May 29th, 2014

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

By Carl Gustafson

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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