Life at Work Live

Amy Joyce and Stephen Hinshaw
Washington Post columnist and guest
Wednesday, February 21, 2007; 11:00 AM

Washington Post columnist Amy Joyce writes Life at Work on Sundays in the Business section and appears online every Tuesday. In her weekly chat she gives advice on how to handle social and professional situations.

An archive of Amy's Life at Work columns is available online.

Find more career-related news and advice in our Jobs section.

For this discussion, she was joined by Stephen Hinshaw, chairman of the psychology department at the University of California at Berkeley and author of "The Mark of Shame: Stigma of Mental Illness and an Agenda for Change" (Oxford Univ. Press). They discussed her recent column: Should You Tell? For People With a Mental Illness, There's No Easy Answer, (Post, Feb. 18).

The transcript follows below.

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Amy Joyce: Good morning, all. We have a special Life at Work today with Stephen Hinshaw, author of "The Mark of Shame: Stigma of Mental Illness and an Agenda for Change" and chair of the psychology department at UC Berkeley. He and I will try to answer your questions about mental illness and the workplace. I wrote a related story for the Sunday Business section. (Link is above.)

Lots of questions await, so let's go ahead and get started...

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Washington, D.C.: When I applied for a secure government position with DOD I thought for sure they would reject me based on my anxiety treatment. I had to, of course, disclose all this. I'm glad I did because if I didn't, I'd live with a feeling that I was hiding something that was "wrong" about me. I had zero problem navigating complex security interviews, but thankfully, as an extremely nervous person, no polygraphs.

Stephen Hinshaw: This is a refreshing alternative to some of the other posts, in which writers have said that they would (and no one should) EVER disclose. Sometimes 'coming clean' from the outset--so long as there's a boss who 'gets it' and with the backing of ADA, etc., -- is the way to go. Congrats!

Amy Joyce: This is so great to hear. Thanks for sharing. I hope more employers get on board like yours.

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Washington, D.C.: Amy and Stephen,

This is more of a comment than a question, but I want to encourage anyone reading this chat who thinks they may have a disorder to seek professional chat. About two years ago, I was doing horrible at work ... not focused, constantly late, and it was really hurting my performance. After a meeting with a supervisor where upon recieving critical feedback I began to tear up (I had been always someone who looked forward to feedback as a way to improve myself), she encouraged me to seek treatment. I began attending therapy and knew I needed medication, but my health plan made it difficult to find a provider and I kept putting it off. I finally was released from that job, and it was the best thing that happened to me. I ponied up the money to see a physicatrist on my own, got on meds, and have since found a new job that I am accelling at. In this new job, I work completely independently, something I could not even fathom just 18 months ago ... I had always relied on close supervision. I attribute my success completely to the help I got, and hope others who are on the fence and are reading this can learn from my story and seek help for themselves.

Stephen Hinshaw: I couldn't have said it more clearly or articulately -- getting help is SO important, for self-esteem, productivity, satisfaction in relationships and on the job ... bravo to you!

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Rockville, Md.: If there is something going on in your life (whether it be mental illness or a serious personal problem) that is adversely affecting your job performance, I think you owe it to yourself and your boss to acknowledge it. Your boss has likely noticed that your work is suffering and might conclude that you aren't trying or aren't capable of doing the job. A few years ago an employee with an excellent reputation transferred into my group and I couldn't figure out why she was doing such a poor job. Only later -- after her project had been cancelled by the client -- did she tell me she had been having serious problems with a son on drugs. If I had known that she was having personal problems I could have cut her some slack, gotten her some help, and watched the situation more closely.

Stephen Hinshaw: I like this attitude of yours, coming as it does from the 'other side' -- that of the boss. Sometimes (and, I hope, most of the time) everyone gains when a mysterious silence or absence or lack of productivity is suddenly explained by the presence of physical or mental illness. The air is cleared, and coping can begin. Thanks for this most honest and refreshing comment!

