To my students with mental illness

This semester record numbers of my students told me that they are suffering from mental illness. Sometimes these disclosures occurred as part of broader conversations, but most often they occurred because the students wanted me to grade them differently than I otherwise would have. I’m not talking about times when students provide an official form documenting that they should receive specific accommodations for a disability. I’m also not talking about times when a specific medical or personal crisis happens to coincide with an exam or assignment. I’m talking about situations for which there is no paperwork whatsoever, in which students are very distressed about the possibility that they will receive lower grades because they have missed classes, missed deadlines, or done poor/disorganized work as a result of ongoing mental health problems. These situations weigh heavily on me, because although I find it easy to feel compassion for these students, I often cannot give them the grades they want.

A recent essay (Virzi, 2015) captures some of the difficulties that I experience when trying to address the academic challenges faced by college students with mental illness: “When you told her to work harder, she heard you say she wasn’t good enough. When you asked her to drop your class, she heard you say she was a failure.” Written in the form of a letter to the professor of a friend with life-threatening mental health problems, the essay states that the professor had treated the friend with a profound lack of understanding and support. But while there are many problems with how colleges handle mental health issues, the professor targeted for so much disdain in this piece doesn’t seem to be one of them. Unless the professor went about it in an inappropriate or cruel way that we aren’t told about, he/she seems to have taken all the correct steps to help his/her student face and handle the fact that severe illness had taken a toll on her class performance. When a student’s accumulated grades are likely to result in an unsatisfactory course grade, the student can start doing much better in the class (which will require somehow working harder at it), withdraw, or continue as-is and fail. It is unfortunate that the student interpreted these options as an insult or expression of insensitivity by the professor, because in fact they were just the possible outcomes of the difficult situation that the professor was trying to help the student navigate!

By encouraging the student to drop his/her course, the professor was responsibly suggesting that she prioritize her recovery ahead of academics while also taking the necessary step to prevent having an F on her college transcript. But the essay goes on to suggest that professor should have instead encouraged the student to stay in the course, “because it is the only thing in her life that makes her feel normal.” Perhaps this plan might make sense if the student had been auditing the class as a form of occupational therapy, or otherwise had no concern about her grade in it — but college is a lot more like a job than like therapy and chances are that a low/failing grade would not have been well-received. The author also seems to assume that offering the student extensions would have solved the entire problem, though extensions are not always an option, and an unrealistically large pile of overdue work can easily set any student up for failure. Indeed, sometimes a student has already missed or performed poorly for so much of a course that it is no longer possible to pass. The essay portrays the student’s grade as entirely in the professor’s hands, but it is not.

The essay concludes that by addressing the student’s class performance, the professor didn’t treat the student as a human being, didn’t sufficiently acknowledge her struggles, and failed to appreciate her strengths. “Professor, my best friend is smart, driven, and capable….help me celebrate her for fighting this illness.” Here the argument becomes very strange, because college courses are not really intended to celebrate anyone. It is also hard to imagine that the student would have felt celebrated in the absence of a good/passing grade, even if the professor did regularly ask her about her feelings. Importantly, the author isn’t just advocating that students with mental illness should feel more welcome on campus or have more access to mental health care, she is arguing that it is wrong for professors to evaluate these students based on standards for performance. She is saying that by doing their jobs, professors are enforcing cultural stigma and are therefore part of the problem.

I have many students who receive accommodations for learning disabilities and/or ADHD. Typically these accommodations have to do with how students take the required exams (e.g., extended time, quiet spaces) and occasionally a designated note-taker. But I have never seen a document saying that any student should receive accommodations for attending class and completing projects by deadlines that are set far in advance. Another recent essay (Ruriani, 2015) argues that it is unfair of professors not to allow this kind of flexibility to students with ongoing mental health problems. The conclusion is a plea for professors to “look at the whole person” when grading, rather than penalizing students with mental illness for their difficulties meeting the course requirements. While I agree that no one should be harshly penalized for imperfect attendance or imperfect anything, I don’t think most classes could function if the requirements weren’t actually required. I also don’t think absolute flexibility is a reasonable expectation in most aspects of adult life. Finally I have no idea how professors could fairly grade the entirety of a person.

