Managing Mental Illness in Graduate School: Some Recommendations (A Guest Post)

In January, I posted a request on Facebook and Twitter for resources related to mental illness and academia.  I had been contacted by a reader recently diagnosed with bipolar disorder, who was seeking information.  The response to my request was greater than I expected, and many expressed a wish for a list of the resources I discovered. I eventually compiled such a list and posted it on the blog in this post, Mental Illness and the Academy.  I also asked for guest posts on the subject.  I feel it’s important and yet too often shrouded in secrecy and shame.  Today’s post is the first guest post in the series. I expect at least one more. Thank you, reader, for your willingness to share.

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Disclaimer: Every experience with mental health / ill-health and graduate school is different. Diagnoses and graduate programmes vary but, beyond that, some people begin graduate school with well-known and managed conditions, while others have disruptive periodic episodes. Some, like me, are first diagnosed as graduate students and experience the two journeys in tandem.

Near the end of the first year of my PhD I got sick. First came bronchitis, and then came something a lot more frightening and much harder to understand. I didn’t have the vocabulary then, but I’d later come to know that I was experiencing panic attacks, dissociation, elevated anxiety and symptoms related to post traumatic stress. On the one hand I’d just won a major national scholarship and was receiving a lot of public recognition. On the other I was frequently terrified, incredibly forgetful, and easily confused. I would feel detached from my surroundings, sometimes for days, and then would sleep excessively to recover. Fortunately, my worst symptoms fell over that first summer, when I had limited responsibilities, and as far as I’m aware no one noticed.

After a few attempts, I was very lucky to find appropriate care and began the journey of managing my health. I was able to finish coursework on a regular schedule. I could pass for healthy even if it took a lot of effort to do so. I’m very aware that this is not an option that is available to everyone.

Graduate school is a mind game for anyone. We all know the daily feat of trying to motivate ourselves to keep going, to produce more, to be more competitive. To quote Dr. Seuss it is “a game that you play against you.” With a mental illness, it’s understandably more complicated. My brain’s abilities may vary, but as a person I’m still an over-achiever who isn’t satisfied with “good enough.” It’s hard to isolate precisely the impact of my mental health conditions on my academic life. Would I have finished faster, published more? Yes, undoubtedly yes. But how much more?

My experience is one that is rife with contradictions. I became an advocate around mental health before I got sick. I’m involved in campus-based mental health advocacy on campus but I’m also not open about my own situation in an academic context. I understand the problems that this entails – I’m not putting a face, my face, on mental illness. Why? Because I fear the stigma and I want to get a job. Am I shooting myself in the foot? Possibly. I wonder this when I consider why I didn’t pursue academic accommodations, and when I’m faced with an employment equity form with a job application that asks about mental health conditions. On the one hand, I think my situation isn’t severe enough to merit this, and these provisions perhaps weren’t intended for me. On the other hand, I do live with an ongoing health condition that I feel I can’t disclose professionally. As a result, I don’t receive any acknowledgement of that struggle. The decision to disclose is not a simple one.

My university has made significant strides towards acknowledging student challenges around mental health and clearly takes the issue very seriously. Where undergraduates may have a variety of services, however, these are often replaced at the graduate level by a single person – the supervisor. In a lot of ways this makes sense, as we work very closely. However, it can be daunting to discuss your mental health with the person who reviews your work, writes the letters that help start your career and who may also provide your funding. Additionally, counselling services are sometimes staffed by graduate students in psychology, and group counselling programs mix undergraduate and graduate students all of which can be pretty uncomfortable to a TAing grad student. Leave policies are rigid, and disability accommodations are oriented towards course work rather than thesis work. Even where services are available, unless they are specifically labelled and targeted to grad students, grad students also often assume that they are only for undergrads.

Now that I am nearing completion and on the job market, there are a few recommendations I’d make to myself in hindsight and to others in similar situations. Based on numerous conversations with other grad students with mental health conditions I also have some recommendations for departments and universities.

