Talking with Profs about Mental Health

Parents Forum
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<p>I used to post here back when dd was going through the app. process, and thought of it today as an issue has arisen that I want to guide her on properly. Dd was diagnosed with bipolar disorder in her very early teens, and we treated it as tentative. It is very prevalent in our family, but so far for her, has never been completely debilitating. She can typically work well under pressure, and she tried medication at one point in high school, but has been off of it since. She took one semester off for a variety of reasons, mental health among them, and it's been a part of who she is, but never completely prevented her from functioning. For the last five months, though, things have been intense. She had to drop an 8-credit class very late in the semester, and has been in kind of a "survival mode" for much of it, with a few sharp vacillations into superwoman novel-writing cancer-curing mode, with a bit of a destructive spin. She has been in therapy weekly, and has an appointment with a new psychiatrist scheduled, but these last few days has just kind of bottomed out. She has one term paper to go and a week left to write it, but has rescheduled a required meeting to discuss her topic with the professor several times. She is incredibly anxious about how to postpone it again, and I think it's essential that she gives him some honest explanation. She's never taken an incomplete, but I'm encouraging her to consider that option, or asking for an extension, at least, but she's certain something will happen between now and the deadline. I think it makes sense to alert him of what's going on, so it's not a surprise later if anything else happens, and so that he doesn't just brand her a slacker and assume the worst. </p>

<p>How much information do you think would be appropriate to share at this point? </p>

<p>Thanks so much--hope someone can weigh in!</p>

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<p>I think that she should tell him the truth, and also should show him something in writing from her counselor. The latter is because unfortunately lots of students make up excuses about late papers, etc.</p>

<p>She needn't tell him every detail of her disease, but should tell him that she has a problem with depression, and is undergoing treatment.</p>

<p>When I taught college, I had some students who were in similar situations. I gave them extensions as long as they talked to me in time about their situation, and as long as I had some kind of proof that they really were ill (i.e. letter from a doctor or counselor). </p>

<p>One student, however, had to take my class 3 times because she'd simply disappear at the end of the semester and not hand in the work that was 40% of her grade. I had to fail her because she had never asked for an extension. </p>

<p>This probably sounds mean, but it wasn't. She had told me early in the semester that she had bouts of depression, and I had told her that I could make accommodations as long as she told me what was going on. Disappearing, however, with no explanation wouldn't be reason for me to give an extension. Unfortunately, that's what she did twice. She was not hospitalized, just gave up due to her depression.</p>

<p>Interestingly, the student was a star student and was one of my favorites. I also was one of her favorite professors. I also know what it is like to suffer from depression.</p>

<p>Anyway, the student understood where I was coming from, and kept taking my course even though she could have taken it under someone else who probably would have passed her even if she hadn't done the work. The student also got a summer internship as a result of an assignment for my class and a recommendation that I gave her. When she passed my class, both of us were thrilled. </p>

<p>I hope that what she learned was that depression isn't anything to be ashamed of, and it is an illness that understandably can hurt one's productivity. However, one does need to take responsibility for letting professors and employers know that one's work will be delayed due to illness.</p>

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<p>
[quote]
She's never taken an incomplete, but I'm encouraging her to consider that option, or asking for an extension, at least, but she's certain something will happen between now and the deadline.

[/quote]
</p>

<p>First question: Does your D's school offer some form of medical incomplete? Mine had both regular incompletes and medical incompletes, and one of the big differences was in how these were treated by our committee that decides if students should be put on academic probation, be required to withdraw, etc.</p>

<p>Second question: Does your D's school have counseling deans/student support services/something like that? They can act as liaisons with the professors, and help work something out. The professors might have been fine anyway, but counseling deans can provide a safety net. They are also people with whom students can speak more candidly, and help the student sort out how much to tell the profs.</p>

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<p>Northstarmom: Thank you so much for this feedback! She has a great network of therapists and a psychiatrist with connections to the school, so I'll let her know to offer documentation. One of the reasons she's wanting to try medication again is that she wants to feel more accountable all the time. I think one of the main problems she faces is not being able to rely on abilities she knows she has, leading to a blind faith that something will kick in and she'll be able to pull it all together in time. I just got word that she e-mailed the professor letting him know that there is a condition, she's suffering from a current complication with it, and she hopes to be able to meet the deadline a week from now, but will give him notice if it seems to be a problem. Fingers crossed that he's as compassionate as you are! Dd has taken so many B's in courses she could have aced because she didn't want to use her illness as an excuse. I'm so happy that she's finally ready to take charge. </p>

