Reader query on presenting to a department on mental illness

A reader writes in:

I finished my Phd in 2015 and decided not to go into academia. While I don't at all currently regret that decision, now that I have recently been able to finally be completely free of depression for the first time since maybe I was a little kid, I am able to recognize that my decision not to go into academia was at least partly influenced by depression. In short: I had been taking zoloft since my 2nd year in grad school; my marriage fell apart during my 8th year, and I coped by smoking way too much weed; my doctor decided to take me off zoloft because she was worried about its interactions with weed; during my 9th year I completely lost interest in philosophy (similar to my experience prior to taking zoloft during my 2nd year) and was able to eke out the rest of the dissertation but called it quits with philosophy.

Anyways: I was recently chatting with a few of my old advisors back at [redacted]... We talked about how we think it's really a shame that depression just isn't discussed openly within the department, even though so many people have it. I thought that it might be a good idea for me to come back and give talk, sharing my own experiences with depression in grad school, talking about resources at [redacted], etc. He agreed, so I'll be giving the talk in November :) In the meantime, as I'm thinking about the content and structure of my talk, I was wondering if you have any thoughts for such a talk: What sorts of things might be good to include in a talk to a philosophy department whose students suffer from depression and at least some of the faculty are interested in helping and improving the environment of the department?

I think this is a great query, and would like to commend the reader, advisor, and department that took the initiative to organize this individual's upcoming presentation. I'm curious to hear what readers think. I myself feel fairly comfortable offering suggestions, as I have a good deal of experience with mental illness: I worked as an intern in an outpatient ward for a year, was co-director of a group home for the mentally ill for another year, and mental illness runs in my family, being more or less a constant in my life-experience since early childhood. Allow me to share some of my thoughts, then, before I open things up for comments...

My first comment--which I know doesn't really address the reader's query, but which I still want to mention--is that I think other departments should do what this one is doing: make it a priority to openly discuss ways in which they could be appropriately sensitive and responsive to mental health issues. While a number of studies suggest that mental health issues in graduate school--and academia more generally--are a real epidemic, it still seems to be something that grad students, faculty, departments, and institutions rarely talk about or address openly or directly (presumably, I think, because of the perpetual stigma associated with mental illness). So, I think, this kind of thing is a good first step that others departments should take. 

But on to the reader's query. Here are a few topics that immediately jumped to mind that I think the reader might consider discussing:

Stigma: Recent studies show that that there is still a pervasive stigma surrounding mental illness, and that it is a barrier to people receiving effective treatment. I have experienced this first-hand, knowing a number of grad students who struggled with mental illness that kept it a secret from everyone in their program. As I'll explain below, I think this is bad for many reasons, not the least of which is that it can lead gossipy speculation about a person's mental stability, but also to a failure of faculty to understand that a student's temporary academic or social struggles in the department may not be reflective of the student's actual abilities (more on this shortly). Because stigma is such a pervasive and longstanding issue, this is the first thing I would recommend discussing. Few students would be afraid, I think, of telling people in their program that they had cancer, let's say. I wouldn't be afraid of it, at any rate--as I expect people would very much rally around a person with such a terrible disease. I would, however, be very much afraid of telling people that I was suffering from mental illness--from depression, or social anxiety disorder, etc.--as I would be very much afraid of what people would think. Mental illness is a health issue, no less than cancer, or a heart-attack, and so on. And people need to know that it should be treated as such. It is also a health issue that is treatable in many cases, which is why understanding rather than stigmatization is so important.

Institutional resources & departmental policy: Because mental health issues appear to be rampant in graduate school--exacerbated, no doubt, as a result of the inherent stress of graduate studies--I would suggest that our reader discuss the issue of institutional, above all proactive departmental policies, to respond helpfully to students with mental illness. For reasons I'll explain below, I don't think it is sufficient for a department to simply inform their students that there are mental health services on campus. It is important for grad students to have resources within their department, so that students have some opportunity to make their situation known to individuals in their program (such as faculty advisors) should they wish to do so, and in a way governed by clear, binding policies conducive to student privacy and faculty understanding. This is important, I believe, because as I will explain below, it can be very detrimental to students to feel that they cannot tell anyone in their department about their health issues without running the risks that (A) the information will get out, and (B) faculty may not be appropriately understanding of their health predicament. I am not exactly sure what such policies should include, but would suggest that they include some of the provisions below.

