Brit. J. prev. soc. Med. (1955), 9, 39-45

PSYCHIATRIC DISABILITY AND EMPLOYMENT

I. A SURVEY OF 222 REGISTERED DISABLED PERSONS

BY

M. MARKOWE, W. L. TONGE, AND L. E. D. BARBERMedical Research Council Unit for Research in Occupational Adaptation

(1) INTRODUCTIONThe social effects of neurosis no longer need to

be stressed. This is especially true of occupation;the Disabled Persons (Employment) Act, 1944, isan outward sign of the common concern for theproblems of the handicapped. It is generallyassumed that psychiatric illness is particularlypotent in damaging the capacity for work, andemployers may turn men away for that reason. Theprevious work of this Unit has, however, largelyfailed to confirm this assumption (Markowe andBarber, 1952, 1953a, 1953b). These studies wereconcerned with men working in factories, of whomonly a proportion had symptoms and all could beregarded, within broad limits, as adapted to theirwork.The present investigation studied 222 men on the

Disabled Persons Register with overt psychiatricdisturbances. Subjects were selected because theyhad been heavily unemployed or else constantlyemployed over a certain period. The two groupswere then compared in order to demonstrate thatcertain clinical features are associated withunsatisfactory employment records.

(2) PREVIOUS INVESTIGATIONSEisenberg and Lazarsfeld (1938) reviewed the

psychological and social case-work studies onunemployed men and described the deterioration inmorale which was observed in the unemployedAustrian village of Marienthal. They cited evidencethat unemployed workers were more neurotic thanemployed men, and were more depressed abouttheir future than neurotic patients (Morton, 1935;Israeli, 1935).

Lewis (1935) examined 52 men referred by thelocal Public Assistance Committee. He found auniform clinical picture in which hysteria waspredominant. Gross tremor was present in 23patients and three showed a pseudo-dementia.Depression and irritability were common features,

but not self-reproach, and there was much resent-ment and dissatisfaction, which however weredescribed as a paranoiac reactive development ofpersonality rather than as a paranoid delusionalformation. In a follow-up one year later it wasfound that one-third of the men were no longer onout-relief and that many of the remainder weredefective, epileptic, insane, elderly, or physicallyunfit.

Hewitt (1949) examined 50 unemployed disabledmen, and found only seven free from psychiatricdisability. He was impressed by their lack ofinterest in life and their pathological attitudes ofresentment, aggression, and depression. In afollow-up one year later one-third had foundemployment, and Hewitt concluded that the attitudeof mind of the disabled was the most importantfactor influencing employment.

In a follow-up of 103 patients discharged from theBelmont Industrial Neurosis Unit (Jones, 1952),those rated as having made a poor adjustment(including occupational adjustment) differed fromthe remainder in that more of them were single, hada long history of previous psychiatric illness, weremore frequently unemployed before admission, andwere more often diagnosed as schizophrenic orpsychopathic. This confirms previous work (Stalker,1945; Guttman and Thomas, 1946; Harris and Lane,1949). Also reported (Jones, 1952) is a survey ofpsychiatrically disabled men with much unemploy-ment, who had not been to Belmont. They werefound to be disgruntled and embittered, in poorerhealth than the ex-patients, and with little hope forthe future, either for work or for health. All thesestudies stress the importance of personality ratherthan psychiatric syndromes as a determinant ofoccupational adaptation.

(3) METHOD

The group of unemployed men studied in this investiga-tion all had at least 6 months' unemployment during theyears 1950-53, while the employed subjects had less than

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M. MARKOWE, W. L. TONGE, AND L. E. D. BARBER

3 months' unemployment during the same period. Allsubjects had been registered at Employment Exchanges inSouth London as suffering from psychiatric disability.All the 95 unemployed subjects chosen were interviewed,but the 127 employed men who were seen formed only22 per cent. of a much larger group, who were approachedbut did not attend for interview.Each subject was interviewed for an hour by a psychia-

trist and as full a history as possible was taken alongcustomary lines. At the end of the interview a five-pointrating was made of the subject's mental health on thebasis of the history and psychiatric examination.* Aphysical examination was made where indicated, and an

ischaemia pain endurance test was also carried out(Markowe and Barber, 1953b). After the psychiatrist'sinterview the occupational history was taken and thesubject's present economic position assessed. Finally,all subjects were asked to do the Dominoes Test ofgeneral intelligence and to complete the Cornell MedicalQuestionnaire. In addition to information obtained atthe interview, data were obtained also from the files ofthe Employment Exchange and the central offices of theMinistry of National Insurance and Pensions and theNational Assistance Boardt and from the records ofhospitals attended by the subjects.

