Story of Bipolar Tolerance in the Workplace

These next several posts will be dedicated to stories about how my mental illness was accepted or not by my various employers over the years.  This first story is about my first job out of college as a paralegal for a law office in a major New England city.  In the post below, I compare paralegal work and project management work.

When I started working as a paralegal, the Americans with Disabilities Act had not yet been passed.  This was 1986.  When I signed up to work for this law firm, I was asked to fill out a questionnaire.  As memory serves, one of the questions asked about whether I had a mental illness.  This was before it was illegal to ask this question.  The ADA did not get passed until 1990.

At the time in 1986, I opted not to be truthful in the questionnaire.  I felt it was my right and my knowledge that the employer could not or should not access.  This created the start of the process of always wondering whether it was good to declare my bipolar illness or not with an employer. 

During the two years that I was a paralegal at this law firm, I exhausted my sick leave due to the bipolar diagnosis.  I was still in process of getting the right combination of lithium and Tegretol together.  I was also adjusting to taking meds on a regular basis.  As many may know often it takes a year or two before you can accept your illness and that you will need to stay on meds likely indefinitely. 

I don’t recall whether I was put on short-term disability during this time or not.  But there was never talk of letting me go or firing me because of the bipolar illness or because of exceeding the allotted sick time for my station at that law firm.

In general, the lack of a negative reaction to my being out ill was a positive outcome in the long-run.  Today I consider this “tolerance” of my mental health needs to be a very positive outcome with an employer.  I had not yet been certified as a project manager – that would come later in 2002.  All in all and in retrospect, I found that working as a paralegal and having a mental illness were a combination that was somewhat manageable for me and for the employer. 

Years later in the 2000s I found that working as a project manager and having a mental illness was not a manageable combination at all.  The stigma associated with the mental illness particularly in the project management workspace was just too great.  This stigma has been discussed at various of my former blogposts.

What appears to be a deciding factor between “tolerance” and “intolerance” of the mental health condition is whether the specific job is in a supporting role rather than in a leadership role.  As long as I was a paralegal and providing support to a team of attorneys, the idea of having some sort of mental health complications was “acceptable.”  However, a project management role is/was a leadership role and therefore creates/created less “accepted” or “acceptable” responses proffered by the project management organization in the project/program management workplace.  I wonder if I had been an attorney at the same law firm whether the same level of “tolerance” would have been extended to me.  Or, if as an attorney I would have been in a leadership role and, therefore, the complications of mental illness would have also been less “accepted” and “acceptable.”

Stigma Resistance and Existence in the Project Management Workplace:

I have found in my 35-year career mostly doing project management work that the company you work for is only as accepting as the people who make it up.  When I have experienced a supporting atmosphere for my bipolar illness (which is extremely rare), my mentor or my boss has come from a place where mental illness was in their family.  One a husband, one an aunt.  This was volunteered information to me from them.  I find the ability of the workplace to be supportive is in direct correlation to the boss or mentor having first-hand experience with mental illness.  For all intents and purposes, the individual and not the company is the determinant of a supportive environment for working with a mental health condition.

It should not be this way.  The company as a unit in and of itself should be able to show understanding and support for mental health challenges particularly with such advances as the Americans with Disabilities Act. 

In my experience, the company is more prone to act out of fear or out of ignorance and assume someone with a mental health condition is dangerous to themselves and to others around them.  There is a tendency to criminalize people with mental health diagnoses in the workplace when that mental health diagnosis is exposed. 

Not uncommon is the ushering out of the office by building security when the mental illness surfaces.  Is this ever done when you have diabetes?  Or a brain tumor?  Or cancer?  No, you are not humiliated and meant to feel you are criminal just for being ill.  These other illnesses are accepted as part of the risk profile for managing employees.  People are given support for their illness by co-workers and by management for these other non-mental illness profiles, while for mental illness profiles the employee is considered an immediate and unsurmountable threat and treated as a criminal.

Again, I would hope in the US the Americans with Disabilities Act would change this criminalization of people with mental health diagnoses in the workplace, but in my experience it has not.  That sounds out as a sad state of affairs for employment for people with mental health diagnoses.

Have you ever been treated poorly at the office because of a mental health diagnosis or break-through event? Have you ever been treated well for the same? What causes some employers to act in a way that is supportive and others not?

