I suspect that the lack of trust this indicates on the part of the company (not to mention foster on the part of the employee) is probably a sign that you're past the point of no return. I suspect a company that asked for verification was not doing so to see if you were genuinely ill, they're doing so because it's already a problem and they want a nice paper trail for when they terminate you. Of course if you are abusing it, I think that's totally reasonable.

But I think most of my employers (except for one, where I quit for exactly this kind of disrespect) would have had no problem with me saying, "hey I just need a mental break day in order to keep doing this job - I'm taking one of my sick days". If one significantly exceeds allocated sick days, then the reason starts mattering more.

Get into hourly low wage stuff and you are treated like children, many shops require a doctor's note for any and all absences with 1 or 2 dermits until you're fired.

This has reasons from both ends of course. When I was younger I saw the need for this sort of policy or you'd get eaten alive by the low-wage masses abusing it (and abuse it they did). But on the flip-side, these policies tend to simply be abused by management once enacted - with no leeway for people to be human.

In the white collar arena it's pretty damn trivial as a manager to tell who is abusing a PTO policy and who isn't, so only the shittiest of companies enact such policies. Managerial laziness is definitely creeping into this area of life as well too though.

My go-to story: Friend in Japan's train route was significantly delayed by a suicide. Rather than sit in the train station for ~2 hours waiting for cleanup, he leaves, gets on his motorcycle, and rides to work. Shows up 30 minutes late, but his pay is docked those 30 minutes, because unlike everyone else that showed up 2 hours later, he didn't have the little ticket they give you in Japan when your train is delayed. Regardless of him telling HR the situation, showing his house on the train route, etc, nope, he didn't have the slip from mommy, so his pay got docked.

I love working there, but the work culture is infuriating.

Also Japan is just about the most photographical country I've ever been to.

That kind of tradition means a lot more to Japan society than it does for some Western countries, I suppose. You can search for articles on "Japanese corporate bureaucracy" for different perspectives.

Not advocating treating people like shit for missing work once in awhile, just sayin'.

This feeds directly into the popular narrative that the working poor somehow lack moral fortitude. Do you have evidence to justify this claim?

Only 5 years ago I was working hourly just above minimum wage in a job I disliked. The management had a very strict tardiness and absence policy, and a strike system that meant if were absent without proper excuse more than 2 times in a 3 month period you were terminated.

I didn't exactly have a traditional support system while I had that job. Lived with some friends, but couldn't reach out to family or the like for help. That's how most people were at that job. Independent, but broke. Still though, the job was miserable. I think of myself as a work-loving sort of guy but I dreaded every day of it. So we all were absolutely looking for any way to get out a day. Even if it meant we didn't have a 40 hour paycheck, when you loathe your job it just doesn't matter. Maybe you'll not eat lunch or dinner for a couple of days - but at least you'll be free.

I used my hatred of that job to propel me into something more. A lot of people in those positions are held down by other forces which did not affect me. I hope they can find their own ways out someday.

I don't think people like that lack moral fortitude. Going to work is not inherently morally righteous. Nor is a perfect attendance record. But, in my experience, people who have bad jobs that they dislike will game whatever systems are available to get as much time away from them as possible - even if it hurts their financial bottom line pretty badly.

Absolutely mirrors my experience to a T. I wasn't intending to put a moral stance on any of this, but you did a much better job at explaining that.

When I was working minimum wage there was also the working poor: they needed every penny. If they called in sick you knew they were sick. If you asked them to work overtime they did their best to take it because the extra money was needed (they often couldn't find a sitter on short notice though). They didn't stay in minimum wage for long, their efforts were noticed and they were offered promotions to management (not all accepted because management often meant moving away from family, but in that case they still got maximum raises until they reached the top of the pay scale).

Note that many of the working poor got themselves into that position because of their choices, generally they had a kid at 16 and dropped out of school as a result (at best finished at the bottom of their class). They were failing to dig themselves out of the hole of their bad life choices because that kid takes the time needed to get a better education. In short they lack moral fortitude in that they were (and are...) sleeping around, but not in that they are not working hard for their employer.

The vast majority of teenage mothers in the United States do not choose to get pregnant and do not have the choice of terminating their pregnancy. They either do not have access to abortion providers - the majority of women in the United States do not have access to abortion clinics because of fundamentalist Christian activists and politicians: https://www.guttmacher.org/united-states/abortion/state-poli... - or they are coerced by their fundamentalist Christian parents into not having an abortion.

