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Question
Posted by: Sanet | 2012/06/30

Diagnosis disclosed by my manager

Hi, I don''t know if you remember me. I''ve had problems with hypomania and my shrink just dismissed it. It started when Discovery reduced my benefits for Geodon and Epitec. I eventually won the Geodon battle, but still fighting the Epitec battle. I have been unstable for 6 months, in a mixed episode. Firstly I want to know-can you only get a mixed episode in Bipolar 1? My psychologist says that, but my shrink says it can happen in type 2 as well. I was always considered type 2. You can be honest. Type 1 makes more sense to me, because my symptoms were really severe. I have blanks in my memory. I sent my psychologist so many emails and SMSs that she showed me and I can''t remember writing it. I have basically lost 6 months of my life!
I left my shrink of 4 years in Jan because I was unreasonable. I ended up seeing one that did telephonic consultations. I phoned him 6 times to say I''m hypomanic. He didnt make room for emergency consults. He came up with ridiculous ideas. Won''t go into all that. After struggling with him I went to see someone else and se admitted me for 8 days. It was supposed to be 3 nights for Geodon injections, but on the first moning I had a blackout and sustained a head injury. The dr on call stopped my injections and by Sunday I wasn''t stable enough to be discharged. It would have sorted me out. She then decided to refer me back to my original shrink. I was really not stable and on my business trip after discharge I had a panic attack in the guesthouse and took a double dose of Seroquel XR. But at 12am. I couldn''t wake up the next morning, it was terrible. I had to phone my manager and let her know I''m unable to perform the visit.
She took action immediately, without my knowledge she arranged a contract worker to do my work for 2 months. She came to see me and informed me that I must take a month off to get better. On condition I''m hospitalized. I have just been discharged yesterday, but my sister was also involved. She phoned my sister and made all the arrangements. She had been communicating with my sister the last 3 weeks.
During their ''intervention'' it was not discussed what will be said to my colleagues and site personel. She took the liberty of telling people I''m off for depression. I found that out on Wednesday. According to her people noticed I''m on an antidepressant. Did she reaally have to tell people my diagnosis? I work with medical professionals. Apparently they notice these things easier. My shrink says it''s impossible to notice if someone is on antidepressants. I think they saw the effects of Rivotril which I increased the dose of because I needed to bring myself down.
But it proves that she told my sites I have depression. For the people in the office she apparently said I''m off for depression and it''s not open for discussion. Why did she entertain the questions from the sites?
My reputation in the industry is ruined. I think she could have handled it differently. Bipolar or depression is personal and unfortunately stigmatized.
She initially told me to take next week off as well. But then she arranged a business trip for 9 July. So I have to go into the office anyway next week.
I really like her as a manager. She''s compassionate, caring and supportive. But do you think it was handled correctly?
I was the top performer in the company before this happened and even almost up to my admission. I think I can still do damage control with my old sites. But I got new sites and they don''t trust me yet. I know I''ll have to work very hard to get rid of this stigma.
My sister also made promises of paying for the kennels for the dogs, she never did that. They borrowed money from me and is repaying it monthly. It was such a drama to get R300 out of them to fix my car. Yesterday I insisted on payment of the rest. Suddenly they don''t have money. But they''re going on holiday today. After a lot of nastiness I got my money. And I told her I''m not asking for favors, I''m not demanding that she honors her promises. I''m asking for MY money. She a,so didn''t pay for my Epitec like she promised. What do I do with that? I''m broke after paying R2500 for kenneling in the last 2 weeks. I must still pay for parking for my trip and more kenneling fees. I don''t want to ask her for money. I don''t want to take money from her, but I need it.

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Our expert says:
Expert ImageCyberShrink

