ADHD (Attention Deficit Hyperactive Disorder) was a syndrome defined by Henrich Hoff for the first time in 1854. This problem has been known by various other names like, Minimal Brain Dysfunction (MBD), Hyperkinetic Syndrome, Strauss Organic Driveness Syndrome etc. The general onset of the condition is below 7 years of age. The reported prevalence is probably 3%-5%. The male to female ratio in prevalence is reportedly 5:1. A majority of children show symptoms by the 4th year of life. The child shows the following symptoms, including poor attention span with distractibility (i.e does not seem to listen, easily disrupted by external stimuli), hyperactivity (fidgety, difficulty in sitting at one place for long, moving about here and there) and impulsivity.

At present the types of treatment for ADHD, which have been advocated by various professionals, has been either behavioural therapy or pharmacotherapy. But, in our society, as it is with all such disorders, the entire emphasis of the treatment has been using psychotropic drugs. I have been trying to explore the reason for such a skewed leaning towards drug therapy in this disorder, even though my experience in field has given excellent results with behaviour therapies. I have not had to use even a single dose of medicine. The entire focus of the therapy is to use a different technique to enhance the learning ability of the child. The reason is very logical, as the behaviour therapy enhances the attention of these children. As far as my knowledge goes, no drug can do this job. Once we have been able to enhance the attention of the child, it becomes easy to draw his / her attention to a particular stimulus and by reinforcing proper responses of the child, we can induce learning.

In practice, however these children go to the psychiatrist, who in all cases without exception, try to treat them with drugs. They do not offer any other mode of treatment. These poor children are seldom referred to a therapist. This is very sad because therapy has shown excellent results in these cases. One of the reasons, which I could think of for this trend, could be due to ignorance of the parents and psychiatrists. Probably there is also a defect in our medical education system, which has gradually become over-medicalised, even in the psychiatry field. Lack of resources like availability of therapist can also be an important reason.

I strongly believe that not only ADHD, but a few other similar problems must be treated in a separate wing of general hospital which could exercise behavioral treatment at the right time (early age) in their lives. In fact delay in proper treatment also makes treating these cases later on more difficult.

In order to reinforce my view I am putting a case story of a four years old boy of an upper class family.

The child has gone through various medical examinations, but facts about a clear diagnosis was not explained specifically to his parents, though he was treated with several psychiatric and other medicines. Methylphenidate (Ritalin) has also been given to him.

The drug companies have been pushing this drug by means of advertisements, which reinforce the medicalised model. Inspite of controlling abnormal responses, the medicines induced huge sluggishness in the child's activities. His participation in all routine activities became very passive. Throughout the day, the child used to sit quietly with head bent and face facing downward. The medicine also increased his sleep duration. He stopped taking adequate diet as he was taking earlier. He used to go to his grandfather earlier and interact with him, which he had completely stopped. Earlier he was playing self - exploratory games (taking small object in hands and manipulating it for seconds), which he totally stopped.

Even though there were a host of other symptoms in the child I could specifically ascribe these to be the side effect of Ritalin. And surprisingly the parents were not aware that these are the side effects of the medicine the child were taking, rather they felt that the condition of the child was worsened.

The parents realized that there is something adverse happening with this medicine so they gave up the treatment. Parents travelled a lot, with the doctor shopping approaches they had. Then being fed-up they stopped for couple of months. Meanwhile the child acquired many other behavior problems.

Meanwhile the organisation started a day- care center in Barwani town. Parents were asked to keep their child in this center for management. Here a maladaptive behavior checklist was administered and a behaviour package on the basis of ABC model (William Yule 1982) was designed and applied with close monitoring by the therapist. Continued duration and frequency recording was made for three days. After only a weeks time, the child was seen sitting quietly and doing scribbling / playing with small objects for 30-35 minutes without any distraction. He also started using ideomorphs (self made words) while maintaining eye contact for more than 30 seconds. He pays attention to commands /instructions given by parents / therapist in simple sentences.

What kind of initiatives shall be created to meet the (Behavioural Intervention) needs of such children?

statements. The FDA has also ordered all manufacturers of atypical anti-psychotics, including Eli Lilly, to add a warning statement to their drug labelling, stating risk of hyper-glycemia and diabetes.

