Access to Higher Education for the Mentally Ill:
A Review of Trends, Implications,and Future Possibilities for
The Americans With Disabilities Act and The Rehabilitation Act
David T. Liebert, Associate Professor
Department of Social & Behavioral Science
St. Petersburg College
Post Office Box 13489
St. Petersburg, Florida 33733
Leibert, D.T. (2003) The mentally ill and access to higher education: a review of
trends, implications,and future possibilities for the americans with disabilities act and
the rehabilitation act. International Journal of Psychosocial Rehabilitation. 7,
Key Words: Higher Education and Mentally Ill, Americans with Disabilities Act and Mental Illness, Mentally Ill and Access to Higher Education
Significant strides have been made for those with disabilities in obtaining access to higher education for the purpose of pursuing independence, life goals, and being productive members of society. Yet, one area of disability that has not made as significant gain as others is mental illness. Those who have a mental health diagnosis—regardless if the diagnosis is being controlled or is resolved—face undue discrimination in spite of legal protections afforded by such federal legislation as Americans with Disability Act. This article provides an analysis of several contemporary United States federal court cases involving students who have or had a mental illness. This analysis sets out to demonstrate that "otherwise qualified" has a different interpretation when applied to the mentally ill.
The diagnosis of a mental illness is a powerful social label. For those diagnosed, the social stigma of mental illness too frequently becomes a master status. Not only do many in society look at the mentally ill with moral disgust, hostility, and fear, but also for those diagnosed there is often the reality of social isolation, an absence of self-esteem, and a bleak outlook for the future (Link & Phelan, 1999). Perhaps the true strength of this stigmatizing label is witnessed best at that time the patient becomes asymptomatic. The stigmatizing effects of mental illness can long out live the disorder itself. Not all forms of mental illness represent lifelong conditions. Mental illness can resolve. Moreover, many types of mental illness do not render the patient completely dysfunctional. Some people who suffer from mental illness are able to function at relatively high levels especially when following through with an ongoing treatment plan.
Those who once suffered from mental illness or must manage and control their psychiatric symptoms face intimidating obstacles in their effort to become reintegrated back into mainstream society (Link & Phelan, 1999). Bearing in mind many forms of major mental illness such as schizophrenia often manifest initially in late adolescence or the early 20s, it would seem logical that for many former mental patients the process of reestablishing a healthy life would include the pursuit of formal higher education. Higher education is a socially accepted means by which we pursue our life goals and meaningfully participate as productive members in society. Yet, the walls within higher education do not readily offer sanctuary for the mentally ill from the stigma of their condition. "[M]ental health service providers may not be providing these individuals with support for their educational endeavors" (Mowbray & Megivern, 1999, p. 32).
It is the purpose of this paper to point out that for the asymptomatic mental patient and former mental patient access to the world of higher education poses yet one more obstacle. The institution of higher education is a reflection of the larger society; it is a microcosm for the larger society. We will find within it the same values, beliefs, and prejudices that we find in society as a whole. This paper will explore the legal standards established by the courts and policies of higher education in addressing issues of admission and access for the asymptomatic patient and former mental patient. Specifically, this paper will explore the legal protections afforded to the mentally ill in seeking access to higher education by reviewing the 1973 Rehabilitation Act and by reviewing the Americans with Disabilities Act. This paper will go on to analyze how the courts have interpreted these protections for the asymptomatic and former mental patient by reviewing several contemporary federal court cases. Finally, recommendations for potential policy revision and reform will be offered.
The Rehabilitation Act and The Americans with Disabilities Act: How it Ought to Be
Students with disabilities, such as mental illness, who are otherwise able to meet the criteria for admission and academic performance are afforded various protections in the United States under two pieces of federal legislation: The Rehabilitation Act of 1973 and the Americans with Disabilities Act. These two acts collectively help to ensure that institutions of higher education make reasonable accommodations to those with disabilities by using federal funding as political leverage. In this section, we will briefly explore the basic foundation and purpose for each of these two federal acts.
