Posts (16)

Jul 14, 2016 · Don't think about breathing

rising steam

Photo credit: Unsplash, Zugr

I haven’t written much lately. Even though it takes more than two hands to count the number of times I have sat down with an idea for a blog or article in the last year, and written a couple sentences, none of those ideas have hatched into anything coherent enough to be worth sharing. But I’ve been trying! Really hard. Writing stories on topics I’ve been reading about or opinions that have precipitated in my mind is quite cathartic. Evidently I am also pretentious enough to think that someone else might care that I have an opinion. But, lately when I’ve tried to collect my insoluble thought products and extract them into words it all seems to lose inspiration and fall dead on the floor like an old balloon from last week’s birthday picnic. How uninspiring. How not to liven up the party.

What a ridiculous impasse. It’s easy to blame the mental block on grad school – working 60+ hours a week on a project that can be frustratingly filled with unknowable variables seems to be a drain on the creative batteries. Besides, putting together formal papers on my research has taken some of the joy out of sitting down with a blank word doc and creating something fun to write and (hopefully) interesting to read. But nobody likes excuses and I shouldn’t let work get in the way of doing things that I love. Not only is creative / informal writing something that I really enjoy (creative / informal writing meaning blogging about science, health, and education), but for me it has been a crucial part of progressing as a scientist. My job requires me to find creative solutions to problems, and creativity is a muscle. The more I exercise it, and the more I exercise it in new ways, the stronger it will become. If all I did at the gym was the stationary bike and nothing else, at some point I would reach a plateau where the stationary bike can’t help me much anymore. It’s better to mix up the workout and keep my muscles on their toes, so to speak (am I mixing too many metaphors?).

Photo credit: David Marcu

Photo credit: David Marcu

Anyways, I was spelunking through some of the cavernous vaults of the internet and came across a couple pieces of advice that encouraged me to stop trying so stupidly hard. One was by The Oatmeal, and due to its nefarious (and hilarious) content I won’t link it to our squeaky clean Diversity in Education blog (but if you Google search “the oatmeal creativity” you might be on the right track). As the only breakfast cereal that isn’t bad for you puts it, creativity is like breathing – “when you make stuff, you’re exhaling. But you can’t exhale forever. Eventually, you’ll have to breathe in. Or you’ll be dead.” How uplifting, right? It is, though. Don’t be a dead balloon that just slowly leaks out someone’s old breath. If all I do is try super hard to squeeze out stories and blogs because I think that I have to, I’ll end up gasping for breath with no creativity left within to fill the empty shells of ideas that build up inside me. What a way to barely not die. So, the second source of wisdom came from the wonderful people at FiveThirtyEight. Christie Aschwanden wrote about her conversation with cognitive modeling researcher Kenneth Stanley, and his advice on creating something (which was, essentially, “stop trying”). Stanley had written an AI program that would create random images, then produce iterations or “children” of those images based on selections by human users. Sure, you might expect this to only result in the production of random blobs shaped like nothingness, but users guided the program to create beautiful images of planets and racecars and butterflies. All from random figures that an AI produced. An artist couldn’t start the process thinking “today, I will draw a butterfly!” The program forced them to simply follow their intuition – the only thing guiding the evolution of the image was their projection of what any given set of assorted colors, shades, and lines might be. This forced users to stop trying to create, and simply let creativity be. How nauseatingly meta (yet superbly intelligent).

Photo credit: Alice Achterhof

Photo credit: Alice Achterhof

Naturally, these things got me thinking about how to write, and how I seem to have lost some innate capacity to build stories. Have you ever sat down and thought about breathing? It’s really weird. If you think about it, you can control it. In, out. In, out…But now it’s annoying. It’s suddenly awkward and full of effort. You have to lift your shoulders a bit, pull air in, push it out. Don’t push out too much. Don’t pull in too little. But all this time you were sitting here reading and breathing, not thinking about how you were doing either, and I just ruined it for you. You weren’t controlling it at all. You were letting yourself do the breathing because your body knows that it’s just better when you don’t think about it or try hard to do it. Which is exactly like creativity – don’t try hard to do it. If you do, you’ll ruin what it was supposed to be. Just let yourself write, paint, play dodgeball, sample mustards, record music – whatever it is, you’ll be better at it when it’s less about producing some specific thing, and more about letting out the stuff that builds up inside and needs to be expressed.

So, no, this doesn’t mean I’ll be back at it again, writing blogs right and left about good food, cool grad students, or why you should stop sitting around reading my blogs. Because if I promised you that, then I would have to try hard to keep my promise, and that would negate everything I just learned. Alternatively, what I can promise is that I’ll just let myself enjoy it, and so should you.

Have comments or questions? Leave me a message below!

Jan 28, 2016 · Medical "Marriage" - Improving the Clinician-Patient Relationship

Great article Tom! Thanks for sharing. I really like your point about students being more concerned about renin-angiotensin (or whatever rigorous scientific topic) and less concerned about learning to connect well or communicate well. It seems like changing that attitude may benefit many scientists and clinicians.

Oct 21, 2015 · Mayo grad students reach out to their neighbors (in El Salvador)

Written by Crystal Mendoza and Carl Gustafson

The Biomedical Engineering and Physiology (BMEP) students are going global! In 2009, a few students got together and formed the Initiative for Medical Equipment Sustainability (IMES) to address issues of transferring medical technology to developing countries, and making those technologies sustainable. Since then, the program has grown to become part of the local Biomedical Engineering Society (BMES), and has received funding and mentorship support from the Program in Underserved Global Health (PUGH).

The IMES team from Mayo Clinic in San Salvador, September 2015.

The IMES team from Mayo Clinic, along with local collaborators from Hospital Nacional Rosales in San Salvador, September 2015.

