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4038Prelims.qxd 7/12/02 3:03 PM Page i
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Copyright © 2002 by Sage Publications, Inc.

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying, recording, or by any information storage and
retrieval system, without permission in writing from the publisher.

For information:

Sage Publications, Inc.

2455 Teller Road
Thousand Oaks, California 91320
E-mail: order@sagepub.com

Sage Publications Ltd.

6 Bonhill Street
London EC2A 4PU
United Kingdom

Sage Publications India Pvt. Ltd.

M-32 Market
Greater Kailash I
New Delhi 110 048 India

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Handbook of mental health in the workplace / edited by Jay C. Thomas

and Michel Hersen.
p. cm.
Includes bibliographical references and index.
ISBN 0-7619-2255-5
1. Industrial psychiatry. I. Thomas, Jay C., 1951- II. Hersen,
Michel.
RC967.5 .H355 2002
616.89—dc211
2002001784

02 03 04 05 06 10 9 8 7 6 5 4 3 2 1

Acquiring Editor: Jim Brace-Thompson

Editorial Assistant: Karen Ehrmann
Copy Editor: Liann Lech
Production Editor: Claudia A. Hoffman
Typesetter: C&M Digitals (P) Ltd., Chennai, India
Indexer: Molly Hall
Cover Design: Michelle Lee
4038Prelims.qxd 7/12/02 3:03 PM Page v

Contents

Preface ix

Part I: GENERAL ISSUES

1. Mental Health in the Workplace: Toward an
Integration of Organizational and Clinical Theory,
Research, and Practice 3
JAY C. THOMAS AND JEFFREY HITE

2. Mental Health and Disabilities, the Employer,

and the Law 15
H. JOHN BERNARDIN AND BARBARA A. LEE

PART II: WORKING CONDITIONS,

LIFE STRESSORS, AND MENTAL HEALTH
3. Models of Job Stress 33
VALERIE J. SUTHERLAND AND CARY L. COOPER

4. Effects of Job Stress on Mental and Physical Health 61

CARLLA S. SMITH, LORNE M. SULSKY,
AND KRISTA L. UGGERSLEV
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5. The Unbalanced Life: Work and Family Conflict 83

LESLIE B. HAMMER, CARI L. COLTON, SUZANNE CAUBET,
AND KRISTA J. BROCKWOOD

6. Organizationally Targeted Interventions Aimed

at Reducing Workplace Stress 103
TERRY A. BEEHR AND MICHAEL P. O’DRISCOLL

PART III: EFFECTS OF PSYCHOPATHOLOGY

ON WORK
7. Depression in the Workplace 123
PAULA TRUAX AND TRACY MCDONALD

8. Bipolar Disorders 155

EDWARD S. FRIEDMAN, ANDREA FAGIOLINI,
AND MICHAEL E. THASE

9. Generalized Anxiety Disorder 175

ERIN L. SCOTT, DAVID M. FRESCO,
AND RICHARD G. HEIMBERG

10. Social Anxiety Disorder, Specific Phobias,

and Panic Disorder 193
DEBORAH A. ROTH, BRIAN P. MARX,
AND SCOTT F. COFFEY

11. PTSD in the Workplace 215

WALTER PENK, CHARLES DREBING,
AND RUSSELL SCHUTT

12. Schizophrenia 249

KIM T. MUESER AND DEBORAH R. BECKER

13. Antisocial Personality Disorder 269

KIRSTEN N. BARR AND BRIAN P. O’CONNOR

14. Borderline Personality Disorder 291

BRIAN C. GOFF
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15. Eating Disorders 311

DAVID H. GLEAVES AND ANTONIO CEPEDA-BENITO

16. Traumatic Brain Injury in the Workplace 331

CHARLES J. GOLDEN

17. Insomnia 349

CHRISTINA S. MCCRAE, H. HEITH DURRENCE,
AND KENNETH L. LICHSTEIN

PART IV: EFFECTS OF DISRUPTIVE BEHAVIOR

AT WORK
18. Alcohol and Drug Problem Management
in the Workplace 371
PAUL M. ROMAN AND SUZANNE C. BAKER

19. Social Dysfunction in the Workplace 381

LINDSAY HAM, MELANIE VAN DYKE,
AND DEBRA A. HOPE

20. Anger, Hostility, and Violence in the Workplace 401

JOHN L. MCNULTY, ROBERT HOGAN,
AND CHRISTOPHER R. BORDEAUX

21. Harassment and Discrimination in the Workplace 413

TAHIRA M. PROBST AND DONNA J. JOHNS

22. Absenteeism and Mental Health 437

GARY JOHNS

23. Passive-Aggressive Behavior in the Workplace 457

JOHN F. BINNING AND EDWIN E. WAGNER

PART V: ORGANIZATIONAL PRACTICE

AND MENTAL HEALTH
24. Dysfunctional Behavior in the Workplace and
Organizational Design, Climate, and Culture 477
DANIEL J. SVYANTEK AND LINDA L. BROWN
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25. An Application Model Relating the Essential Functions

of a Job to Mental Disabilities 501
STEVEN F. CRONSHAW AND BRENDA L. KENYON

26. Job Accommodations for Mental Health Disabilities 519

LOIS E. TETRICK AND LEAH P. TONEY

Author Index 535

Subject Index 555

About the Editors 561

About the Authors 563

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Preface

T he Handbook of Mental Health in the Workplace is a unique

contribution in a burgeoning new field because it combines insights,
methods, and problems from multiple disciplines. The growth in
interest in mental health in the workplace is fueled by two trends. First,
clinicians are growing more aware that the mental health concerns of their
adult clients are affected by the workplace, and that treatment without regard
to what happens in the employment setting is not likely to succeed. Second,
there is growing recognition of the extent of psychopathology in the workforce.
Prevalence rates of mental disorders make it likely that many, if not most,
employees will, at some time during their career, either experience one or more
episodes themselves or know someone who does. In the past, the employer’s
response to mental illness was to simply discharge the employee, but over the
past decade, laws regulating employment of individuals with disabilities have
made this a problematic practice. In some cases, such as conditions resulting
from job stress, the employer may be considered to have responsibility for the
condition and may even be liable for damages. Consequently, organizations
have to contend with issues related to psychopathological or disruptive
behavior that, a few years ago, they would have swept under the rug. Thus,
we see three audiences for this book: clinical and counseling psychologists, who
need to know how work and the workplace will influence their clients’
progress; industrial and organizational (I/O) psychologists and human resources
managers (HRM), who need to contend with organizational environments and
policies; and administrators of Employee Assistance Programs. Students in these
fields will also find it useful in providing them with a distinctive perspective
and information that is not readily available elsewhere.
The book is divided into five parts. Part I, General Issues, provides an
overview of the problems surrounding mental health in the workplace and
describes the employee and employer rights and responsibilities under the law.
Part II, Working Conditions, Life Stressors, and Mental Health, presents
the current thinking and research on job stress and its effects on mental and
physical health; the impact of work-family conflict, a special type of stressor of
particular interest to women; and organizational interventions for reducing job
stress and work-family conflict. Part III, Effects of Psychopathology on Work,

ix
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x HANDBOOK OF MENTAL HEALTH IN THE WORKPLACE

presents detailed descriptions of the most common forms of psychopathology

that may affect the workplace. Although each of these diagnostic categories
is well documented elsewhere, the unique contribution of this book is to
concentrate on how the disorder affects the ability to work, precipitating
factors, and recommended treatments and their likely side effects. All of this is
designed to give the clinician, the I/O psychologist, and the HRM the
information they need to determine the employee’s fitness for work and what,
if any, accommodations may be needed. Part IV, Effects of Disruptive Behavior
at Work, deals with behavior that may or may not fall into standard diagnostic
categories, but that has clear mental health implications. This includes the
effects of anger and violence in the workplace, poor social skills, the impact
of abuse, exposure to traumatic events in the workplace, passive-aggressive
behavior, and the impact of grieving on work. Part V, Organizational Practice
and Mental Health, describes how mental health issues need to be considered in
designing organizations, designing policies related to mental health concerns,
analyzing jobs to identify essential functions that may be affected by mental
health, and designing accommodations for psychological disabilities. These
chapters will be particularly useful in meeting the legal obligations of employers
toward psychologically disabled employees.
The authors of the chapters deserve special recognition because we asked
them to think about their subject in new ways. Although this led initially to
some intellectual discomfort, the result was to stimulate new perspectives on
established theories and to generate some practical, yet rigorous, solutions to
new problems.
We also thank Carole Londerée for her immense contributions to the
organization of this project and Kay Waldron for continually going above and
beyond her duties in the preparation of this book. The able assistance of Alex
Duncan and Angelina Marchand was invaluable. Finally, Jim Brace-Thompson
and his staff at Sage Publications have been a delight to work with and have
provided great assistance. Jim, in particular, has been very patient, yet a great
motivator in having us complete this project.
— JAY C. THOMAS
Portland, Oregon
— MICHEL HERSEN
Forest Grove, Oregon
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Part I

GENERAL ISSUES
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CHAPTER 1
Mental Health in the Workplace:
Toward an Integration Organizational
and Clinical Theory, Research, and
Practice

JAY C. THOMAS
JEFFREY HITE

U ntil recently, there has been little

need for a Handbook of Mental
Health in the Workplace. Two
factors accounted for this: lack of awareness
of the extent of mental disorders by those
how mental health issues intersect with
organizational practices. No attempt is
made to be comprehensive in reviewing the
literature to meet this third goal. The other
chapters in this book, some of which we cite
who design and manage organizations, in this chapter, accomplish that. The intent
and the ease of eliminating the problem by is to present the issues sufficiently to demon-
eliminating the affected employee. In this strate that mental health and organizational
chapter, we present sufficient data to show theory and practice are, indeed, bedfellows,
that mental illness1 is pervasive in American and have been for a long time.
society as well as in economically advanced The stigma attached to mental illness
societies in general. We also argue that was sufficient to cause most people to keep
organizations will find it in their own inter- personal or family distress hidden whenever
ests, as well as the employee’s, to attempt to possible. One result of keeping mental
accommodate the needs of an individual health issues in the closet was the perception
experiencing mental distress. Our third goal that such problems were rare, and hence of
in this introduction is to outline briefly no concern to anyone except those who

AUTHORS’ NOTE: The authors would like to express their appreciation for the helpful comments by
Jon Frew and Paula Truax on earlier drafts of this chapter.

3
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4 GENERAL ISSUES

were afflicted and medical or psychological indirectly by mental illness, through family,
specialists. Mental health has come out of the coworkers, friends, or neighbors. With all of
closet, thanks in part to the well-publicized this information, it is impossible to escape
problems of several politicians, celebrities, the conclusion that mental health concerns
and athletes. When the public learned of can, and probably do, appear in almost any
senators and Olympic champions coping workplace in the country.
with depression, of movie actors with The second factor why a handbook on
personality disorders, and of innumerable mental health in the workplace is needed can
well-known personages struggling with be traced to the needs and responsibilities of
alcohol or drug addiction, not to mention employers. It is now clear that mental health
the thousands of veterans with symptoms of issues are in the workplace, but these issues
posttraumatic stress disorder, the problems affect the way organizations are managed
of a parent or child, or of one’s self, became and even the profitability of enterprises.
less shameful and were recognized as a Recently, the Wall Street Journal acknowl-
common situation. edged this impact by devoting most of the
Mental disorders are, in fact, extremely cover page of its Marketplace section to this
common. Epidemiological studies cited in topic. The lead article begins as follows:
Milazzo-Sayre, Henderson, and Mander-
scheid (1997) indicate that within the United In a typical office of 20 people, chances are
States, in a 1-year period, approximately that four will suffer from a mental illness
this year. Depression, one of the most
28% of the adult population has a mental
common, primarily hits workers in their
or addictive disorder. These authors cite
most productive years: the 20s through
other evidence that indicates that nearly 3% 40s. Its annual toll on U.S. businesses
of the adult U.S. population suffers from a amounts to about $70 billion in medical
“severe” mental disorder during a 1-year expenditures, lost productivity and other
period. The National Institute of Mental costs. (Tanouye, 2001, p. B1)
Health (NIMH) provides data on its Web
site that give an idea of the numbers of Gabriel (2001) gives a somewhat more con-
Americans with various types of mental servative estimate of the cost of depression
disorders. Selected figures are presented in to U.S. employers: between $30 billion and
Table 1.1. Comorbidity—the joint appear- $44 billion. These totals consist of direct
ance of two or more disorders—complicates treatment costs, costs associated with
the picture somewhat, but the total still adds absenteeism, lost productivity, and mortal-
up to a great many people. These numbers ity costs due to suicide. Such costs will also
represent only adults, who may have jobs. occur for other mental disorders, although
There are also millions of children with the weighting may change as a function of
mental disorders whose parents may well the type and severity of disorder.
be employees, probably distracted ones. Gabriel (2001) also cites interesting
Finally, the prevalence of mental disorders is figures from First Chicago Corporation,
sufficient to gain the attention of the which indicate that, out of 10 common
Surgeon General of the United States, who medical afflictions, mental illness is second
commissioned a major report issued in 1999 only to ischemic heart disease in total cost.
(Satcher, 1999). This report concluded that Cancer is a near third. Outpatient treatment
all Americans are affected either directly or costs are comparable for all three, and both
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Integrating Theory, Research, and Practice 5

