The Cost Of Things: Living & Working With Depression

by Dan Shewan

This past winter, I gradually decreased the dosage of, and eventually stopped taking, my antidepressant medication.

Although I felt better for a short while, it ultimately proved to be a grossly irresponsible decision. After just a few weeks, I could barely leave the house. To do so, I had to take at least one Xanax to calm my nerves. I couldn’t sleep. When I did, I slept for twelve hours straight, longer if left undisturbed.

During this time, I missed plenty of work. Some days, I was fortunate enough to have the weather to blame. Boston was enduring a particularly harsh winter, and on several occasions, my wife and I were literally snowed in. On days when we did manage to wrestle our front door open, the record snowfall frequently brought the city’s decrepit rapid transit infrastructure to a standstill, preventing me from getting to the office. While other people cursed and spent hours shoveling driveways and trudging down unplowed sidewalks and inching along icy highways, I was deeply, intensely grateful. I savored every moment that I could hide in the safety and darkness of my apartment without having to see or speak to anyone.

Most of the time, though, I called out sick.

The amount of time I was taking off or working from home soon became problematic. Terse emails requesting that I log days I had worked from home in the vacation calendar, something I had never been asked to do before, replaced the cheerful emails telling me to “feel better!” I had received in the past. My managers’ formerly warm dispositions became curt and indifferent.

Sensing the gravity of the situation, I confessed to my immediate manager that I was suffering from serious mental health problems. I told her I was struggling with severe depression and acute anxiety due to “changes in my medication regimen,” that leaving the house was extremely difficult if not impossible, and that I was finding it difficult to cope. She was kind, patient, and sympathetic, but she had no choice but to tell her boss. It wasn’t the kind of company where words like escalation were used to describe talking to employees about their personal problems; still, the conversation transformed a private matter into a documented issue. It had become real.

I started taking my medication again, but my return to normalcy was slow. I continued to miss work due to my anxiety. I couldn’t concentrate. I frequently made routine mistakes. My demeanor was brought up during an informal performance review.

“I know you’ve had … some health problems,” my manager said, “and that’s probably had something to do with it, but there’s a perception among the team that you’d rather be somewhere else.”

I did want to be somewhere else. I wanted to be at home, in bed, the curtains drawn and the lights off. I wanted to be in a mental health rehabilitation clinic, the kind of place celebrities go to get over vicious cocaine habits or dry out after epic, month-long benders. Even a short spell in the mental ward of the hospital was becoming increasingly attractive.

I couldn’t afford any of these options. Instead, I took a week off, the longest possible period I was legally allowed to take before I would have to claim short-term disability if I wanted to keep my job. As beneficial as an extended leave of absence would have been to my recovery, I simply couldn’t afford to file for disability. The company had agreed to pay 60 percent of my salary while I was on medical leave (a legal requirement, thanks to the Americans with Disabilities Act of 1990), but the prospect of taking a 40 percent reduction in pay was simply unthinkable.

I went back to work.

According to statistics from the National Institute of Mental Health, approximately 16 million Americans suffered a major depressive episode during the past year. Many resist seeking formal treatment, and most have little choice but to keep working, to “man up” and get on with it. Data from the Centers for Disease Control and Prevention states that workers suffering from depression take an average of almost five sick days and lose more than two working weeks in lost productivity in a three-month period. Only slightly more than half of the more than 14 million people diagnosed with major depressive disorders every year seek ongoing professional help, largely due to the pervasive social stigma associated with mental health problems.

We hear a lot about the cost of illness, whether physical or mental, but it’s the way these costs are presented that is perhaps most troubling. When studies and reports are published on mental illness, they almost invariably calculate the financial toll it takes on the nation’s economy: the expense incurred, the productivity lost, the dollars wasted. For example, data from the Anxiety and Depression Association of America suggests that anxiety disorders alone cost the U.S. more than $42 billion per year. For a little perspective, that’s the same as the annual budget for the state of Minnesota.

Aside from catastrophic tragedies and sordid celebrity scandals, the American media apparatus loves nothing more than assigning monetary value to the intangible. Framing important social issues in a financial context can be extremely powerful, and to some extent, this contextualization makes sense. Focusing on the collective societal impact of illness can be incredibly revealing, especially concerning conditions that often remain largely invisible to those not directly affected by them. It also highlights the enormity of these illnesses, not only in terms of their impact on the country’s financial health, but also how we respond to them.

As useful as they can be, these reports rarely investigate the personal costs, financial or otherwise. There are dozens of reports and studies on the connection between long-term unemployment and depression, but few if any that investigate whether mental health problems contribute to unemployment in the first place. Similarly, there is a wealth of data that suggests unemployed individuals suffering from depression often withdraw from social activities, but much of this data frames the problem in the context of unemployment itself being the determining factor. The assumption becomes that depressed, unemployed people socialize less because of the diminished sense of self-esteem related to their joblessness, not due to the suffocating loneliness and despair that often define major depressive episodes or the fear of speaking out that accompanies them.

America’s Calvinistic work ethic is so deeply ingrained into the nation’s cultural identity that it is virtually impossible to separate the two. Even as the country’s most urgent social issues force us to reconsider our slavish devotion to arbeit über alles, raising a hand to admit we’re struggling, especially with something widely considered to be as trivial as depression, isn’t just a personal failure, it’s un-American. Daring to question the status quo isn’t merely perceived as weak — it’s blasphemous.

Six months after I first approached my manager about my mental health difficulties, my company decided it would be in everyone’s best interests to renegotiate the terms of my employment. I am no longer a full-time salaried employee with paid vacation time and health benefits, but rather an independent contractor: another hired gun in the mercenary army of freelancers, contractors, and “supertemps” that, according to some estimates, now makes up approximately 34 percent of the nation’s workforce. It’s all on me now: filing taxes and submitting 1099s, finding and paying for my own health insurance, keeping track of and submitting invoices, agonizing about whether I can afford to take an unpaid day off — the hallmarks of true American freedom envisioned by Silicon Valley’s most powerful entrepreneurs as the future of work in 21st century America.

Although my mental health problems have cost me a great deal during the past decade, I don’t lament how much more productive I could have been, or how much more work I could have done. I don’t worry about how the earnings lost during periods when I simply couldn’t work will affect my financial future, or whether I’ll be able to retire at sixty-five. Perhaps I should.

I do, however, think about the millions of people out there just like me who are struggling. People who worry about what the next inevitable sick day will cost them, whether they’ll have a job to come back to after a period of medical leave, when the hammer will finally fall and they’ll be let go altogether because of an illness.

It’s too soon to say whether my newfound professional freedom will work out. Like the other 54 million freelancers out there, piecing together a living in today’s much-lauded “gig economy,” I’m figuring it out as I go. It really is an ideal arrangement for all concerned, but I would be lying if I said I wasn’t terrified.

At least I don’t have to go into the office anymore.

Dan Shewan is a nonfiction writer and essayist based in New England. Dan’s work has appeared in a range of publications, from national newspapers to small literary journals. He is currently working on his first book. Follow Dan on Twitter @danshewan, or read more of his work at

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