Mental Illness in Academe

November 25, 2009

My students filled the room. They were interested and eager, unusually so, given that they were second- and third-year law students for whom the fear and trembling that came with the first year had long since faded. The course was "Advanced Mental Health Law." The day's topic: Billie Boggs. A street person who lived over a hot air vent in midtown Manhattan, she threw food at people who wanted to help her and chased them across the street. Her rantings and ravings seemed crazy to most of the students, and we were discussing whether she should be sent to a psychiatric hospital.

I heard myself speak, surprising myself by the steady sound of my voice as I tried to restore my attention to the group before me: "What if Billie Boggs were your sister—would you put her in a psychiatric hospital then?" Up shot the hands.

Concentrate. These are your students. You have an obligation to them. Canceling class would be admitting defeat. But there are explosions in my head. They're testing nuclear devices on my brain. They're very little and they can get inside. They are powerful.

I pulled myself together, enough to point to a young woman who spoke often in class. "I couldn't let my sister live like that," she said from across the classroom, which held the students in curved rows, like a giant palm before me. "I know my sister. That wouldn't be her. There's one and only one of her—and that's the one before she got sick."

Is she trying to kill me? No, she's a student. But what about the others? The voices inside my head, the explosions. What do they want? Are they trying to interdict me, to hit me with the Kramer device? I went to the store and they said "interdiction." Interdiction, introduction, exposition, explosion. Voicemail is the issue.

I knew not to say those thoughts out loud. Not because they were crazy thoughts—they were every bit as real as the students sitting right in front of me—but I kept silent because others would think them crazy. People would think me as deranged as Billie Boggs.

But I'm not crazy. I simply have greater access to the truth.

"Good," I replied. "But why isn't it the case that your sister has two selves, the sick one you see now and the healthy one you've known all your life? Why should you get to pick which is real? Shouldn't your sister make that choice?" Up shot more hands.

My brain is on fire! My head is going to explode right here, right in front of my class!

"But isn't health always preferred to illness?" a bright-eyed young man countered. "We should prefer the healthy self."

Mercifully, the class ended. A law-school dean spotted me as I walked back to my office. He said I looked as if I were in pain. "Just a lot on my mind," I heard myself reply as I continued quickly down the hall. Keys out, door open, door shut. I crumpled into my chair and buried my face in my hands.

That was in September of 1991, and it was one of my worst such incidents. Ten years before, in my mid-20s, during my third psychiatric hospitalization, I had been given the diagnosis "chronic paranoid schizophrenia with acute exacerbation." My prognosis? "Grave." I was, in other words, expected to be unable to live independently, let alone work. At best I would be in a board-and-care, holding a minimum-wage job—perhaps flipping burgers—when my symptoms had become less severe.

That has not turned out to be my life. I am the Orrin B. Evans professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California's law school; adjunct professor of psychiatry at the University of California at San Diego's medical school; and an assistant faculty member at the New Center for Psychoanalysis, where I am also a research clinical associate.

My schizophrenia has not gone away. I still become psychotic, as happened in class that day in 1991. Today my symptoms, while not as severe, still recur and I struggle to stay in the world, so to speak, doing my work. I have written about my illness in a memoir and much of the narrative takes place after I had accepted a tenure-track appointment at USC.

Barring a medical breakthrough of Nobel-Prize-winning proportions, I will never fully recover from schizophrenia. I will remain on antipsychotic medication and in talk therapy for the rest of my life. Yet I have learned to manage my illness. How? Do I have any words of advice for others who have a serious mental illness and are on the tenure track?

The first question you must ask yourself is whether to tell your chair and dean. I can think of arguments both in favor of that, and against.

One of the pluses would be the psychological benefits of not having a secret and being able to be open. More practically you might be able to get extra support, or formal accommodations under the Americans With Disabilities Act (ADA). You would serve as a model for other academics in your department and your students.

There are, of course, real pitfalls to telling, too. There is a tremendous stigma, still, around mental illness. People may believe, consciously or not, that you are unreliable or even dangerous, and they may fear you. They may think you can't do the work or your scholarship isn't good, even if it is very good. That may not be intentional on their part but can nonetheless have a big impact on your work life and your prospects for tenure.

My own tack was not to tell, except for my closest friends on the faculty. Even that limited disclosure served me well when I became ill—there were people I could turn to. And so a colleague, Ed, helped get me home and connected with my psychiatrist after my experience teaching class while psychotic. But I didn't want my situation to be known broadly. I work on a wonderful faculty, so it would most likely have worked out well anyway. But I didn't want to risk it.