Since colleges and courses vary a lot in their emphasis on things like attendance, students should seriously consider whether or not the requirements for a particular class are likely to be a good fit. Students also should consider the fact that being critically evaluated on course requirements is a central part of what it means to be in college. If students are likely to feel suicidal or otherwise suffer serious health consequences from receiving a disappointing grade, they should postpone their education until they are ready to handle it, because professors can’t give better grades out of concern for these things. No one can expect to do everything well, and disappointing results are especially likely when people try to do too much at once. Accepting this is part of what it takes to live and work responsibly as an adult with mental illness.

One semester while teaching I was suffering from an extraordinarily severe depressive episode in which I couldn’t sleep or make even trivial decisions. I was frequently late for class, and once even missed class because after several days of insomnia I had fallen unconscious on my way to the campus. Though I tried my absolute hardest, I sometimes couldn’t get my class materials prepared on time and it took me quite a while to grade students’ papers. In their course evaluations, my students tore me apart for my disorganization, lateness/absences, the ways in which my ability as a lecturer was impeded by discomfort being in my own skin. In other words I was judged not for who I am as a whole, or the potential for greatness that my illness had prevented me from showing; I was judged simply on the merits of what I produced at the times I was supposed to produce them. Students don’t say “Hey, professor, you didn’t sleep? How about you rest and we’ll all come back for the lecture later.” They just give you a “poor” rating as a professor — and this is how most of the world works. I try not to blame myself for these poor ratings because I did the best I could under the circumstances. And I don’t blame my students, because they evaluated my performance by the appropriate criteria. Illness can make even the best student’s or worker’s performance suffer. This isn’t because of stigma, but because of the illness itself, and it is incredibly sad.

It is human to want to channel feelings of powerless despair into indignation, and we have to feel for how much despair these authors have been through. Nevertheless, I disagree with them, and not because I need any mandated faculty training to understand mental illness! I’m not even sure that these two essays are really about mental illness. To me, these essays are largely about looking for someone to blame for the fact that we can’t always do everything well — even when we have lots of potential and are trying as hard as we can. Unfortunately, I don’t think these expressions of misplaced outrage are likely to be helpful for improving the lives of people with mental illness. Isn’t it dangerous to imply that people with mental illness are too fragile or too incapable to be held to and evaluated on performance standards? Isn’t it unreasonable to accuse professors of being stigmatizing or discriminatory if they lack warm/fuzzy therapist qualities or sometimes have to be the bearers of bad news about students’ performance? Aren’t efforts to address real issues related to mental illness stigma and discrimination potentially damaged by overly-inclusive applications of these concepts?

When you don’t get the grade you want, this doesn’t mean that you are destined for failure in life; it also doesn’t mean that your professor lacks understanding of your suffering or appreciation for your strengths.  Professors can only grade performance on specific class assignments by specific deadlines, based on requirements explained in painstaking detail on the syllabus, grading rubrics, and so on. Professors cannot and should not attempt to grade a student’s worth or potential as a whole person and I think it would be a mistake for any of us to give anyone that kind of authority. We are all more than the sum of our grades and evaluations.


Thinking of my doctor on Thanksgiving

Last spring, shortly after meeting the doctor who provides my ketamine infusions, I realized that he must have an office full of patients like me 7 days a week, traveling to see him from all over the world. When I asked about this he said that the only day he makes sure to take off is Thanksgiving. I hope he is having the day that he deserves, and that he knows how grateful we are.


Saying what goes unsaid

I’ve stopped writing because I can’t stand the sound of my voice, hate everything I say, and hate myself for saying it. I’m finding it hard to want to talk, and whenever I do I spend a lot of time afterwards regretting that I let any of this nastiness out where other people have to hear it. I’m finding it especially hard to work as a professor because so much of this job is conveying (convincingly) to students that what you have to say is interesting and valuable.

I tried not to let this happen. I’ve been through several medication changes in the last month, trying to stop it. So far that has only made things worse because one or more of these medication changes has been keeping me from sleeping.

I’m afraid that I’d lose my job if anyone knew how close to the edge I’ve felt a lot of the time. I also can’t (convincingly) argue that I wouldn’t deserve to lose my job, but I’m not even going to let my thoughts go down that path right now. My only option is to keep trying to pretend that everything is normal and that I’ve got it all under control.

