Being Bipolar & Working Around It

By Chris Swingle







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Managing bipolar is a full-time job. No wonder full-time employment can be a challenge. We look at the different ways people deal with that.



For most of his working life, Charles of Florida took pride in his identity as a hard-driving professional. At different times, he ran a jewelry repair shop, directed campaigns for the United Way, and worked around the clock as a political fund-raiser.

“I enjoyed the power and the prestige, and I enjoyed the money,” the 58-year-old says.

That all changed when he hit a wall of depression seven years ago. He couldn’t stop crying. Everything felt threatening. Diagnosed with bipolar disorder, he realized the high energy and workaholic tendency he’d had since his early teens were hypomanic symptoms.

Since then, Charles has been able to manage only slow-paced, part-time work. He puts in about 10 hours a week posting sermons and other information on two church websites.

Financially, “it’s been like falling off a cliff,” he says. No more expensive cars, fine clothes, and vacations in the Caribbean. His savings are gone and he depends on food stamps and government support. On top of that, he’s traveling a long road of redefining himself in terms beyond, “So, what do you do?”

Kathleen, 45, of Connecticut, was diagnosed with bipolar disorder when she became manic during her first year at Harvard Law School. With her degree in hand and her disorder under treatment, she thought representing clients at a legal aid program would be her dream job. Then she was voluntarily hospitalized five times over 18 months for depression. It became obvious that she couldn’t stay in that line of work and stay in balance.

Now she’s thriving in a position with a legal aid hotline, she says, “doing a job I absolutely love.”

Like many people with bipolar disorder, Charles and Kathleen have learned that finding the right employment fit is a key to managing their mood disorder. Solutions vary from individual to individual: switching to a different type of job, scaling back to part-time employment, or taking on volunteer positions as a way to get the structure, socialization and satisfaction provided by work.

There’s nothing really wrong with being a ‘Type B’ person. It’s just different for me.

Multiple studies have found that a majority of people with bipolar don’t hold a paid job. In an analysis of work functioning that appeared in the February-March 2007 issue of Bipolar Disorders, Canadian researchers phrased it this way: “Employment rates are relatively low in this patient population.”

The heightened creativity and energy of hypomania can lead to distractibility and ultimate loss of productivity, while full-blown mania may cause a worker to become disruptive, aggressive and prone to errors in judgment.

And research suggests the fatigue, irritability, and inability to concentrate in a depressive phase can hurt job performance even more. A review of nine studies involving more than 3,000 people, published online on August 6, 2012 in the Journal of Affective Disorders, found that cognitive deficits and depressive symptoms were predictive of unemployment.

Yet quite apart from economic necessity, work can be a major factor in our sense of self and how others see us. Many people go through a grief process when they have to stop working because of a mental health crisis, says Larry Kohn, MS, of the Center for Psychiatric Rehabilitation at Boston University.

“It’s hard letting go,” agrees Charles, who misses the prestige he felt in his former high-powered pursuits. It’s only recently that he’s been able to tell himself, “There’s nothing really wrong with being a ‘Type B’ person. It’s just different for me.”

He’s trying to change his focus from what he’s missing in his life to what he can accomplish now. For example, he used his marketing and advertising skills to help raise more funds at his church’s fall festival. In consultation with his psychologist and other trusted advisors, he’s also looking into creating a part-time project that would protect his own mental health while he helps other people with mental disorders find work.

While he still needs to be able to adjust his schedule depending on his bipolar symptoms, he says, “I hope to find satisfaction and a sense of myself doing something worthwhile.”

Am I what I do?

Katherine, also had to make peace with the fact that part-time work and volunteering are all she can manage right now. In dialectical behavioral therapy she learned a technique called “radical acceptance,” which helps her let go of things she can’t change.

When she first lost a job nine years ago because she had trouble concentrating, she was devastated.

“Numbers were always my thing. To know my numbers had failed me or I had failed the numbers, was something I never dreamed would happen,” says Katherine, who lives in Lancaster, Pennsylvania. “I felt like an idiot—and I’m a very intelligent woman.”

Katherine had handled 50 hours a week as the bookkeeper and buyer for a seafood store. She was also helping her husband out with a pest control business they started together in 1994. Then her marriage fell apart and mania struck, disrupting her accuracy and ability to focus.

For two years, she and her boss tried various accommodations: different shifts, fewer hours and responsibilities, having her work from home. In the end, her accuracy hadn’t improved enough for her to keep the job and they parted ways amicably.

