Should We Expect People with Serious Mental Illness to Work?

Posted on July 9, 2019

I struggle with my expectations for our son who has a serious mental illness. When he’s doing well he seems full of potential, but that is not always the case. Many mental health professionals seem to have the same dilemma.

Dr. E. Fuller Torrey

In the seventh edition of his book Surviving Schizophrenia, Dr. E. Fuller Torrey writes, “The effect of lowering one’s expectations is often to be able to enjoy and share things with the person for the first time in many years.” He gives an example that if a person who was an accomplished flutist prior to becoming ill takes up the flute again to play simple pieces, both the person and the family can enjoy that accomplishment. “It is no longer going to be seen, implicitly or explicitly, in the light of when-you-are-well-you’ll-be-able-to-give concerts-again-dear.” I greatly admire Dr. Torrey, but on this point I believe he underestimates the potential of people with serious mental illness.

Sam Miltich

Sam Miltich, a talented young jazz musician, was born into a family of musicians. His father sings and plays string bass; his grandmother was a cellist. All his aunts and uncles played music, and family gatherings usually included a jam session. By age 18, Sam had performed at Lincoln Center in New York and with one of Europe’s hottest jazz bands in Amsterdam. He was profiled on National Public Radio’s “Morning Edition.” When schizophrenia disconnected his reality in 2008, he continued to play. He benefited greatly by being surrounded by family and friends, including his girlfriend who is now his wife. Everyone stuck with him and assumed that of course he would continue to play, even as he struggled for two years to stabilize.

Recently I had the privilege of meeting Sam before he performed jazz with his band at a nightclub just outside of Minneapolis. He talks about his mental illness at some of his performances. He said he likes to give people hope and encourage them not to give up. I was inspired by him and struck by his quiet confidence and gracious personality. He gave me more hope for my son.

Madeleine Albright

In her most recent book, Fascism: A Warning, Madeleine Albright writes about the dignity that comes from regular employment and the precious sense of being useful and optimistic about what lies ahead. She doesn’t exclude people who have disabilities, and I don’t believe we should either.


Most everyone wants dignity for each person. We should especially seek it for people with a serious mental illness—those who are often set apart from society. I have met professionals, however, who still believe it is too stressful for people with serious mental illness to work much. I maintain that it’s more stressful not to work or to have meaningful volunteer work. Such activities integrate people into the fabric of life. Doing less for people with serious mental illness compounds their isolation.

My son spends a few hours each week entering data and much of the rest of his time drinking coffee and smoking cigarettes. He says he feels “existential despair” about the meaning and usefulness of his life. When I suggest he take a college class, work more hours or engage in more activities, he suffers from inertia and lethargy. When I suggest his mental health professionals help him do more or find him a job coach, they seem to harbor the same judgement as Dr. Torrey or else they dismiss his sparse life as his choice.

I wish more of them could meet Sam Miltich.