Mental Health While Working in Project Management

This is a series of blogs which attempts to talk about stigma existence and stigma reduction in a particular field of work – project management.  Beginning in 2002, I became certified as a Project Management Professional.  This feat was subsequent to obtaining my college degree and my Masters in Business Administration.  In this series of blogposts, I will talk about several issues including: 1) being accepted (or not) for having a mental disorder while serving as a project manager, 2) addressing stigma associated with a mental health diagnosis while practicing as a project management professional, 3) learning to adopt risk management principles from project management principles to self-care and risk management with a mental health diagnosis,  4) detailing work places and individuals that seemed accepting of mental health diagnosis either before, during or after practicing as a project manager full-time,  5) balancing two or more projects versus one project while being diagnosed with a severe mental illness, 6) calculating the rewards and the challenges associated with compartmentalizing mental health issues while serving as a project management professional, 7) relaying the benefits of openly discussing the impacts of mental illness on my ability to serve as a project manager, and 8) detailing specific examples of prejudice in the workplace due to a mental health diagnosis.    

Some of the material may seem redundant as I have experienced repeatedly non-acceptance in the field of project management for mental health in general and for mental health diagnoses in particular. 

Stigma through the lens of history

I have written before how stigma is more than half the battle against a mental health diagnosis. Today I would like to add that stigma against any kind of mental illness has its roots as far back at the 1800s and early 1900s or before. During the “good old days,” family members with mental illness were sent away quite literally to “lunatic asylums” to suffer and die or to be locked in the attic of their homes. Often times there was not even a diagnosis rendered. There is one such mental asylum in Milledgeville, GA.

For more on Milledgeville, go to http://www.peteearleyhttp://www.peteearley.com/2019/03/15/the-worlds-largest-mental-asylum-from-the-horrors-of-the-back-wards-to-todays-jails-and-prisons/.com/ Sorry if I cannot link up properly here but this is a great blog post by Pete Earley to review. Please copy and paste in your browser if the link is not activating and scroll down till you get to the post above. My apologies for my linkage problems.

In Milledgeville, people who died of mental illness and related complications were buried with no more than a number to their identity. These “unmarked graves” are testimony to the fact that people with mental illness were not people they were numbers in a cog of a wheel that was mostly about doing away with any showing of mental illness in the family through the institutionalization process. There are some powerful pictures at the post above as well.

Here we are in 2021. I would have to say we have made loads of progress in the last one hundred years or even since the 1960s. That being said, the bar for that achievement is really really really really very very low. During this past time, treatment consisted of lobotomies and older renditions of electroshock therapy. Thanks to science and to the pharmaceutical industry we have plenty of medicines to choose from which keep many of us from going into the “mental asylum” or mental health hospital for good. Now we have short hospital stays and more helpful meds. There are some side effects from meds typically including weight gain and that definitely needs to be expressed as an appeal and answered. Also, there are still some of us with persistent or treatment-resistant mental illness.

Why am I harping on and on about the past? I feel the stigma toward mental health is ingrained in our society much like racism. There is no quick fix to either. Both have been on-going for more like 200 to 300 years plus. Mental illness in the home is also something that often is not talked about as are the impacts of slavery on multiple generations of folks who likely came to the US against their free will. Both mental illness and the ongoing impacts of racism are systemic and not easily tackled. In many cases we have only been willing to talk about root cause and reparations for slavery in the very close past weeks and months. I see no such parallel effort to address root cause of mental illness although this stigma is just as prevalent.

I cannot pretend to know the experience of racism in the US. But I do have a clear view of how people can be treated as less than for the color of their skin or the processing speed and accuracy and chemical make-up of their brains. How nice would it be to address stigma against race and stigma against mental illness with the same vim and vigor.

A way toward stigma reduction?

A blogging colleague of mine have been talking a little bit about stigma reduction associated with keeping mental illness symptoms associated with the illness itself rather than with the person. For example, the anxiety that I experience is a feature of my bipolar illness rather than some character defect or short-coming of my person. What if we were to try to represent and talk about mental illness symptoms as being features of the illness or diagnosis itself rather than characteristics of the person or the patient? By way of example, we do not think a breast cancer survivor is cancerous. Instead we say she has had cancer and fought it and is still fighting it and/or is in remission. The disease and its symptoms are not synonymous with the patient. In fact with cancer it is the other way around. People always talk about those people who are able to beat the illness cancer — it it not a part of who that person is but rather a fight to fight and to win and to overcome.

So why do we think of mental health symptoms as somehow the failure of the person experiencing the symptoms such as anxiety, depression, PTSD or some form of psychosis? When it’s mental we tend to assign the symptoms to the patient rather than to the illness. This person is anxious. This person is depressed. This person is psychotic. This makes overcoming the stigma of mental illness even tougher.