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Anonymous: I first want to say how timely I thought Sunday's article was. My question: I asserted by ADA status by acknowledging my bipolar and depression on all appropriate forms. Things were fine until after consecutive outstanding performance ratings, numerous accolades I had my first hospitalization. I was suddenly seen by me as a slacker, I've been demoted, denied an alternative work schedule, penalized in the form of numerous offical reprimands including a harsh suspension. I've obtained legal counsel, but my employer is unrelenting and my legal bills (combined with my medical related bills) are now taking a toll. The EEOC makes mounting a legal defense against a well endowed federal agency almost an impossible. I have been seeking to be removed from a restricted leave status and obtain an alternative work schedule since 2004. I'm already out 10,000 in legal fees without anything much to show for it. Any suggestions?

Stephen Hinshaw: This is outrageous, to say the least, and shows how strong the stigma still is. Unfortunately, 'test cases' like yours can be enormously expensive. The question is whether you want to stay in the fight (and can afford it). Worth pushing on vs. letting others pick up the slack against this agency?

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Silver Spring, Md.: Thanks for the article. It touched on some significant issues. I would like to suggest that you take a broader look at the issues and obstacles confronting people with psychiatric and other disabilities more generally when considering working or working to a significant extent. People with disabilities, especially serious psychiatric disabilities, have by far the highest rates of unemployment or underemployment of any identifiable group, something that hasn't changed much or at all over the past 20 to 30 years, despite all sorts of legislation such as the ADA and the Social Security Ticket To Work program and all kinds of new and supposedly better treatments and medications for mental illnesses. For example, of the millions of persons on Social Security Disability (SSDI) or SSI (another federal disability program) less than one in 200 work enough to go off these programs permanently, which was the ostensible purpose of the failed and fatally flawed Ticket To Work Program.

Stephen Hinshaw: Unfortunately, you're right, but I believe that what you say reflects the STIGMA against mental illness as much as (if not more than) the actual disabilities incurred by mental illness itself. With support, job training/coaching, therapy/medication, and the like, many more people with mental disorders can and will work than is currently the case.

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Richmond, Va.: It's all the worse in D.C. where so many jobs require clearance. Many people say they think they can't get clearance if they get on antidepressants or admit to a history of mental illness. I know a few people who are not getting the care they need because they don't want to risk losing their clearance.

Stephen Hinshaw: Good point, here in our current post-9/11 era. Clearance is an issue for a great many jobs these days. I haven't been thinking about this enough.

Amy Joyce: I heard from someone yesterday who said he would/could never admit to his illness because he has top secret clearance. But with so many people who have depression and other related illnesses that are treatable, I wonder if the companies requiring clearances refuse everyone outright who might be on meds or have a history of mental illness?

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Anonymous: Amy -- What a great article! My husband has been diagnosed with clinical depression and had only negative situations with his employers. He was actually fired from one job because his "attention span" wasn't good enough for his job. He discussed that he and his doctors were working on his meds and that he simply needed some time. They didn't care. They dismissed him. We consulted a lawyer and were told it was a huge uphill battle even with ADA. He has finally decided to be a stay-at-home dad because he was unable to find an understanding company.

It is a shame that he had to give up his career goals; but, at least we had the financial option that many others didn't have.

Stephen Hinshaw: Right, all too many families wouldn't have the financial base for this decision. There's no single answer or "right course" for everyone. The hope is that, over time, he can try again with another company.

Amy Joyce: And perhaps his therapist might be a help. There are good job coaches out there who know better than I how to navigate the system when dealing with mental illness. You might want to look in to that. Good luck to you.

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Baltimore, Md.: Great column on Sunday. RE: disclosing/not disclosing having depression or bipolar disorder -- I would say NEVER tell them. I told a boss years ago when I had a bad reaction to new medication and two weeks later he fired me saying that he would never be able to trust me to do the work since I had this 'condition.' Nothing the EEOC or anyone could do. The only way this will change is when society changes and accepts this 'illness' rather than fears and mocks it. I have NEVER told another boss. I currently work for someone who routinely repeats personal, confidential information very casually, and I recently heard her dissing someone in another dept as "she's totally bipolar." I would tell anyone who's thinking of going public with depression -- DON'T. It will cost you, no matter what you think, no matter how understanding your boss may be. He/she could be replaced and you're out of luck.