I feel somewhat bad suggesting that not telling is the better course. Recall the scene in the movie Milk, when Harvey Milk, running for city council, says words to the effect of "I am running for government as a gay man, and I am proud." Having schizophrenia is not something I am proud of, but I am less ashamed than I used to be. Yet am I, in effect, telling people with mental illness to hide—to not be proud? Perhaps the message should be that, given the immense stigma, hiding is the prudent course but one should recognize there is no shame in having a mental illness.

Beyond that question, what steps can academics with mental illnesses take to make life easier for themselves? Some are steps that everyone with mental illness should take. First, learn about the illness you have—the typical signs, symptoms, and course. Many excellent sources are available. You may want to start with the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR. Psychiatric textbooks, e.g., Kaplan and Sadock's, can be helpful. I have also discovered excellent lay accounts of mental illness.

Second, understand how your illness affects you. What are your triggers? What are your early warning signs? What can you do to minimize your symptoms when they worsen—e.g., call your therapist, increase your medication, listen to music, exercise? Try to devise some techniques for your own situation. Some colleagues and I are studying how a group of high-functioning people with schizophrenia manage their symptoms. You are in the best position to determine what works for you.

Put a good treatment team in place. You need a therapist you can trust and can turn to in times of difficulty. Does he or she respond if you call in crisis? The same is true of a psychopharmacologist. Make friends and family members part of your team.

Sometimes your team can see early warning signs before you can. For instance, my closest friend, Steve, and my husband, Will, often identify when I am slipping. Will says I become quieter in a particular way that signals all is not well. It's a blessing to have such people in your life. Seek them out.

Structure your professional life in a way that works for you. Schedule your courses carefully. If your meds make you tired in the morning, try not to teach morning classes. Try to choose courses that you like to teach—you will do a better job and feel less stressed.

Two other things have been important to me professionally. First, I work hard. I go in seven days a week because I know I may have down times. (I also love what I do, so working is not a chore.)

Second, I try to maintain a professional demeanor. How does a person who becomes out of touch with reality do that? My approach has always been to ask myself, even in those moments where I think I have a special insight on the truth, whether others will think my beliefs are crazy. When I recognize that they will, I simply don't express my views, because I don't want to be thought crazy. My motivation to appear sane leads me to self-censor. If I am so tortured by my beliefs that I know I will not be able to keep quiet, I withdraw—I simply go home.

To circle back to the issue of disclosure and accommodations, many of the things you can do to help navigate the tenure process are things you can arrange without formally disclosing your illness.

For instance, scheduling courses is something that I imagine most departments would want to accommodate to the extent they are able. True, in an unfriendly department, you may need to invoke the ADA. If you need more time on the tenure clock, and your department is not well-disposed to offer it, the ADA might also come to your rescue.

All of that said, the balance of factors for and against telling may change once you do get tenure. Being open about your illness at that point exposes you to less risk and may have the advantages mentioned earlier—e.g. not having a secret, being able to serve as a role model for others in academe.

We also need to put a face on mental illness. Being open about one's own illness will probably do more good than all the laws we can pass.

My own "outing" of myself was a bit of a risk, but has turned out well. I am glad and relieved I no longer have to hide. And my story seems to be meaningful to people—it has helped people understand mental illness more and perhaps has led to a decrease in the stigma. I was lucky in that my law school accommodated my teaching needs without my having to invoke the ADA. My colleagues are supportive, and I no longer feel ashamed about needing their help.

The suggestions I have made here are all straightforward. There is, unfortunately, little engagement with the issue of mental illness and academic employment. I began a campus support group for professors with mental-health issues; one person showed up for the meeting. I don't know whether people fear confidentiality won't be maintained, are too busy, or, as professors, tend to "fly solo." In any case, the effort failed.

I hope that this article will help start a much-needed conversation about mental illness in higher education. (Indeed, it might be worthwhile to start an online support group for professors with mental illness. If you are interested, please contact me.)

Perhaps most important: Seek help when you need it. Mental illness is a no-fault disease like any other, such as cancer or diabetes. Help is available, but you need to ask for it. Don't let the threat of stigma deter you. You shouldn't have to suffer.

And you shouldn't allow mental illness to stand in the way of the wonderful contributions you are poised to make to your students and to your field.

Elyn R. Saks is a professor of law, psychology, and psychiatry and the behavioral sciences at the University of Southern California's law school. She is the author of a memoir, "The Center Cannot Hold: My Journey Through Madness" (Hyperion, 2007).