“To fill the emptiness”: The importance of work in life history narratives of older adults with schizophrenia-spectrum diagnoses

Abstract

Objective: This study’s purpose was to develop an understanding of the importance and meaning of vocational histories, present-time employment status, and vocational goals for older adults who were in treatment for schizophrenia-spectrum diagnoses. Methods: The theory of cumulative adversity and advantage focused 35 semistructured interviews and 43 field observation points that developed life history narratives of seven older adults in treatment for schizophrenia-spectrum diagnoses. Thematic narrative analysis was the primary analytic strategy. Results: Five shared themes within the life history narratives connected to vocational histories: “Purpose is provided by work,” “identity in work,” “perseverance toward value-based vocational goals,” “the importance of an income,” and “illness symptoms and their treatment disrupted work.” Discussion: Findings connect to practice implications for vocational programs for persons with serious mental illnesses, suggesting that vocational services for older adults could be rehabilitative and that vocational assessments should be holistic and values oriented. Psychiatric rehabilitation programs developed specifically for older adults might benefit from the inclusion of vocational rehabilitation options that do not rule out competitive employment. Social workers must be aware of bias in the profession toward persons on the basis of age and serious mental illnesses. Conclusion: In line with current vocational rehabilitation literature, the study concludes that psychiatric rehabilitation treatment that inhibits work can have unintended negative consequences for all persons with serious mental illnesses. Those negative consequences have to potential extend into later life challenges that range from identity challenges to challenges in day-to-day survival.