Mental Health and Career
In our nursing curricula, we teach students how to assess for depression, anxiety, and other mental health diagnoses. Social media posts regularly remind us to look for signs of mental health crises in friends and family and push us to reach out to those in need, because they will likely not ask for help. We talk about self-care and the importance of good mental hygiene. All of these are meaningful, important messages that are worth reinforcing. They have served a very important role of helping reduce the stigma of mental illness by elevating the discourse beyond hushed voices and closed doors. Unfortunately, we sometimes miss mental health crises in ourselves and as much as we would like to eliminate mental health challenges with Facebook posts, and public health campaigns, we cannot be cured by Pollyanna-ism alone.
I have always been a high achiever. I enjoy the rigor required to conduct great research. I especially love making a real connection with the communities I study and, when my work is driven by what the community wants and needs, I get a fire in my belly that lights up my life. Nursing school wasn’t always easy for me, but I loved learning about the research process and listening to nurse researchers tell their stories. I envisioned them walking down a long dark hallway of locked doors, and one-by-one they found the keys to open doors no one has ever been behind, and the coolest thing was now everyone else behind them knew the way. I love that and knew I would follow in their footsteps.
I started my professional career in a tenure track position enthusiastic and ready to be one of those nurse researchers, ready to unlock door after door until I retired. I worked and worked, as hard as possible, jumping on to as many grants as I could so I could learn from the best. I did an intense post-doc training program specifically designed for Native Americans. I earned the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars (NFS) grant. I was doing everything right. Nose to the grindstone with blinders on and everything else. But it wasn’t enough.
Midway through my RWJF NFS grant, I hit a stumbling block. I was at mid-tenure and mid-way through my project. The project wasn’t going well, my community partner wasn’t working out, I wasn’t publishing anything, and instead of feeling excited about my work, I was just going through the motions. I went to work, I went to meetings, I went to conferences, I went home. I did everything I was supposed to do, but I also did nothing. I knew what I was supposed to be doing, but every time I tried to move the work forward, something would get in the way, until I started to feel like it wasn’t worth trying.
I have lived with depression for most of my life. I didn’t know it was depression until that year, when I went for a regular check in with my migraine doctor. I ended up chatting with the neurology department’s clinical pharmacist about my medications. In that conversation, he asked me if I wasn’t also a little depressed, because, “Here you are, living with all this pain. Isn’t that just a little depressing?”
I tried hard to keep myself from crying. I denied feeling depressed, of course I was not depressed. I was handling everything just fine. Maybe I had missed my last five deadlines and I had stopped trying to even pretend I was staying on top of my work and yeah, I wasn’t going to faculty meetings, and I had migraines 25 days out of the month. But this is the life of tenure track scientist, right? I told myself it was normal to hide in my hotel room when I went to conferences and justified it by saying I was treating it as a writing retreat, even though I never wrote anything except terrible short stories, none of which I finished. At the end of that doctors’ visit, the pharmacist and I agreed that I would try to take Wellbutrin for a month or two and see how I felt.
A month later, I felt like I had been hiding at the bottom of a sleeping bag, dark, hot, and very close to smothering myself, and now I was finally out in the cool clean air of day. I was looking at emails I had written six months prior with no memory of having written them. Every day I would receive a reminder of some commitment I had made with no intention of following through- an invitation to do a guest lecture across campus, contributions to an article that I had never submitted, appointments to committees I had never attended. Worse, there were meeting minutes from committees that showed me as present, but I had no memory of attending those meetings, no idea who the people were who were also at that meeting.
When we talk about depression, we usually focus on the crisis stage. We talk about diagnosis and treatment and about creating a safety net to catch people when they are falling. For those of us who are high achievers, the falling part is the easiest part of depression, because we don’t have to do anything except dwell in our misery. We can ignore emails, watch Netflix, listen to sad music, and do whatever we do to escape. The hard part comes afterwards, when we are digging ourselves out of the mess we made, sifting through the pile of papers on the desk, and wondering what the hell happened. As nurses, colleagues, and friends, we need to work on helping people after the fall.
