Job discrimination and mental illness

Recently I've applied for a number of library government positions in southern Oregon where I'm fairly sure I met the minimum requirements but was never even asked for an interview. The basic requirements were the following: a high school degree and some experience working in a library.I wonder if there is some way to report discrimination at the level of a job application if it was due to age, mental illness(I admitted a disability) or gaps in employment? I have a recent seven-year gap in employment due to illness of parents and self. My father had heart problems and died in 2011 and my mother has dementia since 2009 due to a stroke. I additionally experienced a psychotic episode in 2010. During that period( 2010 - 2017) I volunteered for two years in a college library, assisted a person with research on a book and have taken care of my mother who has a moderate level of dementia.

Since I have a bachelor's degree in Biochemistry/Psychology, five years experience working in a library(OHSU/ Lewis and Clark) and two years experience supporting systematic type health reviews in the Portland VA, I feel more than qualified for a position that could be filled by some one with lower qualifications. I have also applied for some office assistant positions at a university which I'm sure I met the minimum qualifications but was never even asked for an interview. I think my gaps in employment in addition to age ( which can easily be looked up) prevented an interview. I think when employers see large gaps they sense something is wrong health and or personality wise. I love how people are angry at the unemployed/disabled while at the same time discriminating unjustly against them. An excerpt from a medscape article  and a second article summarizes it best.

Work is a major determinant of mental health and a socially integrating force that is highly valued. No single social activity conveys more of a sense of self-worth and social identity than work. To be excluded from the workforce not only creates material deprivation but also erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability.

“Once they heard that word that’s it. Sometimes I think it’s worse than telling them you’ve been in jail. Once you mention that their face changes and their body language changes and you know you won’t get the job”.
“I applied for a government job and they said the mental state wasn’t quite what they were looking for.”

I believe that discrimination due to mental illness was at play also when I lost my last position with the VA. I overheard conversations toward the end about me which strongly hinted that my health was problematic and that they needed to be cautious about getting rid of me. This came from a medical doctor who should be more enlightened on the topic. In the end, they gave much of my work to an intern who was doing it for free and when I protested my position was eliminated.

Is there any recourse here? Obviously if one reports discrimination he/she will probably not get the position or even if he/she did probably wouldn't want to work there because of potential retaliation. This issue bothers me on principle and also obviously for financial reasons. Reporting employers like this would feel like time well spent but in the long-term might be bad strategy. I think employers know this and this is why this crap persists.

Is there a connection between migraines, seizures and depression?

For most of my life I've experienced fatigue and headaches. It wasn't until relatively recently though that it occurred to me that my fatigue might be related to having migraines. In 2009 after reading about the connection between mood disorders and migraines I convinced my GP to let me try Valproate to prevent migraines. During that time though I experienced a psychotic reaction and the focus on treating the migraines was some how lost. I also tried Propanolol but it had such a sedating effect I couldn't tolerate it for long. I felt like I was about to pass out the entire time I was on it.

A young woman holding her painful head

Recently after some reflection it occurred to me that the symptoms that I was experiencing for most of my life in addition to the fatigue were those of a migraine. A few of those symptoms include the following: problems with temperature regulation, stiffness in neck and jaw, sensitivity to light, sensitivity to sound, tingling sensation, problems finding the right word, stomach problems and sleepiness. According to research people with chronic fatigue are more likely to experience migraines. These studies according to Healthrising support my hypothesis to a degree.

Two studies suggest as many as 75% of people with chronic fatigue syndrome experience migraines and that most migraines in ME/CFS are undiagnosed.  Agreeing that migraines are common in ME/CFS, WebMD, which has very little to say otherwise about chronic fatigue syndrome, states ME/CFS is one of five disorders  with high migraine rates.
Given the long list of migraine symptoms and the considerable overlap with ME/CFS symptoms (visual disturbances, sensitivity to light/sound, weakness, pins and needles, speech problems, nausea, vomiting, increased urination, etc) .the low diagnostic rates may not be surprising.

What additionally supports my hypothesis is that my chronic fatigue started around age twelve which coincided with the start of menstruation. Women according to statistics are more likely to have migraines, depression and chronic fatigue. Oddly, I also occasionally experienced a brief remission of depression and fatigue during menses.

