The uses of care

(Here is a link to the original post published on December 16, 2015 at University Affairs: The uses of care.)

Recently on Twitter and Facebook I’ve seen more articles on taking care of ourselves and the practice of “self-care” in academe, which makes a lot of sense at a time of year when (in the Northern hemisphere) the combination of colder weather, anxiety and exhaustion at the end of the semester—and the potential added stress of the holiday season—means that many academics and students are feeling worn out and in need of a break.

But when I see these articles and blog posts that take up the concept of self-care, I can’t help also thinking of (and comparing to) the articles from business publications that frame some of the same activities in a completely different way: from the viewpoint of employers, where our wellness is too easily seen as valuable only if it leads to improved productivity and an increase to the bottom line. These latter “advice” pieces are also regularly shared on social media.

In this post I’m going to look at the issue of how those very different “framings” overlap and intersect: what’s the connection between self-care and the “care work” that is done every day, often invisibly and without compensation? How does all this care work happen in the context of managerial governance with its imperative to productivity—and in a competitive academic culture? Is it also possible that “wellness” and related practices can work more in the interests of employers than employees, transferring the responsibility to change problems in the workplace and its culture?

For a start, care is work, as an entire body of academic research can attest; this work is also gendered, disproportionately performed by women. Women are already engaging in this “extra” work both in professional settings and in their personal lives, because it’s what’s expected of them. Tina Barnes-Powell and Gayle Letherby write that “[b]oth in the wider community and in the communities of higher education (whether provided by women or men), ‘care’ is feminized and undervalued.” Care work is often invisible and informal work, present and necessary but largely unacknowledged in everyday life.

For scholars who hail from groups traditionally marginalized in academe, (mutual) care is even more crucial, since working in the institution so often feels more like trying to work against it—both for themselves and for their students. That accumulation of daily experiences is a process of sedimentation, a psychological, emotional and physical burden generated by the structural gaps those scholars are expected to work to fill in themselves. If “diversity work” is also care work—work that can’t be done by committee or accomplished with a policy—it is beyond the logic of institutional rewards.

The concept self care used in this context has its roots in Black feminist thought, exemplified in the well-known words of Audre Lorde: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.” As Sara Ahmed explains in her post on “Self-care as warfare”, this is radical because it involves caring for one’s self when the (social) world daily denies one access to that care. The elements of race and gender are key to the analysis, because of the performance of care for others that is expected of Black women, the discrimination they face, and the low value placed on their lives and work: “some of us, Audre Lorde notes were never meant to survive.”

Lorde’s work shows “how structural inequalities are deflected by being made the responsibility of individuals,” and we can see this pattern also in current discourses about workplace stress and mental health. For example, I wrote “Beyond puppies and yoga” to critique the tendency to individualize the “solutions” for the effects of systemic changes to (and problems with) how we live and work, including in academic institutions; in another previous post I discussed how this individualistic framing is reflected and reinforced in media coverage and advice columns about mental health. No amount of tending to the self can adequately compensate for the broader lack of access to mental health resources for those who need them, or indeed for the effects of discrimination and economic inequality on people’s health.

In the media articles we see now, this care for the self is re-articulated through the overarching, individualized logic of productivity. Examples show that a certain level of stress and anxiety is deemed to be fair and “natural,” but that we can manage it ourselves by taking control with advice and adopting appropriate practices. Naps, we’re told, are a good thing because they increase productivity (and sleeping close to your work has never been easier!)—while the debate about how much sleep we “need” rages on, because sleep, of course, is not (in itself) productive. Happiness itself can be calculated as another part of the equation that leads to more productivity. The Onion’s parody of the advice of “wellness experts” only works because we’re so familiar with the content and tone of said advice and the context in which it’s offered.

