For years I had heard people laughing about going on stress leave. I've heard stories of people who were on stress leave for long periods of time. I do not know how they were able to achieve that. Stress is subjective and, therefore, getting a diagnosis that would have allowed me to be out of the workplace on paid leave proved very difficult in the long term.
This is the beginning of that part of my story. The part that does not involve those in the workplace who were bullying me, but involves the system. The walk through bureaucracy.
It also has the potential to be boring as there is not much action. It is also not as easy to describe using emotion and descriptive words because this is the "clinical" or assessment phase. The phase where I'm trying to get help within a flawed system and get a leave of absence from an incredibly stressful and harmful situation.
It also sets the stage for future events. Therefore the groundwork has to be laid carefully block by block.
*****
Visiting the Crisis Clinic at the local emergency room was a good first step as it bumped me up on the waiting list for a pysche consult. I'd been on a waiting list for a psychiatric consult for months in hopes of getting on a leave of absence since the accusation and write up for alleged violation of privacy. At the time of the write up, I was at the healthiest I'd ever been emotionally. Life was good. I was learning who I was and was comfortable within my own skin for the first time in my life. It showed. People, even complete strangers, commented on it. After that allegation, the subsequent write-up and the realization that the Union Representative seemed to be defending the complainants rather than me, I was confused. After all, I was the one who had been investigated, why was she defending them? To my mind, they didn't need defending. I did.
I saw a psychiatrist within the next few days of the ER visit who grudgingly granted me four weeks reprieve from the work situation. I had been warned by the psychiatric nurse at the crisis clinic that some psychiatrists were not willing to fill out forms, as in the ones necessary for getting a leave of absence. This doctor was one of those. He did fill out the form granting me some relief from the relentless onslaught in the workplace, albeit under duress.
I was very disappointed in the visit. In the past when I'd had an assessment with a psychiatrist for medication purposes, the doctor had spent at least an hour with me. Sometimes more.
My expectations did not meet reality.
Things have apparently changed in the system since I'd had previous assessments to ensure I was on the right medication and/or make changes in the medication. My assessment felt rushed. I didn't time it; however, I doubt it was 30 minutes in length - or less. My guess is that it was closer to 15-20 minutes. In that short span of time, this doctor diagnosed me, a patient he'd never seen before, with bipolar and mixed personality disorders. He prescribed two medications: one a sedative; the other probably an antidepressant. I'm really not sure now what it was. He did fill out the required form for a four week leave of absence which I've already said he did "under duress". He did not feel it was his job to fill out forms.
I felt better ... and worse.
I was confused as to how I could be adequately diagnosed in such a short time. But I really had no choice. This psychiatrist was the only rope I had to hold onto at that time. He did not arrange any follow ups.
Through a mental health program initiated by my visit to the ER, I began taking some ongoing classes on coping mechanisms etc. These were for a max of four weeks.
****
The tool which the psychiatrist used for an assessment of my current level of functioning was a Global Assessment of Functioning(GAF), which ...
... assigns a clinical judgment in numerical fashion to the individual’s overall functioning level. Impairments in psychological, social and occupational/school functioning are considered, but those related to physical or environmental limitations are not. The scale ranges from 0 (inadequate information) to 100 (superior functioning). Starting at either the top or the bottom of the scale, go up/down the list until the most accurate description of functioning for the individual is reached. Assess either the symptom severity or the level of functioning, whichever is the worse of the two. Check the category above and below to ensure the most accurate one has been chosen. Within that category there will be a range of 10. Choose the number that is most descriptive of the overall functioning of the individual.He rated me as functioning somewhere in the 60s which states in the percentile from 61 to 70 :
Some mild symptoms (e.g. depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
I don't remember all that I was feeling and/or experiencing in the way of symptoms at that tine but I know I had symptoms of depression and suicidal ideation. I was stuttering badly. Along with that, there was probably anxiety. I definitely by that time had trust issues. I cannot remember how exactly I was functioning at that time, except to say that keeping my head afloat was hard. I could still read recipes and cook and enjoy cooking. So some cognitive function was still there. Communication with the stuttering (I've never been a stutterer) was definitely compromised.
To him these symptoms were mild. To me, they weren't.
In an interview lasting less than 30 minutes, he had assessed my symptoms as mild. My guess is that it was because I had (and still have) some meaningful interpersonal relationships.
One problem with any assessment is that the clinician is assessing the patient as they present at that particular time, date and place.
And therein lies the rub, I think I was presenting at a higher functioning level in the psychiatrist's office than I was in other places and at other times.
I've linked a copy of the GAF used in my assessment to this blog. It is highly subjective, especially if the doctor in question is not really listening to the patient and/or trying to rush an assessment into an incredibly short time period. To me, it relies heavily on the clinician's assumptions and perfections about the patient which in my case could be based on appearance: hair combed, dressed, bathed, etc.
I believe it was a flawed assessment which assigned me a higher functioning value than I was achieving during that time period and which had significant ramifications in the days and weeks to come.
I also believe that he misdiagnosed me and, therefore, prescribed medications that were not the best for my condition.
the diagnosis of bipolar and mixed personality disorder would have significant ramifications in the near future of this journey in accessing future leaves of absence.
People who knew me well - and loved me anyway - totally disagreed with the bipolar diagnosis. On the one hand, I was definitely experiencing down symptoms i.s. depression, but where was the "bi" part of it? The manic part?
All in all, it was not the most positive experience I've ever had.
*****
At this point in my journey, I'm attempting to fulfil the company's requirements for a leave of absence beginning with an assessment by a specialist in this case a psychiatrist.
However, there were more requirements under the radar which I would need to fulfill in the future to be able to continue on a leave of absence. Requirements that were not obvious to the naked eye.
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