Working With Mental Illness

In case you haven’t read anything I’ve discussed my diagnoses in, I struggle with Borderline Personality Disorder, Obsessive Compulsive Disorder, Major Depressive Disorder, and Social Anxiety Disorder (as well as some symptoms that leap from Social to Generalized Anxiety). I was first diagnosed with MDD and Generalized Anxiety Disorder in the fall of 2007, the beginning of my Freshman year of High School, after I self harmed for the first time in my life, which was also when I started psychiatric medication. My diagnoses stayed the same throughout moves across the country and the transition from high school to college, and I tried different SSRIs and accompanying anti-psychotics and attended therapy. Nothing seemed to help and I’d go through suicidal periods, periods of depression, and fear of transition.

Unfortunately, it took a suicide attempt for me to finally diagnosed with OCD and BPD. Even then it took me looking at things that I had always thought were “normal” and so had never discussed in therapy or psychiatry and asking the question “could there be more to this?” Turned out that the reason I hadn’t seen lasting effects from medication or therapy was because I’d had BPD the whole time which was causing the depression, but which requires a completely different therapeutic and psychiatric approach, specifically because for most patients with BPD medication can’t carry all of the weight, while classic MDD can be (though isn’t always) controlled by medication under close supervision by a psychiatrist who can tweak the dosage when necessary in addition to regular talk therapy. BPD, unfortunately, is a little more complicated. Not to say at all that MDD isn’t difficult to deal with, it absolutely fucking is. It’s debilitating. I’m not in the business of creating hierarchies for mental illnesses. The point is that BPD is very difficult to manage with medication and even in the best of situations, research suggests that medication alone just can’t help all the symptoms.

So with that backdrop, we’re gonna skip through the last year or so where I’ve been in and out of Inpatient, Residential, and Partial Hospitalization programs (all at the same place thankfully so there’s been an amount of continuity of care that’s helped). If I haven’t written about all that yet, maybe I will sometime in the future. But what I want to talk about now, is the issue of actually working, as in having a job, when you have mental illnesses that still aren’t completely controlled or at least controlled to an extent that they can be. See my parents live in Arkansas. They’ve been phenomenally supportive of getting me treatment, and have gone above and beyond in making sure that I get the care that I need, and have even come a long ways in pushing themselves to be more comfortable with my gender identity. So I’m much more comfortable with them than I had been… but that doesn’t mean I’m comfortable with Arkansas. I spent 5 years in Louisiana and a few months in Arkansas and I intend on doing whatever I can to ensure I don’t have to live in the south anymore.

So currently I’m working in Wisconsin. I have a lot of extended family here, who, while not all supportive of my gender identity, very clearly love me and are supportive of and fairly knowledgeable about what I’m going through mentally and emotionally. So that helps. Also Wisconsin has an abundance of mental health resources, especially compared to Louisiana and Arkansas, so I’ve been able to get good therapists that understand what I’m going through and have worked with Borderline patients before, as well as getting a Psychiatrist who knows what he’s doing. Of course, that’s not the end of the story. One of the stipulations of me staying up here and living somewhere where I pay rent is that I do my best to contribute financially, aka get a job. This doesn’t sound like a huge issue, which is where we get to the main issue here: working with mental illness, as in working, having a job and holding it down, while suffering from mental illness. Many people with mental illnesses or neurodivergences have difficulty with this and it’s something that employers tend to not understand how to accommodate for. It can be an issue in a lot of different ways depending on the person and setting; for me work is a tender area where from the get go many of my BPD symptoms and Social Anxiety combine to make even the “easiest” thing incredibly difficult. I get incredibly stuck in black and white thinking, start predicting the future and reading minds, any kind of transition in the workplace is the cause of major stress, I’m terrified of making a mistake because of how it might affect others, and on and on and on.

So the first job I had up here was before my second go ’round with Residential care. I was working with children on the Autism Spectrum, most of them nonverbal, learning to give them individual care in Applied Behavioral Analysis. I loved this job. I worked there for two months and for about a month I would say there weren’t any problems. Then for about three weeks I started to spiral down. I started to dread going into my shifts despite loving the work. It wasn’t something I could explain, but it was essentially debilitating and I was getting to a place where I was having suicidal thoughts essentially 24/7. Eventually I noticed this and told my boss I needed to resign for medical reasons, and then went back to Residential care.

Next, I had identified that maybe working so closely with clients was too much responsibility for me at the moment, and had to fight some black and white thinking telling me that if I didn’t get a job in a Psychology-related field then somehow I wasn’t preparing myself adequately for what I wanted to do correctly and other thoughts like that. So this time I applied more to administrative assistant positions because I’d done that before and even though that ended terribly, it wasn’t because of the job. Unfortunately in an odd twist of luck, I was hired for a job similar to that of a Residential Counselor with lots of close interaction and responsibility with clients, which was the only position like it that I had applied to among over a dozen applications I had sent out. I was excited for it, though, because, hey, maybe it would work out and it seemed like a really amazing opportunity. Unfortunately, after about two days of in-classroom training being told what our responsibilities would be and stuff like that, my OCD symptoms came storming back in a terrifying way and I had to resign without any practical experience.

