Degree In Sight

Heal thyself

The last six years of graduate school haven't been easy for Gretchen Foster*, who describes herself as a "high-achiever who wants to do everything right." Her clinical psychology program was exceedingly competitive, and she had trouble figuring out the complex politics of her department. Foster often had more work than she could handle, so she had to let some assignments go unfinished. And being new to the area, she had few friends outside of the department.

Those issues might sound familiar to many graduate students, but they were especially trying for Foster, who was diagnosed with an anxiety disorder at age 17. "I would push myself really hard and feel sort of like I had exhausted my supply of energy," she says. Medication helped her cope, but some days the anxiety overwhelmed her. "I would just have to go home and give up the day and know that there was no way I would be able to get work done," she says. Foster feared that those lost days would cause her to fall behind her peers, and she felt frustrated with herself.

Trying to handle grad school's heavy workload while still having a social life and maintaining a healthy lifestyle can be enough to stress anyone out, says John C. Norcross, PhD, a psychology professor at the University of Scranton in Pennsylvania who studies self-care and personal therapy among psychologists. These challenges can be especially daunting for students suffering from a mental illness, he notes.

"Most studies of full-time doctoral students show they are routinely working 60-plus hours [a week]," he says. "And when you're working that many hours, self-care tends to plummet."

Just how prevalent mental health problems are among graduate students is an open question. Only a few surveys have been conducted, and the magnitude of the problem appears to vary from school to school, depending in part on how they define mental health issues.

A 2008 survey at the University of California–Irvine, for example, found 17 percent of students reported having a serious mental disorder and nearly 30 percent reported having a mental health concern that affected their well-being or academic performance. A survey from 2006 at Berkeley found that 45 percent of graduate students polled said they had a mental health issue that affected their well-being or academic performance, and almost 10 percent of respondents reported they had considered suicide in the past year.

Even fewer studies have explored the prevalence of mental health problems among psychology graduate students. There have been studies of symptoms, however: A 2009 APA survey found that 87 percent of psychology graduate students reported experiencing anxiety, and 68 percent reported symptoms of depression. Even suicidal thoughts — with a prevalence of 19 percent — were relatively common.

"The numbers suggest we're certainly not immune [to mental health problems]," says Phil Kleespies, PhD, a psychologist with the Department of Veterans Affairs Boston Healthcare System in West Roxbury, Mass., who co-led an inquiry on suicide risk among psychologists.... "Having a doctorate in psychology doesn't necessarily mean that you're going to be able to deal with your own personal depression."

According to a report from California's Student Mental Health Committee, today's students are "experiencing mental health problems that are qualitatively different [from] and significantly more complex" than past generations. The explosion of medications to treat mental illnesses has enabled people who may not have been able to handle the stresses of higher education without drugs to enter college and thrive. "A lot of different books and articles have been written about the crisis of campus mental health in the last ten or fifteen years, mainly looking at undergraduates," says Lisa Brandes, assistant dean for student affairs at Yale University in Connecticut. But mental health problems appear to be affecting graduate students as well. "Some of the graduate student mental health issues are just as serious or in some cases more serious than what we may be seeing in undergraduates," she adds. For people with mental illnesses, "the stress and structure of a graduate program can exacerbate their issues or [overwhelm] their coping skills."

There's a saying that psychology research is actually "me-search," meaning that some people go into the field to understand themselves and deal with their own mental health concerns. And to some extent, that may be true. "I think people who are drawn towards professions such as psychology, usually their interest comes from something very personal," says Russell Federman, PhD, the director of counseling and psychological services at the University of Virginia in Charlottesville. "It's not because they've had a simple, gilded, wonderfully supported life."

To Tell or Not to Tell

You might assume that psychology graduate programs would welcome and accommodate people coping with mental health problems. However, that's not always the case, says Foster. She says she does a decent job of masking her anxiety, but others in her program have mental health problems that are harder to disguise. "In general, it was assumed that they were going to be poor performers," she says. "Even among the professors, who are all clinical psych PhDs, there are biases against people with mental illness."

Every program is different, Federman says. In some cases, the faculty are extremely supportive. Other times, faculty may feel that "their department turns out exceptional individuals," he says. So if one of their students discloses that he or she is struggling with mental illness, "that doesn't fit into that picture of 'We are producing the best of the best.'"

Susie Louis*, who has long struggled with anxiety and more recently was diagnosed with obsessive-compulsive disorder (OCD), decided to postpone graduate school for more than a decade so that she would have time to get a handle on her mental illness before dealing with the stresses of a doctoral program. To prepare, Louis began volunteering in a psychology lab that investigates OCD. She recently disclosed her diagnosis to one of the professors in her lab, but she doubts she will tell the faculty in her future graduate program, at least not right away. "I don't want it to become my identity," she says. "I don't want to have to prove my mental health as well as my academic competence." She worries that she might end up being treated like a patient rather than a student.

