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One thing I have heard that pdocs and tdocs not infrequently tell their patients with psychotic disorders is that they should lower their expectations and not expect to have any kind of meaningful career. (One example that sticks out in my head is Elyn Saks being told she should quit law school and instead become a cashier.) I had never run into this in the past; of course, I was being treated as primarily having a mood disorder, with the psychotic element of it having little attention until recently. But something my tdoc said recently really stuck out, which was that I was actually doing really well, since I have a decent job, which of course implies that having a decent job at all - even though a good amount of the time I have been essentially flailing at it over the past year - is exceptional, and that I should not expect to have one at all - even though I had never even thought of not having a job (aside from when between two different jobs), or even taking off from my job (except when I have to go IP), even at my very most ill, as even a possibility

So have any of you ran into this sort of thing yourselves?

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Yes. In the past I told my pdoc I wanted to possibly work in the future but he said I shouldn't right away because the added stress will trigger my symptoms. I've been on SSI since my early twenties so I've barely ever worked (did college though). I want to work someday just because it could add some normalcy to my life. Now that I've been 80% stable for a year with clozapine, I was thinking about taking some coursees at the local community college to prepare me for a job. My only fear is that I don't have much of a resume and I can't explain to an employer why all those years after school were blank.

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The problem I have had is that over the past five years for a good while there I would not last at a job for longer than 2/3 of a year at most, which was hard to explain to future employers. In that case I still tried very hard to find another job, and then another, regardless; I did not even know anything was really wrong with me aside from the time I got severely depressed and lost one job in 2013 (and that was caused by running out of risperidone, long story), as I was not aware of having negative symptoms, which likely contributed to my problems with work. Of course with the most recent job I have been more symptomatic than I had been since 2013, but the job itself is less stressful and seems to be more tolerant of me not exactly functioning 100% much of the time.

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Yes, I think one of the things (and I think it might be changing now) is that I'm hard on myself because I think I'll never make it to grad school because of how much MI affected my cognitive function. The theme seems to be trying to get me to be okay with that. 

Quote

I was actually doing really well, since I have a decent job, which of course implies that having a decent job at all - even though a good amount of the time I have been essentially flailing at it over the past year - is exceptional,

Oh my god, this is so annoying. For almost 4 years I've been working for a psychiatrist who knows I'm MI and he feels a loyalty to me (he also knows I'll stay up for 3 days if need be). If I didn't have such an understanding boss, my ass would've gotten fired a long time ago. Prior to that I was working for my freshman mentor (my financial aid program assigned us a mentor on our first year). So put me in a job where I don't have a relationship with the people I'm working for and I would get fired. Actually I just remember that my 2nd to last semester in college I was almost in danger of losing the office assistant position I had. I was missing shifts and just not doing well. My supervisor called me in to talk about how I had been performing the last few weeks and was able to say I was just stressed from midterms but now that that was over I would start showing up on time.

Like some days I don't even show up to work or I show up at 1PM or I show up physically but not mentally. In the last two weeks I've probably done 10 hours worth of work. I work full time. Yeah...

Being told that it's still good enough is so invalidating. Or that it's enough to get the job done.

Or another one is me not being believed that my cognitive functioning has decreased significantly over the years because I hold a decent job and must be smart enough and I shouldn't expect myself to know everything. I don't! I just want to go back to being able to understand things like I used to. 

Edited by iaawal
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Yes, very funny you said this .. just today I got the email from the job I applied to, I didn't get. I have a huge gap in my resume.. also i don't have a college degree. This past week in my session with my therapist we were talking about careers and working. She said I most likely will always have to be on disability. If that is the case... that is basically living on welfare. And I don't want that. I brought up some careers to her that I am interested in. She looked at me with a blank stare. It was really discouraging. I then asked her? What do you think I should do ?? " It's not up to me what you should do, that's up to you" Typical therapist answer... I said you are useless lady. Just give me some advice you should know me by now. The jobs I have had in the past.. I could not keep them for long due to my MI. So yes, You can't set the bar too high. I have to remember I always crash :/.