Privacy: In my experience, worries about privacy can be an immense deterrent to students letting anyone know of their health condition. Contrast, for instance, what might happen if word that one has cancer got out, versus what might happen if word that one has major depression. In my experience, people generally respond positively to physical health issues, offering support, comfort, understanding, and so on. Unfortunately, at least in my experience, things can be very different with mental health issues. Instead of support, there may be gossip; instead of understanding, people may wonder whether one has the mental fitness to "finish the program"; and so on. Because of the stigma attached to mental illness, there should be a binding expectation of privacy--one subject to serious institutional sanctions if violated, just as is the case with disclosing a student's entitlement to special accommodations due to disability or a report of sexual violence. Mental health issues are, once again, a health issue, and as such should be something students are entitled to discuss with faculty without fear. 

Understanding: Finally, I would recommend discussing the importance of understanding. Once again, I suspect if a student told faculty or their department they were receiving treatment cancer, there would most likely be an outpouring of understanding. Among other things, faculty (and fellow students) might understand that the person's health issue may impact their ability to get their work done, perform to the highest level of their ability, and so on. Mental health issues should, in my view, inspire similar levels of understanding. I have known students who faculty thought were "performing badly"--not writing good papers, not participating in departmental events, making social faux pas (appearing angry, morose, etc.), making personally and professionally harmful choices (e.g. abusing drugs or alcohol)--because of their mental health issues. In these kinds of cases, it may be tempting for faculty and other students to think the person is a bad philosopher or a person who is "not cut out" for academic philosophy. Yet, I have also seen people like this entirely turn things around--writing good papers, making better personal and professional choices--once receiving effective treatment.

This is, in my view, one of the main reasons why students should have clear, effective departmental resources and policies. Faculty may misjudge the promise of a student suffering from mental illness, lowering their estimation of the student's promise on the basis of what appears to them to be "substandard performance", but what is in actuality the manifestation of mental health issues. Faculty need to be aware that such "substandard performance"--including "bad life choices" affecting their work--may not be indicative of a student's true character or abilities, but a temporary set of symptoms of disease that may be effectively treatable. In my view, this is crucial. One of the most important--yet very difficult--things for people to understand about mental illness is that a person's "bad professional or life choices" (the way they treat others, the way they comport themselves, etc.) may not be at all reflective of who the person really is, but instead a temporary reflection of their mental health disease. I've seen it many times with my own two eyes: a person having no control over their "bad choices", only to see those choices turn into "good choices" literally overnight after receiving effective treatment. It is vital, in my view, for faculty aware of students' mental health challenges to develop this kind of understanding.

Anyway, these are just a few suggestions that popped into my mind. Do you have any of your own? Do you agree/disagree with the suggestions I've made? Let's try to help our reader with their excellent query!

Comments

[Amanda]

This is an important post. I just wanted to confirm that there is a huge stigma with mental illness, especially with depression in particular. I find it much easier to talk about anxiety, but when you mention depression it is almost as though people get insulted you are talking to them about it. I hear many academics still express the idea that people with "good lives", "shouldn't be depressed." I hear people look down on those who take depression medication because it is better to overcome it "naturally". And lastly I have seen many people suggest that anyway who mentions depression should, "go talk to their therapist", i.e. as in do not talk to me. Funny because if someone had cancer, as Marcus notes, no one would tell them to confine the discussion of it to their doctor.

While therapy is great, rarely can people get enough of it that it alone can make the difference. Mental health coverage is very weak in most cases. People can often only see a therapist twice a month. In short, it is sad that at this day and age there is still such a stigma. It hurts a lot of people.

[Instructor Gadget]

I learned I had OCD a couple years after grad school. Here are three questions that would have been useful to me to think about as a grad student.

1: How do I recognize that I have a mental disability?

Occasionally I had some hazy awareness that something was going on. But I didn't get it. I didn't have any idea that I had OCD or how much of a bearing it had on my life.

2: How helpful/invasive is therapy and medication?

I had no idea how helpful these things could be. And I was afraid of them.

