Monday, November 30, 2009

Self Revealing

There was a very powerful story in the Chronicle of Higher Education issue dated November 25, 2009, under Advice, "Mental Illness in Academe," by Elyn R. Saks. The title is rather bland, actually, and does not begin to describe the dynamite within the short essay. She begins by recalling a psychotic break she endured while teaching an upper level class in law school in September, 1991. Professor Saks was diagnosed ten years earlier with chronic paranoid schizophrenia with acute exacerbation, a devastating mental illness, which would prevent most people from any kind of productive work life. Instead, she is justifiably proud:

That has not turned out to be my life. I am the Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California's law school; adjunct professor of psychiatry at the University of California at San Diego's medical school; and an assistant faculty member at the New Center for Psychoanalysis, where I am also a research clinical associate.

My schizophrenia has not gone away. I still become psychotic, as happened in class that day in 1991. Today my symptoms, while not as severe, still recur and I struggle to stay in the world, so to speak, doing my work. I have written about my illness in a memoir and much of the narrative takes place after I had accepted a tenure-track appointment at USC.

Barring a medical breakthrough of Nobel-Prize-winning proportions, I will never fully recover from schizophrenia. I will remain on antipsychotic medication and in talk therapy for the rest of my life. Yet I have learned to manage my illness. How? Do I have any words of advice for others who have a serious mental illness and are on the tenure track?

The first question you must ask yourself is whether to tell your chair and dean. I can think of arguments both in favor of that, and against.

One of the pluses would be the psychological benefits of not having a secret and being able to be open. More practically you might be able to get extra support, or formal accommodations under the Americans With Disabilities Act (ADA). You would serve as a model for other academics in your department and your students.

There are, of course, real pitfalls to telling, too. There is a tremendous stigma, still, around mental illness. People may believe, consciously or not, that you are unreliable or even dangerous, and they may fear you. They may think you can't do the work or your scholarship isn't good, even if it is very good. That may not be intentional on their part but can nonetheless have a big impact on your work life and your prospects for tenure.

My own tack was not to tell, except for my closest friends on the faculty. Even that limited disclosure served me well when I became ill—there were people I could turn to. And so a colleague, Ed, helped get me home and connected with my psychiatrist after my experience teaching class while psychotic. But I didn't want my situation to be known broadly. I work on a wonderful faculty, so it would most likely have worked out well anyway. But I didn't want to risk it.

I feel somewhat bad suggesting that not telling is the better course. Recall the scene in the movie Milk, when Harvey Milk, running for city council, says words to the effect of "I am running for government as a gay man, and I am proud." Having schizophrenia is not something I am proud of, but I am less ashamed than I used to be. Yet am I, in effect, telling people with mental illness to hide—to not be proud? Perhaps the message should be that, given the immense stigma, hiding is the prudent course but one should recognize there is no shame in having a mental illness.

Beyond that question, what steps can academics with mental illnesses take to make life easier for themselves? Some are steps that everyone with mental illness should take. First, learn about the illness you have—the typical signs, symptoms, and course. Many excellent sources are available. You may want to start with the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR. Psychiatric textbooks, e.g., Kaplan and Sadock's, can be helpful. I have also discovered excellent lay accounts of mental illness.

Second, understand how your illness affects you. What are your triggers? What are your early warning signs? What can you do to minimize your symptoms when they worsen—e.g., call your therapist, increase your medication, listen to music, exercise? Try to devise some techniques for your own situation. Some colleagues and I are studying how a group of high-functioning people with schizophrenia manage their symptoms. You are in the best position to determine what works for you.

Put a good treatment team in place. You need a therapist you can trust and can turn to in times of difficulty. Does he or she respond if you call in crisis? The same is true of a psychopharmacologist. Make friends and family members part of your team.

Sometimes your team can see early warning signs before you can. For instance, my closest friend, Steve, and my husband, Will, often identify when I am slipping. Will says I become quieter in a particular way that signals all is not well. It's a blessing to have such people in your life. Seek them out.