Table 1.1 Estimated Numbers of American Adults With Various Mental Disorders

Disorder Estimated Occurrence

Major depression More than 19 million

Manic-depressive illness (bipolar disorder) More than 2.3 million
Schizophrenia More than 2 million
Anxiety disorders
Overall More than 16 million
Panic disorder About 2.4 million
per year
Obsessive-compulsive disorder Approximately
3.3 million
Posttraumatic stress disorder About 5.2 million
Social phobia About 5.3 million

SOURCE: National Institute of Mental Health (n.d.-b).

heart disease and cancer have roughly with mentally disabled employees does not
double the inpatient cost of mental illness. end at the U.S. border.
However, mental illness results in far higher Even if there were no legal impedi-
short-term disability costs, which ultimately ments, termination has not been easy and is
result in increased expenses and lower pro- often costly (Miner & Brewer, 1976). Labor
fits. Disability is a common consequence agreements, while allowing for termination
of mental illness. Internationally, mental ill- in cases of egregious behavior, often afford
ness, including suicide, is second only to “all an employee with protection, so that termi-
cardiovascular conditions” in disease burden nation can be a drawn-out and expensive
(measured in DALYs—Disability Adjusted affair. Unless the employee has managed to
Life Years, lost years of healthy life) in alienate his or her coworkers, there are also
established market economies (NIMH, problems of morale and perceived injustice.
n.d.-a). Therefore, disabilities are expensive These may have significant, albeit hidden,
to employers, those who are disabled, and costs that many employers would just as
society at large. soon avoid. There is also the issue of fair-
In the past, because mental illness ness. We do not terminate an employee who
was so costly, as long as sufferers were stig- has suffered a heart attack or cancer. A
matized, employers could deal with the broken leg, not covered by ADA, may still
problem easily by terminating the affected be looked upon with some patience by an
employee. Since enactment of the Americans employer, although with some disappoint-
with Disabilities Act (ADA) in 1990, it ment. Why, then, terminate an employee
has been illegal to fire an employee solely who is suffering a bout with depression or
because of a disability. “Reasonable accom- anxiety? Indeed, an employee with a broken
modation” must be made to allow most leg from a skiing accident may be out of
people with disabilities to continue working, action longer than many with major depres-
if at all possible. Many other countries have sion. Finally, a employer may have a lot
similar or more stringent laws (Gabriel & invested in an employee, an investment that
Liimatainen, 2001), so the need to work is not easily abandoned. So, there are a
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6 GENERAL ISSUES

number of sound business reasons to find 2. He lacks ambition, dislikes responsibility,

an accommodation. Cronshaw and Kenyon prefers to be led.
(Chapter 25) and Tetrick and Toney 3. He is inherently self-centered, indifferent
(Chapter 26) offer insight into how such an to organizational needs.
accommodation may be found and imple- 4. He is by nature resistant to change.
mented. However, the human resource
5. He is gullible, not very bright, the ready
professional or industrial and organizational
dupe of the charlatan and the demagogue.
(I/O) psychologist needs some basic knowl- (McGregor, 1966, p. 6; items renumbered
edge about the most common disorders, from original)
including the nature of the disorder, precipi-
tating stressors, and treatment. Theory Y, in contrast, was based on the
opposite assumptions of human nature. Of
note is the Theory Y assumption that “people
ORGANIZATIONAL PRACTICE are not by nature passive or resistant to orga-
AND MENTAL HEALTH nizational needs. They have become so as a
result of experience in organizations [italics
Elton Mayo (cited in Gellerman, 1963), Chris added]” (McGregor, 1966, p. 15). Thus, if
Argyris (1957), Douglas McGregor (1960, Theory X paints a picture of a man or
1966), and other mid-20th-century writers woman who lacks full mental health, Theory
pointed out that organizational practices may Y holds that it is the organization for whom
affect mental health. Mayo’s work inspired he or she works that is responsible. Today,
an extensive, but curious, form of indu- we would question this last premise, realiz-
strial counseling, similar in some respects to ing that to some extent, employees bring
Rogerian nondirective counseling, but their mental disorders with them to work or
oriented toward work (Highhouse, 1999). develop them coincident to employment.
Although there was some anecdotal evidence Meaningful work is regarded as therapeutic
of the method’s effectiveness, it eventually by some psychologists, as described in some
lost favor due to an inability to show a posi- later chapters, but it seems doubtful that
tive impact on employees or the bottom line. work alone is generally an effective therapy.
In the Argyris formulation, a worker’s adap- We present these classic theories in some
tation to rigid hierarchy, autocratic manage- detail because they form the foundation for
ment, and an unenriched job was itself an the primary organizational and motivational
indication of retarded emotional develop- theories up to the present. On the intellec-
ment. The nature of the job could prevent the tual side, virtually everyone hopes for a
worker from attaining full mental health. world in which Theory Y is true, but our
McGregor, writing more or less contempora- behavior often reveals little faith in that
neously with Argyris, believed that organiza- occurring. To illustrate, one of the unspoken
tions were designed based on assumptions worries about the ADA was that it would
about the workers. His Theory X2 consisted encourage malingering, the ultimate Theory
of management assumptions that had three X behavior. Claims of disability are often
basic assumptions but included several met with skepticism by management and
inexplicit beliefs, such as the following: coworkers. No one disputes that disability
claims should be investigated and substanti-
1. The average man is by nature indolent— ated, but we maintain that this book will
he works as little as possible. help lead to informed skepticism rather than
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Integrating Theory, Research, and Practice 7

an automatic assumption that a claimant is implicit in McGregor’s (1960, 1966) writing.

most likely “faking it.” Today, descendants of these ideas have been
The universal rejection of Theory X by validated by considerable research on the
organizational theorists opened the door for impact of stress on the worker and the work
current conceptualizations of flat hierarchies; (see Sutherland and Cooper, Chapter 3, and
self-managed, team-based organizations; and Smith, Sulsky, and Uggerslev, Chapter 4).
expectations that employees make decisions Too much work, poorly defined responsibil-
with the organization’s interests at heart. All ities, an unsupportive boss, a lack of control,
of these concepts require an assumption that and many other factors can constitute stress-
employees either can or can be easily taught ors that, in turn, under the right (or perhaps
to communicate openly, face situations we should say wrong) conditions, can create
honestly, work together with others, recognize sufficient strain such that a person becomes
others’ priorities and adapt to them, shift pri- physically or mentally ill.
orities or tasks quickly and easily, and make Unfortunately, stress appears to be addi-
and carry out decisions that may be contrary tive because the key is the total stress under
to their own interests (Cannon-Bowers, which one operates. Stressors need not be
Tannenbaum, Salas, & Volpe, 1995; Wellins, confined to one area of life. Stress from a
Byham, & Wilson, 1991). People who are person’s non-work life can combine with
depressed, anxious, or overly stressed may work stress to create problems. Making
have difficulty carrying out required behav- matters worse, different aspects of life can
iors to meet these assumptions. Individuals interact to create even more stress. Work-
with personality disorders or psychotic con- family conflict is the classic example of this
ditions may not be able to gain or use such and the cause of much distress across the
skills, except in extraordinary circumstances. workforce. Hammer, Colton, Caubet, and
Thus, the ultimate success of current theories Brockwood (Chapter 5) show how work and
of organization may depend upon the preva- family life conflict can wreak havoc in one’s
lence of clinical or even subclinical mental life, and Beehr and O’Driscoll (Chapter 6)
disorders in the workforce. To our knowl- describe how organizational stress and work-
edge, few, if any, studies have examined the family conflict can be reduced.
robustness of these management theories to Current organizational theories differ
violations of the assumptions of a mentally from those of the mid-20th century in two
healthy workforce. important ways. First, the assumed motiva-
tional foundation for employees has shifted
from needs-based theories to a complex
THE IMPACT OF THE WORKPLACE mix of environmental, social, cognitive, learn-
ON MENTAL HEALTH ing, emotional, and personality factors.
This wider vista of motivational forces
The workplace itself may contribute to dis- eventually will lead to an even fuller under-
tress and, ultimately, to mental disorders. standing of behavior in the workplace by
This notion dates to at least the 1930s, with allowing a stronger connection between
studies examining the presence of inhalable organizational and clinical perspectives.
toxic chemicals and employee emotionality Newly developing organizational and clini-
(cf. Tiffin, 1942). As we described earlier, cal theories of motivation are beginning to
the effect of the social organization was parallel one another in unexpected ways.
fundamental to Argyris’s (1957) work and As one example, Nolen-Hoeksema (1993)
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8 GENERAL ISSUES

proposed that one causal factor in the difference between a rumination strategy and
development of depression was a response a state orientation or between a distraction
style she termed “rumination.” Rumination strategy and an action orientation. Addi-
consists of focusing inward on one’s emo- tional research testing for both of these
tional feelings. Nolen-Hoeksema (1993) theories is needed before they can become
cites examples, such as thinking about how fully established, but we anticipate that they
tired one is or how much one is lacking in will prove to be useful additions to our store
motivation. Rumination may also include of knowledge. A useful rule of thumb is
worrying about the implications of symp- that when two different fields of endeavor
toms, such as not completing important independently develop very similar proposi-
work. Ruminative responses have been tions, it is likely that these propositions will
tied to depth and duration of a depressive prove to be important and general.
episode and to interfering with the ability to A second important difference between
make the instrumental responses necessary mid-20th-century organizational theories
to eliminate the source of the worry. In and current ones lies in the motivation for
other words, ruminating over one’s failure choosing the preferred organization design.
to complete an important task may well Lawler (1991) traced this development from
interfere with initiating the behavior neces- the Human Relations school, in which
sary to complete that task. At the opposite participation was valued because it would
pole from ruminators are distracters. A dis- result in greater employee satisfaction and
tracting response style consists of removing commitment; to the Human Resource
attention from the negative feelings and approach, in which an investment in people
concentrating on something else—almost pays off because they are more valuable;
anything else. Distracters find that they and to the High Involvement Organization
are able to plan effectively and carry out ideal, in which having a hand in decision
problem-solving behaviors efficiently and so making in the management of their work
do not slip into a depressive cycle. by even the lowest level employees makes
Compare Nolen-Hoeksema’s (1993) for greater organizational effectiveness.
theory to a theory of motivation that is The impetus for such effectiveness comes
beginning to attract attention within I/O from the necessity of adapting to forces in
psychology: Kuhl’s Action-State Theory the outside world: changing competition,
(cited in Hall, Schlauch, & Chang, 2001) technology, consumer preferences, and other
and its attendant Action-State Orientation. environmental influences (Galbraith &
In this theory, when people encounter an Kazanjian, 1988; Mohrman, 1993). Being
anxiety-provoking situation, they adopt a driven by the environment requires a broad
state orientation, characterized by thoughts perceptual focus, openness, and the ability
of failure, and exhibit difficulty in taking to make realistic appraisals of opportuni-
useful actions. People with an action orien- ties and threats. It also requires the ability
tation, in the same situation, may express to translate these appraisals into changed
anxiety about failure, but they use effective goals and priorities and the skill to commu-
coping responses to plan and execute nicate this to others. Most people would
behaviors. Hall et al. (2001) utilize this the- find working in such an environment arous-
ory in an interesting attempt to explain the ing. It is well established that arousal and
effects of autonomy on job satisfaction and performance are related to each other
performance. There appears to be little according to an inverted U function
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Integrating Theory, Research, and Practice 9