Stephen Hinshaw: I can sure see why you have taken this stance. The larger problem, of course, is that if everyone keeps silent, the problem just builds and builds. There has to be a better way than having 'guinea pigs' take all the heat.

Amy Joyce: Seems to me like people need to be educated much more in this realm. (A perfect time for me to suggest all managers read Dr. Hinshaw's book ...)

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Portland, Oregon: I understand the purpose of this discussion is to focus on mental illness. But, the bigger picture is employer-employee relations recarding medical disabilities and the employer understanding reasonable accomidations.

There are some medical conditions that people understand even if they never experienced it. Some of these are cancer, heart attack, stroke, or diabites. Some other conditions there generally is empathy for like wheelchairs, or other obvious medical conditions like someone who broke a bone, have an amputation, or someone having a device to asssist walking for various conditions.

But for conditions that can't be seen are a problem with employers and supervisors in their lack of understanding and violations of the ADA. Mental illness is one example, but so are epilepsy, asthama, and tyrettes syndrome just to name a few.

Personally I have asthma and eoilepsy and through my experience, my supervisors do not understand my condition.

Stephen Hinshaw: What you are talking about is really important. In the research literature, there is a distinction made between 'visible disabilities' (e.g., you're in a wheelchair) and 'hidden disabilities' (e.g., you have a seizure disorder, asthma, or a mental illness). Sometimes the latter are called 'concealable.' Although it might be thought that visible disabilities incur more stigma, it is actually the hidden forms that can yield great anxiety and problems, because, as you say, they are harder to identify with and because it is a problem to know whether and when to disclose. Excellent point.

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Washington, D.C.: Hello Amy and Dr. Hinshaw,

Many thanks Amy for writing your recent column on mental illness and the workplace. I have been struggling with bipolar disorder and psychotic tendencies for the past 14 years. Through the help of my doctor and medication I am able to have a productive and rewarding career and make a good living. But it took a lot of pain and effort and hiding my symptoms from people before I got to this now, stable point in my life. I have never disclosed my illness to my bosses but they do notice I take at least a day every month off (to visit my psychiatrist). But so far these days off have never been a big deal. I think that if enough prominent role models were to "come out" with their success stories in dealing with mental illness that it might lessen the stigma somewhat. I am still afraid of the stigma and backlash I might experience if I were to be totally open about my illness to my workplace (the same way a diabetic, for example would be open). I have known people who have become homeless or came close to it because of dealing with mental illness. The hardest part is trying to get a career path going. But with the long-term and consistent help of a doctor, medication, and discipline, it can be done. I am living proof.

Amy Joyce: I'm so glad to hear about your successes. Thanks for letting us know.

Like you mentioned, more well-known people are coming "out" about similar illnesses. I mentioned a few in my article, but there are many others, including journalist Mike Wallace, Rep. Patrick J. Kennedy (D-R.I.) and professional basketball star Chamique Holdsclaw. Hopefully, the vast majority will soon learn that this can be treated. And with the right treatment and help, most can go on to be great employees.

Stephen, your take?

Stephen Hinshaw: Right, mental illnesses do not have the 'star power' of disorders like Parkinson's disease, where Michael J. Fox and Muhammed Ali are national spokespeople. Still, Brooke Shields and Jane Pauley and many others are beginning to come out of the closet, and show everyone that people with mental disorders are people first. Bravo to your efforts!

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Anonymous: I've been seeing a therapist for a few years now and had scheduled my time so I had my 40 hours and could leave early one day a week to go to see him. Recently, my boss decided that the accomodations were unacceptable and I have to take sick time for my appointments. I have no idea why. I'm okay with that, I guess. My real problem is that he told his supervisor about my therapy appointments. I don't care that she knows, but it should have been my place to tell her. The whole thing just makes me angry. It was inappropriate for him to do that and I feel violated. Am I overreacting?

Amy Joyce: I'm not positive about the legality here, but it seems to me like your boss is violating the rules of the Americans With Disabilities Act. If the accommodation is reasonable, which it obviously is because he is still letting you take that time off, the company needs to provide it as I understand. Also, the information should be confidential, so I'd say you're right to be a bit upset that this was shared with the supervisor above you. Do you have a human resources department you can talk to about this? Sounds like your boss might need some training.

