When mental illness gets personal - bridges burnt

That's a tough situation, I'm sorry to hear it. First of all, I hope you're receiving treatment/medication and found things that help. I'd be worried that something like this could happen again, especially in a doctoral program where the pressure/intensity of the workload is much greater in addition to directly interacting with clients.

But assuming you have that under control, I would probably try again to mend the relationship with your PI. I can't judge her unwillingness to meet with you because I'm unaware of the contents of the email you sent. I would maybe email her and say that I completely understand why you don't want to meet with me, and maybe ask to just speak with her on the phone for 5 minutes. Then you can apologize again providing some context for your behavior, stating how important your career goals are and that you're willing to do whatever it takes to work towards them etc.

If that doesn't work, I'm not really sure of other options besides trying to find other PIs/people you can work with who would write you solid recommendations.

 

A few thoughts, in no particular order.
1. I'm unsure what you mean when you say you did internships at top spots but did not do any hours because you were getting a research degree. If you did not provide clinical services under supervision, that is not the definition typically conferred with 'internship' or 'practicum'.
2. I won't speak to the supervisor, but there are many reasons that I don't answer e-mails. Not the least of which is that I'm busy and they are missed. This may or may not be the case for you, but it is not unreasonable to assume this /may/ be the case. It would not be unreasonable, no matter the reason for the initial non-response, to follow-up given that you last attempted to contact in September. I typically give about 2-3 weeks so that it stays on my radar.
3. I would be wary of saying that it is "unethical not to recommend" you because of a mental illness because the larger issue may not be due to the binary of 'you have/do not have' a mental illness and may reflect how the illness impacted your work. Mental illness is a struggle. However, it is important at those struggles are not impacting work capacity.
4. I think its very poor form not to meet with a research lab member.

 

Relationships are part or work and I consider those things together when evaluating what type of recommendation I can write / how I want to involve someone with my work.

 

Sending "incoherent emails" to multiple people, including your supervisor, and "quitting (not sure why you put this in scare quotes)" when you were still hypomanic are not demonstrations that it was impacting your work?

It really seems like you're not telling us the whole story.

 

Sorry to hear about this. As a person with a chronic medical condition that has affected my work life/ career progress at times, I feel for you. That said, there is not a whole lot to do here. It is not unethical for her to not write you a recommendation or to discuss plans with you. It would have been unethical to fire you or kick you out of a grad program, but even jobs or schools don't have to give you a POSITIVE recommendation when you leave. Using her as a reference may not be the best idea as she cannot speak only to your positives, but to your negatives as well. If asked for an opinion by a potential employer, she would likely struggle to call you a reliable volunteer. If I were you, I would evaluate the options you have, consider whether the direction you are looking at career-wise will allow you to remain stable on medications or may be to stressful for you, and pick whatever option best allows you to remain stable. This may involve a few steps back, but you will have to find a place where you can prove a track record of positive performance without the mood sx affecting your work. Good luck

 

I'm sorry about this. It's really unprofessional of them to behave this way - doubly so because of our line of work and supposedly enlightened education.

I think it bears mentioning that it's really hard for us in this line of work being diagnosed ourselves with something that could impair our performance in this manner. And there is a lot of silence around it when it happens - nobody wants to be too close to a physician that's going through a dark place. I think there's this feeling that it might be catching and the work we do is so heavy sometimes that it's frightening to imagine ever being on the other end of the desk. I know I have a hard time with this.

I find I run into this issue around prejudices a lot - I'm try to be very open about my diagnosis, orientation, gender identity ets. If I do not have the courage to be open about this, how will the stigma ever end? But it does have consequences...and sometimes I just crawl right back into that closet and pull the door shut behind me.

I find the issue of disclosure of mental illness resonates for me a lot with my experience as someone on the LGBTQIA spectrum. You simply can't say who can or cannot afford to be out of the metaphorical closet. But there's always this hope that someone will do it for the good of all of us.