Teenagers around the US do not as a rule have convenient access to contraceptive pills. That's because the FDA refuses to approve them for OTC sale, despite their safety relative to many other OTC meds. The stated reason for refusing OTC sales is that allowing them would prevent women from seeing their doctors for other medical issues (this is also the reason you can't buy extremely useful and safe meds like Ondansetron OTC). I feel like I'm on firm ground when I add that this is unlikely to be the only reason you can't buy OTC contraceptive pills.

Meanwhile, about half of US states require parental consent for most minors before doctors can issue prescriptions for birth control.

As a fun additional wrinkle, churches, and in particular the Catholic church, run some of the largest hospital and health chains in US metro areas. Church-run hospitals routinely refuse to provide access to contraceptive services. In Chicago, the Loyola health system --- an otherwise well-regarded health services chain! --- won't prescribe contraceptive pills to adults even for non-contraceptive reproductive health purposes!

I don't think we need to spend too much time talking about Planned Parenthood clinics; the issues there are obvious to anyone familiar with the state of reproductive health in the US.

So, no, I don't think it's reasonable to argue that any teenaged girl in the US should be expected to be fully armed with all the tools of modern contraception.

You're also giving teenagers a pass for having unprotected sex as if they don't know there's a risk of 1) getting pregnant and 2) getting an STD.

Certainly some birth control measures are less accessible to teenagers, but what I'm arguing is the parent's claim that "The vast majority of teenage mothers in the United States do not choose to get pregnant"

That's not accurate unless what is meant is that "the vast majority of teenage mothers don't want to get pregnant (but choose to forego readily available birth control / condoms)". I'd believe that.

It's common knowledge how reproduction works. You have condoms, birth control pills and copper rings among other options.

That's simply not a reasonable argument. Don't move the goalposts now.

If you don't use a condom no matter what age you are and get an STD - same thing - that's on you too.

Your argument about post-conception options - I agree that not everyone has the same access. But I'm not talking about that.

Condoms work. Teenagers know the risk. They're just being dumb and it's on them.

Now - your argument that making birth control more available - sure I think that's a good thing too. But the notion that "the vast majority of teenage mothers in the United States do not choose to get pregnant" is irresponsible because almost all of them got pregnant by being wreckless while viable options are readily available. Specifically condoms.

(The comment I just replied to was edited extensively after I replied to it. That's OK; I said what I wanted to say.)

Under those circumstances, it's not surprising that teenagers have sex, don't know how to do so safely, and end up pregnant without meaning to. That is: a teenager absolutely can choose to have sex without choosing to get pregnant, simply because the society around them has conspired to make sure they don't understand how one leads to the other.

It's strategic: prevent women from accessing the tools and knowledge to keep themselves safe, then justify denying them rights "to keep them safe."

Things could be better, of course, and that's worth talking about, but your argument has turned into a caricature.

You also have minimal->zero private money and come from a poor background so it's too expensive. Your parents are religious and it's difficult to privately have & use birth control. Copper IUDs create pretty bad periods and are more painful to insert if you never given birth. Giving yourself a megadose of hormones with other implants is pretty freaky.

But your 16 years old and have a lot of hormones...

That is part of the reason why the entire obamacare free birth control fight was pretty emotional in the USA.

Wouldn't you rather call it the failure of a community - a society - to prepare its new members to the complexities of life?

Oh but it's easy to climb up the high horse, brandish the sword of Morals and throw the erring off the tower (incidentally, it's the same ISIS does to its own "deviants")

Religion comes into play because the lobby against making birth control available to teenagers is also the lobby against abortion clinics (and any clinics that offer health services and birth control to teenagers) is also the lobby to teach abstinence in schools (or not teach sex ed. at all), and that lobby gets most of its funding from religious organizations.

So, the slightly awkward week in sixth grade where my teacher gave us anatomy lessons and a birth video is something my daughter didn't get to experience, even though I brought my family back to my hometown. Instead, she gets the even more wonderfully awkward talk from her parents, which my wife likes to paraphrase as "your mouth won't get pregnant" (thanks Bill Clinton).

Teen pregnancy is not currently a common issue (it has been declining since 1990), but that doesn't mean it won't start going back up if we continue making it more difficult for young women (and men) to have access to birth control and education about safe sex.

We even had some discussion in school about how to reduce the risks of experimenting with drugs, though I don't think many people followed those directions.

Religion never worked great, but it was all they had.

You are looking at a problem with a simple and well-understood solution, and instead of talking about implementation you're going "Tsk, tsk, it's their own fault for being stupid." So, yes, you're absolutely moralizing.

> it's not some arbitrary religious code.

Giving teenagers worthless abstinence education instead of proven sex ed is the definition of an arbitrary religious code.

