We all have our ups and downs. We have our difficulties dealing with the challenges of today. We wonder what it is that we might be doing wrong. I think that's all normal, and it's something that we need to accept as the way that life is. There is, of course, the Hollywood fairytale, that elusive unicorn that is perpetuated by the idea that there are people out there that everything comes easily to, and they are just happy and running through their lives exactly how they want to all the time. Maybe that person exists, or maybe that's just one of the archetypes that each of us might have some part buried in our souls.
I think the big issue is that this sets up a system where people who can't "keep on keeping on" for whatever amount of time are blamed for these problems when, in fact, these problems are the result of a conglomeration of issues, pulling in from their genetic inheritances, to their upbringing, to their random luck of the draw on any series of events that led them to where they are.
Until I went out on leave 2 months ago, I had been a consistent and contributing member of the industry that I entered out of college somewhere around 22 years ago. Some might call this a midlife crisis. I might have called this me being too weak to handle my own problems. I might have told myself that if I just kept on working hard, I would get over this hump and my life would be better again. I might have actually recognized the symptoms leading up to this mess, and addressed this with my managers (who were actually very concerned and very much willing to help me make things work). I might have, with the help of my therapist and psychiatrist tried to implement some changes that would help me cope better but I was already past the event horizon. Those fixes will likely be the things that help me from having a recurrence in the future, but the changes were a classic case of too-little-too-late, and my brain simply broke that one horrible day.
What I have determined in the time since that day is that the systematic bias against mental health issues is alive and well in many aspects of the way the United States runs. When I was out on a disability years ago following my appendectomy and then 2 successive hernias (I had to lie on the couch for a month to let my abdomen heal after tearing it twice), all it took was my surgeon's note to the insurance company and it was done. When I was out for 4 weeks last year with that very odd recurrence of mono (reactivated Epstein-Barr), all that took was my doctor's form indicating the diagnosis and the blood test showing the blood markers of the acute phase of EBV. When I originally went out on this leave, the state of California treated this no differently than the physical disabilities I've previously had. It was the private insurance that proved difficult. A six to eight page long form was included to establish "behavioral health markers," and my cognitive capabilites. I laughed hysterically when one of those methods was to have me count backwards from 100 by 7's. What I couldn't do at the time was recall how to write an algorithm to compute a Jacobian for a multidimensional optimization problem I was working on, and how to maintain the multiple lines of simultaneous thought I needed to rapidly debug the code I had written to do it. It's just possible that the idea that someone can capture 'cognitive incapacity' in the form of a questionnaire is fucking ludicrous. I could always rise momentarily, when it was needed. I just could not be me--I could not be my normal--highly goal aggressive, solution-finding, problem-solving self. The physical symptoms peaked on that awful day. Low back pain (of a non-physical source), an inability to sleep, and problems with controlling my obsessive thought processes preceded that day for weeks, if not months, or even a year if I look back on how 2018 evolved for me.
Adding to the ridiculousness of this, the private insurer has required reinvestigation and renewal every 4 weeks through this period. It was determined early on that my psychiatrist should be the one to submit the paperwork to put me on leave, which presented a unique set of problems. She is a psychiatrist that accepts insurance in the Los Angeles area, which makes getting an appointment difficult at best. She met with me on her lunch hour to accommodate these problems, but we have both remarked about how backwards this policy is. The very people who need to be out lack the abilities that they need in order to navigate the horribly complex system. My latest renewal was complicated by a miswording on the form that was submitted. My psychiatrist determined that I am 30% recovered and "within the normal range." The insurer interpreted "within the normal range" as me being able to go back to work because I was normal, setting off two weeks of confusing phone calls that eventually resulted in the approval of the next 4 week period. This occurred while I was racing at IGLA, and put my mind back into the mess of corporate America when I should have been decompressing from it the most. My compensation will lag due to this delay, but that's not a huge deal. What is a huge deal is the fact that people in a similar position might simply give up, all because their provider meant "within the normal range of being recovered 30%" as opposed to "with the normal range" of fully functional. She was incredibly apologetic, but it's not her fault--it's the way the system is set up.
You can see the giant disconnect here. The process for the publicly funded state disability system is at odds with the private (I believe 'for-profit') disability insurance that covers my salary beyond the state upper bound. I actually have no idea how that cost structure is created and the relationship between my company and that insurer--and I shouldn't have to. The system is set up in a way that results in a significantly higher set of hurdles for the privatized industry than for the public industry.