I think you deserve a pat on the back for that. It's a bold move and I think it makes you one of the best of us. Whatever that decision may cost you, you should weigh it against just how much it helps others to have you be out there. When I find out that someone I work with struggles too it immediately makes me feel less anxious. Just that feeling of not being the odd one out does something for our sanity.

Thanks for being seen.

 

The person quit their job in manic state. The illness affected their professional integrity and working professional relationships. The fact that the PI is distancing themselves or declining to write a LOR or rehire the OP is consistent with the APA ethics code.

2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

 

How exactly would you know, without a shadow of a doubt, whether you will or will not continue to have periods of serious impairment in the future? Do we suddenly have a new way of rating severity of illness in Bipolar Disorder that I missed, one that tells patients when they can expect to have their next manic episode and how serious the issue will become?

He acted, I think, in as professional a manner as is possible for someone with this type of disorder.

He has constrained himself to work that is less likely to lead to stress that might endanger his health. When he became observably symptomatic he removed himself from his duties and he took immediate steps to manage his relapse.

The unfortunate incidents themselves, are to my mind, comparable to vomiting on the ready room couch because you have food poisoning. It's hardly something you should lose your career over. It's not like a patient was endangered by his misconduct. To me that is the essence of the regulations: Did everyone who was at risk make it out ok? Did you do everything you could to keep this from happening? Is there any reason why what's going on with you fundamentally disqualifies you from this kind of work?

If he were working for me an the reference was mine to give, I'd likely have called him in to discuss my concerns for his competency in person, and gauged first whether he understood the implications of what had happened and how he may need to rethink his future plans. I certainly wouldn't give him a cold shoulder. Whatever words passed between us would have been during a period that he was not considered compos mentis and should not count against him professionally.

Would they have had the same response if he was suffering from an illness like Diabetes for example?

I think you forget that the incidence of mental illness is something like twice as high in our profession as in other walks of life. If the APA began barring every physician the moment they were diagnosed there would be nobody left to treat the patients.

This attitude of yours is the very reason so many with mental illness never get help. Damned if we do, damned if we don't.

 

Epidemiological studies.

And you need to keep in mind, these people are running a business/professional operation, not a therapy/treatment service. No one is under any kind of moral or ethical pressure to recommend, rehire, or even associate with someone who has jeopardized their business...whatever the reason for that may have been. You can empathize with someone while at the same time not wanting to recommend or rehire them.

No one's career has been ruined, but the OP may need to move on from this particular situation.

 

One thing that resonates with me is your fallacious comparison between being a diabetic and being bipolar. Having to take an insulin shot does not impair you in any capacity clinically (unless, say, you forget to take a medication and then pass out while working with a patient). Most diabetics whom are aware of their condition will adhere to their medication. Bipolar, on the other hand, is a serious mental health condition. If patients adhere to medication and therapy, they can live somewhat stable lives. However, bipolar medication adherence is an issue, and when individuals relapse into mania or hypomania, the social consequences are serious. Carrying a clinical patient load is a serious committment, and is a requirement of clinical psych/counseling psych training programs. The stress even affects otherwise "mentally healthy" individuals. My question is does the risk of relapse for a clinician with bipolar in remission outweigh potentially benefits (e.g., empathy, compassion, true understanding) for clients. The answer, in my opinion and probably many rooted in patient ethics, is no (if the bipolar has any risk of affecting patients). This is not a "cuddly" answer, but a frank reality of what clinicians need to do to ensure safety and the best care for their clients.

Could the OP be a scientist in the mental health field? Quite possibly! Personal experience usually inspires interests. However, it would be important to (of course) remain objective in science and, still, adhere as much as possible to treatment regiments. The stigma of mental health is serious, and outbursts and actions like OP did, regardless of diagnosis, will almost always get you fired in most professions (maybe not if you are tenured in academia). Another reality is that mental health, stigma or not, mental illness is not an excuse to get out of the conseqeuences of socially unacceptable behavior.

