Karen returned to work after a three-month medical leave. Diagnosed with bipolar illness many years ago, her symptoms had been successfully managed with medication and Karen’s own hard work in psychotherapy. A manic episode, seemingly from “out of the blue,” made it impossible for her to work for a few months. She needed the time to adjust her medication and to deal with her own feelings about this re-emergence of symptoms. She didn’t expect any problems when she went back to work. An experienced nurse, she thought her colleagues at the local hospital would welcome her back just as they always welcomed any other person who had been away for a time due to illness. She was wrong. Most of the staff didn’t mention her leave at all. Those that did were clearly uncomfortable. Some people seemed to be pointedly ignoring her. “We’re medical people, for heaven’s sake,” she said to me in our first session. “We’re used to people getting sickand getting well. What’s the big deal?”
Tom took an extended leave of absence as he struggled with a severe and debilitating depression. For weeks at a time, he couldn’t get out of bed, much less function at his high-pressure sales job. Although he had been the top performer at his company for the past five years, he was laid off when he tried to go back to work. His job, he was told, had been “redefined” so that he was no longer qualified. Tom was devastated. “What kept me going through the worst of the depression,” he told me, “was thinking about getting back to work. Work for me is what keeps me going.” He went on to say that he had thought that famous people like Hugh Downs and Henry Kissinger coming forward about depression made it more acceptable. “I found out differently. If you’re just a working guy instead of some bigwig, depression is the kiss of death at work,” he said angrily.
We live in a culture in which most medical diagnoses (with some notable exceptions like AIDS) are immediately responded to with sympathy and concern. But when a person is diagnosed with a mental illnessparticularly a mental illness with psychotic featuresa good many people respond as people once did to lepers: with discomfort, disdain, distancing, and even outright fear.
These reactions are often painfully obvious in the workplace when an employee either shows symptoms of mental illness or when he or she tries to return to work. Without the bonds of love, family, or long friendship to sustain the relationship, people’s insecurity and fears about mental illness can surface in surprising and hurtful ways in the workplace. Employers wonder if the person can still do the job. Supervisors, worried about legal implications, fear saying the wrong things, and often say nothing at all. Co-workers don’t know how to respond. Customers may be confused about the sudden unexplained absence and return of a favored contact in the company. The resulting awkwardness and tension make it difficult for an already fragile employee to do his or her job.
Shame or fear can exact quite a price. To avoid the real or imagined consequences of telling an employer or co-workers about his or her illness, the employee tries to “tough it out” alone. Some people don’t use their insurance for fear that it will alert their employer to their problems. Some put off getting treatment. Still others find a psychotherapist many miles away from home to prevent discovery. Those who use any of these tactics find themselves with a double problem: the original symptoms of an often frightening mental illness plus the enormous anxiety that their secret will be discovered.
It often becomes easier for the employee to leave the job than to put up with feeling like an outcast or to manage the worry about discovery. The company loses a good employee. The employee loses a good job. And the stigma and confusion about mental illness continue. People like Karen and Tom end up suffering many times over: first from a mental illness, then from the stigma associated with being mentally ill, then from the loss of self-esteem that comes with feeling that they failed at work.