Students:

  • Seek health care as soon as possible. There may be a waiting list and seeking care also provides a paper trail if you ever need to document your illness.
  • Find out what resources exist on campus and what the provisions for leave (and what sort of documentation you might need) and disability services.
  • Take leave when your symptoms are severe. This didn’t seem important to me in first year, but now that I’m running up against the clock having those 4 months would be helpful.

Departments:

  • Cover mental health as part of your grad student orientation.
  • Bring in campus-based resources as part of orientation if possible.

Universities:

  • Make leave an accessible option. Policies that require leave to coincide precisely with term dates may be unrealistic for episodic illnesses.  If possible, allow students to take leave and not lose all financial support (or health insurance) during that time.
  • Consider having targeted grad student mental health services (ie specific therapy groups and expertise).
  • Have personnel located outside of departments that can provide grad school, job and career advice (similar to undergraduate faculty-level advisors).


As for me, my journey is ongoing and I’m still aiming for an academic career. Alongside my degree, I’ve learned a lot from my experience with mental illness (and, I’m sure still have a lot more to learn). It has taught me about vulnerability, resilience and forgiveness and has shown me how fortunate I am to have the people in my life that I do. It has also given me both sensitivity and admiration for my own students who choose to disclose to me.

About Karen

I am a former tenured professor at two institutions–University of Oregon and University of Illinois at Urbana Champaign. I have trained numerous Ph.D. students, now gainfully employed in academia, and handled a number of successful tenure cases as Department Head. I’ve created this business, The Professor Is In, to guide graduate students and junior faculty through grad school, the job search, and tenure. I am the advisor they should already have, but probably don’t.


Comments

Managing Mental Illness in Graduate School: Some Recommendations (A Guest Post) — 20 Comments

  1. Thank you for this post. I had a very similar experience with an anxiety disorder in grad school. I’ve come to realize just how prevalent such mental health problems are for grad students. I was feeling very self-conscious about being on medication, and one of the profs commented to me ‘don’t worry, we’re ALL medicated’, which is a rather alarming statement about what it might be about the academic environment that fosters certain types of mental health issues.

  2. Dear Guest and Karen,
    I say again what I posted on the last piece. What about the ADA? We have a saying in the Disability Office, Do you want to work harder? or Smarter? Your comments and reasoning about not approaching the DSS office are common, based on false assumptions AND a form of denial. Everything we do is confidential, you do not need to provide any health information to your supervisor unless you choose, and sometimes that is good others it is bad. but let us help you with the decision. Nor do you have to wear a t-shirt like in the tv commercial with famous folk and their kids or siblings or neighbors.
    As a DSS office one of the more common ways I meet students/staff is when they are in the middle of a crisis like failing out or being suspended or up against some rigid policy with a timeline or past extension. I can not help you with the past, only with the present if/when you come in a start the DSS procedure. When the shit hits the fan is not the time to turn to the ADA/504 regs, by then it is to late. Don’t be late!

    Greg

    • Dear Greg,

      Thank you for taking the time to write this comment. It is an important message. I am not fully familiar with the ADA as I am outside of the United States, but this sounds like very valuable information to make clearly available to grad students there.

      My purpose in describing my difficulties around disclosure was not in any way to argue I made the right choice, but to shed some light on how this process can be a significant struggle.

      Again, thank you for your comments.

    • Greg, I appreciate your comments encouraging folks to use DSS services and to request accommodations when needed, but I understand why many do not. (The original poster recommending going to DSS, so I’m not sure what you referred to as false assumptions.)

