Take Charge of Bipolar Disorder

WORK AND MONEY

Bipolar disorder is notorious for causing work and financial problems. From depression to mania and everything in between, the illness can seriously impair your ability to work effectively and manage your money. These work and money problems can also affect you in other areas, including your ability to get health insurance and the quality of relationships with the people in your life, especially those who may judge you because you can’t work the way they think you should. Many people with bipolar disorder simply can’t handle the stresses of everyday work. Bipolar disorder is an illness that is often triggered by outside events, and for many people, work is one of the biggest triggers.

Work and money problems can also affect your self-esteem and your hope for the future. You may wonder what the future holds for you if you have trouble working and currently can’t make enough money to support yourself. You may have made some big financial mistakes when you were sick that now cause significant stress in your life and impair your ability to get better and move on. The good news is that there are solutions to these problems. It takes time, but a comprehensive treatment plan can often help you find enough stability so that you can work effectively and make the money you need to support yourself in the future.

This chapter helps you get a realistic picture of your current work and financial situation, so you can decide what kind of work you can do while still maintaining your stability. It also helps you get a current financial picture, offers tips on how to get help if you are in a financial crisis, and covers disability and where you can go for information on what to do when you are unable to work and support yourself.

For Family and Friends

This may be the hardest chapter for you to read. It’s often the family members who feel the burden of a relative who can’t work or make much money. Friends are often affected by this as well. Our society ties so much self-worth to career and financial stability, so it’s natural that the behavior of people with an illness that causes work and financial problems would create misunderstandings and frustration all around. Many people with bipolar disorder struggle with this constantly. The more you can understand why your loved one may not be able to work or make money right now, the more you can help him or her get better and create a plan that can allow for going back to work in the future.

THINKING ABOUT WORK AND MONEY

When you’re sick, this may be a topic that you wish would just go away. It’s hard enough to deal with treating this illness, especially if you were recently diagnosed or spent time in the hospital. Thinking of work and money may seem overwhelming right now. This chapter will gently guide you through the process so that you will at least have a clear picture of where you stand, and help you ask for the assistance you need.

FRIENDS AND FAMILY MEMBERS

Do your friends and family members question you about your work ability and the trouble you have with money? It’s possible that people are frustrated with your lack of current work, and may not understand that it’s often a part of the illness, and not always something you can control. It might help to read this chapter with your friends and family and ask for their help with the exercises. It may be that they can be more understanding when they see that work and money issues are a problem for most people with bipolar disorder, and that you’re not alone if you struggle with finding your place in a world that emphasizes work and making money.

SHAME, EMBARRASSMENT, AND WORRY ABOUT WORK AND MONEY

You may have a lot of painful emotions surrounding your work and financial situation. Our society places a high value on working and making money, and if bipolar disorder has affected your ability to work and earn, you can easily feel like a failure. For many people, not being able to work the way they know they’re intellectually capable of working is one of the most devastating side effects of this illness. You may feel worthless and ashamed at your inability to do what is expected of you, especially if you have a family you can’t support or have to ask for financial support from family members and friends. It’s also terribly hard to come out of a severe manic or depressive episode and face the work and financial mistakes you made while you were sick. Some people go home from the hospital to thousands of dollars of debt, having lost everything they worked to build. Does it help to know that you’re not alone if this has happened to you? Shame, embarrassment, and worry over work and finances are a large part of having bipolar disorder for many people, and the sooner you can accept that this is just another part of the illness that needs to be treated and prevented, the sooner you can make some positive changes to make sure it never happens again. You’re not the exception if your work and financial life are a mess. You’re certainly not without hope.

THE PRESENT

The first step to getting your work and financial position back on track is to see where you are with work and money right now. The clearer you are on how you feel and where you want to be in the future, the better able you will be to make decisions on what you need to do now to improve your situation.

For Family and Friends

There is a good chance that your loved one has caused some family financial problems. Sometimes you just have to accept the consequences of this illness and then do everything possible to help make sure the big problems are prevented in the future. And yes, this may include limiting contact with someone who refuses treatment and continues to make disastrous financial decisions.

