Certificate of health for the chronically misdiagnosed
August 30, 2016 11:39 AM Subscribe
I am considering going back to the programme in Japan that I quit three years ago. They need a certificate from a doctor/therapist assuring them I am fit to go back. Things are complicated.
As documented here on MeFi, I quit my grad programme in Japan three years ago due to terrible depression. At that time, a psychiatrist in Japan diagnosed me with adjustment disorder after a short talk, wrote a note to my school so I could be excused, and basically sent me back home to Germany. Before that, when I went home during the summer, a German doctor had told me it was probably "just" hormones, whÃch seems like it was actually the right diagnosis, even though she didn't actually do anything to help me.
Back home, yet another doctor diagnosed me with depression, told me with my choice of study field of course I'd get psychological problems (he became a doctor for the financial stability), put me on antidepressants and sent me to therapy, which wasn't very successful due to a bad fit and then my insurance stopped coverage. I gradually started feeling better anyhow and went about my life, keeping hormones in the back of my head without looking into them further.
This year, I started looking into thyroid problems more deeply after being diagnosed with endometriosis and reading about the different causes for the disease, one of them being estrogen dominance, and a correlation with thyroid problems, mostly Hashimoto's disease. This was difficult because thyroid issues seem to be a puzzle to a lot of doctors, even specialists, so I was once again told it was all in my head, especially since I had the prior diagnosis of depression in my file. I finally found a somewhat famous thyroid specialist in Germany that had a lot of good reviews in the German thyroid internet communities, went to see him and he gave me a prescription for thyroid replacement hormones, even though I don't actually have a diagnosis of Hashimoto's or hypothyroidism (yet.) He mumbled something about Hashimoto's considering my symptoms - my dark episode in Japan began with rapid weight loss and jitteriness and then morphed into depression, and I did eat a lot of algae etc. back then - and a nodule meaning my thyroid could do with some support. None of this is in his report, though, and the endocrinologist I saw in Switzerland for "maintenance" said she doesn't think I have a thyroid problem, but may have had a thyroid inflammation in 2013 because the symptoms I described sound like that, and she doesn't think it's all just psychological and that I should keep taking the meds.
Ever since I started the thyroid pills, I feel so. much. better. The whole bag of anxious and depressed thoughts I was still carrying with me just vanished. It's like I cannot even form those same thoughts anymore, and even when I look back through my diary from my darkest days, I can sympathize with that girl back then, but the thoughts don't find a hold in my brain anymore. It's great.
Right now, I am living alone in Switzerland after my partner had to go back to Japan, and while at first, I was scared of being alone in a foreign country again and things turning out like in 2013, I am actually doing really well. I feel like I am finally back to the me that can cope with stressors without falling apart, and that can have fun even alone. I am seeing a therapist as well to get rid of any patterns established during my depressive episodes and just for general personal improvement, stress reduction etc., and that's great as well.
So far, so good. While I am still not sure whether I actually want to go (which is a separate problem), I need to at least hand the documents in soon before my last chance for rematriculation slips away. It would be perfect as my job contract ends in January and school starts in April, and I'd follow my partner to Japan and get married, then go to school or, if I don't want that, find a job there.
The problem is, they want a statement from a doctor or my therapist stating that the problem that caused me to withdraw in 2013 will not occur again. How am I supposed to prove that? I could get my endocrinologist to write me a letter stating I am healthy, but how can I get the university to believe that I will not get what probably even wasn't adjustment disorder in the first place again? I called the administration and explained the problem to them and they said a letter from my therapist would be fine, but neither she nor I are completely sure what to write here. I was thinking something along the lines of "I have treated Loony Lovegood and she is mentally stable and will be doing maintenance therapy sessions with me during her time in school", but this doesn't really seem enough. I will be able to write a letter of explanation as well, and there will be an interview via Skype (or in Japan if it's during the time I'm visiting my partner), but I am still completely puzzled how I can convince anyone that I will be okay here. Any ideas?
As documented here on MeFi, I quit my grad programme in Japan three years ago due to terrible depression. At that time, a psychiatrist in Japan diagnosed me with adjustment disorder after a short talk, wrote a note to my school so I could be excused, and basically sent me back home to Germany. Before that, when I went home during the summer, a German doctor had told me it was probably "just" hormones, whÃch seems like it was actually the right diagnosis, even though she didn't actually do anything to help me.