(Sutherland & Cooper, Chapter 3). Move a Foundation from 1956 to 1970 was an
lethargic person up the arousal continuum exception to the general separation of
and performance improves. Move too far clinical and I/O psychology. At that time,
and performance deteriorates. Undoubtedly, he worked primarily on the “three A’s—
there are individual differences in where absenteeism, alcoholism, and accidents”
the apex of this curve lies and even in the (Levinson, 1983, p. 8). Levinson has contin-
function relating environmental forces to ued to exert an influence on the field of
the degree of arousal. Degree and type of organizational theory, although his psycho-
psychopathology may well influence both. analytic framework has left him somewhat
Psychotherapists and physicians sometimes outside the mainstream of I/O psychology.3
recommend transfer to “a less stressful job” As mentioned previously, early counsel-
as an accommodation for mental disability. ing programs in industry faded away by
Such requests are often defined so poorly the late 1950s or early 1960s (Highhouse,
as to be “impossible to satisfy” (Conti & 1999). There remained a need for the coun-
Burton, 1999, p. 331). Moreover, if they seling of employees with emotional or
were defined clearly, such jobs may not mental health problems, a niche eventually
exist in organizations relying on high- filled by Employee Assistance Programs
involvement strategies. (EAPs). These programs began as a means of
providing employees with many types of
The Need for Integration of Knowledge assistance, including financial advice and
Between Clinical and I/O Psychology planning, but have expanded their services to
and Human Resources include providing mental health and some
wellness services. As such, EAPs are primar-
For many years, clinical/counseling ily the reserve of clinical/counseling psycho-
psychologists have gone one way, and I/O logists, counselors, and social workers. They
psychologists and their colleagues in human have developed largely independently of I/O
resources have gone another. Tiffin’s (1942) psychology but are integrated with human
textbook on industrial psychology included resources, because that is the department
explicit attention to emotional factors and, in that usually selects and hires the EAP
the context of personality testing, explained provider. By the mid-1970s, work in EAPs
the major mental disorders as they were had evolved to the point where Manuso
conceived at the time. Sometime after Tiffin’s (1983) coined the term occupational clinical
text, such matters largely disappeared from psychology. The scope of EAP service deliv-
I/O psychology. Such research as was con- ery has expanded to the point that many pro-
ducted through 1970 was reviewed by Miner vide organizational services (Cagney, 1999),
and Brewer (1976) in the first edition of which may be indistinguishable in name
Dunnette’s (1976) Handbook of Industrial from those offered by I/O psychologists (see
and Organizational Psychology. In their Ginsberg, Kilburg, & Gomes, 1999, for an
chapter on the management of ineffective example). Although I/O psychologists often
performance, “stress, emotion, and emotional complain among themselves about this devel-
disturbance” comprised 2 out of 34 pages, opment and the loss of “their” market, a
whereas alcoholism and drug addiction reversal of this trend does not seem likely in
together took up three pages. the foreseeable future. Joining together scien-
Levinson’s (1983) work at the Division tists and practitioners from the clinical, I/O,
of Industrial Mental Health at the Menninger and human resource disciplines will further
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10 GENERAL ISSUES

the interests of organizational and individual Conti and Burton’s (1999) description of
clients, a theme included in Manuso’s (1983) how to manage behavior health disability
book, and enrich development of the knowl- makes it clear that this knowledge is essential
edge base of these fields. in creating workable solutions. In addition to
By the second edition of Dunnette’s ADA issues, the workplace poses various risk
Handbook in the early 1990s (Dunnette & factors for mental health, many of which
Hough, 1992), which had grown to four would seem to be logical targets for therapy.
large volumes, a chapter appeared detailing Kasl (1992) listed 10 dimensions of the work
how to utilize counseling techniques in the setting that he considered to be at least
development of employees and to achieve provisionally affecting worker psychological
behavior change in general (Hellervik, health. These included interpersonal factors,
Hazucha, & Schneider, 1992). Lowman such as coworkers and leaders; work content;
(1993, 1996) has presented an integration of organizational and structural aspects; and
clinical and I/O psychology in his work on community and social aspects, such as pres-
dysfunctional employees. Similarly, symposia tige and status of occupation. A clinician who
and posters have appeared at Society for knows how organizations operate, the roles
Industrial and Organizational Psychology of leaders, the impact of organizational cul-
(SIOP) conferences concerned with alcohol ture and climate, the impact of discrimination
and drug use, emotional behavior, use of and harassment, and other features of the
EAPs, and other clinically related topics. workplace will be better placed to assist
Recently, one of us (JCT) attended a precon- clients in decision making, recognizing cogni-
ference workshop at the SIOP conference on tive or behavioral traps, and otherwise mak-
executive coaching. The issue that brought ing helpful changes.
the greatest discussion among participants As scientists and practitioners in the field
was how to differentiate between a client of human behavior, we need to know more
who was “odd” or “eccentric” and one who about the borders of normal behavior, if for
had a mental disorder that required clinical no other reason than to better understand
skills to treat and that lay outside the scope everyday life. That is as true in the work
of coaching. The workshop participants setting as in the rest of life. Herbert Simon
understood the high probability that an exec- (1969) wrote that we gain our greatest
utive coach with a large clientele would run understanding of systems when they break
into this situation eventually. They also rec- down. We know a good deal about how the
ognized the need for gaining information average person responds in a large number of
that may be useful in such circumstances. organizational situations, but relatively little
Thus, we see a press for greater integration about how people at the extremes of person-
of I/O and clinical psychology from the per- ality, cognitive capacity, and emotionality
spectives of research and practice. respond. There is a shortage of research on
Clinicians and counselors work with the workplace and mental health. An excep-
clients on workplace issues. Under ADA, they tion lies in the area of counterproductive
may make recommendations as to fitness for work behaviors, most notably anger, hostility,
duty, limitations on work, and even the types and violence. McNulty, Bordeaux, and Hogan
of accommodations that may be necessary. It (Chapter 20) review this area, whereas
is difficult to see how this is done properly Svyantek and Brown (Chapter 24) examine
without a basic working knowledge of work the interaction of these behaviors and orga-
and the workplace, but it is being done. nizational climate and culture. Binning and
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Integrating Theory, Research, and Practice 11

Wagner (Chapter 23) present a review and amenable for use with small samples, such
theory of passive-aggressive behavior, the as randomization or permutation tests
first and only mental disorder originally (Edgington, 1995; Ludbrook & Dudley,
identified in the workplace. 1998). It may also require greater accep-
Enough is known about mental health tance of some existing, but underused,
in the workplace to fill a large book, but we techniques. Babiak’s (1995) case study of
would be the first to admit that what we an industrial psychopath is an excellent
know is insufficient. Although some interest example of the latter. His detailing of that
in the topic goes back many years, it is psychopath’s mode of operation provides a
only because of legal and social changes of rich source of potential further research
the past 10 or 15 years that we have cre- ideas and also gives direction for the prac-
ated the conditions where such a book is titioner faced with such a person in a client
possible. Much more research is needed. organization. As new research accumulates,
Although we have made the case that men- we expect organizational, human resource,
tal disorders are common in the workplace, and clinical practice to evolve along with it.
the base rate for a particular disorder in a Integration of I/O and clinical psychology,
particular workplace is likely to be too low human resources, and other disciplines in
for commonly employed research technolo- the study, prevention, and treatment of
gies. Generating the knowledge we will mental health issues in the workplace is an
need for future developments may require exciting development that should pay
the development of new research techniques dividends for many years.

NOTES

1. We use the term mental illness with some reluctance, but it is the phrase
used in the most current literature (e.g., Gabriel & Liimatainen, 2001).
2. Although McGregor’s nomenclature of Theory X and Theory Y implies a
sort of algebraic objectivity, we believe that there was a clear message to the reader
of the day. In the 1940s (at least) through the early 1960s, a common advertising
ploy was to compare the name brand against “Brand X.” Brand X was always
decidedly inferior in results. It would be difficult for a reader in 1960 to not get the
connection between “Theory X” and “Brand X.”
3. A brief review of the psychodynamic view of organizational behavior,
inspired largely by Levinson, is provided by Cilliers and Koortzen (2000).

REFERENCES

Argyris, C. (1957). Personality and organization. New York: Harper & Row.
Babiak, P. (1995). When psychopaths go to work: A case study of an industrial
psychopath. Applied Psychology: An International Review, 44, 171-188.
Cagney, T. (1999). Models of service delivery. In J. M. Oher (Ed.), The employee
assistance handbook (pp 59-70). New York: John Wiley.
Cannon-Bowers, J. A., Tannenbaum, S.I., Salas, E., & Volpe, C. E. (1995).
Defining competencies and establishing team training requirements. In
4038ch-01.qxd 7/12/02 3:05 PM Page 12

12 GENERAL ISSUES

R. A. Guzzo & E. Salas (Eds.), Team effectiveness and decision making in

organizations (pp. 333-380). San Francisco: Jossey-Bass.
Cilliers, F., & Koortzen, P. (2000). The psychodynamic view on organizational
behavior. Industrial-Organizational Psychologist, 38(2), 58-67.
Conti, D. J., & Burton, W. N. (1999). Behavioral health disability management. In
J. M. Oher (Ed.), The employee assistance handbook (pp. 319-336). New York:
John Wiley.
Dunnette, M. (Ed.). (1976). Handbook of industrial and organizational psychology.
Chicago: Rand McNally.
Dunnette, M. D., & Hough, L. M. (Eds.). (1992). Handbook of industrial and
organizational psychology (2nd ed., Vols. 1-4). Palo Alto, CA: Consulting
Psychologists Press.
Edgington, E. S. (1995). Randomization tests (3rd ed.). New York: Marcel Dekker.
Gabriel, P. (2001). Mental health in the workplace: Situation analysis—United
States. Geneva: International Labour Office.
Gabriel, P., & Liimatainen, M.-R. (2001). Mental health in the workplace:
Introduction. Geneva: International Labour Office.
Galbraith, J. R., & Kazanjian, R. K. (1988). Strategy, technology, and emerging
organizational forms. In J. Hage (Ed.), Futures of organizations (pp. 29-42).
Lexington, MA: Lexington Books.
Gellerman, S. (1963). Motivation and productivity. New York: American
Management Association.
Ginsberg, M. R., Kilburg, R. R., & Gomes, P. G. (1999). Organizational counseling
and the delivery of integrated services in the workplace: An evolving model for
employee assistance and practice. In J. M. Oher (Ed.), The employee assistance
handbook (pp. 439-456). New York: John Wiley.
Hall, R. J., Schlauch, C. A., & Chang, C.-H. (2001, April). Implications of an
Action Control Theory approach and Action State Orientation for the under-
standing of autonomy effects on satisfaction and performance. Paper presented
at the annual meeting of the Society for Industrial and Organizational
Psychology, San Diego, CA.
Hellervik, L. W., Hazucha, J. F., & Schneider, R. J. (1992). Behavior change:
Models, methods, and review of evidence. In M. D. Dunnette & L. M. Hough
(Eds.), Handbook of industrial and organizational psychology (2nd ed., Vol. 3,
pp. 823-895). Palo Alto, CA: Consulting Psychologists Press.
Highhouse, S. (1999, April). Frazier in the factory: The brief history of personnel
counseling in I-O. Paper presented at the annual meeting of the Society for
Industrial and Organizational Psychology, Atlanta, GA.
Kasl, S. V. (1992). Surveillance of psychological disorders in the workplace. In
G. P. Keita & S. L. Sauter (Eds.), Work and well-being: An agenda for the 1990s
(pp. 73-95). Washington, DC: American Psychological Association.
Lawler, E. E., III. (1991). High involvement management. San Francisco: Jossey-Bass.
Levinson, H. (1983). Clinical psychology in organizational practice. In J. S. J. Manuso
(Ed.), Occupational clinical psychology (pp. 7-13). Westport, CT: Praeger.
Lowman, R. (1993). Counseling and psychotherapy of work dysfunctions.
Washington, DC: American Psychological Association.
Lowman, R. (1996). Work dysfunctions and mental disorders. In K. R. Murphy
(Ed.), Individual differences and behavior in organizations (pp. 371-415). San
Francisco: Jossey-Bass.
Ludbrook, J., & Dudley, H. (1998). Why permutation tests are superior to t and
F tests in biomedical research. American Statistician, 52, 127-132.
Manuso, J. S. J. (Ed.). (1983). Occupational clinical psychology. Westport, CT:
Praeger.
4038ch-01.qxd 7/12/02 3:05 PM Page 13

Integrating Theory, Research, and Practice 13

McGregor, D. (1960). The human side of enterprise. New York: McGraw-Hill.

McGregor, D. (1966). The human side of enterprise. In W. G. Bennis & E. H. Schein
(Eds.), Leadership and motivation (pp. 3-20). Cambridge: MIT Press.
Milazzo-Sayre, L. J., Henderson, M. J., & Manderscheid, R. W. (1997). Serious and
severe mental illness and work: What do we know? In R. J. Bonnie &
J. Monahan (Eds.), Mental disorder, work disability, and the law (pp. 13-24).
Chicago: University of Chicago Press.
Miner, J. B., & Brewer, F. J. (1976). The management of ineffective performance.
In M. D. Dunnette (Ed.), Handbook of industrial and organizational psychology.
Chicago: Rand McNally
Mohrman, S. A. (1993). Integrating roles and structure in the lateral organization.
In J. A. Galbraith, E. E. Lawler III, & Associates (Eds.), Organizing for the future:
The new logic for managing complex organizations (pp. 109-141). San Francisco:
Jossey-Bass.
National Institute of Mental Health. (n.d.-a). The impact of mental illness on soci-
ety. Available at www.nimh.nih.gov/publicat/burden.cfm.
National Institute of Mental Health (n.d.-b). The numbers count. Available at
www.nimh.nih.gov/publicat/numbers.cfm.
Nolen-Hoeksema, S. (1993). Sex differences in control of depression. In
D. M. Wegner & J. W. Pennebaker (Eds.), Handbook of mental control
(pp. 306-324). Englewood Cliffs, NJ: Prentice-Hall.
Satcher, D. (1999). Mental health: A report of the Surgeon General. Washington,
DC: Government Printing Office.
Simon, H. A. (1969). The sciences of the artificial. Cambridge: MIT Press.
Tanouye, E. (2001, June 13). Mental illness: A rising workplace cost. Wall Street
Journal, p. B1.
Tiffin, J. (1942). Industrial psychology. New York: Prentice-Hall.
Wellins, R. S., Byham, W. C., & Wilson, J. M. (1991). Empowered teams: Creating
self-directed work groups that improve quality, productivity, and participation.
San Francisco: Jossey-Bass.
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CHAPTER 2
Mental Health and Disabilities,
the Employer, and the Law
H. JOHN BERNARDIN
BARBARA A. LEE