      I’m a graduate student and I was recently diagnosed with ADHD, so I’ve been looking into campus resources. The DSS office was quite caught off guard by my request for help with the dissertation stage, since the accommodations they offer are generally related to discrete course-based tasks. They’ve arranged for me to meet with the one person in their office who has a PhD and is familiar with the dissertation process, and hopefully she will be able to help me apply new ADHD-related strategies to dissertation progress. (I don’t know that dissertation experience is really necessary for helping me, but I’ve been talking to mental health professionals for years about my writing struggles, and the first person to recognize ADHD features was someone with a research-based degree.) That is a wonderful resource and I’m enormously grateful for it, but the other accommodation I really need is time–time to put this new information to use and write the dissertation I’ve been floundering with for years. Just to request that accommodation, an extension of my deadline, which is ultimately the dean’s decision, I’ve had to to inform: my committee members (to see if they are willing to continue with me if I get an extension), the director of graduate studies, the department chair, and the graduate recorder within my department–that’s the minimum simply for processing the request. After that it will go to the College, and then the Graduate School. While technically I could have let them know in vague terms that I have a health issue or a disability (suddenly after they’ve known me for all these years), that would just raise more questions and probably be less helpful than disclosing the specific nature of my challenges. So whether or not I end up receiving accommodation, I will have revealed this personal detail of my mental health to the same chain of people who will judge my dissertation and, whenever I do graduate, be my professional colleagues for the rest of my career. Any one of them would recognize my unique research topic in an anonymous review. These people are spouses, roommates, research partners, and rivals of other people in my department and field. And since professors rotate in and out of administrative positions and are also/otherwise peers, there is often no practical veil of privacy between “chair” and “professor” among faculty. I’ve already had to start my request over from scratch with a new director of graduate studies, outing myself to yet another person in my field. So while I trust that the DSS office will not broadcast my secrets, and I hope that the faculty will not mention it to their besties when it’s time to appoint teaching assistants for next year, it’s disingenuous to dismiss the very real concerns people have for the consequences of seeking help. I already had to get over the anxiety of facing my students in the waiting room of the counseling center (which happened) and the DSS office. Now I get to do it before senior and junior scholars and hope for stigma-free attitudes when I ask them for letters of support for grants and jobs, while I’m still grappling with my own sense of stigma about this diagnosis.

      I realize my experience is particular to the ABD stage, but I’d imagine similar issues for teaching and research assistants and those taking courses as well. The relationship between the graduate student and the person who will ultimately be asked to make accommodations–whether for tests, teaching, or something else–is significantly, structurally different from the relationship between an undergraduate and an instructor. So I’d also encourage graduate students and faculty to find and use the available resources. But there is a lot at stake, and as the original poster said, it is not a simple decision.

      • I agree with this post this happened to me before the dissertation phase in my 3rd year and now faculty know. I don’t even want to think about what’s going to then happen at the dissertation phase… Yes the DSS office won’t broadcast everything but the system is set up do that eventually it forces you to do that yourself..

    • Greg – I so wish you were part of the Disability Services department at my University! I was just diagnosed with Depression this spring, during the middle of a few family crisis situations that hit at the same time, but as I look back now, I have probably been fighting this for a long time. After I started to wrap my head around my diagnosis, I went to Disability Concerns – everyone there is very nice, but I don’t think they know what to do with someone in a doc program. The process of “qualifying” for services is so hard- I have been trying to get the appropriate letters that say the correct things since May, and in Aug I still am in limbo.

      Today, I had an appointment with my adviser but was ambushed by the grad coordinator who felt she needed to sit in. This person informed me that I am not making adequate academic progress and am to be kicked out of the program starting for Fall semester. She claimed that she can dismiss anyone for this, even though in this, my last semester before comps and dissertation, I could literally fail all 9 credits I took and still have a GPA above the 3.0 that is listed in the graduate catalog as constituting “good academic standing”, and have 3 years available in which to complete my comps and dissertations within the 8 years the catalog lists as being the max. time frame for a graduate degree.