Stephen Hinshaw: Right, talk with HR there. At the very least, this was insensitive; it may even be illegal. Good luck.

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Virginia: About your column on "Should You Tell? For People With a Mental Illness, There's No Easy Answer" at www.disability.gov, EEOC and DOJ both differs on employees with psychological or psychiatric disorders. And also under the ADA, it is illegal to ask "Are you disabled?" but legal under the Rehabilitation Act of 1973, Section 501, for federal employment. So there is a Catch-22.

Stephen Hinshaw: Right, indeed. We are in a mess when one statute says one thing and another says something else. I am not a lawyer, so not sure what advice to give here.

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Portland, Oregon: Your Sunday article doesn't just apply to mental illness, but to other medical conditions. All supervisors have an understanding of conditions they can relate to where their elder family memebers have the condition.

Some of these are cancer, heart attack, or diabites. They also seem to understand the rules involving very obvious conditions such as confined to a wheelchair. The problems occur when it involves conditions that are not very obvious to the naked eye.

Some of these conditions are mental illness, asthma, epilepsy, and migraines just to name a few. What happens is a darned if you do, darned if you dont with informing your supervisor of your condition. Some understand and its a non issue and others don't understand and hold it against you.

Now with more and more companies instituting health improvement policies opens the door on even more discriminatory cases where they either will not hire you, or convietly eliminate you because of your medical condition (insurance costs). I am fimiliar with this first hand. Through my career I was not hired for jobs because of my appearance or perceived medical condition.

One time, 20 years ago while working for one of the fast food places, me and another person were not scheduled for work for a few weeks as a way to try and have us quit working because of perception.

Stephen Hinshaw: This is a huge problem. I replied just a moment ago to another correspondent that 'hidden disabilities' (like migraines, epilepsy, mental illnesses, etc.) are, paradoxically, harder and more stressful than overt, visible ones, because of all the struggle about whether to disclose or not.

We need parity legislation, so that mental disorders get the same level of coverage as physical illnesses and employers cannot get away with failing to cover someone because of a mental illness.

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Alexandria, Va.: Good morning, Amy and Dr. Hinshaw.

Thank you for taking my question. Have any of the studies on depression and bipolar disorder really gotten into the "discouraged worker" aspect of the unemployment rates? I have bipolar disorder and am discouraged from seeking a job from previous experiences.

Stephen Hinshaw: There are studies out there that deal with the long-term consequences of mood disorders for relationships, employment, lowered income, etc., but not enough about the actual demoralization that occurs at a psychological level. We do know that experiences of stigma lower the motivation to seek treatment or stay with it (and even to pursue jobs). So, you're really on to something here.

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Ashburn, Va.: A comment on 'Should You Tell': After being diagnosed with depression when I was working for a large company (the thought being, I have job stability), then having to look for a job and ending up in a contracting position, I found that getting health insurance was difficult to impossible. I thought that my medical history would result in higher premiums; I didn't realize that I would just get turned down, specifically due to the depression diagnosis.

I certainly will never discuss any mental health/depression issues with my doctor again. I can't afford it.

Amy Joyce: But can you afford NOT to discuss these serious medical problems with your doctor? I know insurance is unbearable to deal with in this situation, but I think you really have to consider your health first. Otherwise, you may end up in a situation where you can't work and can't support yourself at all.

There is legislation pending in the Senate and soon to be in the House for mental health equity.

Stephen, do you want to expand on this?

Stephen Hinshaw: Yes, Congress finally has a decent chance, this term, of passing the Paul Wellstone Mental Health Equitable Treatment Act, which would guarantee true parity (equal coverage for mental disorders, related to physical illnesses). This will go a long way, symbolically and practically, to ensure that people get the help that they need. The cost of NOT talking with your doctor/therapist is that the underlying issues will either lie dormant or get worse, so please reconsider your position, maybe with a different provider.

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Arlington, Va.: Hi, Amy. I just wanted to give a big thank you for coming out with this article. If only I had known that I should have fully disclosed to my supervisor that I was in therapy and on antidepressents and sleep meds to deal with the death of my father, maybe I wouldn't have been fired for falling performance and signed away my right to pursue legal action so that I would receive a severance. Thank you for making sure others have the information they need to protect themselves and the ones they love.

