I left my first job as a social worker in a cloud of shame and humiliation. After two psychiatric hospitalizations for depression in rapid succession at the end of 2005 and in early 2006, I came back from hospitalization number two to find that my caseload had been reduced by half and I had been auspiciously assigned the duty of training the other clinicians in the agency's new computer software. I felt as Hester Prynne must have, wearing the scarlet "A" on her breast, only I wore a "D" for depression. In a mental health agency no less. A later therapist asked me if I had considered that management may have been trying to make returning easier for me, and this was something I hadn't thought about, but reflecting back, the atmosphere which I returned to was not one of support — it was more one of degradation.
I soon quit the job and suffered a full-blown breakdown which required four additional inpatient hospitalizations (I was often suicidal), some of with courses of electroconvulsive therapy (ECT). The depressions were accompanied by psychosis. Numerous medication cocktails were tried. I regressed in my ability not to act on my impulses; there were episodes of self-destructive behaviors. There were also several admissions to partial hospitalization programs as step-down measures.
I was just cognizant enough to be aware enough of what was happening to me; being shuffled from inpatient unit to partial program and back to inpatient —.but not perceptive enough to be able to grasp the gravity of the situation. I dutifully followed my psychiatrist's instructions and the instructions of the hospital staff.
I was awarded Social Security Disability (SSD) based on the paperwork that my psychiatrist Dr. Adena* filled out. I was pretty much unable to function, much less work, with the combination of medications I was taking and the after-effects of the ECT. A shell of my former self, these almost two years had left me defeated, without a purpose in my life. I also had no medical insurance so I applied for and was accepted by Medicaid.
Through twice-a-week sessions, adjustments in my medications, and the healing attribute of time, the opaque feeling that was clouding my brain gradually began to lift. Dr. Adena, not one to let her patients languish on government rolls, strongly suggested that I obtain a volunteer job. I argued with her that all that ECT had organically damaged my brain; that I would never again be able to work as a social worker, so what was the purpose of trying anything at all.
I lost that argument and found what I considered a meaningful and challenging volunteer position; tutoring inmates in reading comprehension and writing at a maximum security women's prison. Twice a week I made the ½ hour drive and went through a metal detector, was patted down and made my way through a maze of hallways with locked gates. I was never frightened; the women who I tutored were grateful and welcomed what I could teach them
Several months after I started at the prison, the depression inexplicably returned and I was readmitted to the partial hospitalization program. I had to leave the prison job which with the commute and the ritual of actually getting to the tutoring room, coupled with my worsening depression, had become a burden.
The next job I obtained was at the women's clothing store JJill. It was part-time which paid just above minimum wage. There was a ceiling on the amount I was allowed to earn so it would not affect my disability payments. I hated it from the beginning. My five hour shift dragged. Either I was out on the floor greeting customers, "Hello, welcome to JJill. Can I help you find something today?" I felt like a manikin with an automated voice. If I wasn't out on the floor, I was folding sweaters. Sometimes we folded sweaters that were already folded, just for the sake of appearing to be busy. Or I was at the cash register which I could never master. Once, I think I swiped a gift card for a customer for $100 but never swiped his credit card. I don't know if the manager ever found out because I wasn't there that evening when they closed the register. I lasted five months and then magically, I told Dr. Adena I was ready to start looking for a job in social work.
A tiny ad in the newspaper caught my attention and I blindly faxed my resume to an agency thirty miles away for a part-time, per diem job where I would get paid only for the patients I saw.. The Executive Director took a chance on me despite the two year gap in my resume (I said I had taken a break to write) and hired me for two days a week.
With this job I made too much money to stay under the limit where I could keep my benefits. I was put on SSD's trial work period where I continued to receive my benefits for nine months — just to ensure that I could handle the stress of working. I also enrolled in Medicaid's Buy-In for Working People with Disabilities so that Medicaid still covered my medical expenses, most importantly my medications which cost upwards of a thousand dollars a month.
I was frightened to give up the certainty of an income, regardless of the fact that it was limited. I didn't know if I could handle the pressure of working with patients, providing them with a sense of consistency by remembering each account of their lives week-to-week. Dr. Adena lent me one of her basic psychology texts so I could review the fundamentals of a mental status exam. I was terrified that that my psychiatric history would be found out at the job.
After three months I was working four days a week, and after nine months I was hired on a full-time basis with benefits. I worked hard for the promotion, coming in early and staying late, making sure my paperwork was perfect before I handed it in each evening.
There is another benefit program, not as well known, designed to help Social Security beneficiaries who have returned to work and are off SSD and other benefits. AAATakeCharge provides counseling to help make wise choices in pursuit of employment goals. In addition, TakeCharge also provides me with Work Support Payments which helped me remain in the workforce once I found my job. Now that I was able to earn enough from my position to leave the benefit rolls, I am receiving Work Support Payments. The money has to be used for work-related expenses such as my commute, which between gas and tolls comes to not an insignificant $500 per month.
I see patients in all phases of the process of returning, or not returning to the work force; some have been on entitlements for as long as twenty years, have never worked, and are terrified of even obtaining a volunteer job for fear that Social Security should see them as too competent to keep receiving benefits. I try to explain the reality of the situation — that Social Security doesn't monitor volunteer jobs, but their fear is all consuming.
Others have expressed interest in returning to work, but first want to obtain basic or futher education - like a GED or specialized training. I encourage them to explore going through a program that will give them counseling and financial support like VESID (Vocational and Educational Services for Individuals with Disabilities). Some patients will call and follow through with the program which takes a great deal of perserverance, some of them will make the initial call but don't follow through, and some will take the number and never call.
Other patients want to jump right into the workforce and they give it a good try, but due to the current economy, difficulty with interviewing, (i.e., how to cover the gap in their resume) they get discouraged and give up. We role play in therapy sessions, trying to anticipate questions that may come up, but patients' anxiety is heightened, they get thrown a curve ball in the interview and feel that they've failed.
I understand the fear, and the hesitancy to give up the security of a regular check coming in regardless of the fact that the patients have to struggle with a small amount that is often not enough. I understand the reluctance to take this huge risk and to have enough faith in themselves that they can succeed at a better paying job that will give them more choices and ultimately, more freedom.
I wish that I could use the success stories of some of my patients who have returned to work to inspire others, but of course I can't. I long to tell my patients my own story but I cannot do that either. I do let them know that I believe it's never too late to learn; having revealed that I am an example when I returned to graduate school at the age of 38.
I am thriving at my current job; I have reached a level of responsibility that I never dreamt I was capable of. It was a process that has taken, at last count, almost five years. All along there have been good days and terrible days; I like to think of the climb not so much as linear, but as of a dance with all the steps having a purpose. Two steps forward, one step back, three steps forward, one-half step back. And so on it goes.
* Names have been changed