#talkitout

Letter to my boss

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The purpose of this communication is to dispel any concerns you may have of late about my performance. Believe me, I have been discouraged many times to be so open and vulnerable in a professional setting. My hope is that you hold up your end of the bargain in telling me your company sees employees as people and not machines that are replaceable at the first sign of defect.

You see, I am fighting for my very existence as we speak. Every moment of every day, I am holding onto what I can in a tsunami of depression, and at the same time trying to recall what the standards of proper financial statement presentation is. My mind is flooded with thoughts like “I just want to disappear” and “I hope my job can survive this time.”

I promise I had all the best intentions and gave my honest assessment of how strong of an employee I was when I interviewed four months ago. It is just, two months ago, I was ushered into a doctor’s office and given grave news that I am still processing. The life-saving medication I had taken every day religiously for seven years was no longer an option and I was given two weeks to sort out what my future plan of survival would be.

Ironically, health insurance companies do not operate that quickly. They want to know all else failed for six months prior to approving the best and most effective treatment. I don’t fit that category. I was doing well on an unconventional drug that is not in their list of “try this first.”

But I digress into my own woeful experience. Back to what matters, and that is how is this going to impact you. I’m stuck in trying to explain how my brain is in complete dysfunction. First, my memory is shot. I know I passed all four exams for the CPA on the first attempt, something only 5% of accountants can accomplish. But I feel like none of that or the decade of experience is accessible right now. I forget to write an email moments after discussing it. I can’t remember how to format a document after a two hour training. Second, my concentration is infantile. I struggle to even remember what I needed to say in this letter. Finally, my energy or drive or motivation, however you want to call it, is at an all time low. You know how an overweight person gasps for air after climbing one flight of stairs. This is how my brain feels after one 30 minute meeting.

So, instead of doing what society says I should do, and “faking it til you make it” or just staying positive, I am sending this letter to ask that you please let me be a human and just suck at my job for a little bit. Let me be forgetful, and unfocused, and tired. Let it not matter until the insurance approves the treatment I need.

Because I am a life and a human and i don’t know that I can do even that right now. I know I haven’t proven my worth to you yet, but just wait and I’ll show you someday it was worth it.

Sincerely,

Someone who wishes I could actually send this letter to you

Letter to my boss

The Cost of Happiness

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Several months ago I started a new “add-on” antidepressant medication to be taken in addition to my current medication regimen. The doctor handed me a small white paper bag containing a few months worth of pills in sample packs for me to “try before I buy.”

Much to my surprise, they worked! I had a long and disappointing track record of medications not being effective for me. The new technology in pharmaceuticals really is something! My brain fog lifted, I felt more grounded, engaged, and energetic.

The next visit followed suit like the first. I reported the great results and we adjusted the dosage slightly and I walked out with my white bag of happiness. A couple months later just before Christmas break, I phoned the doctor’s office requesting a script to be called into my pharmacy as I was running low.

My pharmacy run went smoothly, $57 for my first medication, and $32 for my new one. Despite a stressful holiday season, I made it through with a little more motivation and peace.

Last week, I needed a refill of my fancy new drug. I called up the doctor, and shortly after received a call from the pharmacy. I thought it was a bit odd because usually I just get a text notification when my scripts are ready. The pharmacy tech politely said, “We have your script here, and we already applied the manufacturer’s coupon for $400 off. But the balance for one month supply is $900, and we wanted to see if you still wanted this filled?”

*Gasp* NINE HUNDRED DOLLARS for 30 pills?? How in God’s green Earth could a tiny pill cost so much? Without the coupon, that is roughly $43 per 1mg pill. That is more than I spend to feed my whole family of three in one day, at a nice restaurant nonetheless. That is like me going out to eat a filet minion every day of the year. Apparently the last time it was filled, I had met my deductible and out of pocket max.

I smiled and thanked the pharmacy tech for the call and let her know I would pass on filling the script. Flashbacks to when I found the only effective medication was not labeled for depression and the typical administration of it was intravenous infusion, costing $500 each time. Thankfully, I was able to manage to convince the doctor to order me the oral compound version for $1,943 less each month.

What I can’t understand is how we expect society to avoid constant mental illness crisis among the poverty-stricken. To obtain my medication, I am required to visit my psychiatrist every two months, by law. If I had no insurance, this is $250 for 15 minutes, or $1,500 a year. Medication is not enough though. For my therapy every week, it costs me $70, or $150 for uninsured. That is another $7,500 a year. So sure, let’s go ahead and tack on another $15,000 for medication.

