Being proactive about mental health in academia

At some point in your academic career, someone you know will struggle with mental health to such an extent that it interferes with their academic work. This could be a labmate, a co-worker, a student, or you. The bad news is that problems like depression and anxiety are so prevalent in academia that some have referred to the issue as a “mental health crisis” and “the elephant in the room”. The good news is that academia is gradually shifting away from a culture of silence and stigma towards one of discussion, intervention, and prevention. The other piece of good news is that there are many things we can do, for ourselves and for others, to be proactive and vigilant about mental wellbeing. One of the first is not being afraid to talk about it. Even if the topic can seem awkward, there are wide-reaching benefits of having a discussion around topics like: How can we as individuals develop the tools and skills to cope with stress and other challenges to mental health? How can we create productive labs, departments, and institutions that encourage psychological wellbeing?

Written by Gerry

If you’re struggling with mental health, you’re not alone. This topic is really about the aggregate diverse experiences of many people, but I’ll say a bit about my own personal experience. During graduate school, I struggled with anxiety, insomnia, and eventually major depression, and it became particularly bad in my last PhD year when I was living alone and working all night. I couldn't sleep despite being exhausted. Depression colored everything I did and everything I perceived. The hopelessness and despair are difficult to describe; it was just unbearably painful. If I took the time to think it through rationally, it was obvious to me there was something acutely wrong, but I didn’t see a solution. I didn't finish my final experiment in my last PhD year because I was hospitalized for being suicidal. I’ve told a few people about this, but not many, and it’s hard to write about even now. I have this cringing expectation of being judged, not explicitly but silently; I’m afraid of alienating readers in a way that affects my reputation. But see this is my point-- as a community or an individual, it’s hard to overcome problems that we don’t talk about. Trying to remove the stigma around this topic is one of the whole points of writing this post. One of the things that has helped me was reading blogposts and articles about the personal experiences of successful academic scientists. Hearing scientific public figures like Robert Trivers and Robert Sapolsky talk publicly about their psychological struggles helped me feel like I was not alone or exceptional. 

I’m not just inspired to hear about other people’s academic success, their scientific discoveries and achievements; often it’s more inspiring for me to hear about people’s hardships and failures. It’s important to see how life goes on and things get better. My low point was four years ago now. My overall mental health has greatly improved, and things have never been as bad as they were in my last year of graduate school. My life is beautiful now. If I could go back in time I would tell myself that things will get better in ways I could not see or even imagine at the time. I won’t give detailed advice about what’s been helpful for me because every case is different, and it’s important to get individualized advice from a real expert. My own strategy was to make improvements in sleep hygiene, exercise, light exposure, and supplements of omega-3 fatty acids; but a strategy that helps one person might make life worse for another, because we don’t really understand mental illness scientifically well enough to do a test and provide a very reliable solution. Brains are the most complicated thing in the known universe. Some experimentation is required for every individual. But in general, managing mental health is mostly about taking the necessary time to focus on it, and not trying to simply push through without help.
 
My own mistake was giving up too quickly on getting professional help. I remember going to see a psychologist at my university and deciding that she seemed just as depressed as me, and being put on some huge wait list. The system at the university was clearly overburdened. I didn’t go back. I also did not really come to terms with the biochemical reality of depression. I did not believe that “clinical depression” was something real because of how imprecise it all seemed to me. I read the Diagnostic and Statistical Manual of Mental Disorders, and it all just seemed so unscientific. This led me to hold the implicit view that my experience was a response to bad circumstances, something I could simply fix by changing my surroundings or my behavior. I thought that if I could just catch up in my work, things would get better. But it’s not that simple. When I left the hospital, I went on a trip I do every year to the mountains with a close group of friends. I thought spending time doing my favorite things with my favorite people in my favorite place would help “pull me out of it”. But every morning I could barely get up. I spent a lot of time sitting and crying, right in front of my college buddies. It was surreal. Inside I felt completely broken. That was when I fully realized that depression can be a devastating injury to the brain, and it doesn’t go away overnight. It’s not something you just get over by going hiking in the mountains. Untreated depression causes measurable long-term damage to the brain (to get into this literature, google ‘neurotrophic hypothesis for depression”), and the lingering biological effects of stress is one of the most well-established topics in biology.
 
