Wednesday, February 08, 2006



Bipolar Disorder and Disability Benefits

For quite some time, I have been noticing that many of the individuals who visit my disability site (often through my FAQ page on social security and ssi disability) are looking for disability benefit information, primarily as it relates to bipolar disorder.

While I haven't found it surprising that this would happen (bipolar disorder is a terrible neurochemical illness and is much more than its constituent parts--depression and manic behavior--would imply), I have to admit, I have been surprised at the level of occurrence. Put simply, there are many more bipolar cases out there than even I would have thought.

You may be wondering: why was I surprised and what is my particular background to account for this surprise. Well, I am a former medicaid caseworker and, more relevantly, I am a former disability claims examiner for the social security administration. In that latter capacity, it was my function to, on a daily basis, receive new disability cases, send off for medical records, review the records when they came in, and, then, in consultation with a physician, render a decision on a claim.

I did this job for several years and, as a consequence, I may have come across nearly every (though, certainly, not all) medical condition for which a person might imaginably file for disability benefits. And without a doubt, I came across a fair number of cases for which bipolar disorder was a primary allegation. But I don't recall seeing as many bipolar cases then as I currently see now.

What could be the reason for the rise in bipolar disorder cases? I've wondered about that many times. Some individuals might say that the illness is being overdiagnosed, and that opinion has been leveled at ADHD. But, I don't think this is the case and here's why: Bipolar disorder typically requires the use of prescription medication for proper management. Bipolar also frequently occurs in combination with other illnesses, such as OCD, or obsessive compulsive disorder and ADHD, or attention deficit hyperactivity disorder (and, yes, it is not unheard of for a patient to be concurrently treated for all these conditions). Of course, ANYONE who has ever been put on a medication treatment regimen that attempts to treat multiple conditions simultaneously will know automatically what sorts of problems this may pose.

What are those problems? For starters, a medication that works just fine for ten million other patients may not work at all for just one. Or, it may work fine for awhile and then not work at all. Or there may be side effects to the medication that are somewhat unpleasant and/or stimulate other psychological issues (weight gain, sexual performance issues, to name a couple). Throw in more prescription meds to treat other conditions (in our example, we cited OCD and ADHD) and you enter into the equation even more variables: will med A negate the potency of med B, will med B overenhance the effects of med C, will med C in combination with med A cause other physical or mental issues to surface, etc, etc.

For these reasons (all boiling down to the fact that very strong medications with very strong effects and consequences are being prescribed), I sincerely doubt that bipolar disorder is being overdiagnosed, or is even misidentified on a large scale.
In fact, quite the opposite may be happening. That is, mental health professionals may simply be improving in their ability to properly diagnose this condition. Additionally, individuals with bipolar disorder may, as a consequence of greater recognition and understanding of their illness, be more willing to initiate disability applications.

One might ask "Why would someone not file for disability benefits when they have a condition that affects them so profoundly"? This may go back to that "greater recognition and understanding part". I'll reference this example, which, in my case, comes from my personal life. I have an in-law who currently is treated with outpatient shock therapy. For the sake of confidentiality, I'll refer to him as Bob. Among his various diagnosed conditions, Bob has a particularly severe case of bipolar disorder. And for many years, he was unable, despite many attempts, to maintain employment for longer than 90 days. Yet, despite this fact, despite his many problems with getting the right medications, and despite the fact that he has been receiving ECT (electroconvulsive therapy) for more than a year---he still has at least two family members who somehow think "he should have tried harder".

Such thinking is incomprehensible, of course, given the facts of Bob's situation. However, the stance taken by these family members probably had much to do with why Bob did not file a
disability application much sooner. Also, the pressure put on Bob by members of his family to "keep trying to work" may have hastened his descent into auditory hallucinations and shock therapy.

Therefore, "if" the rise in disability applications filed on the basis of bipolar disorder can be accounted for by either or both of the following---

1. an increased ability of mental health professionals to recognize the disease.

2. an increased empathy and understanding of bipolar disorder on the part of family members.

---then this is certainly a good thing.

Whether this is actually happening, of course, is a matter that is subject to debate.




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What is the decision making process on a Disability claim?
Getting a Disability Lawyer - Information for Disability Claims ?
Apply for SSI
Disability lawyer - when to get one
Social Security Disability SSI Massachusetts

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