This has happened to me only a few times in my professional career as an academic nurse researcher. That time was the worst, and I am still grateful for the compassionate understanding of Jackie Campbell. Without having to explain myself, she kindly accepted that I had trouble, I sought help, and I was working on getting back on track. She was the mentor that I needed at the time, and still is. We need more Jackie Campbells in academia. I never felt judgment from her for having allowed myself to fall so far behind with what was essentially her money (via RWJF). She never said those words that had been cycling through my own brain: that I was a failure, a disappointment, that I was living up to the expectations that everyone had for me, that they had only given me that opportunity because they needed more diversity in the cohort. Instead, Jackie and I worked together to set new deadlines and I finished the program with the deliverables in place and the project completed.
Occasionally, I do the unproductive work of comparing myself to my peers. I don’t have the R01 grant yet. I am not living in a fancy house, driving a fancy car. I don’t have a big team or a lab filled with eager grad students. Nobody is giving me any awards or inviting me to be on their fancy task force teams. All those great ideas I have are still great ideas, but they are still on my hard drive and not out in the world. On better days, I know that comparisons are useless, but when my brain is on the downhill, those comparisons ignore the context and wonder why I don’t have all those achievements my peers have. The solution my depressive brain always reaches is that I just haven’t worked hard enough. My depressive brain never reminds me that I have to work extra hard to see projects through, or that I have to make sure I exercise regularly, and get enough sleep, and get outside regularly.
Instead, I have to stay on top of my depressive brain to make sure she doesn’t get the upper hand. I don’t plan to move any time in the future because I know I am in a location that makes me happy, and I would not be happy in a place where there was no sun, or where it was oppressively humid, where there weren’t other Native Americans, and I couldn’t be near my extended family. My depressive brain conveniently forgets how awful it was to feel stuck somewhere, miserable and unhappy, on the fifth month of overcast days with no end in sight. My healthy brain knows that my mental health is place-bound.
Along with knowing that this is part of what makes me special, I also try to be more mindful now about what I take on. I think hard about who I work with and what projects I work on. I may not have a massive publication record, but I don’t feel like compromising my integrity or forcing myself to be miserable is worth my happiness. I do my best to give my collaborators and myself realistic timelines. I won’t try to write a grant in two weeks, it’s not feasible unless I am willing to pull all-nighters, and I know that pulling all-nighters is a one-way ticket to the sleeping bag cave. I try to leave my weekends open as much as possible so I can relax, spend time with my family, and do things I enjoy. I work from home or at my beloved co-working space, so I don’t have to force myself to be around people all the time, which I find absolutely draining. Finally, and I mentioned this once but it’s worth repeating, I’ve changed jobs and am now doing work that I love with people I enjoy and admire.
Since the year I was officially diagnosed with major depression, I’ve found ways to try to protect my career when things start to slide downhill. I have a better support system. I have a more supportive job. I have good friends and a wonderful family, and I see the right medical professionals who help me tremendously. Even so, after a major life event this year I noticed one day that the sun wasn’t shining as brightly, the birds weren’t singing quite as sweetly any more. I spoke to my psychiatrist and we changed my medication. And after a few weeks, I sifted through the emails again, prioritizing those that needed the most attention so I could begin the walk back out of that stuffy sleeping bag.
As nurses, it is our professional duty to not only care for our patients, but to care for ourselves. Supporting our mental health isn’t optional, it isn’t something you can tend to with a mental health day every so often or a visit to the spa. Supporting your mental health means you take care of it every single day and you take an action-oriented approach to surround yourself with people and work that fills your soul. I am convinced that my experience is more common than we would like to admit, and believe it’s time to start a real conversation in academia about how we can support mental health in our work environments every day to not only look for those in crises but to support them once they are there.
Dedicated to Dr. Ruth McCorkle, PhD, RN, FAAN, who opened doors for so many.