This article is excerpted from Chapter 8 of
Adult Bipolar Disorders by Mitzi Waltz.
There are two major on-the-job issues for people with bipolar
disorders: getting work, and keeping it.
Most Western and Asian
countries offer employees at least some protection from
disability discrimination on the job. In the US, the Americans
with Disabilities Act (ADA) makes it illegal to refuse to hire a
person simply because she has, or appears to have, a
disability-as long as that disability will not prevent her from
doing the job.
Careful preparation for job applications and interviews
can help you avoid job discrimination. Make an honest assessment
of your skills and job history when deciding what job to apply
for. Working with a job counselor can help you prepare your
resume and practice interviewing skills. Apply only for jobs that
you are able to do, as employers have the right to reject you if
you are not qualified for the job. If you have a choice, choose
to work for a company with a large workforce, as it is less
likely to discriminate and more likely to offer group life and
Interviewers are only allowed to discuss a job applicant's
disabilities if they are visible, or if the applicant brings up
the topic. Accordingly, you don't need to volunteer information
about your mental illness during a job interview.
Monique, a woman with bipolar disorder, says:
"With my current employer (a mental health advocacy group) it has
not been a big deal, and I've felt comfortable talking to people
here about my mood disorder. But with other jobs that I've had, I
have been hesitant and afraid of discussing it. I don't want to
be treated differently than any other person,
"I think if it was a position where I felt I was going to stay
there and I felt comfortable with my co-workers, I would reveal
it-but not at the job interview.
"And even though I have told people here, I haven't told everyone.
It's personal, and I want to feel comfortable with the person
before we talk about it."
Unless you have specific mental or physical limitations
that affect the type of work you are applying for, the fact that
you have a bipolar disorder should have no bearing on your
qualifications for the job. Knowing your rights, and preparing
strategies for your job interview, can make the difference
between being hired and being rejected. The following suggestions
on how to conduct yourself during a job interview may help.
Do not volunteer information about your medical history.
Employers have the right only to determine if you are capable of
performing the job. They do not have the right to ask about
personal or confidential information during an interview.
Under the Americans with Disabilities Act, employers
cannot ask about medical history, require you to take a medical
exam, or ask for medical records unless they have made a job
Do not lie on a job application or during an interview.
You can be fired later if your dishonesty is uncovered. Instead,
answer only the specific questions asked. Try to steer the
conversation towards your current ability to do the job, rather
than explain your past.
Do not ask about health insurance until you have been
offered a job. Before accepting the job, get the benefits
information and review it thoroughly.
If your medical history becomes an issue after the job
offer, get a letter from your physician that briefly outlines
your treatment and stresses your current good health and ability
to do the job. Ask the doctor to let you review the letter prior
to giving it to your potential employer. If your doctor is
willing, you might even prepare this kind of letter yourself and
give it to your doctor for a signature.
See the web site of the
US Equal Employment Opportunity Commission
for the EEOC's technical
assistance documents on Pre-Employment Disability-Related
Questions and Medical Examinations. The EEOC also has a document
on the definition of disability used in federal civil rights
Both federal contractors and federal aid recipients
(hospitals, universities etc.) are required to actively recruit
people with disabilities. If you are seeking a job with one of
these employers, inquire about its affirmative action program.
People who need to take a pre-employment drug screen, or whose
jobs require regular screening for drugs, will need to inform the
tester about prescription medications they take. In most
circumstances this information is not shared with the employer.
Americans with Disabilities Act
The Americans with Disabilities Act of 1990 (ADA)
prohibits many types of job discrimination based on actual
disability, perceived disability, or history of a disability by
employers, employment agencies, state and local governments, and
labor unions. Any employer with 15 or more workers is covered by
In addition, most states and some cities have laws that
prohibit discrimination based on disabilities, although what
these laws cover varies widely. If your state or city has laws
that provide more protections than the ADA, those laws prevail.
If the ADA provides more protection than local or state laws, it
The ADA requires that:
Employer may not make medical inquiries of an applicant, unless:
Applicant has a visible disability, or
Applicant has voluntarily disclosed his medical history.