In the 10th Plan, 190 crores has been sanctioned by the central government to strengthen the mental health sector in the country. The DMHP was sanctioned 27 districts in the 9th Plan. The remaining 23 districts are to be sanctioned funds for the DMHP in the 10th Plan. A total of 63 crores has been allocated for this purpose. 10 crores have been allocated for IEC activities, and another 5 crores, for research and training. The remaining funds (a whopping 112 crores) have been allocated for strengthening the bio-medical service programs in mental health, namely, the mental hospitals and the medical college / GH psychiatry departments. Let's be prepared for more drugs and shocks, folks! If we remember that the DMHP models set up by NIMHANS are anyway bio-medical in their practice, we can literally write off the entire 10th plan budget as drug and shock money.

There is consensus on the fact that sexuality forms an important aspect of an individual's identity and that positive experiences around one's sexuality are an important indicator of well-being. However, when it comes to the sexuality of the sexual minority group, the picture changes completely; sexuality is no more looked upon as a positive, self-affirming experience, a vital form of human communication. Instead, it becomes an issue shrouded with a number of negative and sometimes hostile beliefs and reactions.

Lesbian and Gay (LG) individuals experience discrimination at various levels due to a socially stigmatised sexual identity.

The state criminalizes their sexual expression (IPC, Sec. 377), the police harass them under the shield of the law; marriage/union for them is illegal, hence all the benefits that are automatically conferred upon heterosexual marriages such as social recognition, security, parental rights etc. are denied to them. The media renders them invisible with either no representations or distorted images of their lives. The health and the mental health systems 'pathologize' their behaviours.

Lesbian/Gay Identity & Psychiatric Vulnerability:
Community-based surveys provide empirical evidence that sexual minority status is a significant risk factor for LG adolescent's physical and mental health. These youth face a greater number of stressful events and have access to less social support that their heterosexual peers (Safren & Heimberg, 1999). The unique stress factors that affect sexual minorities include verbal and physical victimisation, which are known to exacerbate psychiatric morbidity (Hershberger & D'augelli, 1995).

LG youth are at greater risk for major depression, generalised anxiety disorder, conduct disorder, substance abuse, suicidal behaviours, sexual risk taking and poor general health maintenance than are their heterosexual peers (Fergusson, Horwood & Beautrais, 1999; Lock & Steiner, 1999; Safren & Heimberg, 1999). The report of the Secretary's Task Force on Youth Suicide (Gibson, 1989) reports suicide to be the leading cause of death among LG and bisexual youth, with LGB youth being two or three times more likely to kill themselves than their heterosexual counterparts. In fact, LGB suicides constitute 30% of all adolescent suicides (Remafedi, 1987; Farrow & Deisher, 1991). Similarly, the National Institute on Drug Abuse (1991) has indicated that, the lifetime prevalence rates for LGB youth are 50% higher for alcohol, three times higher for marijuana and eight times higher for cocaine/crack. This increased substance abuse may be indicative of the high stress that LGB youth experience because of their sexual orientation. It may also reflect the reality that for many youth of both sexes, the bar subculture, with it's emphasis on alcohol has been a main entry into adult LG communities.

Mental Health Practise / Clinical Issues:
Studies on psychological adjustment of LG individuals in comparison to heterosexual men and women have shown no differences on various personality and adjustment dimensions (Hopkins, 1969; Ross et al. 1988; Thompson et. al. 1971; Dean & Richardson, 1964).

Influenced by these and similar findings as well as due to various political reasons, the American Psychiatric Association passed a resolution for the removal of 'homosexuality' from it's list of mental disorders (APA, 1974).

The statement approved by the board of trustees reads as follows -

"Homosexuality per se implies no impairment in judgement, stability, reliability or general social or vocational capabilities, therefore it be resolved that the American Psychiatric Association deplores all public and private discrimination against homosexuals in such areas as employment, housing, public accommodation and licensing and declares that no burden of proof of such judgment, capacity or reliability shall be placed upon homosexuals greater than that imposed on any other persons..."

Since then, empirical research has been carried out to demonstrate a positive association between 'affirmative LGB identity' and feelings of self-worth (Helminiak, 1989; Savin-Williams, 1990), well being (Carlson & Steuer, 1985) and psychological adjustment (Hammersmith & Weiberg, 1973). This knowledge base has provided practitioners with an important implication that the consolidation of an 'affirmative sexual identity' is associated with positive mental health.