I think my migraine like headaches started when I was rather young, age six. Around that time I experienced a concussion after falling off of a bike. My pediatrician thought at the time that my headache was related to diet- specifically chocolate. At this time after reading about head trauma and migraines I think my condition might have something to do with the concussion and it might be exacerbated by diet and hormone levels.

There is also an epileptic or kindling connection here. According to some recent research migraines are a type of seizure and kindling in the past has also been used to try to explain the recurrent nature of major depression. This is an excerpt from a 2014 study that examined the relationship between seizures and migraines.

What they found was completely unexpected. Adding basic conservation principles to the older models immediately demonstrated that spikes, seizures and spreading depression were all part of a spectrum of nerve cell behavior. It appeared that decades of observations of different phenomena in the brain could share a common underlying link.

The idea though that my fatigue could be a low level migraine is controversial because it differs from the definition of a chronic migraine. A chronic migraine includes many of the symptoms that I listed above however it includes moderate pain as a criteria. I generally experience the pain as mild. Perhaps I should try to more aggressively and persistently pursue this migraine hypothesis. I generally don't have much faith in my insights but maybe I should since many have been supported in the past.

Boundaries of mental illness

Isn't everyone a little mentally ill? This seems to be the prevailing idea on my FB feed via memes. One of these memes says, " relax...we're all crazy, its not a competition". When I see this I feel annoyed but at the same time I wonder is there a clear boundary between normal and abnormal? As someone who has experienced psychotic depression, OCD and Dysthymia I'm annoyed because that large of a spectrum invalidates my difficulty to a large degree. I think these people mean well because they are trying to include me as normal but on the other hand  saying that I don't have much to complain about.

The competition part of the meme is particularly interesting since this is the feeling that I get from many people regarding mental illness or any other condition like chronic fatigue which is hard to distinguish from normal. I have long learned not to bring up my problems in anticipation of competitive people. Unfortunately this includes medical doctors who think they are more fatigued than anyone else.

The ability to function well has often been where the line has been drawn between normal and abnormal. This is probably the most practical way to make a distinction however I always wonder function at what level? Are you talking about brushing ones teeth or doing calculus? What complicates this further is that depression often strikes when ones abilities are uncertain, often in college.

People on the antipsychiatry side, such as Moncrieff, are not helping this problem either since they emphasize the lack of objective physical evidence for mental illness. This is good in a way since it will encourage new and innovative thinking regarding mental illness but bad because it reinforces the idea that people with mental disorders some how lack will power.

While it is true that physical evidence is lacking via lab tests this doesn't mean that at some point in the future there won't be some test. I find this obsession with the past and present on the part of antipsychiatry somewhat odd. Jung might say these people tend to prefer sensing because they focus mainly on the past and present while people who prefer intuition focus more on the future.

As someone who prefers intuition I tend to focus on recent research and consequently the future. At present there appears to be some hope regarding research focusing on inflammation, the microbiome, sleep, diet and a variety of genetic studies.

Here is an excerpt from one article discussing research on inflammation and it's relationship to glutamate. The idea that glutamate plays a major role in mental illness is not new but it's relationship to inflammation and depression is new and exciting to me.

"Our results suggest that inflammation markers can guide us to which depressed patients respond best to glutamate blockers," says lead author Ebrahim Haroon, MD, assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and Winship Cancer Institute. "This could be an important step toward personalizing treatment for depression."
"Still, we think that one of the ways that inflammation may harm the brain and cause depression is by increasing levels of glutamate in sensitive regions of the brain, possibly through effects on glia," he says.
We focused on the basal ganglia because we had previously seen that a treatment for hepatitis C virus that arouses inflammation and can trigger depressive symptoms could also increase glutamate levels there," Haroon says.

Most recently a gene that is involved in synaptic pruning has been recently implicated in schizophrenia. So, there is still some hope and reason to believe eventually there will be a physical basis for mental disorders. Perhaps the boundaries of pathology will have to change as well since there is still much that we don't know about the nervous system.

Manic depressive controversies

An interesting lecture from Nassir Ghaemi on the bipolar spectrum concept. According to him unipolar and bipolar used to both be encapsulated under the phrase "Manic Depression". "Manic Depression" meant someone who either experienced severe depression or mania. "Bipolar disorder" is defined by an individual having both depression and mania/hypomania. The two phrases differ only by a conjunction....something I hadn't paid attention to before. Additionally, according to Kraepelin, a well known historic authority on the topic, individuals displaying mixed states were more common than the ones who had more pure states of either depression or mania. This has been noted more recently by other researchers such as Benazzi who published a number of articles about people who experience mixed depression.

