Being open about mental health issues?

(Updated with links to additional discussions of related issues).

In our newest "how can we help you?" thread, a reader writes:

I am a PhD candidate who is about one year away from defending and entering the job market. I wanted to know how open I should be about belonging to a protected mental health and disability category (both in my application materials, and on my social media which is under a pseudonym, but could be linked to me with some effort). I have bipolar disorder one, and I know that there is a lot of stigma surrounding mental health in general (and even more acute stigma surrounding mental illness that can involve psychosis). In my personal life I am quite open about this - I think that telling stories about what it is like to live with this disorder is important for destigmatizing it. It is also important to me to be open about it because I think I stand as a good example of how it is possible to live a very happy and productive life despite having this kind of disorder. However, I do not want my condition to count against me when I go on the market! This question was raised for me most focally this month because I wanted to tell a few stories of my experience on a social media platform for Mental Health Awareness Month, but I am quite nervous about the kind of impact that might have on my job prospects down the line. Any thoughts you all have would be very much appreciated.

This is an extremely important query. Unfortunately, my experience is that there is real stigma against mental illness in the profession. As a case in point, another reader submitted the following reply:

First, the chief concern many hiring committees will have is that you might have a psychotic episode during the semester, and need to be hospitalized. Then they, your new colleagues, will have to scramble to cover your teaching - and they will often get no resources from the administration to do it. So imagine a five person department - now everyone's load is increased by 25 % because one person is on a medical leave. And there is no time to prepare lectures. And you might already being doing a 4-4 load ... and your own child is going through a teenage crisis, etc. No one wants that. Second, from my experience, it pays to indicate on the HR forms that you belong to a protected group. I have seen cases where HR intervened and insisted that files be considered.

I've known academic philosophers who have been very open about their mental illness, and at least anecdotally (from what they have reported), it may have very much worked against them on the job-market, impeding their ability to secure a permanent academic position. I've also known many academic philosophers (including tenured ones) who keep their mental illnesses a secret out of fear of discrimination. To be clear, I think this is awful. Mental illness is a veritable epidemic in academia, yet social norms in the profession incentivize people to keep their illnesses a secret. So unfortunately, my sense is that one has to make a very difficult choice: one can either be open about one's health and be an advocate against stigmatization--but at a potentially serious risk to one's career--or one can keep it a secret. I'm not sure there is any 'right choice' here. One must, I think, simply make a choice one can live with. But these are just my thoughts. What are yours?

Update: Justin Weinberg (South Carolina) kindly drew my attention to these two Daily Nous discussions of mental health in academic philosophy.

Comments

[no way jose]

There seems to be a few things run together in this post: (1) the mental health epidemic in academia, (2) depression and anxiety, and (3) significantly more stigmatized psychotic illnesses including bipolar disorder type 1, schizophrenia, and (occasionally) major depressive disorder with psychosis.

I'm not sure that the mental health epidemic in academia is related to (3). (3) is better treated as a chronic illness, like having lupus or Chron's disease. Some cases of depression and anxiety ought to be as well, but other cases are merely a response to environmental decreases in the ability to thrive (lack of job security, malleable social structures, capitalism). The mental health epidemic is related to (2), but not necessarily to (3). Of course, environmental improvements will benefit everyone, but more so the increases in depression and anxiety, not BD Type 1 (or 2 for that matter) nor the rest as far as I am aware.

When framed this way, the reply doesn't make much sense in response to the original post...in that case a department should worry about hiring *anyone* with a chronic illness, including recurrent forms of cancer. Maybe that would still be the case, I don't know. Compassion is often in short supply. But BD is also well moderated with medication--many of us only ever have one manic episode in a lifetime. If I recall correctly, this was the case for Paul Lodge, and also myself (so far, anyway). It's just that even one episode drastically restructures a person's life, forever.

From my vantage point it seems that the stigma for (2) is much less in the younger generations than in the tenured generations. For (3)... it's a catch-22. With fear there will continue to be stigma, with less fear there is less stigma. Changing the situation requires a few casualties and a certain amount of bravery. I will almost certainly be more fully "out" in the future (not now!), but that's only because one of my top values is authenticity, and I just like helping others who have been in similar situations. It's not really a relatable condition for most people.

On the bright side: Paul Lodge has taken a step in destigmatizing BD Type 1 with an episode of psychosis (IIRC). And your colleagues are likely to be more accommodating if you win a Nobel Prize or equivalent, even if you decide to stop taking medication (looking at you, John Forbes Nash...). ;P

Paul Lodge's article: http://www.oxonianreview.org/wp/what-is-it-like-to-be-manic/

[Marcus Arvan]

no way: thanks for chiming in with your insightful comment. I guess I’m less confident than you are that the issues in 2 (anxiety and depression) face less stigma than 3.

You write: “ When framed this way, the reply doesn't make much sense in response to the original post...in that case a department should worry about hiring *anyone* with a chronic illness, including recurrent forms of cancer.”

However, this I think is the problem: that mental illness in *general* is stigmatized in ways that physical illnesses may not be (though I would also add, sadly, that I suspect people on the hiring side of things might well discriminate against those with a history of cancer, as well). Here’s why I say this: I know people in the profession with anxiety and depression who report that they have been discriminated against on the basis of these things, and that being open about these things may have hurt their chances on the job market. To be clear, nothing I wrote in the OP suggests that departments *should* worry about hiring people with these conditions (or with chronic illnesses more generally). My claim was (and is) merely that, from the OP’s/job candidate’s side, there are real reasons to worry about being open about these things.

