The new Netflix sitcom Lady Dynamite is about a mentally ill entertainer whose past mental breakdown forces her to make tradeoffs in her career. Maria Bamford, the show's star, really does struggle with bipolar type-II disorder, and she had herself voluntarily committed three times in 2011, only to return to comedy and acting. Years later, when Lady Dynamite was in production, Netflix had to take Bamford's mental health into account, allowing her to take the 12-hour work breaks she said she required between every shoot in exchange for a pay cut.
Maria Bamford's ability to maintain a high-profile career in spite of her struggle is astonishing, but she's also lucky in one way: Her profession pays reasonably well, and her status allows her to demand flexibility.
Most people who have breakdowns aren't in Bamford's position. Too often, getting healthy is a financial burden. For many, handling the day-to-day pressures of a full-time job alongside a nervous breakdown means struggling through each day, waiting for your work situation to get better, and biding your time until you can quit.
"We don't use the term 'nervous breakdown' as a diagnosis," said Dr. Amber Walser, a clinical psychologist in Los Angeles. But the cultural phenomenon corresponds, she said, to when a patient 'decompensates' rapidly from a stable level of functioning."
"Decompensation" is a clinical term referring to a sudden worsening of symptoms that the patient had previously been able to deal with. The point of "breakdown," Walser said, is when "someone checks themselves into a psych hospital" in order to return to managing their mental illness, as opposed to someone becoming suicidal or psychotic.
Recovering from a breakdown sometimes means taking leave from work, and the 1993 Family and Medical Leave Act (FMLA) sometimes makes this possible. Walser's three-week program for stress is covered, for instance. "I actually sign off on FMLA paperwork regularly," she said.
As for me, I've "decompensated" a couple times due to debilitating anxiety, and I only learned about FMLA recently. But in my mid 20s, when my illness was at its worst, I worked for a small business with about 20 employees, and likely couldn't have taken FMLA leave, according to John Head, a spokesman for the Bazelon Center for Mental Health Law. Qualifying employers, he pointed out, "must have fifty or more employees."
When taking leave for mental health reasons, you aren't required to tell your boss, according to the Department of Labor—only if you need something to change in the workplace—but depending on your relationship with your boss, it might be easier than going on medical leave without explaining what's wrong. Still, announcing that you're leaving for mental health treatment may make sound like you're being dragged away to a padded cell. Head points out that "FMLA [leave] doesn't require psychosis or any particular diagnosis," and that it simply "has to be a 'serious health condition,'" which can be—among other things—any illness requiring an overnight hospital stay.
Besieged by the classic symptoms of severe anxiety, I struggled to churn out 3,000 words a day at a small SEO company, not knowing my anxiety was becoming a "serious health condition." I used to sneak away from my desk every few days, run to my office parking lot, and hide in my car. There, I would try to push the increasingly dark thoughts away as best I could, but with my daily word count dropping every moment I was away, I could only afford a few seconds. A few deep breaths, and I was back in the fray.
Jenell Taylor, a former emergency veterinary technician in San Diego had to balance her high-stress job with manic depression and anxiety, and tells a similar story to mine: "I would make an excuse and run for my car if I could. Other times I would have to power through," she told me. On days when coping was impossible, she said she would use the physical symptoms of her mental illness as an excuse. "I can't come in today, my back is really hurting," she recalls telling her boss. But things eventually became intolerable. "Eventually I had to leave my career," Taylor said. She's now on permanent disability.
Head told me that "[the Americans with Disabilities Act or] ADA applies to any employer with fifteen or more employees, so many employers may be covered by ADA even if FMLA does not apply." But according to the Department of Labor's guidelines, disabilities are largely irreversible conditions.
"I think there is a lot of confusion, and very little awareness surrounding these acts," said Walser. "People should educate themselves about the options before they ever need to use them."
But of course, taking leave can jeopardize your career. "If an employer fired or disciplined an employee for seeking to take leave under either FMLA or ADA, that would be retaliation," Head told me. But according to Scientific American, 90 percent of the time employees sue over ADA discrimination, courts side with employers.
I didn't take FMLA or ADA leave, and in July of 2012, I saw strange specters in my field of vision, and under the belief that I was having a stroke, I spent a night in the hospital for symptoms that turned out to be a either a migraine or nothing—I never got an official diagnosis. With an IV in my arm, my doctor lectured me from my bedside about the hazards of drinking too much coffee. My out-of-pocket for the hospital stay, plus two pointless CAT scans and an MRI, was over $4,000, a little more than what was in my meager savings account. My job didn't cover my medical insurance.
The following year, I went part-time at that job, and it was a big help, although it was a huge hit to my bank account. That was also the case for Ashley, a woman who asked me not to use her full name. She worked part-time as a substitute teacher in Southern California when she had what she considers a nervous breakdown. "I was working per diem on call work, so it was possible to take time off with minimal problems," she said.
But of course work challenges aren't the only thing standing in the way of treatment. "A lot of people wait too long to get help because it's hard for many people to talk about personal things, or they think they can manage on their own, or their pride gets in the way," according to Walser.
As for me, I eventually found a better job. It has a health plan, but more importantly, it's less demanding than my previous job, and I can afford to be upfront about my mental health. I haven't had a serious issue in about four years, but I'm confident that I could currently navigate a breakdown without having to quit.
In other words, I know that I, like Maria Bamford, am one of the lucky ones.
If you are concerned about your mental health, or the mental health of someone you know, visit the Mental Health America website.
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