I do know one thing is I am not going back to college esp a 4 year degree... I can't have 60k in debt. There are different types of trade schools that cost less. 

My biggest fear is losing my insurance. 

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47 minutes ago, iaawal said:

Or another one is me not being believed that my cognitive functioning has decreased significantly over the years because I hold a decent job and must be smart enough and I shouldn't expect myself to know everything. I don't! I just want to go back to being able to understand things like I used to. 

I have the thing where I have been told by multiple people, not laypeople but people like pdocs, my tdoc, the nurses in IP that I am quite intelligent, but I do not believe them whatsoever. Sure, I have decent insight and am perceptive, but that is not intelligence. And they all seem to think you need to be intelligent to do what I do (working on code for MRI machines)... when anyone with a basic knowledge of C, C++, Objective C, and Java could do my job. I am surrounded by bright people where I work, and feel like a mere code monkey in comparison. Likewise the people I work for like what I do... but the thing is really anyone with a basic knowledge of programming could do it. And a lot of the time I feel like I am struggling at work... but no one really notices. It feels like I need an awful amount of hand-holding from my team lead to get anything done, because I can never keep track of everything I need to do. Sigh.

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4 minutes ago, Closure said:

I have the thing where I have been told by multiple people, not laypeople but people like pdocs, my tdoc, the nurses in IP that I am quite intelligent, but I do not believe them whatsoever. Sure, I have decent insight and am perceptive, but that is not intelligence. And they all seem to think you need to be intelligent to do what I do (working on code for MRI machines)... when anyone with a basic knowledge of C, C++, Objective C, and Java could do my job. I am surrounded by bright people where I work, and feel like a mere code monkey in comparison. Likewise the people I work for like what I do... but the thing is really anyone with a basic knowledge of programming could do it. And a lot of the time I feel like I am struggling at work... but no one really notices. It feels like I need an awful amount of hand-holding from my team lead to get anything done, because I can never keep track of everything I need to do. Sigh.

That is exactly what happens to me. My job doesn't involve code but the same thing happens. Anyone with basic common sense can do my job. I work as a research coordinator so the most technical my job ever gets is knowing how to use branching logic when making a study database which is not complicated at all. Not even one bit. 

I also feel like I'm struggling but no one notices either. I'm very good at BSing when I don't get something that I would consider simple. I was a philosophy minor in college so if I don't understand something I can BS my way out of it. :P 

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10 hours ago, Closure said:

But something my tdoc said recently really stuck out, which was that I was actually doing really well, since I have a decent job, which of course implies that having a decent job at all - even though a good amount of the time I have been essentially flailing at it over the past year - is exceptional, and that I should not expect to have one at all - even though I had never even thought of not having a job (aside from when between two different jobs), or even taking off from my job (except when I have to go IP), even at my very most ill, as even a possibility

That was a really a rude thing to say, IMO.  It sounds to me like she is almost setting you back in your treatment, saying in a way to lower your expectations.  Seeing how you have a decent job though and you have been doing well with it ... why would you need to lower your expectations?  Am I reading what you wrote correctly?

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9 hours ago, iaawal said:

Or another one is me not being believed that my cognitive functioning has decreased significantly over the years because I hold a decent job and must be smart enough and I shouldn't expect myself to know everything. I

That must be so annoying.  Like they don't believe what you say at face value.  That hits a nerve with me.

9 hours ago, iaawal said:

Being told that it's still good enough is so invalidating.

Out of curiosity why is this invalidating?

8 hours ago, Closure said:

Likewise the people I work for like what I do...

