Thursday, 26 September 2013

Quandary of Hidden Disabilities: Conceal or Reveal?


Quandary of Hidden Disabilities: Conceal or Reveal?

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A YOUNG woman with hearing loss wrote to me recently about being interviewed for a senior position in a major library system. She was well qualified for the job, and as her interviews progressed through the day, she sensed that she was about to be offered the job.
Julia Yellow
Then the top executives invited her to continue the discussion over drinks. The bar was noisy and she couldn’t keep up with the conversation. She didn’t get the job.
The woman, who asked me not to use her name, is among those whom the Americans With Disabilities Act can have a hard time protecting: people with hidden disabilities.
What should she have done? During the interview process she might have disclosed her hearing loss in a way that showed how effectively and creatively she compensated for it. When the drinks suggestion was made, she might have said: “I’d prefer we met in a quiet place so I could respond more easily. Would that be O.K.?”
But the woman’s choice not to disclose her disability was understandable. In fact, Joyce Bender, who owns a search firm in Pittsburgh that helps place people with disabilities, says that revealing a disability in an interview should be avoided if possible. And it should not be mentioned on a résumé, she says, as doing so may mean never reaching the interview stage.
Ms. Bender herself has epilepsy, a factor in her decision to focus the work of Bender Consulting Services on people with disabilities. “People with epilepsy have been viewed as mentally insane, degenerate, demonic or intellectually diminished,” she said. “Today the stigma for people with epilepsy is that you are strange, dangerous, weird and someone to avoid.”
An employee is not required to disclose a disability after being hired, but may choose to do so. Someone with epilepsy may want to ensure that the employer will know how to deal with a seizure. A diabetic might need to be away from work for insulin shots. Someone with mental illness may need a flexible schedule to allow for psychiatrist visits. A recovering alcoholic or drug abuser might need time off to meet with a substance abusesupport group.
But it’s a hard decision to make: If you announce your condition, you risk being stigmatized; if you keep it a secret, you risk poor performance reviews or even being fired.
AS someone who suffers from hearing loss, I understand this quandary all too well. When I was an editor at The New York Times, I was hesitant to discuss my condition. I told a few close colleagues about my disability, but I never explained how serious it was. Nor did I admit to myself how much it affected me professionally.
Former colleagues have since told me that they sometimes thought I was aloof, or bored, or maybe burned out. The fault was mine, in not disclosing the disability and asking for accommodations. I could have asked for a captioned phone, for instance, which would have made my job much easier and reduced a lot of the stress. I could have used a hearing assistive device, a small FM receiver, to pick up voices at staff meetings.
So why didn’t I say anything? I feared being perceived as old. For nearly three decades I tried to fake it, as my hearing loss worsened to the extent that I could barely manage in the workplace even with a hearing aid and a cochlear implant.
My experience, and that of others, shows that invisible disabilities in the workplace may lead managers and colleagues to view employees as difficult, lazy or not team players.
Most companies are in compliance with the Americans With Disabilities Act, and many seek out employees with disabilities. But there are subtler, gray areas of discrimination, usually unintentional. These can start with the application process.
Some big retail companies use prescreening tests with job applications that can exclude certain employees, said Jan Johnston-Tyler, founder and chief executive officer ofEvoLibri, a company in Santa Clara, Calif., whose services include job placement for people with disabilities.
One of Ms. Johnston-Tyler’s clients, a 25-year-old with Asperger’s syndrome, applied for a position at Subway. While most of the online application was routine, the last step was a multiple choice questionnaire. One of the 60 questions was, “Sometimes I have a hard time figuring out how I am supposed to behave around others.”
Most of us would check off the “disagree” option, but as Ms. Johnston-Tyler pointed out, many people with Asperger’s “are generally honest to a fault.” She contacted Subway’s corporate parent and was told that her client could fill out a different application without social suitability questions.
The interview process can be another minefield, as the woman who wrote to me about the library position found. And once people with hidden disabilities start their jobs, they face more risks.
