Can you really hold down a job? REALLY?

June 22, 2012 3:44 PM

How do you figure out whether or not your mental illness is serious enough to (basically) permanently stop working? Are there books or worksheets you can use to sort this out?

As some of you may remember from my previous questions, my last really huge depressive meltdown was last year - symptoms got worse from February to July, got very very bad from July to August, I spent all of September in a partial hospitalization program, and didn't get back to working full-time until two weeks before Christmas.

The time before that was July to October of 2009, with partial recovery by around June of 2010.

I never really fully recovered from the 2011 episode, but things got much worse again starting around March of this year, and on Tuesday I will be back on disability and I'm on the waiting list for the hospital. I've been increasingly suicidal (ideation, no planning,) self-harming, and dissociating/hallucinating for the last two weeks - it's gotten very very much worse on a daily basis. I don't want to think about what I'll be like a week from now.

In other words: I've been moderately to severely clinically depressed almost continuously for over three years, with some breakthrough hypomanic episodes and a few euthymic days here and there.

I've been asked by my employer to seriously consider whether or not I'm actually capable of holding down a full-time, responsible job. And I don't know the answer, or how to figure it out. When I get back from this disability period, they expect to have a formal, sit-down conversation on the subject - they straight up asked me what percentage of people with my condition hold down full-time jobs (the answer appears to be about 15%, if you limit it to "competitive" employment.)

I am smart enough and good enough to keep working in one sense -when I have things together emotionally, I'm darned good at my job. I'm articulate, I'm helpful, I'm polite. I have a good education, I write really well. I spot errors other people make and I take initiative to fix things. I improve processes and teach people stuff and so on. The trouble is, I basically can't hold things together at all outside of the five to eight hours I manage to be at the office daily (I have to be hypomanic or at least in a REALLY good place to pull off stuff like taking out the trash, etc., without supervision.) And when things are really bad, which they've been about forty percent of the time, I am brutally incompetent at work, too - I can't concentrate enough to read a short email, I burst into tears at the slightest provocation, and so on. I've been late to work almost every single day for the last three months.

Unfortunately, there's no such thing as a "show up whenever you feel like it" job - at least, not one that pays well enough to make sure the bills get paid during the one to twelve months a year when I can barely feed myself (even given the presence of edible food and the means to cook it.) I've only kept this job as long as I have because of luck (tenure, the timing of a huge hypomanic episode, etc.)

I know that going on disability will be deeply problematic logistically (and yeah, expect future AskMe questions in the future.) Right now I just need help in trying to do this analysis: how do you know if you're really incapable of holding down a responsible long-term job/it'd be unwise (for your own safety/health) to keep trying?

(Books and such are especially helpful, because I'm going to need to sit down with a family member who can help me through the analysis; I am really bad at getting anything done right now.)

posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to health & fitness (13 answers total)

Are you receiving mental health care of any sort? If so, it seems like whomever you're seeing for that care would be a very useful resource for this discussion -- more so than a family member.
posted by brainmouse at 3:47 PM on June 22, 2012

Your employer is not asking appropriate questions.

It seems that you know with very good precision the specific circumstances under which you can succeed. Have you communicated this to the employer? Is your doctor involved in the conversation?

Go to the ER if/ when you are self harming. Don't take chances with this.
posted by moammargaret at 3:58 PM on June 22, 2012

You need an assessment from a mental health care professional, possibly a couple if your insurance/resources can handle it just to make sure your bases are covered. And it's unlikely to be a one-meeting thing; you'll have to go in 3-4 times before they'll be comfortable giving you some kind of diagnosis. Testing may also be in the cards.

If you expect to go on long-term disability, this is probably something you will need to do anyway, because you'll need a professional's say-so. (Keeping in mind that whatever agency runs that will likely send you to one of their approved professionals, but still)
posted by curious nu at 4:00 PM on June 22, 2012

In case it wasn't clear, I meant to add: any analysis you do on your own is not really going to mean anything. Your brain chemistry is completely out of whack and cannot be trusted; on top of that, you are entirely too close to the situation to be able to make some kind of objective assessment. You need outside help to come up with a productive answer.
posted by curious nu at 4:03 PM on June 22, 2012 [1 favorite]

When you say you are going on "disability" is that a government programme or an insurance plan you have paid into? In addition to a mental health professional you need to speak with a social worker about ALL resources available to you, both through your employer and the wider community.
posted by saucysault at 5:00 PM on June 22, 2012

Oh, hey, yeah:

I totally have all sorts of official diagnoses and am in frequent contact with professionals - my last meeting with a counselor was on the 20th and my next psychiatrist appointment is on the 25th. I think about my well-being in terms of GAF and BDI scores (especially since I found out that's part of how the hospital assesses whether I'm stable enough to go back to normal outpatient.)

And my employer said that in front of a licensed clinical social worker (I'm terribly curious as to what they said after I left the room - they were in there together for another ten minutes at least.) The LCSW said I was supposed to try not to worry about this question until after I got back to work. My brain doesn't really work like that: this has been all I could think about since I got out of the meeting.

