ORDERLY DISORDERS AND DISORDERLY DISORDERS

DISCLAIMER : Although these aspects may signify a potential problem, only a trained professional can evaluate whether the degree is significant enough to warrant diagnosis or treatment. Most human beings have some of each one of these aspects. It is the degree and use of these aspects which signify a potential problem. This information should not be used in any way to diagnose, treat or discriminate against any persons without the assistance of a trained, licensed or appropriately certified mental health professional such as a:

• State Certified or Licensed Mental Health Counselor (Master's level or more)

• State Certified or Licensed Social Worker (Master's level or more)

• Licensed Psychologist

• Medical Doctor or Psychiatrist

• Credentialed EAP Provider (Master's level or more)

 

Clinically diagnosable mental disorders come in a wide array of size , shapes and dimension and present themselves in quite a variety of equally interesting demonstrations . The Mental Health profession has, for the sake of treatment, intervention, research, and insurance reimbursements, labeled with terms like depression, anxiety, chemical dependency, schizophrenia , antisocial personality disorder, borderline personality disorder , eating disorders, sleeping disorders, thinking disorders, rage disorders and violence disorders, to name a few. Some diagnosed mental disorders have small presentations and symptoms, and others have ponderously enduring patterns of extreme and bizarre behaviors that are markedly different from what most people consider "normal" in western culture. Employees with these problems may look like everyone else, be well dressed, and show up to all meetings, but under extreme stress, medication disruptions, or other challenging circumstances, they may end up acting differently because of the way their personality seems to be structured or functioning.

How they adjust to changes at a work site can be very different. They may be very successful at adjusting under regular circumstances. Managers who know they have people on board with mental illness can usually openly discuss with them about what they might need during a crisis. Just as a manager who knows that the receptionist is diabetic and may need to call for assistance if her medications fail, managers should have the same knowledge about managing a mental illness. Chronic illness does not need to interfere in any workplace strategy. It does need to be factored into Emotional Continuity Management planning. Stress might make the person with diabetes more at risk during a crisis, but his or her daily work is not a risk factor.

Mental illness should be treated with the same deference, supported well, managed well, and taken into consideration as a risk factor. Of course, if the receptionist with diabetes keeps it a secret, or the person with a diagnosed mental illness does not disclose, the manager will be left with the risk of the unexpected response during a crisis.

A word of caution goes here. Because the world is filled with prejudice and fear, the majority of people with a chronic physical or mental disorder will NOT disclose to you. This is a business expectation and people will try to hide what many perceive as weaknesses to keep their jobs. It would be a better world if this were not true, but managing the truth of the situation means you need to have a cursory understanding of the most prevalent disorders to protect yourself from surprises . You should recognize signs and symptoms of diabetes, coronary disease, epilepsy, severe allergic reaction, contagious disease, poisoning , and have a basic knowledge of first aid and CPR. You should also recognize the signs and symptoms of a mental illness that is suddenly exacerbated.

Employees with special needs often make good employees. This has been well established in the business community. Special needs employees generally require some extra attention during a crisis. For example, employees who worked in the World Trade Center had special training to deal with evacuating people in wheelchairs in case of emergency. This training procedure saved several lives in the 2001 attacks. Disaster planners and business continuity planners take these special issues into consideration and have found that employees with special needs do well with an "emergency buddy." Some companies are advanced enough in thinking that they provide system-wide training on the emergency requirements of their special needs employees. Managers can do this if given the supportive environment required to consider all employees as valuable resources. If not, it will probably be up to you to provide services.

There are clear rules, procedures, codes, symptoms, listings and criteria that mental health providers use to establish a diagnosis of mental illness. Medical professionals are trained to tell the difference between a cold and cancer and mental health professionals are trained to tell the difference between a personality difference and a personality disorder. The diagnostician considers a full range between simple and wild possibilities and then narrows it down to the most likely. This process is called a "diagnosis of exclusion." The diagnostician further narrows down the possibilities to the most likely possibilities given the signs, symptoms, and hunches of the diagnostician. The practitioner may perform some testing prior to confirming the diagnosis or may have seen it so often that they can diagnose on the spot. Sometimes the diagnosis is so obvious that testing is not necessary.

Diagnosis is followed with the most efficient forms of treatment with ongoing assessment to determine if the condition is responding to treatment, getting worse , or improving. Mental health professionals use a tool called the Diagnostic and Statistical Manual of Mental Disorders (American Psychological Association, www.apa.org) to standardize the naming of the disorders. The disorders must meet a specific number of features for a specific length of time to be considered diagnosable. A few of the more prevalent diagnoses are listed below. Reviewing the following list is simply the first step for managers to think about employees as perhaps more than they may appear on the surface. Keep in mind there is a range in each of these categories and there are always exceptions. A common response when learning these labels is to diagnose everyone including yourself ” don't go there! Even people without mental illness have moments in their lives where they are so temporarily disturbed that they think they are losing their minds. Mental illness is different in that it represents an enduring pattern of thinking or behaving.