Which brings me to my “current” job. It’s a retail job near my house. Starting out the first thing I noticed was that the management seemed really good which is huge. I hadn’t ever worked retail before, and I knew from stories I’ve heard that it could be incredibly difficult and strenuous, but it wasn’t the kind of strenuous that I’d had with my last two positions. I got through the formal training, started to learn the register, which was definitely stressful. One day that I was called in to cover a shift, I was tasked with watching someone else work the register as they explained it to me and then jump in when I felt ready. That was one of the harder days, as after about an hour I was on the brim of a panic attack, so I took my short break and tried to do some deep breathing, but couldn’t even inhale fully. That was when I went to my manager (probably obviously shaken and shaking) and told them that I had an anxiety disorder and I didn’t always know when it would flare up but that I was having a really hard time. They very calmly and compassionately told me that I didn’t need to justify it to them and they completely understood, that they were more than willing to work with me on this and I should go home for the day, try to relax and hopefully be a little more relaxed for my shift tomorrow. And I was! Yeah it was still stressful, but it wasn’t panic attack stressful, and now I knew I had my manager on my side, and had someone who really understood what I was going through, at least to the extent I divulged.

So fast forward a few days to my psychiatry appointment when I told my psychiatrist that my like baseline anxiety was a lot higher that it usually was and I was having more panic attacks. So he recommended that we switch one of my medications to the extended release version of it. He let me know that there would be side effects on the switch but they only lasted 3-4 days for most people. So I start taking the new medication right away because he had samples that he was able to give me. Everything was normal for a few days, then, one day when I was driving into work I got about halfway and pulled into a parking lot, realizing that I could barely concentrate on the cars around me, my cognition was slow, my mind was wandering, and I felt kind of weak and drowsy. I realized looking back that the entire morning had been like this: woke up late (which I hardly ever do), had no sense of urgency to get ready, couldn’t concentrate, and was just kind of cloudy and couldn’t make sense of the clock, leading me to leave much later than I usually did. Once I realized this it was obvious that these were the side effects that my psychiatrist was talking about so I immediately called in and told my manager exactly what was going on (albeit about 10-20 minutes before my shift so understandably frustrating). I told them that I was on a new medication that my doctor told me should help with my overall anxiety, but there were gonna be side effects to get through and I would be happy to come in but that I would likely be pretty slowed down and have difficulty. They sounded frustrated and said it would be better for me not to come in.

As the next few days passed, I had to call in about four shifts, although I did so much more in advance, as the side effects were unpredictable but always debilitating when they came and I did not feel safe driving. After the weekend I went in to talk to my manager in person (utilizing the morning, a time when, since I started taking the medication earlier in the evening, was a little more predictably clearer). I reiterated what was going on, and that unfortunately I had no way of knowing how long it would last, which was why I was asking for any kind of unpaid leave I was eligible for to give me some time to adjust to this medication before coming back to work (as at this time it had become evident that while the side effects were having quite an effect on me, the medication was also doing wonderings for my depression, suicidal ideation, self-harm urges, and anxiety, so I knew I didn’t want to switch back). My manager still seemed pretty pissed off. They made it clear at one point that the only reason they weren’t firing me was that they had invested so much payroll in me. I explained that I understood what an inconvenience it had to have been, and if they needed someone more consistent and this was all too much of a burden I would put their needs ahead of mine and resign.

Eventually, what was settled on was that they would put in for a two week leave for me which may or may not be approved, and if it is approved there’s no telling if it will start retroactively, meaning I will have to work immediately or soon after I hear from them (regardless of the status of the side effects), or if it will start when granted, leaving me still with enough missed shifts for disciplinary action including termination. So this is where I sit as I write this, waiting to hear about the fate of my job. Of course I’ve got a ton of black and white thinking going on. But the one thought that’s persisted is that it’s amazing how quickly someone can go from “we’ll do whatever it takes to accomodate you” to “this has been really inconvenient and we may just fire you.” From the other side, accommodation must be something that has to happen on their terms, something that is only okay if it meets a threshold of comfortability, like allowing someone to leave when you have enough people working, or someone calling a day ahead to explain that they plan on being too anxious to come to work. But on my side, and I’m sure the side of many people that need accommodations at  work, it’s the inconvenient accommodations that I really need and appreciate understanding with, because my mental health doesn’t fit to a schedule, and typically when I need accomodation and understanding the most is when it’s going to be least convenient on the other side.

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