I ndividuals with mental or emotional

disorders face challenges in the work-
place. Stereotypical attitudes about
the behavior and abilities of workers with
psychiatric disorders may lead to exclusion,
workers, we will restrict our detailed
discussion to descriptions of the ADA and
the case law relevant to psychiatric disorders.
The purpose of this chapter is to
describe the ADA, discuss the current state
discrimination, or harassment. Although of ADA law as it applies to psychiatric
workers with such disorders are protected disabilities, and report on a survey of atti-
by federal and state nondiscrimination laws, tudes and opinions regarding workers with
managers’ and coworkers’ attitudes toward disabilities. Based on our review of the case
individuals with psychological disorders, law and the survey results, we conclude with
judicial disinclination to view such disorders some recommendations for employers and
as worthy of accommodation, and the stigma workers with psychiatric disabilities.
that clings to individuals with mental dis-
orders exacerbate the difficulties that these
workers encounter. THE AMERICANS WITH
Most employees are protected from dis- DISABILITIES ACT
ability discrimination by state or federal
civil rights laws (and, for many workers, by The ADA provides that qualified individuals
both). The Americans with Disabilities Act with disabilities may not be discriminated
(ADA) of 1990, the Rehabilitation Act of against by a private sector organization or a
1973, and the nondiscrimination laws of department or agency of a local government
each state forbid an employer from making employing 15 or more employees, and must
employment decisions solely on the basis of provide the disabled with “reasonable
an individual’s physical or mental health. accommodations” that do not place an
Because the ADA is most relevant to most undue hardship on the business. Reasonable

15
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16 GENERAL ISSUES

accommodations are determined on a case- hardship” would occur for the business. It
by-case basis and may include reassignment, is not clear, however, how organizations
part-time work, and flexible schedules. They can show undue hardship, although the
may also include providing readers, inter- law suggests that a reviewing court compare
preters, assistants, or attendants. No accom- the cost of the accommodation with the
modation is required if an individual is not employer’s operating budget.
otherwise qualified for the position. Box 2.1 Temporary help agencies and their
presents excerpts from the ADA. clients are considered employees under the
According to the Equal Employment ADA according to the EEOC. Temporary
Opportunity Commission’s (EEOC’s) 1997 or contingent employees are thus protected
EEOC Enforcement Guidance on the by the ADA from disability discrimina-
Americans with Disabilities Act and tion by either the help agency or the client
Psychiatric Disabilities (available at http:// organization. For example, neither the help
www.eeoc.gov), the ADA rule defines agency nor the client may ask disability-
“mental impairment” to include “any related questions or require medical or
mental or psychological disorder, such as psychiatric examinations until after a job
emotional or mental illness.” Examples of offer has been made. This is an important
“emotional or mental illness(es) include interpretation because people with disabili-
major depression, bipolar disorder, anxiety ties often seek temporary employment.
disorders (which include panic disorder, The EEOC approved enforcement
obsessive compulsive disorder, and post- guidelines on preemployment disability-
traumatic stress disorder), schizophrenia, related inquiries and medical exams under
and personality disorders.” ADA. The guidelines state that “the guiding
The 1999 EEOC Policy Guidance on principle is that while employers may ask
Reasonable Accommodation (also available applicants about the ability to perform job
on the EEOC Web site) under ADA suggests functions, employers may not ask about
the following process for assessing “reason- disability.” For example, a lawful question
able accommodation”: would be, “Can you perform the functions
of this job with or without reasonable
1. Look at the particular job involved; accommodation?” But it is unlawful for
determine its purpose and its essen- an employer to ask questions related to a
tial functions. disability, such as “Have you ever filed for
worker’s compensation?” or “What pre-
2. Consult with the individual with the scription drugs do you take?” or “Have you
disability to identify potential accom- ever been treated for mental illness?” After
modations. an employer has made an offer and an
3. If several accommodations are avail- applicant requests accommodation, the
able, deference should be given to the employer may “require documentation of
individual’s preferences. the individual’s need for, and entitlement
to, reasonable accommodations.”
Public facilities such as restaurants,
doctor’s offices, pharmacies, grocery stores, ADA Case Law and Psychiatric
shopping centers, and hotels must be made Disabilities. Many workers with psychiatric
accessible to the disabled unless “undue disabilities have sought protection from
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Disabilities, the Employer, and the Law 17

Box 2.1 Excerpts From the ADA

Section 102. Discrimination

(a) General Rule. No covered entity shall discriminate against a qualified

individual with a disability because of the disability of such individual.
(b) Construction. As used in subsection (a), the term “discrimination”
includes:
(1) Limiting, segregating, or classifying a job applicant or employee in a
way that adversely affects the opportunities or status of such applicant
or employee because of . . . disability. . . .
(2) Participating in a contractual or other arrangement or relationship that
has the effect of subjecting a qualified applicant or employee with a
disability to the discrimination prohibited by this title. . . .
(5) Not making reasonable accommodations to the known physical or
mental limitations of a qualified individual who is an applicant or
employee, unless such covered entity can demonstrate that the accom-
modation would impose an undue hardship on the operation of the
business of such covered entity, and;
(7) Using employment tests or other selection criteria that screen out or
tend to screen out an individual with a disability or a class of individ-
uals with disabilities unless the test or other selection criteria, as used
by the covered entity, is shown to be job-related for the position in
question and is consistent with business necessity.
(c) Medical Examinations and Inquiries
(1) In general. The prohibition against discrimination as referred to in sub-
section (a) shall include medical examinations and inquiries.
Section 3. Definitions
(2) Disability. The term “disability” means, with respect to an individual:
(A) A physical or mental impairment that substantially limits one or
more of the major life activities of such individual;
(B) A record of such an impairment, or;
(C) Being regarded as having such impairment.

Section 101. Definitions

(7) Qualified Individual with a Disability. The term “qualified individual
with a disability” means an individual with a disability who, with or
without reasonable accommodation, can perform the essential functions
of the employment position that such individual holds or desires.
(8) Reasonable Accommodation. The term “reasonable accommodation”
may include:
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18 GENERAL ISSUES

(A) Making existing facilities used by employees readily accessible to

and usable by individuals with disabilities, and;
(B) Job restructuring, part-time or modified work schedules, reassign-
ment to a vacant position, acquisition or modification of equip-
ment or devices, appropriate adjustment or modifications of
examinations, training materials or policies, the provision of qual-
ified readers or interpreters, and other similar accommodations for
individuals with disabilities.
(9) (A) In general. The term “undue hardship” means an action requir-
ing significant difficulty or expense.
(10) (B) Determination. In determining whether an accommodation
would impose an undue hardship on a covered entity, factors to be
considered include:
(i) the overall size of the business;
(ii) the type of operation, and;
(iii) the nature and cost of the accommodation.
Section 103. Defenses
(b) Qualification Standards. The term “qualification standards” may
include a requirement that an individual with a currently contagious
disease or infection shall not pose a direct threat to the health or safety
of other individuals in the workplace.
Section 104. Illegal Drugs and Alcohol
(a) Qualified Individual with a Disability. For purposes of this title, the
term “qualified individual with a disability” shall not include any
employee or applicant who is a current user of illegal drugs. . . .
(b) Authority of Covered Entity. A covered entity:
(1) may prohibit the use of alcohol or illegal drugs at the workplace by
all employees;
(2) may require that employees shall not be under the influence of
alcohol or illegal drugs at the workplace;
(3) may require that employees behave in conformance with the
requirements established under “The Drug-Free Workplace of
1988” (41 U.S.C. 701 et seq.) [See Chapter 16, page . . ., and;
(4) may hold an employee who is a drug user or alcoholic to the same
qualification standards for employment or job performance and
behavior that such entity holds other employees. . . .
(c) Drug Testing
(1) In general. For purposes of this title, a test to determine the use of
illegal drugs shall not be considered a medical examination.
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Disabilities, the Employer, and the Law 19

alleged employment discrimination under was issued in 2001 to help interpret the
the ADA and other laws. For example, most recent Supreme Court rulings.
between the date the ADA became effective Despite what appears to be strong
(July 26, 1992) and the end of the 1999 protection from employment discrimination
fiscal year (September 30, 1999), indivi- for workers with disabilities, workers have
duals filed 25,221 claims involving alleged found it difficult to prevail in court. Until
employment discrimination related to some 1999, most individuals with disabilities
type of psychological or cognitive impair- who filed discrimination claims with the
ment—fully 20% of all ADA claims filed EEOC or discrimination lawsuits in federal
with the EEOC for that time period (EEOC, court under the ADA used the first “prong”
2001). This category of disorders constitu- of the definition of disability: an individual
tes the largest of all categories of disorders whose mental or physical disorder substan-
in EEOC claims for this period of time. tially limits one or more major life func-
The proportion of EEOC claims related to tions. The EEOC Interpretive Guidance to
mental disorders parallels their frequency of the ADA states that the mere presence of a
occurrence in the working population; by disorder is not enough for ADA coverage;
some estimates, approximately one out of the effect of the impairment on the individ-
five individuals has a diagnosed or diagnos- ual’s life and ability to work must be deter-
able mental or psychiatric disorder in any mined. The lower federal trial and appellate
particular year (Hall, 1997, p. 248). courts disagreed on the interpretation of the
The ADA protects workers who are ADA’s definition of disability, particularly
discriminated against by employers because with respect to whether the individual’s dis-
of an impairment that meets the law’s order should be evaluated in its unmitigated
definition of disability (discussed below). state, or whether any mitigating measures
Workers are also protected from discrimi- that the employee took, such as medication
nation if they have a record of a disability or the use of a prosthetic device, should
(but are not presently disabled), and also if be taken into consideration. Research con-
they are regarded as disabled (but are not). ducted on all federal appellate court opin-
Therefore, the ADA provides three theories ions published in the 6 years subsequent to
of disability discrimination under which the date that the ADA became effective
workers can proceed. (July 26, 1992) demonstrated that plaintiff-
In March 1997, the EEOC issued a employees prevailed in ADA lawsuits only
document titled “Enforcement Guidance 4% of the time (Lee, 2001b).
on the Americans with Disabilities Act and A trio of opinions released by the U.S.
Psychiatric Disabilities” (EEOC, 1997). Supreme Court in the summer of 1999 has
This guidance, developed in a question- focused the attention of claimants on the
and-answer format, addresses numerous second and third prongs of the definition
issues such as coverage of mental illness of disability (Albertson’s v. Kirkingburg,
by the law, how to assess whether the dis- 1999; Murphy v. United Parcel Service,
order interferes with a major life function, 1999; Sutton v. United Airlines, 1999). In a
employers’ rights to seek information on the group of cases called the Sutton trilogy, the
employee’s disorder, and many other issues. Court determined that an individual’s cov-
Reasonable accommodations for employ- erage by the ADA should be determined in
ees with psychiatric disorders are also dis- light of whatever mitigating measures the
cussed. An Addendum to the 1997 guidance individual had taken to minimize the effects
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20 GENERAL ISSUES

of the disorder. Thus, these mitigating illnesses and the hesitancy of individuals
measures had to be taken into account with such illnesses to seek treatment for
during the determination of whether an them compound the difficulty faced by
individual was “substantially limited” and workers with psychiatric disorders.
therefore could meet the Act’s definition Even if an individual with a psychiatric
of disabled. These rulings meant that even disorder can meet the law’s definition of a
individuals with serious conditions such disabled individual, the ADA also requires
as cancer, multiple sclerosis, and epilepsy that the employee demonstrate that he or
could not demonstrate that they were dis- she is “qualified”—that he or she can per-
abled if their medication or other mitigating form the essential functions of the position.
measure controlled the more severe effects Courts have ruled that regular attendance
of their disorder (Goldstein, 2001). and appropriate workplace behavior are
So, if a person has little or no difficulty essential functions of every position (Lee,
performing a major life activity due to the 2001b). Even if an individual with such a
mitigating measure (e.g., medication), then disability has the skills, education, and
that person does not meet the ADA’s first experience to perform the job, the side
definition of disability. Readers should effects of medication, or the employee’s
consult “Instructions for Field Offices: decision not to take medication (an element
Analyzing ADA Charges After Supreme of the underlying mental disorder), may
Court Decisions Addressing ‘Disability’ and affect the employee’s attendance, job per-
‘Qualified,’” which can be retrieved from formance, or behavior at work. These diffi-
the EEOC Web site (http://www.eeoc.gov). culties for employees with mental illness are
The significance of the Sutton trilogy is compounded by the courts’ lack of sympathy
particularly great for individuals with mental for employees who are periodically absent
or psychological disorders whose effects or tardy, who have difficulty following the
can be controlled or limited by medication. directions of supervisors, or who may have
Simply obtaining a diagnosis of a mental interpersonal problems with coworkers or
or psychiatric disorder is insufficient under customers, even if these problems are related
the law to entitle the employee to coverage directly to the underlying psychiatric disor-
by the ADA. He or she must either demon- der. Although not all individuals with mental
strate that the medication, therapy, or other illness have these problems, such perfor-
mitigating measure does not sufficiently mance issues are not unusual for individuals
neutralize the effects of the mental illness, with psychiatric disorders (Zuckerman,
or that the side effects or other reactions to Debenham, & Moore, 1993), and individu-
the medication themselves create a substan- als with behavioral or performance problems
tial limitation to a major life function. For have been very unsuccessful in pursuing
example, in Taylor v. Phoenixville School ADA claims in court.
District (1999), the court refused to award Scholars and commentators reacted to
summary judgment to the employer because the Court’s rulings in the Sutton trilogy by
the plaintiff was able to demonstrate that predicting that employees would turn to the
the medication she took for her psychiatric second and third prongs of the ADA’s defi-
disorder (depression) caused nausea and nition of disability (a record of disability or
impaired her ability to think clearly. Further- being regarded as disabled). It appears that
more, the episodic nature of psychiatric they have done so, but an analysis of ADA
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Disabilities, the Employer, and the Law 21

