Invisible Disabilities

Depressive Disorder. Substance Use Disorder. Bipolar Disorder. Binge Eating Disorder. Obsessive Compulsive Disorder. These are not character flaws. They are categories in the DSM-5, which is the fifth and current edition of the Diagnostic and Statistical Manual of Mental Illness.

On Sunday, the New York Times published a special section commemorating the legacy of the Americans with Disabilities Act, passed 30 years ago. 2 dozen articles and essays explore disability as “widely shared experiences intersecting with many aspects of modern life”. Mental illness is a disability, and that is the focus of “Invisible Disabilities” by Andrew Solomon, the first article in this special section.

Solomon is the author of Pulitzer finalist “The Noonday Demon: An Atlas of Depression”, which won the National Book Award. Solomon has lectured widely on depression, notably at Harvard, Yale, Princeton, Stanford, Cambridge, MIT and The Library of Congress. Here is one of his many TED Talks: Depression: The Secret We Share https://youtu.be/-eBUcBfkVCo

Solomon’s article begins, “I have depression and anxiety.” That kind of candor and transparency takes courage. Not only are mental health disabilities invisible, they are usually veiled in secrecy.

The ADA requires employers, businesses, transportation and public facilities to make accommodations for the disabled. But there is very little clarity around what constitutes a disability, and for that matter what that accommodation would look like. When we hear the word disability we think wheelchair ramps, closed captioning, handicapped parking and braille. But how do we accommodate those who cannot or choose not to disclose their handicap?

The co-morbidity rates in substance use disorder and other mental illnesses are staggering. Many addictions begin with an intuitive instinct to self-medicate. Someone with hyperactivity or manic episodes might initially “benefit” from a few drinks or some weed to “take the edge off”. Those suffering from depression often turn to speed, cocaine or meth. These substances will also suppress the insatiable appetite of someone with binge-eating disorder. It feels like it works and sometimes it does.

Until it doesn’t.

In early sobriety I was diagnosed with Bipolar II Disorder. When unchecked, this will manifest as either hypomania or depression. During a hypomanic episode, I am excited, energetic, creative and impulsive, sometimes to the point of recklessness. I speak more quickly and loudly. I sleep less and I do more. It’s hard to hide, so that’s the side of me that you are more likely to see. Because when I’m depressed, I don’t want to be seen. I go dark.

I am invisible.

Today I choose to manage my bipolar disorder without medication, but for many that is not an option. I have a wellness plan that involves diet, sleep, meditation, exercise and complete abstinence from alcohol, caffeine and sugar. But I know that the disease is still there. I am accountable to and deeply grateful for my support network and I need always be vigilant, and willing to accept additional help if needed.

Something else happened on Sunday, the day I read Solomon’s essay. One of my very good friends took his life. We are all shattered, and the nearly universal reaction? “He’s the LAST person I would have guessed would do that. He was the happiest person I knew!” Those who were closest to him knew that he was struggling. But even they couldn’t have anticipated that ultimate act of desperation. In a show of profound courage and faith, his family came forward on social media immediately with a statement acknowledging the cause of death and his battle with depression and anxiety. In his life, Thomas made a positive impact on literally thousands of lives. My hope is that from his death, many of them will learn more about how to recognize and acknowledge the hidden handicap that he was so easily able to hide.

I can’t hide. I must give my disability a voice, and in doing so invite others to do the same.

There are no designated parking spots for people with anxiety.

Or depression.

Or addiction.