Robert’s Story

Age 39

My sister never really did any real work as far as I was concerned. She was just sort of a perpetual student. She worked at a few jobs but seemed to leave them early. If she had a way not to stay at the job, she would just leave. She moved a lot. It’s as though she didn’t care. She was never in a state of mind to keep a job for a long period of time. Personal issues at her jobs were too much for her. Then she was diagnosed and started a treatment plan. She made a lot of changes. Now when she has an idea that will make money she’s able to do it. She still gets sick and depressed and sometimes she is way too talkative and goes out too much and does things that make her more ill, but nothing like before. She just has to take it easy. It takes her longer, as she gets sick when she takes on too much, but she’s pretty amazing.

How You Feel About Work

A person’s ability to work is often taken for granted. It’s simply what a person does. When you have an illness that takes away this ability to work, you can have some serious internal conflict about who you are as a person and what your future will be like. Answer the following questions regarding work to get a clear idea of how you feel about your current work situation.

How does bipolar disorder affect your work abilities?

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How does work affect your bipolar disorder symptoms?

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What changes would you like to make regarding work?

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What are your work goals for the future?

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How You Feel About Money

Depending on how much you have been able to work in the past, your financial situation may be quite serious as well. Once again, it may help you to know that you’re not alone if you have significant financial problems because of this illness. Answer the following questions regarding money to get a clear idea of how you feel about your current financial situation.

How does your bipolar disorder affect your moneymaking abilities?

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How do your financial problems affect your bipolar disorder symptoms?

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What changes would you like to make regarding money?

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What are your goals for the future regarding money?

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Orlanda’s Story

Age 25

It’s tough being diagnosed with bipolar disorder. My whole life changed. My dreams for who I wanted to be just seemed to disappear. I cried a lot when I realized that all the years of searching for the “right work”—in other words, work I could handle without getting fired or leaving due to stress—was really about an illness and not about my ability to move forward in life. I know my family looked at me like a failure. I felt like a failure. I was supposed to be successful just like all of the people in my family. My father is a professor. My brother is a lawyer and my mom is a principal of a middle school! Everyone, including me, had ideas of where I should be. I just couldn’t get there. I felt like someone or something had stolen my life from me. Work is just so important. I had a friend from France once tell me I worried about work too much. “Work is just something you do for money,” he said. “Real life is about friends and family.” I wanted to believe him, but I wasn’t even able to work for money! I had to go on disability for almost a year after my suicide attempt. I honestly thought I would never work again. And if I did get better, what work could I possibly do? I realized that the high expectations I had for myself would have to change. I would have to look for something that fit into the diagnosis, as I knew for sure that a busy, stressful job would make me even more ill. Time has helped a lot. I manage this illness every single day. I’m not one of those people who takes a pill and goes back to the high-pressure job. I had to make changes. I now work as a graphic designer for a small firm instead of a large one. It’s less money and certainly less glamorous, but I can stay well. Everyone knows about the bipolar disorder. I’ve taught them how to help me stay stable. No, this is not the work life I expected for myself. I had to change my expectations. I am so proud of myself now! Five years in the same job and no more visits to the hospital. I am a success.

Now that you’re more aware of how you feel regarding your current situation, you’re ready to get a clear picture of your past experiences with work and money. You will then use all this information to create a plan for your future.

For Family and Friends

Family members and friends can definitely help with the work and financial history sections of this chapter. Think back as far as high school in order to get a clear picture of your loved one’s work and financial history. People with bipolar disorder who were diagnosed later in life usually have a checkered work history, and seeing it all on paper can be stressful. Still, it’s a needed tool to help your loved one get realistic about what he or she can do now instead of blaming him- or herself for the past.

CREATING A WORK HISTORY CHART

It’s important that you look at your past work history in order to get a realistic picture of your future work prospects. It may be that medications will work well for you and that you will be able to work normally. If this is not currently the case, however, it’s important that you be realistic about what you can and can’t do at this time regarding work. If you just came out of the hospital, it may take some time before you can go back to work, and you may have to take on unexpected jobs until you are well enough to return to your regular work. The following exercise will help give you a complete picture of your work history; you can use the information to decide what work you can do realistically in the present and near future.