This is what I need to live. I know I quip this is the cost of “happiness” but it isn’t even that. It is the cost of functioning at a job, parenting my children, keeping myself alive. I have a terminal illness called major depression, where if untreated has a fatal prognosis.

So what can I do? What can anyone do? How does it change? I do the only thing I know… I go to my doctor and ask for another white paper bag, praying the day never comes that they stop receiving samples to give.

The Cost of Happiness

Day Two: Ring Theory

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**This week’s blog posts are dedicated to advocating for effective mental health treatment and educating patients, family, and friends in all areas of inpatient psychiatric care. The perspectives shared here are not that of a mental health professional, but rather someone with lived experience. Information shared may not align with every circumstance or viewpoint of readers, but is meant to offer guidance in an area that is often confusing and holds little resources.**

Oftentimes when we know someone facing a crisis, whether it be a close friend, family member, or just an acquaintance, we don’t always know the right words to say. We may also have a difficult time processing the crisis through our own emotions and actions and before long, the wrong words come out to the wrong people at the wrong time. Several years ago, I was introduced to something called the Ring Theory and it became a very simple tool to use in any crisis, mental health related or otherwise. It saves friendships, relationships with family members, and ourselves from embarrassment and bitterness.

Essentially, this is how it works:

  1. Draw a circle with the name of the person in crisis written in the middle. In our case, this is the person being admitted to a psychiatric hospital. This is the first ring.
  2. Draw a second circle and name the person(s) closest to the person in crisis in terms of relationship. This is most likely a spouse and any children.
  3. Draw a third circle and name close family that is not part of the second circle, such as parents, siblings, very close relationships with aunts, uncles, cousins, or grandparents. For minors, this circle would actually be the second circle.
  4. The next rings are completed unique to whomever is using the tool. For example, if the person in crisis is your family member, the fourth ring and beyond will people in relation to you from closest in relation to furthest in relation. These rings will likely be filled with people that may know of your family member but don’t know them directly, like your coworkers, friends, church leaders, and your personal therapist.
  5. Using the tool: When communicating about this crisis and how it impacts you, the rule is “Comfort In, Dump Out.” What that means is anyone in a smaller circle than where you place yourself should only receive support and desire to understand. Anyone in a larger circle moving outward from where you are on the rings are safe to vent to, seek advice, and generally receive support from. The closest outward ring from you is typically the safest group to disclose details in confidence and less details should be shared the further you get from the center. Likewise, be accepting of negative dumping from anyone in a smaller circle than you, including the person in crisis. See below for a diagram of what this looks like.

In practice, this would look like a close aunt to their adult nephew in crisis phoning their best friend to entrust their emotions regarding their nephew being hospitalized. But when she is getting updates from her nephew’s spouse, she should refrain from expressing these emotions (don’t say “I can’t handle this! I have never seen him like this. What in the world are you going to do?”). She would offer comfort, help, and advice if solicited to the nephew’s spouse, and dump out the stress and fears and emotions to her best friend.

So what do you do if you are on the same ring as someone else? How do you communicate to other close family members? or what if one of your tight-knit group of friends is hospitalized? This is where judgment comes to play. Evaluate if factors exist that would place you or the other person closer to the situation or the person in crisis and apply the theory. Seek an outer ring connection to be safe if it is unclear. But, in reality, this most often looks like mutual support, a give and take from both people. Share when the other person is strong to support you and be strong when they need support.

As the rings go in, the emotional stress of the situation increases. This means the highest stress level outside of the person in crisis is usually the spouse and children. In the same respect, the further in, the harder it is to reach out. Many times, a spouse struggles to share with anyone how the situation is making them feel. My best theory for why this is, is because when they are in personal crisis, their closest confidant is usually the one who is in the center of the rings at this moment. The person they usually dump everything on should only be receiving support right now. It can leave a person feeling isolated, alone, and seeing their negative emotions build up. Empathy and understanding in the silence can go a long way, and providing practical help is sometimes the only avenue we can take to support.

In closing, there is one person that trumps all of the rings. And that person is your personal therapist. Having a therapist, you can always rest assured you are dumping everything to an appropriate person without question and you can ensure you are receiving the support you need to be better equipped to be an asset to the ones closer to the crisis. It is typically overlooked when someone has a mental health crisis that anyone other than the person in crisis is in need of professional help. In reality, friends and family members having an outlet in speaking to their personal therapist actually is in benefit to everyone involved. Practice using this tool in small ways and prepare for when it can be used in the hardest of days.

For more information on Ring Theory and its origins, please click on this link.

Day Two: Ring Theory