(4) FINDINGSAGE. The mean age of the 127 employed subjects

was 42-43 years (S.D. = 11 -83) and of the 95unemployed 41 -65 years (S.D. = 9 -66). Thesemeans do not differ significantly. The age distribu-tion does not differ significantly from that given foradult males in the 1951 Census Report for theCounty of London (General Register Office, 1953).

(a) Affective Disorder, Hysterical and ObsessionalStates.-These diagnoses are equally representedamongst both employed and unemployed subjects,but many of the unemployed had either been illfor less than 3 years or else had a personalitydisturbance as a background to the illness (Table II).No type of personality disturbance was found morefrequently amongst unemployed than employedsubjects.

TABLE II

REVISED DIAGNOSTIC GROUPS AND EMPLOYMENT

Type of Disorder Unem- Em- Totalployed ployed

Less than 3 years' 1 3duration ... . 12 3 15

Affective Stablehysterical personalities 7 37 44and More thanobsessional 3 years' Mildly

duration disturbedpersonalities 180 43 61

Inadequatepersonality

Psychopathic Gross emotional 26 9 35____________ instability

Depression ..Involutional Cerebral 6 15 21

arteriosclerosis J

Schizophrenic 1 4 15

Others (including mental defect) 15 16 31

Totals 95 j 127 222

X= 47 8; P < 0 001 (6 d.f.)

DIAGNOSIS.-Table I sets outcategories of the subjects.

the diagnostic

TABLE IDIAGNOSIS

Type of Disorder Unemployed Employed Total

Affective disorder .. 25 67 92Hysteria 8 11 19Obsessional state .. 4 5 9Involutional depression 2 8 10Cerebral arteriosclerosis and

organic deterioration 4 7 11Schizophrenia .. .. 11 4 15Inadequate personality 19 8 27Gross emotional instability . 7 1 8Mental defect .. 14 10 24G.P.I. .. .1 1 2Parkinsonism 1 1Epilepsy (without psychiatric -

complications) .. _ 2 2Buerger's disease .. 1 IThyrotoxicosis (without

psychiatric complications) . . - 1 1

Totals .95 127 222

* The ratings were: (1) "sympton free"; (2) "a few minor symptomsonly"; (3) "some symptoms present, but no disability"; (4) "handi-capped and distressed; may be receiving treatment from G.P., but doesnot require specialist psychiatric treatment"; (5) "materiallyincapacitated; required specialist psychiatric treatment".t Permission was obtained from all subjects for these files to be

consulted.

Within the group of 105 subjects with more than3 years' illness there is a clear association betweensevere mental ill-health and unemployment, whichis statistically significant at the 0- 1 per cent. level.There were eighty subjects in this group who were

employed; of these subjects those who were improv-ing in economic position were more often of stablepersonality and of better mental health, while thosewho were deteriorating in economic position were

often of worse mental health with disturbedpersonalities. This last association was statisticallysignificant at the 1 per cent. level.

(b) Involutional Illnesses.-In this group subjectswith depression and those with organic deteriorationmay be classed together, for their problems ofoccupational adaptation are essentially the same.With the exception of one man aged 48 years, allthe subjects were in the sixth and seventh decades,and showed the rigid personality pattern typical ofsuch illnesses. Three-quarters of them were

employed, and, although a number of them hadbeen skilled workers, all were now employed inunexacting occupations: messenger, night-watchman,

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PSYCHIATRIC DISABILITY AND EMPLO YMENT. I

lift attendant, door-keeper, etc. Of the six who were

unemployed, three were considered to be too ill towork: one had only recently been discharged fromhospital and had probably not yet had time to finda suitable job, one was pensioned off and could nottherefore be regarded as still part of the labour force,and information was lacking for the sixth.

