Mental health stigma

[HyacinthMacaw]

Dear folks,

I'd like to elicit your thoughts and comments on a heartbreaking issue. I came across this article in which the authors surveyed graduate admissions committees for "kisses of death" that would lead them to reject otherwise strong applicants. I discovered that the disclosure of struggles with one's mental health represented an ostensibly egregious error in that category. To survey respondents, this indicated emotional instability, and the authors of the article warn that evidence of a turbulent personal history or trauma could suggest an inability to function as a successful graduate student.

I'm objecting to this reasoning not only because I've struggled with severe recurring depression ever since I was 13, engaged in violent self-harm before attempting suicide nearly two years ago, and am thus inclined to rush to the defense of the despondent. I object because the characterization of my brothers and sisters in suffering as "unable to function as successful graduate student" infuriates me, and I view surviving trauma and abuse (or self-abuse) as a testament to one's strength, not infirmity. I object because exhibiting our humanity when we convey these narratives should elicit respect in the very least--not icy reprimands, "kisses of death."

I object because divorcing personal history from professional ambition can carry particular sting. In this context, stigma is the shame of having to keep something private for fear of prejudice, disgust, disdain, disapproval. I have no doubt that private victimization, however defined, can propel us to achieve in our fields. Grief motivates us to dream harder. And the relationship is bidirectional; our academic work can spur emotional growth, our zest for living. There are probably hazards to this linkage of the private and the public, but they do not justify discriminatory admissions practices. Indeed, very few things do.

The Americans with Disabilities Act (ADA) prohibits discrimination against qualified people with disabilities, including those with mental illness. I say "qualified" because an applicant or employee must still perform the "essential duties" of his or her position. If a psychiatric diagnosis interferes with this, then an employer could legally deny an applicant employment. It's immaterial whether the disclosure of psychiatric history is voluntary, I believe, as in the case of personal statements--just as an employer or university cannot discriminate on the basis of religion if one were to offer that information. In any case, the judgment that a mentally disordered individual cannot execute the basic functions of his or her position cannot be made on the basis of stereotypical generalizations but on objective evidence. This also applies in assessments that an individual may be a "direct threat" to him/herself or to others.

For all the moral disgrace of mental health stigma, prejudice, and discrimination during the application process, I've discovered that these are likely to dissolve once nestled safely in a graduate program and under the wing of a supportive advisor. I was blessed with such an advisor already; indeed, I was surprised he was capable of such compassion as when I informed him via email that I had landed in the hospital after doing all I could to end my life. I don't plan on disclosing my history to my current advisor, but I can already tell that if I were to relapse, she would grant me all the resources I would need for an accelerated recovery.

So how are admissions committees quick to dismiss applicants who discuss emotional/physical trauma and/or mental illness but equally quick, as individual advisors, to accommodate students suffering the same? If mental illness really does manifest an inability to function as a successful graduate student, then graduate students who disclose their illness to advisors and department chairs would be deemed unfit to continue their studies and promptly expelled. The reasoning of survey respondents in the above article leads to that harsh conclusion.

Ultimately, capricious, inscrutable admissions committees can reject applicants for reasons that have nothing to do with merit. We've grown accustomed to that by now. Fairness doesn't always prevail. So why raise the issue?

Well, for one I'm concerned that misconceptions about the mentally ill as violent or dangerous will continue to dominate admissions/hiring decisions. Though this callous discrimination can melt away in relationships with colleagues, thus challenging those stereotypes, our attitudes towards groups as whole entities does matter. There's a difference between demonstrating compassion to a schizophrenic co-worker and having favorable attitudes towards schizophrenics in general. These are of course related, but I would argue that much of what passes for prejudice reduction occurs at the interpersonal level only, not the intergroup level. So ambivalence towards certain groups can survive independent of our interpersonal treatment of members of these groups. And such ambivalence (or antipathy) still poses a problem because it can predict discrimination in organizational settings and perhaps political opposition to budgetary allocations for mental health services.

Put simply, I will never doubt the capacity for human beings to love one another within their established social networks, but I am far more pessimistic of our good will towards groups in general. To bridge that distance, I suppose we ought to feel every suicide as the suicide of a loved one, every abuse as the abuse of a loved one, every illness as our own--but that would defy our bloody history. That's the tragedy here--placing groups at a psychological distance justifies our cruelty even though every tear, every death, should break our hearts whether or not we know the afflicted.