<p>Jessiehl: I'm not sure if they offer a medical incomplete, but I know many students have taken medical leaves, and that Incompletes are by no means unheard of. The term paper for this class is due before the deadline for grades, so I'm hoping that if anything, an extension will come into play. I'll look into it, though, in case! I know there are great advisors who D worked with when she had to drop a class. If there's any trouble, I'll mention this suggestion to her. Thanks for your help!</p>

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<p>ColumbiaMom - I'm a college Dean of Students and I work with several students each semester who have to drop courses late in the semester or take Incompletes for mental health reasons. Occasionally, I work with students after the fact to document the medical bases for failing grades in order to retroactively change failing grades to Withdrawals. At our campus, the student has to provide documentation and I review their record to determine that the poor attendance or performance was a deviation from their normal patterns, then we make the case to the instructors and the Dean's office. We generally have no problem getting the consideration we're seeking. Often, the greater challenge is getting students to feel OK about opening up and sharing their needs - a challenge that is never there when the cause of the absences is another medical emergency.</p>

<p>One caveat however - if your daughter is at Columbia, you should know that most Ivy League schools have never embraced the Student Affairs profession, so they tend to not have professional Student Affairs administrators, preferring instead to promote professors to administrative roles. As a result, they're occasionally way behind the times when it comes to dealing with and addressing student trends and changes resulting from case law that those of us in the field make our business. If your daughter finds that attitudes in the Dean's office there are behind the times, she may have to search for another advocate within the school.</p>

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<p>I'm a psychologist and in my experience the superperson save the world mode is a red flag for a manic episode, especially if she's not eating and sleeping properly. Sounds like you recognize this. There is a perfectionistic thing that works until it doesn't--bipolar people tend to put huge amounts of pressure on themselves. This is a generalization, of course, but I'll bet you know what I mean.</p>

<p>Yes, I think someone at the school needs to know that your daughter may need some accomodations. If gadad is correct about most Ivy League schools being not so good about this, that is unfortunate. Be your daughter's advocate until you find one within the school or without. Keep us posted.</p>

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<p>My daughter is in a similar situation. The head of the disabilities office at her college is communicating with her professors. Students with mental illness are legally entitled to an education under the ADA. That's why the disabilities office is involved. I was given legal advice that it's best to have these matters dealt with by either the disabilities office or the counseling office in order to keep medical information out of academic records. If indeed the college is "behind the times" or recalcitrant about providing accommodations, you may need an attorney who specializes in education law.
Best of luck!</p>

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<p>"One of the reasons she's wanting to try medication again is that she wants to feel more accountable all the time."</p>

<p>I have several friends who are bipolar including one who is a social worker, one who is a lawyer, and one who is a graduate student. All are on medication. </p>

<p>I think it is a very good decision for your D to decide to go back on medication. No one whom I know who is bipolar has been able to do well without medication. In fact, from what I've seen, it's red flag when a bipolar person decides to stop medication. That can be a sign that they are in denial of their illness, and may even wish to reexperience mania, which they may be nostalgic about its pleasant aspects while forgetting how it eventually becomes very destructive.</p>

<p>I also hold a doctorate in clinical psychology, though I am not licensed and have not worked in the field for many years due to burnout.</p>

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<p>My brother has struggled mightily with bipolar disorder his entire life. He is brilliant. One of his greatest frustrations is watching friends who go off of medication as soon as they think they're doing better. It seems to plague some of the bright light bipolar warriors (my term). They don't all make it to their 60th birthday, as he is about to, and he's also about to remarry someone he's known for about 5 years, a solid partnership. Do I sound proud of him? I am, but it has been HARD for him. Lithium, for example, didn't even come onto the market until the early l970's when he was in his early 20's. Imagine.</p>

<p>He works now for NAMI, National Association for Mental Health. They have a different approach that is client-oriented. ("Client," not "patient"...), working in collaboration with medical professionals but giving additional resources to complete the picture.</p>

<p>Their website, at the very least, might be something for her to peruse during the upcoming vacation. Perhaps she'd find a new paradigm for thinking about her own situation. There are also local chapters with people for support and inspiration. </p>

<p>Someone as young as she is should not have to go into her life without a modern understanding of how to manage her situation. If she had hypothyroidism and stopped taking her replacement hormone whenever she was "doing better" she'd just keep getting sick. "Doing better" is evidence the medicine is effective, but the brightness and drive to achieve is exactly the tripwire for many bright bipolar clients. So says my bro, one of the bravest people I know. </p>