A useful example of this is the concept of “mindfulness” that is now regularly discussed in business magazines and mainstream media advice columns, having developed as a trend after gaining popularity in Silicon Valley. Zoë Krupka writes that “pasteurised versions of the ancient practice of mindfulness are now big business,” but they are about fixing “not so much what ails you, but what is ailing those who depend on you.” Using mindfulness as a tool to manage stress and increase innovation and productivity doesn’t get at the underlying problem, which is where the stress is coming from, why the work is so stressful, and how much stress people have to deal with (a few more critiques, if you’re interested, hereherehere and here). The strategic application of mindfulness is not a way to address overwork and unhealthy conditions in the workplace, and it places the responsibility for sustaining those conditions directly onto individuals.

These examples show how something that has a great deal of potential to be positive, can be reinterpreted through the lens of economization and enfolded in its logic. Mindfulness really does have benefits; and sleep, healthy food, exercise, and so on, are things we need in order to be healthy, things that improve our lives. It’s more the conflation of our lives and health with the needs of our employers that is potentially a problem, one that’s particularly prevalent in academe, but certainly not only there.

Robin James gets to the heart of this problem by making a distinction between “self-care as surplus-value producing work” or “resilience,” and “guerrilla self-care” (I recommend you read her post on this). The former, argues James, “is not about personal healing: resilient self-care is just another, upgraded way of instrumentalizing the same people” in the service of the same structures that caused them stress in the first place. It’s not “about cultivating what you need, it’s about adapting to dominant notions of success.” Guerrilla self-care, like the “subversive self-care” discussed here by Shanesha Brooks-Tatum, is a means of pushing back against destructive systemic problems as well as alleviating their effects on us.

This is why it’s important that we acknowledge care as work, which is a fundamental element of relationships and organizations, yet exists outside the “value” that matters in a market. The issue with care work, for the self and others, is not that it needs to be done at all but more that some people are expected to do it or compelled to do it—while others can take it for granted that the work will be done for them (by the institution or by other people in their lives). This is also why each of us needs to think through our unique position in relation to these institutions, their histories and their current priorities. Each of us will be able to do different things to contribute in this context. For example, learning to “say no” to extra uncompensated work is a lauded practice, but not everyone is in a position to do this without negative consequences. Those who can, need to make sure the work they say “no” to is not simply downloaded onto others who can’t refuse.

In this context it is radical to resist working on ourselves for the sole purpose of producing value for a “greedy institution,” in a competitive market for stable paid employment. Can care work become radical, resistant, in a system that attributes no value to it yet cannot function without it? Instead of (ironically) individualizing our problems and expecting people to deal with them through technologies of self-management, we need to acknowledge — and keep re-acknowledging — structural problems including those that create stressful, unhealthy workplaces. We also need to de-individualize our means of response so that the burden does not fall, as it has done and still does, on those already most affected by systemic injustices; otherwise we’re merely re-inscribing the things we claim to critique, both to our own detriment and to other people’s.

Beyond puppies and yoga

While the past decade has brought a great deal of discussion about mental health in Canadian higher education, these issues are usually framed and discussed as individual rather than systemic, and as problems that PSE institutions should be able to resolve with more supports. But universities and colleges can only do so much, and when services and supports are radically under-funded in the broader health system, we are failing not just students but everyone else who relies on the public system for care. Here is a link to the original post published on January 14, 2014 at University Affairs: Beyond puppies and yoga.

Last October was Mental Health Awareness Month in Ontario (October 10 is World Mental Health Day), and as part of the province’s mental health and addictions strategy, there was much fanfare over the launch of new initiatives for postsecondary students bolstered by $27 million in funding. This is an important and positive step, because there’s been an increasing demand for the limited support services available on campuses, and the problem has been worsening for at least a decade.

Unfortunately, what students experience is part of a much bigger problem. Universities and colleges, as much as they may try, cannot plug the yawning gap in our system that is an issue far beyond the campus. There are many people in Ontario who need help with mental health issues and may be seeking it actively – but can’t get it. Why? Because the system is reactive. It’s designed to deal with short-term problems and with extremes and crises, rather than to help us prevent them, or help us to live with long-term conditions. This matters because ultimately, the services on campuses have to mesh with off-campus services in or connected to the healthcare system.