      The rotten part is, both my physician prescribing meds and the counselor I am seeing at the student health services want the other person to provide documentation, because I have not been working with them “for very long” on this issue. It does not seem to matter that they are the ones who brought the diagnosis to my attention, so actually they have know about for longer than I have. But, since they are busy pointing fingers and I am not “approved” for services I had to self-disclose to my dissertation chair and the graduate program coordinator this morning when they kept pressing for “why I should be allowed to continue” and “how could I tell them anything would improve if I did continue?” and will likely still be kicked out without any recourse because I am not yet covered by the Disability Services program.

      How long should it take to get approved? And, is there anyway if I do get approved they could say my coverage started when I first contacted them in May?

  3. thanks very much for posting this. it’s hard to find information about mental health in academia that goes beyond autobiography and is also helpful/empowering to other people (like me) with similar issues. even grad students lucky enough to have health insurance still have limited options for psychiatric care/medication management through our health plans. do faculty have the same problems? as a faculty member (let’s hope), will I also have to go to the health center for psychiatric care and meds, and not be able to apply insurance to a private psychiatrist?
    thanks for your advice!

    • Dear Grad Student,

      All universities and states differ as to available mental health care options for faculty, so, prior to graduation, be sure you have a plan-even if this means you must get your meds temporarily from a family physician, you must be prepared to manage your illness with or without the care of a psychiatrist. Mental health care services were not provided to faculty at my university; only to students. Prior to graduating, I learned that my new insurance would not cover mental health care, so I scheduled an appointment with a family physician, briefed him on my situation (I had been taking the same meds and dose for years and my illnesses were well under control), and asked if they would be willing to write prescriptions for me until I found mental health care services. Most cities have such services for people with low income or who have no insurance-ask your current mental health care professionals for help on this. I quickly found services and no longer had to rely on my family physician.
      Best of luck!

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  5. Hi Karen,

    I’m about to enter into my first year of graduate school after being recently diagnosed bi-polar in 2012.. My final year of Undergrad did not end on good terms, I felt given the circumstances surrounding my thesis I was not able to put in my best effort and it did not give a good representation of my true abilities as a student. This has put a big dent in my self esteem and has a significant amount of doubt that I am now finding in surmountable to overcome. It has affected me, my family and my friendships and has lead to a very dark side of mental illness. I have been working closely with my therapist to over come some of the hurdles encountered, but that does not seem to be enough.. I will be moving further away from home to complete my masters degree and I came to the conclusion that it could either offer me a new start or put added stress on my current mental state. I was wondering if you could offer help or shed light on avenues that may lead to healing and overcoming the pitfalls so a can improve as a person and improve in school.
    Having said that, I would like to thank you for posting this forum and website, I was offered me a life raft so to speak by providing evidence of other who have overcome their illness to go onto leading fulling lives and recoup some of the things lost throughout the process of diagnosis.

    Sincerely,
    Stephen

  6. Greetings,
    I learned the hard way that it doesn’t pay to hide one’s mental illness, to play the role of the stoic grad. student who forges on no matter what. Prior to graduate school (and during it, I might add), I had suffered/still suffer debilitating mental illness that landed me in the hospital more times than I can count. Fast forward several years ahead: I’m in graduate school, on the cusp of graduating, having only to finish my practicum + internship before receiving my M.A. in the Professional Mental Health Counseling field. Except what I did not foresee was an unsympathetic supervisor, advisor, dean, and department chair. The one supervisor to whom I confided that I was having anxiety problems ultimately failed me. She gave me an arbitrary evaluation, replaced a very real anxiety disorder and a very real family crisis that I was going through at the time, with the label “INCOMPETENT.” I fought like hell to stay in that graduate program. I explained to the Review Panel my situation, which had been a legitimate family crisis concern coupled with a transient flare-up of anxiety and depressive symptoms. The entire PMHC department treated me as though I were guilty until proven innocent. I cannot tell you how much the negative attitude of that department affected me. But I haven’t given up. I am determined to get back into graduate school because I have faith in myself and the fact that, in spite of an at times crippling mental health problem, I am an ASSET to the mental health field. Notwithstanding a mental health disorder, I would be an asset to any graduate program.

