Mary V. Seeman, MD
Centre for Addiction and Mental Health
University of Toronto
Bob Seeman, BEng LLD
Seeman, M.V. & Seeman, B. (2000) Earning money via the internet: perceptions of women with
schizophrenia of in-home computer work. International Journal of Psychosocial Rehabilitation. 5, 35-40
Objective: The aim of this inquiry was to find out whether women attending an outpatient clinic for schizophrenia had an interest in part time work from home using the Internet. Background: The literature suggests that in-home work on a part time basis suits the needs of many individuals recovering from schizophrenia, particularly women. Method: Thirty-two women attending an outpatient clinic during one week in June, 2000 were asked whether or not they had a computer at home and whether they would be interested in earning money doing part time work over the Internet. Results: Five women were interested and capable. One, with the help of a boyfriend, was already earning money via the Internet. Conclusion: By side-stepping some of the disabilities inherent in this psychiatric condition, training patients with schizophrenia to work from home to earn money via the Internet may be a realistic way of increasing both finances and self-esteem.
Correspondence may be addressed to Dr. Mary Seeman, Centre for Addiction and Mental Health,University of Toronto,250 College St. Toronto, OntarioM5T 1R8 Canada. Phone:416 979 4671 fax 416 979 6931 email: email@example.com
Work plays a central role in most people's lives. Those who do not work suffer because of it - economically, socially, and personally. The experience of clients of a Canadian clinic for women with schizophrenia (1) provide glimpses into the challenges of finding appropriate gainful employment. These women speak of the futility of seeking work, even after full recovery, once a disabling illness has struck. Part of the problem is that, paradoxically, work can jeopardize earnings. Beyond a small permissible amount, provincial disability entitlements in Canada subtract all earned income from the monthly government subsidy. Moreover, provincial plans insist that individuals with a history of once having worked (those who, among this population, are the most likely to find employment after recovery from an episode of psychotic illness) apply to the Canada Pension Disability Plan at the same time as they submit their disability claim to the province. The federal disability pension, if granted, disallows all remunerative work. Most individuals with a psychiatric disability realize that illness can recur unexpectedly and are reluctant to abandon the
security of pension benefits (which include health and drug coverage) to venture into the uncertainty of the job market. They are, therefore, not interested in full-time work because it automatically cuts off government support. And full time employers, looking for long term commitment from employees, have little interest in ex-psychiatric patients.
Most of the women in the clinic lean toward the part-time or temporary job market (2). Because there is no permanent commitment on the part of the employer, he or she is more likely than the full time employer to take a chance on hiring individuals with a history of mental illness. This market usually demands few skills, but the pay is low and there are no associated unemployment or other benefits. Although such part-time jobs may not interfere with pension benefits, they nonetheless exact a heavy price.
Required tasks are frequently routine, unhygienic, and sometimes unsafe (3). Such low level, occasional work means always being on the bottom of a hierarchy, playing a submissive role vis à vis co-workers, having little access to collegial support and no assurance of job continuity. Occasional workers are told what to do and how to do it; they have no decisional authority or latitude. They are never allowed the autonomy to arrange individual time schedules and have no privacy in their work space, all of which results in stimulus overload. These are the very conditions that are known to promote job stress (3-8) and that, from a rehabilitative point of view, should be avoided by individuals vulnerable to recurrences of serious psychiatric illness. Unhealthy work conditions have been suspected risk factors for episodes of schizophrenia (9). At the same time, it is known that individuals prone to schizophrenia, in order to avoid competition, undue expectation, or social interaction, seek out low level jobs where work conditions, almost by definition, are unhealthy (10).
When questioned, the women in the clinic endorse the opinion that a major source of job stress for women in general, and particularly for women with a history of psychiatric illness, is the conflict between obligations of work and home (11-15). Already feeling guilty that episodes of illness have involved absences from home and from the continuity of marital and mother-child relationships, women in the schizophrenia clinic express ambivalence about joining the work force. On one hand, they want the pride of achievement, the salary, the identity, the collegiality that comes with a job; on the other hand, the guilt of less time spent with children, with necessarily lowered domestic standards of cleanliness and nutrition and the burden of organizing complicated schedules of delivering children to school and picking them up, plus arranging a back-up system when children are ill, is viewed as overwhelmingly stressful.
Many clients of the clinic are single parents living in poverty. They frequently have no one to whom they can safely entrust the care of their children. They may be alienated from parents or other family members. These women want occasional work that is not demeaning, that can be done in the privacy of their own living space, during times that are convenient to them. They prefer not to interact with others face-to-face and they prefer not to be placed n a position which allows comparison to others. They do
not think, for the most part, that they are well-groomed enough or well-dressed enough to work in an office with other women. Elsewhere, employment specialists have been successful in placing similar clients in individualized job settings suited to their needs (16-19).
