Students fighting depression and anxiety are not alone
Graduate school is gaining a reputation as an incubator for anxiety and depression.
Social isolation, financial burdens, lack of structure, and the pressure to produce groundbreaking work can wear heavily on graduate students, especially those already vulnerable to mental-health disorders.
Studies have found that graduate school is not a particularly healthy place. At the University of California at Berkeley, 67 percent of graduate students said they had felt hopeless at least once in the last year; 54 percent felt so depressed they had a hard time functioning; and nearly 10 percent said they had considered suicide, a 2004 survey found. By comparison, an estimated 9.5 percent of American adults suffer from depressive disorders in a given year, according to the National Institute of Mental Health. Meanwhile, nearly a quarter of the graduate students surveyed were not aware of mental-health services on the campus. And another Berkeley study recently found that graduate students were becoming increasingly disillusioned with careers in academe and did not view large research institutions as family-friendly workplaces (The Chronicle, January 23).
Temina Madon knows the problem all too well. Her former boyfriend, a doctoral student in biophysics at Berkeley several years ago, had talked about suicide on multiple occasions. Madon, then working toward her Ph.D. in visual neuroscience, begged him to seek help. The university's counseling center referred him to a therapist off campus, but he said it wasn't the right fit. Nine months after the couple broke up, and a few months after he sought help, he hanged himself. "It shouldn't have happened that way," says Madon, who now directs a center at Berkeley that studies diseases in developing countries. But there is still a stigma among graduate students about acknowledging mental-health problems, she says. In a highly competitive atmosphere, it can be seen as admitting weakness.
"Grad students are in a remarkable position of powerlessness," says Thomas B. Jankowski, an adjunct assistant professor of political science and gerontology at Wayne State University who runs PhinisheD, an online support group to help graduate students finish their dissertations. Often a single thesis adviser seems to control a student's destiny, he notes, and it can take years to finish a dissertation. And even if a student finishes, success on the job market is far from guaranteed; today's poor economy has only worsened job prospects. For students who already lean toward self-doubt or mental anxiety, graduate school can act as a magnifier.
One former graduate student blames his depression partly on the type of graduate program he chose. Diagnosed with depression as a teenager, he had been on antidepressants for most of his adult life but went off them a few years before going to graduate school. When he arrived, though, he realized he might need them again.
"I'm a very introverted person," says the former student, now a professor at a small Midwestern college. "I'm very self-critical. This is something grad school encourages."
The content of his history program, he says, was more focused on destructive rather than constructive behavior. He says students were encouraged to rip apart arguments found in reading assignments. Classroom sessions often turned into contests to determine who could be the most damning of one another's points. After one such class, he remembers struggling to work on his dissertation. "It was paralyzing," he says.
And even if things are going well, depression can skew one's perceptions. During his first year, the former student says, he constantly felt inadequate despite doing well academically. And because those who are depressed sometimes cut themselves off from people who want to help them, their condition can worsen. Luckily, he talked to his adviser, who also had a history of depression. She reminded him how well he was doing — a good reality check.
Gregory T. Eells, director of counseling and psychological services at Cornell University, says it is not unusual for some graduate and professional students to be turned off by the Socratic or adversarial teaching methods so common in graduate programs. And while many worry they will fail, statistically they are wrong. "Most make it through," Eells says. One problem, he notes, is that there is less built-in social support for graduate students than for undergraduates, who have many clubs, activities, and fraternities to keep them socially connected. And because graduate programs usually require many solitary hours in the library or laboratory, with little structure or external motivation, the isolation can separate students from resources that could help them.
Educating students about depression is crucial, experts say. Some warning signs and symptoms include difficulty concentrating, fatigue, feelings of worthlessness, a change in sleep and eating patterns, persistent aches and pains, and a loss of interest in activities and hobbies that were once enjoyable.