Ms. Johnston-Tyler sees a lot of inadvertent discrimination. She told me about a client with Asperger’s who was working for a community college as an accountant and was having a very difficult time interacting with others because of his poor social skills and boundaries. He was lonely and wanted social time with others, and got in trouble for asking too many questions.
She also had a client who lost his job as a line cook because he could not keep up with the food orders being called out. He had a condition called central auditory processing disorder, “which made it virtually impossible for him to interpret the orders when he was not looking at the waiter’s face — he was facing the stove,” she said. “We helped him get a job in catering, where he could read the orders needed.”
About half of Ms. Johnston-Tyler’s clients are referred by mental health practitioners. People with mental illness have a particularly hard time finding and keeping jobs, in part because of isolated cases of violence that lead to negative — and out of proportion — publicity about mental illness, Ms. Johnston-Tyler says. For this reason, employees rarely disclose a psychiatric disability, either before or after they are hired. This leaves them open to misunderstanding.
Ms. Johnston-Tyler recalled placing a bipolar client in an internship for dog grooming. Her internship was terminated because the client “didn’t seem that interested” in the training, Ms. Johnston-Tyler said, “when in fact, it was her mood disorder that made her appear apathetic.”
Hidden disabilities can come into play with veterans. Ms. Bender says: “I hear so many employers say, ‘I would love to hire a veteran with a disability; they will get top priority when I hire new associates.’ ”
What they really mean, she says, is, “Send me a veteran with a visible disability,” and yet “many servicemen and women return from the wars in Iraq and Afghanistan withtraumatic brain injury or post-traumatic stress disorder.” Employers tell her, “I don’t know how to accommodate something like PTSD; the veteran may not be able to handle my stressful work environment.” Very few companies, Ms. Bender points out, have a stress level like the one that caused the PTSD.
Ms. Johnston-Tyler estimates that 75 percent of the employees she places choose not to disclose their disabilities. Even after placement, both her company and Ms. Bender’s continue to be involved with the applicant.
Ms. Johnston-Tyler does advise disclosing a disability “if an employee receives a very poor review, or is placed on a performance improvement plan.” It may not help, but “if nothing else, this slows the termination process down a bit and allows us to see if we can resolve the situation for everyone.”
Why don’t more employees open up about their disabilities? As Ms. Johnston-Tyler put it: “Think about someone going on public record that they were gay in the ’70s or transgender in the ’90s, and you pretty much have it. Society is simply not there yet for this to be a safe conversation for most people.”
TO help employers avoid inadvertent discrimination, Ms. Johnston-Tyler wrote a paper in 2007 that offers sample human resource training programs, and contains references to others. She explains the employer’s rights as well as the employee’s. For example, if an employee comes to a manager with a disability that cannot be seen and asks for accommodation, it’s fair for the employer to ask for verification. In an interview, Ms. Johnston-Tyler added that it’s also important for the employer to communicate to all employees the general information that workers may need to take time off for medical care, without naming employees.
But therein lies another problem. As Lynne Soraya, the pseudonym of a blogger who writes about her Asperger’s, puts it: “In today’s world, we require people to be labeled in order to give them help and coaching in the areas they need.” Even though disclosing her condition in her personal life has been a “godsend,” she writes, “in the area of work, I still have grave misgivings.” Many people with hidden disabilities share those doubts.
John Waldo is the founder, advocacy director and counsel to the nonprofit Washington State Communication Access Project, which aims to reduce barriers that prevent people with hearing loss from participating in public life. He sees a lot of unintentional discrimination.
Mr. Waldo, like many I talked to in the field of employment practices, is willing to give employers a break.
“When Congress passed the A.D.A., it recognized the important and fundamental reality that discrimination is seldom intended,” he said in a speech recently. “Rather, discrimination against the disabled is most often an unintended effect of acts or omissions undertaken without considering the impact on people with disabilities. Put bluntly, the problem is not so much that people are mean, but rather, that people are clueless.”
Katherine Bouton is the author of “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You.”