I carefully avoided passing a moral judgement on their acts. However the fact is sex at 16 immediately jumps into moral issues (not just Christian - most world religions encourage marriage). I did my best those to focus on the fact that as a result of that choice they have eliminated their ability to get a head.

YOU are the one placing moral judgement on their choices and trying to make it look like my judgement.

I don't buy for a second that being sexually active as a teenager somehow equates to lack of moral fortitude.

There's plenty of teenagers that are aware of birth control and use it appropriately. Do they lack moral fortitude, too?

Or put it another way, you cannot talk about kids having sex without everybody bringing their own different morals up. The two are very intertwined.

I never looked at it as pure spending money - it was mostly saving for an education and a start in my adult life. Might be why I'm one of the few of my generation that doesn't think the entire economy is stacked against them?

Edit:I did say _anyone_ in the past 20 years so that is some unfortunate hyperbole on my part

This doesn't make a lot of conceptual sense. If 100,000 people move into a town of formerly-3000, they will severely outnumber the open job slots from before they moved in, but that doesn't mean no work is available for any of them. Most of them will find work just as most people everywhere find work.

Work is available to anyone who can do something productive.

Some US based acquaintances recently discussed the college options and choices of their kids. A year at the cheapest college they discussed cost more than twice (tuition, without a room) as much as my German B.Sc. and M.Sc. combined: that is, 5 years of study (or longer - I decided to study part-time and earn real money in parallel. It costs little extra).

NOPE. More like they feel abused by society, so they rightfully abuse it back by taking as much as they can and giving as little as possible. Of course, the result is a vicious cycle they can't get out of: if you play the lazy parasite once, you do get some kind of "abuse" back (even if it's just passive-aggressive attitude from colleagues) even if you mostly get away with it and as we're all wired up to do you then have to "retaliate".

Of course, people who don't have a history of being abused by the system, eg. people who've had good managers, don't feel the need to abuse the system themselves, so no problem here.

And breaking an established cycle requires a great manager (hint: probably the one you're not going to hire, because it makes more business sense to spend more on legal, accounting, or even a developer...), assuming not very stubborn employees and no underlying mental issues.

Most socio econ systems fail because some people feel abused and abuse the system back. Abuse your workers well enough an you get, surprise, communism, when they abuse you back. Circle of life and all that shit...

(And don't get me wrong, I think it's good that a sizable percent of population is pre-programmed to "abuse-back", this prevents us being turned into a mindless remote controlled flock of sheeple... And I kind of think lighter collar "information jobs" people should learn a thing or two from the abuse-back attitude of blue collars because nowadays they tend to be sheepified too, and some "abuse-back feedback" would help the system!)

The poor have much less leeway in their lives. Sometimes, they need to choose between 'abusing the system' or e.g. dealing with a family emergency. Say your car broke down and you need to get it fixed. Do you call in sick and get it done or do you bus it until you get some free time when the mechanics are working?

What I've seen is that in the jobs filled by younger people with little skills on the worker side and near-exploitative conduct on the employer side, was a) a rather shallow loss function ("what if I lose this job? I'm underpaid, it's a dead-end, and I can easily get another job like this", that they often still live in their parents' basement exacerbates that effect) and b) a feeling of justification for these actions ("They exploit me, I'll exploit them back").

And those weren't simply rationalizations, so I'm not sure if it's a matter of moral fortitude or lack thereof, just of a different set of morals that (are understood to) underlie that type of job. There was a strong sense of moral in the people I worked with, just along other axes (eg. stronger loyalty between peers, but much weaker up and down the hierarchy).

Not really. Not every bad job is held by an oppressed proletariat. Many times they're held by mischievous PFYs who still think they're immortal and that $20 is a lot of money. Youthful indiscretions are one the most common sources of this type of behavior. It's extremely common to not have a professional attitude in your "first real job", or to not even consider most minimum wage jobs as a "real job". There's an entire genre of movies that relies on this culture. Slacker culture has been part of pop culture for decades, now. When you don't have any actual responsibilities it's pretty common to treat any new ones like a big joke, or as "suggestions".

And it doesn't just happen at work - there are people with extremely cavalier attitudes towards education. I had a conversation with my kid about other kids getting around attendance rules in high school by showing up to class and then "going to the bathroom" and not returning to class again. Skipping class to go smoke, race, shop, etc has been a thing for at least 50 years. It's kind of telling, though, that most slacker movies were about college-age (or younger) kids. Ones for adults (e.g. Office Space) are pretty rare and rather niche.