Fantastic voyage

A week ago I cried (with only brief pauses) for over 8 hours, while on a plane and various airports, on my way home after presenting at a professional conference. When it first started I hid in a bathroom stall and tried to stifle the sounds while other patrons were using the facilities. But over the rest of the day tears found their way down my face even while I was just sitting silently. The barrier had been breached and that was that.

A snarkier, clickbait article about this might be written for various mental illness advocacy websites. The article might be called “X things not to say to a crying stranger,” and would shame the various people who ineffectively tried to help me that day for their ignorance or at least lack of subtlety. But I didn’t know what to do in these situations and can’t find fault in the strangers who didn’t know what to do either.

  • One startled bathroom attendant started shrieking when she saw my swollen, bloody eyes and wet face; I think she was truly upset that some crisis might be under way.
  • The woman next to me on the plane kept trying to reassure me, or to reassure herself, that I was “just having a bad day, that’s all, right?” I shook my head, thinking: ‘I have a serious illness that was in remission and now it is back and I’m frightened about what is going to happen’. But not wanting to have to explain that I don’t have cancer, I forced a teary smile and said nothing. She probably repeated that phrase 3 or 4 times.
  • The flight attendant asked if I was OK and gave me a pile of napkins, which I really appreciated. She also offered to escort me off the plane or get assistance. I said no, all I really need is to get home, and she assured me that she would get me home. This was actually comforting, but the silent tears nevertheless persisted for the entire flight. Before landing, she crouched in the aisle beside me and said “I don’t know what faith you are but if you want me to pray with you, let’s do that.” I thanked her with another weird, wet smile, not having the heart to tell her that I’m an atheist.

Remember it’s true, dignity is valuable
But our lives are valuable too
from “Fantastic Voyage” (Bowie/Eno)

Holding tight to this dream of distant light

I’ve been reluctant to admit this to myself, but the ketamine treatments have stopped working. Trying to deal with this, I’ve been going for booster treatments every 2-4 weeks and getting a relatively strong dose each time. But over the last few months, the benefit of each treatment has become smaller and smaller. Sure, other medications that had been somewhat helpful to me in the past (e.g., MAOIs) eventually stopped working, and I feel a little foolish that I never considered this might happen with ketamine too. I certainly never considered that it might happen quite so quickly. I don’t know where to go from here; obviously some serious conversations with my doctors are the next step.

I’m grateful to have been able to experience those several months of remission I had with ketamine; after so many decades of depression I didn’t even know it was possible to really feel OK like that. I’m trying to hold on to the memory of that feeling, while completely overcome with grief that it is gone.


“…And yet I’m still holding tight to this dream of distant light, and that somehow I’ll survive. But this night has been a long one, waiting on a sun that just don’t come…”
– Speed of Sound by Pearl Jam (2009)

Epilogue: In the fall of 2015 I had severe work stress (I was being bullied by several students) and I started taking clonazepam much more regularly. It turns out that clonazepam has been observed to sometimes interfere with the effectiveness of ketamine infusions (although this depends on the dose and timing of the clonazepam, as well as other individual factors). Once I got myself off of that stuff, the infusions started working again. And of course when that semester was over, the reduction in stress was really helpful for my depression too.

Finally the shades are raised

Over the last several weeks I’ve been trying to finish an essay that is expected to be published in the near future, about my decision to stop talking to my father. Working on this essay made my recurring nightmares about him much more frequent and intense, so I hope it will be worth it.

At the risk of stating the obvious: Pearl Jam songs have been one of my main sources of comfort for over 20 years. I was first drawn in by how much I could relate to the heartbreak expressed in “Black,” a staple of the radio station I listened to in the early 90’s. But when I first saw the band perform on Saturday Night Live in 1994, they did a pair of songs about childhood abuse that took my breath away  – and I still can’t watch that performance of “Rearviewmirror” without getting chills.

Verbal/emotional abuse and neglect were a routine part of my upbringing – but there was never any physical or sexual violence, and with my parents’ encouragement my sister and I were very well-behaved, high-achieving kids. I never felt like I had the right to my real story and these songs helped clarify it for me in a way that nothing ever had before: my father’s cruelty to me had hurt me irreparably, and the futility of continuing to trying to please him was still hurting me. Though it took me another 20 years to say it, eventually I did tell my father: Don’t call me.