With its passage in 1973, the Rehabilitation Act (RA) required that all postsecondary institutions receiving federal funding make their programs accessible to those students with disabilities. Institutions that participated in federal funding programs were now prohibited from denying access to students with disabilities. Such access did not, however, apply to all students with any disability. Rather, it applied to those with a "qualifying handicap." As the RA states:
This concept of a "qualified handicap" was clearly defined in the landmark Supreme Court Case of Southern Community College v. Davis. Ms. Davis, a nursing student, was denied continued admission in her clinical nursing program because she was deaf. The community college she attended believed that her hearing disability posed a safety risk to patients and there was no "reasonable" means for the disability to be accommodated. Ms. Davis sued and the community college initially prevailed. Ms. Davis appealed the decision, and the higher court then found in Ms. Davis’ favor. The court ruled that Southeastern Community College must evaluate Ms. Davis without consideration of her disability. The college appealed to the United States Supreme Court. The Court was essentially being asked to decide if "otherwise qualified" means that one is able to perform in spite of the disability or that the disability may not be considered in assessing the candidate’s propensity to perform in the academic program. The Court ruled that "An otherwise qualified person is one who is able to meet all of the programs requirements in spite of his handicap" (Southeastern Community College v. Davis, 1979, p. 406). No qualified handicapped student shall, on the basis of handicap, be excluded from participation in, be denied the benefits of, other otherwise be subjected to discrimination under any academic, research, occupation training, housing, health insurance, counseling, financial aid, physical education, athletics, recreation, transportation, other extracurricular, or other postsecondary education aid, benefits, or services to which this subpart applies. (§104.42)
Therefore, institutions may deny access to the disabled if their disability inhibits their ability to reasonably complete the course of study, but not if the disability can be reasonably accommodated for rendering the student "otherwise" able to perform. For instance, a technical college could deny admission into a dental hygienic program to a blind student because there exists no reasonable way to accommodate for the disability. But, admission could not be denied to the same student into a history department because the disability could be reasonably accommodated. Reasonable accommodations may include, for instance, having books read onto tape, classroom note-takers, use of tape recorders, or the use of service animals.
With the passage of the Americans with Disabilities Act (ADA) in 1991, the implications of the RA were broadened. Title II of the ADA not only applies to schools receiving federal funding, but it also applies to all public entities regardless if they receive such funding. The ADA also expresses broader goals. As McGovern (1992) explains, the ADA is motivated by two far-reaching goals. First, it is the intention of the ADA to advance a primary goal of eliminating the stigma and discrimination too frequently associated with disability. Second, the ADA expresses the goal of minimizing the impact of a disability on a person by maximizing the person’s growth and development as an autonomous person.
Clearly then it has been established that students cannot be discriminated against simply due to a handicap. Moreover, this same argument applies to those with mental illness as well (Stefan, 2001). In other words, postsecondary institutions cannot deny access to higher education programs merely due to a student’s psychological disability. Schools, of course, may deny access if the student’s mental disability cannot be reasonably accommodated for. For instance, if a student suffering with schizophrenia is actively experiencing psychosis and is acting dangerously to himself or others, he may be denied access. As Alikhan explains, "A person who poses a ‘direct threat’ to the health or safety of others will not be considered a ‘qualified person’ with a disability" (2001, p. 165). In contrast, however, a student being treated for schizophrenia with the use of antipsychotic medication may experience significant uncontrollable tremors of his or her hands. Providing the use of a tape recorder or note-taker for class lectures and discussions could reasonably accommodate for such side effects.
In summary, those with mental illness are afforded the same protections under RA and ADA as others suffering from physical disabilities. However, as we will come to see, institutions of higher education do not apply the RA and ADA as vigorously to those with mental illness as is applied to those with a physical disability. Not all forms of disability are equally stigmatizing.
Higher Education and Accessibility for the Mentally Ill
In some respects, higher education has been rather distinguished in its employment of accessibility for the mentally ill. As Stefan (2001) points out, academia has been forthcoming in making reasonable accommodations in several respects. For instance, many students with diagnosed learning disabilities and other recognized disabilities such as Attention Deficit Hyperactivity Disorder are granted increased time for examinations; classroom note-takers aid students in getting the professor’s lecture down on paper, and by providing private testing environments, students are better able to manage the distractions or anxieties brought about by their psychological conditions. In addition, institutions of higher education are now readily omitting from admissions application questions concerning mental health history. Asking a student what sort of psychological disorders he or she has been treated for is no longer appropriate, or necessary admissions data. These are certainly positive changes from the perspective of those with mental health disabilities. Clearly, some of the walls have been broken down.
Higher education, however, is also a social institution within a much larger society, and as a social institution, higher education represents a microcosm of the larger society. We can see within this institution ethnocentric reflections of what is believed to be right and wrong, just and unjust, and we can find expressed the prejudices the mentally ill face in the larger society as well. In spite of several gains, higher education has at the same time maintained undue challenges and obstacles for the mentally ill in their quest for access to higher education. We can see these challenges evolve out of the civil litigation brought by students seeking relief from the courts under the RA and ADA. In this section, we will examine several contemporary civil cases and explore the implications of accessibility for the mentally ill.
Doe v. New York University: U.S. Court of Appeals, Second Circuit (1981)
Doe, a medical student at New York University (NYU), sought legal intervention from the court because she was denied readmission to NYU due to a psychiatric disability. Does suffered from Borderline Personality Disorder. On appeal, the Supreme Court found in Doe’s favor.