Chris Brownson, the head of counseling services at the University of Texas at Austin, directs a national research consortium of counseling centers in higher education. A recent study by the group on student suicide at 70 institutions found that 47 percent of graduate students who considered suicide in the last year did not tell anyone. And 52 percent did not seek professional help. Students reported that relationship problems had the biggest impact on their suicidal feelings, followed by academic, financial, and family problems. Indeed, graduate students often feel the strain of juggling multiple roles, such as being a spouse, parent, and caregiver to an older parent, usually while bringing in very little income.
Meanwhile, graduate students are intimately tied to their specific programs, so relationships within their department become all the more critical, Eells says. "You can get blackballed," he warns. Counseling can help graduate students figure out what is important to them and learn to state their needs, respond to stress, and set boundaries. "You are more than a graduate student," he tells his patients. "It's easy to lose sight of that in graduate school, because there are pressures that say this is the most important thing in your life right now."
A ninth-year graduate student at a top Midwestern university, who had a long history of depression, fell into an unhealthy relationship with her academic adviser. Like many graduate students, she says, she arrived on the campus feeling intimidated and emotionally fragile. While she knew she needed to take care of herself, she also felt she should "tough it out." So when her usually supportive adviser began to bully her, she took it to heart. Her adviser told her, for example, that it would take long, grueling workdays with four hours of sleep a night to do well in academe. And the student was warned that she would have to quickly absorb an immense amount of material. She went into hyperdrive. She felt trapped because her adviser held her ticket to success. "In academe, there isn't enough status to go around," the student says.
Finally, the student realized she had to switch advisers. She began to exercise again. She found PhinisheD, the Web site run by Wayne State's Jankowski, which promotes the idea that "good enough is good enough." That means if a chapter of your dissertation is good enough for your adviser, for example, it should be good enough for you.
Avoiding perfectionism helped the student, who lagged behind her peers by a year or two, make progress. She suggests that others in her position seek out a dissertation-writing group, along with any activity, such as meditation, that promotes stress relief, and choose supportive friends. For her, cognitive therapy has also helped. She hopes to receive her Ph.D. in May.
Keeping balanced is essential to avoiding the kind of single-mindedness that graduate school fosters, experts say. James Alan Fox, a criminal-justice and law professor at Northeastern University who studies campus violence, believes graduate schools tend to reward students who go way overboard on work, "even if that means jeopardizing other aspects of their lives." Colleges should instead help graduate students avoid unhealthy extremes, he says. They could, for example, offer workshops on such life issues as relationships, balancing work and children, and managing finances. And all colleges should make sure that graduate-student health care includes mental-health coverage, he says.
Galen Papkov listened to the experts. He made a conscious effort to create a positive graduate-school experience for himself. Papkov, who received his Ph.D. in statistics from Rice University last year, had fought depression before graduate school. After college he worked in New York City as an actuarial analyst, which paid well but didn't excite him. Then his new girlfriend moved away. He got into "a downward spiral of negative thinking" and even contemplated suicide. "I really remember lying in bed one night having no control of my thoughts. I realized, something's wrong and I need help."
Seeing a therapist weekly for 18 months allowed him to gain control of his life again. At Rice, he took a proactive approach to meeting people and keeping active. He lived in graduate-student housing on the campus and was a resident assistant, ensuring lots of social contact. He also played intramural sports and consequently made friends with people from different departments and disciplines."I knew that would keep me healthy and happy," he says.
While counseling or therapy can help many, some students aren't at the point where they need it. For those simply in a funk, who are behind on dissertations, another option is a dissertation coach.
One such coach, who uses only her first name, Dale, on her Web site, says her job is to help people apply practical work strategies while building self-esteem. "Because if the Ph.D. process does one thing," she writes on her site, "it's to beat you down into a bloody and insecure pulp." She uses her own experience to inform her work. At Rutgers University, she finished her graduate course work in biology and was A.B.D. when she moved out of the state, divorced, found a new full-time job, and met a man. Meanwhile, her dissertation started to gather dust. It wasn't until she got an e-mail message from her department's secretary in her ninth year at the university that she made progress. The secretary told her she could not register for research credits unless she planned to finish the dissertation promptly. So she finally did, writing it in 15-minute increments, something she occasionally advises her clients to do.