However, despite these findings, the Committee on Lesbian and Gay Concerns of the American Psychological Association found that many psychotherapists are unaware of the specific difficulties experienced by LG individuals (Garnet, Hancock, Cochran, Goodchilds & Peplau, 1991). Psychotherapists have often acted in ways that increase distress among LG individuals -

A survey of 2500 members of the American Psychiatric Association (Time, 1978, as cited in Marmor, 1980) found that the majority of members considered homosexuality as pathological and perceived homosexuals to be less capable of mature and loving relationships than heterosexuals. More recently, the American Psychological Association task force on heterosexual bias in psychotherapy (Garnets, Hancock, Cocharn, Goodchilds and Peplau, 1991) surveyed over 2500 members of APA and found -

• Psychologists differed in their use of gay-affirmative practise

• Biased, inappropriate or inadequate practise was found in the understanding, assessment and interventions of a wide range of topics such as, identity development, lesbian and gay relationships and parenting

Smith, Johnson & Guenther (1985) studied over 2,000 lesbian and bisexual women to investigate sexual orientation disclosure to health practitioners. Over 40% of the sample believed that disclosing their sexual orientation to their gynaecologist would hinder the quality of their medical care, and 1/3rd of the sample had not disclosed their sexual orientation for this reason. Green (2000) in his introductory note to the special issue on "LG issues in family therapy" of the Journal of Marriage and Family Therapy stated that nearly half of the All American Association for Marriage and Family Therapy (AAMFT) members did not feel competent in dealing with lesbian or gay individuals in therapy (Doherty & Simmons, 1996), even though a large majority of these therapists (72%) report that at least one out of every10 cases in their practise involves gays or lesbians (Green & Bobele, 1994).

Outcome research on conversion therapies has pointed out the limitations of these therapies in changing the sexual orientation of homosexual clients besides highlighting the ethical issues involved in such therapies (Haldeman et. al. 1994; Ramaswamy, 1982).

As a response to this growing evidence of homophobia among practitioners and the knowledge that the clinician's value system has an influence on the therapy process, the American Psychological Association (2000) brought out "Guidelines for Psychotherapy with Lesbian, Gay and Bisexual clients". There are sixteen specific guideline principles, which would serve as reference points for therapy with LGB individuals. Some of the areas covered include-

Thus awareness of the developmental milestones in the formation of a gay/lesbian identity, effects of growing up in a heterosexist society with no LG images for identification and effects of gay/lesbian-related stress and stigma would be important tools for practitioner's aspiring to carry out ethical and informed mental health practise.

APA, (1974). Position statement on homosexuality and civil rights. American Journal of Psychiatry, Vol 131 (4), April, pp. 497

Carlson & Steuer (1985). Age, sex role categorization and psychological health in American homosexual and heterosexual men. Cited in Elizur, Y. Mintzer, A. (2001). Family support and acceptance, gay male identity formation and psychological adjustment: A path model. Family Process, Vol. 40 (2), pp. 125-143

D'Augelli (1991). Gay men in college: Identity processes and adaptations. Cited in Savin-Williams, R. (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male and bisexual youth: association with school problems, running away, substance abuse, prostitution and suicide. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 261-269.

Deshmukh, V. (2000). An exploratory study of homosexuals in the city of Bombay, M.A. Dissertation submitted to TISS (Unpublished)

Fergusson, Horwood & Beautrais, (1999). Is sexual orientation related to mental health problems? Cited in Elizur, Y. Mintzer, A. (2001). Family support and acceptance, gay male identity formation and psychological adjustment: A path model. Family Process, Vol. 40 (2), pp. 125-143

I read about myself only on bathroom walls: the need for research on mental health of lesbians and gay men. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 213-220

Haldeman, D. (1994). The practise and ethics of sexual orientation conversion therapy. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 221-227.

