The Questions You May Have When I Take Sick Leave for My Bipolar Disorder

Last summer I lost my job whilst on sick leave for bipolar disorder. One of the factors behind this decision, I believe, is that my boss, who despite already knew about my bipolar disorder, didn’t perceive that I was sick and didn’t understand the need for complete rest my psychiatrist prescribed.

• What is Bipolar disorder?

Coming round from a heavy dose of righteous indignation, I’m realizing the fact I am well most of the time can be confusing for some people. After a few months spent rebuilding my confidence, I now hope I’ll get a new job before too long. So my mind has turned to how I’ll handle sick leave in the future, should it become necessary. I’m not sure I’ll necessarily reveal my condition, but if I do, I want my colleagues to have an accurate perception of my state and understand my needs, rather than assume I can only be off-the-charts “crazy” or stone-cold “sane.”

I’ve chosen to put together an FAQ document I can share when I need, without needing to spend time writing it and measuring my every word whilst I’m sick. As my psychiatrist pointed out, intense conversations about bipolar disorder whilst I’m unwell can only heighten my symptoms, so, like a good Boy Scout, I’ve decided to “be prepared” with something I could send as an email or a letter if needs be.

I now realize these answers might come in useful outside work, too, responding to what friends might want to ask but could feel awkward doing so. Media portrayals of bipolar disorder can be stark, leaving many people confused when someone who appears quite “functional” claims to be part of the bipolar clan. No, we’re not being overdramatic: modern psychiatry can do a great deal to tame the tempests we’re subject to. But medication doesn’t mean we don’t need your understanding to help us weather the storm.

I want to spread the word, too: I’ve never seen a newspaper article or a film about a person with bipolar disorder who responded to treatment. And yet wouldn’t it be great if something like that got a higher profile? Not only would it break taboos, but it could also raise the hopes of all those on the path to being diagnosed.

“Are you sure you have bipolar disorder? You don’t seem bipolar…”

I get that question often.

Many people know bipolar disorder involves mania and depression, but fewer know
there are two different types of bipolar disorder. One involves a tendency towards hallucinations, career and family wrecking behavior whilst manic, and the other involves the same type of upward mood swing without psychosis and disastrous consequences. The second type, bipolar II, which affects me still requires treatment because hypomania (which means mild mania) almost always leads to depression. Bipolar depression is hard to treat because people with bipolar disorders are strongly advised not to take antidepressants, so psychiatrists do everything they can to nip hypomania in the bud.

The media tends to talk more about the spectacular behavior of people who reject medication or unfortunately don’t respond to it. But medication can alter or even eliminate many bipolar symptoms, letting people like me lead (almost) “normal” lives. There are probably many more of us around you than you could imagine, leading outwardly unremarkable lives.

“Can’t you just take a pill or something? We need you in the office.”

I do. I take pills to prevent episodes and pills to dampen the episodes. I see a psychiatrist at least once a month and a lot more regularly if I fall sick. With over 30 years of experience with patients with mood disorders, he knows exactly how to use medication to keep me on an even keel whenever possible. Personally, I feel quite lucky that my medication helps me to lead, in the large part, a good life in spite of this disease.

However, it does mean I need to be vigilant and, as needed, modify my lifestyle to stay well. That means rest when my symptoms go too far. When medication isn’t working well on its own, my doctor often asks me to limit social and intellectual stimulation and thus work.

“But you seemed fine a few days ago?”

I know this can be confusing, so let me clear this up.

To do so, I need to tell you about the bipolar mixed state. Bipolar disorder is actually not as straightforward as a phase of highs and lows. For many people, it can also involve a mix of high and low symptoms at the same time. In my case, most of my episodes involve this particularly challenging mix.

It means I can be more than usually sociable, full of ideas and chatty, whilst at the same time have obsessive dark thoughts and, between intense chats, constantly nipping to the toilets for a cry. When I’m with people, the first set of symptoms tend to express themselves, and when I’m alone the negative ones.

Furthermore, as I mentioned, I’m lucky to respond to medication which generally masks the signs of my illness, making it harder for you to see what’s happening. You might notice a growing social ease and a tendency to talk very fast but fail to see the whole pattern of slowly accumulating symptoms that worries my psychiatrist.

“Doesn’t mania make you super creative and productive? Can’t you ride that wave for a while?”

Yes, it does: and it feels really good sometimes. But manic creativity is kind of like cheap candy: you get a high, but the taste is poor, and no matter how much you eat it’s incapable of satisfying you in the long term.