(c) Schizophrenia.-Only four of these fifteensubjects were employed. Three of them had beendischarged from hospital for over 5 years, andcould be regarded as much improved. There wereno signs of active schizophrenic illness in any ofthem, and they were all employed in unexactingoccupations. The fourth, who had a mild chronicparaphrenic illness, had never been treated, andmaintained a precarious and eccentric adjustmentas labourer in a confectionery factory, where heheld Bible meetings in the lunch-hour breaks. Thepersonalities of all four were relatively well-preserved. Of those who were unemployed, fourwere ill, exhibiting frank schizophrenic psycho-pathology, and in need of treatment, six had a

chronic illness with deterioration and schizophrenicpersonality defects, although the illness was no

longer active, and one had only recently beendischarged from hospital.

(d) Inadequate Personality.-This diagnosiscustomarily leans heavily on the occupationalhistory, but this is insufficient in a study whichseeks to relate psychiatric illness and employment.The outstanding characteristic of these subjectswas the inadequacy of their affective responses atthe interview. The majority were unemployed, andthe eight who were employed were in shelteredoccupations, e.g. Remploy, Local Authority, hospi-tals. The impression was left that, althoughemployed, these men were not in fact at work.

(e) Emotional Instability.-This was representedby a group of eight disturbed, difficult, and aggres-sive men. One man when interviewed roundlyabused the authorities for not awarding him a

pension, then admitted that he had not bothered toappeal against the tribunal's decision, and finallyasked the investigator for a loan of £50. Anotherwas under treatment for exhibitionism, and anotherhad been sent to prison for forging his Post OfficeSavings Book. Only one man in this group was

employed, and he was a clerk; it is to be noted thathe was capable of more exacting work than thepsychopaths of inadequate type in employment whowere discussed in Section (d).

(f) Mental Defect.-24 subjects were diagnosedas being feeble-minded, and the outstanding finding

is the age distribution. With three exceptions, allthe ten employed defectives were under 35 years ofage, and all the fourteen unemployed defectiveswere aged 35 years or older. Data obtained fromthe Ministry of Labour do not confirm this finding,which must therefore be considered unreliable.

(g) Other Conditions.-The employed subject withG.P.I. was very similar in many ways to the groupof employed subjects with involutional illnesses,and he was employed as a hospital porter. Theunemployed subject was much deteriorated. Theremaining five, who were all employed, were ofstable personality, and some were employed in spiteof a considerable physical handicap. The subjectwith thyrotoxicosis, for example, also suffered fromangina pectoris and intermittent claudication; hehad had to give up a job as sales representativeowing to his difficulty in travelling, and now earnsa livelihood by typing at home.

Table II summarizes the clinical findings whichare relevant to employment, and there is a statisti-cally significant association between these clinicalgroups and employment. In this Table the twogroups of psychopathies have been added together,and the two groups of involutional illnesses; this isconsidered justifiable as the employment behaviourof the added groups is very similar. Mental defectwas not considered separately because it was notthought to be a reliable figure.

OTHER CLINICAL FEATURES.-Apart from diag-nosis, the two groups of employed and unemployedsubjects differed in other respects.* The followingclinical features distinguished the unemployed:insomnia, loss of weight, hysterical conversionsymptoms, ideas of reference, lack of irritability oraggressive outbursts, neglected appearance, dis-turbed mood, low or deteriorated intelligence(clinical estimate), presence of abnormal featuresin the mental state, lack of insight into the effect oftheir illness on their occupation, and greater atten-dance at out-patient clinics. They were more oftensuspicious or hostile at the interview, but onlytwelve of the unemployed and three of the employedshowed any marked degree of resentment orhostility. In personality traits the unemployedtended to be immature, irresolute, lacking in socialand personal responsibility, of shallow affect, andintroverted. In the ischaemia pain endurance testthe employed subjects complained sooner than didthe unemployed. In all other clinical findings therewas no significance difference between the twogroups. In the Dominoes Test of general mental

* Unless otherwise stated, all the differences reported arestatistically significant (P < 0 *05).

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ability the mean score of employed subjects wassignificantly higher than that of the unemployed.This difference was still upheld when the schizo-phrenic, feedle-minded, and organic disease of caseswere excluded. Neither the mental health ratingsnor the Cornell Index differentiated significantlybetween the two groups.