And to your point about the incidence of mental health issues being twice as high in our field: this is why medicine likely undervalues our profession as a whole. The sick treating the sick does not make for a good model. I am not saying that you can never struggle with things like depression, anxiety, other mental health issues, etc. However, if these compromise your current work in any way, you should not be seeing patients per the APA ethical code. The same goes for MDs... if you have a neurosurgeon you just had a stroke, would you really want this person operating on your brain? The answer is no for obvious reasons. Of course, if said surgeon is recovered and medically cleared, then you are good. The sick treating the sick in psychology is not a good model for patients or practicioners.

Also, for your point, being LGBTQIA =/= a mental illness (at least according to most reputable professionals in our field). It does, I am sure, carry challenges that heterosexuality does not carry. But it does not inherently compromise your work like severe mental illness does unless because of being LGBTQIA (or for another reason) you have a serious mental illness. I commend you on being open, and hope things are going well. I am not trying to attack you, but I wanted to point that out as someone with several colleagues and family members on the LGBTQIA spectrum who struggle, but don't consider their identity a mental illness.

tl;dr: erg923 is right. Ethically, if a mental illness compromises one's ability to work/treat patients, they need to take serious remediation measures and/or consider another line of work. It's a tough reality, but being a mental health professional is not for everyone (and especially is not for everyone who has and is battling with mental illness).

 

Everything you've shared suggests that, unfortunately, the moment has passed. The circumstances of your departure, the consequences it held for other people, and how you communicated with those to whom you were responsible in the meantime may have been such that this group decided that it could justifiably move on without you, a possibility made more likely by the fact that you volunteered there only 6 months. Clearly this has been disappointing, but it doesn't need to halt your career. My suggestion is to look for other opportunities not affiliated with this research group, and be mindful of the lessons learned from your experience. In your cover letters explain that you have a gap due to a medical condition you now have under control, and jump ahead to your passions, your skills, and how you can help them.

You know, it is very much possible to have empathy and wish someone well, but also to choose not to work with them in the future. I can think of two examples of undergraduate RAs from my lab in grad school, whose experiences of chronic illness went very differently. One became unreliable and uncommunicative once her disease was known to us (due to a medical event that occurred during her lab duties), whereas the other became a very trusted RA and went on to a strong PhD program with our highest recommendation, despite taking off a longer period of time due to her disease.

I am well acquainted with a psychologist who experiences severe, cyclic episodes of depression yet managed to be awarded tenure at a reputable university. There is a model for success in high achievers with chronic mental disorders (or any chronic illness for that matter), and my experience is that these folks are self-aware, possess a growth mindset, are assertive without being demanding or accusatory, and accept that **** happens and life is, at times, spectacularly unfair. Acceptance doesn't mean agreement, but it does imply an ability to see the situation for what it is and not waste effort on things that won't change. They know when to move on, redirect their energy, etc.

In short, I think you are tormenting yourself about something that will turn out to be a blip on the radar in the grand scheme of things, as long as you commit to taking good care of yourself while also challenging yourself and owning your responsibility to manage your condition. Resist indulging in the idea that other people are not carrying their own invisible burdens all around you. Focus more on what actually works for you and less on what other people should or shouldn't be doing.

 

While it may not be what the OP wants to hear, I would say that MamaPhD stated things more eloquently than I. As an aside, those who don't think that emotional stress, diabetes, and cognition can be linked should read the literature. Hell, being sleep deprived can affect the quality of your work. Being bipolar does not necessarily preclude one from being a good clinician. Like everything else, a successful person must find the balance between all personal issues (including medical) and work responsibilities. While understanding is nice, it really isn't anyone else's problem.

I have been through a similar situation due to an exacerbation in my medical condition on internship. Let me say, that my personal experience it was not that different from the OP. While I completed all of my internship requirements, the interruption to my work due the medical condition did cost me a letter of rec I needed from a less than understanding supervisor. It made my path more circuitous and led to some self-reflection. However, if you continue to do good work, it will not go unrecognized. A decade later, I am doing just fine and exactly where I wanted to be.