3: How can I tell whether a therapist is competent?

I get the impression that the quality of therapists varies.

[Original Anonymous Reader]

Hi all, I'm the anonymous reader mentioned in the post. First of all, thank you so much to Marcus for agreeing to post this and for the very helpful comments. And thank you so much to the community for the discussion- this is very helpful for me, and hopefully for others as well :)

Re Amanda: "I hear people look down on those who take depression medication because it is better to overcome it 'naturally'." Yes, this was an issue for me- my mom was horrified when I told her that I was on zoloft, and so pretty much from my 2nd year til 8th year of grad school every single conversation that I had with her she took as an opportunity to remind me that the long term health consequences of zoloft are uncertain, and encouraged me to get off of it. [I don't mean this as a criticism of my mom- she was being a loving mom who felt legitimately worried about the health consequences of zoloft for her son] I honestly didn't really have the strength/motivation to fully investigate her concerns. In my mind, I didn't really care if zoloft did indeed have long term negative consequences [this has certainly not come close to being shown]. In my mind the increased quality of life that zoloft afforded me was well worth the possible tradeoff. But when my doctor insisted on taking me of zoloft during my 8th year, part of me felt relieved, like ok now I can have normal conversations with my mom again. And she was indeed ecstatic about my going off of zoloft. Anyways, this is I think a much underappreciated aspect of the struggles one can encounter with depression.

Re Instructor Gadget:
"How can I tell whether a therapist is competent?"

Yes, this is a very important issue, for a number of reasons. First of all, I think that one of the reasons that depression can be trickier for philosophy graduate students to deal with is because we, or at least certainly I, can have the attitude that it is very unlikely that, given our intelligence, we will find a suitably competent therapist. [I don't mean to suggest that you personally had this attitude as a graduate student] I think that this is a mistaken attitude, though certainly understandable.
Second, I think it is important for graduate students to know that if their first therapist sucks (or is just a bad match, etc), they shouldn't view this as confirmation that therapy is stupid and not worthwhile for them. Instead, they should try to find a better therapist. This was my own experience in grad school- I thought that my first therapist, whom I met with once, was terrible, and it then took me several months to work up the motivation to try to find someone else. Fortunately I was able to find a much better therapist on my second try.
Third, I think that one of the possible benefits of reducing stigma/putting this issue out into the open would be to have some sort of system in place for graduate students to share, anonymously, with each other, therapists that they had good experiences with. That way, when you first take the step of thinking that you'd like to give therapy a try, you're not going into the process completely blind- you have some recommendations to try out :) I think this certainly would have been helpful for me to use as a resource back when I was first trying out therapy.

[Amanda]

The quality of therapists varies a lot. I think the key is to search until you find one that works for you. Ask for recommendations - since academics often want the same thing in a therapist, there is often a therapist that many academics have found to be useful. It is might sound obnoxious but being "smarter" than a therapist is a problem. Psychiatrists I often find better but not always, and they are far more expensive. Also, look at webpages which can be informative. Don't be afraid to leave if something isn't working.

Another note: So I have had very serious mental health issues for a long time. At some point I found out that they were likely caused by a physical disease. It is SO much easier to talk about it when I have something physical to back up my claims, so to speak. It really shouldn't be this way though. Mental illness, after all, is part of the brain which is physical.

[Amanda]

Sorry I didn't notice the other questions.

As how to recognize it: there is a lot of information out there on the web and in the library about different mental illnesses. Read them and you might find something which describes you exactly. That is what happened to me many years ago. I wasn't even looking.

How helpful is medication: It varies of course. But for me I can't even put into words how helpful. I had to experiment. But my medication I can say without question makes my life worth living.

[Original Anonymous Reader]

Re Departmental Policies: That's a great idea Marcus! Do you know of any other academic departments that have put such a system in place? It'd be great to be able to bring a fully formed set of guidelines to my department as an initial suggestion for them to discuss :)

[Marcus Arvan]

Original Anonymous Reader: Unfortunately, I don't of any departments that do that. Perhaps there are some - but for all I know there are none.

Does anybody else know whether any departments have policies to help grad students with mental health issues, and if so, what kinds of policies those departments have? If you're in the know, please do chime in!