That's an understandable concern, but keeping a mental illness secret has some clear disadvantages, says Linda Forrest, PhD, a psychologist at the University of Oregon who studies how faculty respond to trainees that have difficulty developing professional competencies. She believes that graduate students in clinical or counseling programs might benefit from disclosing any mental health problems to their supervisors. Mental illness can affect a psychologist's performance when working with clients. And detecting those performance issues often requires an outside observer.

"Research shows that our ability to self-assess accurately is very limited," Forrest says. Faculty can help students learn how to manage their mental illnesses in tough client situations — for instance, if you are working with a patient who has experienced the same type of trauma as you. Students who don't disclose their own mental health issues are missing out on valuable oversight and training from faculty that could help them become stronger and better practitioners, she says.

Failing to disclose comes with other drawbacks as well. "Trying to mask feeling anxious while feeling anxious is not particularly fun," Foster says.

If you do decide to disclose, wait until you've been accepted to a program to avoid any potential bias in the interview and admissions process, advises Norcross. On campus, graduate students have many resources available to them. Talk to your adviser and other faculty. In addition, most universities have an office of student life and offices designed to support women, minorities or LGBT students. "There are people in those offices who are concerned with graduate students, but who don't have direct academic control over them," Brandes says. If a student comes to Brandes and says, "I'm having an issue with my adviser," or, "I don't know if this is working out for me," she keeps that information confidential unless the student asks her to disclose it.

Students who have a mental illness that interferes with their studies may qualify for reasonable accommodations under the Americans with Disabilities Act (ADA). For example, a student with a diagnosis of depression might be permitted to move through a graduate psychology program at a slower pace. Norcross recommends visiting the ADA compliance officer even if a student doesn't want to disclose. "You say, 'I just want you to be part of my support system and be available for me,'" he says. "You can go to that person for support and referrals."

Steps for Self-care

Whether or not students decide to disclose their illness to faculty members, they must make self-care a priority, says Norcross.

One convenient place to seek help is the campus counseling center, which usually offers students at least a few free therapy sessions. The downside, especially at small campuses, is you're likely to run into students or professors whom you know. Even off-campus counseling centers can be a problem for students who seek anonymity, says Foster. She and her classmates "work in every clinic in the community," she says.

But Foster did find a way to get help. She met with the counseling center director and asked for a referral. "I have since given that name to three or four other graduate students in my program," she says.

Just as important as a good therapist, however, is a solid support system. You should seek out people "who you find to be trustworthy, reliable, sensitive and empathic," Federman says. It's especially important to make friends outside of your program, Brandes says. At Yale, she and her colleagues try to encourage interdepartmental mingling. "We have social events and mixers and sports events," she says. These activities allow students to "get outside of the bubble of their department or program."

Students who spend too much time within the confines of their programs run the risk of letting the program become their identity, Brandes says. Then, when things aren't going well with your studies, "your sense of identity is going to be pretty crushed." Having a support group that includes people who share other interests can make it "easier to ride those low waves," she says.

And whether you have a mental illness or not, all graduate students should take good care of themselves. That means getting enough sleep, eating right, exercising and setting boundaries, Norcross says.

Louis doesn't plan to apply to graduate school for a few more years, but she already has a plan in place for managing her OCD. Like Foster, she intends to see a therapist while she's in graduate school. She also has several safeguards in place to ensure that her life doesn't become too hectic. For example, her husband has agreed to work fewer hours, and her parents have pledged to help out. "I have had three children while overcoming OCD," she says. "I understand precisely the effects of stress on my OCD, and I am surrounding myself with every form of support to set myself up for success in being trained to help others. There will be zero time for allowing OCD to run the show."

For Foster, exercise has been an important part of her recovery. She began weightlifting in graduate school and discovered that she's good at it. The sport gave her "a feeling of competence and confidence in something that had nothing to do with school," she says.

Foster recently went through the internship matching process, possibly the most anxiety-inducing experience any psychology graduate student will have. She secured an internship at her top pick, a VA hospital. "I still have a year of hard work ahead of me," she says, "but just knowing that I matched ... I have this huge weight off my shoulders."

Foster is enjoying her newfound serenity, but she also acknowledges that she might not be where she is today without her anxiety disorder. "It's part of me and part of what drives me to move forward and be really productive," she says. "It's a double-edged sword."

Cassandra Willyard is a writer in New York City.
*The names of all the students in this article have been changed to protect their privacy.