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I have a high-stress job. I'm also bipolar. Here's how I keep myself healthy.

Nine months ago I interviewed for a job with one the world's largest public accounting firms. I was well qualified. I'm a tax lawyer, and, in addition to a JD, I have an LLM in tax law.

Public accounting is stressful. The hours can be long; the work is varied and challenging. I wasn't sure it was the right work environment for me.

I'm bipolar, and I cling to a particular regimen to stay mentally balanced. It works for me, and I am terrified that any deviation will send me into mania, which is torture for me. The most important component of this regimen is sleep; a close second is avoiding stress. The schedule was working for me, and I was more than a little concerned that the stress of public accounting could undo all of it.

Two years earlier, after feeling intermittently suicidal for a month, I was driving to work. It was a beautiful day, sunny and clear. Nonexistent traffic. I felt so content. Expansive. At peace. I loved everyone and everything and I felt like I could float away like a balloon because I was so light and happy.

I was also driving 95 mph. My fists were clenched around the steering wheel, because I didn't know how else to hold my hands. My entire body was humming like a plucked guitar string. Suddenly it was all too much: I wanted to die and I started crying, trying not to give in to the impulse to drive into a wall. After a few minutes I stopped crying, slowed to a reasonable 75 mph, and made it to work unscathed. 

It took three more months of the same thing happening almost every day — sometimes multiple times a day — before I went to the hospital. For weeks I tried to manage the feeling myself, which meant slicing my leg with the closest sharp object. I even cut myself at work, once with a box-cutter I found on top of a box of office supplies. When the cutting stopped working, and I knew I would end up killing myself, I went to the hospital.

After seeing six psychiatrists, I was given a diagnosis of Bipolar Affective Disorder and a prescription for lithium. I knew that the lithium wasn't going to work right away, but it helped having a diagnosis and knowing I would feel better. I learned that the most important part of preventing an episode is getting enough sleep. At least seven hours, but ideally nine. Getting enough sleep is crucial to managing bipolar disorder. My psychiatrist told me that if I get less than six hours of sleep two nights in a row, I should come to her office immediately. I wouldn't even need to make an appointment.

Avoiding stress was also important. Still, I found out, because bipolar disorder is so unpredictable, I could do everything right, and still experience an episode.

Before I was diagnosed, I had difficulty motivating myself at work. I procrastinated horribly. I was anxious all the time. I had trouble focusing. But I noticed, after a few months on the lithium, that my work performance was improving dramatically. Even my manager commented on the difference.

At the time, I was working in the tax planning department of a multinational corporation. But I realized that all the interesting work was being subcontracted to public accounting firms. Since I was doing so well at work, I started thinking about switching jobs.

I decided I shouldn't let bipolar disorder hold me back from trying something I wanted to do, especially since I was qualified. Employers have legal obligations and I have legal protections, and if I determined that the job was too much for me I could always leave.

I got the job with the public accounting firm, working as a senior associate in the Mergers & Acquisitions group. M&A is known for being a demanding field, but it's also the most fun. It's a small group, maybe 15 people. I specifically wanted to work in a small group since I assumed it would be a more collegial environment, and I would be more likely to feel comfortable enough to disclose my condition as necessary. Consulting in general requires a certain flexibility, and an ability to switch between projects fairly fluidly. At any one time I can be involved, actively, in as many as five projects. Some projects last months, even years.

Because I was new to consulting work, and because I had been warned that I would feel out of my depth for a while, I was not surprised to find that I felt overwhelmed by the demanding nature of the work. I expected it to improve as I settled into my new role.

But after a few months, as I became accustomed to the consulting work, I noticed that working in this environment really highlighted my weaknesses, some of which I attribute to bipolar disorder, and some of which I attribute to lithium. I have a tendency to be messy and cluttered, but this is the first time I had had to confront how disorganized I am.

I've gone on a few online forums for people with bipolar disorder, and I have read so many posts about an inability to stay organized. But I haven't yet been able to find a study linking the two. I try to stay organized. I try very hard. Every morning when I walk into the office and see what a mess my desk is, I commit to stay organized that day. How hard can it be? It should be easy. But the next morning when I walk in, there will be papers and books everywhere. Usually I won't even know where it all came from.

Even my email folders are jumbled. I never remember to put important documents into our SharePoint system. I have been lectured many times about how I am supposed to upload a certain email or a certain PowerPoint. I want to be organized and properly filed. It is such a good feeling. But my brain refuses to cooperate.