It's important that we recognize that professionalism is not a natural (or an exclusive) trait. Babies don't pop out of the womb screaming "Please advise." The teenage years are full of people pushing boundaries to learn how they fit into society. We expect mistakes at that age, and those expectations are frequently met.

I've literally met hundreds of people who blew off classes because they weren't the ones paying for it, or who called in sick after a hangover or because they didn't like their job. I've stood around at parties listening to people tell stories of how they ditched work. I had a co-worker call in sick because he "couldn't get his car out of the garage." And having six dead grandmothers in a year is a trope now. It's not everyone, for sure, but it happens. It's just that people do it less with the jobs that they value in the careers they've invested into.

That said, we do need a lot of labor reforms around hours worked, employee rights and privacy, cost of living adjustments, etc. And we need better safety nets for citizens. But those will always extend far more slowly to a job that can be filled by 90% of the population. The supply of entry-level workers far outstrips the demand.

> This feeds directly into the popular narrative that the working poor somehow lack moral fortitude. Do you have evidence to justify this claim?

I wouldn't be surprised if it's far more common among low-wage-job-holders that aren't poor, actually.

And I'd like him to elaborate on those, rather than make a broad generalization. Thanks.

It only takes a few people abusing this before it becomes a problem. At the same time, those who lack moral fortitude are more likely to have low-wage jobs because those are the only ones they can hold down.

So, the shitty people end up over-represented at the low-end of the job market, so those jobs need to consider them more.

Sure, I worked a lot of retail/physical labor/etc. type jobs in my younger years. I was out of the house at an early age, and took these jobs very seriously since they paid my bills. My co-workers for many reasons did not, at least a very significant minority of them.

I don't think it's really "out there" to say that the typical minimum wage worker is not as high quality as the guy 4 years in making $20/hr. That is reflected in their pay, after all. The folks I worked with were either generally reliable and usually job hopped quite a bit every 6-12mo for raises, or they were just workers who barely had enough value to not get fired. The latter were more common, in my experience. Despite what you hear on HN and elsewhere - there are a significant number of people who have zero interest in working, and only do so to pay bills. If they could sit at home all day doing nothing, they absolutely would. Working with them is not fun, and until I found the whole computer/on-line community thing (in the early 90's) I felt extremely alone spending most of my day with those types that had zero ambition to improve their lot in life.

And I think it's more of a "masses" problem - not necessarily class based. Maybe investment based. You likely don't really care much about your $7/hr job, at least a significant portion of people do not. That same is not as true for the $100/hr job. It's simply a filter.

You see the same issues in other "body shop" style white collar offices too. Even relatively highly paid folks like insurance call center workers have to be treated like children, or you'd have half the office call out on a friday before a long weekend. Been there, done that as well. I imagine Infosys and similar companies have policies that look very similar to someone like Walmart.

I'm obviously having trouble describing my thoughts here - but in the end I'd say it's something like professional careerists vs. a just a job. The latter there is very little skin in the game for the average employee comparatively - and those that have that motivation generally don't stay in that socioeconomic class very long. You see the same effects in any space open to various segments of the public. The higher your admission fee the less you have to pay for people destroying things. More skin in the game.

Edit: I think it's important to state these are generalities. The actual working poor tend to be by far the hardest working most reliable folks out there. If they had issues making it to work - it was usually something huge in their lives. The thing is though? These folks typically got promoted or much better paying jobs elsewhere, so it's again a self-selection thing. Sort of like stack ranking your employees and only the lower 50% get to stay in your company.

One other thing, is that minimum-wage jobs are often (not always) filled with entry-level workers. These are people who have never had a regular job. They don't know, or may have unrealistic ideas about the importance of being on time, showing up when scheduled, not taking random time off with short notice, etc. So policies are strict because many workers need to be "trained" about what to expect.

This effect extends thru the entire economy.

From observation its not that people who are poor have no ambition, they just have ambition in areas not involving getting lots of money from work or "reward" from management recognition. They want a happy family life, sex, be cool, get drunk often, ambition in all manner of things, just not into working 10x harder for 2x more money. I probably work 100x harder mentally than when I was a high school kid working at a supermarket and I barely make 10x as much money. For me working 100x harder is not a big deal because supermarket work is not exactly rocket surgery, but I can see a lower ability normie not seeing 100x harder work as achievable without excessive stress for them at their performance level, or perhaps being impossible for them. The "sit at home" under a UBI scenario seems incredibly unlikely. You might not agree with or appreciate the effort of "being cool" or posting high score posts on facebook or obtaining sex, but they will certainly sweat a lot of effort into achieving it. Playing video games is not very profitable but it is somewhat ambitious and takes a lot of effort.

