A letter to a therapist

An email to my old therapist: “Attached as a Word document is what I wrote at home to try to explain to you why what you said to me made me so mad, hurt and upset. If it contains some info you already know as a therapist; that's because I wrote it as a first draft of a potential essay for publication. I hope you read it and gain some understanding.”

Care, Compassion, Parity and Rights

Chronic condition victim blaming

In a prescription drug commercial, a man sits on a couch and is questioned by a voice-over, “Is your asthma under control?” or “Is your asthma managed well?” or something like that. The man answers yes, then a woman appears like magic next to him on the couch, glances at him dolefully and says with an incredulous tone of voice, “You use your rescue inhaler every day!” The man is subjected to other assumed loved ones who materialize on the couch and spit accusatory statements at him that are supposed to contradict his assertion that his asthma is “managed” or “under control.” The voice-over goes on to suggest to him — and of course any person with asthma who suffers symptoms of it — that the drug they recommend will enable them to “manage” or “control” their asthma.

Not only does this obnoxious commercial imply that the wonder drug it’s hawking will make it so a person with asthma will never have any symptoms or emergencies if one uses the drug, but it also implies that any person with asthma who has frequent, active symptoms is “not managing the condition” or not “in control.” This ad guilt-trips the sufferers of a potentially deadly chronic condition that they acquired through no fault of their own into feeling that if their asthma isn’t darn near asymptomatic, they’re doing something wrong. It’s your fault if you need to use a rescue inhaler every day. It’s your fault if you have an asthma attack that puts you in the hospital.

I don’t have asthma, but I know many people who do. Some of them have to carry around and use an inhaler every day. Some of them don’t have to do that, but every once in a while their chests get tight and they need to use a nebulizer. Some take oral medications every day. None of these people smoke or do anything else verboten that would exacerbate their conditions. From what I’ve seen, asthma varies in severity greatly among different people who have the condition; and how badly someone suffers from asthma is a matter of luck, not how much care the person gives to it.

The same is also true from what I’ve seen of diabetes. TV ads for diabetes drugs imply that if you can’t keep your sugar-to-insulin levels normal all the time, that’s your fault. You’re doing something wrong and — of course — this new drug or insulin delivery system will make it all right. It’ll be like you don’t even have diabetes.

The truth is diabetes is a chronic condition that is a booger-bear to manage. I’ve had very close friends with the condition who’ve struggled to keep the food they eat balanced with their insulin or other drug they take. I’ve seen insulin reactions and sugar reactions happen with these conscientious people who weren’t “cheating” on their diets by eating the wrong things. Even if people are “cheating,” well hell, nobody’s perfect. You try going without any food with sugar in it for a day, not less a week, and see how easy that is when TV ads switch from selling diabetes drugs to selling Skittles, Coke and Sara Lee.

I’ve had to give insulin injections, and to have to handle a hypodermic needle and an injectable drug bottle and stay sanitary, draw the drug and give an injection safely and not be a health care professional — that is no joke! Managing diabetes is hard work. Even the late Mary Tyler Moore, a TV star who was practically a poster child for the condition, had complications from her diabetes in her last years.

Blaming the sufferers of life-threatening chronic conditions for suffering from the conditions is a TV ad tactic that originates from living in a society that loves to blame the victim: rape victim, accident victim, physical impairment victim, mental impairment victim, poverty victim, whatever — it’s got to be your fault. This is America, anybody can do anything, overcome any obstacle, pick yourself up by your bootstraps, yadda yadda yadda. There’s no reason for anyone to be sick or suffering or poor or mentally impaired or anything and be hurt or disabled by anything. Just do something about it, and you won’t suffer! Nothing bad will ever happen to you if you do all the right things!

That is big, big, B.S. Many people with chronic conditions are going to suffer from those conditions no matter what they do. Many chronic conditions are hard to treat and manage, and people with those conditions may end up having to miss work, leave work, or go to the hospital no matter how well they do all the right things. Stop blaming these people from suffering from their disabilities. It’s not enabling denial, sloppy self-care or laziness — it’s practicing compassion and providing accommodations.

Mental health chronic condition parity

If I have asthma and I have an attack at work that a rescue inhaler doesn’t take care of — or heck, let’s say I forgot my inhaler or just don’t have one because I’m a slacker who’s not taking care of business — and I told my boss I had to leave work because my condition is too severe for me to stay at work, chances are my boss would hurry up and get me out of there, or even offer to call an ambulance.

