My Senate Hearing on Guilt

This past week I have been really thinking about how to rid myself of the guilt I feel for not working and relying on disability payments from my work to take care of myself. I have been off work for more than 4 years now due to my depression and it's symptoms. I swear everyday I feel bad about not working, about not getting better so I can get back to work, about collecting money for doing nothing, for being a drain on society in this way.

So in my session today I tried to get rid of this obsessive guilt once and for all...but the guilt is so huge...it is unreasonable to assume getting rid of it that easily is possible.

However, my pdoc used a good metaphor for working through this problem. He said there were varying opinions in my "senate" about the best way to deal my guilt and the factors contributing to my guilt. So we spoke of having a hearing and giving voice to all those opinions so I can see everything clearly defined and then vote.

Factors contributing to my guilt:

1. I have a strong work ethic and I want to work. In fact I have never not worked since I was 15. When I am well I love working and feel good about contributing.
2. While I can see other people on disability because of similar symptoms and accept that it is okay, and in fact beneficial, for them to not have the pressure of working while they are trying to recover or become well; I think I should be able to work despite my illness. (Don't ask...even I don't understand how/why I can feel this way).
3. I know that it took 2 years of coaxing and coaching from my pdoc in order for me to feel I could leave work to take care of myself. I also know that when I finally got the courage to leave work to save myself, I was the closest I have ever come to committing suicide. Still, there is a part of me that thinks it was just too convenient that I was able to leave a high stress job that was killing me and still be receiving money.
4. I have a very black and white view of what is considered work..."being off disability, and making enough money to take care of myself" ...volunteer work is not work...I need to make enough money to feel safe.
5. I know, that even if I become well enough to work again, I will never be able to return to my employer's workplace. The work and the company is just too stressful and competitive for me to stay and remain well while working there.
6. Although I enjoyed the teaching aspects of the job, I felt a complete and total disconnect with the moral structure of the organization. Everyday I went to work I felt like I was doing and being the opposite of who I believe I am. This destroyed me. I require a job that is meaningful, purposeful and fundamentally in line with my belief systems.
7. If I know I cannot go back, then I should resign. If I do not resign, I am not telling the whole truth and am receiving money under the pretense that I will go back to work when well.
8. I worry I am not getting well because of this existential nightmare...Maybe because I hated my job, I got sick because of that, and I remain sick because I am afraid I will be forced to return to the job I hated.

If I feel so guilty...why not quit my job and discontinue my disability payments?:

1. I worry that I will quit to relieve my exitstential angst and guilt...and it won't help. I'll still be sick and in an even more stressfull situation...(i.e. sick, unable to work, and have no income). I honestly cannot handle getting more sick than I already am.
2. My symptoms are as bad as when I left work...intense anxiety, suicidal ideation, mood cycling up and down, fatigue, lethargy, amotivation, irritability, agitation, difficulty concentrating/focusing, memory problems (ECT related? depression related? and/or often medication side effect related....remember Epival? Benzodiazepines?), poor sleep.
3. So far my depression and its symptoms have remained treatment resistant to all therapies and medications... and I've tried tons...Antidepressants (SSRI's, SNRI's, Novel Anti-d's, Trycyclics), Mood Stabilizers Anticonvulsants, Antipsychotics, sleep medication, Benzodiazepines, and stimulants, weekly/or twice weekly therapy, hospital stay, ECT, outpatient day program, group therapy...etc., etc.
4. If I am still sick, but I am continuing to try to get well, but nothing is working...is that my fault?
5. Isn't the disability insurance there to protect me when I am ill and unable to work?
6. What if I never get well, or it takes years more to get well...I need to eat and pay for my rent. If I just give up disability and do not become well enough to work I will run out of money and end up mentally ill and living on the street.
7. I am trying...so why do I feel bad about feeling too sick to work?
8. My pdoc, although he said it would be a powerful decision for me to make, said it would be rash to call up the insurance company and cancel my insurance given the symptoms that made me leave work are still with me.

What are my options?

1. Resign from my job, lose my benefits and my disability insurance...I think this would be the dumbest move. It may relieve the guilt, but I can see it would increase my anxiety about not being able to care for myself, and my frustration with not getting well/ or even better, in a timely manner. I think overall, this would destabilize my mood even more.
2. Return to work while still in a MDE and unstable...I would kill myself.
3. Continue on disability leave until my pdoc/ or my self decides I am well enough to return to work, and then resign and look for another job. Note: If I choose this option...I have to know I will be able to do it "guilt-free" and accept I am sick, this illness is disabling, I have disability insurance for this very purpose. Accept that.
4. Phone the insurance company and tell them I will not be able to return to my workplace regardless of my health and ask if their is any provision for retraining into another occupation. (maybe Dr. X. would help me call, or meet with an insurance representative?). Note: If I choose this option I still have to be well enough to learn another occupation. I have been practising with my volunteer work, but even with the work I love to do I have been plagued with symptoms. Also, the stress of making commitments and then being unsure if I will be able to follow through is overwhelming.