To some extent a marketplace that doesn't meet the participants needs is a failure of that marketplace, which describes a lot of our labor system for a very large fraction of the population. Its not really their fault the system is irrelevant to their interests.

Eh, probably not. Some companies do it to everybody especially when they have an employee that they want to get rid of, but is in a 'protected class'. This so they can show HR and the unemployment commission they treat everyone equally and fairly. Unfortunately this leads to the average employee that does their job feeling they are being treated unfairly. The larger a company gets, and the more surface area the company is exposed to lawsuit abuse to, the more commonly these rules are applied to all people in an unfair manner.

Basically, you're right. The verification thing is invoked to provide convenient evidence to get rid of someone they already want to get rid of.

Trust only goes so far. If a company does not have good cost control and verification procedures, they can and will get robbed blind. Heck, the cash register was invented by a bar owner who suspected the bartender was embezzling in a blatant and ruinous fashion.

Why does it even matter why they take the time off?

Make a stupid policy, get a rational response from employees.

There are plenty employers who are willing to accommodate you if you have an actual DSM-diagnosed mental disorder but are skeptical of a "sanity day".

Likewise, there are plenty of employers who will let you take time off if you're actually chucking mucus across the room. But what if I just suspect my immune system is a bit weak from the long hours I've been pulling, and that going into work today is likely to trigger a cold? Or what if, in order to keep up with work, I've been drinking 8 cups of coffee a day and eating nothing but microwave meals because I don't have time to figure out healthier options? Technically, nothing prevents me from performing my job. It doesn't require a doctor's appointment, nor is there some illness that's easily verifiable. I'm not broken yet. I just have a hunch I'm breaking down.

And then there are a whole host of issues that might not qualify as "health issues" but are things I need time to deal with if you want me to function at my best later: childcare, DMV appointments, legal issues, car repair, etc.

There's absolutely something preventing me from doing my job on those days, by the simple expedient that I don't feel like doing it that day. If that doesn't happen more often than I have sick days, I don't see the issue.

https://en.wikipedia.org/wiki/Duvet_day

Though I do agree, that there's stigma towards taking it for personal sanity, mind healing.

At my job we get PTO and holidays (floating depending on the year), but no specific sick days.

Apologies for any naivete.

When I was at Yahoo, we had unlimited sick days (and my manager aggressively enforced that), but after this law passed they asked us to mark any sick days we took off to comply (still unlimited, but somewhat tracked).

You might try to make a distinction between contagious and non-contagious diseases, but it'd probably be unwise as often people don't know if they are contagious or not, and anyway encouraging healing isn't a terrible idea even if they aren't.

That said, you shouldn't be cheap on the vacation days either.

Why limit the amount of days your allowed to be sick? What happens if you are sick for more days than what your contract allows?

I would think that a finite amount of sick days will have the opposite effect of what you are describing. People will come to work even when they're sick, just in case they get even more sick later in the year. Except for the end of December of course, can let those unused sick days go to waste!

The number of days you are allowed to be sick is not limited; the number of days of paid leave to deal with being sick is limited.

> What happens if you are sick for more days than what your contract allows?

Depending on the nature of the illness and other factors, you may be eligible for unpaid (by the employer), job-protected leave under FMLA or similar state laws, and may be eligible for disability payments during that leave under state law. The employer may, even if that law does not apply, extend paid or unpaid leave beyond what it is committed to in your contract, but is under no obligation to do so.

They threaten to fire you for taking too much sick time, and they don't pay you for the additional days. They complain that you aren't reliable enough and that they need someone who is reliable.

https://www.sciencedaily.com/releases/2013/06/130613161831.h...

It is nice to never actually need to provide a reason/note to be out, but I think the combination does stress some of my coworkers (e.g. "I don't want to take vacation because what if I get sick", "Oh great, I'm sick, now I can't take vacation").

[1] http://d3i6fh83elv35t.cloudfront.net/newshour/wp-content/upl...

We have 6 holidays + 1 floating that we can use, and they don't roll over from year to year.

Why wouldn't they be? I assume they're mandatory in most countries.

Sickness is just part of the cost of doing business with people, not robots.

Wow. O.o

So in US employers just whip sickly people into coming to work or how does that line of reasoning work?

http://polishemploymentlaw.com/index.php/tag/day-off/

You shouldn't feel guilty at all. They should feel guilty for making you need to take that day off.

Your workplace should be a refuge, where you charge your batteries and build sanity. Not a constant drain on those resources.

That's a refreshing perspective, I haven't thought about it like this. Indeed, when you're solving tough problems, you'd better concentrate at the private office (which is nowhere to be found, so work from home it is), and the workplace is the place where you go to discuss your difficulties with colleagues to broaden your perspective, and ask senior ones for practical advice. Makes perfect sense.