<p>She needs to learn to manage this, and there's no time like the present. If you are there for her, that will mean so much to her. A supportive family is not always present for those struggling to come to grips with this illness. </p>

<p>Just google NAMI. Do not be concerned about B's instead of A's. It doesn't amount to a hill of beans compared to her getting a handle on her health. Why are we still in the dark ages over this, when so much is known about the chemistry of mental illness? She isn't responsible for having the illness but she is responsible to take her medications, and this is something to emphasize as a parent, I believe. Sometimes my brother needs to have dosages adjusted and he and his doctors just work on it. A body changes, it's a biological organism. </p>

<p>She can play a role in her own health. My guess is she's more frustrated about her B's than you are, so I'm not chiding you by any means! The B's won't change to A's until this stuff is under continuous and steady control by her. This is a LOT for a young person to figure out, which is where NAMI comes in, augmented by family and her doctor. She must have a doctor she respects and trusts. Then all of her talents can flourish. Not simply asking for, and documenting properly, a simple academic extension speaks volumes regarding how she views her illness at this moment. When necessary, she needs to use the tools available to her, provided by her institution, without shame. </p>

<p>The only thing my brother said we did wrong as a family was to rush him back to work and high pressure jobs as soon as he "felt better" because we're so high achievement in our family. She has a basic decision whether to become comfortable with B's or manage her situation so carefully she might actually become an A student, but either life is a good life if she's feeling in charge of the decision of how much she chooses to achieve. </p>

<p>Best wishes from someone who understands, a little bit (as a sister) what she is going through.</p>

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<p>bethievt, is it good medical practice for bi-polar patients to rely solely on therapy? I'm not an expert but my brother was diagnosed b-p and the only thing which seemed to work was medication which he typically stopped when he was feeling "better".</p>

<p>As to the OP and the situation at hand, your DD should not hesitate to speak with her prof about the situation, particularly if she has gotten to know that instructor reasonably well during the term.</p>

<p>As we have gotten to learn about the medical bases of mental disorders like b-p, much of the stigma has gone away. And because there is better diagnosis available, most people have personal experience with some form of mental disorder via family or friends.</p>

<p>Give the experience with my brother I would definitely offer a student good options to get through a couse I taught successfully.</p>

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<p>Everyone I've seen who has maintained a good steady state over time has needed medication. And thank god there is medication now. But it does have side effects that can be unpleasant and achieving effective treatment for both the highs and lows can be a tough balancing act. I would not recommend that anyone try to deal with this biochemical condition without meds. That said, I wouldn't recommend ONLY meds either. Anyone with this condition and everyone around him or her can benefit from knowing more about it and getting support to deal with it.</p>

<p>It's also a bit like diabetes and maybe other physical conditions in that you can achieve a steady state over time but then something can change (stress levels or who knows what) and meds need to be revisited, overhauled, etc. Some people can go on a single medication and achieve balance fairly simply. Others might need to go to a mood disorders clinic and have combinations of meds fine-tuned to achieve balance. I have not been in active practice for some time, so I'm not up on the current medications for this. I assume they've gotten better over time, but there's basically no quick fix. What really doesn't work is taking away the mania through medication and leaving the depression. Both poles need to be agressively treated.</p>

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<p>How can one tell the difference between stress and burnout? I have a student who looks weary, has gained weight, worked very hard throughout the semester, and has little in terms of top grades to show for it. Makes for a delicate situation.</p>

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<p>From someone who has been in the same situation as your daughter: I think she should discuss the situation with her counselor and explain to her professor as much as she feels comfortable. She does not have to provide an in depth explanation beyond "I'm sorry my work has been lacking, I have a medical problem and I need to take an incomplete for this class. Here's a(n equally vague) letter from my doctor." If she wants to divulge more, she can. But she doesn't have to. </p>

<p>I have used this approach, namely when dealing with an employer who did not want to give me (unpaid) leave so that I go to my doctor's appointments. While I find that the stigma for this disorder has lessened in recent years, it still exists in the unenlightened, and it has a habit of sticking around like bad gossip. It follows you around, and you never know exactly who knows, what they know, and when it will pop up. This is why I treat my dx on a need-to-know basis....or under the thin veil of anonymity of the internet. </p>

<p>And I applaud her decision to try meds again. Welcome to the merry-go-round. Please keep all extremities inside the car at all times, and never get off. There are MANY resources on the web for her to go research meds online, as well as online BP support groups. I'd urge her to check those out as well, especially if she isn't in a real-life support group.</p>