Several characteristics help distinguish MPI in the workplace from illness outbreaks due to physical causes: no laboratory or physical findings confirming an specific organic cause evidence of specific physical or psychological stressors victims are mostly women and those of lower socioeconomic status in the workplace hyperventilation-type symptoms are prominent apparent transmission by audiovisual cues rapid spread of the illness followed by rapid remission of symptoms, unless symptoms are fixed by physicians and litigation benign morbidity If a physical or chemical cause of the illness is not obvious and if episodes recur, the illness remains a mystery and the workplace becomes a breeding ground for anxiety, confusion, fear, and rumor. Economic pressures to resume normal operations are counteracted by fears that an environmental contaminant still exists. Once all physical explanations have been ruled out, investigators may turn to psychological explanations and focus on mass hysteria, but that explanation is primarily based on the absence of physical evidence rather than the presence of agreed-upon psychosocial conditions. Some reports suggest that the diagnosis of MPI is really an excuse for not conducting an adequate evaluation of low-level environmental contaminants. The disability in some workers is prolonged and points to non-work-related factors that may be contributing. Were it not for the unverifiable physical complaints and the workers' insistence that the symptoms are the result of physical disease and their concern about the complaints and their reactions to dismissal of their complaints, we would not consider these patients to have a mental disorder. These individuals are reinforced in their beliefs by some physicians and attorneys, and resultant litigation tends to fix their symptoms. In fact, a "conspiracy theory" evolves when there are enough convinced people--and enough people trying to dissuade them. Group phenomena reinforce their beliefs and make renouncement tantamount to betrayal. The mass psychogenic illness or psychiatric epidemic that occurs in the workplace offers an opportunity not only to study the elements of a biopsychosocial system, but also offers opportunities for medical anthropological studies that relate the causes and courses of specific episodes of MPI to the cultures of the individuals who develop symptoms and the cultures of the area in which the epidemic occurs.

Disease Outbreaks↗

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Multiple chemical sensitivities and other "environmental illness": a psychiatrist's view.

The clinical ecology subculture, like earlier medical subcultures, is the product of patient concerns that the medical establishment cannot allay by treatment or by reassurance. For social and behavioral scientists, it represents a "natural" experiment that can be studied. For those physicians who believe that clinical ecology is without scientific basis generally and/or that its practitioners interpret laboratory results incorrectly, it is a challenge and an irritant. The clinical ecologist-physician feels rejected and the victim of bias and unfair attack. The patient in this subculture feels that finally he has found someone who understands him and is trying to help him, but that he must pay the price of being disapproved or rejected by his former physicians.

Ecology↗

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The management of psychopathology in the workplace.

This chapter is an outcome of an educational symposium held by the United States Postal Service to improve the management of medical and psychiatric problems by Postal Service physicians and their medical contractor cohorts. The proceedings have been edited to highlight psychiatric issues. The symposium begins with a case presentation, followed by a discussion, comments, questions and answers. The primary discussants were a faculty of distinguished psychiatrists with a wealth of academic and clinical experience. The symposium begins with an introduction by Ibrahim Farid, MD, senior area medical director for the United States Postal Service, who presents a rationale for holding the symposium.

Health Education↗

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The psychiatry of work.

We recognize that most areas of life function-marriage, parenting, military life-could produce a diagnostic system to describe the special problems in that area of function. This chapter has presented reflections on the categorizations of psychopathology of work, with the expectation that further work will be done in this area by teams of occupational psychiatrists who join together to produce a "diagnostic and statistical manual" of work mental disorders.

Humans↗

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Psychiatric aspects of fitness for duty.

The above examples illustrate the complex of biologic, psychological, and social factors that result in a fitness for duty referral. Workplace needs set the tolerance limits within which the worker must operate. They are different for a police officer, for a correctional officer, for a schoolteacher, and for a school custodian. Tolerance limits are affected by factors out of the employer's control, e.g., civil service rules, union contracts, and by the culture of the workplace, the latter being a set of unwritten rules. Ideally, the psychiatrist who performs the fitness for duty examination would have all of the information described above, but in most cases does not. The psychiatrist who has this information can begin to put in place one part of the mosaic that is the ethnography of work.

Humans↗

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The psychiatric disorders of aging in the work organization.

As Americans begin to spend increasingly more years in the workforce, work organizations will be coping with more of the physical and emotional disorders associated with aging. The authors address such thorny issues as dealing with workers who do not recognize their own mental impairments. They also discuss the opposite problem-a type of discrimination called ageism whereby it is assumed that older workers will be less effective simply because of their age.

Aged↗