My co-founder was relentless in applying guilt and pressure while I vomited for years for weeks at a time - multiple hospitalisations due to severe dehydration. He denies that mental health is even a thing.

So - it's not just an employee thing - even business owners can be severely impacted by uncaring colleagues.

A year out of work and I haven't puked in eight months.

My work requires a medical certificate for certain situations. No exceptions.

Sometimes it's easier for me to simply turn up to work sick for a day, than try and get a cert.

I'd feel worse about doing this, but I am pretty sure other people do this too.

And it's an open plan office of course, so diseases just spread through the office.

You should simply get a large pool of personal leave that accrues and you can take it when you need to.

Good luck mate!

I am happy to report I left that position after 13 months, but consider the plight of the skilled tradesmen who work under those conditions and do physical labor. I was just sitting at a desk programming.

Well that and even the bosses are ready to acknowledge that the job people are paid to do sucks at least sometimes. Many industries and businesses pretend that that's not the case.

Mental illness does not have to be severe just as physical illness does not have to be severe.

Sick leave policies typically only require a doctors note/visit if you are absent for multiple days.

Taking a single day off for mild mental illness, something like elevated stress levels causing anxiety that interrupts your sleep, seems perfectly consistent with most of the corporate sick leave policies I have read.

First, "sick days" generally are a policy for handling acute disorders; e.g. last week I didn't have disease X, today I do, and next week I'll be healthy again. You can't "wait out" a mental disease; taking a day or two off may reduce elevated stress levels but that is not the disease, the underlying problems aren't going to be solved when you come back.

The second issue is that many common physical issues are contagious, and there's a strong benefit for the employer and the society for sick people to "quarantine" themselves instead of going to offices and infecting coworkers and customers.

Mental diseases generally all are chronic and not contagious, and so they're similar in workplace (mis)treatment to things like arthritis or diabetes complications; things that don't map neatly to "x days to get cured" but instead need ongoing maintenance and unscheduled downtime forever.

In the UK time off to manage a long term condition could be justified as a "reasonable adjustment" under the equality act.

I am a proponent of taking time off for mental health, but I have to nitpick here. Medically speaking, physical illness is different from mental illness. One is diagnosed from objective scientific tests (pathology) while the other is not.

[1] Source: medical school. Not finding a study with exact numbers from a quick search. [2] https://www.nature.com/nm/journal/v23/n1/full/nm.4246.html

There are objective tests for all of these pathologies, though those tests are often inconclusive in the face of the symptoms.

>If you don't think there's a physical basis for mental illnesses though, skim through the figures in this article[2] for a prime example of the ways modern medicine is disproving that.

There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM.

https://en.m.wikipedia.org/wiki/Allen_Frances

Nothing good, sadly.

My wife was in banking for twelve years and worked her way up from a teller to a fairly senior position. Her work ethic was spectacular - she had just two sick days in the previous five years and she was promoted almost yearly, always receiving an excellent review.

A few years ago, she went from having occasional discomfort to waking with fairly severe pain daily. It got so bad that she had to take time off, and eventually took FMLA for a full twelve weeks to see if it would help. It didn't and she was fired soon after.

She filed for disability after being diagnosed with Fybromyalgia. Our lawyer sent her to bother specialist doctors and independent testing labs to get complete documentation. They had her complete various tasks like screwing in a screwdriver, raising a weight above her head for X seconds etc. and then asked her to rate her pain levels and other self-reported things.

In the end, she was denied for disability, mostly because disability is no longer about actually being disabled - it's now about essentially filling the gap between welfare and medicaid. In the written opinion however, the stated reason was that all the evidence was self-reported, implying she could be making it all up (because who wouldn't want to give up a successful and lucrative career for some minimal-level disability payments).

Anyway, I learned two main things:

1. There are no commonly accepted objective tests for pain - it's almost all self-reporting.

2. The disability system in the US is heavily used as supplemental welfare.

No, objective tests are in these cases used to exclude other causes to the symptoms, not to diagnose the mentioned illnesses. These are diagnoses of exclusion[1].

> There are physical symptoms of mental illness, but as yet there is no proof of physical causes, which is why the chairman of the Department of Psychiatry at Duke University School of Medicine and the DSM-4 stated "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests". You'll find no objective biological tests in the DSM.