Now, I think you are probably right when you write: “ From my vantage point it seems that the stigma for (2) is much less in the younger generations than in the tenured generations.” The problem, though, as I see it, is that those in positions of institutional power—search committee members, Deans, etc.—tend not to share this feature of younger generations. My sense is that people in these kinds of positions tend to care more about protecting their institution, and so may regard people with mental illness (or indeed, even chronic physical illnesses) as “risky” to hire. Again, I’m not saying this is right. I just think we need to be open and forthright about the fact that not everyone—particularly people in positions of power and authority—may have the most enlightened attitudes about these things (and indeed, may not even be aware of their own biases).

[no way jose]

Marcus: I'd be interested to know more about hiring discrimination on the basis of depression and anxiety. I believe that -- it's just not in my knowledge base, though I get that it's probably difficult to give specifics.

I agree that the situation should be improved across the board, but I also wanted to center (3), specifically. Even in non-academic contexts (in my experience), understanding of depression and anxiety does not automatically lead to understanding of the other illnesses. The others are just less common. There's also the additional worry that some might perceive disorders of (3) to have global effects on one's cognitive abilities in a way that is less likely to be the case for (2). In philosophy this is a huge issue, for obvious reasons. So I think it's important as well to focus more specifically on BD-1, since there are additional reasons to not be open.

The perennial problem is that the less open people are about these kinds of things, then the less likely they are to change. In general I think it's better to just take the risk, even if it has negative consequences for one's job prospects. To me it's more important to live in accordance with one's values, even if those values are at odds with market forces. Others might have a different view. It's a risk.

All that said, there is some irony to writing this under a pseudonym. I think it's also reasonable to wait a few years until you're in a position where you can accept the unfavorable economic consequences of your actions, including waiting until you have a job in hand. Then you just have to hope that you have reasonable colleagues. I do think that everyone is worse off when these things are kept a secret, indefinitely.

[anon]

I'm with @no way jose.

Category (2) stuff - basically depression and anxiety (specifically generalized anxiety) is far less stigmatized than it was in earlier times. It's usually met with hugs and support.

Category (3) stuff is still problematic. On the one hand, we can include disorders such as BP 1 and schizophrenia, which people find 'scary'. We can also include other disorders - such as panic disorder with or without agoraphobia and alcohol dependency - which are misunderstood, hard to treat, and often conflated with 'life choices'. Those are just examples; there are a bunch of other disorders in this category.

Personally, I'm open about my category (2) stuff, which has responded to treatment, and not about my category (3) stuff, which is controlled but not cured. Keeping it hidden and controlled requires me to engage in some behaviors that appear odd, but it's more acceptable to be odd than crazy.

[Malcolm]

An experience during the first year of my PhD ensured I kept quiet about my own struggles with anxiety and depression. Granted, this was over a decade ago, and the person involved is on their way to retirement. However, they're still on faculty, speaking to Marcus' observations about generational differences. I think the anecdote also speaks to the difficulty of giving general advice. It's important to suss out one's own departmental environment.

Early in my first year, the topic of a student who was having a hard time with depression came up in conversation with a (tenured) faculty member in my program. This faculty member said that perhaps this individual should rethink their career choice, since philosophy isn't a good place for people who struggle with mental health issues.

This signaled to me that my department wasn't a great place to let facts about my own personal situation get out. I'm pretty sure I nodded along with this "esteemed" senior person, rather than speaking up. I remember the conversation because of the fear that gripped me at that moment, that I might be "found out" as an imposter in more ways than just intellectual, but now, also psychological.

Now, as a tenure-track faculty member, I'm more open about my personal situation with colleagues, and sometimes students when the context is appropriate, in an effort to de-stigmatize things, as the first OP writes. It helps that my institution is, at least on paper, committed to mental health support for staff, faculty, and students. But I'm not sure that being open on social media about my experiences would have been positive for getting hired. It's worth remembering that different countries have different views about mental health, and the one I work in is still working with stigma about it, even worse than in the US. So it's worth thinking seriously about potential implications.

[toeing the line]

I just wanted to point out that there's a third approach between openness and secrecy: selective disclosure.

I have both a mental health diagnosis and another minority status, and my rule of thumb in disclosing them is to be either strategic or safe. Meaning that I disclose them in situations where either a) to my best understanding, doing so will do me no harm, such as in the company of others with similar considerations; or b) it seems like doing so will harm me, but will also benefit me more than it will harm me. Granted, my assessments of each situation are likely very unreliable, but for me, this has been the solution I can live with. Total secrecy would mean I could not confide in any colleague about these matters, and that would feel exhausting and isolating.

[Anony Mous]

Agree when @no way jose says “The perennial problem is that the less open people are about these kinds of things, then the less likely they are to change.”

Frankly, I wouldn’t wish to be a member of a department where someone’s disability or health condition counted as a potential “point” against hiring them. The issue is fraught; I don’t mean to be reductive. But it seems clear to me that the immediate moral issue is not “Should OP disclose?” but rather “How can we as a community make it safer for our colleagues and friends to disclose their disabilities?” OP should disclose if and only if they want to. What needs to change are the conditions: OP shouldn’t have to worry about their disclosure impacting their prospects on the job market.

Does anyone with hiring committee experience have a view of how these things are actually treated?

[Anonymous Grad Student]

I am a graduate student with bipolar disorder 2. A response I wrote to this query when it was asked of me:

"I don’t want to be hired by someone who’d have that reaction. It would be a toxic workplace and I’d end up resigning. If a committee wouldn’t hire you due to your mental illness, odds are they’d be terrible colleagues."

It is worth remembering that "having an academic job" is not a goal to be pursued at all costs. I'd rather quit academia than spend the rest of my life in a workplace where people think about me as a liability.

The systemic issues ought to be criticized and fixed, but on an individual basis, I think not being open about mental illness will do more harm than good to the individual in question.