That really matters ... if you can do your job, regardless of whether others who could do it or not too, then I see that as a really positive thing.  When someone is working, IMO what matters is keeping up with the job and doing it to your best ability. If I could work, what would matter to me is whether I can do my job right or not.  ie, I wouldn't expect to get fired if I was doing the job the right way.  However if there was a person there (say with a Ph.D) working the same job you do, they could be the one getting fired if they aren't doing their job right.  So having a unique set of skills matters, no matter what job you're doing or whether you have a degree or not.

 

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8 hours ago, melissaw72 said:

That was a really a rude thing to say, IMO.  It sounds to me like she is almost setting you back in your treatment, saying in a way to lower your expectations.  Seeing how you have a decent job though and you have been doing well with it ... why would you need to lower your expectations?  Am I reading what you wrote correctly?

I think her intentions were actually to get me to not put myself down or see things as worse than she thought they were, i.e. she thought that I was doing better all things considered than I thought I was. But what she was saying is that I am doing quite well simply in having a decent job, which is indeed lowering expectations, like having such a job is more than I can really expect for having a mood and a psychotic disorder.

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34 minutes ago, Closure said:

I think her intentions were actually to get me to not put myself down or see things as worse than she thought they were, i.e. she thought that I was doing better all things considered than I thought I was. But what she was saying is that I am doing quite well simply in having a decent job, which is indeed lowering expectations, like having such a job is more than I can really expect for having a mood and a psychotic disorder.

Sometimes even the littlest of things that someone (especially a pdco/tdoc/other DRs) could say make a difference.  Positive or negative.

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20 hours ago, Closure said:

something my tdoc said recently really stuck out, which was that I was actually doing really well, since I have a decent job, which of course implies that having a decent job at all - even though a good amount of the time I have been essentially flailing at it over the past year - is exceptional, and that I should not expect to have one at all

I've experienced this. Or a variation on it. I am treated for a mood disorder, I don't have psychosis, so I hope it's okay to contribute to this thread. It's something I'm struggling with now in therapy. How I appear to be doing from the outside does not match my experience of my illness. These conversations tend to come along with being told I'm a perfectionist. If I would only lower my expectations/standards of myself, I would be happier, because really, I'm doing well - a lot better than I give myself credit for, they tell me.

I don't argue that I'm a perfectionist, or that it's a problem. I know that. But there's a difference between a minimum that I know I'm capable of doing and the perfectionist goals. I'm not even hitting the lower bar that I am (or was) capable of and no one else seems to be worried or alarmed. They just say look, you still have a job that's happy with your output, be happy with that.

 

9 hours ago, melissaw72 said:
18 hours ago, iaawal said:

Being told that it's still good enough is so invalidating.

Out of curiosity why is this invalidating?

For me (and I'm not iaa, obviously, so her experience may be different), being told that tends to come with a lack of understanding of the amount of effort truly required to accomplish the task. It tends to come with being told, essentially, that I'm not as sick/depressed as I claim because if I was I wouldn't be able to do the work I'm doing.

It's like... if I were an olympic figure skater and hurt my knees and couldn't spin or jump anymore but everyone said "you can still lace up your skates and move on the ice, so be happy with that". There's something wrong, but because my starting point is atypical (ie, most people can't skate at the level of an olympic figure skater), people are only looking at the end point (I can still move on the ice without falling much), not the fact that there's been a change. 

 

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7 minutes ago, Geek said:

I've experienced this. Or a variation on it. I am treated for a mood disorder, I don't have psychosis, so I hope it's okay to contribute to this thread. It's something I'm struggling with now in therapy. How I appear to be doing from the outside does not match my experience of my illness. These conversations tend to come along with being told I'm a perfectionist. If I would only lower my expectations/standards of myself, I would be happier, because really, I'm doing well - a lot better than I give myself credit for, they tell me.

This. I've been at least moderately successful in my career so far, yet I have this pervasive fear that people can tell that there's something wrong with me. My therapist insists that how one feels inside doesn't always lend itself to how one looks to other people.

