disability - What specific techniques can help someone facing mental health problems (depression, anxiety, ADHD) have a productive academic career?

Question originally found here

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In the past few months, I have been diagnosed for depression, anxiety, and ADHD. While learning this has been helpful, treatment made my already poor performance worse. Jumping around medications as well as the mental and emotional exhaustion that can come from counseling sessions made my academic pursuits almost impossible.

After medication and therapy, it seems that the only advice I can find to treat my conditions is more self-discipline. I don't disagree and find that it can be extremely helpful, but in this (for lack of a better term) recovery process, self-discipline is made harder. Does anyone who have had similar problems throughout their academic career have experience with "coping" mechanisms that go beyond "make a to-do list"? My goal is to one day enter a graduate program, but most steps I have found in researching both ADHD and depression/anxiety have been more suited for those entering non-academic careers or the parents of high school and grade school students.

Answer

First, please know that you are not alone and that it is possible to pursue a graduate education even with mental health issues. Several studies have actually indicated very high rates (as much as 40-60%) of anxiety and depression among graduate students (Arnold, 2014; Bernstein, 2015; Wyatt & Oswalt, 2013). So, there are students who have mental health issues who are still pursuing a higher degree. That said, just because it is common doesn't mean it is accepted. Stigma is common in academia, as it is in the rest of society (Pescosolido, 2013), and students may fear being stigmatized if they discuss or reveal their condition. Also, mental health issues, like any physical illness, bring additional challenges that must be managed. Fortunately, there are several things you can do to identify the self-management approaches that may help you succeed.

(As personal context, I have a neurological condition and have experienced periods of depression. I am successfully engaged in a doctoral program).

Take care of yourself

You rightly noted that some of your cognitive difficulties may be due to your mental health symptoms. Depression, anxiety, and ADHD have all been shown to compromise executive function, such as attention, concentration, memory, and problem solving (Biederman et al., 2006; Castaneda, Tuulio-Henriksson, Marttunen, Suvisaari, & Lönnqvist, 2008). As you continue with treatment, you may find that some of these difficulties begin to resolve. Whether you pursue graduate school or work, prioritizing your own health and wellness is key (Myers, 2012). Some graduate programs are notorious for suggesting students engage in “self-care” but have such grueling schedules that this is difficult. Guard your well-being ruthlessly. If your physical and mental well-being suffer, so will your performance in other areas of life. Specific suggestions:

• Be open with your mental health providers about your academic and career intentions. Discuss treatment options in the context of being able to effectively function in a graduate school environment. If you find certain medications are causing side effects that impact your academic functioning, bring it up and address it. Determine whether there is a risk of developing a tolerance to your medications so that they would become ineffective. If that’s the case, work to identify two different medication regimens, so when you develop a tolerance to one in the middle of the school year, you can seamlessly switch to the other. I have found many professionals are sympathetic to students who express interest in higher education and was able to effectively partner with my providers.


• Identify a routine that contributes to your well-being and stick to it. For example, if you know that an irregular sleep schedule contributes to your anxiety, make your sleep schedule a priority. If you know your depression worsens when you don’t get enough light, and realize you’ll be working in a dark, interior office, ask your provider about light-box options.


• Consider tracking your schedule (sleep/waking times, eating times and amounts, etc) and symptoms on an ongoing basis, or in periods when your symptoms seem to worsen. This can help pinpoint instances where your routine has become disrupted.

Operationalize your academic challenges, then identify possible solutions

First write down a detailed, specific list of the ways in which you are struggling academically. I posted several follow-up comments to your initial question, because it wasn't clear to me how your studies were being impacted by your symptoms. Determine if there are specific activities or tasks that seem to have become harder in recent months. Once you have list of specific examples, it will be easier to identify specific solutions. Some examples include:

• Problem: Low energy/motivation. Possible Solution: Create a concrete schedule, identifying when you will complete brief, manageable assignments. Unlike a to-do list that is open ended, this involves scheduling writing your methods section for your biology paper at 6pm on Tuesday. Rather than dread completing a task at some point, you’ll know exactly when you need to knock that out.


• Problem: Poor concentration makes it hard to focus on long assignments. Possible Solution: Break tasks into smaller components (e.g., breaking a paper into individual sections), and take breaks in between. Remove other distractions (cell phone, email, TV) from the area where you are working. If you can’t resist temptation, go to the library and leave your phone at home.


• Problem: Poor attention makes it hard to take notes during lecture. Possible Solution: Audio-record lectures so you can listen to them later at your own speed. Join a study group where you can compare your notes and understanding with other students.


• Problem: Difficulties with memory impact school work. Possible Solution: Identify new ways to study, such as taking more extensive notes, re-writing your notes (this is more effective than re-reading them), or using mnemonic devices.

Your therapist should be able to help you think through many of these issues. Additionally, your school may have resources for adapting to learning difficulties.