Making peace with my drugs, and myself

Since the time I was 3 years old, I have been under some form of medication to control my seizures.   And, each time we  moved - and this was quite frequent from the time I was 7 to age 15 -  i saw different neurologists who would prescribe different cocktails of medicine.    When I was younger, I just did I was told and swallowed the pills -   I didn't really understand what that meant,  However, as I grew older and started researching more I was literally blown away by some of the side effects of the medicine I had been taking.  Mysoline for example made you more prone to facial hair.  I suppose that's great if you're a guy ---- but otherwise, no.  


Or,  other medicines made you more prone to mood swings, to become more irritable.  Or that you would be very drowsy after taking your dosage.  I remember clearly during college, I was berated severely for being sleepy during class --- my friend stood up to the teacher afterward and told her there was no reason for that tirade, which was quite humiliating - since my medication caused the drowsiness.  I was really grateful for how protective he was ---- but I also felt deep inside that I couldn't make epilepsy an excuse for anything.  So if I tended to fall asleep after my dosage,  I would load on caffeine to counter balance it.  I admit that in those days, I was also reluctant to explain that I had epilepsy -  no doubt pitying looks would follow and exceptions would be made - which I was really very much against.  I had grown up in a household where we were treated equally -  why would the outside world give me concessions? Why would I even ask for them? On what merit? 

And then it happened.  I had begun a new regime and was weaning off  a current cocktail and was starting a new one.  I woke up that morning feel nauseous - I chalked it up to nerves - after all it was the midterms for Calculus.  Upon reaching the University, my stomach seemed in better shape and I felt  more confident.  Then the test came  - I realized I couldn't read it.  I wasn't sure if I was looking at single differentials or double differentials. I hurried out of the exam -  worried at what was going on with my body.  There were no elevators in the building - and in true Art Deco style, instead, we had winding grand staircases to transport us from one level to the next.  I remember gripping the rails for support tightly knowing that a misstep might lead me head first down the stairs.  I felt cold sweat trickling down my temples.  I told myself over and over - "If you're going to have a seizure, you're going to have to wait till I get down to solid ground, not here on the stairs." It began as an instruction to my brain, and ended up a prayer in its ferventness. 


When I reached the ground floor some friends noticed I was pale -  and supported me to the parking area so I could get fresh air. And that's when I began to vomit and weaken.  It was only then that I remembered that I was in the midst of changing medicines - and this is what might have caused it.  My carpool mates rushed me home -  and then my mother began making calls to find another neurologist who could care for me.  At that time I had just tuned 18.


I then met Dr. Ofelia Adapon - she was motherly, considerate, gave me her home and mobile number in case I needed anything.  Twenty-three years later, even after I had moved to the US to study, and even now as I work in Singapore - she continues to care for me.  She would have it no other way -  and personally I'm glad she won't let me go as a patient.


In our long association,  she has asked me to trial drugs whose approvals had not yet been secured and form part of the clinical trials.  I din't mind really - if this meant I was getting initial access to medicines that could actually help me - why not?  At some point in all our trials to find the right cocktail - I was taking an average of 13 pills a day.   Now I am down to 2.5 pills a day. 



But, I wasn't always this accepting and pliant when it came to taking medicine.  The more books I read which said if you could be seizure free for two years,  you had greater chances to being taken off the medicines - which at that point I felt were quite constricting.  So i thought about the problem another way :  "What if I don't take any medicine at all and am seizure free will that convince my doctor it's time to go off-meds?"  

So that is exactly what I did. Like a true secessionist, I declared myself medicine free - which to be fair lasted a few months.  And then i had a pretty bad episode and I had to come clean.  It became clear to me then, that the only way to be seizure-free, was to do exactly what my doctor said.  There are no short cuts.  In the end,   I had to follow orders - which now I  am grateful for.  I have an inner capacity and endurance which I think would have been impossible to achieve without the discipline instilled in me about taking my medicines regularly.  