On a bright note, that job was terrible anyway and I'm now off the meds and in a wonderful position I love to be at everyday.

Stephen Hinshaw: Thanks for this reply. Wow, what an inspiring story. A lot of correspondents are saying, from bitter experience, 'never tell,' but if that is the M.O., then the whole situation will never really change.

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D.C.: I believe I'm suffering from a mild bout with depression/anxiety disorder. I'm working with a therapist and believe this is temporary condition due to stress at work and a few other personal issues. The condition has made it difficult for me to perform at the best of my abilities at work. I think I am still doing a good job but I know I'm not performing at my peak. Do you recommend I tell my boss I'm having some personal issues?

Amy Joyce: Hi D.C. Sorry to hear about your situation. As I pointed out in the article, it's a very tough decision to make. Part of it depends on the kind of relationship you have with your boss. Does s/he seem understanding? Also, if your company has an Employee Assistance Program, you may want to check in with them, ask for advice on this. Conversations with the EAP have to remain confidential, but they might be able to be a go-between with you and your boss if you decide to tell.

Stephen, your thoughts?

Stephen Hinshaw: Right, there's no set answer; it has to be individualized. But if your boss has a reputation for understanding and some flexibility; if you feel that keeping it all in will only add to your own stress; and if someone from EAP could potentially serve as an intermediary, you might really benefit from letting go of some of this information. Good luck!

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Northern Va.: More input on how honest to be with your boss ... about five years ago, I had a severe reaction to a depression medicine I was put on while being supervised by a pyschologist and pyschiatrist (we are talking suicidal when that was clearly out of character). I was in the hospital over a weekend and requested the following week off of work to get my head back together (literally). My boss begrudgingly gave me the week off, even with a doctor's note and when I had the vacation time available. Though she didn't know why I was in the hospital, I certainly wasn't going to come clear after her initial reaction.

Stephen Hinshaw: Always a tough call to know how 'honest' to be after a situation like this. But consider that, if such would happen again, it gets to be a great strain to constantly 'hide' the real reasons. Are there EAP people at work, etc., who could help with disclosure when the time is right?

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Anonymous: I enjoyed your article about mental illness at work and feel this needs to be an ongoing topic for the media. There are many levels of mental illness, and fortunately more and more articles are being written about depression in general.

My adult daughter struggles with mild depression and anxiety from time to time and has on occassion used medication for treatment.

My question is, where to draw the line on honesty? When medical or job applications ask "have you ever been treated for mental illness?" She has taken perscription drugs off and on for 10 years. This is not a dibilitating situation so she has the dilemma of when to say yes and when to say no. Fear of no coverage or no consideration for the job always loom over her.

Any guidelines or suggestions?

Stephen Hinshaw: This is one of the truly tough questions. Far be it from me to advocate lying outright on an application, but in many cases, honest disclosure at the outset may close the door in your face. If there's room on the form to explain, just as you have in your posting, the situation, you still risk the boss's wondering (because of stereotypes, etc.) whether she's worth the risk. May depend on the reputation and past behaviors of the company -- ask around! Good luck.

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D.C. relative: I cannot thank you enough for taking on this important topic. I have a close relative in another state who was fired from their last job for causing a "distraction" at work. Her boss and co-workers were very uncomfortable with the manifestations of her bipolar disorder -- basically they were freaked out because she talks to the voices she hears when she is in the middle of an episode. There are no jobs available where she lives now -- deep in "rust belt" recession territory. I have encouraged her to move here but she doesn't want to because it is not "home". Would it be really damaging to someone like her to make a big change like that in their life? She can't stay unemployed forever. Thanks for your help.

Stephen Hinshaw: Wow, this is a really hard one, because it involves a double-edged sword: Stay unemployed or risk moving, with the stress that this may incur. Depends on financial resources, availability of treatment in each venue, realistic chances for job prospects elsewhere, etc. The real question may be whether your relative has a support network, including a counselor/therapist, with whom to discuss pros and cons (and who could buffer the stress of the decision, either way). And, is she on the types of medication that can lower the potential of the voices, etc.? Good luck in what is bound to be a difficult, though potentially liberating, decision.