"People call me literally in tears," she says. "Everything is more stressful because you have this huge dissertation in your life." Even just a couple of months of coaching can make a difference, she says, giving people the momentum needed to lift their spirits. "It's such an isolating process," she says, that having someone check in provides some accountability, without the pressure that an academic adviser can bring.
But coaching can cost anywhere from $20 an hour to $50 or more. For students who can barely afford Ramen noodles, a cheaper option is to find a free, online support group. Many struggling students find solace in sharing experiences. In a September 2007 poll on the PhinisheD Web site, for example, users were asked if they had ever taken antidepressants. Thirty percent reported that they were currently taking them, while another 10 percent had taken them in the past two years.
"Getting a Ph.D. is very much an exercise in deferral of gratification," says Jankowski. "That can be very discouraging." He says the typical PhinisheD user is a woman with confidence problems, often because a star faculty adviser is dismissive of her work. "A lot of people feel like they are being hazed," he says. PhinisheD has boards where users can post goals and daily progress, and links where students can get advice on topics as varied as how to have a successful dissertation defense, what bibliographic software to use, and how to deal with an unsupportive spouse.
For students with debilitating mental-health issues or for those who realize graduate school may not be right for them, considering a leave, temporary or permanent, can sometimes be the right solution. A former academic who received her Ph.D. from Berkeley in 2003 did not get up the courage to leave academe until she became a tenure-track professor. In retrospect, she says, she realizes how little support she had as a graduate student. Her laboratory had closed down, her mother had a chronic illness, and then her father and two grandparents died. When she was feeling her worst, suffering from panic attacks, she went to the campus counseling center.
"I was hyperventilating," she recalls. "I couldn't think straight." She says the center offered to schedule her for a 20-minute consultation with a therapist two weeks later. "There was no sense of urgency," she says. She would have had to admit to being suicidal, she says, to be seen immediately. Instead, she went to the emergency room where a physician prescribed a sedative.
She realized she needed to leave academe after she landed a tenure-track job and was stressed out and impatient with her students. While her colleagues were nice people, she says, she never found a true feeling of community. Academe was just too competitive for her. Although she has said goodbye to that world, she still worries that graduate students have problems getting the help they need. "There's this perception that if you hold your breath and make it through, you'll be fine," she says. But if you don't deal with such issues, she says, "you will not be an effective student, scholar, or researcher."
More and more students are seriously considering leaving academe before they even finish graduate school. According to a recent study at Berkeley of students at the University of California's campuses, 45 percent of men and 39 percent of women entering graduate school intended to become professors at research institutions. But for those who had spent more time in their programs, those numbers dropped to 36 percent and 27 percent. And only 29 percent of women and 46 percent of men saw major research institutions as family-friendly workplaces for tenure-track professors. That negative view of faculty life coupled with the factors that encourage anxiety and depression could spell trouble for the faculty pipeline, and for academe's future leadership.
Jeffrey P. Prince, director of counseling and psychological services at Berkeley, says graduate-student care has improved on the campus. An advisory board made up of graduate-student leaders, faculty members, and the associate graduate dean was formed two years ago, allowing Berkeley to expand its offerings to graduate students, he says. Those include a new counseling office dedicated to graduate students and close to their campus. Now, Prince says, graduate students don't have to sit in the same waiting room with undergraduates who might be their students. He says that the board has created a stronger link between the graduate-student community and counseling services in general. However, endemic problems remain. Many graduate advisers are not good mentors, he says. "I think many faculty members don't see it as their role," Prince says. While they may care about their students, they don't always know how to help those in distress, he says.
Prince says his counseling staff trains graduate students to be on the lookout for mental-health issues and to know the resources available, so they can refer fellow students if necessary. The center also publishes a newsletter about managing stress and holds support groups on the topic. Ultimately, he says, graduate students would welcome it if the administration considered mentoring in its tenure-evaluation process. Short of that, the notion of simply teaching people when to seek help would go a long way.
Depression is "not like your thesis," says the former student who left academe. "You're not going to write it up and be done with it.
"You have to deal with these issues, because they don't just go away."
Piper Fogg is a staff reporter at The Chronicle.