And yes, I did some introspection -  I felt if this was the only cross that I had to bear - I should do so with grace and not just irritated tolerance. It was humbling to realize that as much as you want to change things - you have to have faith that what you are experiencing at that very moment, is part of the plan for you.  How you react to  and rise above the situations put in front of you, well that is what defines your character.  And this, epilepsy, i decided is just one of my many facets - it does not control me - but I give it the respect it is due.   


I did a quick search of all the ant-epileptic drugs in the market - and to my amazement I've tried quite a few (those in highlights). Of course I'm happy to have participated in the trials - the more options there are for others, the better chances there are for controlling the effect of seizure activity.




  • Ativan (lorazepam)
  • Buccolam (midazolam)
  • Carbagen SR (carbamazepine)
  • Convulex (valproic acid)
  • Diamox (acetazolamide)
  • Diazemuls (diazepam)
  • Emeside (ethosuximide)
  • Epanutin (phenytoin)
  • Epanutin injection (phenytoin)
  • Epilim (sodium valproate)
  • Epilim chrono (sodium valproate)
  • Epilim chronosphere (sodium valproate)
  • Episenta (sodium valproate)
  • Epival CR (sodium valproate)
  • Frisium (clobazam)
  • Gabitril (tiagabine)
  • Keppra (levetiracetam)
  • Lamictal (lamotrigine)
  • Lyrica (pregabalin)
  • Mysoline (primidone)
  • Neurontin (gabapentin)
  • Orlept (sodium valproate)
  • Paraldehyde
  • Phenobarbital
  • Pro-epanutin (fosphenytoin)
  • Rivotril (clonazepam)
  • Sabril (vigabatrin)
  • Stesolid (diazepam)
  • Tegretol (carbamazepine)
  • Tegretol retard (carbamazepine)
  • Topamax (topiramate)
  • Trileptal (oxcarbazepine)
  • Trobalt (retigabine)
  • Vimpat (lacosamide)
  • Zarontin (ethosuximide)
  • Zebinix (eslicarbazepine)
  • Zonegran (zonisamide)









  • Note: 






    Read more: http://www.netdoctor.co.uk/medicines/treatments-for-epilepsy.shtml#ixzz2g1ExGT1X 




    Wednesday, 11 September 2013

    Running: Mind, Body and Sole

    One of my most fervent dreams when I was younger, was to be a published writer.  I had no idea, that my first article would soon come at the heels of my decision that I would no longer let epilepsy prevent me from engaging in sports that I wanted to pursue.  I was told when I was younger that I could not participate in sports that would lead me to hyperventilate.  That pretty much left everything out, except walking.

    I was in a dilemma.  I wanted to be more active, to participate, to be more active and more healthy. But I had this restriction.  So I would engage in sports and fitness sporadically - and when I had a seizure, I would stop abruptly.  It was very frustrating. And every time I began, there was always some niggling doubt that one day, I would have to stop again.

    Finally in 2012, I decided,  that I would have a different year in all respects.  That I would be rid of my fear.  In many of the books I had read about epilepsy, there was only so much that medication could do - the rest was left up to the individual's will.  I had already displayed an ability to stop a seizure if I set my mind to it - I could at least delay it until I was in a safer place by focusing on that intent.  So I said to myself, "2012 - this is the beginning of a new year, a new life. "  January began with me scaling  a mountain with an elevation of 3000m.  I then decided to take up running with the help of a coach so I could at least learn how to listen to and manage my body-  and soon, I was writing about the experience.  It was so liberating to feel free of the yoke that epilepsy had once thrown on me and finally participate in a sport that I truly loved.

    I realized quickly that one of the things that I loved about running was the sense of strength I felt in each stride - a strength that I had long been told I did not have - because I was different.  And yet, now because I knew how to manage my body and listen to it -  each step forward felt like freedom, and when I told my neurologist later on that I had taken on running - let's say she tried to convince me to take up speed walking instead.  Of course that didn't work - I wanted to be healthier - and as my EEGs continued to improve, my overall health did get better.  There was no telling me otherwise.

    Here's my account of how I fell head over heels (pun intended) with running, published in Run Magazine, Singapore June 2012,  six months after I took after I took my first lap.