In 2009, Mambidzeni (Mambi) Madzivire applied for, and was awarded, a Clinton Global Initiative University grant. She proposed that, through the already established partnership between Mayo Clinic and the Hospital Nacional Rosales in San Salvador, El Salvador, students at Mayo Clinic could provide education and training in the use and maintenance of medical equipment. The focus of this outreach was to improve translation of currently available medical technologies to underserved areas. Later in 2009, Mambi and another BMEP student, Casey Johnson, made their first trip to El Salvador. They quickly realized the best means to establishing a sustainable and impactful outreach would be to focus their efforts on a single, initial task, with the plan to further expand in later years. They chose to concentrate on the repair and maintenance of endoscopy equipment, as the need in El Salvador was striking, and resources at Mayo were strong. Endoscopy equipment, in particular, requires frequent maintenance: if left without repair, entire pieces of equipment may need to be replaced, costing thousands of dollars. In contrast, regular upkeep is relatively cheap, but necessitates that the technicians using the equipment are capable of providing their own maintenance. The impact of well trained technicians was noted by Mambi and Casey, and became the initial focus of the IMES.

Hospital Nacional Rosales, San Salvador, El Salvador.

Hospital Nacional Rosales, San Salvador, El Salvador.

In subsequent years, a succession of students from the BMEP program at Mayo Clinic led and developed the IMES program. Loribeth Evertz, Brent Berry, Sara Aristizabal Taborda, Maria Gonzalez Porras, and Ephraim Ben-Abraham are currently involved in the continuous support of IMES, and training of technicians and students in El Salvador. One of the largest challenges was to secure consistent mentorship from within Mayo, and to find a Mayo Clinic internal funding source to aid in the sustainability of this initiative. In recent years, both missions have been accomplished. Dr. Luis Lujan has joined the IMES group as their faculty mentor and has been exceptionally helpful in providing a clear and consistent direction to the outreach. Further, the Mayo Clinic PUGH, directed by Dr. John Wilson, has continued to provide funding support as well as further mentorship to IMES.

Brent Berry and Ephraim Ben-Abraham address concerns about a piece of endoscopy equipment.

Brent Berry and Ephraim Ben-Abraham address concerns about a piece of endoscopy equipment.

The biomedical engineering program at the Universidad Don Bosco in San Salvador provides the perfect environment for training students and future technicians; this idea of providing education offers long-term sustainability. The IMES group is now working to establish a partnership with the University, with many exciting, new developments to come. If you would like to hear more about the work of the IMES group (directly from the students themselves), come to their talk! This coming Friday, October 23rd at 12 p.m. in Mann Hall, the IMES students will be giving a seminar on their work in El Salvador, and discussing its potential to expand and impact larger fields in the biomedical community. We hope to see you there!

Jul 5, 2015 · Read this while standing

“What you are doing, right now, is killing you!” Nilofer Merchant scanned a suddenly breathless crowd with a faux menace at her 2013 TED talk. The audience anxiously awaited her answer: what could possibly be killing us so menacingly and discretely that we would simply sit here and allow it?

Well, I agree with her, so let me repeat it. What you are doing, right now, is killing you. And me.

We are sitting. And that is what is killing us. I often sit for 8-10 hours every day: reading papers, documenting results, in meetings, culturing cells, you name it – I am sitting down. Then I go home, and…I sit down because I am thoroughly exhausted from all of the sitting. There is nothing inherently wrong with sitting – it would be just as bad or worse if we were standing on our heads for 8-10 hours a day. It is simply the lack of change in velocity, the stationary state, the inactivity in excess that does us in. Just ask Dr. James Levine, the Mayo Clinic-Arizona researcher who coined the phrase “Sitting is the new smoking” simply because, well, the data says it is. The desk chair, the couch, and the recliner are all killing us – they are the scourge of our generation, brought on by an office-based workforce, a vice more rampant than smoking ever was, and contributing to the propagation of a host of chronic pathologies.

Despite frequenting the Dan Abraham center, playing tennis, volleyball, and running triathlons, I essentially live a sedentary lifestyle. And so does nearly every other graduate student, PI, research technician, post-doc or fellow at the Mayo Clinic. Unfortunately, research shows that the 45 minutes of spin class after work, or the run, or the yoga class, do not reverse the damage inflicted from a day of sitting. Here we sit, scientific visionaries prepared to change the paradigms of medical practice and we are slowly, unknowingly, failing to raise our potential by simultaneously failing to rise out of our seats.

Fortunately, we work in an organization filled with innovators and solution-makers. We are here to find solutions for the greatest afflictions to plague humanity, and this cultural epidemic is one of them. Even if culturing cells while walking or pedaling may not be feasible, I am convinced that we can find ways to sit less.

So what can you do to decrease your sitting time? Not everybody wants to be the solo “has-his-own-special-standing-desk” guy in the office. I get it – I don’t either, I like being invited to things. But having one at home probably wouldn’t hurt for those evening shifts writing reports while watching Late Night with Jimmy Fallon. There are easier ways. During her talk, Nilofer Merchant offered a possibly more practical solution to this problem: she advocates for “walking meetings” to replace standard, office-based, sitting meetings. She noted that we average 9.3 hours of sitting time, compared to 7.7 hours of sleeping time every day (I’m sure the graduate student population in the US is weighing the sleeping average down…).  Her meetings take her and, I suppose, whoever has the great fortune of meeting with her, walking as many as 20-30 miles every week. According to Dr. Levine, a single walking meeting would increase your daily energy expenditure by 150-200 kcal. Though a walking meeting might not be appropriate for your entire lab group, I think we could all stand (get it?!) to replace a couple one-on-one meetings every week with a walk outside to the locally owned coffee shop, not the starbucks mini-café in the next building.

Walking the stairs instead of taking the elevator up two flights is a great way to add some activity to your day (à la, “Take the stairs, for a healthier you!” – I secretly love this sign campaign). In order to encourage this, I vote that we make our stairways slightly less like the only passage to the highest room in the tallest tower in the dragon guarded castle, and more like the stairs at your parent’s split level: littered with pictures or posters, well-lit, and colorful.

So where’s the silver lining in all of this gloomy “death by sitting” business? A report published just last April in Preventative Medicine found that Europeans, in 27 countries surveyed, are decreasing their overall sitting time. Between 2002 and 2013, average time spent sitting every day decreased significantly from 316.2 to 291.9 minutes. By no means does this indicate that the US population has followed suit, or that this decrease is matched by an increase in population health, but it does mean that less time in the chair is possible. Our Atlantic neighbors are beginning to lead a healthy trend that is getting them out of their chairs and back on their feet. Let’s keep Mayo Clinic in front of this wave of healthy change and continue to lead the nation by overthrowing the rule of the chair and clamoring for change by climbing to our feet.

