Dear Northwestern administration: Wake up. Stop building $220 million athletic complexes. Start spending just a bit more of that money on the mental health services your students desperately need.
It would be nice to be called “Doctor.”
It would be nice to be paid a very high salary and have a stable job, and to be able to produce an official piece of paper proving that I am Smart.
It would be nice to be published in prestigious journals, to receive emails from others curious about my work. It would be nice to be quoted in newspapers and magazines as an Expert.
It would be nice to be part of the elite–the less than 1% of Americans who have a doctorate.
It would be nice, but it won’t be me. At least, not for a while.
Until recently, I left unquestioned the notion that I want a PhD in clinical psychology. I just wanted it. Why? Well, it would allow me to be a therapist, which is what I want. I would get paid a lot. It would carry prestige.
But gradually my resolve started to break down and I started to wonder, Why?
I discovered that I disliked research. When I told people this, they were often shocked. But aren’t you curious? Don’t you care why people think and feel the way they do? Don’t you want to understand?
Yes, I am, and I do. I’m deeply curious. That’s why I read voraciously. And I am more than happy to read all the answers to my questions when they’re published rather than to work long days in a basement lab somewhere.
I can do research, I’m sure. But it’s not what I love, and there are others who want this much more.
The turning point came when I attended a panel of graduate students in psychology, along with an admissions person for a doctoral program in clinical psych. They all told us that when we apply for grad school, our entire resume and personal statement should discuss nothing but our research experience. Everything else I’ve done wouldn’t even matter–not the year I spent as an RA, not the three years I’ve spent as a member (and, then, a leader) in a sexual health and assault peer education group, not the summer I volunteered at a camp for at-risk kids in New York, not the initiative I started to implement a peer listening program at Northwestern, not my internship at the National Alliance on Mental Illness.
I shouldn’t even include it, they told me, because it would annoy the admissions people.
The work that I love, the lives that I hope I’ve changed–it would be an annoyance.
At first, I thought it wasn’t a big deal. Who cares what I put on my application as long as I get in?
But then I learned more. I learned that I probably wouldn’t be accepted if I admitted that my goal is to be a therapist, because they want to spend their money on someone who would bring prestige to their institution by publishing research. I realized that I would have nobody to turn to for support–no mentors–because I’d have to hide my dreams from them. I learned that clinical training in clinical psych programs is mostly lacking (ironically), so I wouldn’t be learning the practical skills that I need to help people.
And, most of all, I understood that my time in graduate school would be miserable beyond belief, because I would be living a lie, facing extreme pressure to publish or perish, and wasting at least five or six years of my life. During that time, my life would be completely on hold–I wouldn’t be able to move, work, or start a family, if the opportunity presented itself.
The future that I had once dreamed about turned into a nightmare.
It was then that I finally stopped listening to my professors–who, of course, all have PhDs–and listened instead to the friends and family I have who actually are therapists, or hoping to get there. And increasingly I understood that a masters in social work would be a better option.
MSW programs emphasize learning practical skills, and many of them have you start a clinical internship as soon as you start the program, because the best way to learn is by experience. They understand that people aren’t just isolated brains inside bodies, that circumstances affect individuals and that psychological problems aren’t always caused by faulty brain chemistry. They emphasize understanding societal inequality, working with marginalized groups, and picking up where clinical psychology leaves off.
I’ve been told that I’m “too smart” for a masters in social work, that I will be “offended” when I see how little they pay me. People who say these things must not know me very well. Although I wanted a PhD before, I’ve never really needed my career to make me feel important. I don’t need to be important. I just need to be helpful.
As for “too smart,” that’s ridiculous. The helping professions need more smart people.
The truth is that, in my hour of need, it wasn’t a man with a white lab coat and a doctorate who saved me. It was–as corny as this is going to sound–the social justice movement. That was what finally taught me that my feelings are justified, that my thoughts have merit, that my words matter.
I finally learned to see myself as more than just a body with a broken brain. I’m a whole person enmeshed in particular circumstances, and the interaction between the two has made me who I am now.
But my strengths and goals require a different sort of education than what I could receive in a doctoral program, and they point me to a different sort of career than a PhD would prepare me for.
True, I’ll earn less money. There will be hard times. There will, I’m sure, be bureaucracy, budget cuts, and crappy bosses. There will be days when I don’t love it.
But there will not be days when I’m living a lie. There will not be days when I’m sitting in an expensive lab at a prestigious university, doing work that may be meaningful, that may get published, that may be improved upon, that may someday, maybe, help someone. Maybe.