Hammersmith & Weinberg (1973). Homosexual identity: commitment, adjustment and significant others. Cited in Elizur, Y. Mintzer, A. (2001). Family support and acceptance, gay male identity formation and psychological adjustment: A path model. Family Process, Vol. 40 (2), pp. 125-143

Hershberger, S. (1993). Lesbian, gay, bisexual youth in community settings: personal challenges and mental health problems. American Journal of Community Psychology. Vol. 21 (4), pp. 421-446. Hopkins, (1969)

Lock & Steiner (1998). Gay, lesbian and bisexual youth risks for emotional, physical and social problems: results of a community based survey. Cited in Igartua, K. (1998) Therapy with lesbian couples: the issues and interventions. Canadian Journal of Psychiatry, Vol. 43, May, pp. 391-396.

Martin & Hetrick (1988). The stigmatisation of the gay and lesbian adolescent. Cited in Savin-Williams, R. (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male and bisexual youth: association with school problems, running away, substance abuse, prostitution and suicide. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 261-269.

Rangaswamy, K. (1982). Difficulties in arousing and increasing heterosexual responsiveness in a homosexual - A case report. Indian Journal of Clinical Psychology, Vol. 9, (1-2) pp. 147-151

Remafedi (1987). Male homosexuality: The adolescent's perspective. Cited in Pillard, R. Bailey, M. (1995). A biologic perspective on sexual orientation. The Psychiatric Clinics of North America, Vol. 18 (1), pp. 71-84

Ross (1988). Homosexuality and mental health: A cross-cultural review. Journal of homosexuality, Vol. 15, pp. 131-152.

Safren & Heimberg (1999). Depression, hopelessness, suicidality and related factors in sexual minority and heterosexual adolescents. Cited in Savin-Williams, R. (1994). Verbal and physical abuse as stressors in the lives of lesbian, gay male and bisexual youth: association with school problems, running away, substance abuse, prostitution and suicide. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 261-269.

Savin-Williams (1990). Verbal and physical abuse as stressors in the lives of lesbian, gay male and bisexual youth: association with school problems, running away, substance abuse, prostitution and suicide. Journal of Consulting and Clinical Psychology, Vol. 62 (2), pp. 261-269.

Thompson (1971). Personal adjustment of male and female homosexuals and heterosexuals. Journal of Abnormal Psychology, Vol. 78, pp. 237-240.

Ketki Ranade is trained in psychotherapies from the Psychiatric Social Work Department, NIMHANS, Bangalore. She is presently with Seher, a psychotherapy center working with women in Pune city. She can be contacted at rketki@yahoo.co.in

Petals that blossomed yesterday are treasured as pot-pourri,

Memories they are of love and glory.

Sitting by the window, a little gray haired and solemn, feeling left-out, abandoned and rejected,

The dusk comes a - calling upon her youth, forced to face depression, she seems pretty neglected.

She always thought he'd be there for her whenever she needed, but all her loving requests were seldom heeded.

He too had his qualms and queries of middle -age,

Mind, Money matters, and above all Mortgage.

Children had left home long ago, busy as bees, they were neither friend nor foe.

She missed the times when kids were kids and there was a noisy milieu,

At least back then she had someone to say a word or two,

But kids grew up and left mamma far behind, on career paths they brilliantly treaded but to her woes they were blind.

He spent night hours playing "Solitaire",

She tugged along, yet full of despair,

She cooked and she washed and she cleaned good enough, a homemaker she was any man could be proud of,

He too was perfect and had excelled in his pursuits, winning accolades for giving top priority to his work,

But in her eyes he had recently grown to be a cold-blooded jerk!

He wasn't any more; one she had fallen in love with,

There was a question now of; "How they'd fare?"

In love they had grown far apart; which of course wasn't so nice.

So they thought they'd seek some professional advice,

Off to a counselor who'd lend them an ear, they were upbeat about joy they'd acquire

The counselor was compassionate and understanding, "we'll see" said she, "what can be done of the finding",

"Work upon the 'I's to make them 'Us' all you need to do is focus on the binding!

Give it some time don't be in a hurry. Questions they are which you just cannot parry.

There is indeed a candle that can ignite the spark much needed

A tight clasp of hands, embraces unheeded

People say what they want to, you needn't care

It's time you think about yourself of whom lately you haven't been much aware

Lessen the solitude and bind the souls together

I assure like fairy tale couples you too could live happily ever after

The advice worked and they began acknowledging one another"

Custodial institutions have existed for decades. But the definition of "crime" has changed with the transformation of society. Here, I am writing about the "wandering mentally ill". The state institutions criminalize this highly marginalized group. This group comprises of the mentally ill persons among the beggars, homeless, destitute women, rag pickers and mentally ill persons abandoned by their families.