 

I feel for you, and I also see the other side.

To me, what stands out from what you shared is the "accusatory" (per your words) email you sent to a group of researchers...to me that would be concerning beyond the other stuff about quitting. Some reflection on the experience may be helpful to sort out why you communicated negatively toward them.

I think the reality is, even in our field in which we understand mental illness, we still need to be able to hold folks accountable for their behaviors, especially when the behaviors can be negative or affect work, relationships, etc. At the extreme end, I know of someone who behaved in wildly inappropriate/unethical ways in a graduate program (behaviors that were clear grounds for dismissal, and the person was dismissed) and claimed mental illness-based discrimination. In cases like this, mental illness itself doesn't "make" folks do things that are egregious and unethical (in my opinion). Certain behaviors are not things faculty/folks in our field should or can overlook, even if they understand that the person may be struggling.

What happened in your situation was not anywhere near that example, but gives you an idea of how justification/rationalization can be taken to the extreme when it comes to mental illness. Some folks would have been more understanding with you, some would've reacted the same as the PI. You did try to make amends, which is a show of personal accountability. The next step may just be accepting the outcome if the researchers aren't interested in repairing the relationship. Even if people are understanding, they still may not want to engage in further relationship repair, and that's an acceptable outcome, although disappointing, I can imagine.

A little unsolicited advice: keep in mind in a doctoral program you'd be clocking in anywhere from 50-80 hours in time commitments every week before you can think about self-care and even running errands. You don't necessarily have to give up on your career dreams, just make sure you take the time to reflect on what you need for yourself to be at your best in terms of self-care over the longterm, and decide what that looks like for you.

Thanks for sharing your story.

 

Agreed. And I think it's good form and reasonable to communicate that outright and not ghost.

 

You shouldn’t be protected from acting unprofessionally. It was a job/position that you had and the bridge is burned because of your actions.

Use it as a learning experience and guard your health and career more carefully next time.

Good luck

 

I’m actually incredibly disappointed with some of the responses on here. Discouraging people with bipolar disorder from carrying out a clinical career because of the work load. The truth is, that just demonstrates a lack of understanding of the disorder outside of a textbook/definitional understanding. It isn’t fair to make statements like that based on a limited knowledge of what it’s like to have bipolar disorder. OP I wouldn’t listen to some of these comments. It definitely is possible to have a very successful clinical career as someone with bipolar. Also, side note, I don’t know if you would want to check this out, but there is a super supportive online forum called Psychforum.

 

You joined just to advertise another forum?

 

This was my first time posting, not that that is really relevant. As for the forum, I just wanted to put that resource out there because it has a lot of information that OP may find useful as they stated they are having a rough time currently due to their condition.

 

Only jdawg2017 discouraged OP from ever having a clinical career. Other people were noting that this bridge is burned and OP needs to move on with their life and career, as well as that they need to use this incident as a learning experience, e.g., self-care of their mental health, professional relationships, etc.

 

I don't know if I'd say this person "ghosted" OP. Again, we don't seem to have all the info, but it seems like this person was responsive, but terse and not very encouraging. At a certain point, haven't there been enough pleasantries and communication with someone who burned bridges after a six month relationship?

 

You are disappointed because people are giving realistic feedback? Having a clinical career might not be a good idea if you have a serious mental illness that could impact your ability to care for your patients. Not everyone who wants to be a psychologist and treat patients can or should be allowed to do it. When it comes to Bipolar Disorder it does really depend on how severe the illlness and other associated features for that individual. If someone does get through a doctoral program, they will still need to be able to demonstrate that they can function professionally to the licensing board because the licensing boards do ask about it and will want documentation.

 

Licensing boards really ask for your mental health history?

