This study examines the relationship between psychosocial functioning and subjective experience in 193 individuals diagnosed with schizophrenia or schizoaffective disorder according to Research Diagnostic Criteria. Psychosocial functioning was measured as work functioning, social functioning, living situation, symptomatology, and intrapsychic aspects of the deficit syndrome. Subjective experience consisted of measures of self-esteem, satisfaction with life, and subjective distress. Multivariate analyses resulted in two major findings. The first finding is a model of psychosocial functioning that consists of two factors: disorder-related variables (symptomatology and intrapsychic deficits) and functional status variables (work, social, and living situation). The second major finding is a two-tiered model of the relationship between psychosocial functioning and subjective experience. The model suggests a primary and pervasive relationship between the disorder-related variables and subjective experience and a secondary and less pronounced relationship between functional status variables and subjective experience. The implications of these findings for treatment and rehabilitation and for the study of subjective experience in schizophrenia are discussed.

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The first part of this paper presents a vocational rehabili tation model for persons with severe and persistent psychiatric disabilities; the second part tests the model against 5-year outcomes. The Menu Approach to employment combines elements of other approaches under a new philosophi calframework. The philosophy has four principles: (1) work offers many bene fits besides a means to " pay the bills"; (2) virtually all consumers can participate in and benefitfrom meaningful paid work; (3) consumers should be able to choose from a "menu" of employment options, and; (4) multiple tri als of different kinds of paid work are an important part of developing long term employment in competitive settings. An empirical evaluation of the approach, analyzing 5 years of employment data from 102 participants in anACT-based program, found 74% tried paid work, half working competitively; the average number of jobs was 3.6, with an overall average tenure of 19.8 months for all jobs combined; workers earned $561,000 over 5 years, averag ing $2,054per job; those working at competitive jobs earned more and worked more hours per week than those working at jobs in agency-owned businesses.

The authors used the Thought Disorder Index to measure thought disorder in 23 patients with unilateral right hemisphere cortical damage, 20 patients with bipolar mania, and 25 patients with schizophrenia. There were no differences in the total amount of thought disorder in these groups, but each showed a unique pattern of thought disorder. Patients with right hemisphere damage displayed fragmented thinking, manic patients displayed playful thinking, and schizophrenic patients displayed idiosyncratic thinking. These findings support the view that thought disorder is manifested in different forms that are relatively specific to psychiatric or neurological condition.