Since recent economic shifts have highlighted the potential of the work-from-home advantages of Internet companies, we asked all the women attending the clinic during one week in June, 2000 whether they knew anything about Internet work , whether it would interest them, whether they owned a computer with Internet access, and whether they knew how they might go about inquiring into such jobs which might entail reading and email response to customer/corporate enquiries or complaints, carrying out online research, doing web design and layout or digital art work, copy writing, or transcribing and proofing voice dictation.
Of the 32 women we talked to, 8 were students, 3 had full time jobs, 3 worked part-time, 1 was currently looking for work, and 7 had child care responsibility. The remaining ten did not have a definable occupation.
One of the women with a full time job was on a disability leave from work and, as part of her retraining, was taking a computer course. She knew about jobs that could be done from home for Internet companies and had actually had an offer from an acquaintance to work for him. She stated: "I was somewhat tempted, but not seriously so. I don't want to go back to my regular job but, at the same time, I don't want to lose the benefits that come with it. I don't want to go back because they watch me and read my email and tap my phone. And I don't like meeting face-to-face with customers, which is part of my job, and I absolutely hate my boss." On the face of it, this woman seemed like an ideal candidate for a part time Internet job once her employee medical disability ran out and she was on government assistance. "No," she said to my direct question about the new possibilities, "I can't get away from the surveillance. They'd follow me home. I'd have no peace working from home. I wouldn't be able to get away from it."
The other two women who were already working full time could not see an advantage to workingfrom home. Both said they would miss the socialization of work. "Though it's sometimes hard to get up in the morning, I'm glad to have something to get out of the house for." One woman lived with her retired father and didn't like "the idea of spending all day in his company." The other one was married and felt she had to "pull her share of the load" by maintaining her present job until she could claim retirement
benefits. Neither owned a computer nor were interested in the concept of working for a "virtual" firm.
The six students were taking courses in philosophy, environmental studies, English literature, art, cosmetics, and computer science. Some had interrupted their studies for the time being, but were intending to return. None of the six expressed any interest in working from home after graduation except the English literature student who was considering a job writing web pages. She owned a computer and thought she knew how she could obtain work in this field. She thought her father and her brother could
help her. Interestingly, she felt that, since interpersonal relating was a problem for her, the experience of being in an interpersonal environment would be good training so she did not think a 'from home' job was the right way for her to go. The art student was just starting art school and could foresee no difficulty in finding full time work after graduation. Optimism about eventual employment characterized all the six students. They were relatively young compared to the other women in the clinic and had suffered from schizophrenia for a shorter period.
Of the seven women with children, four did not currently live with their children. Two women had children in foster care; the other two women's children had been placed with relatives by Children's Aid. I first asked these four whether they could see themselves doing work part-time from home via computer. Only one expressed interest in a job but was unable to say what kind of job might be suitable for her. The others all felt they were busy enough as it was trying to extend visiting time with their
children and attending parenting classes. The three women whose children were at home were more interested. One was sharing custody of her two children with her ex-husband and was already having trouble organizing her time around the children's schedule so that her interest did not seem realistic. The other two both had child-help from mothers and mothers-in-law and both had had recent work experience.They were interested and quite knowledgeable about what they would need to do to inquire further into job possibilities.For these two women, from home part-time Internet
work seemed realistic and manageable.
Five women suffered from severe symptoms that remained uncontrolled by treatment. One also abused drugs. The idea of work was not at all attractive although one of these women had worked most of her life and was, even in her very ill state, doing several volunteer jobs and taking part in a number of organizations and clubs.
Eleven women without children said they wanted to find work. E. has worked in the past but was now having trouble concentrating and had been unable to complete an entry level computer course. C. is actively seeking work but wants nothing to do with computers. J. wants to do something "physical" like teaching yoga and cannot see herself sitting at a desk. Z. is quite proficient on the computer, very well educated, and had held a number of jobs in the past. Nevertheless, she said: "I do not approve of computer companies and only want to work at something which has meaning and
purpose." L. has teaching qualifications and speaks several languages. Realistically, she could easily do computer work from home but would need to be trained and is, at present, lacking the confidence to try something new. A. has just completed a vocational rehabilitation course where she learned basic computer skills. She is currently on a job placement in an office and may continue in that job. She lives with her parents; her mother works and her father is usually at home. "Being alone in the house with him would not be easy," was her response. S. abuses alcohol and has been unable recently to keep any job she attempts - although she attempts many. If her alcohol problem were solved, she would probably be able to work from home very well. Her boyfriend works with computers and would be able to help. K. is recovering from cancer treatment but is otherwise very interested. She and her roommate have bought a computer and she likes the idea of working from home because she considers herself "too fat to apply for an outside job." R. has worked until recently and is now volunteering in a library, so is exposed to computers and Internet. But she is easily stressed and easily confused and says "computers scare me." B. is a younger woman but also gets confused easily and would probably not be self-directed enough to do computer work from home. She currently works as a volunteer. O. lives with a boyfriend and, together, they collect antiques and sell
them successfully at auction sites over the Internet. They have registered several domain names and hope to sell these as well. O. is an example of how, with the help of an enterprising colleague, someone with a moderately serious form of schizophrenia can be gainfully and creatively occupied from home.
