My intention in writing these posts is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. It’s also to provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in Mental health, and how to work with treatment providers and medication issues. My hope is that reading this may be helpful for people with Mental health issues and also their families and friends.

Disability application

The Social Security Administration (SSA) defines disability as “the inability to engage in any substantial gainful activity by reason of medically determinable physical or mental impairments which can be expected to result in death or which has lasted, or can be expected to last, for a continuous period of not less than 12 months.” The SSA uses “listings” to approve or deny applications for disability. There are nine categories under the mental disorder listings used in making such decisions. Each category refers to a disease process or disorder. Using the model of disease → impairment → disability, impairment refers to the signs and symptoms of the disorder that provide medical determination of the condition (criteria A) and disability refers to the severity of restrictions and limitations of functioning (criteria B) that are directly related to criteria A. The nine diagnostic categories for mental impairments are: organic mental disorders; schizophrenic, paranoid, and other psychotic disorders; affective disorders including depression and bipolar disorder; mental retardation; anxiety-related disorders; somatoform disorders; personality disorders; substance disorders; autistic and other pervasive developmental disorders.

While Bill most likely would have been formally determined at one point to present with a temporary but not permanent disability, he later was declared fully disabled. For people struggling with mental illness, the concept of being declared disabled is bittersweet: Sweet, because it can be accompanied by disability payments due to inability to work, which can be transformative in allowing the person to obtain food and food stamps if necessary, and shelter, but also bitter because it often includes the incorporation of a self-view as diminished, less capable, or defective.

Working to halt recurrence

Bill worked with his therapist to understand how to keep the illness at bay. He voluntarily took his medication: lithium, a mood stabilizer, and an antipsychotic to further control his manic episodes. His work at Midland House, a psychiatric rehabilitation center, grounded him in tasks of daily service to others with Mental health illnesses, and he enjoyed describing the progress of several clients he got to know. He was able, while he was stable, to distinguish the onset of hypomanic episodes and to take increased medication doses to ward them off. This was a tricky part of the illness: being able to recognize the very first symptoms of hypomania before it co-opted his judgment. He wrote about this process—that when he first started to have an illness episode he recognized feeling elevated mood and recognized that this was part of the illness. But very shortly, almost immediately, he began to rationalize to himself that this mood was a good thing and didn’t mean that he was getting ill, but rather that it was part of some new ability he had developed (sometimes religious—Christian, Toltec, or prophesied hero of Finnegans Wake—and sometimes idiosyncratic, such as new physical attributes like dance skills or a new magnetic force field). Working with a therapist to develop strategies to circumvent this process was critical to his ability to stay stable. Naming it—the deception of hypomania, the allure of euphoria, the siren call of feeling special—helped to counter his hypomanic drive to get off of medication and escalate further. But the time window to do this was exceedingly small. It sometimes helped if someone else, usually me, had noticed and pointed out the behavior, but because he was often secretive about what he was thinking, it was difficult to intervene in time.

Implementing strategies for academic progress

While working on strategies to maintain stability, Bill launched into reading the note-taking service notes for his classes and also studied with classmates in study groups to learn the material. Because he was able to focus, he could incorporate the study material into a schema to learn new material. To some extent, it seemed that the reward of learning and making friends could substitute for the hypomanic high. When it came time for exams, he used the flexibility that he was given for his disability to have a longer time to take the exams. This seemed critical to doing well, given his attention problems. For a time, he used his disability accommodation status to stabilize and get through school. I was happy that he was making progress and staying stable. I hoped it would continue.

To find a therapist, visit the Psychology Today Therapy Directory.