Trigger Warning: suicidal ideation
Jackee Schess graduated from Yale College in 2018 with a BA in Economics and Certificate in Global Health Studies. In 2019, she founded Generation Mental Health, a non-profit whose mission is to build the next generation of leaders in the mental health field.
For most of my life, I have had depressive episodes. I was ten when my mom first brought me to therapy. Life went on with periods of low mood and therapy.
In 2017, I was in India for my dream internship: working at a global mental health organization that I had been idealizing for years. Something was different.
I was always on edge, mind buzzing, like I could feel my thoughts pounding around my head. My supervisors kept telling me they couldn’t keep up with me. My coworkers were fed up with me because I wouldn’t shut up. But I knew that if I didn’t bounce my ideas off of someone else, they’d stay trapped, ricocheting, in my head.
I couldn’t sleep. I would sit staring at the ceiling or the walls desperately wanting to sleep but too amped up, like I could see my thoughts around the room. I couldn’t sleep, so I didn’t sleep. Instead, I stayed up until 3 or 4 in the morning, working, and expected others on my projects to do the same.
I knew at the time that something was off. But I thought it was just because I’d been so excited for this internship, that I wanted to fit in everything that I possibly could.
I didn’t realize then how much of a pattern of symptoms those were. I’m still working through what exactly my diagnosis is. I know now that this was a hypomanic episode.
I find it somewhat ironic that I had a difficult period of mood swings while I was working in mental health research—my passion—at a world renowned institution that provided me generally good support. But after talking with people in this field, it has become clear that many of us struggle with poor mental health.
Even in the field of mental health research, stigmas still exist which makes it hard to disclose and receive support for our own struggles—no matter how much anyone in our field knows that stigma is antithetical to our efforts.
During one of my research placements abroad, I spent one evening hanging out with some of my coworkers. Over wine and cheese, we discussed relationships, current events, food—you name it.
But at some point the conversation turned. Each of us started relaying our own experience with mental illness in varying levels of detail. A few mentioned this was the first time they had been this honest about their experience.
“So, we all work in mental health research, and we all have mental illness?” I asked, with an unfortunate knowingness. “Yet we’ve never talked openly about this before.” Everyone nodded.
It has been a journey for me to be open about my mental illness and to break down self-stigma. I’ve had symptoms of mental illness since I can remember, so I’ve had a bit of time to work through who I want to talk to about it and how. But for as long as I’ve had these symptoms, I’ve also been feeling the pressure to keep them hidden.
Sometimes, some of the worst pressure to self-censor has come from medical providers themselves. Therapy and psychiatry sessions, if they’re going to be helpful, must be spaces where you can be most honest. But as many people with mental illness know, there is an incredible and sometimes rational fear of the consequences of our honesty in these spaces.
Let me be clear for anyone who needs to know this: there is a significant distinction between suicidal ideation and suicidal intent (just as there is a significant difference between self harm and suicidal ideation, and suicidal intent, etc.). But if a medical professional believes you to be a “real and present threat to yourself or others,” they are allowed to break their confidentiality agreements with you. Psychiatrists, in particular, have a lot of power to instigate involuntary treatment.
A few years ago I shared some relatively benign suicidal ideation with my psychiatrist. He, however, read this as suicidal intent. Two days of down mood turned into weeks of fighting for my autonomy. Now, years later, it still impacts my trust of providers.
When I shared this, I was about to leave for a research stint abroad. He quickly suggested that I reevaluate this plan. I told him that made no sense.
He said, “Well at least I’m not one of those psychiatrists who’s talking about locking you up!”
This is still the most shocking thing I have ever heard from any mental health practitioner, let alone my own.
He’s right. I was lucky he wasn’t talking about locking me up. I was lucky to even be receiving treatment. But making light of this situation was more than inappropriate.
This is not to say that this is how all practitioners approach these situations—in fact, my experience has shown me that the majority have the highest level of care and empathy towards their patients. Yet that single interaction changed my approach to treatment. I found myself thinking: Will these words haunt me later? Will what I’m about to say empower this person to disempower me? I turned to survival mode, no longer telling my psychiatrist more than he needed to know. For years, I held back in treatment, until my life and work allowed me to find a new provider.
This is a symptom of a larger system that values the words of medical doctors over patients, and a society that inherently doesn’t believe in the capability of those with mental illness to make decisions that are best for them.
The last thing I would ever want is for people to think that I am not capable. On the contrary, I want people to think that I am exceedingly capable. So while it might seem ludicrous that my colleagues and I would self-censor, perhaps it isn’t.
We all know the typical misconceptions we want to avoid: “You’re crazy; you’re dangerous; you’re weak; you’re inadequate.” But there is one message that has stuck with me the most: “You never know what future employers will think!”
We constantly get signals that if we disclose, we’ll be thought of as less than, as not capable. We’re told this by people in the field, our own practitioners.
But then again, the mental health field is so much more than just practitioners: we are advocates, researchers, community leaders. We constantly talk in our own meetings about how stigma has negative impacts on outcomes… and we research it! So shouldn’t we be able to create an environment with no stigma in our own field?
The answer, of course, is HELL YES.
So we have to start talking about how we get there.
I think one of the crucial steps is recognizing that personal experience is, in fact, a core motivator for many of us working in the field. There are many people working at an intersection with mental health—law, public health, economics, journalism, this list could go on—that have chosen to do so because of their own personal experience with mental illness. This is such a natural decision: to want to work in something that makes a difference in your life, and hopefully have an impact on something that has mattered personally to you.
For mental health, I know many of us feel we can’t claim this motivation for fear of personal and professional repercussions.
Working in the mental health field as a person with mental illness can definitely be triggering. There are some days when it would be immensely better to never hear or utter the words “mental illness,” days when I fight to separate myself from my work and my illness. So what do we do when we don’t disclose to our supervisors—ask for a sick day? If our field (or any field) wants to be inclusive of those who know this struggle personally, there has to be space for honesty and real accommodation for mental illness as a disability. There are many commendable individuals who are working hard at creating an inclusive environment in our field, but there is much more to do to reach this vision.
On the other hand, though, there is an amazing empowerment that comes from this work. The opportunity to do work that can make a difference for others who have suffered like you is both humbling and uplifting. I have learned an immense amount through my intellectual pursuits and also from my colleagues. I have met the most incredible people working in this space, people who care so deeply about the things I care about, people who have become some of my closest friends and best supporters.
It is also crucial work, since there is no one more able to understand the work on mental illness than those with mental illness. There is a movement in global mental health that advocates for the inclusion of those with lived experience in every aspect of planning (e.g. the work of Global Mental Health Peer Network). This couldn’t be more important. But this must be enabled through space in our systems. We need de-stigmatization as well as recognition that it is not easy to fight for something that your life, too, depends on.
After my experiences working in mental health, I have come to realize the many ways that the field struggles with power imbalances: one of the most crucial being that it can miss the perspectives of those who have mental illness or use mental health services. These realizations have inspired me to found Generation Mental Health Association, a non-profit which aims to reduce the barriers to entering the global mental health field and improve pipeline development. One of the main goals of our organization is empowering those with mental illness.
As an organization, we recognize the critical fact that so many with mental illness are ready to make the change they want to see. There is too much at stake to sit around and wait. At Generation Mental Health, your lived experience, whatever that may be, is something to be proud of and something to utilize in your search for better mental health care. We are so excited to work towards creating a world where people with mental illness do not feel shame and are empowered to be their full selves—a world with mental health for all.
By Jackee Schess.