PERSONAL AND SOCIAL DATA.-38 of the unem-ployed subjects were single men, 56 were married(including the twelve in which the marriage hadbeen complicated by divorce or separation), and onewas a widower. Of the employed 35 were single, 91were married (including nine cases complicated bydivorce or separation), and one was a widower.The higher proportion of single men amongst theunemployed is statistically significant when com-pared both with the employed and with the figuresfor London Administrative County (GeneralRegister Office, 1953).*

Further distinguishing features of the unemployedgroup were a disturbed or unhappy home atmos-phere as a child, present marital unhappiness anddomestic friction, deficient social interests andactivities, and frequently a lack of service in theForces. Few were receiving pensions.There was a difference between employed and

unemployed subjects in their attitude to their present

* It is of interest to note that the diagnoses of schizophrenia,psychopathy, and mental defect were made in nearly two-thirds of theunemployed single men.

economic position: the majority of the employedsubjects either definitely liked their work or wereactively looking for a change ofjob, but the majorityof the unemployed subjects were not very disturbedabout their unemployment, although they were notsatisfied.

Registration had been advised by the Ministry ofLabour or the subject's doctor in many cases, but31 of the employed subjects and five of the unem-ployed had registered as Disabled at the request oftheir employers. This difference is significant. Onlyeighteen of the unemployed subjects and 26 ofthe employed had attended Government TrainingCentres or Industrial Rehabilitation Units or hadbeen employed by Remploy.

OCCUPATIONS OF REGISTERED PSYCHIATR1CALLYDISABLED.-It was expected that the majority ofdisabled persons would be employed under certainspecial conditions. These conditions include nodirect loss to the employer from inefficiency, noactive pressure from competitors, and employmentswhere national policies concerning disabled personshave most influence; these employments tend also tobe those where the tasks are not exacting to thesame degree as those in industrial employment forcompetitive markets.These conditions obtain in all forms of employ-

ment by public utilities, and local and centralgovernment, and over half the employed subjectsare found in such employments (Table III). The

ILE IIICOMPARISON OF PERCENTAGE DISTRIBUTIONS OF OCCUPATIONS OF REGISTERED PSYCHIATRICALLY

DISABLED MEN

General Categories of Workers Included Total Unemployed Employed and Total EmployedDescription (all interviewed) Interviewed invited to Interview

Builders' Labourers All types of unskilled workers in building construc-tion, and decoration

_________________.._ .._ .._17 1_ 18

Labourers .. .. All general labourers. 18 12 J

Personal Service .. Shop assistants, domestic workers .. ... IS 28 10 17

Factory Workers .. Machine tenders and assembly factory workers.. J

Self-Employed .. Engaged in running own shop, distribution andrepairs, dealing, street vending, etc. 7 5 2

All clerical workers, other than those in publicClerks and emlyenISupervisors employment. 6 6 6

Shop managers, foremen, chargehands, etc. .. J

Skilled Workers .. Apprenticed and specially-trained workers, otherthen those in public employment .. .. 4 11 7

Employed in PublicUtilities, Local and All types of worker .16 55 50Central Government

No Job since 1950 4 - _

Total .100 100 100

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PSYCHIATRIC DISABILITY AND EMPLO YMENT. I

large difference between the proportion of employedand unemployed persons in these occupations alsoindicates that of disabled persons who are employedrelatively few have fallen out of these employments.On the other hand, builders' labourers whendisabled are particularly exposed to unemployment.The category of skilled workers shows exactly theopposite trend, for disabled persons when qualifiedand employed in their own crafts do not readilyfall out of work.Table III also shows that there is no material

difference between employed subjects who volun-teered to come for interview and those who did not.The difference between total employed andinterviewed displayed in Categories 2 and 3 may bedue to the precarious nature of employment,apprehension, and loss of earnings involved incoming for interview. That displayed in Categories6 and 7 suggests that leave of absence could easilybe obtained and may account for the slightly largerproportion among persons interviewed.

INCOME* AND FINANCIAL INCENTIVE TO RETURNTO WORK.-The comparisons in Table IV weremade to discover whether the group of unemployedmen differed in earning capacity when last inemployment from the group of employed men. Itwill be seen that only the single men show adifference so large as to be clearly not due to changesin the value of money, or wage rates. This mightsupport a contention that the unemployed singlemen are a differently constituted group from theemployed single men (see Footnote on p. 42).The financial incentive to return to work is

indicated by the difference between the presentincome of the unemployed from all sources com-pared with the income obtained when lastemployed (Table IV). Most of the single men arehowever living with their parents, and, althoughregular payments were said to be made for boardand lodging, in general such payments were excusedif the parents or siblings were employed, and thefinancial incentive to return to work is corres-pondingly reduced for this group. Married men

* Includes family allowances, wife's earnings, etc.

without dependents have therefore the highestincentive and in fact they form a smaller proportionof the unemployed than do single men or those withdependents (Table V).

