People with schizophrenia are often unable to realize vocational expectations because of schizophrenia-related functional impairments. This is particularly acute in those individuals from advantaged sociocultural backgrounds of whom much is expected. We present the case history of an acclaimed woman artist who lost artistic productivity with the advent of severe and persistent psychotic symptoms. We suggest that “loss of vocational potential” is a major loss worthy of grief work. Introduction and rationale are presented, followed by a case presentation that aims to illustrate the psychological effects of intangible loss for individuals suffering from serious mental illness. Three approaches to grief work are reviewed. The notion of incorporating grief work into the treatment of persons with schizophrenia is introduced. The authors call for increased attention to and study of the symbolic and emotional impact of the interpersonal and vocational losses that accompany schizophrenia. A carefully structured grief work intervention needs to be developed that maximizes adaptation and minimizes risk for suicide and that should be coupled with clinical indicators and validated outcome measures.
AnthonyW.RogersS.CohenM., & DaviesR. (1995). Relationships between psychiatric symptomatology, work skills, and future vocational performance. Psychiatric Services, 46, 353–358.
2.
BaumeisterR.CampbellJ.KruegerJ., & VohsK. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles?Psychological Science in the Public Interest, 4(1), 1–44.
BeckA., & RectorN. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Psychology, 1, 577–606.
5.
BeckerD.DrakeR.BondG.XieH.DainB., & HarrisonK. (1998). Job terminations among persons with severe mental illness participating in supported employment. Community Mental Health Journal, 34, 71–82.
6.
BellM.LysakerP., & MilsteinR. (1996). Clinical benefits of paid work activity in schizophrenia. Schizophrenia Bulletin, 22, 51–67.
7.
BlankertzL.McKayC., & RobinsonS. (1998). Work as a rehabilitative tool for individuals with dual diagnoses. Journal of Vocational Rehabilitation, 11(2), 113–123.
8.
BleulerE. (1950). Dementia praecox or the group of schizophrenias (p. 488). (ZiskinJ., trans.). New York: International Universities Press.
9.
BurnellG., & BurnellA. (1989). Clinical management of bereavement: A handbook for clinicians.New York: Plenum Press.
10.
DrakeR., & BeckerD. (1996). The individual placement and support model of supported employment. Psychiatric Services, 47, 473–475.
11.
GreenM. (1996). What are the functional consequences of neurocognitive deficits in schizophrenia?American Journal of Psychiatry, 153, 321–330.
12.
HarveyJ. H., & MillerE. D. (1998). Toward a psychology of loss. Psychological Science, 9, 429–433.
13.
HogartyG. (2002). Personal therapy for schizophrenia & related disorders (pp. 194–200). New York: The Guilford Press.
14.
JohnsonJ.CohenP.DohrenwendB.LinkB., & BrookJ. (1999). A longitudinal investigation of social causation and social selection processes involved in the association between socioeconomic status and psychiatric disorders. Journal of Abnormal Psychology, 108, 490–499.
15.
KavanaghD., & MueserK. (2001). The future of cognitive and behavioral therapies in the prevention and early management of psychosis: Opportunities and risks. Behavior Therapy, 32, 693–724.
16.
LeachH. (2005). A tribute to David. Vision. A Quarterly Newsletter from NAMI Kentucky, 2(1), 7.
17.
LehmanA.KreyenbuhlJ.BuchananR.DickersonF.DixonL.GoldbergR.Green-PadenL.TenhulaW.BoerescuD.TekC.SandsonN., & SteinwachsD. (2003). The Schizophrenia Outcomes Research Team (PORT): Updated treatment recommendationsSchizophrenia Bulletin, 30(2), 193–217.
18.
LewineR. (2005a). Social class of origin, lost potential, and hopelessness in schizophrenia. Schizophrenia Research, 76(2–3), 329–335.
19.
LewineR. (2005b, March 29). Sociocultural context of psychopathology.Department of Psychological and Brain Sciences 60th Reunion, Louisville, KY.
20.
LittrellJ. (1998). Is the re-experience of painful emotion therapeutic?Clinical Psychology Review, 18, 71–102.
21.
LysakerP., & LysakerJ. (2001). Psychosis and the disintegration of dialogical self-structure: Problems posed by schizophrenia for the maintenance of dialogue. British Journal of Medical Psychology, 74, 23–33.
22.
ModestinJ., & HoffmanH. (1992). Completed suicide in psychiatric inpatients and former inpatients. Acta Psychiatrica Scandinavica, 79, 229–234.
23.
NeimeyerR. (Ed.). (2001a). Meaning reconstruction & the experience of loss.Washington, DC: American Psychological Association.
24.
NeimeyerR. (2001b). The language of loss: Grief therapy as a process of meaning reconstruction. In NeimeyerR. (Ed.), Meaning reconstruction & the experience of loss (pp. 261–292). Washington, DC: American Psychological Association.
25.
ParrottB.ChapmanK., & LewineR. (submitted). Job acceptability and socioeconomic status of origin: Implications for the severely mentally ill. Submitted to the Journal of Vocational Behavior.
26.
PinikahanaJ.HappellB., & KeksN. (2003). Suicide and schizophrenia: A review of literature for the decade (1990-1999) and implications for mental health nursing. Issues in Mental Health Nursing, 24, 27–43.
27.
PriebeS.WarnerR.HubschmidT., & EckleI. (1998). Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries. Schizophrenia Bulletin, 24, 469–477.
28.
RandoT. (1984). Grief, dying, and death.Champaign, IL: Research Press Company.
29.
RectorN. A., & BeckA. T. (2001, May). Cognitive behavioral therapy for schizophrenia: An empirical review. Journal of Nervous and Mental Disease, 189(5): 278–287.
30.
ReynoldsC. F.MillerM. D., & PasternakR. E. (1999). Treatment of bereavement-related major depressive episodes in later life: A controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. American Journal of Psychiatry, 156, 202–208.
31.
SchneiderK. (1959; Originally published, 1958). Clinical psychopathology (HamiltonM. W., trans.). New York: Grune & Stratton.
32.
Schwartz-BordenG. (1986). Grief work: Prevention and intervention. Social casework: The Journal of Contemporary Social Work, 67, 499–505.
33.
ShapiroC. (1993). When part of the self is lost.San Francisco: Jossey-Bass Publishers.
34.
StroebeM. (1992). Coping with bereavement: A review of the grief work hypothesis. Omega, 26, 19–42.
35.
StroebeM. (2001). Bereavement research and theory: Retrospective and prospective. American Behavioral Scientist, 44, 854–865.
36.
StroebeM.StroebeW.SchutH. (2002). Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. Journal of Consulting and Clinical Psychology, 70, 169–178.
37.
Van DongenC. (1998). Quality of life and self-esteem in working and nonworking persons with mental illness. Community Mental Health Journal, 32, 535–548.
38.
WordenW. (1991). Grief counseling & grief therapy. A handbook for the mental health practitioner.New York: Springer Publishing Company.