Structure your professional life in a way that works for you. Schedule your courses carefully. If your meds make you tired in the morning, try not to teach morning classes. Try to choose courses that you like to teach—you will do a better job and feel less stressed.

Two other things have been important to me professionally. First, I work hard. I go in seven days a week because I know I may have down times. (I also love what I do, so working is not a chore.)

Second, I try to maintain a professional demeanor. How does a person who becomes out of touch with reality do that? My approach has always been to ask myself, even in those moments where I think I have a special insight on the truth, whether others will think my beliefs are crazy. When I recognize that they will, I simply don't express my views, because I don't want to be thought crazy. My motivation to appear sane leads me to self-censor. If I am so tortured by my beliefs that I know I will not be able to keep quiet, I withdraw—I simply go home.

To circle back to the issue of disclosure and accommodations, many of the things you can do to help navigate the tenure process are things you can arrange without formally disclosing your illness.

For instance, scheduling courses is something that I imagine most departments would want to accommodate to the extent they are able. True, in an unfriendly department, you may need to invoke the ADA. If you need more time on the tenure clock, and your department is not well-disposed to offer it, the ADA might also come to your rescue.

All of that said, the balance of factors for and against telling may change once you do get tenure. Being open about your illness at that point exposes you to less risk and may have the advantages mentioned earlier—e.g. not having a secret, being able to serve as a role model for others in academe.

We also need to put a face on mental illness. Being open about one's own illness will probably do more good than all the laws we can pass.

My own "outing" of myself was a bit of a risk, but has turned out well. I am glad and relieved I no longer have to hide. And my story seems to be meaningful to people—it has helped people understand mental illness more and perhaps has led to a decrease in the stigma. I was lucky in that my law school accommodated my teaching needs without my having to invoke the ADA. My colleagues are supportive, and I no longer feel ashamed about needing their help.

The suggestions I have made here are all straightforward. There is, unfortunately, little engagement with the issue of mental illness and academic employment. I began a campus support group for professors with mental-health issues; one person showed up for the meeting. I don't know whether people fear confidentiality won't be maintained, are too busy, or, as professors, tend to "fly solo." In any case, the effort failed.

I hope that this article will help start a much-needed conversation about mental illness in higher education. (Indeed, it might be worthwhile to start an online support group for professors with mental illness. If you are interested, please contact me.)

Perhaps most important: Seek help when you need it. Mental illness is a no-fault disease like any other, such as cancer or diabetes. Help is available, but you need to ask for it. Don't let the threat of stigma deter you. You shouldn't have to suffer.

And you shouldn't allow mental illness to stand in the way of the wonderful contributions you are poised to make to your students and to your field.

Elyn R. Saks is a professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California's law school. She is the author of a memoir, "The Center Cannot Hold: My Journey Through Madness" (Hyperion, 2007).


Betsy McKenzie said...

OOTJ readers may be interested in knowing that Prof. Elyn Saks received a MacArthur Genius grant for her work demonstrating that even serious mental illness need not be a life-destroying event.

Burkey said...

Wow, that's fascinating. I came to your site searching for something completely different, that is, an image of justice scales.

I have suffered from a debilitating major depression which made it very difficult to function before I started taking meds ten years ago. My parents were a big influence on me in that they were very open and accepting of the fact that people have mental issues---not just some, but all. It's part of the way we are made. And some of us need treatment. Their attitude made it so that I never thought twice about seeking help when I needed it. That, and a great support system like the professor mentions, is really essential to keeping one's self in enough balance to be effective. The medication made a huge difference. Nothing else was as effective, not exercise, diet, or any of the many things I tried, like going out when I felt like staying in.
I think people generally don't believe that a person with mental illness is capable of exhibiting good or careful judgement. The fact is that it can be managed, like any illness; and one can make good decisions. Pausing and considering for a few days before deciding larger things, and reflecting on them with one's support group, eliminates this problem. You learn to feel when your decision isn't coming from the best place, and hold off on it until you can consult your circle of elders. Ultimately, putting a face on it is really important, and so it's great to hear that someone this courageous has been rewarded for her skill in managing her disability. Inspiring. Thanks for such an interesting article.