Hopefully we'll get some good information. I also like your suggestion for trying to brainstorm a set of guidelines. I think I'll run another post on exactly that issue in the next several days!!

[Amanda]

Kinda disappointing that more people are not posting. I wonder if that speaks to the stigma issue itself.

[Marcus Arvan]

Hi Amanda: I have to confess that I'm really surprised more people haven't weighed in. I think these are really important issues--ones that affect many people, and are rarely discussed in the profession.

As I note in the OP, many studies suggest that mental health issues are an epidemic in grad school and academia more generally. So I would have expected a lot of people to weigh in, especially since people can comment anonymously here. I don't know if part of it is that the Cocoon's site visits are down a bit since my extended vacation (when there were very few new posts). But the numbers aren't down *that* much, so I'm as disappointed as you are.

Readers interesting in drawing more attention to this discussion might consider dropping a line to other philosophy blogs. Perhaps if enough people ask, they will link to it!

[Amanda]

Glad I'm not the only one Marcus. I do think there is a sense in which people are scared to talk about their own mental illness because it comes across as "complaining" or "self-pity", which is basically why I never talk about it unless a very specific occasion arises. But like you say, people can post anonymously so don't be shy!

[deesse877]

I'm not a philosopher, but I am an academic in a humanities field. I agree that this is important, and that dialogue at the department level is important. I also agree that stigma against mental illnesses in academia is HUGE, both as an internal barrier to wellness, and as a form of institutional discrimination against the disabled. I guess I'd pose two questions and make one comment.

1) What institutional imperatives are served by this stigma against mental illness (and depression/anxiety in particular)? It appears as personal prejudice, but it has systemic effects.

A tentative answer: My sense is that that its primary use is to prop up or enable less-avowed and/or more legally-actionable forms of discrimination. In other words, sexism, racism, homophobia and classism don't fly, but stereotypes about crazy women, angry people of color, narcisstic LGBTQ people, and working-class folks who just aren't smart enough to hack it all operate pretty seamlessly. To be clear, relatively few academics who express bigotry against mental illness or psychological disabilities consciously think in such tactical terms, but the beauty of it is that they don't have to. They experience their annoyance at someone else being ill/disabled as natural and authentic, and the institution conserves its resources and reproduces a privileged class.

2) I agree that departmental communities are ideal sites for combating prejudices and oppression via discussion and information. But are departments (or semi-official appendages such as grad student groups) necessarily the best path to services for the mentally ill? My gut says no. The community is pretty small, so recommendations for therapists can get cliquey and awkward (speaking from experience in a small-town setting). Moreover, if a person in authority is recommending or facilitating a particular care option, that can get coercive pretty fast too.

Finally, although I would not use the term "smarter" to describe the difference between an academic patient and a typical therapist (for a variety of pedantic reasons), I do think a good therapeutic relationship can be harder for scholars to find, for non-obvious reasons. We are all about evidence and theory, and in a sense therapy is too, but many academic habits of mind and conversation (ranging from withholding judgment until the facts are all in, to combative argumentation styles) don't work in the latter venue. But it's hard to let them go, and hard even to recognize the need for code-switching.

Anyways. Good luck to all; this is hard.

[Shelley]

Hi Original Anonymous Reader,

I encourage you to visit the Discrimination and Disadvantage blog. The blog has archives that contain resources that may be useful to you.

In particular, I run a monthly interview series with disabled philosophers. A number of my interviewees experience/live with depression. Here is the link for the archive to the interview series: http://philosophycommons.typepad.com/disability_and_disadvanta/dialogues-on-disability/

I recommend that you take a look at the interviews that I did with Jake Jackson, Jesse Prinz, Audrey Yap, and Andrea Nicki (especially). Furthermore, the interview that I will post in the series tomorrow might be of interest to you because it touches upon issues about which you have inquired.

Finally, the blog has a Facebook group in which a great deal of relevant information is shared and discussed. You can get to the group (and join it!) by clicking on the link at the top right of the blog.

Best regards,
Shelley Tremain

[Original Anonymous Reader]

Awesome, thanks so much Shelley!

[Shelley]

My pleasure, O.A.R.