I'm not disputing the fact that it's not possible to do pathophysiological tests for mental illnesses in current clinical practice, but you're creating a false equivalence by implying that being unable to test for a pathophysiological factor is the same as that factor not existing. There are plenty of pathophysiological changes that occur in mental illnesses [2-4], but for obvious reasons it's not feasible to haphazardly take biopsies of the brain to test for them, especially when the patient history and subjective examinations suffice to make a diagnosis in most cases.

Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms.

  [1] https://en.wikipedia.org/wiki/Diagnosis_of_exclusion
  [2] https://en.wikipedia.org/wiki/Mechanisms_of_schizophrenia#Pathophysiology
  [3] https://en.wikipedia.org/wiki/Biology_of_depression
  [4] https://en.wikipedia.org/wiki/Causes_of_schizophrenia

It is feasible post mortem but scientists still have no conslusive proof from such examinations.

>Conversely, my point still stands that the vast majority of somatic illnesses are diagnosed off subjective symptoms - doctors don't bother doing objective lab tests for a cold or a sprained ankle when the diagnosis is glaringly obvious based off subjective symptoms.

That is not in dispute because a cold and sprained ankle are objectively diagnosable post mortem. Mental illness is not.

Oh, and you kind of can diagnose certain mental illnesses post mortem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181616/

No ones knows for sure because no one can objectively explain the nature of consciousness and the mind in the first place. That is of course not to say that chemicals do not have a strong influence on the mind.

>Oh, and you kind of can diagnose certain mental illnesses post mortem: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181616/

The study has no control group and therefore is not objective. If you read the Methodological Issues section, you'll see that this is essentially a study of the neurochemical effects of antipsychotic drugs.

True, but I'm still waiting for a single proposal as to where a mental illness would subside other than physical structures/molecules, because the only other explanation I can think of are in the realm of the metaphysical

> The study has no control group and therefore is not objective. If you read the Methodological Issues section, you'll see that this is essentially a study of the neurochemical effects of antipsychotic drugs.

The article isn't a study/original research, it's a review based off of existing research - generally - in which brains from individuals with schizophrenia are compared to the brains of individuals without schizophrenia (controls). Antipsychotic drugs as a confounding factor is definitely an important factor in these studies though. There are however a number of factors that are are not affected by antipsychotics, notably genetics[1, 2]. Certain genetic variants strongly increase the risk of mental illnesses - by what mechanism does this work other than by translating to proteins that exert an objective, physical effect? (Note that studies on this are primarily GWAS based on large populations, not simple hereditary/familial studies in which one could argue that environmental factors were confounding)

  [1] https://en.wikipedia.org/wiki/Causes_of_schizophrenia#Genetics
  [2] https://en.wikipedia.org/wiki/Bipolar_disorder#Genetic

Isn't this just because we don't actually understand medical illnesses nearly as well as we understand physical ones in general? I don't we actually know that there is anything innate about mental illness that makes it different from physical illness in this sense. That being the case, mental illnesses are just like those physical illnesses that we have yet to understand as well no?

Please correct me if I'm misinformed as this is a topic that I am very interested in.

These tests take a measurement and based on peer-reviewed statistical studies make a determination as to whether or not the measurement falls into a pathological range.

This is exactly the same as measuring blood pressure or cholesterol. You read a number and decide if there is a statistically valid correlation between that number and an identified disease.

Subjective: based on or influenced by personal feelings, tastes, or opinions.

Objective: (of a person or their judgment) not influenced by personal feelings or opinions in considering and representing facts.

What is the difference between being schizophrenic and having the "opinion" that Satan speaks to you through your neighbor's cat?

Mental illness is defined by what a person feels and believes.

What you feel and believe is subjective but you can objectively establish that a particular cluster of subjective feelings and beliefs is abnormal vis-a-vis a populate.

Then when you ask people the same questions and their cluster of responses fits the abnormal definition you can objectively say that they have a mental illness.

The objectivity does not come from the doctor observations or patient self-survey, it comes from the study that created the questions and proved that a certain score or cluster of responses is statistically abnormal.

Honestly, a lot of the time it comes down to observable impact. If a patient comes to a doctor and says that they feel depressed, that's one thing, if they have lost their third job this year because they can't do anything but lie in bed and seem to not care about their own lives (especially if they used to not be like this in the past) that's something else.

How do you objectively verify "manic"? You can track hours slept. No one fakes sleeping two hours a day for a month while having, say, good motor skills in the daytime.

This matters because recurring brief hospitalization is necessary for some people to get back on their axis. This is NOT "sanity days" or "mental healing", it's a clear cut medical issue.

Not all “physical” (the term is not really the correct distinction, since all illness, including mental illness, is physical) illness is diagnosed directly in that manner (not all physical illness can be, because not all is understood well enough to have definitive tests, and it's not always clinical practice to do so even when it is possible in principle.) And, on the other side, some psychiatric conditions have lab tests of the same sort available.