  7. I sit here on a Saturday night, filled with dread and anxiety. I am an MS student struggling to manage my depression while living up to potentially unrealistic expectations. Being a star student always gave me a sense of control and self-worth, but these days I feel academic accomplishments to be draining, inadequate, and over compensatory for my inherent shortcomings. The fear of stigma keeps me silent, and I sadistically push myself even harder. Despite my apparent “success”, I feel like a fraud and failure. All too familiar with depression, I began counseling my first semester here, but have found no reprieve.

    All of the other grad students in the department, along with my husband, are out at a campfire on the river tonight. It is something that the normal, happy me would take pleasure in attending. But I sit here overwhelmed, tired, and aloof.

    Grad school is an opportunity to flourish. Somewhere I know I should be grateful and milk it for what its worth. All I feel like doing is running away.

  8. I was enrolled in a Rehabilitation Counseling graduate program at a prominent institution intermittently since 2008. During my first two semesters in the program, I was hospitalized in psychiatric facilities once each semester. I am a single mother of then 2-3 year-old twins, working part-time and attending full-time. Needless to say, I bit off more than the average person could bite off, mental illness or not. I have had to take a year off from the program from Fall 2009 to Fall 2010, re enrolled in Spring 2011 to Spring 2012. During the most recent enrolled semester of Spring 2012, I again experienced numerous setbacks in my recovery and this had an enormous effect on my academic performance. What breaks my heart is that despite the years of uphill battles and persistence, I was nearing the finish line. I was in the middle of my final semester, well into my field experience internship and had only to edit my Master’s paper and I would have been done. When my health started declining again, I exhibited behaviors that were interpreted by my superiors as incompetence and subsequently forced to withdraw myself from my internship assignment or else I would have been dishonorably dismissed. The behaviors mentioned above due to my symptoms were low motivation, poor concentration, tardiness due to oversleeping, irritability, paranoia and extreme fluctuation of moods and affect. Like some have mentioned in this forum, I, like many afflicted are over-achievers, so in like form, I too was prone to go way above and beyond, making it much more noticeable when I exhibited, for example, lower motivation, even though if you ask me, even with lower motivation, I was performing above average. After my withdrawal from my internship, I was subsequently asked to take a leave of absence until I had more stability. While I was certainly grateful that I was not dismissed from the program altogether, I’m torn regarding whether this is a program I wish to return to. For being a counseling program, the lack of compassion from all faculty, with the exception of an exceptional advisor who advocated for me during this ordeal, is a big turn off, to say the least. I am now considering either transferring to or starting over at another institution neglected to mention that I received an F in my internship course, which of course is now on my permanent academic record. That is my story so far. I did want to pose a question to the forum if anyone is familiar with the process of transferring graduate programs vs. starting over altogether and what the pros and cons would be in each case.
    I am grateful to have discovered this forum. I feel that I am ready to take the next step in my academic career, but have been frantically searching for an answer online to no avail. Thank you all!

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  10. I was diagnosed with Panic Disorder with Agoraphobia in the first year of my undergraduate career. I had my ups and downs throughout the last few years but was pretty much okay after receiving treatment. I’m now in the first year of a Ph.D. program in chemistry and things are not good. I feel like I am drowning under the work load and that my advisor has very unrealistic expectations of what one person can take on. I just wanted to know if you think that I should tell my advisor about my mental health issues? I don’t want him to think that I’m just lazy, but I also don’t know if I feel comfortable sharing this with him.

    • It may be too late for this answer, but don’t tell them, You stand nothing to gain. As much as they admire you now, there will be a stigma over your head and the atmosphere will change. You could possibly experience more symptoms, thus proving the reputation of your diagnosis. It’s jut my two cents, been there and suffered for it.

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