Prevalence of mixed depression, a combination of depression and manic or hypomanic symptoms, is high in patients with bipolar disorders. Controlled studies are needed to investigate treatment of mixed depression; antidepressants can worsen manic and hypomanic symptoms, and mood stabilising agents might be necessary

My experience with mixed depression

While my depression has been more chronic I have experienced periods of time when it lifted and I felt normal and productive. There has also been a pattern to some of these "remissions". They often occurred during my menses and when ever I altered my sleep schedule to a minor degree. These remissions weren't long enough by DSM standards to qualify for hypomania however as Ghaemi states, the threshold for hypomania is to a large degree arbitrary.

I have noticed as well that my depressions didn't seem pure. They often included good amounts of irritability, insomnia, racing/crowded thoughts, hypersexuality, and a little grandiosity. Somewhat interestingly these symptoms tended to occur in the late evening to the early morning hours. This has been noted by some researchers who study ultra rapid cycling in children. Many clinicians would probably categorize my experience as someone who is experiencing a pronounced diurnal variation but I am reluctant to think that since diurnal variation usually means a slight remission of symptoms throughout the day without hypomanic-like symptoms.

Manic-depressive insanity in the sense here delimited is a very frequent disease. About 10 to 15 per cent, of the admissions in our hospital belong to it. The causes of the. malady we must seek, as it appears, essentially in morbid predisposition.-- Kraepelin

Ghaemi's historical perspective different from DSM

Ghaemi's perspective much like Kraepelin is based on the big picture of evidence and history, not mainly on image. At the moment the DSM-V seems to be ruled by people who are primarily concerned with the public's image of them. They mainly don't want to appear like they are over prescribing and over pathologizing normal behavior. The fact that bipolar is no longer grouped with major depression under Mood disorders is one example of their over reaction to anti-psychiatry.

In conclusion Dsythymia not all that accurate

As someone who has experienced chronic depression with a moderate severity, I am tired of hearing how my so called Dysthymia is defined as mild and at one time in the past, a personality issue. Bipolar disorder has been generally viewed as more incapacitating and more endogenous while unipolar depression is more neurotic. Ghaemi and Kraepelin's theories make sense to me in light of my experience with depression. It has been for the most part, quite incapacitating, miserable and briefly quite pleasant.

Could depression be a form of adaptation?

The most recent theory on depression is that it could be some type of adaptation. I have written regarding this idea before in a post titled Evolutionary origins of the depression epidemic. The author of the book in that previous post was making a similar argument. He believed that depression was not a pathological condition but a way of adapting to stressful conditions. For example if a person lost a job and became depressed the depression could perhaps be a way of conserving energy or the depression might be suggesting that a person should change their goals.

In that previous post I wrote that depression in its milder forms could conceivably be seen as an adaptation however in its more severe forms not very likely. After all severely depressed people have problems functioning on a very basic level and aren't analyzing problems in the most objective or productive manner. Often depression seems to reduce flexibility and brainstorming. The only solution for many severely depressed people is suicide. It is more accurate to say that majorly depressed people obsess more than they analyze.

I, for example, have experienced chronic depression for most of my life and while being rather obsessive and analytical still have not gained  much insight into why I have felt depressed for most of my life. I have experienced many periods where I felt normal and quite productive but it wasn't necessarily due to some kind of insight. Those normal periods just happened and sometimes they occurred in a diurnal pattern or in a menstrual pattern which makes no sense in regard to the theory. Why would one person feel severely depressed in the morning and normal at night for a number of days? Why would I often feel normal to euphoric when I had my period? Various levels in hormones and their effect on neurotransmitters seem more likely.

This most recent research is suggesting the adaptation theory once again only instead of conserving energy depression focuses our energy obsessively on one thing and supposedly solves it.

The research suggests that depression may be a natural condition in which the mind concentrates involuntarily on a complex issue to the point where it allocates resources to analyzing the problem at hand, diminishing concentration on other aspects of living, perhaps giving rise to disrupted eating, sleeping and social interaction that are associated with depression.

