On this episode, Morgan and Melissa explore how disability can impact people’s lives, including physical, mental, cognitive, and developmental challenges. The conversation highlights the importance of understanding workplace needs, seeking accommodations, and creating more inclusive spaces where everyone feels supported and valued.

Search: Defining Disability

YouTube: Crip Camp - A Disability Revolution (2020)

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Welcome to A Psycho Delicious Conversation on mental health issues and trends from three local mental health professionals in the greater Lansing area. I'm Michael Stratton, LMSW. And I'm Morgan Bowen, PMHNP. And I'm Melissa Black, PMHNP. And we're here to provide you with a deep dive into the human experience of consciousness and beyond. Our aim is to be educational and entertaining, so just kick back and open your ears and your minds.

Welcome everyone.

This is Melissa and I'm Morgan Dadalyum.

And we're here today talking about disability. This is a huge topic, so it.

Is a big topic.

I'm like prepared and really trying to rein myself in so I'm not absolutely all over the place and hopping all over.

You have a lot to say.

I think there is a lot to say about work expectations and like what someone has to do to be able to support themselves in our current society and like that dissonance with someone who is. Is living with disability and who you know. So I just. There's so much in between those two things that could be discussed but.

Well, and I think it's a common. Well first it's just Melissa and I and Daedalian today.

Yeah. Two thirds of the.

Two thirds of the trio, Mike.

Well, I guess technically they'd be three fourths.

Yeah, yeah.

What do you call a four person? A quad.

Quad.

Yeah, yeah.

Quartet.

Oh, that's two thirds of the mental health professionals.

Yes.

There you go. Because I am not that. So let's make sure they get out there. I think probably to start off you might want to define disability.

Yes. And I have that pulled up here.

Look at you. You were just prepared.

I am as prepared as I can be.

I like that.

A disability is a physical, mental, cogn or developmental condition that limits a person's ability to perform daily activities or interact with the world.

It is often defined by significant long term functional impairment affecting work or daily life with legal definitions focusing on substantial limitations to major life. The legal definition.

Where was that from?

That is. Well, that is from Google AI Overview.

The overlords.

The overlords. And then this is from the Social Security disability website.

To meet our definition of disability you must not be able to engage in any substantial gainful activity sga because of a medically determinable physical or mental disability or disabilities that is either expected to result in death or has lasted or is expected to last for a continuous period of at least 12 months. So something that is chronic, maybe terminal, maybe not.

Like I know prior to transplant my husband Was like automatically approved for disability with cystic fibrosis.

He's a CF kid.

Yes. Yes.

Well, he's not a kid anymore.

No.

Has lived a lot longer than folks with CF once did.

He has more than doubled his life expectancy at birth thanks to the transplant.

Yeah. Double lung transplant.

Yes, double lung transplant.

Pretty significant.

Yes, majorly, majorly.

Huge.

And like another example is folks who are blind, like you don't have to go through a bunch of rigmarole with the government and agencies and whatnot to be able to get approved. You get automat, like just automatic level of approval. I'm not sure what that is. Like if it's, you know, if they're different percentages.

I guess I haven't explored that or just had the experience with like somebody who was blind, who was a patient of mine that, you know, and I.

Had a patient lose their sight in the last year and a half and you know, there's so much that was like, you know, once you contact the Commission for the Blind through the state, you get hooked up if you want with, I mean they have meta glasses. There are these AI glasses. I just learned about this yesterday that looks and see and narrate to you what you're looking at.

I've heard of medical assets but not in the, you know, disability sense.

So they are provided by a federal grant. Now again federal grant.

You know, so there's physical disability and. But mental health disabilities are also covered by the ada. So Americans with Disability act, which a lot of this because policy wise, regulatory.

It's complicated. So complicated, so complicated. But there are, you will find like certain advocacy groups or organizations who are very strong.

So like the blind people's advocacy group sounds like it is quite strong and well entrenched and you know, is a well oiled machine.

Absolutely.

Autism in Michigan also is quite a. I mean there's always room for improvement. But Lieutenant Governor Calley under, was he with Snyder?

There was a Lieutenant governor of Michigan who had a child with autism and he was quite and still is quite influential in programming and advocacy for autism. So Michigan tends to have quite a strong autism advocacy group of people.

Definitely once you get that diagnosis, there are a lot more resources.

That's one of the things I notice in practice is folks who are neurodivergent who don't have an ASD or autism Spectrum disorder diagnosis, struggling to get OT or other types of supports without that. That's a big conversation these days too.