Such questions must be limited to asking the applicant to
describe or demonstrate how she would perform essential job
functions. Medical inquiries are allowed after a job offer has
been made, or during a pre-employment medical exam. The employer
must provide "reasonable accommodations" unless it causes undue
hardship. An accommodation is a change in duties or work hours to
help employees during or after treatment, when symptoms are
worse, or when new health issues arise. An employer does not have
to make these changes if they would be very costly, disruptive,
or unsafe. If it seems likely that an increase in symptoms could
jeopardize your job, work proactively with your employer to make
Employers may not discriminate because of family illness.
For instance, if your spouse has a bipolar disorder, the employer
cannot treat you differently because she thinks you will miss
work to care for your spouse or file expensive health insurance
Employers are not required to provide health insurance,
but if an employer does offer health insurance, the company must
do so fairly to all employees.
The Equal Employment Opportunity Commission enforces
Title 1 of the ADA, the section that covers employment. Call
(800) 669-4000 for EEOC enforcement information and (800)
669-3362 for enforcement publications. Other sections of the ADA
are enforced by, or have their enforcement coordinated by, the US
Department of Justice (Civil Rights Division, Public Access
Section.) The Justice Department's ADA web site is
In Canada, the Canadian Human Rights Act provides
essentially the same rights as the ADA. The Canadian Human Rights
Commission administers the act. You can get further information
by calling the national office at (613) 995-1151.
If you feel that you have been discriminated against due
to your disability or a relative's disability, contact the EEOC,
the Canadian Human Rights Commission, or the appropriate agency
in your country promptly. In the US, a charge of discrimination
generally must be filed within 180 days of when you learned of
the discriminatory act. Although you do not need an attorney to
file a complaint, an attorney experienced in job discrimination
law can help you draft the complaint to make it more likely to be
Leslie, age forty-four, experienced discrimination early in her
career, but was not able to combat it, as it occurred before the
ADA extended protection to people with disabilities:
"I had a summer hypomania in late 1987 and got transferred to a
low-profile position in another department at work.
"When I was depressed again I started withdrawing at work and
obsessing on what had happened at the other department. I
couldn't concentrate on my work either, and spent a lot of time
getting on support newsgroups and e-mail lists.
"My project leader wrote up a humiliating questionnaire for me to
fill out about why I didn't say hi to people in the hallways, why
I spent so much time on the computer, and other behaviors. My
first set of contrite, self-deprecating answers wasn't
acceptable. It didn't occur to anyone present at the meeting that
followed that my problem might be depression."
"Eventually I got on the right medication. However, the damage at
work was done, and when layoffs came around, I went with the
"My career was going fairly well until I got on the psychiatric
meds-many of them trash your short-term memory. Now I have
trouble retaining verbal information especially, and keeping a
job is very difficult. I was recently fired from my job for
requesting accommodations under the ADA."
The Federal Rehabilitation Act bans public employers and
private employers that receive public funds from discriminating
on the basis of disability. The following employees are not
covered not by the ADA, but by the Rehabilitation Act.
If you are a federal employee (section 501), you must file a
claim within thirty days of the job action against you. If you
are an employee whose employer has a federal contract (section
503), you must file a complaint within 180 days with your local
Office of the US Department of Labor, Office of Federal Contract
Compliance Programs. If your employer receives federal funds
(Section 504), you have up to 180 days to file a complaint with
the federal agency that provided funds to your employer, or you
can file a lawsuit in a federal court. The Federal Rehabilitation
Act is enforced by the Civil Rights Division of the Department of
Justice, (202) 514-4609.
Employees of the executive branch of the federal
government. (Section 501 of the Rehabilitation Act)
Employees of employers that receive federal contracts and
that have fewer than fifteen workers. (Section 503 of the
Employees of employers that receive federal financial
assistance and that have fewer than fifteen workers. (Section 504
of the Rehabilitation Act)
Section 504 of the Rehabilitation Act of 1973 includes
protections for adults attending school or working for employers
who get at least some public funds. That list includes colleges,
government bodies, and many non-profits, and may sometimes cover
private firms that accept government contracts.
