The Illusions of Supplemental Security Income, from Someone Who Knows

I've looked at SSI Disability from both sides now, from in and out, and still somehow it's the scammers, the duped, and the resentful I recall.

I have been involved in hundreds of SSI Disability cases.  I have worked in the system providing mental status exams, called consultative examinations, in two states.  I have done dozens of private psychological evaluations for people trying to get on Disability rolls.  I have sent reams of case notes and reports to the Disability bureaucracy on behalf of therapy clients.

There have been memorable examinations.  One was of a sassy prostitute.  She said she worked for an "escort service," but it seemed important to her that I know the full range of her proficiencies.  Her claim for SSI was based on major depression, but she seemed in high spirits to me -- or, as we say, "affect contraindicated mood disorder at this time."  I think she was just getting a little long in the tooth for "claimant's customary employment."

I have interviewed foul-mouthed teenagers whose mommas thought they could shake a few dollars out of the system on the basis of "oppositional-defiant disorder."  One 17-year-old was memorable because she came with a baby on her hip.  Without the sophistication or coaching to understand what kind of money she was trying to get, she told me with more than a hint of hostility how smart, empowered, and free she was to do "whatever the f-" she wanted.  I asked her, "Do you know what the word 'disability' means?"

Another fellow came in rather irritated.  He resented being examined in his current state of residence, South Carolina, because doctors in the state where his back injury occurred 15 years ago "know my case."  He was unusually fit for his age.  He worked on a golf course and wanted to know how much he could work and still keep his Disability payments.  I asked him, "Are you sure it's best for your recovery that your medical care for your injury is in West Virginia?"

I did SSI Disability evaluations on men recently released from state prison.  Who is not damaged by eight years of hard time?  In fact, it was the "feedback" of one such applicant that convinced me to get out of the business of those evaluations.

As a psychologist, I evaluate only mental condition.  I learned a long time ago to watch how clients behave in the waiting room or parking lot when unaware they are being observed.  People who were sitting upright, reading a book or magazine suddenly must lie completely prone in my office.  People who were joking with the receptionist a few minutes earlier can't take a breath for the sobbing.  I used to say to such applicants, "I understand you feel depressed, you didn't plan to be in this situation, but there will be some time today when you're not crying.  Let it be this half hour so we can do a good evaluation."  So 20 of the 30 minutes she's sobbing.  Then I watch from a side window as she bounds outside and into the Escalade for the "How did it go?" conversation with her boyfriend.

A poignant case was of an exploited young man whose politically connected mother got him on Disability for "bipolar disorder" when he was 17.  He earnestly pursued his assigned career as a mentally ill person for 10 years, turning his checks over to his mother.  It took six months of therapy to help him understand that he had gone through a rough patch in adolescence but that he did not have bipolar disorder.  As we brought his brain out from under a rockslide of medication, he began to think about what he could do with his life.  It took several years, but he eventually broke free of his illusion of incapacity and became a successful medical technician.  SSI Disability is meant to be a path back to employment.  His was the only case I saw in which the Vocational Rehab program was actually used for self-rehabilitation.

I have seen SSI Disability from both sides now.  I worked with an Iraq War veteran who was as completely disabled as anyone I had ever seen.  He had an obvious traumatic brain injury, was in a wheelchair, had undergone numerous orthopedic surgeries, and had a nonworking spinal stimulator in his back.  His neighbors ratted him out to the government when they saw him on his boat.  He wasn't angry.  He said, "Dr. Tyler, it takes two people pushing on my butt to get me on that boat."

Many of the Disability cases I've worked, on either as gatekeeper or as therapist, involved people in their 40s and 50s who had the typical health issues which accrue as a part of life.  They came to the Disability program after being thrown away by employers.  With no possibility of regaining their previous income, they turned to SSI Disability.  I worked with one woman who had been molested as a child and had significant emotional problems.  Nevertheless, she held a master's degree and had a successful 20-year career until she was replaced by a younger worker.  Corporations cannot openly discard older workers on the basis of age, so in the new economy, a gold watch often comes in the form of a blast of disparagement on a performance appraisal.  This client wanted to continue working and looked for another job for a year.  When she found out her son was going to be a father, she agreed to take care of the baby and focus on getting SSI Disability.

Advances in workplace and medical technology have reduced the number of people who are unable to work.  For that reason, SSI Disability rolls should be shrinking rather than exploding.  The illusions of disability are tearing down middle-class morals and values.  They are undermining individual and family responsibility and building in a payoff for temporary, treatable health problems to become permanent conditions.  Millions of middle-class people are forfeiting the moral code that honors work, and they are being deprived of the self-respect that comes from doing their best.  They are succumbing to the "government handout" mentality.  The forces destroying the free-market economy are also served by the illusion that Americans are too sick to work.