My memory issue is also highlighted. I try to carry a notebook and pen everywhere I go, but it's not a failsafe plan. If I pop into someone's office or cube to ask a question, I can be sure that I'll leave with three tasks to complete by the end of the day. If I don't write everything down, I will completely forget. And I won't just forget what I was asked to do; I'll forget that anyone asked me to do anything at all. Even if someone asks me how the task is coming along, I might have no idea what they're talking about.

Consulting, in addition to being project-based work, is team-based, and the managers pick their teams at the beginning of each engagement. Some managers prefer to have smaller teams, while some like to have larger teams. Whatever size the team is, the work needs to be done, and it needs to be done on time. So it was important that I stay stable.

I also had to decide whether to explain to my colleagues that I had bipolar disorder, and that this neurological condition is beautifully unpredictable, and that, regardless of how well I take care of myself, I could slip into a manic, depressed, or mixed state at any time.

I prefer to disclose, but carefully. I have to decide if it makes sense to tell the person. I'm not ashamed of having bipolar disorder, but I don't want to go out of my way to tell people. I have to determine the possible negative consequences. Will this person not want to work with me anymore? Will they treat me differently? Will they think I'm unreliable?

If I decide that the value of telling someone outweighs the possible negative consequences, I still have to figure out when to tell. I don't want to have a special meeting about it. I want to minimize the other person's discomfort level as much as possible, and I think having a formal serious discussion about it, while in some circumstances appropriate, can make it more overwhelming for everyone. I prefer to be matter of fact. I look for natural openings. I don't want to give a speech; I want to be conversational. I get very nervous when I am about to tell someone. My voice shakes, my hands shake, I have butterflies in my stomach. I feel like I can't control the volume of my voice.

When I started work here, I knew I would be disclosing to at least some people, but of course I didn't know who would need to know. I wound up telling someone less than a month into the job: one of my managers. I was working on a project with her and another senior associate. The work was challenging, but I never felt overwhelmed or triggered by stress. After a couple of weeks of working with her, I thought she seemed trustworthy. I saw that the project was structured such that the other senior associate and I were working on two distinct portions. If I had an episode, my manager would either need to bring someone new into the project, or the other senior associate would need to take over my portion of the work. It seemed fair to warn them that it was a possibility, so I just waited for an opening.

Telling my manager was easy, so easy that I thought she didn't hear me. The first time we were walking back to the office after lunch, and we were talking about yoga. She told me that she has a friend with bipolar disorder who got really into yoga, and moved to Costa Rica to become a yoga instructor. It seemed like a very good segue into what could otherwise have been an awkward conversation, so I jumped at the opportunity.

I said "I can absolutely see that happening. I'm bipolar, and yoga really helps keep me level." She didn't say anything, or at least I didn't think she did, but we were outside and the traffic was loud. Had she heard me?

She had heard me, as I found out later. It was a huge relief. She continued to include me on projects, and seems to think I'm capable of handling what I would consider to be a reasonable workload. When she gives me career advice, she never mentions ways in which bipolar disorder could be a limitation. She treats me like a normal person.

Within a week after telling my manager, I told the other senior associate on the project. If I had an episode, and couldn't work, my work would probably be assigned to him, and I thought that he should have a heads up. I wasn't as worried to tell him as I had been to tell my manager, since he didn't have the power to keep me off projects or give me bad reviews. He asked if there was anything he could do. I described my manic symptoms and said that if he could tell me if he noticed any of those happening it would be really useful. He promised to let me know.

In my third month, I was assigned three projects with Darrell, a senior manager that I had not worked with before. It was a Friday when he started to explain the first project, but he said we would meet Monday to discuss the details. Unfortunately, on Saturday night around 9, another manager emailed me to tell me I needed to update a spreadsheet that I had worked on, and it needed to be finished by early Sunday morning.

The changes were going to take all night, I knew. I also knew I needed sleep. I was torn: Part of me wanted to tell him to fuck off, and that maybe he shouldn't have waited until the last minute to get me the changes, and that I would do what I could that night, but would most likely not finish until Sunday night. The other part of me knew that it was my own fault for not doing the project correctly in the first place, and that I got into this position knowing that there would be some sleepless nights. I figured one night of not sleeping wouldn't kill me, especially if I slept all day Sunday. I stayed up all night, sent the spreadsheet to Jared at 6 am, then settled down to sleep all day Sunday.

But I couldn't sleep. Not even a nap. I started to feel that jangly feeling, like someone was shaking a set of keys in my brain. Racy and empty and on the verge of tears. When I looked out the window everything seemed hard and jagged.

I couldn't sleep Sunday night, either. By Monday morning, I was a mess. I emailed Darrell, explaining that I was bipolar and that a large part of managing it was to get enough sleep. I said that I had not slept Saturday or Sunday nights, and that I wouldn't be able to come into the office or work from home. He sent a perfectly nice email back to me: "Hope you feel better."