Chronological work history. List as many jobs as you can remember with dates and an explanation of why you left:

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Patterns. What patterns do you see when you look at your work history?

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Money. How much money did you make each year in the last ten years?

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Current work situation. What is your current work situation? If you’re working, how many hours do you work? What is the pay? Are you staying stable?

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Future prospects. Considering your past experiences and your bipolar disorder diagnosis, answer the following questions:

What is likely to be your work ability in the next six months?

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In the next year?

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In the next five years?

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What is different in your life now that will make your work prospects more positive in the future? Some answers could include medications and this book:

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Now that you have a realistic picture of your past and current work situation, you can create a plan for the future. The tips in this book, along with the right medications, can make a huge difference in your life, and you may find that your future work prospects will be better. Or maybe you have always had trouble with work in the past and will continue to have trouble in the future if you don’t make changes now. The above exercise will at least give you an idea of where you are in the moment and what steps you need to take next. The following section will help you do the same with your financial situation.

CREATING A FINANCIAL HISTORY CHART

The next step, after looking at your work situation, is to look at your financial situation in a realistic way. It makes sense that where there are work problems, there will be money problems. You can use the following exercise to help you get a clear picture of where you are financially.

Getting a realistic picture of your finances can be very distressing, especially if you just got out of a bad mood swing. But considering how sensitive bipolar disorder is to stress, the worry brought about from not knowing where you are financially can be worse than facing the reality of your situation. Writing down exactly where you are financially gets it out in the open and can take away some of the fear of the unknown you may feel. No matter how worried you are about filling out the next chart, try to do it anyway. Then you will know exactly where you need help.

	*Your Debts*	*Your Assets*
	Housing: ____________	Cash: ____________
	Car: ____________	Savings: ____________
	Credit cards: ____________	Investments: ____________
	Loans: ____________	Housing: ____________
	Medical bills: ____________	Car: ____________
	Miscellaneous: ____________	Miscellaneous: ____________
	Total debt: ____________	Total assets: ____________

A realistic picture of the future. Look over the yearly salaries you listed in the work exercise, and then look at your present situation. What can you realistically expect to make in the next month, six months, and year?

One month: ____________

Six months: ____________

One year: ______________

Can you survive on this money? ____________

Steps you need to take to support yourself in the future: ______________________

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Knowing your financial history and your current financial situation can take away some of the fear associated with how this illness will affect your future. You can say to yourself, I’m in debt and I can’t work right now because of bipolar disorder—what do I need to do next? Or maybe you will find that your situation is better than you thought. The good news is that using the tips in this book can make a major difference in your work and financial futures. The following section will offer some suggestions on how to get back on your feet and prevent future work and money problems.

RECOVERING FROM AND PREVENTING MANIC DISASTERS

No matter what has happened in the past because of bipolar disorder, you always have the ability to make things better in the future. The future may not look exactly as you expected it to, but you can recover from the disasters caused by the choices you made when you were manic. If you had a severe manic episode that created financial ruin for yourself and/or your family, then welcome to the bipolar disorder club. You’re not alone! Maybe your disaster happened on a small scale, or maybe you’re now in bankruptcy because of the episode. This happens to many people with the illness. Your goal is to set up checks and balances so that you never again have to go through a financial disaster because of bipolar disorder. The following list is a good beginning:

• Take your medications. This is the only way to truly prevent serious manic episodes.

• Create the habit of writing down everything you spend and showing it to someone daily if needed.

• If credit cards are the problem, then you will have to get rid of them or let others hold them for you. Debit cards and checkbooks can be a problem as well. Going to a cash-only system is a good step, even if it’s embarrassing.

• If you’re in a relationship or live with someone you trust, create a weekly check-in where you go over all of your financial decisions and determine if you’re getting manic. There is a space for you to determine your current mood in the journal at the end of this book. This can’t stop just because you start to feel more stable.