employment cases claiming discrimination 3. The employee claims that stress from
on the basis of either physical or mental the job “caused” the disability.
disabilities, decided during the first year after Courts have ruled that stress is a
the Sutton trilogy opinions were released, normal part of worklife and ability to
suggests that employees are no more suc- deal with stress is an essential function
cessful under these theories than they were of any job.
using the first definition of disability. A
4. The employee’s proffered “reasonable
review of federal court cases decided the
accommodation” may be rejected by
first year after publication of the trilogy
the court as unreasonable (e.g., requir-
indicated that plaintiffs prevailed in 3.5%
ing the employer to assign a different
of cases brought under the “regarded as
supervisor to work with the plaintiff).
disabled” prong of the ADA definition,
whereas plaintiffs bringing claims under 5. The employer may not have known
that definition prior to the publication of that the employee had a psychiatric
the trilogy had not prevailed at all (Lee, disorder and thus was not obliged
2001a). Plaintiffs were slightly more likely under the law to accommodate the
to be given the opportunity to take their individual. Only those disabilities
claims to trial (summary judgments for that have been disclosed trigger the
employers were reversed in 9% of the ADA’s protections.
“regarded as disabled” cases pre-Sutton and 6. In some cases, disruptive behavior by
in 12% of those cases post-Sutton). Given the employee has enabled the employer
the great difficulty faced by plaintiffs to claim that the individual is a “direct
claiming mental or psychiatric disorders in threat,” and, thus, accommodation is
prevailing prior to Sutton (Blair, 1999, unreasonable.
p. 1391; Miller, 1997), it is unlikely that
such plaintiffs will be more successful now
that Sutton is binding precedent. ATTITUDES TOWARD
According to Blair (1999), cases in which WORKERS WITH DISABILITIES
courts rule against workers with psychiatric
disabilities fall into six categories. The case law regarding psychiatric disabili-
ties is generally unfavorable to claims of
1. The employee may have engaged in psychiatric disability. Unfortunately, past
disruptive behavior or other miscon- research, albeit limited in scope, also indi-
duct, which makes him or her unquali- cates rather pervasive negative attitudes and
fied because of an inability to perform opinions regarding workers with such dis-
essential functions of the job. abilities (Lee, 1996). However, most of this
research involved respondents who had
2. The employee may have a difficult little or no experience involving workers
relationship with a particular super- with psychiatric disabilities.
visor, but can otherwise function. In order to determine contemporary
Because getting along with super- attitudes and treatment of job applicants
visors is an essential function of the and employees with psychiatric disabilities
job, courts have rejected ADA claims based on actual experience, a questionnaire
under these circumstances. was administered to participants attending
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22 GENERAL ISSUES

a certificate course in human resource 5 years (Gallup Organization, 1992), and

management. Many of these individuals higher than a 1993 survey of New Jersey
had personal experience in human resour- employers (Lee, 1996) in which 55% of
ces (HR) in dealing with disabilities in the respondents reported that they had hired a
workplace. worker with a disability during the past
In addition to inquiring as to whether 3 years.
respondents had any workplace experience We were particularly interested in
with individuals with particular disabilities, attitudes toward psychiatric disabilities as a
we asked what types of accommodations function of previous work experiences with
had been made for the disability, what cost various disabilities. However, we also made
was incurred, judgments of the performance several comparisons among respondents
of workers with disabilities, and whether the who varied on other background variables.
accommodation had been effective. We also We also made comparisons to individuals
asked respondents to provide information who had no prior experience regarding
as to their gender, age, employment status, disabled workers in the workplace.
industry, and organization/company size. We will report the most interesting
The questionnaire was completed at the findings on these differences as they relate
beginning of one of the two 3-hour sessions to attitudes and perceptions regarding
of the seminar. Results of the survey were the following areas: (a) preferences for
reported at the second session. A total of employing workers with various disabilities,
196 questionnaires were completed and (b) experience in accommodating various
analyzed. The majority of the respondents disabilities and cost estimates of the accom-
(82%) worked in personnel and had some modations, (c) relative job performance of
(or more) knowledge of ADA and ADA- disabled employees versus others, and
related compliance activities. (d) relative difficulties in working with
Employed respondents represented employees who are disabled. The majority
the following industries: construction and of respondents to the survey who were
agriculture (8%); finance and insurance presently working in HR-related jobs had
(4%); manufacturing (28%); services (10%); firsthand experience with one or more
trade (25%); transportation, communica- personnel matters concerning a disabled
tion, and public utilities (9%); health care employee. Forty-seven respondents had
organizations (12%). The balance of the firsthand experience in dealing with a
respondents classified their organization as “mental impairment” under the ADA.
“other.” Thirty-one questionnaires were Thirty-two of these respondents had first-
completed by individuals who indicated that hand experience with at least one other
they were “currently unemployed” and had class of disabilities.
no previous experience involving workers
with disabilities.
Approximately 72% of the respondents JOB PREFERENCES
indicated that their organization had AND DISABILITIES
employed a disabled individual in the past
5 years. This figure is slightly higher than a Research has shown that employers gener-
1992 Gallup survey of 400 businesses in ally prefer to hire employees with sensory
which 66% of respondents indicated that disabilities (e.g., sight), paralysis, or develop-
they had hired a disabled worker in the past mental disabilities (e.g., retardation) over
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Disabilities, the Employer, and the Law 23

Table 2.1 Hiring Preferences for Various Disabilities

Disability Class Mean Rank

Sensory impairments (e.g., hearing, sight) 2.2

Mobility impairments (e.g., paralysis) 1.7
Developmental impairments (e.g., mental retardation) 2.9
Diseases (e.g., cancer, diabetes) 3.2
Psychological impairments (e.g., depression, anxiety) 3.4

other classes of psychiatric problems under to accommodate, (b) problems in team

study (Lee, 1996). We explored this hiring work settings, (c) interference with per-
“hierarchy” with a number of questions forming essential functions of the job,
and analysis. First, we asked the following (d) an undue hardship on the employer, and
question of all study participants: (e) employees use these problems as excuses
to get out of work or as an excuse for poor
Think of a position in your organization performance.
that is not physically demanding. Then Ranking psychiatric disabilities as the
review the classes of disabilities below and least preferred disability was a robust
provide a rank ordering of disabilities that finding that did not differ significantly as
you would prefer in workers for this posi- a function of previous respondent work
tion. The #1 ranked disability would be experience with a psychiatric disability or
the class of disabilities that you would any respondent demographic variables.
most prefer, #2 ranked the second most There were some industry effects related to
preferred class, etc. If you are not presently the sensory class obviously related to ability
involved in hiring personnel, please
to perform the essential functions of
provide your general hiring preferences
certain jobs.
for positions which are not physically
demanding.
Although not statistically significant,
individuals who had personal experiences in
dealing with psychiatric disabilities at work
Table 2.1 presents a summary of these expressed a somewhat more negative atti-
results. As with previous research, psychi- tude toward this class of disabilities than
atric disabilities were among the least pre- did those with no such personal experience
ferred of all disabilities for hiring purposes, at work. Conversely, those respondents
regardless of industry or job. who had indicated a personal experience
We also asked respondents to explain with a sensory impairment ranked such
why the selected class of disabilities had impairments as relatively more preferred for
been ranked first or last. Whereas psychi- hiring purposes. Our results suggest that
atric disabilities were ranked last more experience with issues or problems related
often than any of the other classes, they to psychiatric disabilities at work foster
were never ranked as the most preferred dis- relatively more negative impressions of such
abilities. Among the most common expla- disabilities, whereas experience with other
nations for selecting psychiatric disabilities classes of disabilities fostered relatively
as the least preferred for hiring were the more positive impressions of workers with
following: (a) most difficult (or impossible) these disabilities.
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24 GENERAL ISSUES

Table 2.2 Accommodations for Psychiatric Disabilities

Accommodation Percentage Useda

Modified work schedule (part-time, time off) 62

Reassigning tasks to coworkers 21
Additional training and/or reassignment 10
Additional supervision 5
Modifications to work area 8
Assistant, interpreter, reader 0
Equipment adaptation 0

a. Respondents could select more than one type of accommodation.

JOB ACCOMMODATIONS estimates exceeding $5,000. Those respon-

dents who had indicated a personal experi-
Respondents were also asked to indicate ence with a sensory impairment indicated
what (if any) types of accommodations were that accommodations were relatively simple
made for workers with disabilities. Table 2.2 to implement, not very costly (54% indicated
presents a summary of the findings regard- the cost was less than $500), and successful.
ing psychiatric disabilities. For respondents In general, our results indicated a rela-
describing a psychiatric disability, 62% indi- tively more negative attitude toward the
cated that the worker had been provided a effectiveness of accommodating psychia-
modified work schedule (part-time, addi- tric disabilities. Again, although the sample
tional time off). This percentage was higher was small, unlike other classes of disabilities,
than for any other class of disability except those individuals who had work experience
major illness. Other accommodations that related to dealing with a psychiatric dis-
were provided for psychiatric disabilities ability indicated that the attempt to accom-
included reassigning tasks to coworkers, modate the disability was relatively less
additional training, and reassignment. successful. For all other classes of disabili-
There was an indication that individu- ties, the mean rating of effectiveness was
als who had personal experience in dealing above the midpoint of the scale.
with a psychiatric disability at work expres-
sed a somewhat more negative attitude
toward the effectiveness of accommoda- RELATIVE JOB PERFORMANCE OF
tions for such disabilities than did those WORKERS WITH DISABILITIES
with no such personal experience at work.
These respondents were more likely to indi- We were also interested in perceptions of
cate that whatever accommodation was job performance among disabled workers.
provided was not successful, and that the Again, we segregated our analysis by previ-
accommodations provided were relatively ous experience and asked respondents who
more costly. More than 18% of respon- had no previous experience with disabilities
dents who had provided an accommodation in the workplace to respond based on what
for a psychiatric disability estimated that they had read or heard about the disability.
the cost exceeded $5,000. No other class of Table 2.3 presents a summary of the
disabilities had more than 10% of cost major results related to the perceived job
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Disabilities, the Employer, and the Law 25

Table 2.3 Perceived Job Performance as a Function of Disability Class Performance Ratinga

Mean SD

Sensory impairments (e.g., hearing, sight) 3.1 1.1

Mobility impairments (e.g., paralysis) 3.2 1.4
Developmental impairments (e.g., mental retardation) 2.7 1.9
Diseases (e.g., cancer, diabetes) 3.1 1.8
Psychological impairments (e.g., depression, anxiety) 2.5 2.3

Gallup All Disabilities Psychiatric

Performance of workers with disabilities

Is more productive 3.13 3.05 2.52
Is more reliable 3.33 3.18 2.60
Works in a safer manner 3.11 3.01 3.06

a. A rating above 3.0 indicates performance was judged to be more effective than that of nondisabled
workers; a rating below 3.0 indicates less effective.
b. Responses to Likert Scale (1 = strongly disagree, 5 = strongly agree); Gallup sample data are from
Table U, 1992, p. 56.

performance of disabled workers. In general, productivity and reliability of workers with

respondents with no previous experience psychiatric disabilities were significantly
with disabled workers indicated that the job lower than were ratings of the performance
performance of such workers was equiva- of disabled workers in general from the 1992
lent to the performance of others doing the Gallup sample using the same questions and
same work. However, when we asked these rating scale.
same people to speculate on job performance These negative findings regarding
across the classes of disabilities, psychiatric psychiatric disabilities were slightly more
disabilities had a lower rating of job perfor- pronounced when we focused our analysis
mance than all other classes except cogni- on the respondents with previous experi-
tive or learning disabilities. The psychiatric ence with a psychiatric disability. Our small
class of disabilities was perceived more sample of individuals judged the job perfor-
negatively with regard to job performance mance of workers with psychiatric disabili-
regardless of previous experience. The high- ties to be relatively less effective than that of
est percentage of respondents also indicated other workers in general (17%) and workers
that the job performance of workers with with other disabilities (17% vs. 3% for other
psychiatric disabilities was relatively less classes of disabilities).
effective than that of nondisabled workers
performing the same job (11% vs. 4% for
other classes), and the lowest percentage RELATIVE DIFFICULTIES WORKING
of respondents indicated that the job WITH DISABLED EMPLOYEES
performance of workers with psychiatric
disabilities was relatively more effective Table 2.4 presents a summary of perceived
than that of nondisabled workers per- problems in employing workers with
forming the same job (3% vs. 9% for psychiatric disabilities. Although the majority
other disabled classes). Ratings of the of respondents did not agree that any of the
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26 GENERAL ISSUES

Table 2.4 Perceived Problems Working With Disabilities

Mean/SD

Problem Psychiatric Others

Frequent absences 2.9/1.4 2.5/1.3

Difficulty with supervision 2.8/1.4 2.6/.9
Difficulty with coworkers 2.5/1.1 2.4/1.0
Poor work attitude 2.3/1.5 2.1/1.1
Communication issues 2.7/1.6 2.4/1.5
Inexperience 2.4/1.2 2.9/1.1
Poor performance 3.3/1.6 2.8/1.3