There’s nothing really wrong with being a ‘Type B’ person. It’s just different for me.

There were several stumbles as Katherine learned to mesh employment with managing her bipolar. She had to take several months’ leave from her next job, a part time position as a medical clerk. Back in the workplace, putting in 24 hours a week or more, she was easily thrown off balance.

“Even the ringing of a phone behind me would throw me off. I wouldn’t know where I was in the work, or in the building,” she recalls.

Mary Ann, a consultant based in Waterdown, Ontario, develops workplace plans with people who have experienced mental illness and are trying to stay in professional-level jobs or transition back to work after a leave. She says research has found that whether people can return to work after disability leave depends on their mental health (including recovery from symptoms), whether they have coping strategies for stressors, and whether workplace issues that may have contributed to the episode have been resolved.

She recommends putting the plan in writing so that the employer knows what the employee needs to stay productive at work and what steps to take if the worker has performance or behavioral problems in the future. This doesn’t require disclosing a diagnosis because it focuses exclusively on workplace issues and solutions, she says.

If a supervisor is aware of the diagnosis, Mary Ann says, the employee could choose to include warning signs of an impending mental health crisis and what personal contact or practitioner to call. If an employee has a company car and credit card, the plan could indicate when those should be withheld in case an employee’s judgment is impaired.

Of course, not everyone is comfortable sharing mental health issues with the boss. Some employees confide only in a trusted co-worker who’s willing to point out when behavior is shifting. Others keep their diagnosis to themselves and do their own monitoring at work and at home.

“The main thing I talk to people about is this concept of taking one’s own temperature,” says Boston University’s Kohn. A mood episode “doesn’t have to be some freaky thing that comes on and you’re at the mercy of it like a storm.”

Look for changes in your sleep, socialization, eating and spending habits, he advises. Notice if you’re having negative incidents with other people. Then use skills and supports—people, places, things or activities you turn to—to help you get back to an even keel.

Swisher has figured out through trial and error that working 15 hours a week is her maximum…. Her advice: Know or learn what your limits are. LEVEL BEST (right) Representing legal-aid clients wasn’t a good fit for lawyer Kathleen Flaherty, but she’s been “hospital-free” in a more flexible position at a hotline.

When it’s necessary to take a medical leave, Kohn says, transitioning back with part-time work can be “a great way to get your sea legs. To go from no work to 40 hours a week can be a shock to the system.”

Katherine has figured out through trial and error that working 15 hours a week is her maximum. More than that and her moods cycle rapidly, her behavior becomes irrational, and she can’t concentrate. Her advice: “Know or learn what your limits are. And have a solid support system.”

With exercise, volunteer work, and a positive attitude contributing to her recovery, Katherine has patched together a blend of small jobs that allow her to maintain equilibrium. She manages a four-unit apartment building, which takes anywhere from one to eight hours a week. She assists a 90-year-old neighbor with rides and chores. She receives disability benefits, which limits additional earnings to around $1,000 a month.

When Katherine qualified for disability, she says, she initially felt worthless. It helped when someone told her she’d been paying for Social Security Disability Insurance (SSDI), which is funded through payroll taxes, since she began working at age 15.

Even if you’re in a position that you can’t work now, it doesn’t mean you’re not ever going to be able to work.

Still, she’s had to adjust to living on a third of the income she once had. She brings the lessons of radical acceptance to her new lifestyle, where a broken appliance requires careful juggling of her budget. “It takes me a long time to save for things,” she says.

On the job

Sometimes small changes at work can allow an employee to remain reliable and productive. Someone who struggles to concentrate can benefit from written job instructions or being able to tape-record instructions and meetings, says Len Statham, an employment and economic self-sufficiency specialist for the New York state Association of Psychiatric Rehabilitation Services.

“These are very small things,” he notes, but for countless people, “they’ve been job savers.”

Reasonable workplace accommodations for a mental disability—required in Canada under each province’s Human Rights Act and in the United States by the federal Americans with Disabilities Act— could include having a quieter or more brightly lit work space, taking several short breaks rather than one long one, or having flexible hours in order to attend therapy sessions.

Flaherty, the Connecticut lawyer, copes with her 35-hour work week by building health-enhancing habits into the day. She uses part of her hour-long lunch break to either take a walk outside with co-workers or nap in her office with a pillow and a blanket.

It hasn’t always been smooth sailing. There was a period at the hotline when she would take one call and then need a break, overwhelmed by the urge to flee. She persisted until those strong feelings faded and she could function normally.