Got a great idea for how we can all spend less time sitting? Mention it in the comments below!

Mar 19, 2015 · Becoming a Question Artist

“In re mathematica ars proponendi quaestionem pluris facienda est quam solvendi.” – Georg Cantor

Just when you thought Latin was a dead language…

If I were to ask you a question, how would you answer it? …Did you just tell yourself, “well, Self, that depends on the type of question!”? Good. You’re awake! Let’s be more specific.

Here is the question: What did Georg Cantor just say to the world?

Since I assume that you already answered this question, how exactly did you go about answering it? There are possibly thousands or millions of strategies by which to conquer translation and interpretation of Georg’s statement…Did you phone a friend who took Latin in college? Did you download Google Translate and hope that Latin is an option (you’re in luck!)? Did you take night classes in Latin and after hundreds of hours of exhausting rote memorization and repetition, expand your vocabulary to a point where you finally understand Georg’s statement? If so, I am impressed at your…um…dedication (?). Did you read to the end of this paragraph and realize that I translated it for you at the bottom of the page? You have chosen…Wisely. Option D people, can we be friends and can you protect me from Option C people who now want me dead? Thanks!

The art of asking questions. Georg really has some great advice that applies well to biomedical research, or nearly any other research for that matter. If the question we are addressing is a complete waste of time or already thoroughly answered, then even if we solve it, there may be no benefit. Identifying the best question, the most impactful, meaningful question is of great importance. Let’s assume you can pose a powerful question.

How will you answer this question? This is your method. Your assay. The daily grind and dirty work that you will struggle with and push through to discover the true answer to that question. Through murky nights and groggy mornings your caffeine-powered brain will mine the pieces of this answer from the cavernous vaults of data you produce. Nearly as important as your question, your method will often determine the outcome of your question. If you just invested two years of effort taking night classes in Latin in order to translate Georg’s claim, you are now one year, 364 days, 23 hours, 59 minutes and 45 seconds behind the person who Googled it. Unless, of course, it is a leap year. Regardless, your “How” just wasted your excellently posed question.

I contend that the How is at least as important as the Question. The very existence of an assay, a tool or method by which to answer the question, is of principal importance. Subsequently, being skilled in identifying the most efficient and effective way to address imposing questions is priceless. Developing the knowledge and intuition necessary to convincingly solve a puzzle and convince others of its solution is an indispensable skill that is vital for effective contribution within any field. It is important to realize that there are countless questions that simply cannot be answered properly because no precise means to scientifically answer that question has yet been discovered. Maybe Georg assumed that “Is this question currently answerable?” was included in the thought processes of Question Artists. Our ability to answer questions significantly cripples our ability to ask relevant questions. A critical lack of time machines, instruments for detection of divine beings, and warp-capable space ships are notable limitations in our scientific Question Answering powers. Other, more reasonable and less fun examples can be found (particularly from historical scientists whose genius was later realized), but I hope you get the point. This is why methods journals exist. It is extremely valuable to find new ways to answer previously difficult or impossible questions.

Why does this matter? Well, I could tell you that I just spent three frustrating weeks working with a time-consuming in vitro assay only to discover that it could not (and did not) properly answer my question. But that would only be 85% of the truth (and 100% of the whining). I could also persuade you that I often fear that the purpose of my life is simply to serve as a warning to others. But that would only be 5% of the truth (and 100% of the paranoia). I would rather tell you that in the course of my doctoral work, I have realized that identifying an efficient and powerful way to answer a question is often just as important as the question itself. Naturally, that is only 10% of the truth. The better answer, though, is that Georg was right all along. “How”, at its most atomic level, must itself be a question.

“In mathematics, the art of asking questions is more valuable than solving problems.” – Georg Cantor


Carl Gustafson is a doctoral candidate and 3rd-year Ph.D. student in Dr. Michael Yaszemski’s laboratory.

Jan 4, 2015 · Avoiding scientific nostalgia

Hello diversity blog readers and welcome to 2015! Thanks for sticking with us; we hope you’re as excited about the future of the blog as we are. If not, keep reading. Maybe someday we’ll serve up the post you’ve been waiting for.

Science moves pretty fast [citation needed]. In fact, it’s very difficult to quantify the rate of progress of science (umm, units?), and it seems that experts disagree on how to actually do this. Regardless, it appears that global scientific research output (units?) increases at a rate of 8-9% per year. Compare this to the rate of increase in global computer processing power. “Moore’s law” (not really a law…and yes, I got this off Wikipedia, don’t judge) observes that the number of transistors in use, globally, doubles every two years. Whoa. That’s an estimated 4.5 times faster than research moves (output doubles every nine years). Since units seem to be an issue here and this is difficult to visualize…imagine yourself on the highway going 25 mph in your ’94 Ford Fiesta and I pass you in a Ferrari going 112.5 mph…Wheee!

Remember the Nokia 3210 (yes, that was the old-school ice-cream-bar-sized cell phone you all had in the early 2000s)? As much as I enjoyed it, I have never dug it out of boxes in my closet (cyrostorage?) in an attempt to find new uses for it. Technology has moved on, thankfully, to new phones that are faster, have better games, are backlit (*gasp!*), but are certainly not as durable as the old electronic brick that weighed down my already saggy Levis in 2004. Electronic communication exemplifies a field of research that has developed with astounding velocity. This past April, I became the proud owner of a sharp new smartphone and I expect that within the next six months this phone will itself become obsolete due to the release of some other ingenious communication device that will certainly disappoint if it cannot cook a pizza, and levitate, simultaneously. Such is the viciously competitive nature of electronics research and development. In parallel, such is the viciously competitive nature of biomedical research and development. It is of paramount importance that we stay on the leading edge. Innovation and discovery can happen consistently only if we understand the current research and cutting edge of our respective fields. We need to know what has been slain on the altar and dedicated to the gods of PubMed in order to continuously develop our own research in search of the cure for polycystic kidney disease, or hypoplastic left heart, or whatever we may be researching. But, I state the obvious…