Jane Doe’s mental health history begins in childhood with several questionable instances of pathological events. The Court’s opinion cites that in the third grade, Doe experienced difficulty with her grade school teacher that resulted in some sort of intervention with a psychologist. At the age of 14, there was another mental health intervention by a psychiatrist who treated Doe after she and her parents had an argument, and Doe attempted suicide by taking five sleeping pills. These isolated descriptions noted in the Court’s opinion was not sufficient to confirm any presence of childhood psychopathology.
In Doe’s early to mid 20s, her pathology appears more established. Prior to her application to medical school in 1975, there are several events that clearly call her mental status into question. Specifically, there were several incidents where she caused significant physical harm to herself—although it is not stated that these attempts were actual suicide attempts. For instance, she cut herself several times, and on one occasion the self-inflicted injury necessitated a blood transfusion. She violently—but not lethally—attacked several of her psychologists and psychiatrists. These behaviors resulted in several psychiatric hospitalizations. It is also important to point out that these assaults took place when Doe’s psychologists were attempting to involuntarily commit her.
In spite of her psychological difficulties, Doe was able to be in a position to make application to medical school. The Court’s opinion does not speak of her undergraduate accomplishments, but it stands to reason Doe must have completed her undergraduate degree with some level of success, been able to earn a respectable score on her medical school admissions examination, and secure encouraging letters of recommendation in order to be accepted by NYU. NYU admitted Doe in 1975 to pursue the M.D. degree.
Doe’s accomplishments, however, were not all honestly stated. In her application, she falsely represented "…that she did not then have and had not had any chronic or recurrent illness or emotional problems" (Doe v. New York University, 1981, p. 766). As part of the entrance requirement upon starting her first year’s classes, Doe was required to complete a medical physical by a physician representing the university. Upon her physical examination, the doctor noticed several scars from Doe’s previous self-injurious activities. It was at this time, Doe acknowledged her mental health past. This admission prompted the university to require Doe to undergo a more thorough mental health evaluation.
Upon the completion of her psychiatric evaluation, the university initially recommended that Doe withdraw from the university. Doe objected, and the university agreed to allow Doe to purse her medical training as long as she "…undertake psychiatric therapy with a medical follow-up by the Student Health Service. Doe accepted these conditions and was advised that if she had further psychiatric trouble she would be expected to withdraw from the school" (Doe v. New York University, 1981, p. 766). Further psychiatric trouble occurred soon after when Doe bled herself with the aid of a catheter as a means of dealing with stress. A leave of absence was given.
Doe left New York and returned back to California were she began psychiatric treatment by a team of two psychiatrists. In July of 1977, Doe made application for readmission back to NYU medical school. Both of her treating psychiatrists provided positive letters of recommendation to NYU on Doe’s behalf. NYU denied her request.
In short, the university claimed that Doe suffered from a psychological condition known as Borderline Personality Disorder (BPD). Furthermore, BPD is a condition that responds poorly to treatment; thus, there was little hope that she would be able to fully overcome her illness. Any duration of time where Doe was asymptomatic merely reflected a dawdling in her condition. It would only be a matter of time, the university feared, before she would become symptomatic again.
In response to NYU’s decision, in October of 1977, Doe sought legal intervention for the purpose of being reinstated in the medical program. Doe claimed that she had been denied readmission because of a disability that was in direct violation of the 1973 Rehabilitation Act. Schools receiving federal funding are not permitted to deny access to a candidate on the mere basis of a disability. On September 25, 1981, Judge Goettel ruled that NYU had in fact denied Doe’s readmission on the basis of her disability. The judge stated in his opinion:
Does returned back to NYU medical school in October of 1981. [Ms. Doe would] … more than likely than not be able to complete her course of medical studies and serve creditably as a physician…[and] NYU had failed to sustain its burden of going forward and proving Doe was not an otherwise qualified handicapped person or that her application for readmission was rejected for reasons other than her handicap. (Doe v. New York University, 1981, p. 772-773)
The Doe case establishes several important factors in the admissions process for the mental patient. First, as Kaplin and Lee (1995) point out, the burden of proving to the court that the alleged mental disability does not inhibit the successful completion of the course of study falls on the plaintiff, not the defendants. It was Doe who had to substantiate to the court that she was otherwise qualified. Second, "…the court considered the fact that she had a recurring illness, even though it was not present at the time of the readmission decision" (Kaplin & Lee, 1995, p. 395). And, it is this second observation of Kaplin and Lee’s (1995) that establishes the most consequential implication for the mental patient. It becomes the diagnosis that takes precedence over actual behaviors.
The patient’s label is now held in greater scrutiny than his or her actions. For example, referring back to the Doe case, in the time between 1977 and 1981, Doe was accepted into a graduate program at Harvard and completed a M.S. degree in the College of Public Health. She was gainfully employed at a professional-level with the Department of Education and Welfare in Washington, D.C. following the completion of her master’s degree. During which time, her supervisors rated her performance as "excellent."