Yeah, it is, it is. And I just had a situation where somebody was defining Themselves or describing themselves as neurodivergent to their employer.

And there was some difficulty with communication and understanding of expectations that was causing conflict and problems for them in the workplace that was leading to some things. So they were seeking accommodations under the language. Well, but it was under the language of neurodivergence.

But neurodivergence isn't really a defined space in terms of, I don't know, legal or, you know, in clinical, there's not a diagnosis of neurodivergent.

Right.

But it's a very. Well, it's a word that's cropped up and how, you know, last five, ten years or so and is used quite free. I mean, I hear it all the time, but it's.

There's not really any sort of.

So we went through the process of actually, you know, diagnosis, which we did, and then coming to a more clear diagnostic, which then can be used as a platform for requesting accommodations for disability.

All of those hoops are, you know, to think of, like, accommodating an accommodating or accepting workplace. I feel like the range of what, you know, is appropriate, you know, or what is expected.

You know, I think of, you know, an uncle of mine who is very much undiagnosed, autism spectrum individual. And, like, his memory was amazing, and he loved wiring electrical things. And so, I mean, he just like, oh, you're really good at this. You know, so.

And so we're gonna hook you up with this trade, and you love this, and you're gonna do it forever.

And it really, like, feeds, but it's like matching someone's abilities to, you know, something that they would find at least tolerable, if not enjoyable, like, to do, to be able to support themselves, support their families, like, let alone get joy and purpose out of life, but at least, like, you know, I feel like the.

So the disabilities, the agencies and all of that, it's like, okay, there's this bare minimum of functioning, and it's like, all right, okay, let's just get you up to that bare minimum, you know, but once you have that bare minimum of functioning, okay, now you're on your own.

You know, I see a lot of cycles with that and with, like, expectations in the workplace that are just very different, I feel like, than maybe they were 20 or 30 or 40 years ago.

It's a totally different work environment now for people. I wish maybe Dalian can look into the average time frame that somebody has a job for.

So it isn't that you come into a job and you are there for the rest of your working career, it is. You have a job for two years and then you have a job for three years, and then this has been mine experience.

And so for somebody who is, you know, has a disability, that's not a very supportive environment to grow and expand in. It seems like the work environment is so much more about expendable. Like you're expendable.

Yes.

We're not going to put a lot of resources into you because you're probably going to leave in two or three years and somebody else is going to come in and do this and you're going to go somewhere else and do something else. So it's less prevalent that companies invest in their workers and this is wage generalization.

I'd be interested to hear what you guys think about that.

Perfect.

Well, you've got a lot. I know, I met, you know, really pushing the envelope.

I'm actually looking for a personal assistant.

Yes.

So.

Well, and while Dalian's looking that up, I'll list some of the.

The examples of disabilities, you know, visual hearing impairments, hernias, fractures, mobility impairments, developmental disorders, mental illness, cognitive impairment, cardio heart disease, like chronic or congestive heart failure. If, if someone has CHF and it's advanced, you know, they're not going to be able to function.

And respiratory disorders like cystic fibrosis or other like disorders of the body. But there has to be a medical diagnosis which neurodivergence doesn't have. I just wanted to circle back to that. Like adhd. Does autism.

Does adhd, autism. I think I'm trying to think of the things that I typically. Anxiety, acute anxiety with panic. If somebody has depression. Yes.

A lot of times in my experience, like, people are navigating through a larger number of stressors in their life. A parent moves in, they're caring for a sick family member. I mean, FMLA is another sort of subcategory of this discussion.

But, you know, so they were kind of managing okay, but then something happened and it's really exacerbated and debilitated the person and they are really not able to work.

Yes. Like bipolar disorder and schizoaffective disorder, schizophrenia.

I feel like in those cases, sometimes it's a little bit, quote, unquote easier if there's a more obvious external sign of the disability, whether that is a physical disease or a mental disease. Back to Dadalion.

Yeah, there wasn't really. I mean, I found some info, but for the most part it's not changed too much since the 80s. Four to five years, it says.

Well, I need you to do some digging today and I need you to find my smoking gun.

So I have a smoking gun for you in that, like, I mean, I come from a family of workaholics on both sides. So, I mean, the answer to any problem in life was, well, you need to work harder. You know, you need another job, you need to.

You must not be working hard enough.

Again, that wasn't like verbatim, you know, but that was like the overall, like, hey, like, don't worry, just keep working hard, work harder and like, you'll eventually get there. Kind of that promise of like, if you do good work, good things will come to you.