In contrast to electronic communication, biomedical research has a tendency to unearth relics of its belabored and well documented past in a search for new but merely quasi-interesting uses for much-too-tired molecules or methods. Scientific nostalgia (if I may refer to this phenomenon as such), in the electronics industry, would be akin to breaking out your Mom’s vinyl records or repurposing your Motorola DynaTAC. Actually, this does happen. It’s called being a hipster. Thank goodness someone else is in charge of making new phones. Such reminiscing does little to further the field of consumer electronics, and, while entertaining at times, is fortunately not given serious attention in R&D fields. The idea of scientific nostalgia, while thankfully absent from technological R&D, is unfortunately present in biomedical research. Here we beat dead horses: old drugs, tired proteins, and ancient assays all being wrung out ad nauseam in search of new data only to be quickly PLoS One’d, not to mention our archaic systems of identification. As a rising scientist, it’s bewildering to observe brilliant researchers that for 35 years have slowly plucked away at dull projects on the same drug…or the same splice variant, or protein complex, with the same method, or…Examples continue. Creative grants with extensive innovation sections are often ignored as being “too risky” in favor of dry proposals containing exhaustive preliminary data as they are “safe.” At what point did we quench our thirst for truly revolutionary discoveries? Our hunger for progress and invention should be as boundless as our contempt for those willing to rest on their laurels while new frontiers lay waiting.

In part, this affinity for the past may be attributed to the non-quantitative nature of many aspects of biomedical research (with the notable exception of many sequencing technologies and mass spectrometry analyses). It’s easy to quantify outputs such as processing power or internet download speed, but how do we quantify the quality of a western blot for comparison to a technique that could replace it? (No, the correct answer is not “densitometry”…). With these subjective judgments, it is simply too easy to fall back on established methods. Such discussions end in a regression to the mean. Secondarily, I believe this all may be attributed at least in part to a funding system that heavily favors experience in a field. Sydney Brenner spoke at length on this subject in an interview with the King’s Review this past February. Creative differentiation is often inhibited by bias towards the known. As Dr. Brenner put it, “If you’re like me and you know too much you can’t try new things. I always work in fields of which I’m totally ignorant.” Smooth words, Dr. Brenner. It is difficult to become funded in a field in which we are inexperienced (But what do I know? I’ve never been funded, even for things that I “know”…). Researchers may justify continuation in Field X because they have done Project XA and XB, and, although blatantly superfluous, Project XC was funded in lieu of previous success, so the work continues without producing truly inventive progress as this would require further creative differentiation. In reality, re-specialization or branching into new territory may be the best direction for Project X, but it produces challenges for funding and methods reasons. Many times, though, this could turn out to be incredibly successful. The first recent story that comes to mind is the development of CRISPR as a tool for genome editing. Dr. Jennifer Doudna’s lab went from studying influenza infected bacteria, subsequently realizing the potential of a unique observation, to recently forming a company that focuses on applying genetic modifications for therapeutic use. What a turn around.

In some cases, our aversion to perceived difficulty and fond associations with past successes hold back a field that is exploding with potential, many thanks to shotgun “-omics” technologies, high-throughput screening and sequencing, nano-engineering, high definition real-time imaging and a host of other modern research commodities, not the least of which is “the internet.” Let’s keep our eyes open, hands on the wheel, ready to take the next best merge, ramp or exit. Achieving initial success in biomedical research, only to lose interest in continued pursuit of legitimate progress would be like Apple producing the first iPhone, only to subsequently produce further iPhones that never really achieved any significant progress and were quickly left behind by an advancing field of work. Oh, wait…that’s what happened…

 

Oct 9, 2014 · What are we eating?

Contrary to popular belief, Facebook can be good for something every now and then. While wasting precious time on Facebook (shh! don’t tell my PI!), I stumbled across this blog post, by an endocrinologist in California who compared his dining experience at the Googleplex, to his dining experiences at various hospitals.

I sure hope Google starts hiring pharmacologists because his blog raved about the cafeteria food in Mountain View. I don’t know about you, but a good salad bar and a name like “Mountain View” is enough to make me want to apply for a position.

This article spurred me a little. Aside from preparing my CV, I started paying more attention to the food being served on the Mayo campus; as a result, I began asking a few internal questions, which are soon to become external questions, like…wait for itttt… “Are these meals really designed to be healthy for me? Are we serving food that is intended to encourage healthy lifestyles? Why does my “Wellness Entrée” come with an oddly yellow scoop of mystery rice jello? Why haven’t I heard back from my job application at Google? Why are there so many unhealthy options? Are we legitimately invested in promoting better employee and visitor health or not?”

Well, I have decided I’m going to go with “not.”

Every day I walk past the South elevators in Medical Sciences building and there is a sign with, what I assume is supposed to be, a motivational quote on it. It brightly suggests “Take the stairs for a healthier you! + (insert motivational quote).” I’ve seen these signs near every elevator on the Mayo campus and I think they are intended to make me think about eating leafy greens and going to cable class at the Dan. In reality, they make me think about vomiting a little, then taking the elevator out of spite. The point is this: though the posters are well-meaning, it’s quite hypocritical to start a sign campaign in favor of healthy eating and exercise when we actively sponsor unhealthy diets (and thus, lifestyle) in our own campus cafeterias and restaurants. We deliver our patients world-class health care for their struggle with diabetes and heart failure, so to help them along their way we offer Daube’s donuts and Cinnabon, right under their hotel. If they’re really interested in getting a nice, balanced, healthy meal they can go to Subway… Ouch. To be fair, I do not know that Mayo Clinic actively leases these spaces to any of the aforementioned restaurants or has control over the use of this space in any way (in fact, it’s safe to bet that they do not). I simply assume that if Mayo actually did not want Cinnabon there, then Cinnabon would not be there. Further, there are patient cafeterias. I have never been to one. Therefore, it is possible that they only serve delicious and healthy foodstuffs to our lucky, diet-conscious patients. The reality may be that the menus developed at these wondrous patient dining halls are vastly different from our own, employee targeted eating establishments. I will daringly assume the opposite. Harwick serves up fried pork sandwiches slobbered with mayo, chicken wings, mozzarella sticks, soda, cakes, and puddings. You will have to look long and hard for kale, squash, salt-free nuts, brown rice, whole grain breads, or low sodium, minimally processed meats. Interestingly, I have never found the organic / whole foods section at the cafeteria. Methodist cafeteria is only slightly better, possibly because it is larger and possibly by accident. We are willing to invest in bigger buildings, recruit world-renowned speakers, and subsidize wellness campaigns, all under the guise of benefiting human health. We even sponsor an entire exercise event dedicated to “Healthy Humans.” While we’re at it, maybe we could cut the façade and sponsor some blueberries to replace the Fritos.