TABLE VPERCENTAGE DISTRIBUTION OF MARITAL STATUS OF

UNEMPLOYED AND EMPLOYED REGISTEREDPSYCHIATRICALLY DISABLED MEN

Marital Status Unemployed Employed

Married with Dependants 34 38Married without Dependants 14 31Single . . 52 31

Total .100 100

(5) DISCUSSIONAdaptation is probably specific for each group of

occupations. Table III indicates the range ofoccupations encountered in this study. Thesefindings are further restricted in significance by thefailure of many of the employed men to attend forinterview. Their refusals cannot be attributed totheir occupations, which were similar to those ofthe employed men who volunteered (Table III), butwere probably due to differences in personality ormental health. Only tentative conclusions can bereached therefore in this discussion.

CLINICAL FINDINGS.-Employed men tended tohave rather higher wages and total income thanthose secured by the unemployed in their previouswork. Failure to gain employment may there-fore represent an acute episode in the chroniccondition of lacking value in the labour market.Can such a condition be defined in psychiatricterms ?

(a) Type of Illness.-The diagnosis does not seemto bear any special significance for occupationaladaptation in these subjects, apart from thesyndromes which imply particular types ofpersonality structure or disorganization. In theprevious investigation by Lewis (1935) a uniformclinical picture was observed in which hysteria waspredominant, but this was not found in the present

TABLE IVCOMPARISON OF MODAL INCOMES (£), SHOWING FINANCIAL INCENTIVE TO RETURN TO WORK

Employed UnemployedMarital Status Financial Incentive to

Present Total Income Previous Total Income Present Total Income Return to Work(1) (2) I (3) (2)-(3)

Married with Dependants .. 9-2 8-3 6-0 2-3Married without Dependants 10*0 9*0 4-8 4-2Single 7*0 5 *4 2-0 3 *4

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investigation. Moreover, gross hysterical features(tremor or pseudo-dementia) were found morefrequently by Lewis than by the writers. Thereasons for this difference are still far from clear,but it has been noted and discussed by otherobservers (Halliday, 1948).

(b) Mental Health.-There is evidence that arecent disturbance of mental health affects occu-pational adjustment adversely. It is uncertainhowever which is anterior in this relationship. It islikely, for example, that depression is a directconsequence of being without work; some of theunemployed have been seen again since the surveywas made, and there has been an obvious lighteningof mood in those who have found work. Furtherfollow-up studies are needed to elucidate thisproblem, but it is already clear that unemploymentand mental ill-health have an effect of mutualenhancement.The ratings of mental health and the Cornell

questionnaire provided no evidence to suppose thatthe unemployed men were, as a group, moreseverely ill than the employed. Although, therefore,mental health is one factor in occupational adjust-ment, it is plainly insufficient to account for all thefindings.

(c) Personality.-The findings in this investigationleave small doubt that the occupational adaptationof these subjects is largely governed by quality ofpersonality. The analysis of the ratings ofpersonality traits indicates the qualities whichengender poor adaptation, and this clearly reflectsthe finding that unemployment is heaviest in thegroups of inadequate and unstable personalities,and in schizophrenia. Even in the neurotics whowere employed, the economic position of those withdisturbed personalities tended to deteriorate.Another aspect of the differences in personalitybetween the employed and unemployed groups ofsubjects is to be seen in their attitude to their presenteconomic position and in their poor use of leisure;it may be that these men are ineffectual in all theiractivities.Such findings were adumbrated in previous

investigations, although in this respect there is aninteresting discrepancy: bitter and resentful attitudeswere not often found during the present study. Thisis not easy to explain: for the unemployed the worldis patently a different place now from what it waswhen Lewis first made his observations in 1931,yet the "welfare state" had failed to assuage thebitterness of the control group of disabled menreported by Jones (1952), or of the disabled menexamined by Hewitt (1949).