The creativity of bipolar disorder is cruel: it helps me come up with some great ideas, but nine times out of 10 it snatches away the memory and concentration I need to see them through. And as for having any perspective on whether my idea is good or bad: forget it.

As for productivity, memory and concentration issues, which are an integral and untreatable part of bipolar symptoms, tend to put paid for that. These can make it really hard to keep organized and on-track at work.

You might want to capitalize on the fact that I am more than usually charismatic and communicative to win over stakeholders at work. This is risky: try to remember that whilst I might look energetic and positive, I’m actually very vulnerable, and the facade could crumble at any time.

“Nevertheless, can’t you just push through the worst of it?”

First of all, if my doctor had pressed me to take sick leave, it means I have already been pushing through (the crying, the not sleeping, the self-destructive thoughts, etc, none of which you have seen) and the doctor’s years of experience leads him to conclude it has not been working.

When anyone “pushes through” physical and mental distress, its fair to expect payback. But for me, that payback might be a month, whereas for someone without bipolar disorder it might be is just a few days.

“What caused the episode?”

A number of psychological and physiological factors come into play. Common causes are lack of sleep, jetlag and stress. But it might not be work stress that’s involved, which at times I can power through without becoming symptomatic.

Regular sleep is a real must-have. I might need to ask you to schedule flights for work that respect my regular sleep schedule – generally, it’s not worth compromising weeks of productivity for a cheaper flight.

Once an episode has stated, pretty much anything can prolong it, from thinking about other people’s perception of me to the untimely death of my teapot. What’s going on at work could certainly feed into the episode. For example, if I hear that a lot of work pressure is building up for my return, or if I hear something about a delicate office politics situation, it could make my symptoms worse.

“What do you do whilst you’re on sick leave?”

For most of the first few days, I stay in bed and sleep. Generally, every beginning or extension of sick leave leaves me feeling like an enormous failure. I need some time to digest that feeling and also to stop thinking about work projects.

Then I concentrate as much as I can on calming activities like swimming, yoga, cooking and calling or seeing good friends. I try to schedule just one activity a day to keep my mood from going too high.

I have to avoid activities that stimulate me too much like intensive sport or evening social activities. Every time I feel a surge of manic energy — which can be provoked by something as simple as moving around too much whilst I’m cleaning — I make myself lie down in bed, dim the lights and watch something relaxing on Netflix. I think this is where all my time goes: doing something “productive” often goes awry.

Perhaps sleeping and doing gentle activities sounds indulgent, but consider the alternative: having an erratic colleague prone to making more and more mistakes at work and creating more work for everyone else. If it makes you feel any better, chances are I’m not enjoying myself that much!

“What can we do to help?”

First of all, thanks for grappling with this situation: I know for many this is a sensitive and delicate situation to handle and my absence may leave you with additional responsibilities. However, I think you’ll soon see how well and calmly this can work out if we’re all on the same page.

If I’m taking sick leave for an episode, the best thing you can do is to let me go without resistance. I appreciate that you may have questions and worries at that stage, but this is not a good time to discuss these. Talking about my limitations and the effect they are having on you will only send my brain further into a manic or mixed state — and further away from being able to resume my duties and bear my weight in the team. That’s why I’ve written this document, which will
hopefully, respond to most of your concerns.

When I get back, I don’t need any great heart-to-heart about what’s going on, but your steadiness, patience and calm will be invaluable. Please don’t feel obliged to ask me how I’m doing 10 times a day! Consistency and patience speak volumes.

We should probably have a chat about how to handle my duties on the days after I come back from work. (See below.)

“How long will you be off for?”

If the work environment is calm, generally I’ll need about a week. However, if for any reason the work environment is tense, my doctor may suggest I take more time.

“What about when you come back?”

In general, the return to work is pretty stressful, particularly if I’ve been away from work for more than a couple of weeks. My mood might be only just stabilized, and I might have lost faith in my abilities to complete an activity without getting excessively stressed out. I need to start with the least stressful tasks and build up to more challenging ones. For me, the most challenging things are dealing with difficult
people and conflictual situations — as well as tasks that require a great deal of detail.

Let’s talk about how to ramp back into these activities, and in the meantime, I’d really appreciate it if you had my back on that one. I think you’ll see the benefits too, with me more quickly getting back to 100% and pulling my weight on the team once more.

Thanks for taking the time to read this! Perhaps it will have made for uncomfortable reading, but in time, there’s no reason that you shouldn’t come to see me just like a colleague who has regular ear infections.