This is a system in which, without a formal diagnosis, you cannot gain access to accommodations in postsecondary institutions (or elsewhere). Yet to obtain this diagnosis, you have to find the right way in to the system and obtain the right help once you get there. The process can take anywhere from a few months to a year (or longer), depending on how much you know and whether you have an advocate.

For example, an assessment for learning disabilities costs $1,500 to $3,500. Some universities have assessment services, but these refer students to external testing (some of which may be covered, depending on circumstances). You still have to be a registered student to access these, or to have costs partially covered through student loan eligibility; otherwise, you or your parents will be paying. If you’ve had to de-register because of your problems, then you’re out of luck. The same goes for therapy; talk clearly isn’t cheap, in fact it costs $80 or more per hour unless you can use university counselling services – where there is a limit on the number of sessions each student can access. All this is based on the assumption that problems will be short-term and can be “fixed”; wait times for long-term services are often very lengthy.

Of course if you have the resources available, you can simply buy what you need. You can see a therapist of your choice, without waiting months to be told whether you are eligible. You, or your family, can pay for expensive assessments so that problems can be uncovered and named, and help can be obtained. The more fortunate students don’t need most of the university’s services and also don’t have to rely on the government, because they have other forms of support.

Clearly it’s still the disadvantaged students – and less-privileged people in general – who are falling through the cracks in this system. We need to ask, who receives the necessary supports and who does not? Who can step forward and say “I think I have a problem”, without fear of repercussions? Who has the resilience and stamina to pursue a solution that can take so long, and can be so draining, both to discover and to put into practice?

The current system continues to privilege not just people with existing resources but also those who are secure enough to speak about the unmentionable, in spite of the lack of awareness that even those who suffer from such problems may experience themselves. For example, the Council of Ontario Universities held a competition to encourage students to come up with the best mental health “social media strategy”. But the best strategy would be a collective one, informed by (and actively soliciting) the input of those who cannot or will not speak in the public eye. The best process would actively seek out criticism from those most affected, not just the more easily marketable solutions.

University initiatives that gain the most positive media attention often conflate short-term, seasonal stress relating to events like exams, with long-term problems like clinical depression and anxiety disorders (as well as focusing on undergraduate students). Yet it’s the exam period “puppy rooms” that make the news, not the underlying issues that are so much harder to address and resolve, like wait times for “assessments” at university counselling clinics, the lack of privacy many students feel when they go there, the difficulty of having to describe one’s situation repeatedly in the process of trying to find help, and the exhaustion produced by having to negotiate (with) a bureaucracy while simultaneously dealing with the effects of one’s condition.

Giving attention to answers that work well in a PR pitch means depoliticizing our context, and this is a serious mistake. It makes it too easy to forget about all those gaps in the system, and also about factors like poverty, abuse, and discrimination based on race, gender, disability, sexuality, and nationality; it makes it easier to individualize both the problems and the solutions, reducing the answers to “lifestyle choices”. It means we downplay the context in which students are living their lives, and how they bring this to the university when they step onto the campus. That context is part of what enriches teaching and learning, but it also has to be addressed in terms of the problems students experience both on- and off-campus, and how we can help them. Universities alone can’t fix these systemic problems, but perhaps they can bring attention to them, and that would be a great start.

PhD education and mental health: A follow-up

In December, 2011, I wrote a blog post about PhD students and metal health as a major issue in graduate education. The post below is one that I wrote to build on the many issues that came out of discussions generated by that first piece. Here is a link to the original post from January 3, 2012: PhD education and mental health: A follow-up.

As my first post for 2012, I want to provide a bit of a follow-up to my previous piece about PhD students and mental health issues.