Back home, yet another doctor diagnosed me with depression, told me with my choice of study field of course I'd get psychological problems (he became a doctor for the financial stability), put me on antidepressants and sent me to therapy, which wasn't very successful due to a bad fit and then my insurance stopped coverage. I gradually started feeling better anyhow and went about my life, keeping hormones in the back of my head without looking into them further.
This year, I started looking into thyroid problems more deeply after being diagnosed with endometriosis and reading about the different causes for the disease, one of them being estrogen dominance, and a correlation with thyroid problems, mostly Hashimoto's disease. This was difficult because thyroid issues seem to be a puzzle to a lot of doctors, even specialists, so I was once again told it was all in my head, especially since I had the prior diagnosis of depression in my file. I finally found a somewhat famous thyroid specialist in Germany that had a lot of good reviews in the German thyroid internet communities, went to see him and he gave me a prescription for thyroid replacement hormones, even though I don't actually have a diagnosis of Hashimoto's or hypothyroidism (yet.) He mumbled something about Hashimoto's considering my symptoms - my dark episode in Japan began with rapid weight loss and jitteriness and then morphed into depression, and I did eat a lot of algae etc. back then - and a nodule meaning my thyroid could do with some support. None of this is in his report, though, and the endocrinologist I saw in Switzerland for "maintenance" said she doesn't think I have a thyroid problem, but may have had a thyroid inflammation in 2013 because the symptoms I described sound like that, and she doesn't think it's all just psychological and that I should keep taking the meds.
Ever since I started the thyroid pills, I feel so. much. better. The whole bag of anxious and depressed thoughts I was still carrying with me just vanished. It's like I cannot even form those same thoughts anymore, and even when I look back through my diary from my darkest days, I can sympathize with that girl back then, but the thoughts don't find a hold in my brain anymore. It's great.
Right now, I am living alone in Switzerland after my partner had to go back to Japan, and while at first, I was scared of being alone in a foreign country again and things turning out like in 2013, I am actually doing really well. I feel like I am finally back to the me that can cope with stressors without falling apart, and that can have fun even alone. I am seeing a therapist as well to get rid of any patterns established during my depressive episodes and just for general personal improvement, stress reduction etc., and that's great as well.
So far, so good. While I am still not sure whether I actually want to go (which is a separate problem), I need to at least hand the documents in soon before my last chance for rematriculation slips away. It would be perfect as my job contract ends in January and school starts in April, and I'd follow my partner to Japan and get married, then go to school or, if I don't want that, find a job there.
The problem is, they want a statement from a doctor or my therapist stating that the problem that caused me to withdraw in 2013 will not occur again. How am I supposed to prove that? I could get my endocrinologist to write me a letter stating I am healthy, but how can I get the university to believe that I will not get what probably even wasn't adjustment disorder in the first place again? I called the administration and explained the problem to them and they said a letter from my therapist would be fine, but neither she nor I are completely sure what to write here. I was thinking something along the lines of "I have treated Loony Lovegood and she is mentally stable and will be doing maintenance therapy sessions with me during her time in school", but this doesn't really seem enough. I will be able to write a letter of explanation as well, and there will be an interview via Skype (or in Japan if it's during the time I'm visiting my partner), but I am still completely puzzled how I can convince anyone that I will be okay here. Any ideas?
You'd probably be fine with a letter that said, "In my opinion, the previous issues were the result of undiagnosed and untreated thyroid disorder, which is now being treated with an excellent prognosis" blah blah.
posted by Lyn Never at 11:50 AM on August 30, 2016 [2 favorites]
posted by Lyn Never at 11:50 AM on August 30, 2016 [2 favorites]
Response by poster: Thank you! I would normally agree a vague letter is fine, but since the initial diagnosis was pretty much "lol, this girl cannot go to school in Japan", it seems like they're wary about it happening again.
