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Concealing Our Illnesses.

2 April 2015

I’ve been thinking about the Germanwings flight. Everyone has. How horrifying. A pilot, apparently suffering from some kind of chronic mental illness, chooses mid-flight to take this opportunity to end his own life and the lives of 149 other people. He seems to have implacably locked the other pilot out of the cockpit, set the autopilot to a cruising altitude lower than the height of the mountains, and calmly waited for the plane to burn in. A calculated act of mass murder. A terrible suicide.

Now there’s been a great deal of debate about what Germanwings’ parent company, Lufthansa, knew or should have known. The pilot, Lubitz, had been seen by health professionals, who had told him he was unfit to fly. He had ignored those proscriptions. And I understand that. Having a physician or a psychologist tell me I can’t do something makes me bristle, immediately. I think I’m unremarkable in that regard. I think we all do that.

It is natural to conceal our illnesses. I mean that literally. I used to own a small parrot, and one day, when it was sneezing, I took it to the vet. I noted the sneezing and said that I hadn’t noticed any other behaviors that indicated illness. The vet said I wouldn’t. As a prey animal, it is crucial that they continue to behave normally no matter how they feel, he told me. You won’t notice a bird acting sick until it’s at death’s door.

Obviously, it’s a huge and tenuous leap from parrot to human behavior. But I know that humans are almost universally interested in appearing robust, healthy, normal. So much so that we have words like “Munchausen”: disorders which describe people who want to appear ill. We consider it a badge of honor to work when sick. It shows toughness, dedication. Hospitals have to have starkly-worded policies against people coming to work sick, lest infection spread to vulnerable patients.

With mental illness, there are additional layers. Treatment avoidance is a common feature of mental illnesses. Addiction, alcoholism, depression, bipolar disorder*, all of these feature powerful internal obstacles to treatment. In the case of my own illnesses, alcoholism and depression, there are powerful incentives to avoid treatment. I like being drunk. And there is even a strange compelling vitality to my depression that I genuinely prefer to the feeling of being medicated for depression.

This is why I say again that I believe it is not inappropriate for employers to apply reasonable heightened scrutiny to employees with known mental illnesses that might result in workplace harm. As an alcoholic, if my job involved operating machinery or treating patients, it would be thoroughly appropriate for my employer to subject me to routine testing, etc., for alcohol. Even though I have been sober for 7 years.

Imagine if my job were to drive or fly, and I relapsed, and my employer knew that I was in recovery and had not instituted some measure to be assured that I were sober? Of course they’d be liable. Their only other option is to exclude me from those jobs: to discriminate against me due to my status as mentally ill. And I could not blame them for doing so.

It is not my fault that I am an alcoholic. That fault rests in genetics or epigenetics or some fault in brain structure or chemistry or some other peculiar error that arose in the womb. I didn’t choose it. I cannot change it. My choice rests solely in accepting the fact that I am an alcoholic, embracing my recovery, and confronting the consequences associated with my disease honestly.

Certain mental illnesses, like certain physical illnesses (and really, are we certain there’s a difference?), require an employer to take precautions against liability associated with an ill employee. They require me to accept that there are things I can’t do. These are just facts. They’re not fair, and they’re not just. They’re amoral. They are outside of judgement or shame. I am an alcoholic. I suffer from depression. Those diagnoses have consequences. The same as any other.

No one with epilepsy will be allowed to become a commercial pilot. It’s not safe. Now, I’m not asserting that depression and alcoholism are necessarily in that category. But I do assert that insisting without inquiry that they are not actually increases the stigma of mental illness, rather than reducing it.

My mental illness is, for some things, just as debilitating as a physical illness would be. My risk of relapse is real, and permanent. I have to accept that risk because I can’t do anything about it. But no employer of mine has to simply accept that risk without some means of mitigating it. And when I conceal my illness from my employer – as I have in my current position – they are not to blame if I relapse and cause harm in the workplace.

Saying that an employer has no right to precaution and risk management for mentally ill employees – that it cannot discriminate in reasonable ways – is the same as telling me that my disease is “all in my head”. It says that if I were stronger, there’d be no risk for my employer to confront. That I have total control over my risk of relapse. It says that my disease is my fault.

My disease is not my fault. But I, like many mentally ill people, am seduced by my disease sometimes. I enjoy it. I can revel in it. That’s a feature of the disease. It’s a symptom. I conceal it. Because even though I have no obligation to be ashamed, sometimes I am anyway. Because I don’t want to face unreasonable consequences, and I don’t trust my employers only to institute reasonable ones. Because I don’t want to face stigmas. And yes, because I don’t always want to accept the realities of my disease.

Mental illnesses are like physical illnesses: there are some things we can’t do. It’s not fair, but it’s not shameful either. And pretending that’s not true is false compassion. It’s dishonest. And it makes recovery harder.

____________

*Edited from “manic depression” in original posting.

6 Comments leave one →
  1. 2 April 2015 08:55

    “As a prey animal, it is crucial that they continue to behave normally no matter how they feel, he told me.”

    Same thing with Guinea Pigs. We’ve had two of them die on us, and for both we had no indication anything was wrong until the night before when Jenny thought they were a bit off. I didn’t even notice that. Both were dead in the morning.

    • 2 April 2015 08:58

      Yup. And it remains a big leap to human behavior, but conceptually I think the analogy is useful.

  2. 2 April 2015 10:17

    “Certain mental illnesses, like certain physical illnesses (and really, are we certain there’s a difference?)”

    Based on countless lit reviews, reading, discussion, etc in graduate school I am of the opinion there is no difference. Which makes this issue even stickier. What is someone with diabetes is not managing their blood sugar and is at risk of lapsing into a diabetic coma. It could happen, it could not – like acting on suicidal thoughts. Should the employer be made aware of it? It seems like a slippery slope to discrimination.

    • 2 April 2015 10:24

      And that’s difficult. But there’s a difference between reasonable scrutiny and discrimination. Just as a person with epilepsy cannot do certain jobs without precaution, some mental disorders require prudent oversight. That’s not discrimination. That’s reality.

      • meri permalink
        2 April 2015 11:08

        Ultimately, employees, employers and loved ones – as human beings – all need to do the best we can. This important discussion should continue in the thoughtful, admirable and non-judgmental manner in which it was initiated.

  3. Syd permalink
    4 April 2015 08:02

    I had an employee who didn’t disclose he had mental problems (it wasn’t required). He eventually was fired by me for failing to show up for work. Not long after, he purposely ran over a pedestrian and then had a shoot out with a deputy at an intersection near where he killed the pedestrian. I later found out that he had battled mental illness for years. I count myself and my staff as being luck that he didn’t walk in with a gun and start shooting.

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