Identify external supports

In addition to the internal coping skills you are developing personally and academically, it is important to identify external supports. Social support is crucial to successfully managing ongoing mental and physical health conditions (Gallant, 2003; Kolbe, 2002). You’ve mentioned some feelings of embarrassment and worry about how you will be perceived due to your diagnosis. Disclosure of a mental health diagnosis is a delicate subject, primarily because there is still a great deal of stigma towards mental illness. Your decision to disclose will likely depend on whether you trust that the person you are speaking with will be accepting and that the disclosure will not result in negative consequences. In some cases, you might decide if feels safer not to disclose; this is your choice.

Possible sources of social support include:

• Family and friends


• Your therapist and/or medication prescriber


• Professors, colleagues, classmates – You may find you are comfortable discussing issues with trusted classmates, but not with your supervisors. Also, keep in mind that schools and employers cannot legally ask about mental health conditions in interviews and you are not required to mention it. However, once you are hired, you can request certain accommodations (see next point).


• ADA officer – If you live in the United States, mental health conditions are protected under the Americans with Disabilities Act, meaning that employers and schools must make “reasonable accommodations” to allow you to function within that environment (Leibert, 2003). Examples of accommodations include longer testing periods or moving through the program at a slower pace. Most schools have an ADA officer or office that oversees students who want to receive accommodations. Even if you choose not to disclose your condition to your program, you can use the school’s ADA officer as a source of support (Willyard, 2012).


• Some academics and graduate students have been open about their own mental health conditions and the impact it has had on their careers (Keely, 2013; Kelsky, 2013a and 2013b; Shine, 2013). These blogs can provide additional examples of managing mental health conditions in academia.

There are two brief caveats. First, if you choose to disclose you might need to educate people on your conditions. They may not initially understand how it impacts you. You can choose how detailed you want to be; sometimes a general explanation is sufficient. Second, when illnesses are “invisible,” and the symptoms are not immediately apparent to those around us, even people who know you have a certain condition can “forget” about the impact it has on your life on a daily basis. You may need to remind them from time to time, and you may also need to remind yourself! This leads to my last point…

Remember to give yourself credit for managing both academic and personal challenges.

Managing a long-term health condition requires a constant amount of mental and physical energy (e.g., ensuring you get enough sleep, remembering to take medication each day, coping with ongoing side effects). Keep this in mind when you are tempted to compare your own performance, achievements, and routines to other students. Other students may not be facing the same difficulties, and may approach their academic endeavors differently. I’m not suggesting your illness will be an excuse to perform less well than others; rather, remember that in some ways you might be starting at a disadvantage, which makes your accomplishments all the more hard-earned.

References

• Arnold, Carrie. (2014, February 4). Paying graduate school's mental toll. [Web log post]. Retrieved from: http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2014_02_04/caredit.a1400031


• Bernstein, R. (2015, May 13). Depression afflicts almost half of STEM students at UC Berkeley. [Web log post]. Retrieved from: http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2015_05_13/caredit.a1500125


• Biederman, J., Petty, C., Fried, R., Fontanella, J., Doyle, A. E., Seidman, L. J., & Faraone, S. V. (2006). Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder.The American Journal of Psychiatry, 163(10), 1730-1738.


• Castaneda, A. E., Tuulio-Henriksson, A., Marttunen, M., Suvisaari, J., & Lönnqvist, J. (2008). A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. Journal of Affective Disorders, 106(1), 1-27.


• Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education & Behavior, 30(2), 170–195.


• Keely. (2013, February 11). How to keep moving forward, even when your brain hates you. [Web log post}. Retrieved from: http://www.littledose.keelium.com/2013/02/11/how-to-keep-moving-forward-even-when-your-brain-hates-you/


• Kelseky, Karen. (2013a, February 13). Academia and Mental Illness: A Preliminary List of Resources. [Web log post]. Retrieved from: http://theprofessorisin.com/2013/02/13/academia-and-mental-illness-a-list-of-resources/



• Kelseky, Karen. (2013b, March 13). Managing Mental Illness in Graduate School: Some Recommendations (A Guest Post). [Web log post]. Retrieved from: http://theprofessorisin.com/2013/03/13/3546/


• Kolbe, J. (2002). The influence of socioeconomic and psychological factors on patient adherence to self-management strategies. Disease Management & Health Outcomes, 10(9), 551–570.


• Leibert, D. T. (2003). The mentally ill and access to higher education: a review of trends, implications, and future possibilities for the americans with disabilities act and he rehabilitation act. International Journal of Psychosocial Rehabilitation, 7.


• Myers, S. B., Sweeney, A. C., Popick, V., Wesley, K., Bordfeld, A., & Fingerhut, R. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55.


• Pescosolido, Bernice A. (2013). "The public stigma of mental illness


• What do we think; What do we know; What can we prove?." Journal of Health and Social Behavior 54(1), 1-21.


• Shine, Jacqui. (2013, December 18). On Depression, and the Toll Academia Exacts. [Web log post]. Retrieved from: https://chroniclevitae.com/news/228-on-depression-and-the-toll-academia-exacts


• Willyard, Cassandra. (2012). Need to heal thyself? gradPsych, January. Retrieved from: https://www.apa.org/gradpsych/2012/01/heal.aspx


• Wyatt, T., & Oswalt, S. B. (2013). Comparing mental health issues among undergraduate and graduate students. American Journal of Health Education, 44(2), 96-107.