Sodexo Group, a contractor that provides facilities management and food services to a large number of businesses around the world, employs the Food and Nutrition Services and Environmental Services work groups at Mayo Clinic as of September of this year. We have a contract with them to provide food for the various cafeterias and in-room patient dining needs on campus. Outsourcing our food choices to a vendor is convenient. They will efficiently provide the food that most people want on a consistent basis. Unfortunately, nutrition is not a popularity contest and it is often not convenient or easy. If we offer cheese curds, people will buy them. If we offer Dairy Queen, our patients will line up for Blizzards. We need to take upon ourselves the responsibility of patient and employee health and nutrition.

It’s time we stopped being simply interested in employee and patient health. We need to be invested in employee and patient health. Sign campaigns are nice, and one day they did motivate me to take the stairs (for a healthier you!) all the way to Gonda 19… but there are more direct ways to help each other and our patients in achieving healthier lifestyles. The solutions to this problem begin with a change in attitude. We must realize that our reputation as a health-care provider is being tarnished when our patients, peers and supporters observe our carelessness in daily nutrition. The consistent delivery of wasteful, nutrition lacking food-products to employees and patients needs to end. To replace it, we ought to invest in legitimate and wholesome, healthy meals and snacks. This means we cut the french toast and add in a green smoothie bar. It requires that we chop the cheese curds and substitute squash and quinoa. To make this change intentional and well-designed we can recruit diet and nutrition counselors. Yes, maybe we should say goodbye to Carrol’s Cup (*gasp!*) and trays of cookies at every seminar, ever. These cafeteria offerings and other dining choices are undermining our credibility as an institution that seeks the better health of the nation and the world. We consistently set an example that millions of people observe and follow, and we have the power to change how we present ourselves. If Google can eat healthy, so can we. Although, I suppose I don’t really know if they do. They haven’t invited me out for that interview…yet.

Carl Gustafson is a third-year PhD student in Michael J. Yaszemski’s laboratory.

May 29, 2014 · This is your mind on grad school: The state of graduate student mental health at UC Berkeley

Editor’s note: This article was first published in the Spring 2014 edition of the Berkeley Science Review. It has been re-posted to the Mayo Clinic Diversity in Education blog with the direct, written consent of the original authors. You may view the original article here.

This is your mind on grad school

Featured image: In a 2012 survey of UC Berkeley graduate students, nearly half of respondents reported frequently feeling overwhelmed, exhausted, sad, hopeless, or depressed. credit: concept: Holly Williams; design: tagxedo.com; source for words: csf/asuc/ga 2012 graduate student survey and uhs.berkeley.edu

 

This is your mind on grad school: The state of graduate student mental health at UC Berkeley

Berkeley Science Review, Spring 2014

Denia Djokić and Sebastien Lounis

“Graduate school is the first time that you really fail, and really feel like a failure in the one thing that you are really completely invested in.” This observation by a former UC Berkeley PhD student rings true to many that have experienced deep frustrations while in graduate school. “When I think about my years as a graduate student at Berkeley, I think of days filled with a vague, ever-present cloud of guilt and anxiety,” describes another former student.“Most days in lab were spent surrounded by brilliant people striving for something great rather than by supportive people looking to facilitate each other’s growth.” A current graduate student echoes that “there is a deep, pervasive anxiety that seeps into every day of your life, a constant questioning of your capability, intelligence, and whether or not you are cut out to be here.” Another former student says, “It took me many years to realize that ‘normal’ for many grad students means deeply—and secretly—depressed.”

            It is not news that pursuing a graduate degree is emotionally, psychologically, and often physically taxing. Graduate students at UC Berkeley are highly driven, love their work, and are often willing to be pushed to extremes to see their research succeed. When left unchecked, these circumstances can take a toll on students’ mental health. “Graduate school is not something to take lightly,” says Sahar Yousef, a PhD student in vision science. “You’re dropping highly intelligent individuals into extremely unusual life circumstances, with little or no support.” Last fall, Yousef and physics PhD student János Botyánszki began leading a Sufi meditation workshop specifically aimed at teaching introspection and mindfulness to UC Berkeley graduate students to better manage stress.

Mindfulness exercises are increasingly popular approaches to managing stress. In the Fall of 2013, the Graduate Assembly offered the first ever Sufi meditation workshop to teach graduate students these techniques. Credit: Lululemon Athletica

Mindfulness exercises are increasingly popular approaches to managing stress. In the Fall of 2013, the Graduate Assembly offered the first ever Sufi meditation workshop to teach graduate students these techniques. Credit: Lululemon Athletica

This meditation workshop was sponsored by the Graduate Student Support Program (GSSP), a student-led initiative created by the UC Berkeley Graduate Assembly (GA) to broadly address the gaps in services for graduate students on campus and give them tools to cope with the myriad stressors unique to their experience. “We’re all too busy to take care of ourselves,” says Janell Tryon, who is paid part time to be the GSSP coordinator while pursuing her masters in public health. In this role, Tryon is part of a larger conversation that is building around the Berkeley campus, often with student voices at the forefront. Efforts like the GSSP have been bolstered by growing support from advocates within University Health Services (UHS) and the Graduate Division, the administrative unit responsible for graduate student affairs, all of which today consider graduate student mental health a priority. There is an increasing number of resources available to those seeking help, and pressure is mounting for the adoption of broader administrative policies that promote student mental health and wellness.