• Have a regular health care appointment (even if you feel well) in which you can be monitored for mania.

• If you’re married, you may want to have all financial accounts in your partner’s name, including any retirement and investment accounts, so that you don’t have access to these accounts when you’re ill. Once again, this hurts, but you may have to do it.

• Accept that mania is going to affect your life financially, and that one way to protect yourself from this is to prevent the mania by using the tips in this book as well as those from your health care professionals.

Answer the following questions to get started on your own checks-and-balances plan:

What checks and balances can you start today?

Who can you ask for help?

Do you have credit cards? Is it realistic for you to use them?

For Family and Friends

Manic spending is a loaded topic. Many family members and friends often either don’t notice or ignore the subtle signs that mania is starting, then grow very upset when the damage reaches thousands of dollars. If you have anything to do with the finances of someone with bipolar disorder, you must protect yourself first. This means working together as a family (or as a friend) to see the early signs of mania. You may need to make the decision to help and support your loved one emotionally, but not financially, unless he or she is monitoring the mania.

DEPRESSION, WORK, AND MONEY

For many people, depression is the main source of work and money issues. Getting things done when you’re depressed often feels impossible—and work is obviously about getting things done. There are tips in this book on how to prevent depression from reaching this stage. As with mania, prevention is the best way to make sure that depression does not affect your work.

For Family and Friends

How do you feel when you see your loved one sit on the couch or stay in bed all day? You probably want to yell and say, “What are you doing with your life? You need to get up and face the world and take care of yourself! I can’t be responsible for you.” To be honest, this won’t work—depressed people often simply can’t respond the way you want them to. The illness is too strong. Depressed people sit around all day without working because this is a part of bipolar disorder. The only thing that will work is treating the depression. This book has a variety of tips for ending depression and getting back to life. This is the first step to getting back to work.

HOW TO DISCUSS BIPOLAR DISORDER AT WORK

Bringing up bipolar disorder at work can feel impossible for many people. There is still a large stigma attached to mental illness, and being honest about bipolar disorder may be difficult at first. It may be that your past behavior was bizarre and difficult to explain; if you have tried to kill yourself, the topic may feel too overwhelming to broach. It’s up to you to decide how much you want to reveal to your co-workers and management, but in many cases you may find that being honest and asking for help can release some of the burden and fear you feel surrounding this illness. Many people know about bipolar disorder these days due to the attention it has received in the media. There are many tips in this book on how to talk to people about the illness, as well as ideas on how you can involve helpful people in your treatment plan. You will have to decide what you need to do regarding your work. Keeping your illness a secret may be more stressful than telling the truth and asking for help. Ultimately it’s up to you to assess the response you might get at work and make your decision accordingly.

Your Legal Rights at Work

Your legal rights at work regarding taking time off and other issues will depend on where you live. Talk with your human resource or personnel department about your situation. You can also talk with a local mental health organization and your doctor regarding your rights.

DISABILITY

There may come a time that you’re simply too ill to work and support yourself. If this happens, you may have to look into disability to help yourself financially until you’re stable enough to go back to work. Though many people who go on disability remain on it, having a goal of using it temporarily until you’re more stable and more able to support yourself is a much more positive approach. Never forget that bipolar disorder, when treated comprehensively, can and often does get better. Disability requirements are different depending on where you live. Talk with your doctor about your eligibility. Remember that the process can seem overwhelming at first, but it’s worth it if you need time off work to treat the illness so that you can get back on your feet. Disability does not have to be forever. It really can be an interim decision you make until you are ready to return to the work world. It’s nothing to be ashamed of.

What Is Disability?

In the United States, the term disability refers to the assistance provided by the Social Security Administration. This assistance is broken into two categories: Supplemental Security Income (SSI) and Social Security Disability (SSD). SSI eligibility is determined by a person’s income, while SSD eligibility is determined by whether a person is able to work for the next twelve months. When a person goes to the Social Security department to apply for disability, he or she actually applies for SSI and SSD on two separate forms, but is potentially eligible for both forms of assistance.