So what do you think? Is mental health stigma still a problem? I'm sorry I've spit this out so incoherently. Any thoughts or comments would be appreciated. Thanks for reading!

[UnlikelyGrad]

So what do you think? Is mental health stigma still a problem? I'm sorry I've spit this out so incoherently. Any thoughts or comments would be appreciated. Thanks for reading!

Yes, it is. I think dealing with mental health issues is getting better/easier, though, as it's becoming more widely accepted that mental illness is (1) treatable and (2) not a reflection on the person's being "good" and "bad". The real problem, as I see it, is that there are a lot of (mostly older) people who still harbor the old attitudes. I feel like once these all die off, society will be a much more accepting, and an overall better place for people with mental illness.

[mechengr2000]

That's going to be a very tough social struggle. It needs to be done though. I support you fully.

Dear folks,

I'd like to elicit your thoughts and comments on a heartbreaking issue. I came across this article in which the authors surveyed graduate admissions committees for "kisses of death" that would lead them to reject otherwise strong applicants. I discovered that the disclosure of struggles with one's mental health represented an ostensibly egregious error in that category. To survey respondents, this indicated emotional instability, and the authors of the article warn that evidence of a turbulent personal history or trauma could suggest an inability to function as a successful graduate student.

I'm objecting to this reasoning not only because I've struggled with severe recurring depression ever since I was 13, engaged in violent self-harm before attempting suicide nearly two years ago, and am thus inclined to rush to the defense of the despondent. I object because the characterization of my brothers and sisters in suffering as "unable to function as successful graduate student" infuriates me, and I view surviving trauma and abuse (or self-abuse) as a testament to one's strength, not infirmity. I object because exhibiting our humanity when we convey these narratives should elicit respect in the very least--not icy reprimands, "kisses of death."

I object because divorcing personal history from professional ambition can carry particular sting. In this context, stigma is the shame of having to keep something private for fear of prejudice, disgust, disdain, disapproval. I have no doubt that private victimization, however defined, can propel us to achieve in our fields. Grief motivates us to dream harder. And the relationship is bidirectional; our academic work can spur emotional growth, our zest for living. There are probably hazards to this linkage of the private and the public, but they do not justify discriminatory admissions practices. Indeed, very few things do.

The Americans with Disabilities Act (ADA) prohibits discrimination against qualified people with disabilities, including those with mental illness. I say "qualified" because an applicant or employee must still perform the "essential duties" of his or her position. If a psychiatric diagnosis interferes with this, then an employer could legally deny an applicant employment. It's immaterial whether the disclosure of psychiatric history is voluntary, I believe, as in the case of personal statements--just as an employer or university cannot discriminate on the basis of religion if one were to offer that information. In any case, the judgment that a mentally disordered individual cannot execute the basic functions of his or her position cannot be made on the basis of stereotypical generalizations but on objective evidence. This also applies in assessments that an individual may be a "direct threat" to him/herself or to others.

For all the moral disgrace of mental health stigma, prejudice, and discrimination during the application process, I've discovered that these are likely to dissolve once nestled safely in a graduate program and under the wing of a supportive advisor. I was blessed with such an advisor already; indeed, I was surprised he was capable of such compassion as when I informed him via email that I had landed in the hospital after doing all I could to end my life. I don't plan on disclosing my history to my current advisor, but I can already tell that if I were to relapse, she would grant me all the resources I would need for an accelerated recovery.

So how are admissions committees quick to dismiss applicants who discuss emotional/physical trauma and/or mental illness but equally quick, as individual advisors, to accommodate students suffering the same? If mental illness really does manifest an inability to function as a successful graduate student, then graduate students who disclose their illness to advisors and department chairs would be deemed unfit to continue their studies and promptly expelled. The reasoning of survey respondents in the above article leads to that harsh conclusion.

Ultimately, capricious, inscrutable admissions committees can reject applicants for reasons that have nothing to do with merit. We've grown accustomed to that by now. Fairness doesn't always prevail. So why raise the issue?