This theory seems to assume the idea that depression is due to excessive stress which is debatable. One can feel more stressed pursuing a goal and yet have a reduced level of depression.  For example, I have given up on a number of goals which I found stressful and have not noticed any positive change in my level of depression. In fact, I felt worse for giving up on my goal. A proponent of this theory might also argue that I haven't made the right changes in my life. How does one falsify this theory if this is their answer. Additionally, the proponents of this theory keep pointing out that there is no conclusive evidence of pathology in major depression. True but it doesn't necessarily follow that pathology won't be discovered in the future. The fact that depression increases the likelihood of dementia is sufficient reason to keep looking for pathology in regards to depression.

CBT: a questionable form of therapy for depression

CBT is a therapy based on the belief that one's negative illogical thoughts can cause depression and correcting them can treat the depression. CBT therapy is usually performed with a therapist however now computer programs are being created to help depressed individuals. While CBT therapy is endorsed by psychiatry it has a number of problems.

Depression is known to cause distorted thinking so what comes first the depression or the distorted thinking? CBT doesn't clarify this issue. It just says that correcting illogical thinking treats the disorder.

CBT therapy has been shown to be as effective as antidepressant therapy and prevents relapses better than drugs. The problem with this is that antidepressant therapy isn't all that effective. Antidepressants are, in reality, only slightly more effective than a placebo. Additionally, since major depression is cyclical how does one know for sure if the treatment was actually helping. Many experiments are performed over rather short periods of time and a certain percentage of people will have spontaneous remissions. This of course could be the same issue for antidepressant trials.

Experiments involving CBT vs antidepressants are not double blind which is considered essential for the highest level of objectivity. If the researchers and the patients know what type of therapy is being performed objectivity is diminished.

A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in

Researchers say that brain scans show that CBT "works" and yet brain scans are not considered a reliable way to diagnose mental illness. People with mental illness often have more than problem such as depression and ADD. This confounds diagnosing a mental disorder or saying confidently that an individual is in remission. This excerpt from Scientific American explains the problem.

During testing, the system analyzed the shapes of brain regions in each test scan and assigned it to the group it most resembled. The scientists checked its work by comparing the new labels on the test scans with the original clinical diagnoses. They repeated the procedure several times with different randomly generated sets. When the system chose between two disorders or one ailment and a clean bill of health, its accuracy was nearly perfect. When deciding among three alternatives, it did much worse.

The basis of CBT doesn't explain how people with a rapid cycling form of bipolar disorder cycle between depression and mania. Do they start off having negative thoughts during a depressive episode which eventually cycles with mania  and the mania consequently produces delusional thinking? CBT has not been shown to be effective for preventing depressive episodes in bipolar disorder.

CBT has given no biological explanation for how it works and yet implies that possibly negative thoughts might exacerbate stress which in turn precipitates a depressive episode. Even though stress has long been thought to cause depression stress(HPA activation) is not distinctive to just depression. Stress is implicated in numerous health problems in a rather vague manner. To further complicated matters what is stressful to one person isn't stressful to another. Consequently it is complicated to study stress.

In the end CBT emphasizes that depressed people are responsible for their depression which is still questionable in the eyes of science.

Distinguishing low mood from major depression

I think there is still much confusion between depression(normal mood) and major depression and so I thought I would share my thoughts on how I distinguish one from the other. How I distinguish normal moods from major depression:

• Normal moods usually last a fairly short time and are less severe-- often less than a day. Major depression is a moderate to severe depressed mood for at minimum two weeks. Moderate to severe often means thinking about suicide quite a bit.
• With a normal mood one can often tie it to something that has happened or a given thought
•  The mood within major depression is often connected to the circadian rhythms. Often people feel worse in the morning(often suicidal) and their mood improves in the evening
• Distraction will often work with normal moods but not with major depression
• The depressed mood in major depression is often accompanied with severe fatigue(bedridden), lack of motivation, disrupted appetite, lack of pleasure, cognitive problems, and excessive sleepiness/insomnia
• Major depression affects your ability to function on a basic level. Good hygiene seems optional for people who normal have good hygiene

Antipsychiatrists who could be referred to as "lumpers" don't make the above distinctions. They believe everyone experiences depression which is true but not everyone experiences moderate to severe depression that lasts more than two weeks and is accompanied by other symptoms. They also argue that the criteria that distinguish major depression are arbitrary which is also true but many distinctions in life are to a degree arbitrary and yet are still respected. I , a "splitter", sometimes wish that they would come up with a new name for major depression so it wouldn't constantly be confused with a normal low mood.