And I can't get a letter saying I had an undiagnosed thyroid problem because I don't have an actual diagnosis for one, just a "you might have had inflammation/a temporary malfunction back then, keep taking the meds if you insist" thing... :(
posted by LoonyLovegood at 11:54 AM on August 30, 2016
And I can't get a letter saying I had an undiagnosed thyroid problem because I don't have an actual diagnosis for one, just a "you might have had inflammation/a temporary malfunction back then, keep taking the meds if you insist" thing... :(
posted by LoonyLovegood at 11:54 AM on August 30, 2016
I imagine your endocrinologist probably has a template for these sorts of letters already. At least in the US, doctors have to write these types of letters all the time for medical certifications for disability claims, medical leaves of absence and allowing return to work. They are pretty standard.
posted by magnetsphere at 11:59 AM on August 30, 2016 [1 favorite]
posted by magnetsphere at 11:59 AM on August 30, 2016 [1 favorite]
I don't know whether it would be necessary, but do you think you could write to the German specialist and ask for a letter documenting their 2013 diagnosis, specifically addressing the point about Hashimotos & nodule explaining previous symptoms more adequately than adjustment episode? Maybe mention the school's request and ask if you could pay a fee for the letter. (Also say how well you've been doing since their diagnosis & treatment, and how grateful you are, I bet they'd appreciate hearing that.) And then your current endocrinologist could write a letter saying you're ok-super on your maintenance regime.
posted by cotton dress sock at 12:07 PM on August 30, 2016 [1 favorite]
posted by cotton dress sock at 12:07 PM on August 30, 2016 [1 favorite]
If you need to address the "adjustment disorder", have your therapist write something like:
"I have been treating Looney Lovegood for the symptoms of adjustment disorder for the past X months. During our time together she has learned positive coping skills for stress, has identified a support system both in Japan and abroad, and has learned how to identify negative symptoms as they arise before they become a functional problem. She has also identified a plan for success in X program, and I will continue to work with her remotely to provide support and coaching for success. I believe that she will be successful in completing X program and agree that she is ready for readmission."
Of course, all those things need to be true, and you need to be prepared to identify confidently your support system and your success plan when they ask you.
posted by MultiFaceted at 12:12 PM on August 30, 2016 [3 favorites]
"I have been treating Looney Lovegood for the symptoms of adjustment disorder for the past X months. During our time together she has learned positive coping skills for stress, has identified a support system both in Japan and abroad, and has learned how to identify negative symptoms as they arise before they become a functional problem. She has also identified a plan for success in X program, and I will continue to work with her remotely to provide support and coaching for success. I believe that she will be successful in completing X program and agree that she is ready for readmission."
Of course, all those things need to be true, and you need to be prepared to identify confidently your support system and your success plan when they ask you.
posted by MultiFaceted at 12:12 PM on August 30, 2016 [3 favorites]
Best answer: I would make it way vaguer. "LoonyLovegood has been under my care since [date]. In my opinion as a [credential], she is fit to return to [school name] in [town/city name], Japan, to pursue her studies. Please contact me at [contact info] if you have any further questions."
posted by lazuli at 12:28 PM on August 30, 2016 [13 favorites]
posted by lazuli at 12:28 PM on August 30, 2016 [13 favorites]
"In my professional opinion, the issues Looney Lovegood experienced while enrolled in XYZ programme in 2013 were caused by an underlying thyroid condition. Since beginning treatment for Hashimoto's Disease in 2015, her symptoms have been controlled and no recurrance is expected with continued medication."
posted by DarlingBri at 3:11 PM on August 30, 2016 [2 favorites]
posted by DarlingBri at 3:11 PM on August 30, 2016 [2 favorites]
I think Lazuli has it - all they asked for was that you are fit to go back, not a certification that you are cured of the past illness and it will never happen again. Furthermore, a mental health professional is not going to speak to the past diagnosis made by someone else nor guarantee future perpetual good health.
Also, note that adjustment disorder is milder than depression and, at least in the DSM-V there is an expectation that it will resolve within 6 months after the end of the stressful event that you are having trouble adjusting to. So, it would not be a surprise to anyone that with treatment the problem that you got diagnosed with (even if was the wrong diagnosis) was resolved.
