CASE CONTINUED: Redirecting energy into a job search
As I met with Mr. G over the next 3 months, the pattern of malicious communication and actions continued at his office. For example, he received a written reprimand for being 10 minutes late after having overslept when starting flurazepam, which he continued to take for about 6 weeks without further tardiness. I encouraged Mr. G to withdraw energy from work by keeping a low profile and trying not to react to provocations. Instead, I counseled him to put energy into family activities and try to find a new job.
Mr. G experienced relatively mild, first-degree workplace mobbing, but it had a substantial effect on his quality of life and that of his wife for almost 1 year. If I had followed my first impulse and had Mr. G involuntarily hospitalized after our first interview, it would have confirmed rumors at his office and probably would have escalated the mobbing behavior.
Diagnostic recommendations
Consider the possibility that seemingly paranoid individuals could be the target of mobbing at work, and don’t underestimate the psychological stress of being mobbed. Other forms of workplace harassment can be extremely stressful but do not have the “paranoidogenic” potential of mobbing. Patients may be so distressed that it is difficult to figure out what is going on in their work environment.
Ask patients to present physical evidence of conspiracy or harassment. Mobbing patients usually are willing to bring in large quantities of material. Keep in mind that when subjected to mobbing behavior over time, a person who is not initially paranoid is likely to develop some secondary suspiciousness and even frank paranoia.
Also consider the possibility of “pseudomobbing,” in which an individual falsely believes he or she is a mobbing victim. Cases of pseudomobbing have been reported in European literature11 and may represent a negative side effect of greater public awareness of the mobbing phenomenon (and of legal remedies to mobbing available in various European countries).
Mobbing is a serious stressor that can lead to psychiatric and medical morbidity and even suicide. Major depressive disorder—often with suicidal ideation—is frequently associated with being mobbed.12
A diagnosis of PTSD can be missed if the mobbing victim does not seem to have been subjected to a severe enough stress to meet PTSD criteria.
Treatment recommendations
First, do no harm: Do not allow yourself to be used by the mob. This process can be direct—as in the Mr. G’s case, where the patient was almost involuntarily committed—or subtle. For example, a person you know may describe the behavior of “someone at work,” and you may be tempted to respond, “Well, I have not examined this person, but from what you say, it sounds like maybe…” You could then be quoted as a psychiatrist who agrees that the person is paranoid.
Giving your patient a name for what is happening to him or her may be the most therapeutic intervention. Generally, patients have not heard of mobbing. They typically are confused about what is happening and may blame themselves.
Treat secondary symptoms of depression, anxiety, PTSD, or other sequelae with pharmacotherapy, psychotherapy, or a combination as appropriate. Refer patients with somatic symptoms to primary care if you feel that they need further evaluation.
Encourage your patient to visualize choices and ways to escape the situation. Frequently, patients will be locked into “fighting for justice” or putting up with the situation because they see no options.