NOTE: Responses to 5-point, Likert scale: 1 = strongly disagree, 5 = strongly agree.

problems were that serious, the most experience in dealing with a psychiatric
negative responses and the highest standard disability at work and those respondents with
deviations were found when the focus little or no experience in personnel matters
was on a psychiatric disability. For example, expressed relatively more negative views
problems of frequent absences, difficulty in toward this class of disabilities. People who
supervision and getting along with others, had firsthand experience viewed accommo-
poor worker attitude, and interference dations for psychiatric disabilities as rela-
with job performance were all judged to tively more costly, more difficult, and less
be greater when the respondent focused effective. They also considered workers with
on psychiatric disabilities. When the focus such disabilities as more difficult in a num-
was on workers with sensory impairments, ber of respects and less effective as workers.
respondents were more likely to disagree or Compared to the Gallup survey data from
strongly disagree that any of these issues 1992, perceptions of the job performance of
was a problem. workers with disabilities were more negative
The small number of respondents who than were perceptions of workers with
had personal work experience regarding disabilities in general.
psychiatric disabilities was more likely to One possible explanation for such
agree or strongly agree that frequent absen- negative findings when we isolate on people
ces, difficulties with supervision and co- with firsthand experience is that such first-
workers, and attitudes toward work were hand experience may be related to either an
more of a problem for workers with psychi- ADA complaint or litigation. Obviously,
atric disabilities relative to respondents who this bias in our sample could reflect an
did not have personal experience. unrepresentative view of workers with
psychiatric disabilities; that is, respondents
working in an HR department may not even
SURVEY CONCLUSIONS be aware that a worker had a psychiatric
disability if the problem had been resolved
From the perspective of workers with outside of HR by a line manager. Of course,
psychiatric disabilities, results of our sur- the same argument probably could be
vey rival the legal review for pessimism. In made regarding respondents who had first-
general, survey respondents with firsthand hand experience with other disabilities.
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Disabilities, the Employer, and the Law 27

Unfortunately, we have no other data that 2. If an individual with a psychiatric

would enable us to sort out this issue. disorder decides to disclose the diagnosis,
Suffice it to say that the increased negativity he or she should be prepared to provide
reported by those respondents who had information on the underlying condition
actual experience in dealing with workers and the appropriate accommodations (if
with disabilities is disturbing and needs any are needed) to the HR manager. At that
further examination. point, the HR manager and the individual
should discuss the degree of confidentiality
that the individual desires. Although the
RECOMMENDATIONS BASED ADA requires the employer to treat infor-
ON CASE LAW AND WORKER mation about an employee’s disorder as
ATTITUDES confidential, it may be in the employee’s
interest, depending on the disorder and its
Because the Supreme Court’s 1999 Sutton manifestations, to disclose some informa-
trilogy is still a relatively recent precedent, it tion to coworkers or supervisors about the
is too soon to determine whether a shift to nature of the disorder.
the “regarded as disabled” definition of dis-
ability will be a successful strategy for indi- 3. Should the individual be willing to
viduals with psychiatric disorders seeking disclose limited or full information about the
relief under the ADA. And although plain- condition, he or she and the HR manager
tiffs with these disorders have been quite should discuss educating his or her super-
unsuccessful in the past, this does not mean visor and coworkers about the condition.
that employers can ignore the ADA or evade This strategy may increase the comfort levels
their responsibility to provide reasonable of the people working with the individual
accommodations to workers with psychi- and give them an understanding of what the
atric disorders. Combined with the literature worker with the psychiatric condition is
on attitudes toward workers with disabili- facing. Particularly if specific behavioral
ties, and until the ADA is amended or until events may occur (such as periodic depres-
courts become more willing to extend ADA sion, fatigue, nausea, or other effects of
protections to these individuals, the follow- either the condition or the medication taken
ing suggestions may be helpful. to control it), advising coworkers and super-
visors of this possibility in advance may
1. Workers with psychiatric disorders increase their acceptance of the individual
need to determine whether or not to dis- and reduce their fear of the unknown.
close the existence of their disorder. Failure
4. All individuals involved should be
to disclose excludes the individual from
informed that performance expectations for
ADA protections. Disclosure may subject
the individual with the disorder will not be
the individual to discrimination, stereotyp-
changed (the ADA does not require perfor-
ing, negative employment actions, and
mance expectations to be reduced), and that
limited career opportunities. This catch-22
the individual also will be held to the same
situation is a difficult one for individuals
behavioral standards required of others in
with psychiatric disorders, and they should
similar jobs.
confer with therapists, family members,
and others who can assist them with this 5. The individual with the psychiatric
difficult decision. disorder should consider scheduling regular
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28 GENERAL ISSUES

meetings between his or her therapist or psychiatric disorders be meaningfully

other health professional and the relevant employed and avoid the need to use the very
supervisors or managers to ascertain whether imperfect tool of litigation under the ADA.
accommodations are successful or whether As one recent review concluded,
changes need to be made.
Despite passage of the ADA—and efforts
At this point in the evolution of case by companies to make jobs more accessi-
ble—the disabled still face an uphill
law interpreting the ADA, individuals with
struggle when it comes to finding work
psychiatric disorders cannot rely on the law
and earning salaries that are on par with
to punish employers whose fears or bias the rest of the workforce. (Wells, 2001,
against mental illness motivate negative p. 40)
employment decisions. Education of super-
visors and coworkers, and collaboration Our evidence about case law and attitudes
among the individual, the organization’s toward workers indicates that this struggle
management, and the individual’s health may be considerably steeper for people with
care providers, should help individuals with psychiatric disabilities.

REFERENCES

Albertson’s, Inc. v. Kirkingburg, 119 S. Ct. 2162 (1999).

Blair, D. A. (1999). Employees suffering from bipolar disorder or clinical depression:
Fighting an uphill battle for protection under Title I of the Americans with
Disabilities Act. Seton Hall Law Review, 29, 1347-1404.
Equal Employment Opportunity Commission (1997, March 25). Enforcement guid-
ance on the Americans with Disabilities Act and psychiatric disabilities. Available
at http://www.eeoc.gov/docs/psych.html.
Equal Employment Opportunity Commission. (2001). Cumulative ADA charge
data—Receipts. Available at http://www.eeoc.gov/stats/.
Gallup Organization. (1992). Baseline study to determine business’ attitudes,
awareness and reaction to the Americans with Disabilities Act. Washington, DC:
Electronic Industries Foundation.
Goldstein, R. I. (2001). Note: Mental illness in the workplace after Sutton v. United
Air Lines. Cornell Law Review, 86, 927-973.
Hall, L. L. (1997). Making the ADA work for people with psychiatric disabilities.
In R. Bonnie & J. Monahan (Eds.), Mental disorder, work disability, and the law
(pp. 241-280). Chicago: University of Chicago Press.
Lee, B. A. (1996). Accommodation of disability in the workplace: Legal requirements
and employer responses. Human Resource Management Review, 6, 231-251.
Lee, B. A. (2001a). A decade of the Americans with Disabilities Act: Judicial out-
comes and unresolved problems. Working Paper, School of Management and
Labor Relations, Rutgers University.
Lee, B. A. (2001b). The implications of ADA litigation for employers: A review of
federal appellate court decisions. Human Resource Management, 40, 35-50.
Miller, S. P. (1997). Keeping the promise: The ADA and employment discrimination
on the basis of psychiatric disability. California Law Review, 85, 701-745.
Murphy v. United Parcel Service, Inc., 119 S.Ct. 2133 (1999).
Sutton v. United Airlines, Inc., 119 S. Ct. 2139 (1999).
4038ch-02.qxd 7/12/02 3:06 PM Page 29

Disabilities, the Employer, and the Law 29

Taylor v. Phoenixville School District, 184 F.3d 296 (3d Cir. 1999).
Wells, S. J. (2001). Is the ADA working? Human Resource Magazine, 46, 38-47.
Zuckerman, D., Debenham, K., & Moore, K. (1993). The ADA and people with
mental illness: A resource manual for employers. Washington, DC: American Bar
Association; Alexandria, VA: National Mental Health Association.
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Part II

WORKING
CONDITIONS, LIFE
STRESSORS, AND
MENTAL HEALTH
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CHAPTER 3
Models of Job Stress

VALERIE J. SUTHERLAND
CARY L. COOPER

I t is not uncommon for stress and stress

management in the workplace to be
treated with apprehension, suspicion,
and a certain degree of cynicism. Constant
media attention and well-publicized stress
problems is denied and even ignored. Thus,
employees tend to hide a stress condition
rather than admit that they cannot cope.
The business and humanistic costs associ-
ated with this behavior are enormous, and
litigation cases have helped to create a everyone suffers in the long term.
negative and unhelpful climate resulting Recent figures provided by the Health
in some reluctance to tackle a potentially and Safety Executive (2001) suggest that
costly workplace problem. Stress seems to stress-related illness is responsible for the
have become an organizational whipping loss of 6.5 million working days each year,
boy, blamed for all our ills and wrongs and costing British employers around £370
in danger of becoming the “back pain” of million (about $518 million) and British
the 21st century. An unhelpful and damag- society as a whole as much as £375 billion
ing view of stress as a “four-letter word” (about $525 billion). The true impact of
will persist unless we can eliminate the mismanaged stress must be viewed in terms
myths and nonsense that surround the of costs associated with poor performance
concept of stress. and productivity, increased accidents at
Certain problems arise because stress, work, high labor turnover, forced early
like love and electricity, cannot be seen or retirement, ill health, job dissatisfaction,
touched. Most of us have experience with and unhappiness, in addition to increased
these concepts but find them difficult to insurance premiums and compensation and
understand and explain. In addition, many stress litigation costs.
managers believe that “if you cannot see it, If we examine the business case and
you cannot measure it; if you cannot understand the real costs associated with
measure it, you cannot manage it.” mismanaged stress, the need to tackle work-
In such a negative organizational climate, related stress is paramount and the potential
the need to proactively tackle work-related benefits are tremendous.

33
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34 WORK CONDITIONS, STRESS, AND MENTAL HEALTH

In this chapter, we suggest that to A LAYPERSON MODEL OF STRESS

manage stress successfully, we must acknowl-
edge and define what we mean by stress. We A common assumption is that “stress is
need to recognize the effects of exposure to what happens to people.” This is misleading
stress and understand how and why stress is and likely to be the cause of error in our
damaging in its consequences. To do this, understanding about the nature of stress.
we offer a theoretical framework by describ- Such perceptions held by employees, work
ing certain models of stress. Exploration of colleagues, staff, customers, or clients might
models of job stress and an understanding lead to faulty thinking, inappropriate blame,
of the evolution of such models provide an and damage to self-confidence. The organi-
explanation of the stress mechanism and how zation also suffers because stress manage-
and why exposure to certain conditions and ment initiatives are likely to be restricted in
situations has an adverse impact on health, scope, effectiveness, and success. Thus, an
job performance, and quality of life. Most essential part of any stress management
importantly, it guides action in the manage- initiative is to ensure that everyone involved
ment of stress. At both organizational and is aware of the nature of stress and how it is
individual levels, it is important that we damaging in its consequences.
know how and why exposure to the contem- Misinformation and faulty thinking
porary work environment might lead to poor about stress are commonly observed. Pause
performance, low productivity, and ill health. for a moment or two and write down the
By examining models of stress, we can words or phrases that immediately come
into your mind when you think about the
1. Define and clarify what we mean by word stress and what it means to you. If we
the word stress. ask a group of people to take part in this
exercise, the list of words produced usually
2. Explain the various ways in which
has three key characteristics.
stress is perceived.
3. Distinguish between terms such as
stress, stress agent, stress stimulus, and 1. Most of the words or phrases are
stress response. expressed in negative terms. That is, we tend
to perceive stress as something bad or
4. Recognize how and why our response
unwanted. For example, words or phrases
to stress can be behavioral, emotional,
such as “depression,” “feeling out of
physical, and psychological.
control,” “overworked,” “migraine or
5. Understand how models of stress headache,” “time pressure,” “panic attack,”
have evolved to influence our thinking “anxiety,” “unable to sleep,” and “tearful”
about the stress response and stress typically appear on such lists to express
management strategies. thoughts and feelings about the concept of
6. Understand the concept of adaptive stress. Consistently, stress appears to be a
and maladaptive stress coping. pessimistic experience, and this reinforces the
general view that stress is bad. In organiza-
7. Identify potential sources of stress in tional life, the stressed employee tends to
our environment. be regarded as a problem employee and as
8. Understand the concept of individual someone who is unable to cope. Thus, the
differences in response to stress. negative sentiment is intensified. A culture of
Exploring the Variety of Random
Documents with Different Content
running down the centre, a common thing in these cities. But if we
would be missionaries some day, we must not mind the smells now,
especially as we want to become acquainted with some of the
“Pearls of Peru.”
For a minute or two we pause and watch the children, who seem to
swarm everywhere. Some are playing at the nasty drain; no wonder
these little ones droop and die, for there is no friendly policeman to
warn them that this is a death trap!
Where do they all come from? Does no one look after them? For
they are everywhere, in the road, on doorsteps, in the shops, round
the booths in the market-place, under the shadow of the Roman
Catholic Cathedral; scores of them, playing, sleeping, picking up
scraps and eating them, uncared for, and untaught.
See! Who is this coming down the cobbly street, with a big, fat baby
on his back? Only an Indian boy, and not very much bigger than his
baby mistress. What a sad face he has; it does not attract us, for
there is a shade of bitterness about the mouth. His is a hard life—
driven to and fro by the whim of the baby’s mother; no thanks and
no pay; only beatings if he does not please her. An Indian slave! You
look surprised! But this is quite a common thing in Peru and other
parts of this continent.
“Only an Indian slave!
A prey to his mistress’s whim,
Beaten, battered, and starved,
What does she care for him?