So what would it look like if we started talking about mental illness symptoms as part of the illness rather than part of the person experiencing them? It might make us more inclined to believe that getting over anxiety or depression or PTSD or psychosis is a matter of the treatment of the illness rather than the integrity of the patient or the person experiencing the symptoms.

What do you think? Do you think mental health patients are asked “to own” their symptoms in a way that cancer patients are not? Do you feel mental health stigma could be reduced if we were to more often disassociate mental health symptoms from the person experiencing them? Could mental illness be considered a challenge to fight and/or to get through like a cancer but not the result of some character defect on the part of the patient? Do we need ways of talking about mental health that include giving credit for actively working to keep symptoms under control and/or having them be in remission for a time? Do we need ways of talking about successes we have had in combatting our mental illness diagnoses even if those troubles still exist for us on some level? What of all this might help to address the stigma of mental illness?

My Sojourn through Bipolar Illness – Imprinting (reposted and a continuation from prior post)

What I took away from this first break experience during my Senior winter at Ivy College is that being mentally ill meant I was first a criminal and second a person. I know that first responders were doing their jobs to watch out for the safety of all those who were boarding the plane and/or in the airport. But that experience told me: “You are a criminal. You were trying to bomb the plane. You are guilty of anything and everything until proven innocent. You need to be handcuffed. You do not have the right to have fears much less to express them. You do not have the right to have perceptions that are not 100 percent clear. You are a danger to others around you and you need to be locked up.”

My first episode imprinted me for the rest of my life. For years, I would try to escape the label of criminal that had been imposed on me by circumstance and happenstance. But try as I might, I still felt like I was a criminal every time I had a subsequent break-through episode no matter how big or how small.

In hindsight, things could have unfolded quite differently. I could have reported to the school clinic that I was having anxiety about traveling to Chicago and had been having some trouble sleeping. I could have gone into the clinic for a routine evaluation and perhaps been put on lithium or some other drug for bipolar. But sadly, that is not the way my first episode and subsequent diagnosis of bipolar went. I remember to this day looking at those pictures on the wall in the police station and thinking they must be looking for me as “most wanted.” Being mentally ill simply meant I was a criminal.

I will talk later on about stigma and first responders — including the importance of training first responders how to recognize the signs if a person is a danger to him or herself or whether the person is also a danger to those around him or her. But that discussion about stigma and first responder training is for another day.

My Sojourn through Bipolar Illness – What to give up to fight stigma?

Do you feel uncomfortable when there is a news announcement of a violent crime committed by some one who is mentally unstable or mentally ill?  How can we address this stigma such that those of us who live with a mental health diagnosis largely lawfully are not readily lumped together with those people who are committing heinous acts due to their instability?

What might the typical mental health or substance use patient have to give up if there were to develop a Paranoia Hotline, a Paranormal  Institute or a Cohort Model is some level of privacy? (Please see prior posts for a discussion of these concepts.)  It is a “no brainer” to me that weapons do not belong in the hands of the mentally ill even when they are in recovery. 

I also believe we as a society should allow therapists and doctors to report clients who may be showing signs of being a danger to others. This is very tricky territory, but it seems to me that the person providing mental health care should be able to report findings to some larger group whose mission is to follow-up and investigate and intervene if the concerns raised by the therapist show that a patient is a threat to others.     At a minimum in my opinion, such notice from a therapist should ensure the patient goes on a weapon do-not-sell list.

In the past ten plus years the number of school or mass shootings in the US has sky-rocketed with the age of impacted schoolchildren often getting younger and younger.  I feel it is the responsibility of people with mental health diagnoses who know how dangerous paranoia can be and how quickly it can develop into an unsafe situation to speak up in favor of controlling and denying access to guns and other weapons for the mentally ill.  I also think the dialogue about what a therapist can reveal about his or her patient warrants more attention.  If a patient is clearly a danger to others, this fact should be communicated to a third party in charge of reconciling the account.    As people who strive day in and day out to be safe when there is often unsafety lingering around in the shadows, people with mental health diagnoses need to speak out as a group to ensure that lawmakers make weapons inaccessible to the mentally ill and provide societal intervention and/or follow-up for people who seem to be a danger to others.

It is only when we start to differentiate people who are a threat to others from people experiencing mental health symptoms but are no danger to others are we able to begin to address the stigma associated with mental illness.  The public needs to know that it is a small percentage of people with mental illness who are actually a danger to others so that we who are living with the impacts of mental illness are not lumped into that category of “danger to others”  and receive all the stigma that goes with that. These people who are a danger to others need early intervention from healthcare providers and first responders so that they do not act on these impulses to extend dangers to others.

My Sojourn through Bipolar Illness – Coming up Last on the Funding List?