Some people suffer from illness. Some suffer from Medical Aids. If only the sometimes highly unimpressive medical advisors of some of these medical aids would look at the cost of NOT using the right drug for a person, rather than only at the cost of using the cheapest. A drug that doesn't work, is actually very expensive, no-matter what it says on the price-list.
Your psychologist and shrink may be looking at diagnosis differently. According to the internationally recognized diagnostic systems ( like DSM and ICD ) there are certain specific criteria to use when making a diagnosis. They were originally devised for research, so when they were testing whether a new drug is useful in depression, we could be sure they were all treating the same kind of thing. Medical aids tended to leap onto using the system, too.
If the coding system the medical aid ( or your psychologist ) uses says that symptom X DOES appear in condition Y, then they will recognize its presence. If it says symptom X is essential to make the diagnosis properly, then if X is not present, you can't make that diagnosis - ACCORDING to that particular system. And if it says problem Z doesn't arise in condition Y ( and more likely if it just doesn't mention complication Z when describing Y ) this doesn't mean it never happens. just that this particular system of classification doesnt think it typical enough to list it among the symptoms or problems that must be present for a particular diagnosis to be made.
Any competent shrink should be able to tell the difference. Whatever the diagnostic criteria say, they exist for useful but essentially artificial purposes. They must never be allowed to tell us that a patient OUGHT to do next -reality tells us that.
A recipe for bread might not include raisins, but that doesnt stop us from making excellent raisin bread ! The diagnostic criteria are Descriptions, not Prescriptions.
There are 2 types of shrink - those that use the criteria, and those that allow the criteria to use them.
Telephonic consultations, except for emergency advice to a patient already well-known, are dodgy practice, and I didn't think most medical aids paid for them.
When a shrink decides to use an SR or other long-acting drug, this may be useful, but if there is a possibility of episodes when more of a dose may be needed, its wise to provide also a few of a short-acting version for such situations, as taking an extra dose of the slow-release form increases the dose for often much longer than you really need.
I don't think people can easily notice what sort of drug anyone is on ; with the older antidepressants that ALWAYS gave one a severe dry mouth, that might be noticeable, but otherwise, its implausible. But maybe not an argument it would be useful for you to get into right now.
Maybe its worth discussing with your psychoplogist and shrink, what's best for you, in your particular situation, to do about telling those you work with about your diagnosis and treatment. With no explanation, they maye draw even less useful conclusions about what explains your absences and some of your behaviours.
Unexplained absences and odd behaviours can be much more damaging than a respectable diagnosis such as yours.
That you are a top performer confirms how well you can work with the clients even in difficult times.
Of course your sister etc shouldn't be difficult about releasing YOUR money for reasonable and sensible purposes. Discus with her these as examples of what happens when the money matters are not handled as you wish they would, and when it gets confused communication. For instance, did she says SHE would pay for the kennelling with HER money, or that she would pay for it with YOUR money, or what ?

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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Our users say:
Posted by: Sanet | 2012/07/01

Hi Maria &  Liza
Thanks for your advice. It''s just I could hide my diagnosis so well.
My industry is very small and if I was in better shape I would have been able to control what information was disclosed. I feel upset, because it wasn''t done with my permission.
And she didn''t have to tell me about everyone''s comments, like they could see I was on an antidepressant. She says I said things without thinking, but she also said and did things without thinking about the consequences. I''m fine with it being open in the office. But why the clients? I suppose it could have been worse, she could have disclosed Bipolar. I''m just hoping she didn''t. I will never forgive her for that. It was not her personal information to disclose.
I feel apprehensive about going back to work.
It is time for performance appraisals and I need to get 3rd party reviews.

Reply to Sanet
Posted by: Liza | 2012/07/01

As Maria does, I also feel that being completely ''out-of-the-closet'' about my bipolar is better than letting rumors fly around. Naturally there will always be a few who just simply don''t understand and think you''re just crazy and unreliable, but most people are open-minded enough that they only need to be educated about mental illness, which reduces the stigmatization you will feel dramatically. I''ve also recently had to take 3 weeks off for being manic through no fault of my own, but because I''m so open about it and very happy to answer any questions anyone has, there are no rumors flying around. Even our clients are supportive and have extended my deadlines accordingly.

At the start of this year, I moved from Seroquel to the Dopaquel generic because Discovery would only pay for the generic. This caused no problems whatsoever. Then a new generic came onto the market (Serez by Ad -|- Ingram) and the pharmacy didn''t have stock of the Dopaquel so they provided Serez. It buggered me up completely - and I only noticed it at a rather late stage myself becoming more and more unproductive at work over the two months I used it. I''m now back on the Dopaquel generic. It only took 4 days of being back on Dopaquel and my condition stabilized again.

