ON MENTAL ILLNESS: Components of a Disability plus "The Revolving Door"

By Jack Bragen
Thursday August 15, 2013 - 03:37:00 PM

What are the factors that sometimes make a person with mental illness disabled? 

Medication may make a person physically slower. Paranoia sometimes interferes with performing a job. A mood disorder such as clinical depression makes it harder to show up for work. Some days, a person with mental illness simply cannot perform at a good level. Most employers can't or won't accommodate any of that. 

It is harder for a person with mental illness to get hired. The jobs that we are able to acquire are often entry level with a lack of responsibility. This is largely caused by discrimination. Employers invariably find it harder to trust someone with a psychiatric disability. 

Additionally, someone with mental illness might be told by many that they can't work, can't do it, or aren't good enough. Sometimes mental health caregivers believe it is their job to burst people's bubbles. 

Persons with mental illness may develop a negative pattern around employment as I once did. A negative pattern might look like this: To begin with, person with mental illness fails at a work attempt and then is very self-critical. This harsh self-criticism only makes it more difficult to try again. And when we do try again, our efforts are sabotaged by the negative emotions left over from the previous incident. 

Self-trashing is worse than someone else's harsh opinion. You can be immune to someone else's criticism, but not your own. Family members, although they have good intentions, may sometimes inadvertently feed into a negative pattern when they are attempting to help. 

None of this should minimize the fact that many persons with mental illness are great contributors to our work force. Most find it necessary not to disclose their condition for fear that doing so could end their employment. 

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The life path of someone with a mental illness is generally not easy. When we initially recover from an episode of acute symptoms, are released from the hospital, and return to some semblance of normal life, we may believe that we are past the hard part. We may not be aware that the life experiences in our future could be nearly as rocky as what we've already been through, if not more so. 

Everybody wants to have "the good life." However, if someone has a chronic, severe psychiatric disability, often they can not perform at a job on the same level as an unimpaired person. Many of us can work at only a minimal level. This leads to perpetually living on a low income level. Thus we see people our age and younger enjoying things like a house, a new car, travel, parties, and the stock market. We are lucky if we can maintain a part-time job which will allow us to occasionally have a Denny's meal, or to live in a neighborhood other than the very worst. 

When someone in their twenties who has a chronic mental illness holds down a job, they may begin thinking more highly of themselves, which is a good thing. But they may also believe they're cured and don't need treatment, and this could be a mistake. 

The pattern in which some mental health consumers periodically go off medication and then relapse was referred to by one therapist as "the revolving door" of mentally ill people returning to the hospital. 

I have made many of the mistakes typically made by persons with mental illness. 

The pattern for many persons with a mental illness often begins with a period of doing very well. The person with mental illness may or may not go off medication in the belief that they are cured. At some point, something goes wrong. 

Those who remained medicated probably have a better chance of weathering an incident. (Such an incident might be a dog bite, a breakup with a partner, the death of a loved one, a fender-bender auto accident, or something else that disrupts a person's stability.) 

Someone with severe mental illness may go through several cycles before they're done. The person is working and doing well, something happens to them and they deteriorate, and then they return to the hospital and are back to square one. At that point, the person eventually regains a good level of functioning and tries again, or else they might be too damaged from too many relapses to keep at it. 

It is believed that people with schizophrenia often experience fewer symptoms after age fifty. Middle and old age can be looked forward to as a time when things are finally better. For this to happen, someone with schizophrenia must physically survive that long, must not have too many repeat psychotic episodes since each one does damage, and must have some kind of adequate living situation.