The counterpoint is that some people abuse the system, requiring this sort of ongoing review. The classic example is that someone wants to move out of their job and take a long break to "recover" before starting up again. It's a matter of time before that person finds a doctor willing to sign off on it, but the reality is that if that doctor is willing to sign off on the initial application, he/she is very likely to have no issue continuing with the 4 week review cycles. It appears the system is really in place to dissuade the people who need it most from using it--sometimes it is simply too hard to fight back.
Disability insurance policies vary. Mine puts a limit on long term coverage at 2 years for any mental health issue, unless the patient is confined to a hospital and unable to be in the real world. All other disabilities may be covered to 65 years old, when public support becomes available (I think social security, medicare, and medicaid). Therapists and psychiatrists do not want their patients in a mental facility, unless they are at risk of harm to themselves or others, and there are a number of ways they determine if that's the case. There were a number of times I was directly or indirectly asked about this. There are likely exceptions to this philosophy--there may be times when immersion into a mental health facility is beneficial, but not in anything resembling my case.
This type of insurance policy is common, and is included as a "mental health limitation rider" in policies (https://www.policygenius.com/disability-insurance/disability-insurance-and-mental-illness/). The very existence of such a rider carries an implication of bias against mental health issues. Imagining the scenario where the condition that took me out of work this year continued for an extended period of time, I would be incapable of doing my current job, or anything similar to that level of intellectual capacity, but would only be able to be insured for a maximum of 2 years, at which point, I would be largely unemployable, and 47 years old. It's possible I might find some other job requiring more physical labor, but at the deficit I was operating at a month ago, I'm not sure I would have ever come to that conclusion.
That's largely the problem with the way our society is set up with regard to these things. A member of my extended family is out on a more permanent mental health disability. From what I understand, there is some limited amount of public assistance for him, but let's face it, this type of assistance is more along the lines of barely surviving on welfare than coming anywhere near the standard of living required to live well in a place like the Los Angeles area.
I'm going to be ok. But even so, It's okay not to be okay. Stay strong, and ask for help. I'll be there for you, as others have been for me.
Tuesday, July 2, 2019
Monday, July 1, 2019
IGLA 2019 and My Recovery
IGLA 2019 has wrapped up, and the 50th anniversary of the Stonewall Riots and Gay Pride was celebrated yesterday. I loved spending time with old friends, meeting new friends, and getting back together with my swimming community. Hanging with the teams all united in a Team New York/IGLA pride parade group was so much fun (so much glitter, but so much fun).The week before I left for New York, I had appointments with both my therapist and psychiatrist. I'm doing much better, though they both said that if I were to go back to work now, there's a very high likelihood that I would relapse, and it's just not a path I want to go down. The dark times spent dealing with both the physical effects of my breakdown and the time trapped alone in my thoughts are not my happiest memories of any time I have spent away from work.
I don't know if the physical recovery came first, or if the beginnings of the mental side of it did, but I have most of my faculties back. I can't really multitask yet, at least not in the way that I'm used to. I find myself often telling Brian that I'm not listening to him and to give me a minute. I'm sure that the technical side of my brain will pick that back up quickly enough.
I swam faster than I have in a very long time--not across the board. The 200 fly was an exercise in pain tolerance, and I swapped to survival fly at the 100. I was within a minute of my best long course time...I have so far to go! But that's not what it's about. It's about getting up and enjoying the challenge of the day, or the week, or the current season. The meet started with the 200IM for me, and I swam faster than I have in over a decade, pulling in my highest individual place for the meet with a 2nd place age group. The 200 fly is, well, it's always a crapshoot, but I had good improvement from my previous couple of times I swam it, holding my stroke together for the the first hundred. I swam the 400IM, which is a race I'm growing to love. Based on the technicality that I never swam short course meters in high school or college, it was a lifetime best performance--we will just forget about the fact that my previous best long course time was way faster than that.
The race was amazing and fun--I was in a race for 3rd during the last hundred, and my teammate, Dean, managed to pull ahead and grab that, outswimming both myself and Chad (who was actually gunning for a 50 fly record split at the beginning of this race). I gave it all I had, but simply could not power through hard enough to get ahead of either of them, but I loved it. The final day of racing at the pool brought me to the 800 free and the 400 free relay. The 800 falls in the same level of performance as my 400IM, though I was clearly showing signs of fatigue. I cruised through the first 400 with the intention of negative splitting, and then picked up the pace. By the time I reached the 600, it hurt too much to maintain the pace, but I did manage to hang on to out-touch the next guy in my age group.
I leave IGLA with some great memories of my swimming family. There were certainly the bittersweet goodbyes, especially with people that you meet that you know you just click with. As I was reminded though, it is not goodbye, but "see you later."
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