The Disabling Effects of Mental Illness on My Education
Mental illnesses become serious when they are disabling, when symptoms and dysfunction prevent people from achieving their life goals. Although rehabilitation providers often list education as an important goal, rarely has the field done innovative work here. My 400-page textbook on psychiatric rehabilitation includes only four pages on supported education (1). Similarly, a recent review summarizing the literature on supported education concluded that research is sparse, and best practices are unclear in terms of services that assist people with psychiatric disabilities in achieving their education goals (2). Hence, my fellow researchers and I at the Illinois Institute of Technology have decided to expand our research program into the educational needs of people with psychiatric disability. In doing so, I was surprised at my personal reaction to this new direction.
More than 15 years have passed since I came out as having a serious mental illness. I have been diagnosed as having bipolar disorder, major depression, and anxiety disorder. I have frequented crisis programs to deal with serious symptoms of the moment and was hospitalized once when I felt overwhelmed by symptoms. I have been mostly under a psychiatrist’s care for 25 years, regularly taking antidepressants and mood stabilizers along the way. Just this morning I took my lamotrigine and fluoxetine.
Although my mental illness has interfered with work, in retrospect I realize that its greatest harm has been on my educational career. I got through undergraduate education largely unscathed, having earned a B.S. in 1978 from Creighton University in Omaha. However, when I entered Creighton’s medical school the following fall, my career as an individual with a mental illness seemed to begin. Let me say the obvious—medical school was overwhelming. I spent hours in the library studying biochemistry, gross anatomy, and embryology, only to scrape by on tests. I was shocked and confused; having graduated with honors from Creighton with a bachelor’s degree in physics, I never expected med school to be so hard.
Only years later did I understand what had been going on. I was panicked by my failures. I remember sitting in a lecture while feeling overwhelmed by anxiety. Even though I was in a classroom of 100 students, I felt alone, as if I were yelling in the crowd and no one could hear me. I ran out into the quad but did not know where to go. I experienced dissociative feelings of being apart from everyone and failing badly. I became depressed.
I somehow made it through the semester, passed my classes, and retreated home for the Christmas break. I came back during the first week of the new year, crumpled again under the stress, and took a one-year leave of absence. I went home and worked for the family business but otherwise did nothing to prepare for my return. I went back in January 1980 for the new semester, and from day 1, I felt overwhelmed and unprepared. I quit.
Being a doctor was an immense, almost spiritual goal for me. Growing up, college had seemed like a faraway, unattainable place located high on a hill. My brother was the first in our extended family to graduate from college. Although my parents encouraged going to university, they believed “people like us” could never make it in medical school.
The goal was glorious. Dropping out was a monumental loss. So, if I couldn’t achieve an M.D., I would become a psychologist. Like the wounded healer, my struggles fed a desire to help others with mental health challenges. Earning a Ph.D. would do that. After taking a year off to get the undergraduate credits in psychology that I missed as a physics student, I was accepted to the doctoral program in clinical psychology at the Illinois Institute of Technology, where, ironically, I am on faculty today. On the very first day of class I was flooded by the same overwhelming panic I felt during medical school. I struggled through the end of the first week, gave up, and told the head of the program that I quit.
Because I still wanted to be a psychologist, I pursued a master’s degree at Roosevelt University in Chicago. This time I was successful, along the way developing an interest in the philosophy of science. I was then admitted to a University of Chicago program leading to a Ph.D. in philosophy and psychology. Wham! Once again, on the first day of class, I was hit with distress and fugue. This time I made it two days before I quit. I then entered the Illinois School of Professional Psychology, where I slowly and tenaciously completed a Psy.D. in clinical psychology. I was able to finish an internship in California followed by a postdoctorate at the University of California, Los Angeles, which was funded by the National Institute of Mental Health. About six months into the postdoctorate, I found myself in a research meeting with some of the world’s leaders in schizophrenia research, feeling totally overwhelmed with my inabilities. After struggling with my mentor for a week, I convinced myself that I could not complete the postdoctorate and quit.
Last month, during a research meeting on supported education, I had a newfound insight about my disabilities. I had intellectually understood the impact of psychiatric symptoms and dysfunctions on work, but I had never really seen my story in that light. Education was different—mental illness had derailed it. And so, I am especially motivated by the question, How might rehabilitation services help others like me attain their educational goals? What would have helped me almost 40 years ago stay in school?
Reviews on supported education suggest that first principles should include offering reasonable accommodations that help students with school demands (2). What might these be? Our group is scouring the literature trying to systematically answer this question. Ways in which the disabilities office at my own university handles these accommodations seem to reflect the limited state of the art. Students are given extra time for assignments and a quiet place to take tests. That would not have even dented my anxiety.
The university also offers skill building to help students learn to study, manage time, and deal with stress. Helping me learn to study would have been a waste of time, given that I had been a good student. Stress management might have helped. I did not understand my problems were due to feelings of panic that were beyond the norm. I have been in and out of therapy where counselors have taught me relaxation strategies and ways to challenge irrational thoughts. Still, I find that skills-based approaches alone are somewhat lacking. They remind me of the “train and place” theory of psychiatric rehabilitation (3). In the past, rehabilitation approaches involved training people in the skills to handle situations before placing them in those situations. Hence, according to this view, I would have succeeded in medical and graduate school had I first mastered stress management skills. I don’t think that would have worked. Anything I did in the therapy realm back then seemed removed from the day-to-day demands of the real people who were stressing me out at school.
Father Scull’s efforts were not enough, but a more fully developed type of support might have helped me. In supported employment, for example, job coaches assist people on the job, in the moment, helping them interact with supervisors and coworkers when necessary (4). How might these ideas have been adapted for the higher education setting? Might I have benefited from an education coach who was with me when I was panicking in lecture? I felt alienated from my fellow students. Might an education coach have helped me build bridges? This kind of approach would have changed the dynamics of school. How were faculty and administration to be included as allies? I am hoping that personal memories will motivate me to expand a sense of best practices for people with psychiatric disabilities struggling with educational goals.
|Corrigan PW (ed): The Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach, 2nd ed. New York, Guilford, 2016
|Ringeisen H, Langer Ellison M, Ryder-Burge A, et al: Supported education for individuals with psychiatric disabilities: state of the practice and policy implications. Psychiatric Rehabilitation Journal 40:197–206, 2017 Crossref, Medline
|Corrigan PW, McCracken SG: Place first, then train: an alternative to the medical model of psychiatric rehabilitation. Social Work 50:31–39, 2005 Crossref, Medline
|Becker DR, Drake RE: A Working Life for People With Severe Mental Illness. New York, Oxford University Press, 2003 Crossref