There are two appointments involved in applying for SSI or SSD. The first requires you to go to the office to officially apply for disability. The second involves an in-depth evaluation of your case. Applying for disability can be quite daunting. The following section can help you with the process.

For Family and Friends

Disability is not failure. If your loved one had cancer and could not work, you would not consider it a failure. Bipolar disorder, too, is a serious illness, and needing time off from work to get better is normal. This is especially true after a hospital stay.

Finding an Advocate

If you’re ill and unable to work, there is a good chance that the disability application procedure will be quite stressful. One way to help yourself through the process is to find an advocate to go to the appointments with you. This can be a family member, a friend, a social worker, or someone who has successfully been through the process already. If your life is in chaos because you’re sick, can’t work, and have money problems, then it’s very important that you ask for help from someone who is calm, organized, and able to help you through the process.

Here are some tips that can help you when applying for disability:

• When asked why you’re at the SSI office, have a reply ready such as, “I have a bipolar disorder diagnosis and am unable to work. I would like to apply for assistance.”

• At the first meeting, find out exactly what paperwork you will need for the next session. Make a list of this paperwork.

• Be ready for more paperwork than you want to deal with. Use a specific folder for all papers you receive, and keep this with you. (See chapter 9.)

• Take someone with you to the appointments. The wait can be long and quite stressful if you’re already sick.

• Know what will happen before you get there by researching the process on the Internet.

• Utilize the services of NAMI (National Alliance for the Mentally Ill), DBSA (Depression and Bipolar Support Alliance), and DRADA (Depression and Related Affective Disorders Association).

• Have a list of questions you want to ask when you get to the counter.

• Try not to go to the offices on a Monday or a Friday—these are the busiest days. Midweek mornings are best.

• Create a bulleted list of your health history that mentions dates of hospital stays and any other important information. Use the charts in appendix C for help.

• If you were in the hospital, make sure you have a copy of your admitting evaluation and discharge diagnosis paperwork to put in your file.

• If you don’t have a social worker, find someone who knows the social service system and can help you get through the application process.

• Be very aware of the amount of money you will receive, and don’t be confused by the fact that it may come from two places—SSI and SSD. This does not mean you are paid twice, but that the total amount you receive will be split between the two departments.

• Once the office has your paperwork, they will ask for official records from the state regarding your illness. Your complete file will then go to a determination committee, which can take six months or more to make a decision. This means that you will have to find a way to get financial help while you wait for the determination.

• If your application is rejected, it’s a good idea to immediately file an appeal. It’s not abnormal for someone to be denied the first time, especially in the case of a dual diagnosis. You may want to hire a lawyer who practices disability law to help you with your appeal. Such lawyers often get paid only if your appeal is successful.

For Family and Friends

If you’re able to help your loved one apply for disability and go through the process smoothly, it’s a gift he or she will always remember.

Knowing the System in Your Area

It’s important that you know how the system works in your area. In the United States, your county health system is the main resource for information on what is available. If you’re already in this system, you will be assigned a caseworker to help you with the disability application. The county can help you find information on low-cost therapy and help with the cost of medications. You can also use the Internet resources listed in appendix A to help you find information on what to do if you don’t qualify for disability and don’t have insurance. Many of the mental health advocacy groups such as NAMI, DBSA, and DRADA offer information on how and where to find help. Appendix A has a list of their contact information.

Knowing That Disability Doesn’t Have to Be Forever

Disability is something you can use to help yourself financially while you’re working on your new treatment plan. You can use it as a time to help yourself become stable enough to go back to regular work. Needing disability to help you get back on your feet is nothing to be ashamed of.

ALTERNATIVE WORK OPTIONS

It may be that the work you envisioned for yourself is not possible because of bipolar disorder. You may have to find work alternatives in order to support yourself and maintain your stability. This can be depressing in itself, but it may have to happen in order for you to stay well. High-powered jobs with a lot of obligations or deadlines may be a trigger for your symptoms, as can working with stressful people. A job that enables you to work in a nonstressful environment may be the best way for you to maintain stability. Looking for alternatives does not have to be a demeaning or sad situation. When you look at your work and money situation realistically, you can make a simple one-year goal regarding work that will ensure that you have the time to create your 4-Step Treatment Plan, get your medications stabilized, and work on your relationships. You can then make different work choices when you are more stable.