However, despite these improvements, major hurdles will have to be overcome before all those in need are able to access appropriate resources. Budget cuts continue to threaten the ability of UHS to meet demand and provide adequate, individualized services. At the same time, awareness of the existing resources among the graduate student population remains frustratingly low, due in part to the insular nature of traditional academic departments. A broader culture of wellness may prove even more elusive in the face of a rigidly hierarchical academic culture that often rewards drive and sacrifice without encouraging balance. In this climate, graduate student mental health advocates—students, staff, and administrators—face an uphill struggle in the years to come. The consequences of this struggle tear at the very fabric of the academic experience and suggest fundamental misalignment of priorities. As one recent graduate put it, “in the eyes of my department, I would be considered a successful graduate student: I have a publication, I’m graduating in my fifth year and I have a job lined up. However, my frustration with the entire process has led me to feel that I’m leaving Berkeley extremely unsuccessful and thus unsatisfied in my experience.”

Off The Radar

At UC Berkeley, student initiatives have historically been the catalyst for efforts to raise awareness and take action to address graduate student mental health needs. Until a decade ago, the unique mental health needs of graduate students had not even been considered. The university provided a set of services aimed at the general student population, lumping graduates and undergraduates together. However, because little empirical research about the graduate student population existed at the time, these services focused almost exclusively on the latter. “Nobody had really investigated the stimuli or the environmental pressures that graduate students face,” explains Temina Madon, who completed her PhD in visual neuroscience at UC Berkeley in 2004. In this climate, counselors were trained to deal with issues common among undergraduates, whereas graduate students were completely off the radar.

Recognizing this disparity and having observed friends and colleagues suffering from life-threatening mental illness, Madon decided to take action. “It seemed pretty obvious, having been in grad school: you’re in a different age bracket, so the physiological profiles and life circumstances are different,” she says. As she began to dig deeper into the issue, the dearth of research on graduate students was astonishing: published empirical data on mental health focused overwhelmingly on undergraduates. A handful of exceptions existed, but these studies were limited to specific subgroups of graduate students, such as medical students.

Credit: Design: Holly Williams; Data: CSF/ASUC/GA 2012 graduate student survey and uhs.berkeley.edu

In an effort to fill this information vacuum and provoke change on campus, Madon, working with Jenny Hyun and Brian Quinn from the doctoral program in Health Services and Policy Analysis at the UC Berkeley School of Public Health, organized a survey of the graduate population at UC Berkeley. They designed the survey to determine the need for mental health services on campus, to assess utilization of existing services, and to understand how these correlated with factors like department climate, gender, and demographics. The questions were sent to the entire graduate population at UC Berkeley and over 3000 students responded.

The survey findings were telling: nearly half of graduate students reported having an “emotional or stress-related problem” within the previous year and almost 60 percent said they knew another student who had an “emotional or stress-related problem that significantly affected their well being and/or academic performance.” These indicators of distress were notably worse for women and international students. The results also showed underutilization and a lack of awareness of existing mental health services by graduate students. About 50 percent of those reporting a problem considered seeking help but only about 35 percent ended up doing so. About 25 percent of graduate students said they were not aware of the services provided at the university at all. Hyun and Quinn compiled and analyzed the results and presented them to the university administration in March of 2004.

The completion of Madon’s survey was a watershed moment for graduate student mental health on the UC Berkeley campus and beyond, transforming a previously intangible problem into a quantified public health crisis. “[Madon] was such an incredible force in bringing the attention of the administration to these issues,” says Jeff Prince, who has been director of Counseling and Psychological Services (CPS) at the UHS Tang Center for over a decade. “I credit her in shifting the focus at that time.” In response to the survey findings, several committees were formed to further assess these newly uncovered concerns and suggest solutions, including a student committee that would report directly to the university chancellor. The results of the survey were also included in a 2006 report assessing student mental health across the University of California system, commissioned by then-UC President Robert Dynes. No longer out of sight, the pressures and anxieties specific to the experience of graduate education were finally being documented. Through this process, it became clear that there was an urgent need for specialized and targeted services that distinguished between graduate and undergraduate mental health.

Unique Challenges

To some, graduate school may seem like the ideal environment. Seemingly idyllic aspects of the academic landscape include a flexible schedule, time to pursue one’s intellectual passions in an unfettered environment, and funding to further one’s education. However, most graduate students experience a common set of powerful stresses—some inherent to the nature of graduate study, others arising from the incentive structures that drive academic research.

“There are a whole set of circumstances that are unique to graduate students, different from undergraduates and different from professionals,” says Prince. For many students, entering graduate study involves some type of a major life transition, whether it is moving to a new city or country, switching fields, returning to school from a professional career, or some combination thereof. In school, graduate students often find themselves in the awkward position of having a workload comparable to that of a professional position but with, at best, only a fraction of the equivalent compensation. In the case of most professional degree programs, graduate students steadily accumulate debt. An elite institution like UC Berkeley also carries with it the onus of competition. A common phenomenon among graduate students is known as the “impostor syndrome”: the belief that they are not as intelligent or talented as people perceive them to be, and that they will eventually be discovered as a fraud. Because of these factors, graduate students can experience uncertainty and doubt in equal or greater measure to a sense of intellectual freedom and exploration.

Many academic degree requirements are exceptionally high-stress, especially for doctoral students. The pass-or-flunk-out milestones of the oral preliminary and qualifying exams are unlike any faced during a typical undergraduate education. At the same time, much of the academic work leading to a doctoral dissertation is self-directed, operates on an ambiguous timeline, and can be fraught with frustrations. “A lot of our graduate students were good at school [as undergraduates] but didn’t learn to be independent,” says chemistry professor Heino Nitsche, “and they have a hell of a time swimming in the deep end of the pool.” Under these circumstances, it can be difficult or impossible to feel a sense of progress and accomplishment.

Doctoral students also must conduct their studies under the tutelage of a faculty research advisor, a relationship that can make or break their experience in graduate school. “Your relationship with your advisor is a huge deal,” says Galen Panger, a PhD candidate in the School of Information. “It almost can’t be understated when it comes to the correlation between your advisor relationship and your wellbeing and satisfaction in graduate school.” In this advisor-advisee arrangement, the student trades her labor as a researcher for the advisor’s mentorship and, ultimately, the advisor’s approval of her degree before she can graduate. For students seeking an academic position after graduate school, an advisor’s letter of recommendation can be the difference between landing a job and being left out in the cold, a harsh reality given today’s sparse academic job market. All of these factors mean that the faculty advisors hold tremendous power in the advisor-advisee relationships. They are the gatekeepers of success in the graduate endeavor.