This is done by magistrate custody. Rules and regulations similar to prisons are applied here. They have barracks, like the jail. Inmates have to wear clothes given by the institution. Inmates have no liberty as the gate remains closed. A little manual activity is provided, such as tailoring, broom making farming etc., with a minimal remuneration, e.g. 5 Rs. per month. This is very less compared to the jail, since the incarceration period is very less, as per the letter of the law.

Authorities report that beggars' homes are much better than the mental hospital. The mental hospitals are crowded with inadequate services and the admission procedure is very complex. Therefore, they are admitted directly in to the beggars' home. However, conditions are not the same everywhere, despite the best efforts and initiative by some officials. Especially in Mumbai, the male ward of the Chembur beggars' home is very pathetic, where the present capacity is around 850 inmates. Presently nearly 350 inmates are detained in remand. This male ward is very dirty, the environment is not at all hygienic. There is a large spread of communicable diseases wherein, out of every 10 inmates, 2 inmates are chronically sick. They need proper health treatment. Even though they have a dispensary inside the ward, the doctor is hardly seen there. The inmates' ward is almost stinking. The death rate here is 2 or three inmates in a month.

Reportedly, most of the inmates in the beggars' homes are mentally disordered. For example, the Chembur beggars home (women cell) in Mumbai has a capacity of around 350 inmates. Presently 210 women have been convicted, among whom only 20 per cent are "active", meaning that they can work and have the capacity to understand. Mostly stress related conditions, depression and anxiety are found among them. Migrating poor from the rural areas especially draught affected areas left their homes in a depressed mind, searching for livelihood in the city. For years and years, they have been wandering, and because of that, they have forgotten their name, address and the family. Therefore, the probationary officer from the beggars home complained of having a difficulty to prepare their case history. The magistrate sometimes gave 15 days' time for remand custody, for taking out all necessary information. But this does not explain why they keep persons in the beggars home, for more than four or five months as an under trial. There are no initiatives to minimise distress or to enhance mental health. There is a need to start counselling facilities or psychotherapy in these institutions.

"find the beggars and shoot them first". Andhra Pradesh has a record of inhuman treatment of beggars to sanitise the city. The state does have a begging prevention legislation act 1977, but they do not have beggars homes. Beggars are collected and left far away outside the city, or in the jungle, and those who survive wander back. It is a story what happened to the beggars when Bill Clinton visited. During these times, whatever family and social ties are there is also lost. Only recently, the social welfare department has constructed one beggars home for adolescents.

The identification of beggars is also a controversial issue. Generally, if the person is found to be unkempt and wearing dirty clothes or was lying in a public place, they were considered as beggars. Among the people I interviewed, one young lady reported that she was lying on the railway station platform. Her clothes had become so dirty and muddy. The probationary officer arrested her and took her to the beggar's home. She is a graduate, unemployed woman searching for a job. She was too tired to walk and she slept on the platform. The police have an objective of arresting so many persons and filling up the space in the beggars' homes. The beggars homes are not filled to capacity, even though there are many wandering persons on the streets.

There is no procedure for transfer of persons between institutions for sharing the responsibilities of care. In some homes, a psychiatrist may visit occasionally, but as a rule, this is not done. Referral to the mental hospital is not done, because of lack of co-ordination and procedure between the departments.

Women are very much vulnerable. We collected many stories of trauma and deprivations due to sexual assault and domestic violence. Their husband or their sons abandon women. Women have also been abandoned due to inability to deliver a child. So many old women who are now more than 65 years of age are expecting that somebody will come and will take them out of this home. In this time, they have totally been deprived of liberty.

any other status, such as mentally ill status. Article 13 of the ICCPR says that everyone has the right to freedom of movement and residence. Living conditions in the beggars' homes or in the mental hospital hamper the right to freedom and right to self-determination, since the person has nearly always been locked away inside involuntarily and they are invisible to society. The identities of these people are all masked in our society. The general community never bothered about this issue, since the first impression is that begging is an anti-social thing and it is a crime. Well, the other side of the story is that 55 million tonnes of food grains are stored in the government godowns while a 30 million population cannot avail of single roti in a day, which reduces a person to beggary. The question remains whether we can make a concrete rehabilitation center within this custodial institution, modifying it as civil society home, instead of a beggars home, where people living within it would have the freedom and right to self-determination and space for motivation and aspiration.