So, seconding, "LoonyLovegood has been under my care since [date]. In my opinion as a [credential], she is fit to return to [school name] in [town/city name], Japan, to pursue her studies. Please contact me at [contact info] if you have any further questions."
posted by metahawk at 3:22 PM on August 30, 2016 [2 favorites]
Also, note that adjustment disorder is milder than depression and, at least in the DSM-V there is an expectation that it will resolve within 6 months after the end of the stressful event that you are having trouble adjusting to. So, it would not be a surprise to anyone that with treatment the problem that you got diagnosed with (even if was the wrong diagnosis) was resolved.
So, seconding, "LoonyLovegood has been under my care since [date]. In my opinion as a [credential], she is fit to return to [school name] in [town/city name], Japan, to pursue her studies. Please contact me at [contact info] if you have any further questions."
posted by metahawk at 3:22 PM on August 30, 2016 [2 favorites]
Best answer: A) I agree that you are hanging too much on this letter. It is most likely a formality. It needs to be done, but don't hang too much baggage on it.
B) Either via the letter or the interview, I would try to make sure they notice that you are a German national currently doing fine in Switzerland and your problems have been resolved and you are totally up for returning to Japan.
You have proven to yourself you can succeed abroad. You just need to make sure they get that memo, preferably in a way that doesn't sound like you are trying too hard.
Good luck!
posted by Michele in California at 3:28 PM on August 30, 2016
B) Either via the letter or the interview, I would try to make sure they notice that you are a German national currently doing fine in Switzerland and your problems have been resolved and you are totally up for returning to Japan.
You have proven to yourself you can succeed abroad. You just need to make sure they get that memo, preferably in a way that doesn't sound like you are trying too hard.
Good luck!
posted by Michele in California at 3:28 PM on August 30, 2016
Check the school's policies, or ask an advisor what they need to see and how they need to see it, it's ok to do that. Some universities are ok with a vague letter from someone seeing you now; others are more finicky and might want a more detailed chronology with letters from the healthcare professionals who saw you during the time periods at issue.
posted by cotton dress sock at 4:30 PM on August 30, 2016
posted by cotton dress sock at 4:30 PM on August 30, 2016
The school's already said a letter from your current therapist is fine. The current therapist (unless she's also an MD, and possibly not even then) can't really comment about your thyroid, because it's out of her scope of practice. She can't guarantee anything about the future, because she's not psychic. The only thing she can really say is that in her opinion, you're fit to return to school. (And I don't know what mental-health stigma still exists in Japan, but I would shy away from mentioning that you'll need/want ongoing therapy in an official document to the school. I'm a therapist, so I think it's awesome that you'll be doing ongoing therapy, but I wouldn't put that in writing for this purpose.)
posted by lazuli at 4:38 PM on August 30, 2016
posted by lazuli at 4:38 PM on August 30, 2016
I endorse the drafted letter from lazuli. My general policy is that employers do not need to know the intimate details of their employees' health or mental health, and it's probably better for the employees the less they know. Whenever I write certifications to return to work, I avoid even discussing the diagnosis at all, and stick to "X can return to work on X date." or "X can return to work with the following restrictions for the following time period." Don't tell your employer anything you aren't obligated to reveal.
posted by treehorn+bunny at 5:27 PM on August 30, 2016
posted by treehorn+bunny at 5:27 PM on August 30, 2016
As someone who has lived in Japan for 3 years, just get the most authoritative and vague rubber stamps you can get and stuck to the script at your interview. You're overthinking this.
posted by banishedimmortal at 11:58 PM on August 30, 2016
posted by banishedimmortal at 11:58 PM on August 30, 2016
Response by poster: My professoro okayed my return, and while nothing is decided yet, I'm pretty sure they'll let me reenter. Thank you, everyone!
posted by LoonyLovegood at 12:26 PM on September 29, 2016 [2 favorites]
posted by LoonyLovegood at 12:26 PM on September 29, 2016 [2 favorites]
This thread is closed to new comments.
They probably are asking for this as a sort of CYA in case you were to withdraw again or liability of some kind on their part? Hopefully someone with experience in Japanese schools will jump in.
posted by purple_bird at 11:49 AM on August 30, 2016 [4 favorites]