If you live outside the US, talk to a disability advocacy group
about the laws that affect you on the job. If you live in one of
the nations within the European Community, you can cite European
Union civil rights regulations as well as applicable local or
national disability rights laws.
The ADA does have a hitch: it only applies if your bipolar
disorder presents a significant disability, or if your employer
believes that it does-even if that belief is based on
misconceptions about mental illness. This has led to a Catch-22
situation for many people with neurological conditions or mental
illness: yes, there are drugs available that can treat the
symptoms of these conditions, but those drugs don't work
consistently for everyone, and may not work at all for some. They
also carry with them side effects and dangers.
However, recent Supreme Court cases uphold the idea that if a
disability can be corrected with medication, eyeglasses, or other
temporary measures, it does not qualify for ADA protection,
despite many lower-court cases that say otherwise. Future
challenges can be expected in this area of law; indeed,
California recently passed a bill that removes the "significant
impairment" criteria for persons in that state.
One way around this roadblock is showing that the medication
itself creates a disability. Lithium, for example, effectively
suppresses mood swings for many people who take it, but it can
also cause hand tremors and "brain fog." Slow thinking and shaky
hands on the job can be disabling in of themselves, and may
qualify you for ADA protection.
An attorney can explain where you stand legally, and may be able
to help you fix the problem without going to court. Mediation is
an increasingly popular and less costly option.
If you need to be away from work temporarily due to worsening
symptoms or treatment needs, you may have legal job protection
available to you. Since August 1993, the Family and Medical Leave
Act (FMLA) has protected US workers in public agencies or large
companies who need a leave of absence. Only employees who have
worked 25 hours per week or more for one year are covered, and
only if they work for a company with 50 or more employees within
a 75-mile radius.
The Family and Medical Leave Act:
Employers should have procedures in place for medical leaves
covered by the FMLA. Usually you will need to present your
employer with documentation from your doctor stating why the
leave is necessary, and how long it is expected to be for.
Provides twelve weeks of unpaid leave during any
twelve-month period for one's own medical needs or to care for a
seriously ill spouse, child, or parent-sometimes you can take
intermittent leave, which means shortening your normal work
Provides twelve weeks of unpaid leave for the birth of a
child, or due to placement of a child in your home via adoption
or foster care
Requires employers to continue benefits, including health
insurance, during the leave period
Requires employees to attempt to schedule leaves so as
not to disrupt the workplace, and to give thirty days' notice if
Requires employers to put returning employees in the same
position or in an equivalent position
The FMLA is enforced by the Employment Standards Administration,
Wage and Hour Division, US Department of Labor, and the courts.
You can find the nearest Wage and Hour Division office in the US
Government pages of your telephone directory. You have up to two
years to file a FMLA complaint or a lawsuit if your employer does
not abide by the law.
For those having trouble getting a job, the public Vocational
Rehabilitation (VR) system can be part of the solution. The VR
system provides skills assessment, training opportunities, and
job placement services for adults with disabilities. However, in
many states the Vocational Rehabilitation system is severely
overloaded, with wait times for placement ranging from three
months to as much as three years. Typical opportunities range
from sheltered workshop jobs (splitting kindling wood, sorting
recyclables, light assembly work) under direct supervision, to
supported placement in the community as grocery clerks, office
helpers, chip-fabrication plant workers, and the like. Often
people in VR programs work with a job coach, a person who helps
them handle workplace stresses and learn work skills. In some
cases, the job coach actually comes to work with the person for a
Pam, mother of 20-year-old Jakob, says the Vocational Rehab
department has helped him move into employment gradually:
"We had never even heard of Vocational Rehabilitation when Jakob
left the hospital. His therapist at community mental health sent
him there. They had a job counselor who worked with him on his
first resume, how to dress, and what interviews were like. They
placed him in a part-time file clerk job with a hospital near the
community college, and they checked up on him regularly for quite
The Ticket to Work and Work Incentives Improvement Act of 1999, a
federal law that is only now being implemented, will allow states
to extend Medicaid health insurance coverage to people with
disabilities who are working, or who would like to work. This law
is intended to prevent people whose health improves from staying
on SSI because they can't afford to lose their health insurance.