‘A soul, did you say, he possessed?’

She laughs: ‘Why, he’s worse than a dog!
I purchased him, body and soul,
To scold, and to starve, and to flog.’

Only an Indian slave!

He may be in their esteem,
But his soul, with the price of blood,
Christ Jesus came down to redeem.”

May the children of God go forth to proclaim

The loosening power of His wonderful Name.
 INDIAN SLAVE AND HIS BABY MISTRESS
In her fascinating book on “Peru,” Miss Geraldine Guinness says: “In
Arequipa there are three thousand of these little Indian slaves, four-
fifths of whom are cruelly treated, while the good treatment of the
remaining one-fifth, with rare exceptions, consists in the fact of their
not being brutally beaten, and not suffering much hunger.
“I have heard the screams of child-servants not more than seven
years old, who were daily beaten by a bad-tempered mistress. I
have seen children ill and dying, for whom no one cared. I know a
little girl of seven, who, a few months ago, saw her mother’s dead
body taken away to the cemetery. Since that day she has minded
the shop all alone, and kept house for her father, who only comes
home at nights, and who is often away for weeks at a time.”
Some years ago, when the maize crop failed, and there was a
terrible famine in the land, starvation stared the Indian mothers in
the face. What were they to do under such circumstances? They
could not feed their little ones, so the children were brought to the
cities in thousands, and sold for a few shillings or given away, to
save the mothers and other little ones in the mountain huts from
starvation and death. To-day it is not an uncommon thing to be
accosted in the street by an Indian woman, and to be asked to
purchase her little girl or boy for a few coins.
The only British Missionary Society working in this vast republic of
Peru is the Evangelical Union of South America. Try and realize it; a
country half the size of China, and only a handful of missionaries to
proclaim the Gospel to these people. Take your pen and underline
“Lima, Cuzco, Huanuco, Arequipa, and Urco” (twenty-four miles out
of Cuzco), and you have the only centres of British missionary
enterprise at the present time. Let us visit these mission-stations
and see for ourselves what is being done for the children.
Of all the cities in Peru, Lima is the most cosmopolitan. Visiting one
part of the town on the outskirts one might almost fancy we were in
China; at another spot everything is entirely negro, and some other
part appears to be under Turkish supervision. Here we jostle against
Peruvian priests, who do not attract us, American, English, and
Italian merchants, and people from almost every land under the sun.
What a medley!
“The houses in Lima have no chimneys, they are one storey high,
and what windows there are facing into the street are barred,
making the houses look like prisons. The poorer parts of Lima
consist largely of ‘conventillos’ similar to these in Argentina. They are
often large, sunny, open courtyards, and sometimes narrow alleys,
always entered by doors in the walls of the main streets, and
surrounded by cell-like rooms.
“Every aspect of life may be seen in the central yard. There the
dinner is cooked, the baby bathed, the clothes washed, and the
Virgin worshipped. At every step one comes upon a child, and all
appear equally contented and uncared for.
“Lima is in the centre of a region, not only free from rain, but where
earthquakes frequently occur, so that mud, cane, and plaster are
used for house-building purposes instead of stone.
“Although it never rains in Lima, yet during the dry season, Peru’s
winter—June to September—the capital is enveloped in mist, which
is exceedingly disagreeable. For days and weeks the sun is invisible,
and a drizzle, not unlike a Scotch mist, makes the side-walks
slippery, and so permeates the air that the sheets on one’s bed are
chill and sticky.”
Lima is the city where the Society’s printing-press is at work. Month
by month, the little silent messenger of the Gospel, El Heraldo, is
sent forth by post throughout Peru; and as postage is quite free, you
will see that every postman is thus a “colporteur.” Many other things
besides are printed, but El Heraldo is the foremost message
proclaiming “pardon, peace, and power to hundreds whom the voice
of the preacher cannot reach.”
Once more we find ourselves in Cuzco. Here several ladies of the
E.U.S.A. are to be seen at work. Miss Elder, Miss Pinn, Miss Found,
and Miss Trumper, are doing splendid service.
Miss Elder reports that “many of the mothers, having gained
confidence in us, come again for advice and medicine for themselves
and their children.” Speaking of a case she visited, she says: “I had
prepared a nice basin of warm water, and was just ready to put
‘baby’ in for his first bath, when two women rushed up, one on
either side. Baby’s bath was, to their way of thinking, not yet
complete. One poured in alcohol, and the other a large cupful of
greasy soup.
“On asking the reason of this, I was told it was to make baby strong!
So, with a smile and the remark that I had not heard of the custom,
I proceeded with my work. This took place in the house of one of
the upper-class people.
“But I want to give you a peep into some of the poorer ‘homes.’ We
were conducted to a little shop where our patient lay on sheep-
skins. Baby’s wardrobe consisted only of a strawberry-coloured
knitted vest and a bonnet of royal blue! On another occasion, to
reach my patient I passed through two courtyards, and stepped
down into a dark room.
“There was no window. The light entered only through the doorway,
and the round hole in the wall through which the smoke was
expected to escape. The floor was alive with guinea-pigs running to
and fro. A few fowls were roosting in one corner, on sticks placed
there for the purpose, while a mother hen sheltered her brood of
healthy chicks in another. This patient had a bedstead, but it was
composed of rough irregular boards placed together like a raft.
“In addition to the work in Cuzco we have to hold ourselves ready
for outside calls. I was summoned one day to Urco Farm, because of
an accident to Domingo, a little Chuncho Indian boy from the
forests. I left Cuzco at ten at night, on horseback.
“Darkness and the roughness of the road hindered our progress, but
we arrived early in the morning. The boy had fallen from his horse,
cutting his face badly, while one eye was completely lost. We gave
him chloroform and put in five stitches, and the little chap soon got
well again.
“Urco Farm is about five hundred miles from the coast. For the first
one hundred miles it is desert, and the rest of the way beautiful
valleys. The climate is grand. The farm is so large that it would take
many days to see over it all. There is abundance of fruit, with large
quantities of vegetables such as we have here at home. There are
horses for riding, oxen for work, and mules, donkeys and llamas for
carrying goods. There are cattle for meat, and sheep also; for milk
and butter there are goats.”
There are no roads here, but just mountain trails. Everything is
carried on llamas and mules, while you would ride on a horse.
There are over two hundred Indians on the farm, and the Mission is
hoping to establish an Orphanage here, like the one at Sao Paulo in
Brazil, only much larger. Mr Ganton says:—
“Down this valley to the Amazon, and thence to the Atlantic, over
three thousand miles, we know of no missionary! Within our reach
are possibly ten tribes of Indians untouched even by Romanism. In
our own valley there are probably forty thousand people.
“We have some fine boys, and the Indians are very interesting. Mrs
Stockwell is glad to have her little school. The boys are quite apt at
learning texts. Almost any night we can hear them spelling out
passages from the New Testament by candle-light in their little
rooms.
“Our farm work is very interesting, also our people. One soon learns
to have a real love for them. It is hard for the Indian to understand
why anyone should treat him kindly without a selfish motive.”
For the school work the Indian children are gathered together in the
evenings and taught. They attend willingly and gladly. “The scholars
are all ages and sizes, from the ragged little Indian of six upwards.
There are some very promising children in the school, and we hope
that some day they will become messengers of the Gospel to their
own people in the remote villages. Every day we see more the need
of the Orphanage, where the children will be under our direct
influence. We have four already living in the house, and what a
difference we see compared to those outside!
“Mrs Stockwell is just in her glory with the children, and is
completely devoted to her school. She is at work from early morning
until bedtime, and always making clothing for the children.
“Day-school work among native children in Lima is a very special
feature. This was begun in 1913, and a Scripture lesson was always
included in the day’s teaching. It is being proved here, as in
Argentina and elsewhere, that not only does the day-school deliver
the Sunday-school scholars from annoyance, persecution, and
priestly instruction, but it is also an excellent feeder for the Sunday-
school, at which the attendance marked a great improvement in
numbers and steadiness.
“Under the very able superintendence and help of Mrs Millham, there
are two native mistresses, who have been associated with the
Church for some long time.”
This school work amongst the native children of Lima has been laid
upon the workers of the Evangelical Union of South America as a
sacred burden. It is their privilege—not only in Peru but in the other
Republics in which they work—to lift the child out of its ignorance,
and to teach it to know Christ the Friend of little children, to know
the world and all that pertains to it, and to know its own heart.
We will not proceed any further in our wanderings, for in Ecuador,
Colombia, Venezuela, and Panama the same sad condition of things
prevails.
We have heard, not unmoved I trust, the wail of the Indian children
in the forests of Peru and Brazil, and have seen them in the Amazon
valley. We have watched them with painful interest and concern in
the streets of the various cities, children of all colours and
nationalities, and yet all of one blood with us, who call for our
sympathies, our prayers, our gifts, and above all, our love. They call
to us out of their deep need from the Land of Opportunity.
 SOME NOTABLE BOOKS
ON FOREIGN MISSIONS
FROM THE CATALOGUE OF
OLIPHANT, ANDERSON & FERRIER
100 PRINCES STREET, EDINBURGH
21 PATERNOSTER SQUARE, LONDON
A HISTORY OF MISSIONS IN INDIA. By Julius Richter,
D.D. Translated by Sydney H. Moore, Master in the
School for Sons of Missionaries, Blackheath. Demy 8vo,
with map 10s 6d
“Will be indispensable to all students of
Indian Missions. It is singularly
interesting.”—London Quarterly Review.
THE PEN OF BRAHMA. Peeps into Hindu Hearts and
Homes. By Beatrice M. Harband, Author of “Daughters
of Darkness in Sunny India,” etc. Large crown 8vo,
cloth extra, with Illustrations 3s 6d net
HOLY HIMALAYA. The Religion, Traditions, and Scenery
of the Provinces of Kumaun and Garhwal. By the Rev.
E. S. Oakley, of the London Missionary Society, Almora,
Northern India. With 16 full-page Illustrations. Large
crown 8vo, cloth extra 5s net
DAYLIGHT IN THE HAREM. Papers on Present-day
Reform Movements, Conditions, and Methods of Work
among Moslem Women read at the Lucknow
Conference, 1911. Edited by Annie Van Sommer, A. de
Selincourt and S. M. Zwemer, D.D., F.R.G.S. Illustrated,
crown 8vo, cloth 3s 6d net
CHILDREN OF CEYLON. By Thomas Moscrop. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth 1s 6d net
THE MOSLEM DOCTRINE OF GOD. A Treatise on the
Character and Attributes of Allah according to the
Koran and Orthodox Tradition. By Samuel M. Zwemer,
Author of “Arabia, the Cradle of Islam.” 2s 6d net
“A piece of earnest thinking and writing.”—
Spectator.
THE GREAT RELIGIONS OF INDIA. By J. Murray
Mitchell, M.A., LL.D. Large crown 8vo, with Map and
Complete Index 5s net
“There was room for a good book on the
Religions of India, and the task of writing it
could not have fallen into more competent
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Dr Murray Mitchell, who only a few months
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brilliant record of life-long experience of
mission work in India.”—Aberdeen Daily
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MOSAICS FROM INDIA: Talks about India, its Peoples,
Religions, and Customs. By Margaret B. Denning. Large
crown 8vo, art cloth decorated, with 28 illustrations 6s
“Of thrilling interest.”—Spectator.
“One of the most readable and instructive
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VILLAGE WORK IN INDIA. Pen Pictures from a
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Canada Presbyterian Church, Central India. Crown 8vo,
art cloth, with 8 full-page Illustrations 3s 6d
“This book is literature. There is a noble
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FROM ZOROASTER TO CHRIST: An Autobiographical
Sketch of the Rev. Dhanjibhai Nauroji, the first modern
Convert to Christianity from the Zoroastrian Religion,
With Introduction by the Rev. D. Mackichan, D.D., LL.D.,
Missionary of the United Free Church of Scotland,
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“It has a charm of its own, and wins the
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Mackichan has written a fitting Introduction
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Monthly.
THE EDUCATION OF THE WOMEN OF INDIA. By M. G.
Cowan, M.A. (Girton.) Cloth, with twelve Illustrations
3s 6d net
“Miss Cowan presents us with the useful
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THE WRONGS OF INDIAN WOMANHOOD. By Mrs
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numerous Illustrations 5s
“Turns a searching light upon the sorrows
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they are at present bound to submit. An
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CHILDREN OF INDIA. By Janet Harvey Kelman. (The
Children’s Missionary Series.) Large crown 8vo, with
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MEN OF MIGHT IN INDIA MISSIONS. The Leaders and
their Epochs, 1706-1899. By Helen H. Holcomb. Large
crown 8vo, cloth extra, with 16 full-page Illustrations 6s
“This fascinating and beautifully illustrated
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THE COBRA’S DEN, and other Stories of Missionary
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“Interest in the narrative of missionary