Well, for one I'm concerned that misconceptions about the mentally ill as violent or dangerous will continue to dominate admissions/hiring decisions. Though this callous discrimination can melt away in relationships with colleagues, thus challenging those stereotypes, our attitudes towards groups as whole entities does matter. There's a difference between demonstrating compassion to a schizophrenic co-worker and having favorable attitudes towards schizophrenics in general. These are of course related, but I would argue that much of what passes for prejudice reduction occurs at the interpersonal level only, not the intergroup level. So ambivalence towards certain groups can survive independent of our interpersonal treatment of members of these groups. And such ambivalence (or antipathy) still poses a problem because it can predict discrimination in organizational settings and perhaps political opposition to budgetary allocations for mental health services.

Put simply, I will never doubt the capacity for human beings to love one another within their established social networks, but I am far more pessimistic of our good will towards groups in general. To bridge that distance, I suppose we ought to feel every suicide as the suicide of a loved one, every abuse as the abuse of a loved one, every illness as our own--but that would defy our bloody history. That's the tragedy here--placing groups at a psychological distance justifies our cruelty even though every tear, every death, should break our hearts whether or not we know the afflicted.

So what do you think? Is mental health stigma still a problem? I'm sorry I've spit this out so incoherently. Any thoughts or comments would be appreciated. Thanks for reading!

[natsteel]

Whether we agree or disagree, the study shows that adcomms react negatively to disclosure of mental illness. So to give yourself the best shot, don't mention it. There really is no reason to mention it unless it adversely affected your academic record in some way. If we're talking about an SOP, adcomms want to see your professional ambition, not your personal history. Some people use personal history in an SOP to good effect (others not so good), but it usually comes off when it's a positive thing rather than being used as an excuse. OP, if your record was not affected by your mental illness, then there is absolutely no need to disclose it. That's just my opinion, though...

That said, the stigmatization is a problem. I have read posts on the CHE forums in which you can see that some professors aren't very educated about mental health issues. For example. one poster said that they wouldn't meet with a student alone who has known mental issues (in this case, BPD). They seemed to think that everyone diagnosed with BPD is a ticking time-bomb and psychotic or sociopathic. It is something that could use addressing among faculty.

[robot_hamster]

I find it interesting that aside from this, all of the things described in this article are pretty obvious. We all know that grammar/spelling errors in a statement of purpose would be bad, as well as including stuff that falls in the TMI category. It's almost like a game of "What Doesn't Belong?". Why is so much emphasis placed on the disclosure of a mental illness? Hopefully I'm making sense here.

So does this have something to do with the fact that this study focused on psychology graduate admissions? I suppose I could see the connection there (i.e. you don't want a "mentally unstable" person studying psychology). What would you call that? It's almost like a conflict of interest or a contradiction. I'm not saying I agree with it, I'm just saying that I can sort of see where it comes from.

As for the mental health stigma being a problem in general, I think it still is. But as UnlikelyGrad said, it is getting better as old attitudes begin to fade away and mental health issues become more widely accepted. I personally have no experience with being rejected or feeling judged by an admissions committee, but I also did not disclose information about my personal history with depression and anxiety in my statement of purpose. There are people who know about my issues including my adviser and the associate director. This didn't come out until after I was admitted. But it wasn't like I was consciously omitting the information from my statement of purpose, I just felt it wasn't an appropriate place to discuss it. Really, it didn't even occur to me to discuss it there. It just isn't relevant information (but I suppose I could see why someone wishing to study psychology might feel it is relevant). Anyway, at no time did I feel judged by anyone. If anything, it seems like they were genuinely concerned and wanted to help me that much more. This is especially true of my adviser, they want me to succeed.

[UnlikelyGrad]

I personally have no experience with being rejected or feeling judged by an admissions committee, but I also did not disclose information about my personal history with depression and anxiety in my statement of purpose. There are people who know about my issues including my adviser and the associate director. This didn't come out until after I was admitted. But it wasn't like I was consciously omitting the information from my statement of purpose, I just felt it wasn't an appropriate place to discuss it.

Agreed 100%.

[nessa]

I'm applying to grad school in clinical psych, and I also was surprised to see personal mental health issues noted so strongly as unacceptable in SOPs, especially considering that clinical psychologists should be more accepting than most of mental illness. However, that this is specifically in psychology is significant- and if you read more closely, it seems to me that mental illness itself is not the issue.

this is the actual quote from the article (emphases are mine):

Personal mental health. The discussion of a personal mental health problem is likely to decrease an applicant’s chances of acceptance into a program. Examples of this particular KOD in a personal statement included comments such as “showing evidence of untreated mental illness,” “emotional instability,” and seeking graduate training “to better understand one’s own problems or problems in one’s family.” More specifically, one respondent stated that a KOD may occur “when students highlight how they were drawn to graduate study because of significant personal problems or trauma. Graduate school is an academic/career path, not a personal treatment or intervention for problems.”