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Baltimore, Md.: I want to thank you both for this discussion. A few years ago I suffered a period of depression and was on medication. I am aware that I did not perform very well during this period and I was fired from two jobs. I have a new job now and am doing very well, both professionally and mentally. I did have to take a step backward though and one former supervisor said she could not recommend me for a management position. My question is, what happens when I am ready to move back up and interview for positions at other companies. How do I explain this past failure to perform. (I must note that I had 15 years of very successful performance before these two aberrations, but that experience is now nearly ten years ago.) If contact is made to my previous supervisor, I will not get a good recommendation. I still fear that this low period in my life will continue to haunt me.

Amy Joyce: One consolation: Most companies that give references now only confirm start and end dates. They are afraid to be sued by giving poor recommendations. You can hope this happens. And even if it doesn't, you have great work history and a good situation now. Remember that most people don't have a clear, clean, perfect record, and most recruiters acknowledge that. You can be honest enough in interviews if they ask why you were fired by saying something like: "I had some personal issues at that point that have long since been taken care of. As you can see, my work experience since has been stellar."

If recruiters didn't hire all the people they saw who had been fired, they wouldn't have many people to choose from.

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Elk Grove, Calif.: Should you tell your prospective employer on a job application? Or do you mean should you tell your fellow co-workers?

Stephen Hinshaw: Well, each incurs different risks and potential benefits. If you disclose to employer at the outset, will the door be closed in your face right away? If not, however, and symptoms appear, will you be viewed as lazy or hostile or unmotivated?

RE: Co-workers, may be best to sound them out a bit, gain trust, and then with those with whom you feel comfortable, to let go of some issues with medical/psychological history.

Good luck!

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Washington, D.C.: Actually, just a comment. I think there is a difference between a mental and physical illness that is obvious (e.g., MS, anorexia, alcoholism) and one that is not (e.g., depression). In my case, I did not have to tell my bosses: my weight loss was apparent. The HR Director and Benefits Manager thankfully did a form of intervention that landed me in the hospital for three months. That said, I do think it is a case-by-case basis. The employee may feel more comfortable telling her direct supervisor versus the HR/Benefits Manager (or vice versa), and make accommodations that way. But the HIPFA rules and regulations may add a layer of complexity. I do wish there was no shame attached to mental illness, but there is; and for sanity -- and financial sake -- you need to do what makes most sense.

Stephen Hinshaw: Thanks for the comment. Right, it IS highly individualized. Making the decision to disclose is not 'all or none' but rather varies with symptoms, personal strength and motivation, and accessibility of HR/EAP vs. a willing boss.

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Washington, D.C.: How do you keep mental illness from interfering with a job search? I have anxiety problems, and when I think about picking one job out, I worry that I'm ruling out all sorts of other positions. It keeps me from looking on many days.

Also, how do you explain to prospective employers breaks in employment? Lie?

Stephen Hinshaw: The first part here is hard for everyone -- if I try this, am I ruling out that?--but in the case of an anxiety disorder, in which rumination and obsessive thinking are part of the mix, this can be overwhelming, stopping someone in his or her tracks. This whole issue would need to be part of the therapy -- i.e., working with counselor/therapist on just these kinds of 'worry' issues.

Now, about explaining past employment history, this raises the huge question of whether to tell all at the outset or to wait and see. Depends on personal stability, the reputation of the boss/company...if there are major gaps, may look funny not to say something initially; if more minor, then maybe don't raise too much too soon. Good luck.

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RE: Anonymous: I thought that is now illegal for a company to ask if you have been treated for mental illness. Privacy issues?

Amy Joyce: The way I understand it, it's illegal for them to ask in the interview process, but okay to ask after they have given a person an offer. That way, the person interviewing has been given an offer, but if they say they were treated for a mental illness and the offer is taken away, they can show potential discrimination. Check out the EEOC guidelines here:

http://www.eeoc.gov/policy/docs/psych.html

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LaPlata, Md.: I suffer from dysthymia which is chronic depression and mild mania. I have lost jobs due to the illness as their are some days I just can't do anything (despite being on medicine). I know that I should alert my supervisors, but I am embarassed. How do you approach that subject? Also, when you are interviewing for a job, how do you explain that you were let go due to a mental illness the ex-employer never knew about?