For a variety of reasons, most of the women questioned would not be interested or would not be able to attain sufficient skills to work from home on the Internet but 5 of the 32 or 1/6 of those questioned seem to be likely candidates for this form of training. Patient O. is a good example of how well this can work if circumstances are right.
We need to foster conditions which allow individuals with schizophrenia to work at their own pace, from the security of their own home, away from the gaze of others, and yet to obtain both job satisfaction and good pay. Specialized training programs have proven effective (16-19). The Internet in this new century has opened up opportunities which overcome the weaknesses of people with severe psychiatric disorders and draw, instead, on their strengths.A variety of personal service exchanges such as smarterwork.com and eFrenzy.com which are already in existence could be helpful to psychiatric patients..
1. Seeman MV, Cohen R.: A service for women with schizophrenia. Psychiatric Services 49:674-677, 1998.
2. Catalano R, Drake RE, Becker DR, Clark RE. Labor market conditions and employment of the mentally ill. J Mental Health Policy and Econ 1999; 2:51-54.
3. Spector PE. Perceived control by employees: a meta-analysis of studies concerning autonomy and participation at work. Hum Relations 1986;39:1005-1016.
4. McNamee S, Vanneman R. The class structure of job rewards. Work Occup 1987;14:190-215.
5. Link BG, Lennon MC, Dohrenwend BP. Socioeconomic status and depression: the role of occupations involving direction, control, and planning. Am J Sociol 1993;98:1351-1387.
6. Muntaner C, O'Campo PJ. A critical appraisal of the demand/control model of psychosocial work environment: epistemological, social, behavioral, and class considerations. Soc Sci Med 1993:36:1509-1517.
7. Lennon MC. Work conditions as explanations for the relation between socioeconomic status, gender, and psychological disorders. Epidelmiologic Rev 1995;17:120-127.
8. Ross CE, Mirowsky J. Does employment affect health? J Soc Behavior 1995; 16:230-234.
9. Link BG, Dohrenwend BP, Skodol AE. Socioeconomic status and schizophrenia: noisome occupational characteristics as a risk factor. Am Sociol Rev 1986;51:242-258.
10. Muntaner C, Pulver AE, McGrath J et al. Work environment and schizophrenia: an extension of the arousal hypothesis to occupational self-selection. Soc Psychiatry & Psychiatr Epidemiology 1993:28:231-238.
11. Seeman MV: Schizophrenic men and women require different treatment programs. J Psychiatr Treatment & Evaluation 1983; 5:143-148.
12. Barnett RC, Marshall NL. The relationship between women's work and family roles and their subjective well-being and psychological distress.In: Frankenhaeuser M, Lundberg U, Chesney M, eds. Women, Work, and
Health: Stress and Opportunities. New York, NY. Plenum Press 1991:111-136.
13. Lennon MC, Rosenfield S. Women and mental health: the contribution of job and family conditions. J Health Soc Behav 1992;33:316-327.
14. Bird CE, Ross CE. Houseworkers and paid workers: qualities of the work and effects on personal control. J Marriage & Family 1993;55:913-925.
15. White C, Nicholson J, Fisher WH, Geller JL: Mothers with severe mental illness caring for children. J Nerv Mental Dis 1995;183:398-403.
16. Kates N, Nikolaou L, Baillie B, Hess J. An in-home employment program for people with mental illness. Psychiatric Rehabilitation J. 1997; 20: 56-60.
17. Drake RE, McHugo GJ, Bebout RR, Becker DR, Harris M, Bond GR, Quimby E.: A randomized clinical trial of supported employment for inner-city patients with severe mental disorders. Arch Gen Psychiatry 1999;
18. Drake RE, Becker DR, Clark RE, Mueser KT. Research on the individual placement and support model of supported employment. Psychiatric Quarterly, 1999; 70:289-301.
19. Fuller TR, Oka M, Otsuka K, Yokoyama N, Liberman RP, Niwa SI. A hybrid supported employment program for persons with schizophrenia in Japan. Psychiatric Services 2000; 51:864-866.
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