I know I'll need help in deciding whether I'm right or wrong, but I can't even figure out what I think about this, and that's why I want a book or something. I've also found that sessions with professionals go much better when I've done a lot of work ahead of time. Like with my psychiatric advance directive thing.

(All my conversations with professionals lately have been about just how bad off I am and how to get through the next few days; I have a lot of time on my hands to sit and think about my future, but not much spare time in session to talk it through.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:02 PM on June 22, 2012

I would solicit opinions from at least one of the following:

-- a psychiatrist who has experience with the disability system

-- a lawyer who has handled disability cases

Then you might want to do a little research on your country's disability system. In the USA, that would be the Social Security Administration. Get some pamphlets. Talk to one of their representatives. That sort of thing. You don't have to commit to filing a claim. You're just gathering information.

Above all: please talk to professionals. This exercises-in-a-selfhelp-book business is not gonna cut it.
posted by jason's_planet at 5:04 PM on June 22, 2012 [1 favorite]

I am about to go on short term disability (an insurance program through my employer.) That's already been decided.

I'm thinking about applying for SSDI and the permanent disability program also offered through my employer at some point in the relatively near future (like, say, at the start of yet another freaking major depressive episode.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:05 PM on June 22, 2012

I think that maybe you may not have enough information to adequately answer this question.

You've found that you have difficulty maintaining a full time job. What about a part time job, or one that allows you to work from home? Do you think it might alleviate your symptoms so that you can function?

Before you seek permanent disability, I think it's worth examining - in part because permanent disability doesn't actually pay very well, and it'd really suck if you wound up accidentally screwing yourself.

If you are able to work part-time, but not full-time, you may be able to get partial disability, where you receive payments, but are still able to work.
posted by corb at 5:07 PM on June 22, 2012 [2 favorites]

I agree with talking to a lawyer. In my jurisdiction applying for permanent benefits and stating you are unable to return to work actually disqualifies the worker from the more lucrative insurance benefits. Keep in mind too, leaving your employer's insurance or gramme will affect the medical care you receive (I am in a country with socialised medicine and there are still things only covered by employer's benefit plan).
posted by saucysault at 6:08 PM on June 22, 2012 [1 favorite]

I know someone who was having severe mental health issues last year that seemed to be tied to certain aspects of her job. After a two month break for medical leave (and partial hospitalisation) she was asked by her employer whether she really thought she could continue working in that organisation.

This question was resolved by a series of meetings between her and a psychiatrist paid for by the employer; her and the psychiatrist and the employer and a couple of lawyers (one retained by her; one by the employer); the psychiatrist and the employer; and the lawyers with each of their clients. (She needed the lawyer, by the way, because the psychiatrist was hired by the employer and therefore she could not trust that they were unbiased.)

(The answer turned out to be no, she would not be able to continue to work there, but she got a very lucrative payout.)

I don't think it's normal or appropriate for your employer to expect you to figure out this answer on your own. And it sounds weird that it's an all or nothing question. Since you mention tenure, I wonder whether you are in academia. If so, that's a pretty flexible career. It seems like they could try putting you on e.g. 1/4 of your former salary (bumped up by disability), and not expecting you to do any teaching. Then you could continue to do your research whenever you feel able, and just not work when things are bad.
posted by lollusc at 6:28 PM on June 22, 2012 [2 favorites]

seconding lollusc's strong answer. you need a team.
posted by facetious at 1:24 AM on June 23, 2012

Does your job provide disability insurance? It may have a different set of rules than Social Security.

What accommodation can be made to help you be reasonably functional and still able to do most of your job well? If your employer is a large organization, esp. a gov't organization, they must reasonably accommodate your needs if you are disabled. Not working makes a lot of people more depressed, and you sound like you want to work. During severe depression, could you have a job coach/assistant to help keep you organized?

You're likely to need a lawyer, so start researching who is a good disability/ADA (Americans w/ Disabilities Act, in the US)/FMLA(Family Medical Leave) specialist. Get the copy of your coverage that was sent at the beginning of the year, as well as any union contract, employee manual, copies of correspondence, and any notes. I've lawyered up w/my employer and an underemployed friend with appropriate skills and experience has agreed to be my paralegal if needed, and accompany me to meetings, to take notes. Way less expensive than the lawyer.

Try to get a handle on what you want, and then a lawyer can help figure out if it's possible, and how to get there. Don't waste your and the lawyer's time explaining too much; the lawyer is, by default, on your side. You are genuinely disabled by a medical condition, and there are laws providing some protection.

Also, from personal experience, psychiatrists vary; medications vary. Get a good medical/psychiatric review of your meds and health. The recent onset of such severe depression should be carefully looked at. Also from personal experience, vitamin D is helping me a lot with the depression exacerbated by my job horrors, some of which were caused by other job experiences.
posted by theora55 at 4:11 PM on June 23, 2012