You know, that kind of like universal golden rule was applied both to like work and just how you were as a person.

And it's very American.

Yes, yes.

And both sides of my family felt that super strongly, you know, so I've, you know, dad who even though he like bounced around, he built homes, you know, for 30 plus years, mom and stepdad worked at GM. I have a lot of personal connection with disability. My mom has been medically disabled and retired since she was in her mid-30s.

So I kind of watched her go through that. Getting injured at GM and then having undiagnosed chronic health and mobility disorders that just got worse and worse.

Did she get sucked into a machine and like her arm ripped off or something?

No, but like eds, Ehlers Danlos runs in the family. So we all knew we were hyper mobile. It was like the 80s. Like Pat Benatar, you know, like Joan Jett, like, love it. Like women like power.

I'm gonna do all the jobs the guys can do. Give me that torque gun. I'm gonna. You think I can't do that, I'm gonna do it. And she did it. And she was a tough, tough cookie. Yes, very tough cookie.

But.

Right.

Didn't realize it was so like a.

Repetitive use type of injury.

Yeah.

After having been an athlete and having many repetitive use athletic injuries throughout her whole life, getting a lot of cortisone shots throughout the 70s and the 80s, which now we know Cause makes arthritis worse. So, like, they're like, oh, you know, you can't run those hurdles in your time. Your hip hurts, your knee hurts, your foot hurts, whatever.

We're gonna give you some cortisone just like new.

So using her as an example, or just in general, like, how does that affect a person's life? I mean, that's a big. You know, it's. Yeah. I mean, I wanna say devastating. I mean, it can be devastating.

And I think that. And I know she wouldn't mind me using her as an example. Absolutely devastating.

And from a standpoint of being on the sidelines, you know, she never involved us in that. You know, never really talked about any, like, deep feelings about it. But you could see, and we can talk now that I'm an adult.

I mean, that was her whole sense of identity, was her work, as it.

Is for a lot of people.

Yes. And even now, she still is like that with the work she's able to do around the house. As she's gotten older, mobility has gotten even worse.

She's able, you know, had less and less.

But I would say it was probably in her, like, late 50s, early 60s, so, like, almost 30 years into being disabled, where she even approached some level of acceptance of, like, I can be easy on myself. Like, the stress of continuing to try to do everything that I always did is actually making things worse.

And when your message that you always have and you've always given is work harder, I mean, that is that neuro circuit that's firing in the brain.

And I think for anybody that goes through disabling injury, there's a difference between maybe a congenital. Somebody who's born with something and grows up. And I'm thinking about the disability kind of rights movement, like cerebral palsy. Yeah.

Blindness, dwarfism, limb abnormalities. You know, sort of adapting to the disability is less of the focus because the person has done that their entire life. So it's more. It's.

You know, I'm speaking for. You know, I feel a bit uncomfortable speaking for a bit.

But there's a great documentary, which I'm trying to remember, about the sort of, like, disability rights movement. But it was like, you know, there are things that we can do, and we haven't really been given the chance. We're just kind of, like, ignored.

We're looked over. So more of, like, a community, population sort of idea versus somebody adapting to an injury and their life has changed.

Crip camp. I was gonna say that. I hope you were talking about that at some agency.

I can be Your personal assistant. You just gotta give me something that doesn't require me to look up deep stats. That's all I'm saying.

If you have not seen Crip Camp, it's really great. It's a great document.

I worked for CMH and the community services for the developmentally disabled for seven years as a tech. So that was like my first job in patient care at all. And it was all about inclusion, adaptability, being as independent as possible.

But these folks had like major disabilities where it was not a fight to keep them qualifying, quote, unquote.

They didn't have that stress, but like housing stress, supports, like schooling, like any type of education, work experience, community inclusion at all. So I always had this view of like, we can adapt, right? And if we can adapt, like we can pivot and maybe find something else.

But I feel like some of the employers that at least I'm interfacing with when I'm trying to support patients, you know, they're going to take some of those instances as opportunities to like say, well, you can't do this job because you're not meeting these black and white definitions even if you can do it. And like it's not more expensive for us, you know, this is a pain in the butt for us. So yeah, you know, that is the.

Gray area that is a very difficult area to navigate. And I think we're going to talk about this maybe more in detail in the second episode.

But we as mental health clinicians, as nurse practitioners are often asked to provide documentation to an employer or a school for accommodations based on disability. And so for us, because we're mental health, it's, you know, it's frequently accommodations for adhd.

I do that quite a bit with school age or college age students who need more time on tests or testing areas that are less like stimulating. Yeah, exactly. Things like that.

