So I was reading a 2012 report by the National Alliance on Mental Illness (NAMI) recently. Over 750 college students were surveyed, with NAMI attempting to determine views of mental illness among young adults, and the quality of campus services. The report is located here (PDF).
Most interesting to me is the data on disability accommodations (pages 12-13). While there is a lot of current data on students and mental health, they usually focus on counseling services. In that area, the rate of students getting help has sharply increased, though college-age adults remain the group least likely to seek help. This isn’t a terribly good survey in terms of research design, but any information is good.
A couple key insights emerge, which I’m fairly confident would hold in a more rigorous study.
- There is a substantial difference between how many people with mental health conditions who know about accommodations, and those that actually use them. About 20 points separate the two.
- Disability resource centers are orientated to physical disabilities, and aren’t designed with psychological conditions in mind.
- Among those that dropped out of college due to mental health issues, getting accomodations may have kept them in school.
The conceptualization of disability in the United States has created these conditions. This gap between physical and mental doesn’t emerge from modern disability law necessarily, where the definitions are broad and inclusive. Rather, society has yet to shift its perspective on mental illness. Some tendencies:
- People discount any claimed disability that is not clearly visible to outsiders. When I served on a county disability commission a couple years ago, a long impromptu discussion broke out during a meeting about people being harassed for parking in the special spaces because they didn’t “look like they needed it.”
- The stigma against mental illness and disability are different, and a sizable group of people accept their belonging in the former group but not the latter.
- The type of assistance given to people with psychological conditions, including more time on exams, exams in a quiet room, and longer deadlines, may seem unearned by those who qualify. Accomodations otherize. If you take your exams in a different room, or have different deadlines than your classmates, there may be resentment.
- Faculty treat psychological accomodations as less important than physical accomodations.
The disability office as an institution is caught in the crossfire. It can be a key part of students succeeding in college, but many people have no concept of mental illness as being connected.
Sulome Anderson’s feature last week, “How Patient Suicide Affects Psychiatrists” is a great inversion of a big social problem. Most features on suicide and mental illness (including the great The Cost of Not Caring series by USA Today) tend to focus on the individual who committed suicide and the impact on their family and community. Anderson did quality journalism to create this feature, which helps humanize doctors who naturally become the bad guys in some of these cases.
Personally, last year someone I knew tried to end their life- I had talked to them the a few hours prior to the attempt, having a short conversation about family relations that turned out to be much more important in hindsight (they wanted to know if I had special insight on why I have a good relationship with my parents, and they had the opposite. I wasn’t helpful, though I tried to be). When I visited this person the following day, they were still attempting to die in the confines of the hospital room. Never have I seen desperation more fully realized. It’s profoundly disturbing, and the feature gets across that this sentiment crosses all lines of profession or experience. You don’t become truly adjusted to suicidal people in your life, even if you chose psychiatry as a profession.
Personally, I thought that my history of mental illness would help deal with this experience. I’ve never been particularly suicidal, but my choice to be an activist and socialize within the community has put me into contact with many people who are open about their past with suicide. Turns out that was all (I suppose) wistful thinking. It’s horrible to witness, even in the context I had, where I had some time to mentally prep.
This feature helped develop a three-dimensional picture of the tragedy, which I wish was available with all social problems. Everyone loses someone in a suicide, and we each lose a part of ourselves when someone we know personally attempts or completes it. And yes, as Anderson comes to- sometimes there is nothing that can be done. Zero suicides is an ideal to strive towards, but no free society can ever attain it.
We are all humans with flaws and we are not omnipotent. There is only so much we can do for those we love. All we can do is our best.
It’s common to hear those living with a mental illness to refer to normalcy. They may even wish to be normal. In my teens I was part of that camp; bipolar disorder was isolating, isolation being the common denominator of all mental conditions.
But then, the thought drums at the back of your skull. It grows until you have to face it – what on earth is ‘normal’? What are its characteristics, and why have I aspired to be it?
Really, when people have some kind of isolating characteristic, they aspire towards a statistical concept. Normal is the mean, or the median. It’s not a real, tangible thing. It’s like the all-American family with their 2.4 children. The 2.4 can’t be applied to a single, ‘normal’ family. And all these normal, average metrics are just a combination of variation, and include extremes. 2.4 is averaged from many zeroes, along with reality-show families with two dozen kids.
In the end, I am normal. I’m a part of the average, with a lot of people like me and a bunch that are totally different. Dysfunction and function exist in a complicated relationship – what is weird or immoral varies over space and time. Ask the next ten people you talk to if they can define what ‘normal’ is to them. You’ll get >1 ideas from that sample.
Part of ending the pain of isolation is to end self-isolation- in which people define themselves as outside certain boundaries and barriers. These barriers can be real and tangible, but they are also self-assigned. Even if certain legal and economic obstacles are removed in the struggle for racial equality, people must emerge from those feelings of inferiority or superiority that came with those policies. Just because those with mental illnesses don’t get locked up for decades at a time that often doesn’t mean the separation ceases to exist.