EPILEPTIC SEIZURES, PSYCHOLOGICAL FACTORS AND OCCUPATIONAL ADJUSTMENT.

SUMMARY One hundred nineteen epileptic former inpatients of the Boston Veterans Administration Hospital were interviewed and tested to evaluate their vocational adjustment since the onset of their seizures. The sample was restricted to males between 20 and 50 who had some adult work experience before developing seizures, and who had the onset of epilepsy more than three years prior to interview. The study excluded patients who had significant physical handicaps in addition to epilepsy, as well as those who had been treated for psychiatric disorders. Patients were classified as to severity of their seizure pattern, by means of a Work Suitability Scale. Personality and social history factors related to work adjustment were studied by means of a projective Sentence Completion test, an intelligence test, and a structured interview. Occupational adjustment in the two years preceding the first seizure was compared to that in the two years just prior to the interview. Ratings were based on the steadiness of employment, on the proportion of full-time pay earned, on the frequency of job changes, and on the socio-economic level of the occupation. The overall employment rate of 82% subdivides into a small group of 24 severe epileptics with a 50% employment rate and a larger balance of 95 subjects whose employment rate is 89%. The latter group, in turn, was made up of four levels of severity, according to the Work Suitability Scale. The most severe of these groups (52 patients) showed almost 50% decline in one or more of the indices of occupational adjustment i.e., steadiness, job changes, occupational level. The three mildest groups are uniform in their low (9%) unemployment rate and proportion of decline in occupational adjustment. The failure of the Sentence Completion test to discriminate those who adapted successfully is attributed to the restricted range of emotional disorders included in the sample. The 16 severe alcoholics in the study numbered among the most severe epileptics and accounted for one third of the totally unemployed. Premorbid training was also an important factor in the occupational prognosis, in that 37% of those who had unskilled occupations prior to seizures had been completely unemployed for the two years preceding their interview. Examining the circumstances under which the most severe epileptics continued to work revealed the existence of special sheltering conditions in every case. Of four who were unemployed, in spite of minimal seizures, all showed marked passive dependent traits and an accepting family setting. It is suggested that the group of epileptics having more than one grand mal seizure a month, without other complications, can profit the most from placement services. The cultivation of suitable job resources for this group is recommended. RESUME 119 Epileptiques prealablement hospitalises au “Boston Veterans Administration Hospital” ont ete interviewes et soumis a des tests dans le but d'evaluer leur capacite de travail et son evolution depuis le debut des crises. II convient de preciser que la population ne concerne que des hommes de 20 a 50 ans ayant deja eu une certaine experience professionelle avant le developpement de leurs crises et dont l'epilepsie etait survenue plus de 3 ans avant l'interview. D'autre part, ont ete exclus de l'echan-tillonage, les patients souffrant d'un handicap physique en outre de leur epilepsie ainsi que ceux ayant subi un traitement psychiatrique prealable. Les malades ont ete classes, selon la gravite de leurs crises, au moyen d'une “work suitability scale”. Les facteurs de personnalite et d'histoire sociale lies a leurs possibilites de travail ont eteetudies a l'aide du “sentence completion test”, d'un test de niveau et d'une interview. La capacite de travail pendant les deux annees precedant immediatement la premiere crise a ete compareee a celle des deux annees ecoulees avant l'interview. Les taux de capacitye de travail ont ete apprecies en se basant sur la regularite de la presence au travail, la proportion du salaire de plein temps gagne par l'interesse, la frequnce du changement d'emploi et le niveau socioeconomique de cet emploi. Resultats de l' enquete. Le taux general d'emploi des 119 malades est de 82%. lis se subdivisent en un petit groupe de 24 epileptiques graves dont le chiffre d'emploi est de 50% et un plus vaste groupe de 95 sujets atteignant un taux d'emploi de 89%. Ce dernier groupe a ete lui-meme partage en 4 sous-groupes de gravite differente en accord avec la “work suitability scale”. Le groupe le plus atteint (52 malades) montre un deficit voisin de 50% en ce qui concerne les indices d'adaptation a l'emploi, c'est a dire la regularite du travail, le changement d'emploi, le niveau de l'occupation. Les 3 groupes les moins atteints presentent un abaissement comparable du taux de emploi (91%) et des indices d'adaptation a l'emploi. L'insuffisance du “sentence completion test” pour la discrimination des sujets qui s'adaptent avec succes a leur travail tient sans doute a la faible importance des troubles emotionnels dans l' echantillonage. Les 16 alcooliques graves compris dans cette etude comptent parmi les epileptiques les plus atteints et forment un tiers de ceux consideres comme totalement sans emploi. L'existence d'un entrainement professionnel prealable aux premieres crises constitue un facteur important dans la prevision de l'incapacite professionelle ulterieure: 37% de ceux qui n'avaient pas d'occupation specialisee avant les crises s'etaient trouves completement sans emploi dans les deux annees precedant l'interview. L'examen des circonstances dans lesquelles les epileptiques les plus graves continuent a travailler revele l'existence de conditions de protection speciale appropriees a chaque cas. Quant aux 4 malades sans emploi malgre des crises legeres, ils presentaient tous des traits d'une dependance passive a l'emprise familiale. On a l'impression que le groupe des epileptiques ayant plus d'une crise de Grand Mai par mois, sans autre complication, est le plus susceptible de profiter des services de placement. L'orien-tation vers un travail approprie est reeommandee pour ce groupe.