States will also be allowed to cover working adults with
disabilities who have never been on SSI, but do need affordable
health insurance. There may be an income-based charge for this
"That was perfect: he's been there two years, and now he's
taking classes part-time also."
Some public and private agencies may also be able to help with
job training and placement. These include your state employment
department; the Opportunities Industrialization Commission (OIC);
the Private Industry Council (PIC); and job placement services
operated by Goodwill Industries, St. Vincent de Paul, and similar
service organizations for people with disabilities.
All people with disabilities should receive appropriate
vocational counseling, including aptitude testing, discussion of
their interests and abilities, and information about different
employment possibilities. People with the ability to work should
not be shunted into dead-end positions that leave them
financially vulnerable. This can be a problem when in the VR
system: some VR counselors assume that their job is to get you
into a job, any job, regardless of your past accomplishments,
educational level, or long-term aspirations.
Truthfully, very few career options are off-limits to people with
bipolar disorders. If anything, people with bipolar disorders are
over-represented in creative careers-art, acting, music, and
writing. Many also gravitate toward high-excitement occupations,
including brokerage work, the top levels of marketing and sales,
medicine, and other jobs that feed their need for challenge and
Of course, the more exciting the job is, the greater its
potential for stress and mood swings. That shouldn't dissuade you
from pursuing your dreams, but may require lifestyle adjustments
to make things work out well.
One door that is barred to most people with a bipolar disorder is
the US military. Current regulations prohibit anyone who has ever
taken a psychiatric drug from enlisting. If you have never taken
medication, the diagnosis itself may not preclude enlistment if
you can pass the preliminary mental health screening.
There is ample reason to believe that people who have taken
psychiatric medications have entered the military, however, with
varying degrees of success. Whether they did not divulge their
medication use when enlisting, or whether the officers in charge
simply chose to ignore this one "blemish" in an otherwise
promising candidate, is an open question. With Ritalin and Prozac
now topping the list of childhood prescriptions, it does seem
likely that the military will have to take a second look at this
policy to keep its ranks filled. Should the draft be
reinstituted, the ban will almost certainly have to be lifted.
Other careers that involve firearms may also be off-limits,
including work as a police officer or armed security guard.
That's because under some gun control laws, a person who has been
found mentally ill by a court or who has a "history of mental
illness" as defined by the state involved is legally prohibited
from purchasing or being licensed to carry a gun. Most police
departments also put applicants through a mental health screening
process. A person whose bipolar disorder is well-controlled by
medication could probably pass one of these, however.
In some states, and under some circumstances, a bipolar diagnosis
could cause licensing problems for certain types of
professionals. If you are in a profession that requires state
licensing, such as law, medicine, nursing, or teaching,
familiarize yourself in advance with the rules governing
licensure. Under current US disability law, it would not be legal
to fire someone simply because he or she has a certain
diagnosis-there would have to be some kind of problem behavior or
loss of ability involved. However, bar associations and medical
boards are currently allowed to suspend or deny professional
licenses on such grounds, and so far most challenges have been
upheld by the courts.
If a problem related to your illness does occur on the job and
you are a licensed professional, there is usually an option to
keep your license by entering a diversion program. Each state has
its own regulations on diversion. In a diversion program, you
practice under supervision, and may need to satisfy treatment or
performance-improvement guidelines. If you do well, your license
Entering a diversion program is voluntary and confidential,
although in some states that confidentiality can be breached if
program officials feel you pose a danger to others. If you quit
or do not comply with the program, you may not be able to enter
it again. If you do complete a diversion program successfully,
the records are usually destroyed after a specified period of
The world of high-stress employment is not for every person with
a bipolar disorder, including many who initially choose it. You
may find that life outside of the fast lane better suits your
Shoshana did not expect to opt for a low-stress lifestyle:
"I lead a much quieter life now, but I'm not sure this would have
been my choice. I loved intensity, and wanted to live life
intensely-I went into law because it was a field where there was
no mandatory retirement at age sixty-five.
"I've not returned to the practice of law, and it doesn't look too
likely at this point, since stress triggers off nasty mood
"How ironic it all is."