Stephen Hinshaw: Great questions, and difficult ones.Answer may depend on your current stability -- and on the reputation of the current company for being understanding and flexible vs. rigid and unyielding.

Remember, under ADA, it's your right to be considered for job on your own merits, so overcoming embarrassment and being able to talk honestly may be important for your own psychological well-being and the ability to get a job! Good luck.

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Waco, Tex.: I'd like to share an experience I had several years ago when I was working in DC at a local university. I went through a period of severe depression for quite a bit of time (three years total). Informing my boss was necessary -- I had medical appointments every week for treatment. The condition impacted work, and one day, my boss was forced to confront me. Somehow, a meeting that started with raised voices ended with joking -- but I owned up to what I needed to do and asked for a little more patience until I could do it.

Several weeks later, I was reviewing the employee policy manual and came upon the section on employee discipline. I realized my boss could easily have written me up and I went to her asking why she hadn't. Fortunately, she was very wise with these things. She said that she knew I was going through some hard times and was working on those issues, thus she gave me some leeway. However, if she had thought I was otherwise perfectly healthy and normal, she would have started official disciplinary measures because my work performance and behavior was not acceptable.

That moment I realized what mercy had been extended to me and I've appreciated it ever since. That mercy would not have come had the mental illness of depression not been known to my supervisor. Since then, I have vowed not to waste that mercy, and to reasonably extend it to others when the situation arises.

Amy Joyce: Great story. Thanks for sharing. In a way, I'd say that was less about mercy, and more about smarts. You're lucky to have such a good manager.

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Displaced: Good morning, Amy. And welcome Dr. Hinshaw.

Thanks for openly discussing mental health in the workplace. Don't disclose. It killed my career. In my case, I sought assistance from my agency's EAP for my mental health issues, who in turn forwarded my information to security and my clearance was revoked. I will be separated from my job soon. I had exceptional reviews throughout my career, until my boss learned of my condition last year.

My question: How do I address the "have you ever been fired" question with future employers? How do I deal with the reference checks by future employers? My meds work, so I have my health and a supportive family.

Thanks for taking my question.

Stephen Hinshaw: This makes me so angry! We've had a range of postings, from 'yes, disclose' to 'never do so,' and your story is poignant, tragic, and so unnecessary.

In terms of 'have you ever been fired,' my guess is that it's better to come clean than to lie outright...but it depends on how closely the new prospective employer might check past references. The problem with 'never disclose' is that you don't give the new firm a chance to understand why you might have been (illegally) terminated from past work. So, think about your automatic answer a bit. And all best in your search.

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Anonymous: Amy and Dr. Hinshaw: Thanks for the chat. I'm in the exact same situation as Anonyomous, including being bipolar, but with higher fees. With all this hanging over my head, how do I start over from an employment perspective, without returning to eating ramen noodles?

Stephen Hinshaw: Hard to know, without more info -- but you may need to get something going, build an employment history, and work up. Disclosing past mental illness is a hard choice, but timing is everything. Good luck!

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Baltimore, Md.: Due to a number of traumas, I have been dealing with PTSD for a long time. I have been advised to receive treatment but am reluctant because although I now have some coverage, I think I need long-term help, and don't know how I would pay for it. Also, I am reluctant because I have doubts I can find help from someone who would understand my experiences, since some of them were very unusual. It is easy to tell people to get help, but what about the fact that it is hard to pay for and hard to find the right kind of help?

Stephen Hinshaw: First, we hope that current Congress will enact parity legislation, so that treatments can in fact be covered. Second, PTSD can be awful, but it IS treatable--and may victims feel that no one can or will really understand. I urge you to seek a therapist with experience in treating PTSD, as I think that the understanding, support, and skills you will obtain will take away some of the aloneness, 'difference,' and possibly isolation you may be feeling. Good treatment may be a great investment in your future. Good luck -- you sound brave.