As a support group facilitator with the National Alliance on Mental Illness, Flaherty has seen how different jobs suit different people. Some like a more rigid, predictable situation, while others like a mix of activities. The flexibility of working from home could be a perfect solution for one individual while another would find it too isolating.

Kohn agrees that it’s impossible to generalize about the “right” type of work for someone with bipolar. He points out that a job that might seem low in stress could be nerve-racking if it comes with a grumpy, micromanaging boss.

Above all, says Flaherty, don’t despair if it takes time to find the right solution for you.

“Even if you’re in a position that you can’t work now, it doesn’t mean you’re not ever going to be able to work,” she says. “You still have an identity and you’re still a person if you don’t have a job.”

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Putting disability to good use

Regina, says she left “some serious jobs” during bouts of depression or unrecognized mania. She made an abrupt departure from a national magazine where she was a celebrity interviewer. She impulsively quit “a good government job” with the U.S. Treasury Department.

“Nobody quits those, right?” the 57-year-old asks quizzically.

Although she picked up freelance work between her steady jobs, her finances inevitably took a hit. “It was tough because I often didn’t have [health] insurance … and the work wasn’t steady,” she says.

While doing contract work with the Social Security Administration in 2004, she learned about a program that encourages federal agencies to hire people with disabilities. It was an “Aha!” moment, but there was one hitch: She would have to be declared “disabled.”

“I ruminated about it for about eight months,” she says. “I didn’t know if I wanted to designate myself as such.” Financial need won out. Regina went through her state vocational organization and her psychiatrist to be approved, then pursued a job through the U.S. Office of Personnel Management’s Schedule A.

Regina has been a public affairs specialist with the government for the past eight years. It helps that start times for the work day are flexible, her duties aren’t overwhelming, and her supervisor overlooks the occasional out-of-bounds remark.

“I tell myself that no matter how badly I want to quit, I simply can’t,” she says. “And if I were to do it impulsively, I might now have more recourse due to my documented disability.”

Taking a step back to move forward

Curtis, of Alberta, (not pictured) was diagnosed with bipolar I when heavy depression and a manic phase disrupted his college studies in electrical engineering. With treatment, he was able to return to university, graduate, and find work as an engineer.

Unfortunately, his job involved daily meetings with anywhere from 3 to 20 people. His anxious dread in those meetings got so bad he ended up quitting.

To address his anxiety, he followed his psychologist’s advice to exercise regularly and practiced derailing his negative self-talk. He grew confident enough to apply for another engineering job, but before his final interview he was nailed by depression. He realized he couldn’t go back to his chosen field until he had his illness under better control.

In the meantime, his doctor suggested finding less stressful employment. “I think he wanted me to enter the work force at a level where I would not feel overwhelmed,” says Curtis.

Curtis had worked as a pipe layer and handled stock at a department store, so he was comfortable swapping his white-collar career for blue collar jobs in a warehouse, a liquor store, and a grocery store.

“All of the jobs I’ve had have benefited me in ways I would not

have expected,” he says. For example, the retail work gave him more exposure to dealing with the public.

He also joined Toastmasters to further improve his social skills and ability to be in front of groups. He tracks symptoms in a daily journal and seeks help if he sees red flags several days in a row. With his new skills and tools, he says, he feels ready to move back into engineering.

Salvaging her self-worth

Three years into her high-stress job as a negotiator for a labor union, Kimberly S. of, Ontario, went out on leave because of a major depressive crash. It was the first of “many shorter leaves” over the next decade, she says.

She would generally take from one to six months off to recover, then return to the same long hours and demanding responsibilities. (An attempt to give her a “special assignment” backfired, she says, because having more down time allowed her anxiety to spiral.)

Her last leave started in 2006—and she hasn’t been back. Her psychiatrist told her she shouldn’t attempt to work again

“This left me believing I was ‘useless’ to society,” says Kimberly, 47. “That turns out to be far from true.”

Kimberly has found purpose and satisfaction through volunteering. Knowing that she fills a need, whether as an usher at her church on Sunday or answering phones for her 12-step program one afternoon a week, fends off feelings of worthlessness that can be toxic for her.

“I have many skills and talents and I needed to find a way to put those skills to use,” she says. “I’ve learned that I need to contribute to society to feel whole.”

She still has to be careful not to overcommit, especially when she’s hypomanic and ready to take on the world. “The trick for me has been learning how much is too much for me,” she notes. “I’ve had to learn to say, ‘No, I can’t.’ My full-time job is managing my illness.”

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Printed as “What WORK Works for You?” Winter 2013