How common is mental illness in academia?
At Emory University in the USA, about 1 in 14 graduate students that responded to a survey reported recently having thoughts of suicide. I’ve talked with graduate students and postdocs who have experiences both similar and different to my own. In almost every case, I would have had no idea from just knowing them as friends or co-workers that they had been or were struggling. It made me wonder how common these experiences were.
 
A good comprehensive review of the literature from 2007-2017 was compiled by the Rand Corporation, and you can read it here. Here’s a summary: Academics have among the highest levels of common mental disorders (37%) when compared to other occupational groups (alongside teachers and social service workers) and the general population (where prevalence of mental disorders is 19%). The large majority of cases include depression (75% of cases of mental disorders) and/or anxiety with panic attacks (42%). Seven published studies at universities in the USA consistently found frequent symptoms of severe stress and/or depression (around 40--45% of graduate students and postdocs). A study done in Belgium (n=3,659) found that the prevalence of depression and other common mental disorders for PhD students was almost twice as high compared to undergraduate students, and almost 3 times higher than a control group of highly educated employed people. A more recent study in 2018 of 2,279 graduate students worldwide reported rates of depression and anxiety that were six times higher than those in the general public.
 
Several studies have linked mental health outcomes to stress. A survey of members of the UK University and College Union (n=14,667) reported that 3 out of 4 academics found their job stressful, half reported that stress was high or very high, and more than 1 in 3 reported often or always experiencing ‘unacceptable’ levels of stress. Only 2% reported that they never experienced unacceptable levels of stress at work. Levels of ‘burnout’ in higher education are high, similar to those seen in healthcare workers.
 
Unclear causes
Several articles have discussed these results and more recent findings as evidence for a ‘mental health crisis in academia’, but the reality is a bit more complicated and still not fully understood.  Since few studies have assessed researchers outside a university setting, it’s also not yet possible to compare scientists working in universities to those at research institutes or in industry. The report on stress by the University and College Union shows that the main sources of unacceptable levels of stress in higher education were “lack of time to undertake research” followed by “excessive workloads” and a “lack of resources to undertake research, including problems in obtaining funding”. At earlier points in one career, additional pressures are a lack of money and career insecurity.
 
It’s also possible (and seems likely to me) that individual traits that make people attracted to academia predispose them to disorders such as depression and anxiety. For example, there is some evidence that depression is positively correlated with intelligence, perfectionism, the personality trait of neuroticism, and people who write for a living or as a hobby—all traits that may be selected for by academia.
 
Among occupations, academics are not alone in their struggle with prevalence of mental illness. For instance, the prevalence of psychological disorders is as high or higher in school teachers. Mental disorders appear elevated in professions where people are responsible for others, in professions that require difficult social interactions, and in jobs with low rates of physical activity. Examples include lawyers, teachers, salespeople, and healthcare workers. The “mental health crisis in academia” might therefore reflect a more general reality about many high-pressure white-collar careers.
 
There’s still much disagreement in the literature on prevalence of mental disorders and the meaning of the disorders themselves. It’s not actually straightforward to interpret the statistics or to pinpoint the relative importance of different causal factors. But regardless of the cause, the toll mental health on academic performance is real and demands a consideration of solutions.
 
Removing the stigma
Despite the prevalence of mental health issues in academia across all career stages, they are massively under-reported. In a setting where people are often evaluated for their productivity, it is not surprising that academics tend to not discuss mental illness with their departmental superiors, their PI, or their co-workers and lab-mates, resulting in a culture of silence.
 
Imagine that when a professional athlete injures their ankle on the field, the social norm is for them to hide their injury and continue playing so as to avoid being considered weak. It’s ridiculous, but this ‘presenteeism’ is still too often common in high-skilled white-collar workplaces where it does more harm than good. Professional athletes take the prevention and treatment of an injury seriously. Injuries require a period of rest, followed by a regimented period of therapy and recovery. That is how you restore and safeguard the physical abilities of an athlete.  
 