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11 minutes ago, Geek said:

For me (and I'm not iaa, obviously, so her experience may be different), being told that tends to come with a lack of understanding of the amount of effort truly required to accomplish the task. It tends to come with being told, essentially, that I'm not as sick/depressed as I claim because if I was I wouldn't be able to do the work I'm doing.

It's like... if I were an olympic figure skater and hurt my knees and couldn't spin or jump anymore but everyone said "you can still lace up your skates and move on the ice, so be happy with that". There's something wrong, but because my starting point is atypical (ie, most people can't skate at the level of an olympic figure skater), people are only looking at the end point (I can still move on the ice without falling much), not the fact that there's been a change. 

 

That makes a lot of sense.  Thanks for the explanation.

 

11 minutes ago, Geek said:

They just say look, you still have a job that's happy with your output, be happy with that.

It is more than just that though, like you've been saying.  It also seems to me like they are "passing you off" as ok, when really they aren't looking beneath the surface.  Like a bandaid or something.

 

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42 minutes ago, melissaw72 said:

That makes a lot of sense.  Thanks for the explanation.

 

It is more than just that though, like you've been saying.  It also seems to me like they are "passing you off" as ok, when really they aren't looking beneath the surface.  Like a bandaid or something.

 

@Geek described it so accurately. 

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On 2/25/2017 at 2:22 PM, melissaw72 said:

It is more than just that though, like you've been saying.  It also seems to me like they are "passing you off" as ok, when really they aren't looking beneath the surface.  Like a bandaid or something.

Yes, that is also true.

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On 2/25/2017 at 2:22 PM, melissaw72 said:

It is more than just that though, like you've been saying.  It also seems to me like they are "passing you off" as ok, when really they aren't looking beneath the surface.  Like a band

Like for me, lately I have been suffering from psychotic symptoms, more intensely than I had before aside from a short period in November, but I got the impression from my tdoc that she was viewing things as generally okay since I could still work and all that, as if it was the fact that I could work that really mattered and not my being quite symptomatic. Of course, she could be using my ability to work as a proxy for how severe my symptoms really are... except the thing is that I manage to get out of bed and go to work every single workday (provided I am employed and not in IP) no matter how severe my symptoms are (I might not get any work done, but I will still get myself to work), so simply my managing to get to work every day is not a very good measure of how well I am doing.

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11 minutes ago, Closure said:

except the thing is that I manage to get out of bed and go to work every single workday (provided I am employed and not in IP) no matter how severe my symptoms are

Does your tdoc know this?  Maybe you aren't thinking along the same lines? ... where she might be interpreting things one way, and you another.

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4 minutes ago, melissaw72 said:

Does your tdoc know this?  Maybe you aren't thinking along the same lines? ... where she might be interpreting things one way, and you another.

I don't think I have made this clear to her. E.g. when my symptoms are severe I will often go to work and literally stare at my computer screen all day long, but I still go to work regardless.

Edited by Closure
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5 minutes ago, Closure said:

I don't think I have made this clear to her. E.g. when my symptoms are severe I will often go to work and literally stare at my computer screen all day long, but I still go to work regardless.

I would definitely bring this up with her when you see her next, to make sure she knows what you are thinking of/interpreting things in terms of what she's said (see below post in bold) and how you feel about it ... and before you leave to make sure you and her are thinking along the same lines.

 

25 minutes ago, Closure said:

Like for me, lately I have been suffering from psychotic symptoms, more intensely than I had before aside from a short period in November, but I got the impression from my tdoc that she was viewing things as generally okay since I could still work and all that, as if it was the fact that I could work that really mattered and not my being quite symptomatic. Of course, she could be using my ability to work as a proxy for how severe my symptoms really are... except the thing is that I manage to get out of bed and go to work every single workday (provided I am employed and not in IP) no matter how severe my symptoms are (I might not get any work done, but I will still get myself to work), so simply my managing to get to work every day is not a very good measure of how well I am doing.

 

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