It seems like the real issues are 1) having an untreated illness (and having any unresolved issue is a red flag in an SOP) or 2) only caring about the field because of your experiences with mental health. Think about it this way: if you were applying to an immunology program, and your entire SOP consisted of a discussion of your own autoimmune disorder, and how you want to go to grad school to figure out what was going on with your disorder, that wouldn't be looked on very favorably either.

However, I want to emphasize that I do believe discrimination based on mental illness happens all the time, including (especially?) in graduate admission, and that I do believe mental illness, and the skills gained in overcoming it, are not viewed the way they should be. But, in psychology, there is good reason to warn against dwelling on it in the SOP.

Edited May 27, 2011 by nessa

[squaresquared]

I'm applying to grad school in clinical psych, and I also was surprised to see personal mental health issues noted so strongly as unacceptable in SOPs, especially considering that clinical psychologists should be more accepting than most of mental illness. However, that this is specifically in psychology is significant- and if you read more closely, it seems to me that mental illness itself is not the issue.

this is the actual quote from the article (emphases are mine):

Personal mental health. The discussion of a personal mental health problem is likely to decrease an applicant’s chances of acceptance into a program. Examples of this particular KOD in a personal statement included comments such as “showing evidence of untreated mental illness,” “emotional instability,” and seeking graduate training “to better understand one’s own problems or problems in one’s family.” More specifically, one respondent stated that a KOD may occur “when students highlight how they were drawn to graduate study because of significant personal problems or trauma. Graduate school is an academic/career path, not a personal treatment or intervention for problems.”

It seems like the real issues are 1) having an untreated illness (and having any unresolved issue is a red flag in an SOP) or 2) only caring about the field because of your experiences with mental health. Think about it this way: if you were applying to an immunology program, and your entire SOP consisted of a discussion of your own autoimmune disorder, and how you want to go to grad school to figure out what was going on with your disorder, that wouldn't be looked on very favorably either.

However, I want to emphasize that I do believe discrimination based on mental illness happens all the time, including (especially?) in graduate admission, and that I do believe mental illness, and the skills gained in overcoming it, are not viewed the way they should be. But, in psychology, there is good reason to warn against dwelling on it in the SOP.

I agree that the emphasis is on untreated mental illness. Grad school across all departments can be extremely stressful and this often exacerbates established mental illnesses or can act as a trigger for those at risk (or even those who think they are completely 100% 'normal'). This is a very high occurrence in medical school and luckily, students are given the support of the program if they request help (or even if someone in the program is starting to notice certain behavioral trends); however, the students are already in the program. Admissions committees would no doubt question accepting a student who is stating they have untreated mental health issues because grad school stressors may cause them to completely break down or turn to more drastic measures like suicide. In a way, you could counter and say that they are trying to protect the student's already fragile mental health.

As the other posters shared, I also agree that mental illnesses are often viewed negatively in comparison to physical ('visible') illnesses and they really shouldn't be, but at the same time, certain professions require you to be mentally 'stable' -- particularly in professions helping others with illnesses of varying type and degree. I think with the new generation, the stigma associated with mental illness will lessen, but I believe it will still strongly affect certain professions -- especially those in the health fields that deal with patients. It is amazing to learn how quickly patients judge their health care practitioners on things that you may not even think matter THAT much (shiny shoes, groomed nails, nice teeth, physical proximity, smell of breath etc.), so I can only imagine what would happen if a practitioner was openly struggling with a mental health illness, in terms of patient trust and interaction.

[MissH]

I wish you luck. (seriously)

[long_time_lurker]

First, I agree with natsteel. Whether it's right or not, it's not worth mentioning if there's even a chance it's going to negatively effect your odds of admission.

Next, for what it's worth, a full professor for clinical mentioned in our course this semester that the discipline tends to attract more of those with mental health diagnoses (e.g. clincial depression) than others. At least in clinical practice it can become an issue of competency, as one must make his/her diagnoses solely based on the attributes of the client and not by interjecting personal experiences. No mention was made whether this would affect someone's admission chances.