We do not yet have a precise definition of mental illness. The Blacks Law Dictionary defines mental incapacity as, "such is established when there is found to exist an essential privation of reasoning faculties; or when a person is incapable of understanding and acting with discretion in the ordinary affairs of life". The only kind of reference that mental illness gets in Indian laws is that of it being a legal disability. Mental illness is not merely seen as a medical condition in law, but as an important illness category, which also has many social repercussions. This is because a mentally ill person's source of livelihood is severely affected as a result of his or her condition.

Employment is a very important source of livelihood in the absence of express welfare provisions for people in such situations. Employment in the present context would mean both employed as a labourer as well as an executive in a multinational company. Mental illness becomes important in the sphere of employment because there are no expressly beneficial enactments for persons who are mentally ill or who become mentally ill as a result of certain employment and for people who were once mentally ill and have recovered and would like to be employed. The present paper proposes to examine how mental illness affects a person's employment.

The various legislations on health and labour are so constructed as if mental illness does not even exist. Though there is no dearth of labour welfare legislations in India, they have no provisions for people with mental illness. The Factories Act 1948 has a number of provisions for the health, sanitation and hazardous occupation but no provision for mental health. Section 2 (oo) (c) of the Industrial Disputes Act provides for termination of services on the ground of continued illness. This provision is very detrimental to the interests of the people with mental illness because mental illness often requires long leave of absence. Thus such a person not only loses the job but also the retrenchment benefits. 

In this case a senior security guard was absent for 257 days on account of mental illness. He did not reply to the first notice sent to him. To the second notice sent to him the worker sent a doctors certificate, which had prescribed him bed rest because he was suffering from hypertension. The third notice was given to him on the 14th November 1999 at 6 pm for a hearing, which was to take place next day on 15th November. The Industrial Tribunal upheld the enquiry, which was held ex parte against the worker. The single judge bench of the High Court of Andhra Pradesh decided in favour of the worker. When the matter came before the Division Bench of the same High Court it held that, when a person complains about the violation of principles of natural justice, he is required to show prejudice caused by it. In the present case, the worker was held to have admitted his guilt on the submission of the medical certificate at the second time when he was served the notice. Principles of natural justice in administrative law should not work in a vacuum. Here the departmental inquiry was held ex parte because the person concerned did not reply to the show cause notice, taking little notice of the fact that the worker on account of mental illness was not in a position to comprehend the relevance or the necessity of such a notice. If the courts had taken into account that mental illness at times affects a person's functional levels, then they would not have decided in the same manner as they did in the present case.

The concept of "disability acquired during the course of employment" is another serious limitation. Both the Workman's Compensation Act 1923 and the Employees State Insurance Act 1948 define disability as "such disablement, whether of a temporary or permanent nature, as incapacities a workman for all work which he was capable of performing at the time of the accident resulting in such disablement". The expression "accident" restricts the meaning of disability to just physical disability.

The court interpreted this concept very narrowly little realizing that, had he not been on the ship when diagnosed of suffering from depression, he would have been in a hospital with little chance of committing suicide.

However the recent legislation, Persons with Disabilities Act 1995, includes mental illness as a disability. Now courts have granted disability benefits if it can be proved have been acquired as a result of nature of employment. For example in  Mahabir Singh Rawat v. Union of India (2001 (034)-LIC-0685 ALL) the petitioner was an army personal who was medically fit when he joined services but later it was found that he was suffering from Neurosis Anxiety 300. The petitioner was refused disability pension on the ground that mental illness is constitutional and not attributable to service. The petitioner's contention was that the stress and strain suffered due to continual posting for 3 years in high altitude of Udhampur district, Jammu & Kashmir, caused the mental illness. The court allowed him disability pension.

In certain cases, mental illness may have a direct and proximate relation with conditions of work and the work environment. A number of desk jobs require quick decisions and prompt action, which has high stakes. Monetary benefits are dependent on the quick transactions. This is especially true of persons working in the financial sector, where the making of a lot of money depends on the ability to speculate. The resultant uncertai