Though I always had the sense there was a problem with mental health in grad school and especially during the PhD, I was still surprised by the intense reaction to my post. As I write this, there are 38 comments (not counting the one I left myself). Some of these comments are very moving and all of them are refreshingly honest, and I’m extremely thankful that so many of you shared your experiences and insights. Throughout this post I will link to your comments directly.

Through Twitter, Facebook, and the comments on my post, many relevant points were raised. Some people discussed an assumed “ideal” for PhD students, and a sense of guilt and self-doubt they felt when they “failed” to live up to this, which in turn can be exacerbated by the isolation of the process and by the apparent lack of structure in advanced academic work. Others mentioned the persistently gendered (masculine) nature of the scholarly ideal, with women being affected by systemic biases that implicate them differently in academic work as well as in parenthood and family life. Bumblebee wrote that the effect of PhD problems on intimate relationships could be disastrous, particularly without institutional support.

I focused on some of the structural issues in PhD education because I think they contribute to a “pluralistic ignorance” — the fact that a student may believe that she is the only one with a problem, and blame herself for it as well, even while others are experiencing the same thing. Several people commented that compounded by insecurity and isolation, the lack of acknowledgment of and open discussion about depression and mental health issues — the “silence” associated with stigma — is actually the most significant problem because it prevents students from seeking help either from the university or from their peers.

Another effect of silence is that prospective students cannot necessarily make an informed decision about whether to enter a PhD program at the outset (and which program and supervisor to choose). Marketization of higher education is problematic because it encourages institutions to persuade students to enroll rather than informing them about their “best fit” for the program or department. A PhD program tends to be a “black box” in terms of information about problematic aspects of the course and/or the negative experiences of students. This is only compounded by not asking students who leave about the reasons for their departure (reasons that are not always negative—as noted by Alex O).

In another comment, Lil makes the crucial point that accessing support services on campuses can be a trial in itself. Students need somewhere else to turn for support and perspective when significant academic relationships begin to turn sour. But it can take time — sometimes weeks — to land an appointment with a counsellor, and in some cases students will be speaking with a trainee rather than an experienced professional. Usually they will be speaking with someone who is not familiar with the PhD process and the kinds of issues that can arise during it. Often there are a limited number of appointments available to each student in a given period, and since these services tend not to be covered by available health benefits, the student may not be able to afford to go anywhere else for help. Some students may feel too uncomfortable even to seek out professional assistance, which requires a kind of self-exposure that can be off-putting.

Of course not everyone who enters a PhD program will suffer from mental health problems. Students with a lack of social and academic support and/or past histories of depression are more likely to be vulnerable (and this applies to other high-level forms of education as well). But it’s important to consider carefully the nature of academic environment and the ways in which it can affect students’ experiences, both the good and the bad. Graduate students, like all students, are not only learning but also becoming different people; they are “changed” by their experience, and this includes the psychological and the emotional as well as the academic and professional.

Many of the comments I received thanked me for being brave enough to write publicly about this issue. On the one hand it’s disturbing to me that there is such a lack of public discussion in spite of the apparent pervasiveness of the problem. Then again, if my posts can be used as a way to open the door to that discussion, then I’m happy about it indeed.

“My grief lies all within” — PhD students, depression & attrition.

I wrote this post about depression and attrition among PhD students, thinking I’d probably chosen a topic that would only be of interest to a niche audience. To my surprise it became the most popular blog post I’d written (and still is). I still think this indicates that not enough public attention has been directed to the structural elements that contribute to mental health issues among PhDs and in other student groups as well.

In a follow-up post I addressed a number of the issues that had been raised in the comments on the initial piece. These include the role of the “ideal” for and of students; insecurity and isolation; lack of information before applying for the PhD, and the difficulty of accessing resources to help with mental health issues.