PARANOIA	Suspicious that others are exploiting, harming, or deceiving him/her
SCHIZOID	Does not want and does not enjoy relationships, including with family
SCHIZOTYPAL	Odd beliefs or magical thinking behaviors that are very different than other people
ANTISOCIAL	Does not feel the need to accept the regular rules of society, does not respect laws, and repeats illegal activities
BORDERLINE	Makes significant and special efforts to avoid real or imagined abandonment
HISTRIONIC	Needs to be the center of attention all the time
NARCISSISTIC	Exaggerated sense of self importance, all life revolves around "me"
AVOIDANT	Avoids life and work activities that involve interpersonal contact, hates criticism, fears disapproval, or rejection so disapproves and rejects first
DEPENDENT	Has a very hard time making everyday decisions. Needs extreme contact for advice and reassurance
OBSESSIVE COMPULSIVE	Preoccupied with details, rules, lists, order, organization, schedules, and demands perfectionism that interferes with regular activities

Why should a manager think about mental health diagnosis? Our society continues to maintain a strong aversion to mentally ill people. Although some conditions make it impossible for people to function well, there are countless degrees of mental impairment that are well managed with medications, counseling , and support. If an employee has a diagnosed mental illness or impairment , or one that is obvious, the manager is pre-aware that there will be special issues to consider during normal and abnormal working conditions. Many businesses, for example, hire individuals with mental retardation, Downs Syndrome and developmental delays, and enjoy their contribution to the organization. A business continuity plan will usually include any special needs for these valued employees. It should be noted though that under duress, their needs may vary from the norm. This is also true for employees with other mental illnesses, diagnosed or not.

Businesses and managers have hesitated to take an active interest in the mental or emotional well being of employees due to the appropriate concern that they do not have basic or advanced training in discerning differences in wellness . Indeed, many normal behaviors of healthy people are very odd. Some mental impairments or disorders can mask themselves as other things. It is difficult for professionals to know what is going on when one symptom looks like four other things. For example, numb and tingling fingers can be caused by a pinched nerve from sitting too long in one position with your hand on a computer mouse, or be the early signs of a serious and even deadly disease. It is hard to know what is what.

A grand source of amusement to educators is that most medical students are certain they are going to die of some horrible death as they identify the symptoms for every disorder as they study. Mental health students do the same thing when they are studying symptoms of mental disorders. They know they have this or that disease, as do their friends , families, and strangers. Many of the symptoms of serious problems look a lot like regular things to start with. This is why doctors and mental health professionals use clear scientific technical tools like books, scientific studies, evaluations, tests, seminars and information sharing as well as nontechnical tools like staff meetings, discussions, ideas, and personal hunches. Technical and nontechnical data is important to an efficient diagnosis. Therefore, if you see some of these signs and symptoms in yourself, your spouse or best friend, or employee, try not to overreact. Pay attention, make a mental note, observe and ponder. Take your time. If it is not life- threatening , you will have time to make a good observation and evaluation.

If an employee appears to behave in a way which interferes with workplace functioning, then the signs or symptoms may indicate a problem or an issue which suggests an individual may be operating with a significant past, current, or emerging impairment. Your job as a manager is to be aware of this as it influences the workplace so that it does not turn into a systemic emotional spin. You do not need to diagnose or treat people with impairment. You do need to have an excellent working knowledge of impairment categories. Impaired employees deserve excellent support, referrals, information, opportunity, remediation , or release with dignity . Many organizations now provide internal treatment programs for impaired employees. Everyone has some reflection of impairment features because these are, in fact, human features.

An example of one way you can think about this is to consider that many regular people have times when they may feel a little bloated, not hungry, or are concerned with their weight. This does not interfere with work to a great degree; that is human. Someone with the clinical Mental Disorder of Anorexia is obsessively compelled to control these normal feelings in an extreme manner by not eating at all, sometimes for weeks and months to the point of near-death. They may take a sick day if they are upset over eating an almond. Missing lunch can make an average employee a bit spacey and off-track for the afternoon; anorexia can create an increasing loss of mental capacity, create secondary illnesses, and distort the decision making capacity of the individual. If someone with unmanaged anorexia is in a key position, this is an important management consideration. This employee will need management. Your other employees will, as well. Direct time loss can accrue from other employees who are concerned or angry about this person's weight loss, without understanding that their thinness is not cosmetic but unnatural .

An employee with the mental disorder of bulimia will have to control their normal feelings of eating and feeling full after a meal with forced vomiting or extreme use of laxatives. Constant vomiting or ritual laxative use can interfere with workplace tasks . The normal person may have momentary issues of fullness after food, or a desire to lose those love handles; someone with Bulimia will also have extreme responses to eating that one almond.

An employee who is clinically paranoid may think that pesky almond is tainted with anthrax. Of course in today's world that is not as paranoid as it may have been a few years ago. The difference is that the paranoid person will act on this terror in ways that are not functional. A regular employee may question the anthrax on the almonds, look for signs of white powder, and even insist that you toss the almonds out. The paranoid person will go through the same behaviors, but will take it a few more steps. They may need to have the building sealed, the counters that the almonds sat on replaced immediately, or start an emotional spin in the company that no one is safe.

It is not the disease that will interfere with performance ” it is the unmanaged symptoms . Managers should know the differences between normal and abnormal reactions . A local mental health counselor or EAP professional would no doubt be more than happy to teach you what signs to watch for in your worksite.