Best,
Shelley

[Amanda]

Re deesse877 some of the things you mention are probably operating at some level. I also think a lot of the bias comes the from the broader society bias, which academics grew up in like everyone else. There hasn't been nearly the same movement to fight prejudice against mental illness as there has been a movement to fight prejudice against racism and sexism, for instance.

I am not sure what you mean by are departments the best place to "service" the mentally ill. I think the service should certainty be got at a professional institution meant for that service. But departments should be a place that offers help for WHATEVER problem is rampant among their students and colleagues, and stats show mental illness is one of them. Also as people, I think we should be concerned about how well the people we see everyday in our life are fairing, and take small actions to help when we can. As far as clique recommendations go, sure that can happen. Or a recommendation could really help. I think informal recommendations for anything are usually good, as it is a collective way to gain justified beliefs. And even if referrals are not the best, they might help some people go seek some help they never would have before.

[harry b]

Ask people to look at the stats. In a reasonable sized department, at least a few of the faculty are taking anti-depressants, and at least a few more have taken them at some point, When you teach a large lecture class, a substantial number of students are taking them, and a substantial number more are not, but probably should be. Part of our job as professors is to give the right kinds of signals to our students. Depression and anxiety are bad for the people who suffer them (just to be clear, I have suffered depression on and off most of my adulthood, and had a pretty serious episode combined with serious anxiety a few years ago), but they are also pretty normal. Saying that -- that whereas because of the stigma everyone thinks they are suffering alone, in fact they're often sitting in rooms with many others who think they are suffering alone -- can be helpful. For me, when I had what was essentially a breakdown, it helped me enormously that a friend of mine had talked about his own, openly, a decade earlier.

On therapists. I went to a therapist for a couple of years. Truth is she wasn't that bright, and wasn't that great a therapist -- she had a kind of formula, that was a bit obvious, and didn't really know how to deviate from it But she was good enough--- supportive, and offering strategies for me to try -- and gave me stuff to read that helped a lot. You don't expect your doctor, or plumber, or auto mechanic, to be smart (at least no if your sensible) -- you go to them for specialist skills that you don't have and that for whatever reason other people around you don't have or are not in a good position to use on you.

By the time I had that breakdown, I was already senior, and tenured. I confided in one of my colleagues, early, and probably others knew. I was more or less functional at work, and especially good in the classroom (which was lucky). I didn't talk with colleagues about it. But I do mention it in class, just as I mention other things about my life, and do so seamlessly but deliberately, both to signal to mentally ill kids that they're not alone (and a lot of them come and talk to me), and to signal to other students, who tend to think (rightly) that I am a pretty normal (if eccentric) and well-put-together person, that depression and anxiety, though well worth trying to combat and overcome, are pretty normal.

[Amanda]

That was a nice post Harry. I think you are right that even when a therapist is not the best or brightest, they might help you. Maybe even help a lot. On the other hand, some people might not have reacted well to the ability to sort of predict what the therapist is doing. Via a reccomendation I did find a therapist that was as smart or smarter than me. I felt that the sort of things I could talk about was a lot deeper, and it really helped that I felt the therapist could get me.

[Original Anonymous Reader]

Thanks Harry, very helpful :) I was thinking that in the part of the talk that I discuss my own experiences I would preface it by mentioning the problem of stigma and that I hope that the discussion of my own experiences can help at least a little in reducing stigma in our own department.

Yes, I have definitely had good therapists that I didn't think were as bright as me. But, to paraphrase David Foster Wallace (who I think was paraphrasing something from Alcoholics Anonymous), it's good to keep in mind when your life falls apart and you're seeking help that "my best thinking got me here".

[harry b]

That's a funny quote from David Foster Wallace. For me, one great benefit of the breakdown experience (I realise that is probably not a technical term)apart from it prompting me to get help that previous lower-level depressions didn't prompt me to get was that it taught me humility -- I really wasn't getting things right! So that does help in approaching therapists. I am also much less judgmental, and much warmer and kinder especially with students who struggle (for whatever reason -- not just if they have mental health issues, but if they have just mismanaged their time, or frankly even if I think they are lazy).

[Original Anonymous Reader]

That's so awesome, I had never thought about how our own experiences with depression can actually help us become kinder wiser teachers :)