The first post was republished on World.com on January 3, 2012, and a summary appeared on The Scholarly Web on the Times Higher Education UK website on January 12, 2012. Here is a link to the original piece from December 14, 2011:  My grief lies all within” — PhD students, depression & attrition.

From November to March is prime time for academic burn-out in graduate programs — I’m convinced of that. Perhaps it’s a seasonal thing; it can be easy to sink into a trough of exhaustion and stress, and not climb out of it for months. But rather than just the seasonal doldrums, my sense is that clinical depression, extreme anxiety and other mental health issues are becoming more common in graduate programs as well as in undergraduate education.

I asked one fellow student her opinion of this, and she replied, “it seems like everyone I know in academia is depressed.” On another occasion when I was very unwell, I was told that “everyone” has some kind of breakdown during the PhD; my troubles were nothing to worry about!

Is this a serious structural (and normalized) issue rather than an anecdotal one, and if so, why is no one discussing it? When I sampled the Twitterverse, I received many replies reinforcing and elaborating the impression that yes, this is a problem — perhaps now more than ever — and that it can’t be reduced to students’ individual propensities and “weaknesses.”

In the current context, there are plenty of structural issues that contribute to the PhD as a time when students are vulnerable to stress.

Within their programs, students face a more intense workload than in their undergraduate degrees, and they may for the first time be around students with as much academic aptitude as themselves. These factors can contribute to “imposter syndrome,” the sense that one is about to be “found out” for not really being smart enough. As adults being placed in a subordinate position, some PhD students experience a sense of infantilization alongside the conflicting expectation that they develop a professional identity.

In terms of the student’s academic experience, the PhD emphasizes a transition to autonomous work that is often a new challenge. The lack of structure, and unclear boundaries about responsibilities, mean that some students are unsure what help they “can” ask for from supervisors. This is compounded by the lengthy isolation from peers that often occurs in the later stages of research (in the humanities and social sciences at least).

Career-related pressures in academe have intensified in the face of recession and long-term political economic changes that have affected the university and its governance. Graduate programs in Canada and elsewhere have increased enrollments often without proportional increases to the tenured faculty who provide supervision, or to non-repayable funding. The shortage of funding can lead to student debt and other financial difficulties as well as more intense competition for grants and teaching positions, and pressure to “complete” sooner. Fewer tenured faculty means that students may need to compete for academic mentorship and support as well. And all these changes have helped to feed further competition in the form of a tightened market for academic (i.e. tenure-track faculty) jobs; this kind of competition can be depressing and stressful.

While only a relatively small proportion of PhD graduates obtain permanent faculty positions, in many PhD programs there is still a deeply-held assumption that students can or should strive to engage in research-oriented academic careers. Thus the definition of successtends to be rather narrow, making it easier to feel like a “failure.”

The culture of academic replication — the inculcation of certain academic goals above all others, in spite the “reality” of the larger job market for PhDs — has been roundly criticized, even compared to a cult. Taking on an awkward double stance, many students are engaging in a process of translation and re-valuation of themselves and their work that continues until long after the degree is over; some must overcome a long-held sense of exceptionalism with regards to their academic chances.

And of course, alongside the professional pressures there are also the so-called “personal” issues and events that affect everyone, and which can throw one’s entire degree (and life) off-track if they occur — a break up or divorce, for example, which can itself result from relationship problems triggered by the academic lifestyle.

A larger problem is not only the context described above (and its effects), but also the thickly oppressive silence that surrounds it. Not coincidentally, I think, there is a parallel silence around the issue of attrition. Considering the high rate of attrition from PhD programs and the cost of graduate education, you’d assume there would be a plenty of research on the reasons why students “drop out.” But according to Chris Golde (2000) we still don’t have much information on why students leave PhD programs, partly because PhD attrition “looks bad” for everyone involved (responsibility for this “failure” is usually transferred to the student). I wonder how many students simply leave due to mental health and related issues brought on or exacerbated by the psychological minefield of the PhD process — and how much of this is preventable.