Has behavioral health always been the red-headed step-child in terms of funding levels for medical research and treatment?

If the statistics on mental health and addiction were more widely publicized, would we begin to see more clearly the widening funding gap between dollars to treat and cure mental illness versus research and treatment dollars dedicated toward heart disease, diabetes or cancer?  Currently, while mental health and behavioral health including the opioid epidemic and addiction pose tremendous challenges, the funds and expertise to tackle behavioral health and addiction just aren’t forthcoming at the same rate say for cancer research or funding.  What would happen if we as a society could place as much money and effort into mental health and addiction research and treatment as we do into cancer?  The projected impacts would likely be enormous.

  1. For one we would have adequate beds to treat people who need inpatient care for behavioral health or addiction. 
  2. For another, we would have adequate funding to develop psychotropic drugs and other interventions without such severe side effects as weight gain and Type II Diabetes onset and memory loss. 
  3. Additionally, we would be treating war veterans for mental health or behavioral impacts that often can go untreated or undiagnosed.
  4. Fourthly, we would have enough resources to fund a Cohort Model of support for those in a crisis or post-crisis state. 
  5. Fifthly, with more co-mingling of people with and without a behavioral health or addiction diagnosis we might be able to reduce stigma substantially.
  6. Finally and most importantly, by being proactive in our behavioral health and addiction programs in the United States, we may be able to develop awareness of early warning signs among people struggling with mental health and addiction before their symptoms become dire. 

It only follows that research for and treatment of mental illness and addiction is proportional to the level of medical challenge that is presented with these diagnoses.    

My Sojourn through Bipolar Illness – Stigma

I have often felt that the stigma associated with bipolar illness is as big if not bigger (twice as big) as dealing with the illness itself.  Every time there is a school shooting or a gun incident or a drug cartel development that involves an unstable person with mood issues, all parties with a behavioral health diagnosis suffer.  The emphasis in society rarely is on developing preventive care for people with behavioral care diagnoses.  Admitting such people to jails appears to be more of the status quo in the years following the closing of many State-run facilities.  Undoubtedly, there has been a cost savings with the closing of hospitals across the United States but the flip side of this is that many people with behavioral health diagnoses end up in jail or homeless on the streets.  Too often people may encounter the fact that there are no beds available when they go to be evaluated for admission to a behavioral health facility.

While I am not an expert in addiction issues at all, I feel that the opioid epidemic of the last several years is evidence of the fact that our behavioral health and addiction facilities are lacking in funding and in expertise while the world is lacking in understanding and compassion.  The stigma associated with having an addiction or an addiction-based personality is a huge factor I believe in addressing this crisis.  What is evident now more than ever is that addiction issues (and behavioral health issues) do not discriminate based on race or socioeconomic stature or religion or any other factors.

I have encountered stigma in the workplace, during the job interview process, in the neighborhood, in the world of health insurance, and just about in every facet of society.  I have often heard of the comparison of behavioral health issues to diabetes.  Would you think less of a person who takes insulin daily? Probably not.  But would you think less of a person taking psychotropic drugs?   Today, the typical answer to this question is probably so.  Would you think less of a person who has exited the opioid epidemic and is actively addressing addiction tendencies?  Hopefully the answer is we are learning to be proud of that person for reaching out and for getting help with a problem that is real across all sectors of American society.

The stigma issue at least in behavioral health tends to feed on itself.  Because the stigma is high with regard to behavioral health diagnoses, I find it hard to share my diagnosis and my daily troubles with others.  This need for secrecy or keeping the diagnosis story a secret in turn creates undertones of distrust or lack of trust and/or continuing questions.  If I share my story with person x, will he or she keep that story confidential or not?  What will be the fallout if my diagnosis is shared in the neighborhood or in the workplace or at my daughter’s school?  These are serious questions regarding a very serious topic.

Mostly I have found that people outside my family circle are not at all aware of or supportive of mental illness concerns.  The education that they receive typically comes through the news where the typical story involves a young teen or twenty-something who is disturbed at home, who may have sought psychiatric care or may not have, and who decides to engage in some sort of heinous premeditated shooting rampage.  Unfortunately these stories of misunderstood teens and young people on a death rampage have become more of a norm in our society in the last ten to fifteen years than anyone would care to admit.

To me there are very clear steps that society should be taking to counter-act these potentially preventable heinous acts of violence. 

These include:

1) Background checks for the purchase of guns and other weapons such that people with a history of mental illness may not purchase or own a gun or weapon under any circumstances.  This includes background checks for all types of gun sales and gun ownership.