For some persons, part-time, temporary, or on-call work are the best
option. Although these work styles may not offer the same level
of financial security as full-time or permanent employment, they
do provide more down time and flexibility. For others, a position
that offers predictable hours, a steady workflow without too many
"crunch periods," and a relaxed atmosphere is sometimes worth
taking a cut in pay.
You may be able to take the skills earned in your old high-stress
job and apply them to something less hard to handle. For example,
lawyers can become legal researchers or consultants, nurses can
move from the ER into long-term care, and executives can drop
down a rung on the corporate ladder to get out from under long
hours and constant changes.
Sometimes an existing job can better meet your needs with a
little restructuring. If you find that sleep deprivation caused
by frequent travel is affecting your stability, see if you can
pass the conference circuit responsibilities on to a co-worker
and take on some in-office projects instead. It all depends on
how flexible your employer, and you, are willing to be.
You don't have to talk about your diagnosis when making these
kinds of changes. Simply tell curious co-workers and friends that
you're simplifying your life, want more time for your family, or
desire a more satisfying new career direction.
To tell or not to tell, that's the big work issue for most
bipolar adults. Some feel that their employers might see them as
unworthy of responsibility or promotion, or worry about how their
mental health could affect company operations. Although it's
illegal to discriminate on the basis of mental illness, most
bipolar adults have personal experiences with job discrimination,
or know someone else who has. Your reticence is natural-and may
be warranted. In a 1991 Harris poll about attitudes toward people
with disabilities, 59 percent of people surveyed said they feel
comfortable with someone who is in a wheelchair, but only 19
percent had the same level of comfort with someone who has a
If your symptoms are well-controlled, there's probably no reason
to tell, unless it is required by company policy. If you
occasionally have breakthrough symptoms, you may want to consider
confiding in one key person at work. That person need not be your
direct supervisor-the personnel department might be a better
choice. You can ask the personnel department to place a letter in
your personnel file outlining your diagnosis and any
accommodations you might need if your symptoms worsen.
Lillian, age nineteen, says:
"Don't be embarrassed about it, but you don't have to tell
everyone about it. A friend of mine told everyone when she got
the diagnosis. It's not cool, it's not a status symbol, but it's
not something to be ashamed of. It's who you are."
If you do have a sympathetic boss, approach the topic with
caution. You might try making a joking reference to the illness
(on a particularly frantic day, "I think I'm having one of those
manic mood swings my doctor warned me about", for instance) to
break the ice. Some people have simply left their medication in
plain view one day-another conversation opener.
People who feel secure in their ability to manage on the job are
often comfortable about addressing the issue forthrightly and
openly. It would be wonderful if more people could do so.
You can get more information about the legal rights of disabled
people on the job, including tips on approaching employers, from
the Job Assistance Network (800-ADA-WORK) or the US Department of
Justice Hotline (800-514-0301.)
Marcia, age twenty-six, says:
"When it comes to who you should and should not tell, honestly I
am still unclear on what is best. All my immediate family and
close friends know I am bipolar.
"Actually, I feel like my
diagnosis has helped strengthen my relationship with my friends
and family. Now that we have identified my symptoms, my family
and friends know when it's me and not the illness talking.
"Even though I have been working now at the same company for
almost three years, I have not told any of my coworkers about my
bipolar disorder. Whether or not that is the right decision, I am
Civil rights laws do protect you against workplace harassment
based on your disability. As with other types of harassment
cases, it's important to let harassers know exactly how you feel
about their actions, to keep detailed records of incidents, and
to go through any formal grievance procedure your company or
labor union has before filing a lawsuit.
Most large firms have a staff member who handles internal
complaints of sexual or racial harassment. This is probably the
right person to see first if you find that your illness has
become the topic of rude remarks, practical jokes, or other cruel
actions by fellow employees or supervisors. You should inform
this person about your disability, and make it clear that you are
bothered by the behavior. This will either bring down the weight
of company policy on the offenders, or form the legal basis for a
future discrimination claim.
If you're not sure how to handle a workplace problem related to
your bipolar symptoms, call your state's Protection & Advocacy
system for free advice. Some NAMI
chapters can also refer you to legal counsel, and occasionally
national advocacy groups get involved in prominent or