SCHOOL

School problems tend to mimic work problems, and this makes sense when you realize that it’s the people interaction, obligations, and deadlines that often make work a difficult place for people with bipolar disorder. School has all of these demands and can be just as stressful for people as work. Many people with untreated bipolar disorder have a checkered school history, especially those who have a tendency to pull all-nighters to study for exams. If school is currently your issue, you can use the ideas in this chapter to help you get a clear picture of your ability to go to school in the present, and to see what might be possible in the future. You can also look into the Americans with Disabilities Act to see if you qualify for special assistance.

SLEEP PROBLEMS DUE TO WORK AND SCHOOL OBLIGATIONS

As you read in chapter 2, a significant cause of bipolar disorder symptoms is work or school schedules that affect sleep. Shift work is a main source of symptoms, as is exam time in school. It is imperative that your sleep schedule remain stable if you want to successfully treat this illness. This may mean changing jobs or taking fewer classes at school.

DEALING WITH A WORK OR FINANCIAL CRISIS

Whether you have just come out of the hospital, maxed out your credit cards while manic, or made detrimental bipolar disorder decisions regarding work and money when you were depressed, there are solutions to these problems. They may take awhile and they may be daunting at first, but you can make it out of some terrible situations if you have a plan for stability and then a plan to take care of your current work and financial situation. The following are some tips for getting through a crisis situation:

• Ask for help from the right people.

• Ask for a letter from your doctor explaining the illness, which you can then send to your creditors.

• Call your creditors and consolidate your debt. Talk honestly: “I have an illness called bipolar disorder. One of the symptoms of this illness is excessive spending when I’m manic. I just went through a manic episode where I made some very poor financial decisions. I have a letter from my doctor explaining this situation. I would like to know what I can do to arrange paying off this debt.”

• Go to consumer credit counseling—but only if there is no fee and the organization is legitimate.

• If necessary, explain your situation honestly to the people where you work.

• Keep your doctor’s appointments.

• Stick to your treatment plan in order to prevent the mood swings from going this far again.

• Take your medications faithfully.

• Remind yourself that it’s money and that you’re alive. It may take years, but you can turn around your money situation.

Now that you’re starting a treatment plan for bipolar disorder and learning to manage the illness comprehensively, there is a good chance that you can improve your work and money situation greatly. You can learn what it is about work that triggers your symptoms and find work that better fits your lifestyle. You can learn to prevent the mood swings that cause financial problems and ask for help for any problems that you have now due to the illness.

For Family and Friends

Even after reading this chapter, you may still feel completely frustrated and out of control in the situation with your loved one. It’s surely the case that you did not expect to have to support someone too sick to work. But as you’ve read in this chapter, work and money problems are completely normal when someone has bipolar disorder. And unfortunately, you may have to be the one who supports your loved one until he or she is able to go back to work. Or maybe it was your money that got spent during a manic episode. The ideas in this chapter can at least help you set up your own checks and balances to protect yourself in the future. If you can work together with your loved one to prevent serious mood swings, this is the best defense against work and money problems due to bipolar disorder.

This chapter has been a quick overview of a very serious topic. Work and money issues are so bound to bipolar disorder that they may seem impossible to mend. As you probably know, lifestyle changes due to work and money issues can be significant at first. But the situation can and often does get better. Give yourself time to fill out the exercises in this chapter, and then make some small decisions that will take you where you want to go in your future. If you have had years of untreated bipolar disorder, you may have a lot of work and money messes to clean up, but you can do it. It just takes time and planning.

Your Toolbox

Knowledge about bipolar disorder.

A correct diagnosis.

A list of your major symptoms.

Medication knowledge.

Help with side effects.

A regular sleep schedule.

A bipolar-friendly diet.

A daily walk.

Regular and appropriate bright light exposure.

A clear picture of your work history.

A clear picture of your current financial position.