‘Mental sports’ also require mental health. Psychological wellbeing is of course far more complicated than sports medicine, and it involves disorders that are far less well understood, but a key difference is that physical illness and injury do not carry the same moral judgment and stigma as mental illness. Too often, people assume that mental illness means “difficult to work with.” It’s also easy to naïvely conflate “anxiety” and “depression” in the clinical sense with “anxiety” and “depression” in the sense of an extreme but temporary emotion. Mental illness is often viewed more as a personal weakness, like procrastination or laziness, rather than as a true illness like diabetes or heart disease. This difference in perspective is crucial, because a personal weakness is overcome through willpower, while an illness requires serious treatment from a medical professional.
 
Building resilience in institutions and people
The physical injury analogy is also apt because it leads to the insight that reducing problems requires a two-pronged approach. Athletes need to learn the skills to prevent injuries and athletic institutions need to put structures in place to prevent them, and to support their treatment when they do occur. The same will be true for academics if we hope to change the uncomfortable statistics on mental health.
 
With regards to mental health, I see evidence that academic institutions are indeed scrambling to do what they can. The authors of the most recent large study on mental health in academia “have been receiving three or four invitations per week from institutions to present their findings and help set up monitoring and prevention practices.” These institutional structures are necessary because the responsibility of the academic mental health cannot fall solely on the shoulders of other academics who have neither the time nor the training to deal with these complex and difficult issues.
 
Getting help and advice if you’re struggling
“Resilience” is a useful concept; it is a kind of psychological immune system that helps you deal with serious problems you encounter in the future, whether it’s failing to get a position or grant, not being able to keep up with a workload, being stuck on a problem in your research, or a personal tragedy. These are all surmountable problems, until your resilience is eroded away. One little booklet that I came across and particularly liked was designed for physicists and is called the Resilience Toolkit. How does on build resilience in academia?
 
First, it is important to establish a social support network of people with whom you can have open and honest conversations. Social isolation is the wellspring of many mental disorders. Finding social support can be a challenge during transition and relocation periods that are common during the postdoc years, so it’s wise to prepare in advance for these stressful periods.  One should feel no more shame in seeing a mental health professional than one feels talking to a doctor about carpal tunnel syndrome.
 
Second, many people have made successful changes to their lifestyle such as adopting an exercise regime or a practice of mindfulness meditation. Both of these are shown to have comparable effects to medication for many people. Lifestyle changes can embed structure and discipline into your life and have a profound impact on your mental health. Work-life balance does not simply mean that time spent working should be balanced against time being active, spending time with friends and family, and resting; if you don’t spend sufficient time investing in your mental wellbeing, then your work productivity will go down, not up. You may enter a vicious circle where lower productivity leads to more stress which leads to a mental state that is less productive. There is no ‘tradeoff’ between mental health and productivity, just as there is no tradeoff between physical health and athletic performance.
 
Third, learn about imposter syndrome as a source of anxiety and how common it is. My own feeling about imposter syndrome is that we academics are too incentivized to focus on ourselves: Are we good enough, smart enough, or productive enough? These are not constructive questions. Success relative to others is an always-moving target, and is based in large part on luck. You don’t control your talents and past experiences or whether a given experiments turns out to make a surprising discovery versus fails completely due to unforeseen events. Rather than focusing on who we are, it’s better to focus on what we are doing next: Are we spending our time how we want to spend it? Are we doing the work we want to be doing? What obstacles do we need to overcome and how can we do that? According to my completely nonrandom twitter poll (n=127),  most of us would still do (or have done) a PhD if we were 100% certain there would be no job at the end. And I think most of us would still do science if we didn’t need any money for the rest of our life. In science, the work itself is the reward. So try to focus on enjoying the work and creating the best work you can, rather than wondering if you’re good enough. Imagine you’re handed a blank canvas and a paintbrush, and you must submit a painting in 2 hours. Is it as a competition or a fun experience? How we view the experience can determine whether we find it stressful or relaxing or fun. Will you spend those hours painting or worrying that you are not a real artist? It’s easy to trick ourselves into thinking that our worrying serves an important function, when often it does not.
 
