Recently a tankard of ink, both physical and virtual, has been spilled on the topic of depression and suicide. A significant portion of this, particularly on Twitter, was focused on identifying depression and convincing the afflicted to “get help.” The whole discussion, while well-meaning, seemed just as inane as the business plan of South Park’s underpants gnomes:
- Get help.
The advice dispensed by university-affiliated advisers and counselors to PhD students who find themselves in crisis is little more sophisticated than the 140-character exhortations percolating through the Twittersphere.
Assuming, of course, that a student recognizes that there is a problem affecting her ability to function, she will have a number of barriers to traverse. Fellow students will tell her she’s worn out and just needs a little exercise. Her advisor may dismissively remark on stress reduction strategy sessions provided by the university—but by whom? The advisor isn’t quite sure.
Eventually she will find the office that provides psychological support for students, which is often, ironically, just another barrier. At this office, she may find under-trained staff incapable of functioning without a checklist. She will find few (or no) professionals with knowledge of the demands that distinguish the PhD student experience from the undergraduate one. She will likely find that there is no consistent psychological evaluation process, and anything beyond “exam stress” is likely beyond the scope of the office. There will be paltry, if any, access to a psychiatrist.
By this point, the PhD student will probably have discovered that the resources the university provides for psychological support are insufficient for what is not stress, but a mental illness.
She will be patted on the head, given a list of “community” resources, and shown the door. No one will bother to confirm if she actually “got help.”
PhD training is naturally individualistic. It requires that the student produce an extensive scholarly body of work that both contributes significantly to the field, and also is not derivative of anyone else’s. The PhD student, whether he is a literature scholar writing in a library or a biology student in a laboratory full of people, ultimately works alone.
The PhD student is supposed to be self-sufficient, as any well-trained academic should be. But by the end of the first year, most students discover that academic self-sufficiency is a fallacy. Academia is fueled by networks of collaboration and the exchange of knowledge and resources. Ultimately no one expects the PhD student to complete the degree all on her own. So, then, why does academia expect self-sufficiency of the student with mental illness?
Abrogation of this responsibility by higher education arises from many causes, but the final result is the same: the wounded PhD student is left outside the walls and scrambling for treatment. The university doesn’t want to invest funds on complete psychological and psychiatric services. The student’s department doesn’t want the stain of a mentally ill student on their august legacy. Professors just can’t be bothered, or aren’t trained in proper methods of assistance. If lucky, the student fumbles her way through training with a patchwork of treatments and therapies, often at significant financial cost.
At worst, the student is forced to leave the PhD program because of mental illness. The additional strain of dismissal could change a treatable illness into a terminal one.
I have attended the same university for post-graduate study for the past nine years (not including the previous four years of undergraduate education). My first severe episode depression happened a mile away from where I sit now, in my third year of undergrad. I had to 1) recognize my clinical symptoms, 2) summon the energy to pick up the phone and call psychological services, 3) propel myself a half-mile across campus, and 4) agree to talk to a social worker. After five sessions, all students, no matter the condition, were booted out and given a list of “community providers.” If I was not comfortable leaving campus, I would have stopped right there. And no one followed up, even though I mentioned suicidal thoughts. That was the assessment and treatment process for undergrads.
Psychological support, as has been observed, is superior on most US campuses for undergraduates as compared to PhD students. My subsequent experience as a medical, then PhD student supported this experience. Returning to campus after a two-year hiatus with a newly minted diagnosis of bipolar disorder, I experienced another depressive episode. I wasn’t even offered the full number of sessions—not that I was interested in psychological bandages. I was handed a list of “community providers” and sent on my way. No one bothered to check and see if I called, or even if they were taking patients. Again, on my own. Fortunately, my tearful calls resulted in finding a psychiatrist who has shepherded me through nine challenging years. My bipolar depression is currently in remission not because I “got help,” but because of luck and the support of individuals, both from the university and from my personal life. Institutional supports simply did not, and do not, exist for persons with mental illness.
Having the dubious distinction of having both a mental illness and autoimmune illness, I find myself in the position to compare and critique the dichotomy of support and services available in each case. This is not to say that the services for chronically ill students are absolutely stellar. However, the institutional supports provided are much more obvious and readily available. When I was still in medical school, I first experienced symptoms of what was eventually diagnosed as lupus. I went straight to the student health clinic when I couldn’t bend my toes and spotted shiny patch of scalp in the mirror. My symptoms were recorded and blood was drawn and tested. When the results were concerning, the nurse practitioner both emailed and called me, with an appointment already set up with a community-based rheumatology practice. After my first visit, the same nurse practitioner followed up with me. When I had a lupus-related hospitalization earlier this year, physicians from health services came to the hospital, and a staff member from disability services emailed, as well as called, to offer services. This was a good deal better than what was offered to me the three times I was in a partial hospital treatment program for bipolar depression. The difference is striking: if I am having lupus-related problems, people are aware, sympathetic, and institutional supports can be rallied, even if the process is less than ideal. If those problems are depression-related, then it’s every student for herself.
A few months ago, I had the good fortune to speak with a person who assesses support systems for PhD students, particularly ethnic minorities, in STEM programs at US universities. I had met with her a couple of times in the past few years, but this time I had a cane. Eventually my hospitalization came up. When she asked me about anything that I thought might be a hindrance to my progress, I said: disability.
The lack of support, not just for “obvious” disabilities, but also chronic illness, especially mental illness has been isolating. The National Institutes of Health (NIH), I exclaimed, doesn’t even keep track of researchers with disabilities, and they are the largest biomedical research-funding agency in the United States. While this was of interest to her, it wasn’t until I started telling her my plans for restructuring disability support for PhD students in STEM that her notebook came out. (And I received “inside information” in the process—the NIH is going to start tracking disabilities. Whether mental illness is separately tracked remains to be seen.)
PhD students are taught not just to identify problems, but propose solutions. As disabled PhD students and activists against institutional ableism, it is even more imperative to force The Powers That Be to see the glaring holes in their support systems for students with mental illness.
However, these complaints must also be accompanied with solutions. Where would I start? First and foremost, “mental health” does not address “mental illness.” To treat them as if addressing the first adequately deals with the second is an egregious fallacy. I believe that any institution with psychological services must rapidly adapt and train to modify their services to the unique circumstances of PhD students, not just cut and past from undergrads. Secondly, extensive peer support networks should be developed within departments, whenever the number of students makes this possible. If the numbers aren’t there, then develop networks across department, based on type(s) of disability and other interests. Perhaps individualized educational plans based on learning style and self-assessment, taking disabilities, especially limitations due to mental illness, into account.
Self-sufficiency definitely harms PhD students with mental illness. But it doesn’t have to, if we can dismantle the system from a model of self-sufficiency and individualization of mental illness to one of broad-based support institutional networks. When I’m having a good day I write down some ideas. One of these days the system is coming down. I know I there are more PhD students with depression, or bipolar disorder, or any mental illness who must be willing to join me. I’ve got some wrenches.
cginpvd is a US-based PhD student in Biomedical Sciences. She is currently in the final throes of completing her dissertation, and has decided to forego tenure-track academia for more enriching pastures. Contact on Twitter at @cginpvd or at her blog chronicallyphd.wordpress.com.