2) Some form of alert that can be provided by a mental health worker if a particular patient is in distress and appears to be a danger to himself and others, particularly to others.  Right now, most privacy laws do not allow for that disclosure given doctor-patient confidentiality laws.

3) A clearer understanding for Crisis Intervention workers and teams including training in mental health issues.  First Responders need to be armed with a greater understanding of when a crisis event is a dangerous event for others versus when a crisis event creates danger for only the patient and the patient’s life.

4) Funding and payment to Crisis Intervention workers for this training.

5) Funding and training to mental health workers to help distinguish patients who pose a threat to society as compared to patients who are experiencing a threat to themselves.    

6) Additional early intervention work for teens in inner city environments with behavioral health concerns to get them off the streets and out of association with gangs and gang behaviors with the end game being to treat these kids for psychiatric issues before they get a criminal record and are incarcerated. 

This requires that we look at the cost-benefit of treating at-risk teens for behavioral health concerns versus the current pattern of enabling criminal activity among teens by not providing the behavioral health care that they need until after they are in jails.  In my opinion, society needs to accept the cost of working with at-risk teens on behavioral health issues so as to avoid the huge cost of incarcerating a large and growing sub-population of mentally disturbed people with a history of criminal behavior in our inner cities and towns.    

If we are going to progress past the stigma of mental illness diagnoses, it may be necessary to give up some of our freedoms.  If we are going to differentiate between a mental health event that endangers the patient versus a mental health event that endangers community or society, we people with behavioral health diagnoses need to be willing to give up some of our freedom.  To me giving up freedom is agreeing to sign off on background checks for guns and other weapons as well as amending doctor-patient confidentiality laws if there is clear evidence or behavioral propensity of a danger involving the greater community.  Clearly if we are going to expect care-givers and first-responders to bear the responsibility of determining if the event scope is patient-only versus community-reaching, we will need to provide topnotch education to both mental healthcare providers and First Responders.  Both groups need to be well-versed in signs that distinguish when the patient is a threat to self but more importantly a threat to others.   Both care-givers and first-responders need to be armed with an understanding of how these two scenarios differ and how they are the same with the end goal being the care for human life – the life of a disturbed teen but also the lives of those in community with this teen.

Stigma delay or not?

What strikes me as poignant is that the stigma/judgment/prejudice associated with mental illness is less visible or more delayed while the stigma/judgment/prejudice associated with darker skin seems more immediate.  To the average Joe, I look like a white housewife with no major troubles.  It is not until my mental health behavior gets in the way that someone might recognize me as having a behavioral health disorder and therefore might judge me as less than.  Behavioral health stigma is not generally associated with the way a person looks right off the bat unless that person shares that information upfront.  Whereas, with black and brown skinned people, it seems to me (from the outside looking in) there may be no such “delay” or “invisibility.” Someone with brown or black skin appears to be judged even before any behavioral questions good or bad emerge just because of how he or she looks on the spectrum of dark skin to light skin.

I hope I have not offended anyone of color with this comparison or that you think I think I can comprehend what it is like to be black or brown and to be judged by your appearance alone. 

I do not make the comparison to mental health above because I know how it feels to be judged by the color of my skin.  I don’t.  I have not experienced that.  But I would like someone of color to know that I do understand very well what it is like to be judged for something I was just born with. Perhaps I am not at liberty to make that comparison because I am not dark-skinned.  But I do think part of the solution in the Black Lives Matter movement is that we become unafraid to talk about our perceptions of race and racial stigma.

From here the conversation atrophies into the question: why make a comparison between skin color and a disability?  It is not a good comparison to make.  Yes, I agree a disability is not the same as skin color.  The whole “Black is Beautiful” movement underscores that. 

Then the conversation atrophies again, as a person with a disability, I am supposed to think of myself as a person WITH bipolar illness not that I AM bipolar.  I am not my illness.  I am supposed to not let that “label” define me.  Should we in turn say someone of African American heritage is a person with black skin rather that black?  Probably not.  For the behavioral health person, we typically don’t want labels to define us.  But for those with black and brown skin, the difference may be in embracing that difference and celebrating it along the lines of “Black (or Brown) is Beautiful” from the 1960s or 1970s.

Somewhere also in the midst of this conversation is the reality that up until the 1950s people with behavioral health problems were locked up in institutions largely for life.  Families sent them away to institutions where they were often forgotten and buried as a number in a mass cemetery for the mentally ill rather than by name.

So all in all, the parallel between having a disability and having darker skin has limits.  Perhaps this is just an ice breaker into a conversation of what can be and what we want to be different for those experiencing racial pain and stigma and those experiencing mental pain and stigma.