 

If you have a condition that jeopardizes your ability to serve patients, per APA recommendations it ethically is your responsibility to be forthright and recognize if the best course of action is to "limit, suspend, or terminate" clinical activities. So no, you don't have to disclose to licensing boards, but if you are aware of your condition and blatantly disregard its implications on treating others, that is unethical.

 

It may depend on state, but not in CA....they only ask if you currently have a mental health impairment that could negatively impact your performance as a psychologist (paraphrasing). Not sure what happens if you say yes.
I was under the impression that ADA protects privacy of folks' past mental health treatment in most states.

 

27. Have you been diagnosed in the past 5 years with a physical condition or mental health disorder involving potential health risk to the public? If yes, please provide a detailed explanation.
This is from the application from state I am licensed in.

 

@Katie256 there is a distinction between being discouraging and being informed about the realities. On the whole, responses have been pragmatic. The reality is graduate school is, for most people, a huge mental and emotional strain at various points, even for folks without pre-existing mental health concerns to account for. That doesn’t mean someone with a mental health condition cannot succeed, but it is good to be informed about the challenges. 80 percent of the people I know who quit various programs quit due to mental health. (The other quit to go to med school). I also know a few folks with bipolar or MDD diagnoses who have successfully made it through graduate programs or med school but they are very open about how hard it was and the extra steps they had to take to make sure they were monitoring their well-being and patient care and setting up supports/checks proactively. For OP this may be the experience that leads to the level of introspection needed to determine what types of steps they need to take and supports they need to have in place to set them up for success in the future.

 

Agreed that we are unlikely to know all the facts. But if I've had someone working with me for 6 months as a research assistant, it is reasonable to take 30 minutes to meet with them and explain how behaviors/mental illness/whatever has impacted your relationship. It isn't about pleasantries, it's about being entirely upfront so that the person understands what to expect and why you have made that choice. Of course we don't know how the e-mail exchange went between the two, but meeting with someone (in person) who you are withdrawing from your lab is reasonable, as is discussing how events have changed what you can do. Sure, it's not a fun conversation but that's the other, less fun side of transparency. Quite frankly, meeting with someone you work with is common decency is far as I'm concerned and that is what I take issue with and why I think its reasonable to e-mail the POI again. The POI owes that to the student- nothing more, nothing less.

 

But according to OP, they quit on their own and it sounds like there already has been some conversing back and forth about this with the POI.

Honestly, based on what OP did and the previous communication between them, I don't really think that the POI owes anything more than has already been said and done.

 

This assumes that the impaired Psychologist still has enough insight left to comply with the ethical requirements. I am not sure he did, at least initially, based on the description of events. Apparently he *did* regain some insight since, again based on his description, he eventually wrote apologies and obtained professional assistance. I see nothing in the code sections you cited that suggest that the PI is required to do anything at all in this situation other than perhaps prevent him from have client contact while he is ill, and apparently this was and is a research program. Rehiring him, particularly with a promise of medication adherence, does not seem to be an ethical problem.

 

I would honestly say that there are a lot more highly successful psychologists with MDD than most people realize. Just off the top of my head, I know multiple full professors at R1s, TDs at competitive training sites, etc, who have MDD. They don’t talk about it (at least not until they make full professor and even then, it’s iffy) but there are plenty of them out there. Mania or psychosis gets much trickier, I think.

 

In the grand scheme of things, six months in a (presumably part-time) student volunteer gig is not a terribly long time. Setting aside the manic episode, I don't think that the PI "owes" it to you to be in continued contact, let alone to rehire you, based on a relatively short time with their group. If the PI isn't interested in meeting with you, she is not obligated to do so.

Without knowing how much of those six months overlapped with the onset of hypomanic symptoms, it's possible that there were other issues that did impact your work beyond just the quitting abruptly and the accusatory emails. There's just no way to know. What you do know is that right now it doesn't seem like this PI is interested in repairing this particular bridge, and I think that pushing back on that boundary is unlikely to change that. I don't think you necessarily need to give up on your goals, but I do think that you'll likely need to pursue other research groups at this point.