A recent question concerned a 48 year old individual with a very long work history in construction who had a heart attack. His heart recovered, but his mental state deteriorated and provoked uncontrolled panic attacks. Almost all of my physically disabled clients are also depressed and anxious. I have other clients who suffer from no physical symptoms but have a mental condition that prevents them from being employed on a sustained basis. They all have three problems in common.
First, they look fine to themselves. They do not understand why the experience break through tears, racing heartbeats and/or just want to be in a dark room. They feel like they "should be able to control" these symptoms. Well, here's the deal: they can't. Mood is regulated by chemicals (called neurotransmitters) in the brain (most notably Adreniline, Seratonin and Noropinephrine). When those get out of wack, the person's mood will not be within normal limits. The mood condition can be "chronic" (which means it says that way a long, long time). Or it can vascilate for no particular reason. A person can no more control neurotransmitters than the person can control insulin levels. A qualified doctor - including most family doctors can help. No need for a head-shrinker. (You can't think diabetes away, for example.) So, these people also suffer from a profound sense of failure - which produces even more depression.
Second, they look fine to other people. The old addage "You can't judge a book by its cover" is particularly true in disability cases. Most of my clients look fine. There have been several who've walked in the door who, in the first 10 seconds, seemed "fine" to me - and I do this for a living. No one can tell whether someone has a chronic back injury, a chronic heart condition, diabetes, cancer or a whole host of problems just by looking. This is particularly true with mental conditions. Thus, other people - frequently friends and family - just don't get it. It leaves the person feeling misunderstood, isolated and like a failure. Thus, depression continues.
Third, their illness prevents them from seeking help. I have a number of clients who literally cannot leave their house; can't talk to stranges (including me) and/or do not have the energy to do anything but sleep.
Happily, if they can get to me, or someone like me, many find that their mental condition alone, or incombination with their physical condition, does qualify them for Social Security Benefits. But going it alone, in the face of the Social Security Administrations giant machine is really hard.