Occupational Disorders: A Treatment Guide for Therapists

The target audience for this book consists of staff members of human resources departments and employee assistance plans as well as office-based therapists who regularly treat people with occupational disorders. In fact, the author has written a book about how to recognize and how to treat occupational disorders with a vocabulary and a simplification of concepts that will likely appeal to a wide and diverse readership. However, it will not serve as an academic psychiatric reference.

The premise is that most occupational disorders are "little more than 9 to 5 manifestations of a larger physical or emotional… disorder." The author notes that he delves deeply into the dynamic causes of occupational disorders, and that most work disorders originate at least partly in the worker's early relationships.

Although the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders is mentioned, slavish adherence to the descriptive criteria is not encouraged, and the author puts his own spin on the diagnostic schema. The case examples highlight his teaching points well, and this book is not a difficult read. Classifying personality disorders through the metaphors of onions, garlic, and red peppers is a clever and effective way of conveying the import of these often incompletely delineated axis II concepts.

Despite my overall approval of this book, I found that several pertinent matters are not addressed, including how the various therapeutic approaches lend themselves to the time constraints and cost restrictions associated with managed care. Malingering, symptom exaggeration, and the emotional components related to primary and secondary gain do not receive sufficient critical scrutiny, although these issues can contaminate treatment and preclude successful outcome. Remarks such as "Pharmacotherapy worked, but it made him intellectually dull" and "Medication helps with stage fright like alcohol helps the person afraid of flying to get on the plane and get through the flight" do not adequately acknowledge the dramatically effective help that contemporary psychopharmacology offers.

The author's treatment approach includes the psychoanalytic-psychodynamic model, cognitive therapy, and supportive therapy. However, he does not discuss individuals who may need hospitalization because of serious mental illness or the potential of dangerousness in the workplace, or when and how referral should be made to a psychiatrist for medication. He challenges the reader to pursue specific causality and suggests that such study starts with a developmental and dynamic assessment of the individual and the individual's disorder—a tall order that does not lend itself easily to brief therapy.

This book will serve as a useful reference for individuals who make initial contacts with emotionally troubled employees and will provide a basis for a preliminary understanding. However, those who take on the successful treatment of DSM-IV disorders will need additional sources of information.

Dr. Weitzel is clinical professor in the department of psychiatry at the University of Kentucky College of Medicine and is in private practice in Lexington.