“Daughter” tells of a young girl striving to be worthy of her parent’s admiration. But behind the clean pretty façade of this family life, there’s something wrong. The lyrics can’t seem to decide whether it is the parent or the daughter who is unworthy (“unfit”) to claim their relationship with the other, and the daughter is apparently trapped by this same confusion, as she holds the hand that holds her down. As the song ends, the shades go down, both hiding her suffering and leaving her in darkness.

“Rearviewmirror” describes someone who left an abuser behind, and saw things clearer as a result. “I gather speed from you fucking with me… Once and for all I’m far away… hardly believe, finally the shades are RAISED.”


Surviving until I could make my life worth living

I’ve spent most of my life wishing I were dead, and as a college student I tried to kill myself. The story of my survival, and of my promise to never try to take my life again, is posted today on the Active Minds blog, here:

Since this seems to be a broken link, below you’ll find what used to be posted there:

According to the Interpersonal Theory of Suicide (Van Orden et al., 2010), desires for suicide arise from a combination of perceived burdensomeness and thwarted belongingness. The capability for suicide is separate from this, and many people experience persistent desires for suicide without capability for it. That was the case for me for most of my life.

I’ve almost always felt like a burden –which makes sense considering that my father, frustrated that I didn’t have the attributes he had wanted in a child, frequently said I was a burden. When I cried, he reminded me that unlike many children in the world I wasn’t being beaten, wasn’t impoverished, had both my legs, etc. He taught me to see my depression as another sign of my selfishness, and did his best to prevent me from getting help.

Thwarted belongingness has been a longstanding problem for me too. Growing up, I felt as though no one in the world could accept or understand me, and this made me vulnerable to putting up with rather rotten behavior on the part of friends and romantic partners who had once thrown me a few crumbs of kindness. Repeatedly, after a friend or partner started to bully me, threaten me, use me, cheat on me, abandon me, or otherwise treat me badly, I assumed I somehow deserved it (for being too boring, too needy, insufficiently giving, and so on). I would then spend several years mourning the loss of what we’d once had, just hoping that somehow they’d come back and care about me again that tiny little bit.

Of course, interpersonal problems – such as feeling like a burden and feeling alone — go hand in hand with depression, which I’ve had since childhood. Often interpersonal problems are the stressor that makes someone with a vulnerability to depression begin to have far worse symptoms than before. Depression also has a way of exacerbating interpersonal problems and separating us from others. Some people become frustrated with our depressive behavior and reject us, and because we fear this happening, many of us pre-emptively back away from people who might have been accepting if we had let them.  

I’ve had several severe depressive episodes, but the only time I ever tried to kill myself was in college, because it was then that I felt most alone. Everyone I knew was facing their own changes, going in different directions.  I felt that no one could stand to be around me, and I couldn’t stand to be with myself either. I felt sure that I was a burden and that my death wouldn’t matter much to anyone.  But I survived and afterwards just went on as if nothing happened.

Though I continued to have very strong suicidal wishes, I never made another suicide attempt because I started to worry that killing myself might make me MORE of a burden, rather than less. First I thought that I couldn’t kill myself because I didn’t want other people to have to clean up the messy state in which I keep my personal belongings. Then I told myself that I couldn’t do it because my cats needed me. Finally, I started believing that it would cause other people emotional pain if I killed myself, and I resolved never to do it, no matter how much I didn’t want to live. 

While my depression and isolation were still quite severe, I remained very tempted to kill myself and was afraid that I may not be able to resist. So during my third year of college I admitted myself to the hospital and then went to live in a residential treatment center. From there, I resumed college classes and applied to graduate school in psychology.

Today I am a college professor. I work hard to manage my mental illness, with ongoing treatment and making healthy lifestyle choices (including carefully choosing caring people for companionship). Without depression clouding my vision, my long-held assumption that I am a burden no longer seems indisputable, because I think I do make a difference for my students and other people close to me. I’m not just waiting to die, but trying to make the rest of my life one worth living.