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Silver Spring, Md.: I say NEVER disclose to a boss. I told a superior that I was going to AA. I come from a family who has a history of the disease and I didn't want to end up like them, so I decided to join BEFORE it happened to me. The next day, my direct supervisor, told me he wanted me to look for another job. (The reason that I had never told him about AA is that he is "perfect" and not very tolerant of imperfection.). I left when I found a new job, not because I really had to, but because I didn't want to put up with him anymore. Don't disclose unless you want everyone in the office to know something.

Stephen Hinshaw: Unfortunately, this is the experience of too many people. The problem with 'never disclose' is that the entire problem keeps mounting, at a regional and national level. I hope that you find a more open and encouraging setting in the future!

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Glenn Dale, Md.: Just want to weigh in on disclosure and knowing your boss. I was a manager and had an employee commit herself for treatment which eventually spanned several weeks. Due to the nature of our jobs and security clearances I did inform her that I would have to report her absence to security. She concurred. Security was great in doing a compassionate evaluation when she return and she maintained her job and clearance. Now for the kicker -- when she was in my position she harassed an employee going through a situation similar to hers. I advised the employee to contact HR and deal with the problem. Unfortunately the second case left a bad taste in everyone's mouth.

Amy Joyce: Glad to hear people can maintain clearances. But strange situation with the kicker. I hope the other employee's situation turned out okay.

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Pennsylvania: Someone at work misinterpreted something I said and thought I was considering killing myself. They then asked to have lunch with me to discuss this, only I didn't realize what it was they wished to discuss. This person later cancelled the lunch. Later, when I heard about the misinterpretation, I was curious as to why the lunch was cancelled. The co-worker told me that his wife called and said she needed him to come home and walk the dog. It dawned on me: a higher priority is placed on walking the dog than killing myself. Should I now be depressed?

Stephen Hinshaw: Well, people do get afraid when their own stability is threatened or rocked. I would urge you to find a way to talk to this co-worker, or even send a letter, to clear the air. At least you will have had the chance to speak your piece--and maybe the co-worker will have a chance to hear refreshing honesty, rather than avoidance.

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Anonymous: My PPD went untreated for a year and that plus other stressors sent me spiraling into clinical depression. Sadly, I did not get treatment until forced to by a poor review and warning with the employer's "full support". Everything improved -- I even received great reviews but then I was fired anyway and threatened by the legal team (I guess to scare me away from a lawsuit).

It was the best thing that could have happened BUT I will NEVER let my employer know my medical issues now. It is MY responsibilty to reach out to the supports I know of if I feel the darkness creeping up again.

Stephen Hinshaw: Sorry that it happened this way -- getting support is indeed crucial. But the hope is that, in the future, more sensitive places of employment could be part of the support team rather than adversaries.

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D.C.: I suffer from clinical depression and mental illness has decimated my family. However, no one talks about the fact many mentally ill people can also be highly manipulative. How can one accomodate someone suffering from a illness without making those who don't feel as if they are being punished for being OK? This is a family and work issue.

Stephen Hinshaw: Tricky one here. Being manipulative is not the exclusive province of those with mental illness! Remember that it is important not to reinforce stereotypes -- some people with mental illnesses are highly manipulative, but others are not at all. Important, though, to reinforce those who don't 'work the system' for their ethical behavior!

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Washington, D.C.: I was somewhat surprised that, according to your article, employers can ask you whether you have a mental illness if they have made a "conditional offer" to you. What does that mean exactly? What is a conditional offer?

Also, can an extended leave of absence to treat a mental illness be considered a "reasonable accomodation" under the ADA?

Stephen Hinshaw: I would need to be (or consult with) a lawyer to answer this very good first question accurately.

As for the second one, I think that this could be considered such an accommodation, but asking HR or EAP may be the best course here.

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West Coast: Is there a difference between a mental illness and a personality disorder? Are both covered under ADA rules?

Stephen Hinshaw: Personality disorders are considered a form of mental illness, technically on "axis II" of the DSM rather than "axis I." Both forms should be covered. Good luck.

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Amy Joyce: Thanks all. I hope we were helpful to you today. Much thanks to Dr. Hinshaw, whose answers were enlightening to me, as well.

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