And I have nothing but respect for people who want to do that. I admire that, and maybe someday I’ll return to school for a PhD. But at this stage in my life, it’s just not for me. After all, I can always get a PhD; what I can’t do is unget one and unwaste all that time.
I don’t expect every single day to be productive, every session to help every client. But I do expect that at the end of my life I will be able to look back and know beyond a doubt that, in my own way, I changed things for the better.
That’s why I’m choosing social work.
P.S. A little disclaimer–I’m not looking for any comments on how I’m wrong about the doctoral route or why I should reconsider my decision. There’s a lot more than went into it than I could even discuss here, and there are enough Older and Wiser People trying to tell me how to live as is. Thanks.
Spoiler alert: They have nothing whatsoever to do with each other.
There are different levels of stigma surrounding mental illness. There’s the stigma of having a disorder in itself, the stigma of being in treatment for a disorder, and, perhaps most of all, the stigma of that treatment being pharmacological.
People love to hate psychopharmacology, especially antidepressants, the efficacy of which is constantly being questioned (often for good reason). However, I’ve noticed that drugs like antidepressants receive a special type of scorn, one that cannot be based solely on the efficacy mystery.
I’ve found that where mental treatment is concerned, therapy holds some sort of moral superiority over drugs in many people’s eyes. I think many people still feel that mental disorders are spiritual illnesses, not medical ones, and that treating them with a pill is some sort of cop-out. (Imagine the public furor if researchers came up with a pill to, say, erase the feeling of guilt.)
This would explain why, though therapy is still stigmatized–after all, the Ideal Person works out these issues on his or her own–it is considerably less looked down upon than psychotropic medication. Our culture values struggle and hard work so much that even recovering from an illness should be mentally effortful.
What people don’t realize is that there are plenty of perfectly legitimate reasons why someone might choose medication over therapy, at least in the short term. Consider, for instance, the situation I found myself in a month before I began my sophomore year of college. Having spent my entire freshman year growing progressively more depressed, I’d thought that coming home for the summer would magically fix everything. It didn’t. With a month to go, I realized that I felt like I’d rather die than go back to school.
That was when I was first diagnosed with depression, and I think my psychiatrist realized, as did I, that I just didn’t have time to muck around with my feelings–I had to get better quickly, or else going back to school would be more upsetting and stressful than I could handle. So I started taking antidepressants and quickly improved enough to feel like I could deal with being in school. The mucking around with my feelings came later.
Aside from that, I can think of many other reasons medication can at times make more sense than therapy. For example:
- Financial concerns. Antidepressants cost me $30 a month, while therapy costs $80 for four weekly sessions. That’s a pretty big difference for many people.
- Time. Some people are at a point in their lives where they literally can’t spare an hour or more a week for therapy. That might sound ludicrous to you, but if you’re a college student, a new parent, or a low-income worker, it probably doesn’t.
- Availability. Unfortunately, not everyone lives in an area where good therapists are available and accessible (and bad therapists will do more harm than good). This is especially true for members of marginalized communities, who may have a hard time finding therapists who are sensitive to their issues. Not all therapists are as open and accepting as they should be.
- Insurance. I’m lucky to have a fantastic insurance policy that covers basically everything I’ve ever needed. However, many policies are very picky with regards to therapy (as opposed to medication, which does require a prescription from a person with an MD). For instance, some policies refuse to cover therapy unless there’s an official diagnosis, and you don’t necessarily need to have a diagnosable mental disorder in order to need help. Besides, you can’t be diagnosed without going to a specialist to begin with.
- Nature of the disorder. Although most mental illnesses obviously involve a psychological component, some do not. For example, many people in temperate climates get Seasonal Affective Disorder (SAD) during the winter months, which is characterized by a low-grade depression as well as various physical symptoms. It’s usually treated with antidepressants or light therapy, which actually has people sit in front of full-spectrum light.
- Language. Therapy requires people to talk pretty extensively about themselves and their lives, something that would be very difficult for, say, a new immigrant who’s just learning English. Unless such people are able to find a therapist who speaks their native language, it would be pretty hard for them to get anything out of therapy.
- Comfort. As a future therapist, I obviously wish that everyone were comfortable with the idea of therapy. But not everyone is. That could be because of cultural factors, family attitudes, personality, or negative experiences with therapy in the past. I think that using medication to improve your quality of life while working up the courage to see a therapist is perfectly okay.
I hope that this list shows that making decisions about mental health isn’t that different from making decisions about physical health–it has more to do with personal preferences and practical concerns than with the strength (or lack thereof) of one’s character.
Of course, I do believe that therapy is really important and generally awesome, which is why one of my upcoming posts will be about why I think that everyone (or almost everyone) should see a therapist. Stay tuned.