Mental health and treatment in graduate school

Talking about mental health is hard. Let’s start there.

I think I have always been relatively transparent (some might disagree, which is fair) about my mental health experiences in graduate school. Now that I have the privilege of watching other new scholars grow and have been somewhat removed from my own graduate school experience in terms of time, I get to reflect on my entire journey.

I am not the first, and I will certainly not be the last, to talk about problems with mental health in graduate school education. (See here, here, and here for examples.)  However, for me, my own mental health journey during graduate school was greatly influenced by my sense of what was going on in my community, and as such, I think that simply having academics constantly engaged in this conversation may be an important step forward.

What does the problem look like, though? I cannot speak for anyone’s experience but my own, but in sharing my own experience, I hope that those who are struggling might find some comfort, if not insight. My goals in writing this are two-fold: (a) to help people reflect on their own experiences, and (b) to simply share what helped me through my own issues. In particular, I focus on why treatment was important for me.

Before I say anything else, I would like to emphasize that I am not a mental health professional. I do not claim to know why some of the things that I experienced happened, nor do I assume that other academics, much less a majority, have experienced the same things.

As a brief bit of background, I was not particularly attuned to issues of mental health before starting graduate school. I grew up in an environment that largely diminished mental health issues. However, throughout my time in graduate school, I slowly came to realize that my patterns of thought and behavior, whether chemically-induced or simply habitual, were causing major problems in my academic and personal development.

Some of the signs:

  1. Days to weeks-long periods where I would obsess over previous social interactions.
  2. Not being confident in anything I ever said in class, and taking any contradiction of anything I said in class as a sign that I didn’t belong there and that people didn’t like me.
  3. Complete withdrawal from my peers and colleagues for long periods of time.
  4. Complete dismissal of the idea that they were really peers and colleagues in the first place.
  5. Being unable to attend class because I couldn’t bring myself to be around other people.
  6. A paralysis where whenever I got any indication that I had made a mistake (real or not), I would find myself on my couch, in silence, unable to do anything or speak to anyone for hours on end.
  7. I was never much into crying, but oh goodness, the crying.
  8. Bouts of internal panic where certain stressors would send my brain into a kind of overdrive where my thoughts would become incoherent and I could not process events. This was often accompanied by actual physical reactions as well.
  9. A general lack of motivation or interest in anything I was doing, which I confounded with disinterest in my research or any research at all.
  10. Eventually, realizing that getting up every day was something I dreaded and that if I had my way, I would simply cease to exist.

Again, I do not claim that these issues emerged because of graduate school, but I do think that some aspects of the graduate school experience certainly did not help. Continuing with my disclaimers, I do not know if this experience is the norm, nor do I think it should be normed. I think that as a society, there is some serious work to be done to think about how the structure of graduate student life is or isn’t particularly healthy. We also, I think, need to have a conversation about certain tacit expectations we have that graduate school will be tough and stressful and life-swallowing. Until that happens, though, we as individuals also need to talk about ways that people can cope. Much of this evolution is just learning how to be an adult and deal with stress, but there are many other ways in which it is more specifically about real, psychological problems that cannot be attributed, I think, to simple immaturity.

First and foremost, I got help. I had always been fairly anti-therapy and very anti-medication when it came to psychological issues, but upon educating myself about the risks, I decided that the risks associated with trying treatment were much lower than the risks of leaving my issues alone. After a fair amount of evaluation, I was diagnosed with major depression as well as social anxiety. As such, it was recommended that I work simultaneously on two treatment paths – regular counseling with a psychologist and medication through a psychiatrist. For most of this time, every week (and later, every two weeks), I would have a session with a psychologist. Every two weeks (and later, every month), I would meet with a psychiatrist.

I think there’s an important point I should note here: I did not get better right away.

In fact, I had several fairly major setbacks in the road, including a period where I stopped therapy because I wasn’t seeing progress, at least two changes in my psychologist and one change in my psychiatrist, maybe five or six changes in medication as we tried to figure out what would work, consequential swings in mood and other physical reactions as my body reacted to the chemical changes, a fairly embarrassing moment where I got in an argument with the leader of a group therapy session and never went back, at least one fairly frightening withdrawal period that involved extreme paranoia and insomnia when I stopped taking a medication, and lots and lots of me going into an appointment with nothing to say but, “I feel exactly the same as I felt last week, if not worse.”

In my case, I didn’t see a lot of immediate change, but upon reflecting on my entire treatment period over the course of three to four years, I can see now that I changed tremendously. I went from dangerously low moods to fairly middling moods by the end of graduate school. While I cannot say that I was completely “fixed” by the end, I know that without having addressed it head-on, my outcomes might have been very different.

Not everyone is going to need the same things, but for me, what was probably the most important part of my growth was recognizing I had a problem and sticking with working towards a solution. Farther down the road, I think it paid off. Was the process of writing and completing my dissertation still difficult and stressful? Of course. Did I still have my low moments? Yes. But I was better able to cope with those moments because I had finally gotten to the place where I knew for a fact that those moments would be temporary. I may not have the kind of zest for life that a completely healthy person would have, but there is something comforting about knowing I am nowhere near where I used to be.

In reference to my own experience, were I to go and give my early-scholar self some advice, this is what I would say.

  1. Not all professors are particularly adept at addressing these issues, nor do I think, being a faculty member now, that we can be expected to do so. If you feel that you are in danger, seek professional help, as the conversations you have with unqualified (though well-meaning) individuals may in fact make things worse.
  2. If you feel comfortable enough, do try to be honest with at least one person about what you are going through. No, do not use them as your therapist, but it was critically important to me that at least one person knew what was going on so that when I did have depressive episodes that got in the way of my academic work, at least someone knew why it was happening and didn’t think it was just because I was a bad student.
  3. Patterns are patterns, no matter how bad. Psychological treatment is about more than just suicide prevention (which is what I used to think). You don’t need to be immediately in danger of dying to see a primary care physician. The same applies here.
  4. Putting a priority on your treatment is important. This does not mean ignoring academic responsibilities, but it does mean arranging your life such that you still have time for therapy. The times when I skipped therapy because “I just have too much to do this week” never turned out particularly great.
  5. Advocate for yourself. Communicate with your mental health providers about your goals, fears, and concerns. If you feel that you are not getting what you need, just let them know.
  6. Sometimes, you will withdraw from people who care about you. Sometimes, this will be for quite some time. That is okay. Of course, you should still be respectful of the people around you, but make sure to consider your own needs as well. People who care about you will understand.
  7. Be patient with yourself. Change will not happen tomorrow. It may not happen next week. But over the long-run, change, indeed, will come.

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