Talking with others about mental health if you are struggling
Many graduate students and postdocs struggling with severe mental health issues are unsure about what aspects of their situation they can or should discuss with their PI when it becomes relevant. Will my PI think that I’m weak or even manipulative? As a PhD student, I remember telling my advisor I stopped my experiment because I went to the hospital for psychological reasons and worrying a bit about this ending up on a reference letter and preventing me from ever getting a job. This did not happen. Most professors are not trained therapists who always know what to say, but they are often more compassionate than they may seem on the outside. But attitudes about mental health differ widely and others have had different experiences, so it’s a good idea to feel each situation out. For example, one professor apparently referred to their experience of supervising a student who developed mental health difficulties as "a blemish on my career”. Maybe this PI was callous as they seem, or maybe they just never took a moment to think about mental health more carefully or talk to someone who suffered from a mental illness. I think such attitudes are in decline, but they do exist so it makes sense to talk to people you trust and to develop a sense of resilience to dealing with attitudes like this. Don’t forget to look outside your immediate circle for support. In my own experience, I found that there were a lot of invisible people out there willing to help me that I didn’t know existed.
 
Talking about mental health with someone else who is struggling
As the head of a group or lab, how can we best encourage an environment that respects the importance of mental health? It’s not an easy question, but I think having a compassionate attitude about the topic is already a start.  Many PIs might worry about knowing what to say in response to a student struggling with mental health. Is it intrusive to check in on them? How do I know when to recommend professional help versus give some motivational “you-can-do-it” advice? Again, I don’t have the answers, but I think it’s good to discuss them with other PIs and maybe even with students at a lab meeting that focuses on a general topic like wellbeing.
 
One thing I can say is that it’s probably unwise to generalize from your own situation to others. I think it is also wrong to normalize depression, or to say that depression is just part of graduate school. Do not try and prevent students from getting advice and help from others. If an intern or student comes to you with a mental health issue and it’s beyond what you can take on, there should be an institutional counseling or crisis center you can connect them to. If not, ask why not?
 
Looking forward
I’m optimistic about the future of mental health in academia because more and more people are talking about it. There are many problems in academia (like the reproducibility crisis and the scandal of academic publishing) that once recognized are being addressed using the creative resources and energy within the scientific community itself. Although our work lives are constrained and defined by funding agencies and academic institutions, we do have a say in the culture and compassion of our labs and workplaces. The young scientists I have met are among the most inspiring, interesting, and talented people I know. So I am optimistic that the academic culture surrounding mental health will improve as we talk more about the problem, discuss skills to bolster wellbeing, and create more supportive environments. If we want to maximize scientific excellence, we must improve the lives of current scientists and strive to hold on to scientists who would otherwise make important contributions but leave academia due to mental health issues. Finally, I think in today’s academic environment, it’s too easy to forget about the big picture. Let’s not forget why we do science and what we love about it. We pursue intellectually stimulating and meaningful work. We contribute to something larger than ourselves: humanity’s collective library of knowledge. We have the creative freedom to ask our own questions and design our own research. We experience the excitement of solving new puzzles (which Richard Feynman called ‘the kick in the discovery’) and encountering surprising new facts, and awesome, beautiful, and profound new ideas. We can spend so much time thinking about the career sides of academia that we can sometimes forget about the joy of the science itself.
 
Three gateways to more information online:

• Academic Mental Health Collective
• A list of resources from a blogpost (2013)
• “On Faculty and Mental Illness” with link to the free book Promoting Supportive Academic Environments for Faculty with Mental Illnesses

 
Gerry Carter is a Humboldt Research Fellow at the Max Planck Department of Collective Behaviour, and soon-to-be Assistant Professor at The Ohio State University