While there are fortunately many advisors who actively make their students’ personal growth and wellbeing a priority, a point that must not be understated, the students’ powerlessness in this relationship can make them vulnerable to neglect and abuse. “Mentorship is important,” explains Nitsche when asked how to prevent struggling students from falling through the cracks. “You need to care and you need to know how to care.” However, mentorship is not always emphasized as a priority for faculty. Tenure-track professors are under tremendous pressure to produce publications—both the university’s reputation and their own research funding and job security depend on their scholarly productivity. This pressure creates a strong incentive for faculty to prioritize research results above all else, sometimes at the cost of their students’ wellbeing. Some professors even take on more graduate students than they can effectively advise, “weeding out” or neglecting those who are unproductive after their first year or two of graduate school. This practice may seem like a perversion of the advisory role, but if it ultimately leads to a strong publication record, the faculty member has little incentive to reform. A cascade effect can follow—if the publications lead to renown within the field, the professor will likely have an oversupply of students eager to join his or her research group. “You can’t shift perspectives on mentorship in this situation,” according to Nitsche. “It’s supply and demand.”

For many students, the pedigree of a Berkeley education and the opportunity to work on cutting-edge research make dealing with these stresses a worthwhile bargain. Many may even be driven by the intellectual, mental, and physical challenges of the highly intense and competitive UC Berkeley graduate experience, accepting these travails as a necessary—even mandatory—rite of passage in the development of their academic character. At the same time, some faculty members feel that a degree of pressure and stress is an essential component of the graduate experience. Removing this pressure, they fear, could undermine the drive for excellence that gives UC Berkeley its reputation as an elite institution. “This is Berkeley,” says Nitsche. “You don’t want to throw the baby out with the bathwater.” However, the vulnerability that comes with cutting one’s teeth in a high-pressure academic environment is often overlooked and, as Madon’s survey results suggest, the pressures of graduate education can become overwhelming and exhausting even for highly capable students. The varied nature of these stresses, on top of the typical strains that accompany the late 20s and early 30s, can quickly build and become an impediment to productivity and wellness, turning pathological in more severe cases. Perhaps the most unsettling result uncovered by Madon’s survey: 18 students reported having attempted suicide in the 12 months preceding the study, nine of them in the sciences.

Positive Feedback

Thankfully, several initiatives aimed specifically at improving graduate student mental health have emerged in the last decade, andthe conversation about student mental health has picked up momentum on campus. “Mental health is a buzzword these days,” Tryon observes. In the most successful of these efforts, students, student government, and university mental health professionals and administrators are working closely together.

Shortly after Madon’s survey was published, CPS formed the Graduate Student Mental Health Advisory Committee (GSMHAC), to directly incorporate graduate student perspectives in the development of programs at UHS. “We use them as a sounding board,” says committee chair Susan Bell, who is the assistant director for outreach and consultation at CPS. Since then, input from the GSMHAC has helped CPS develop new programs aimed specifically at graduate students. One example addresses a common fear for graduate students considering seeking help at CPS: that of potentially encountering their undergraduate pupils when seeking services at the main CPS office. Recognizing this as a barrier to entry for those in need of help, the GSMHAC advised CPS to establish individual satellite offices in discreet locations around campus. At these locations, a graduate student can meet a counselor for individual therapy without worrying about exposing themselves to their mentees. CPS now operates satellite offices in nine different buildings across campus.

Tryon’s work as GSSP coordinator is another prominent emerging endeavor. The GSSP is tasked with serving the wide demographic of graduate students in all things related to their mental health. This includes raising awareness about existing services and developing new health and wellness programming, like Yousef and Botyánszki’s meditation seminars. Tryon also plays an important role as a connector between different groups across campus, which can sometimes be isolated from one another. “What I think is needed most right now is communication between all the different facets of health conversation on campus,” she says.

Design: Holly Williams; Data: MIT, Yale, Texas A&M, CMU.

Among these conversations are grassroots student-led efforts that have sprung up within individual departments at UC Berkeley. Recently, students in Molecular and Cell Biology (MCB) decided to take action, feeling that they could no longer rely on the administration to prevent their peers from slipping through the cracks. Having observed that many individuals feel a strong sense of isolation while pursuing their PhDs—both when first starting to navigate their program as well as later on, when much time is spent in the lab or library—a group of MCB students formed a student support group called the MCB Grad Network. To provide an outlet to candidly ask questions and express concerns and frustrations, all MCB graduate students will, starting this fall, participate in regular mentoring discussions between older and younger students, with no faculty present. “We hope that this will instill a feeling of community connection and safety in that the discussions will only be peer-based,” says Adrienne Greene, a PhD candidate in MCB who helped spearhead the new group. CPS will help train the older graduate students in a national peer mentoring training program called QPR (Question, Persuade, Refer). If peer mentoring proves successful in improving the student experience in MCB, Greene hopes that students in other departments will follow their lead by replicating the program. “The idea is to expand this to every department,” she says.

All of these efforts are forming a growing network of services that are tailored to the graduate student experience. It is here that communication across departmental boundaries can play a critical role by preventing duplicate efforts, allowing interested individuals and groups to share their experiences, and ensuring that graduate students are actively aware of services that exist. Already, there are signs of success: the fall 2013 semester saw 20 percent more students—graduates and undergraduates—utilize Counseling and Psychological Services than in previous semesters. This is a good indication that the word is getting out. However, more data is needed to fully assess and track the state of graduate student mental health, both relative to Madon’s 2004 survey and moving forward. To address this lack of data, a Graduate Assembly resolution was recently passed to conduct a targeted survey that, starting this spring, will take the pulse of the graduate student body each year. The development of the GA’s “How We’re Doing” survey has been spearheaded by Panger, along with fellow PhD students Stephanie Cardoos and Christine Gerchow. The goal is to use this survey as a tool to establish continuity, track trends over time, and to inform a broader discussion about mental health. “The conversation starts with sensitizing people to the issues,” Panger says. “And it’s important to have data in which to ground the discussion.” The survey was disseminated in March and results are expected by the end of this semester.