It is easier to talk about "personality traits" thanto define them. At best they are illuminatinginferences from observed behaviour, and they maybe much less than that. Moreover, the separationof "personality" from "mental health" is at timesarbitrary, as in the diagnosis of psychopathicpersonality, so that a more accurate statementwould be that in the subjects investigated thepermanent characteristics of a person's behaviour-revealed both in the history and on psychiatricexamination-are of the first importance indetermining the subject's occupational adjustment.

SoCiO-ECONOMIC FINDINGs.-The most importantfact arising from the socio-economic findings is thedifference in the levels of financial incentive offeredto the three groups ofmen (married with dependents,married without dependents, and single). As theearning potential of the unemployed persondecreases, so the financial incentive to resume workalso tends to decrease in effectiveness, even to theextent that among those having the lowest earningswhen employed the adjustment of choice might be astate of unemployment. The work records of theunemployed often show a surprising degree offamiliarity with the regulations and conditionsgoverning the payment of benefits of all types, andbetray a skill in manipulating these regulationswhich in itself represents a high degree of"adaptation".

REHABILITATION.-Two separate problems seemto be involved. Men with stable or well-preservedpersonalities, especially those who have onlyrecently fallen ill, merit the maximum attentionfrom those responsible for resettlement. Such menare likely to return to industry as efficient workersregardless of diagnosis, and it is possible that theperiod of total disablement could be reduced. There-employment of men with inadequate personali-ties, however, may not amount to much more than asocial service; the impression formed by the presentinvestigators was that such men are not able tocompete successfully with more productive workers.Careful assessment of personality is needed toobtain successful resettlement, and this requirescloser co-operation between the doctor and thedisablement resettlement officer than can be obtainedfrom the simple filling in of a form.

SUMMARY(1) 222 men, all registered as disabled persons

through psychiatric conditions, were examined; 95were unemployed and 127 employed,

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(2) The clinical and social histories of theemployed and unemployed men were contrastedand compared.

(3) The following tentative conclusions werereached:

(a) Occupational adaptation is primarily deter-mined by the personality of the subject.

(b) The subject's occupational adaptation isadversely affected by recent disturbances ofthe mental state, but not so much as bydisturbances of the personality.

(c) The type of mental disorder is withoutsignificance for occupational adaptation unlessit also implies a serious personalitydisturbance.

(d) Subjects who can earn only low wages havelittle or no financial incentive to regainemployment.

(4) Successful rehabilitation of the psychiatricallydisabled largely turns on whether the workerpreviously had a stable personality and asatisfactory work record.

Acknowledgments are made to Professor Aubrey Lewis,Honorary Director of the Unit, for guidance andcriticism throughout, and to Dr. G. M. Carstairs for

special assistance in the "follow-up" clinic. The prepara-tions for, and the planning of, the survey were greatlyassisted by conferences with the headquarters staff of theMinistry of National Insurance, the London and South-Eastern Regional Office of the Ministry of Labour andNational Service, and the National Assistance Board.This investigation could not have been carried out withoutthe invaluable co-operation and suggestions of theGroup Disablement. Resettlement Officer, and theManagers and Disablement Resettlement Officers of theSouth London Area.

REFERENCES

Eisenberg, P., and Lazarsfeld, P. F. (1938). Psychol. Bull., 35, 358.General Register Office (1953). "Census 1951, County Report."

H.M.S.O., London.Guttman, E., and Thomas, E. L. (1946). "A Report on the

Re-adjustment in Civil Life of Soldiers discharged from the Armyon account of Neurosis." Ministry of Health Reports on PublicHealth and Medical Subjects, No. 93. H.M.S.O., London.

Halliday, J. L. (1948). "Psychosocial Medicine", p. 112. Heinemann,London.

Harris, A., and Lane, M. A. (1949). Brit. med. J., 1, 982.Hewitt, M. (1949). Lancet, 2, 523.Israeli, N. (1935). J. apple. Psychol., 19, 67.Jones, M. (1952). "Social Psychiatry." Tavistock Publications,

London.Lewis, A. (1935). Lancet, 2, 293.Markowe, M., and Barber, L. E. D. (1952). Brit. J. industr. Med.,

9, 221.- -(1953a). Ibid., 10, 125.-- (1953b). British Journal of Preventive and Social Medicine,

7, 205.Morton, N. W. (1935). "Occupational Abilities: a Study of Unem-

ployed Men", p. 96. Oxford Univ. Press, Toronto.Stalker, H. (1945). Brit. J. phys. Med., 8, 18.

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