Which ones?

"psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests" -Allen Frances

https://en.wikipedia.org/wiki/Allen_Frances

See, e.g., http://www.thedailybeast.com/can-a-blood-test-diagnose-menta...

>Diagnosis is based on observed behavior, the person's reported experiences, and reports of others familiar with the person...As of 2013 there is no objective test. [5]

https://en.m.wikipedia.org/wiki/Schizophrenia

Edit: the source you edited in simply states the corollary to what I've been saying all along: that scientists are still searching for a biological test for mental illness but as yet still do not have one

https://www.scientificamerican.com/article/can-brain-scans-d...

I'm sympathetic, but don't make the discussion worse by throwing falsehoods like this around.

Besides the fact expressed by others that physically illness is more diagnosable, you typically don't get mentally ill from being in proximity to a mentally ill person. (At least, I never have.)

Physical illness is a different situation. That's why my workplace offers near unlimited sick time for this reason. As much as we'd love you have to working, we don't want your diseases.

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(Granted, having an anxiety attack in the middle of work may not do wonders for the mental state of your coworkers, but blithey asserting this "no different" is dubious at best.)

You also don't get physically ill from being in proximity to someone with a non-contagious disease or a sprained ankle, so that's an irrelevant distinction.

Sick days are not just for flus and colds that are contagious...

Agreed. I meant to mention that.

> so that's an irrelevant distinction.

Flus and colds are by far the most common uses of sick days, so I wouldn't say it's "irrelevant."

Contagious diseases (and, a fortiori, those that are contagious on casual contact) are a distinct subset of so-called “physical” illness.

You don't get cancer from being in proximity to someone with cancer, either.

The disease itself is a delusion, regarding microscopic fibers in the skin. Sufficiently impressionable people simply hear about it, convince themselves that they have it, then they go on to try to convince others that it is a physical ailment rather than a mental illness.

If you are politically incorrect enough to classify religions as mental illnesses, many of those appear to be contagious as well.

But on a smaller scale, workplace morale is definitely infectious. If someone is having a particularly stressful day, they may be rude to someone else, who then feels worse as a result, and may propagate that to yet another co-worker. Of particular interest is that such transmission need not take place in person. A person with a common cold could work from home to keep everyone else from catching it, but someone with malaise or anxiety could transmit that via any medium that can include emotional undertone, such as a voice or video call.

Enter the Internet. Now all the susceptible people can aggregate around their own forums/boards/podcasts/groups/subreddits and infect each other with their unique strains of madness.

There's no more herd immunity, because all the susceptible people can find each other instantly.

In the sense that you can go to a doctor, get diagnosed, get treatment, get that treatment paid for by an insurance company and get legal protections under laws applying to health care they are "no different."

Since we are talking about how corporate HR policies apply to mental health and not the philosophy of medicine I would argue that these are the similarities that actually matter.

I tend to agree with you, but the concept of "contagion" is widely used in mental health settings. Self harm, or suicidality, can be "contagious".

Waiting until the worst happens isn't sustainable and just makes things harder to recover. Perhaps burnout isn't just simply mental but a larger, systemic degradation of the body.

That sounds pretty standard in any contract here in Denmark, and we have some very strong unions which have created good conditions for employees. I personally think it's fair for the employer to ask for a doctor's note if he/she thinks an employee is skipping work just for the hell of it. Though said unions have made it so that the employer has to pay for the doctor's note, when they request it, so it happens rarely.

On my particular team, we can call in day-of often, if we don't have imminent deadlines or important meetings. "Hey, not feeling good, PTO". No one questions it. It's not abused, in that I have never felt it impacts the team's work.

And I guarantee I've used it for sanity days, especially recently!

It means that I cannot simply take care of myself, but that I have to go to a doctor and have them tell me that I'm sick and to do the things that I'd have done anyhow, like get plenty of rest and take some Nyquil at night.

The end result is that I almost never take 3 sick days in a row, even if I'm really sick. I end up coming to work, getting others sick, and getting nothing done. (Or worse, doing damage that I later have to repair before I can get work done.)

The alternative is PTO, which is usually worse because sick leave gets mashed with vacation.

The problem is that this scenario is socially viewed as my foult or being irresponsible; I should have seen to it that I got good sleep. If I slip off of my porch and hurt my back no one questions me not coming in; No "You should have used the handrail" or "maybe de-ice your steps regularly"

Mental illness is a real thing, it is not just "I don't feel like going to work"