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IN THE TIGER JUNGLE, and other Stories of Missionary
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paper, cloth extra. With Portrait and seven Illustrations
“There is a romance about many of these 3s 6d
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The illustrations are good.”—Record.
HINDUISM AND CHRISTIANITY. By John Robson, D.D.,
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THE MOSLEM CHRIST. An Essay on the Life, Character,
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and Orthodox Tradition. By Samuel M. Zwemer, D.D.,
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Cloth, with Illustrations and Facsimiles 3s 6d net
SOO THAH. A Tale of the Making of the Karen Nation.
By Olonzo Bunker, D.D., Thirty Years a Missionary in
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Crown 8vo, illustrated 3s 6d
Sir William Muir, Edinburgh, in a letter to
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FIRE AND SWORD IN SHANSI. Being the Story of the
Massacre of Foreigners and Chinese Christians. By E.
H. Edwards, M.B., C.M., over Twenty Years a Medical
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“Inspiring in the revelation it gives of a
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MISSIONARY METHODS IN MANCHURIA. By the Rev.
John Ross, D.D., Missionary of the United Free Church
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“Dr Ross writes a quiet, methodical,
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Preston Guardian.
CHILDREN OF CHINA. By C. Campbell Brown, Author of
“China in Legend and Story.” (The Children’s Missionary
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A MISSION IN CHINA. By W. E. Soothill, Translator of
the Wenchow New Testament; Author of “The
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CHINA IN LEGEND AND STORY. By C. Campbell Brown,
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“Ten years’ residence in China, close
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CHINA’S ONLY HOPE. An Appeal by her greatest
Viceroy, Chang Chih Tung, Viceroy of Liang Hu, with
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the Rev. S. I. Woodbridge. Introduction by the Rev.
Griffith John, D.D. Crown 8vo, cloth extra, with Portrait
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“One of the most remarkable, if not the
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CHINA IN CONVULSION; The Origin; The Outbreak;
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“The fullest and fairest statement of the
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CHINESE CHARACTERISTICS. By Arthur H. Smith,
Twenty-seven Years a Missionary of the American
Board in China. New and Enlarged Edition, with
numerous Illustrations. Demy 8vo, art linen 7s 6d
“A very striking book. One of the best
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people.”—Sydney Morning Herald.
METHODS OF MISSION WORK AMONG MOSLEMS.
With an Introduction by E. M. Wherry, D.D. Being those
papers read at the First Missionary Conference on
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MISSION PROBLEMS AND MISSION METHODS IN
SOUTH CHINA. By Dr J. Campbell Gibson of Swatow.
Large crown 8vo, cloth extra, with Coloured Map
Diagrams, and sixteen full-page Illustrations. Second
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“Teeming with valuable testimony as to the
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his life work has been carried on;
containing a well of information as to the
methods by which he and his fellow-
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lectures gathered together in ‘Mission
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missions or the broader subject of the Far
East.”—Daily News.
VILLAGE LIFE IN CHINA. A Study in Sociology. By
Arthur H. Smith, D.D., Author of “Chinese
Characteristics.” Demy 8vo, art linen, with numerous
Illustrations. Fourth Edition 7s 6d
THE ANALECTS OF CONFUCIUS. A new translation by
William Edward Soothill, Principal of the Imperial
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Large crown 8vo, cloth 15s net
The Discourses, commonly known as the
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recorded by his disciples. The Analects
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 of the New Testament hold to the whole
Bible, and, like the Gospels, is the most
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THE ORIGINAL RELIGION OF CHINA. By John Ross,
D.D., Author of “Mission Methods in Manchuria.” With
Diagrams from Original Plans, and other Illustrations.
Large crown 8vo, cloth extra 5s net
A satisfactory account of the Earliest
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present except in a voluminous work by de
Groot. Students of Comparative Religion will
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are missionaries and many others who will
find it very serviceable.
THE MARVELLOUS STORY OF THE REVIVAL IN
MANCHURIA. Transcribed by John Ross, D.D., from the
letters of the Rev. James Webster. With Portraits 6d net
THE LORE OF CATHAY; or, the Intellect of China. In
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Martin, D.D., LL.D., Author of “A Cycle of Cathay,” etc.
“‘The time,’ writes Dr Martin, ‘is not, I10s 6d
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Nothing should tend more to hasten the
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EAST OF THE BARRIER; or, Side Lights on the
Manchuria Mission. By the Rev. J. Miller Graham,
Missionary of the United Free Church of Scotland,
Moukden, Manchuria. Crown 8vo, with Illustrations and
Map 3s 6d
“A book which takes rank among the most
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THE HEATHEN HEART: An Account of the Reception of
the Gospel among the Chinese of Formosa. By Campbell
N. Moody, M.A. Large crown 8vo, cloth extra, with
Illustrations 3s 6d net
“The most illuminating book on missions I
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THE SAINTS OF FORMOSA: Life and Worship in a
Chinese Church. By Campbell N. Moody, M.A., Author of
“The Heathen Heart.” Large crown 8vo, cloth extra,
with ten Illustrations 3s 6d net
“A charming book.... When Mr Moody tells
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he is not less interesting than when he
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FROM FAR FORMOSA: The Island, its People and
Missions. By George Leslie Mackay, D.D. New and
Cheaper Edition, large crown 8vo, art canvas binding.
With four Maps and sixteen Illustrations 5s
 “One of the most interesting books on
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Glasgow Herald.
CHILDREN OF WILD AUSTRALIA. By Herbert Pitts.
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with eight Coloured Illustrations, cloth 1s 6d net
CHILDREN OF BORNEO. By Edwin H. Gomes, M.A. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth 1s 6d net
CHILDREN OF JAMAICA. By Mrs Isabel C. M’Lean. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth extra 1s 6d net
CHILDREN OF JAPAN. By Janet Harvey Kelman, Author of
“Children of India.” (The Children’s Missionary Series.)
Large crown 8vo, with eight Coloured Illustrations,
cloth extra 1s 6d net
THE GIST OF JAPAN. The Islands; their People and
Missions. By the Rev. R. B. Peery, A.M., Ph.D. Large
crown 8vo, art canvas, with eight full-page Illustrations
“This is an interesting and honest book, and 5s
its statements gain by its extreme candour,
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Standard.
KOREAN SKETCHES. A Missionary’s Observations in the
Hermit Nation. By the Rev. James S. Gale. Crown 8vo,
cloth extra, with eight Illustrations 3s 6d
“The author of ‘Korean Sketches’ has gone
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He has done so, moreover, as his book
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IN AFRIC’S FOREST AND JUNGLE. By R. H. Stone.
Crown 8vo, cloth extra, illustrated 3s 6d
“A welcome contribution to missionary
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DAWN IN THE DARK CONTINENT. By James Stewart,
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6s net
“We have no hesitation in saying that Dr
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DAYBREAK IN LIVINGSTONIA. The Story of the
Livingstonia Mission, British Central Africa. By James W.
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binding, with Map, a Plan of Livingstonia Institution,
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“We have no hesitation in saying that this is
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AN AFRICAN GIRL: The Story of Ma Eno. By Beatrice
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page Illustrations. Large crown 8vo, cloth extra 1s 6d
“This book is interestingly written, and will,
we doubt not, go far to accomplish its
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Outposts.
CALABAR AND ITS MISSION. By Rev. Hugh Goldie. New
Edition, with Additional Chapters by the Rev. John
Taylor Dean. Large crown 8vo, cloth extra, with Map
and fourteen new Illustrations 5s
“Mr Goldie has an interesting story to tell of
the place, of its people, and of the mission
work that has been carried on there. It is a
story which the opponents of missionary
enterprise can hardly get over.”—Spectator.
AMONG THE WILD NGONI. Being Chapters from the
History of the Livingstonia Mission in British Central
Africa. By W. A. Elmslie, M.B., C.M., Medical Missionary.
With an Introduction by Lord Overtoun. Crown 8vo,
cloth extra, with Illustrations and Portraits 3s 6d
“In this volume he has at once done a real
service to missions, and has made a most
valuable and interesting addition to the
fast-growing literature of Central Africa.”—
The Times.
CHILDREN OF EGYPT. By L. Crowther, Old Cairo. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth 1s 6d net
THE ANGEL OPPORTUNITY. By Jessie F. Hogg. Author of
“The Story of the Calabar Mission.” With Frontispiece
from a Pencil Sketch by H. C. Preston MacGoun, R.S.W.
Crown 8vo, cloth extra 2s 6d
This is the story of a missionary’s family
sent home for education, and is full of
humorous and pathetic incidents, in the
experience of a little girl, in her desire to
discover and influence the home heathen
among whom she found herself.
DAVID LIVINGSTONE. By T. Banks MacLachlan. Post 8vo,
art canvas 1s net
“It has been an unmixed pleasure to read
this life of David Livingstone. The book is
interesting from first to last, and gives a
vivid picture of a rare character.”—Madras
Christian College Magazine.
MUNGO PARK. By T. Banks MacLachlan. Post 8vo, art
canvas 1s net
“We owe to Mr Maclachlan not only a
charming life-story, if at times a pathetic
one, but a vivid chapter in the romance of
Africa. Geography has no more wonderful
tale than that dealing with the unravelling
of the mystery of the Niger.”—Leeds
Mercury.
CHILDREN OF AFRICA. By James B. Baird, Church of
Scotland Mission, Blantyre, Author of “Nyono at School
and at Home.” (The Children’s Missionary Series.)
Large crown 8vo, with eight Coloured Illustrations,
cloth extra 1s 6d net
“Boys and girls who read what Mr Baird
says will have a vivid picture of African life
in their memories, and will see how blessed
is the light the Gospel carries to their black
sisters and brothers in the Dark
Continent.”—Presbyterian Messenger.
AN ARTISAN MISSIONARY ON THE ZAMBESI. Being
the Life Story of William Thomson Waddell. By Rev. John
MacConnachie, M.A. Large crown 8vo, illustrated
“It is a moving account of unselfish1s 6d net
heroism for the sake of Christ, and Mr
MacConnachie has told it in a way that will
 impress the reader afresh with the splendid,
unassuming courage of their rank and file in
Christian missions.”—British Weekly.
ARABIA: The Cradle of Islam. By Rev. S. M. Zwemer,
F.R.G.S. Studies in the Geography, People, and Politics
of the Peninsula; with an account of Islam and
Missionary Work. Demy 8vo, canvas binding, with
Maps and numerous Illustrations from Drawings and
Photographs 7s 6d
“The best book on Arabia from every point
of view—scientific, literary, and missionary.
It is well illustrated, especially by such
maps as Ptolemy’s, Niebuhr’s, Palgrave’s
and plans of Mecca, Medina, besides maps
of Arabia as it now is, and of the islands of
Bahrein.”—The Scottish Geographical
Magazine.
CHILDREN OF ARABIA. By the Rev. John C. Young,
M.A., M.B., C.M., Sheikh Othman, Aden. (The Children’s
Missionary Series.) Large crown 8vo, with 8 Coloured
Illustrations, cloth extra 1s 6d net
WITH THE TIBETANS IN TENT AND TEMPLE. Narrative
of Four Years’ Residence on the Tibetan Border and of
a Journey into the Far Interior. By Susie Carson Rijnhart,
M.D. Large crown 8vo, cloth extra, gilt top, with
fourteen Illustrations. Fourth Edition 6s
CHILDREN OF PERSIA. By Mrs Napier Malcolm. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth 1s 6d net
“A charming book for children. The life and
surroundings of child-life in Persia are
described with sympathy and insight. The
young reader is carried through a very
 strange world of fascinating interest.”—
Missionary Record of the U.F. Church of
Scotland.
CONSTANTINOPLE AND ITS PROBLEMS. Its Peoples,
Customs, Religions, and Progress. By Henry Otis
Dwight, LL.D. Large crown 8vo, art linen, gilt top, with
12 Illustrations 6s
JERUSALEM THE HOLY. A Brief History of Ancient
Jerusalem; with an Account of the Modern City and its
Conditions, Political, Religious, and Social. By Edwin
Sherman Wallace. Demy 8vo, cloth extra, with 15
Illustrations and 4 Maps 7s 6d
MISSIONS IN EDEN. By Mrs Crosby H. Wheeler. Crown
8vo, cloth extra, illustrated 3s 6d
CHILDREN OF LABRADOR. By Mary L. Dwight. (The
Children’s Missionary Series.) Large crown 8vo, with
eight Coloured Illustrations, cloth 1s 6d net
THE CROSS OF CHRIST IN BOLO LAND. A Record of
Missionary Effort in the Philippines. By John Marvin
Dean. Crown 8vo, illustrated 3s 6d
“This book should be widely read
throughout the country. It is worth more
than a bale of newspaper print. The author
is a competent and credible witness of what
he has seen in the Philippines. He has done
good service there.”—The Outlook.
WITNESSES FROM ISRAEL. Life Stories of Jewish
Converts to Christianity. Edited by Rev. Arnold Frank,
Hamburg. Translated from the German by Mrs A.
Fleming, with Recommendatory Note by Rev. Professor
Nicol, D.D., Convener of the Jewish Committee of the
Church of Scotland. Crown 8vo, cloth extra 1s 6d
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