Or if somebody's having a crisis and they are going to need to be off work for three months, six months, then they, there's a short term disability concept. So these are the times in which we interface. We're advocating for the patient, but we also have to be very careful about.

There's laws protecting folks, but it's also opening a door to, you know, the kind of things that you're just mentioning like can the person do the job? And we didn't know that they had this disability and what does that mean and does that change the way we think about them?

And on paper it's not supposed to,.

But I asked Ryan about this, my husband, you know, because he has been on disability at different times in his illness and he's, you know, he's a nurse practitioner and he worked as a nurse for many years. And like med surg did travel, nursing, did like infusion, chemo, sickle cell clinic. That was not something he ever disclosed to employers.

You know, so as even, yeah, cystic fibrosis. I'm not going to tell anyone that I have cystic fibrosis. Like well, they're going to know that I'm probably going to get sick.

They're not going to think of me as a good hire. And he always worked well and I think that that was the right call for him.

But now I love that there's like this inclusion and like there's more discussion about it and normalization of like differently abled individuals and like we're not all supposed to have the same abilities and that's like we're not robots or machines, we're not overlords.

Yeah.

And I like that about humanity that we are all different.

And I feel like I've got that maybe rose colored glasses of, you know, my upbringing of like we can all do it, you know, even if that not necessarily real life. I recognize that.

Well, I also come from the mindset where it's like, okay, if you have a human resources department, I mean human resources is about in my mind protecting the employee. It's about advocating for their employees having a healthy workforce. And you hear this at jobs all the time.

We want you to feel comfortable, we want you to, to take the time you need. But do they?

I have to say my experience has over the last, let's say, let's say in, in 20 years I've been dealing with my own like injuries, illness, disability and working in healthcare. Over 20 years I have watched it.

You know, again this is my own observation and my own personal situation where it is less and less like it's been this slow like morphing of, for the employees to protecting the employer and really not even being somewhat supportive at all or like you know, yeah, we're not going to, we're not going to do this or I don't know, that's just been my.

Yeah, well, it's a triangulation. This, you know, so for me, for us as clinicians, for our patient and then for the employer, I mean it's kind of this triangle of.

It's not that I try not to speak with the HR department, but I would rather not.

Oh for sure.

You know, it's, it's not, you know, and it's really not my, my place to like what, what I'm doing is providing corroboration. This is a diagnosis. And there's sometimes where it's like, I'm not sure you want me to be very clear about the diagnosis.

And then with a diagnosis, this is the symptoms that can happen with the diagnosis that can cause issues for the person. Right now in mental health, that does not mean that the person always has these issues.

Maybe it's when they're stressed, maybe when it's all these other things that are going on, but it's not my job to explain this is why they can't do this particular situation that's causing the issues. That's not my role. But sometimes the patient kind of thinks that that's my role.

And so it can just cause a lot of friction and you know, the like just reading between the lines, it's, it can be a very tense, tense thing. That's my experience.

And who I mostly seem to like send records to or try to quote unquote, like convince with my documentation are these disability insurance companies. And they are supposed to kind of gatekeep the information away from hr. So HR doesn't have the details, but I feel like that is not always the case.

I agree that it seems that that is not always the case.

And for the person who is like having difficulty and is, you know, really stressed out about all of this, but also going through whatever is the reason that they're on, you know, leave or whatever, it's a new thing for them usually. And they don't, there's not a lot of times. And this, this is increasingly. So there's less advocacy in hr.

Melissa Black

It used to be that you would have like, oh, this is your HR representative. And they can walk you through, you know, the process of this. They can tell you the pros and the cons and the ins and the outs.

Now a lot of times companies hire a third party. It's not an in house hr. It's a third party company that is hired to do all of this because it's a, I mean frankly, it can be a nightmare.

It's less personal and it's less positive experience for the employee.

A Psycho Delicious Conversation is meant for educational and entertainment purposes only. It is no substitute for therapy and should not be treated as such. If you feel a need for real therapy, you should consult your local provider, Google “therapy” or “therapists” in your area. Check with community mental health or a suicide hotline if you are feeling suicidal. Mike, Morgan and Melissa welcome your questions, feedback or dilemmas. Feel free to send your emails to [email protected] that's P S Y C H dot D E E L I S H at Gmail dot com. The views expressed on this podcast are solely the opinions of Mike Stratton, Morgan Bowen and Melissa Black and do not reflect the views or opinions of any site broadcasting this podcast. Replication of this podcast without written permission is strictly prohibited.