The collection of more data about trends in graduate student sentiment, along with an increasingly vibrant conversation and a growing number of tailored services, are all indicators that UC Berkeley is poised to better address graduate student mental health needs. But, however well intentioned, these services are unlikely to fully meet demand. “We don’t have enough resources to do everything we want to do,” says Bell. “We can’t possibly reach everyone on the campus.” To truly bring needs and services for graduate students into balance will require broader changes to the graduate student experience that make mental health and wellness a priority on campus. Doing so will likely require tackling more deeply rooted cultural norms.

The Culture Barrier

Culture, within academia and beyond, is simultaneously the most daunting and difficult-to-quantify barrier to improving mental health for graduate students. While cultural norms cannot be enumerated in a budget or counted like a counselor-to-student ratio, they are often a major factor in an individual’s choice to seek, or not seek, professional help. Because cultural beliefs are often deeply held, they can be difficult to rationalize away. Nonetheless, changing culture could be the single most important step in addressing graduate student mental health issues at UC Berkeley.

Click to enlarge. Credit: Design: Holly Williams; Data: UC Berkeley University Health Services

Credit: Design: Holly Williams; Data: UC Berkeley University Health Services

            The very need for CPS satellite offices is an embodiment of the cultural stigma graduate students feel around their own mental health—the prospect of being “exposed” as having mental health concerns is so shameful that it prevents students from seeking help when they need it. While this stigma is almost certainly rooted in deeper societal prejudices, the perceived expectations of academic achievement can make it more severe. “Everyone thinks that they ‘should’ be unhappy, because graduate school is difficult,” explains Tryon. Though advisors and departments play the most direct role in a graduate students’ life, they are also usually the last places that students turn to for help under these circumstances. “You’re trying to present yourself as a brilliant, unique, competent student to your advisor and to your professors and you want to seem like you’re on top of it. And people think that feeling mentally unwell is counter to that,” Tryon observes. “Part of the culture shift will have to be having more informed staff, administration, and faculty so that this is a discussion that is not stigmatized and is not scary.” Prince, of CPS, concurs: “We need to continue to find more creative ways for reaching out to students,” he says, “to encourage them to seek help, feel included, and talk through issues early enough, before they become too overwhelming to handle.”

Changing faculty and department culture may require pressure from the administration as much as from students. For faculty, who face tremendous pressure to focus on research publications, this means making sure that good mentorship is rewarded and poor mentorship is accounted for at a level that is meaningful when held alongside research funding and prospects for tenure. To encourage such a shift, Vice Provost for Graduate Studies Andrew Szeri worked in 2011 with then-Acting Vice Provost for Academic Affairs and Faculty Welfare Angelica Stacey and Academic Senate Chair Fiona Doyle to provide a set of guidelines for evaluating the quality of graduate student mentorship in faculty performance reviews. However, although the guidelines are an important step in raising the profile of mentorship within the faculty ranks, these evaluation criteria are not mandatory for faculty. More powerful incentives will have to be built explicitly into faculty evaluations and hiring criteria, where they can have a direct effect on employment outcomes.

Beyond new policies to fight stigma and provide overt incentives for faculty to focus on mentorship, a broader question looms: how can the overarching culture on campus be shifted to one in which mental health and wellness are encouraged and embraced? For some, like Tryon, this question is tantamount, and requires considering the wellbeing of all the individuals participating in the campus community, including faculty. “This is a public health issue,” according to Tryon. “If the university wants to see a healthier student body, they need to prioritize that kind of health at the faculty level, and they need to invest in their faculty as more than research machines.”

This holistic message is echoed by Bell, who says many students seeking services at CPS feel tremendous pressure to put research above all else because they see the same level of sacrifice in their faculty advisors. “It’s hard to live a healthy, balanced life when your role models are people who are sacrificing their own wellness for their career,” she explains. “We have to own this issue as a community. We’re all responsible for each other.”

Sharing Stories

Open conversations within a community are the starting point for addressing controversy, building a common vision, and taking action to realize that vision. In this way, the state of dialogue around graduate student mental health is simultaneously a reason for optimism and exemplary of the problem that remains. As more and more individuals across all tiers of the campus hierarchy talk about mental health and wellness, the likelihood of changes in policy and culture increases. At the same time, many graduate students today still feel they do not have an outlet for their struggles, whether it is through conversations with their peers or faculty advisors, or by accessing a support group or therapist.

The results of the Graduate Assembly’s “How We’re Doing” graduate student wellness survey may represent another vision for what is needed on UC Berkeley’s campus. A unique aspect of this survey is that its questions take into account both positive as well as negative aspects of the graduate student experience. Its results are meant to guide a multi-faceted conversation on campus that addresses the problems as well as the success stories that abound. The more platforms that are available for students, faculty, and administrators to share stories about mental health and wellbeing, the less these topics will be stigmatized. The documentation and encouragement of positive trends in student initiatives, faculty mentorship, and administrative programs will be particularly instructive in defining a vision for which the university and its academic departments should strive.

Realizing this vision will be no small task; the dissonance between the cultivation of excellence and a culture of wellbeing at an elite institution such as UC Berkeley is substantial. However, these two goals should not have to be at odds with each other. Wellness and excellence can be symbiotic, even in a high-intensity environment. As Panger points out, the scientific literature has established that positive emotion is associated with creativity, goal-seeking behavior, and physical health, all of which are important to academic productivity. “It’s really important to promote positive emotion and wellbeing to enable graduate students to do their best work,” he says. If history is any indication, graduate students will play a central role in leading the conversation and initiating cultural progress. However, as current efforts have already begun to show, real and lasting change will require the engagement of the entire campus community.

Another editor’s note: The managers here at the Diversity blog read this article and enjoyed it so much we couldn’t resist sharing with you guys. Special thanks to Denia Djokic, Sebastien Lounis and Alexis Fedorchak from UC Berkeley’s BSR for letting us re-post it (and for writing such an awesome piece!).

– Carl

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