If that boss insisted I stay at work, or even threatened to fire me if I leave as I’m struggling for every breath — which might be my last if I don’t get treatment immediately — that boss would be recognized by everybody with any sense as horribly lacking in compassion and with an excess of cruelty. (If you think this kind of thing doesn’t happen, go to notalwaysright.com, click on “Working” and read plenty of true anecdotes of bosses who refused to release sick, injured or even bleeding employees from work.) That boss would also potentially be in violation of the Americans with Disabilities Act for not granting accommodations for a disability, in this case a chronic physical health condition.

Now, let’s say I don’t have asthma. Instead, I have panic disorder. This is a mental health condition characterized by sudden episodes of extreme anxiety, uncontrollable fear, sweating, shaking, rapid heartbeat, dizziness, nausea and other symptoms. Panic attacks can vary in severity and duration. They can be so severe that they can be mistaken for a heart attack, and they can range in duration from one minute to more than an hour. Like with asthma, some people have more severe symptoms than others. Some people have treatment that works well for them and others have treatment that isn’t working as well or takes a lot of time to work. With some people, specific triggers (things that someone fears, such as heights) can set off a panic attack. With others, there could be no trigger at all; it just happens.

So at work, I have a severe panic attack. I’m having all the symptoms described above at a high-intensity level. I don’t have any treatments or methods on me that can stop this attack, and it’s definitely going to go on until I have some kind of help. I go to my boss and try to tell her that I’m in a state where I can’t work and need to have someone pick me up and get me help.

Because this is a mental health condition, my boss thinks I can just calm down and snap out of it. Like with mental health conditions in general, my boss is pretty ignorant about mental health issues and has stigmatizing, outdated ideas about them. So she dismisses me and tells me to go back to work. Meanwhile my panic attack is increasing because of the added anxiety from my boss’ attitude. My boss tells me, “Get yourself together or get fired.”

My mental health condition is covered by the ADA law, but my boss, and most bosses, won’t treat it the same as a physical health condition with a severe symptom flare-up. I’m just “tripping out” or “losing it,” and I need to “pull myself together.”

So in desperation, I tell my coworkers that I can’t work and call someone to take me home. The next day, the boss accuses me of “walking off on the job,” threatening me with being fired.

A similar thing happened to me some years ago, but in my case in advance of that situation I had handed my boss two letters from two different therapists telling her I have a mental health condition covered by the ADA that may require me to leave work. That headed off any attempts to fire me or cite me for misconduct.

If I had asthma, or if I had diabetes with an insulin or sugar reaction that required me to leave work because I can’t perform my job with the symptoms and I don’t have access to treatment, or treatment isn’t working, I wouldn’t need any letters from doctors proving I have a “real” condition that can disable me from working. I could just tell my boss I’m sick and then take my leave, and very few bosses would have a problem compared to what I face with a mental health condition.

If frequent absences or leaves from work kept me from doing my job, I should be treated exactly the way a person with a physical condition whose health issues are impacting their ability to work. If a boss would fire the person with many physical health absences and leaves, then they should fire me for the same thing. But if they accommodate a person with frequent physical health-based absences, I should receive the same accommodations.

I was a beyond faithful worker at my former job, working at all kinds of hours, under ridiculous conditions, and even taking work home and doing it unpaid. For a lifetime, I have struggled with a mental health condition that is potentially crippling and even life-threatening. When my symptoms are severe, sometimes I can use what I’ve learned in therapy to reduce them. Sometimes, it doesn’t work at all, and not because I doing something wrong or not doing anything. Even if I’m not doing something right, like the diabetic who shoots her sugar up by “cheating,” if I need to leave work because I cannot function there with severe symptoms, I have the right to do so, just like that “cheating” diabetic!

My letters from my therapists that I gave to my boss were not a crutch or an excuse or a sign that I think I “just can’t handle it”: It articulates a right that I have, a right I shouldn’t have to have a note from an authority to exercise! Again, I wouldn’t need it if I had diabetes or asthma.

My mental health condition is real, not something I can just “snap out of.” And I can suffer from severe symptoms that impair me at work and that may not immediately respond to treatment. It happens, just like with asthma or diabetes. Hopefully, it can happen less often. But it can happen, and if it does I have the same right to leave my job to get treatment, or just because I can’t work, as a person with a physical health condition.

I’m used to laypeople being ignorant, bigoted and just plain callous about mental health issues and especially mental health parity. When I see a mental health professional not understand this, it hurts and it diminishes my hope to live in a society free of ignorance and discrimination. I shouldn’t have to argue with a therapist about my claiming legal and human rights that she interprets as “acting on anxiety.” One form of discrimination against people with mental health conditions is to claim that things they want or believe in that you don’t understand or agree with are some kind of symptom of their condition. This is the kind of thing that makes people leave therapy.