As for lending money to friends and family - I have the policy that I don''t lend out money unless I can afford to give it to whomever is asking. That way I don''t expect to be repaid and actually getting the money back is a pleasant surprise. If I can''t afford to give that money away then I can''t afford to lend it to anyone either. Friends and family will ALWAYS feel less guilt about repaying any loans than they would if they''d taken out a personal loan at the bank. Subjective feelings of ''You can afford it and I can''t'' are the main culprit. They see the lender as being off so much better than themselves, that they use that to rationalize not paying back money that they owe.

Good Luck
Liza

Reply to Liza
Posted by: Maria | 2012/06/30

Hi Sanet

How are you feeling now after the hospitalisation?

I''m so sorry that your manager apparently didn''t handle your disappearance from work well. However, having seen similar situations at work, the problem is that people are going to talk and ask questions. If they don''t get an answer, rumours start flying which can be wildly inaccurate. If you work with medical professionals they should understand that bipolar and depression are illnesses that can be treated successfully but sometimes require you to take time off and be hospitalised. I suppose she could just have said that you had to take time off for personal reasons.

I decided a long time ago to be open and honest about my depression, as it breaks down the stigma when people know you and have experienced you when you are functioning well. It''s difficult and perhaps more of an issue with bipolar, but perhaps you can consider this an opportunity to correct people''s misunderstandings. Just continue your work as if nothing happened, hard as that may be, you know that you are very good at what you do and people will see that.

Can you ask the kennels if you may pay off the fees over a period, maybe with some interest?

Why does your company not pay for business trip parking?

Take care.

Reply to Maria
Posted by: cybershrink | 2012/06/30

Some people suffer from illness. Some suffer from Medical Aids. If only the sometimes highly unimpressive medical advisors of some of these medical aids would look at the cost of NOT using the right drug for a person, rather than only at the cost of using the cheapest. A drug that doesn't work, is actually very expensive, no-matter what it says on the price-list.
Your psychologist and shrink may be looking at diagnosis differently. According to the internationally recognized diagnostic systems ( like DSM and ICD ) there are certain specific criteria to use when making a diagnosis. They were originally devised for research, so when they were testing whether a new drug is useful in depression, we could be sure they were all treating the same kind of thing. Medical aids tended to leap onto using the system, too.
If the coding system the medical aid ( or your psychologist ) uses says that symptom X DOES appear in condition Y, then they will recognize its presence. If it says symptom X is essential to make the diagnosis properly, then if X is not present, you can't make that diagnosis - ACCORDING to that particular system. And if it says problem Z doesn't arise in condition Y ( and more likely if it just doesn't mention complication Z when describing Y ) this doesn't mean it never happens. just that this particular system of classification doesnt think it typical enough to list it among the symptoms or problems that must be present for a particular diagnosis to be made.
Any competent shrink should be able to tell the difference. Whatever the diagnostic criteria say, they exist for useful but essentially artificial purposes. They must never be allowed to tell us that a patient OUGHT to do next -reality tells us that.
A recipe for bread might not include raisins, but that doesnt stop us from making excellent raisin bread ! The diagnostic criteria are Descriptions, not Prescriptions.
There are 2 types of shrink - those that use the criteria, and those that allow the criteria to use them.
Telephonic consultations, except for emergency advice to a patient already well-known, are dodgy practice, and I didn't think most medical aids paid for them.
When a shrink decides to use an SR or other long-acting drug, this may be useful, but if there is a possibility of episodes when more of a dose may be needed, its wise to provide also a few of a short-acting version for such situations, as taking an extra dose of the slow-release form increases the dose for often much longer than you really need.
I don't think people can easily notice what sort of drug anyone is on ; with the older antidepressants that ALWAYS gave one a severe dry mouth, that might be noticeable, but otherwise, its implausible. But maybe not an argument it would be useful for you to get into right now.
Maybe its worth discussing with your psychoplogist and shrink, what's best for you, in your particular situation, to do about telling those you work with about your diagnosis and treatment. With no explanation, they maye draw even less useful conclusions about what explains your absences and some of your behaviours.
Unexplained absences and odd behaviours can be much more damaging than a respectable diagnosis such as yours.
That you are a top performer confirms how well you can work with the clients even in difficult times.
Of course your sister etc shouldn't be difficult about releasing YOUR money for reasonable and sensible purposes. Discus with her these as examples of what happens when the money matters are not handled as you wish they would, and when it gets confused communication. For instance, did she says SHE would pay for the kennelling with HER money, or that she would pay for it with YOUR money, or what ?

Reply to cybershrink

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