I wasn't able to come into work until Wednesday, and even then, my thinking still wasn't quite straight. Darrell was irritated with me. When we met to discuss the project, he lectured me about taking time off work without warning. I explained that I let him know as soon as I thought I wouldn't be able to come into work. He said he needed to be able to rely on me, and that it seemed like I wasn't reliable. There was nothing else I could say. He didn't even look at me while he was talking.

This was the first negative reaction I had had to telling a coworker that I had bipolar disorder. It was unnerving. I had taken for granted that people would be supportive.

Even though I rarely work directly with the partners, I wanted to get ahead of any rumors. I thought that if I was proactive about disclosing that I had bipolar disorder, it would be perceived as taking control of the bipolar disorder as well. It could maybe counteract any preconceptions.

There are two partners in the M&A group, but only one, Luis, is in the office regularly. I knocked on his door and asked if he had a minute to talk. He said of course. I told him that I was sorry I had missed a couple of days, and that it was related to my bipolar disorder. I started to explain how lack of sleep could trigger an episode, but he interrupted to ask if I was a danger to people in the office. Maybe I should have been offended, but I wasn't. It seems like after every mass shooting there are discussions about the mental health crisis; bipolar disorder and schizophrenia in particular. So I didn't blame him, but it did hurt. I'm not a violent person, except against myself. I told him that, and he seemed satisfied with the answer.

Then he asked if the stress of this job could trigger an episode. I said that yes, enough of the right kind of stress could trigger an episode. He asked if I was sure that this was the right job for me. He said he could find me a job in-house somewhere if I wanted. I said I would like to at least try it here longer, if that was okay. He said of course, and that he wasn't trying to push me out. If I couldn't handle the stress, they could also figure out a way for me to work with a lightened schedule. Nine months into the job, I haven't needed, or asked for, a lightened workload.

All told, I have at this point told nine of my colleagues that I have bipolar disorder. And of those, only two had negative reactions. Everyone else is more than happy to work with me, eat lunch with me, go for a run after work. I even told some of my coworkers that I was writing this piece, and they were all extremely supportive. It's so important to me to have such a strong support system, especially since I spend so much time at work. I also think it makes me more productive to work in this type of environment.

According to the National Institute of Mental Health, the best estimate of American adults with a diagnosable mental disorder within the last year is 20 percent (43 million). About 2.6 percent of American adults have diagnosable bipolar disorder. A survey by National Depressive and Manic-Depressive Association showed approximately 60 percent of bipolar individuals were unemployed. Aside from those statistics, information is scant with regard to issues of employment and mental illness. There are no large-scale studies documenting the effects of bipolar disorder on successful employment. Rather, such studies focus on smaller groups of individuals with bipolar disorder, following their employment over a period of years.

According to the American Journal of Managed Care [2005; 11:S91-S94]:

"Bipolar disorder affects many aspects of an individual's life and greatly interferes with a person's ability to find and maintain employment. The evidence indicates that a majority of patients with bipolar disorder are not employed and many others are employed only part-time. Job-related difficulties are common, and patients with bipolar disorder tend to have higher rates of absenteeism from work compared with working individuals without bipolar disorder."

With the unemployment rate for people with bipolar disorder being so high, I can't recommend either way whether someone should or should not disclose at work. Although if someone has bipolar disorder which rarely or even never disrupts work, I would recommend against disclosing. I'm not sure how many people are out there whose bipolar disorder is so well-managed. Hopefully a lot.

For the rest of us, it's a risk to tell and a risk not to tell.

Whichever is least likely to end in termination, I think. I believe that, to the extent possible, people with bipolar disorder should work, and only partly because of health insurance. Mood stabilizers, psychiatrists, therapy, and hospitalization are expensive, but work provides so much more than insurance. Like structure. Just going to work every day provides me with the structure that I need and can't do for myself. And work is an important social outlet. People with bipolar disorder have a tendency to isolate, and having to interact with people on a consistent basis is invaluable.

Yes, bipolar disorder is a disability, and I am protected from discrimination and wrongful termination. And I don't want to discount the importance of those protections being in place. But one co-worker has already frozen me out of all of his projects. And while I believe that the problem is, at its core, the fact that I have bipolar disorder, he would likely say that it's because I'm unreliable. Or something else that sounds reasonable. I'm very lucky that most of the people I work with accept it, even if they can't relate. But not everyone has that luxury. And despite the protections afforded to people with bipolar disorder, it's easy to disguise discrimination.

Charlotte Maine is a tax attorney living on the East Coast.

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