differences 49 histrionic personality disorder 51, 67–9 narcissistic personality disorder 51, 69–72 not otherwise specified 51 obsessive-compulsive personality disorder 51, 78–81 overlap 84–5 overview 48–9 paranoid personality disorder 50, 55–7 passive-aggressive personality disorder 51, 76–8 sadistic personality disorder 83–4 schizoid personality disorder 50, 57–9 schizotypal personality disorder 50, 59–61 self-defeating personality disorder 81–3 spectrum hypothesis 50 summary 84–6 theories of 85–6 treatment 86 typology 50–1 personality traits 49 psychopathy 139–40 pessimism, and stress 31 pharmaceutical model 180 Phillips, L. 93 phobias 37–8 physical energy 115

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physiological arousal, anxiety disorders 41 Plant, M.A. 128 Porter, G. 112 positive attitudes, promoting 200–4 positive psychology 207–8, 211 and happiness 208–9 positive reinforcement theory 90 post-traumatic stress disorder (PTSD) 42–7 accommodating in workplace 44–6 co-worker support 46–7 consequences in workplace 43–4 overview 42–3 signs and symptoms 42–3 stress management 46 postnatal depression 34 presenteeism 215 prevalence 2, 4–5, 150 alcohol dependence 91–2 prevention 186 The Price of Greatness (Ludwig) 140–2 primary prevention 186 problem-focused coping 169–70 professional help, reluctance to seek 2 promoting positive attitudes 200–4 Protestant work ethic 113 psychiatry, schools of 10 psychoanalytic psychiatrists 10 psychological energy 115–16 psychopathy behavioural indicators 137 defining 134–7 managing 138–9 non-criminal 136–7 personality traits 139–40 research 134–6 self-report 137 work success 137–40 see also anti-social personality disorder psychotic depression 35

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race culture shock 184 Rathus, S. 3 re-professionalization and re-licensing shock 184 reciprocal determinism 21 recognition of illness awareness of behaviour changes 165–7 coping strategies 169–70 mental health literacy 149–63 overview 148–9 responding to crises 168–9 screening programmes 170–1 signs and symptoms 167–8 summary 171 redundancies, impact 7 responsibility 130 reverse culture shock 184 Robbins, A. 113 Roberts, S.E. 127 Rosenhan, D. 3 Rosenheck, R. 27 sadistic personality disorder 83–4 Sainsbury Centre for Mental Health 5, 124–5 Saks, Elyn R. 27 Sass, L. 142–3 scapegoating 205 Schaar Report 102 Schaufeli, W.B. 113 Scherer, M. 169–70 schizoid organizations 122 schizoid personality disorder 50, 57–9 schizophrenia 23–9 case studies 27 consequences in workplace 26–9 cultural differences 176 diagnostic criteria 25–6 managing at work 195–6 overview 23–5 signs and symptoms 28–9, 168 subtypes 24–5

schizotypal personality disorder 50, 59–61, 144–5 schizotypy 23 Schneier, F.R. 39 screening programmes 170–1, 186 seasonal affective disorder 34 secondary prevention 186 sector-specific illnesses career selection 122–4 organizational neuroses 119–22 overview 119 summary 132 see also work-induced illness self-assessment 161–3 self-defeating personality disorder 81–3 self-fulfilling prophecy 204 Seligman, M. 3, 211 Shaw Trust 199 Shirom, A. 116 sickness behaviour 21 signs and symptoms 163–4 agoraphobia 40 anxiety disorders 167 burnout 33 conformity 174 depression 33–4, 167, 193–4 generalized anxiety disorder (GAD) 38 post-traumatic stress disorder (PTSD) 42–3 schizophrenia 28–9, 168 social phobia 39 stress 31–2, 167–8 Sigurdardotter, T. 6–8 Silver, E.J. 219 Simonton, D.K. 140 situational depression 35 smart working 220 Snir, R. 113 social inclusion 196 social phobia 39–40 consequences in workplace 41–2 signs and symptoms 39

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Index

socio-centric cultures 177 socio-cultural factors, alcohol dependence 96–100 socio-cultural theories, personality disorders 85 sociological perspective 11 sociopaths see anti-social personality disorder Sorenson, K.L. 112 spectrum hypothesis 50 Spence, J. 113 Stack, S. 127 Stainton Rogers, W. 177–8 Stansfeld, S. 125, 131 statistical viewpoint 19 Stein, D.J. 39 Stein, M.B. 39 stereotypes 2, 132, 199, 203–4 stigma 2, 202–4, 205–6 stress 29–33 burnout 32–3 consequences in workplace 31–2 coping strategies 31 defining 29 demand-control theory 29–30 factors 30 hardiness 31 managing at work 195 and optimism 30–1 overview 29 and pessimism 31 signs and symptoms 31–2, 167–8 stress disorders 38 stress management, and PTSD 46 subcriminal psychopaths 135 subjective viewpoint 18 subjective well-being (SWB) see well-being substance dependence see addictions suicide, effects of recession 7–8 suicide risk at-risk occupations 127 work-induced illness 127–8

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Swami, V. 150 Swider, B. 112 symptom repertoires, globalization 174–5 Szasz, Thomas 10 Taris, T.W. 113 Taylor, M. 113–14 tertiary prevention 186 test of mental health literacy 150–61 theories of addiction 90 addictive personality 88–9 theories of health and illness 178 Thornicraft, G. 203 Time to Change campaign 203 Torpy, J.M. 38 training for co-workers 198, 206 trauma, exposure to 129 treatment 10–12 Trickey, J. 123–4, 187 Trust, S. 148 UK, costs to business 5 unemployment 202–3 units of alcohol 100 US, costs to business 5–6 Ustün, T.B. 35 Vallerand, R. 114–15, 117 Van Beek, I. 112 Van den Broeck, A. 112 Van Rhenen, W. 113 vicious cycle of job uncertainty 8 vignette identification methodology 150 vigour 116 Waddell, G. 193 Walker, E.F. 3 walking meetings 219 Wall, T.D. 131 Wang, P.S. 6, 219 Ward, C. 182 Wastell, C.A. 129

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Weintraub, J. 169–70 well-being 4 and happiness 206–8 white-collar psychopaths 135 Widom, C.S. 136 Wilhelm, K. 125, 131 Wong, E. 122 work centrality 113 work engagement 213–14 work-home balance 218–20 work-induced illness addictions 128–9 depression 125 exposure to trauma 129 high-risk jobs 125–9 job characteristics 130–2 overview 124–5 suicide risk 127–8 summary 132 work passion 114–17 workaholism causes 110 early research 108–12 effects of 113 engagement 113

joylessness 112, 113 later research 112–14 Machlowitz’s advice 111 managing 117–18 Oates’ advice 108–9 overview 107–8 and personality 113–14 summary 118 theories of 112–13 typology 109 work passion 114–17 workforce education 200–2 workplace phobia 41–2 World Health Organization (WHO) 1996 report 6 International Classification of Diseases (ICD) 12–13 writing, for well-being 208 Ylipaavalniemi, J.

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Zetsche, U. 37 Zhou, Y. 182 Zickar, M. 112 Zimmerman, R. 112