Boyle v. Brown University: U.S. District Court (1995)
The defendant—Brown University and various members of the administration—won the case on summary judgment arguing that the alleged events took place prior to the enactment of the Americans with Disabilities Act. Nonetheless, this case provides valuable practical insight on the administrative authority higher education attempts to exert over those suspected of having psychological problems. This case was brought fourth by Ms. Sarah Boyle, a first-year medical student at Brown University College of Medicine. Ms. Boyle claimed that she suffered from Chronic Fatigue Syndrome (CFS) and also claimed that the university discriminated against her as a result.
Ms. Boyle had never placed the administration on notice about her alleged CFS disability, but she had independently negotiated with various faculty special testing accommodations. After receiving examination scores that were not to Boyle’s satisfaction, she complained to the faculty that the special testing accommodations had not been sufficient. At this time, the faculty went to the dean of the college raising questions about Ms. Boyle’s psychological fitness. The dean responded—without even having first spoken to the plaintiff—by giving Ms. Boyle one of three options before she would be able to proceed further with her medical studies. First, she could undergo a psychiatric evaluation. Second, she could meet with the Independent Medical Students Committee (IMSC). The IMSC—not a specific committee of the university—was established to provide various forms of support for medical students within the state. Finally, if the plaintiff refused the previous mentioned options, she could face unspecified administrative actions from the university. With reluctance, Ms. Boyle opted to meet with the IMSC.
The IMSC shared with the dean the content of the meetings that took place between Ms. Boyle and the IMSC. Apparently, Ms. Boyle raised some concerns regarding her "behavior" that prompted the dean to formerly respond to Ms. Boyle in a letter stating in part:
Ms. Boyle also claimed in her action, that the administration shared with the faculty concerns of her psychological fitness. [It would appear] …that you do not have an emotional or psychological problem of such duration or severity as to affect academic performance …[and] although you apparently are able to perform academically, the behavioral issues remain. These issues must be resolved, particularly as you enter the clinical years where your professional behavior with patients, peers and faculty will be judged with equal weight as your cognitive knowledge. (Boyle v. Brown University, 1995, p. 749)
Although the case was dismissed, it does raise at lease two interesting points for consideration. First, do institutions of higher education have the right to mandate a student seek mental health treatment or evaluation? At what point does the institution’s concerns for professional development of the student exceed the privacy and right of self-determination of the student? In the facts presented, it is clear that the university’s administration considered her academic performance as acceptable. The concern raised is the possibility of inappropriate behavior/interactions with patients and peers. Therefore, the university is justified in requesting the student to seek out psychological intervention. Again, does this exceed the pedagogical authority of the university? Second, to what extent should knowledge of a student’s mental status be disseminated to faculty? Do faculty have a need to know this information? What useful purpose does it serve for faculty to know information that otherwise ought to be private? Again, there did not appear to be any problem with Ms. Boyle’s academic performance in the classroom. Information that would normally be considered private and confidential should be treated as such by administration and faculty who become privy to such knowledge from other departments within the university.
Maczaczyj v. State of New York: U.S. District Court (1997)
Mr. Maczaczyj (plaintiff) sued Empire State College of the State of New York when the college failed to accommodate the plaintiff’s disability. The plaintiff was admitted into a master’s degree program at the college upon the completion of his undergraduate degree. Although the majority of the graduate program was delivered in a nonresidential format, the program did require 12-credit hours of residency through week long intensive "orientations."
The plaintiff notified the college that he suffered from a host of anxiety disorders such as Panic Attack Disorder, Generalized Anxiety Disorder, and Agoraphobia. As a result, he requested from the college an accommodation for his disability. Initially, the plaintiff requested he be excused from participating in the "orientations." The college responded by offering the following accommodation to the plaintiff:
The plaintiff rejected the college’s plan for accommodation claiming that any face-to-face interaction was too anxiety provoking. The plaintiff then countered requesting the college to make the orientation available via video conferencing or telephone conference calling. The college denied the request. The plaintiff would (1) be able to be accompanied by a friend or advisor of his choice, (2) have access to a vacant room to which he could retreat whenever the need were to arise, (3) be excused from those portions of the residency which were deemed predominantly of a social nature (i.e., lunch period and coffee break periods), and (4) have his choice of location within the meeting area where the residency is to be conducted. (Maczaczyj v. State of New York, 1997, p. 405)
In February 1997, the plaintiff sought legal relief from the court. He was claiming that he was being denied reasonable accommodation by Empire State College under Title II of the ADA. "The protections afforded by the ADA ensures that with or without reasonable accommodations of programs and services, a disabled individual who meets the essential eligibility requirements to participate in the program …is not discriminated against by reason of the disability" (Maczaczyj v. State of New York, 1997, p. 406).
The college argued to the court that the plaintiff’s request for telephonic or two-way video attendance at the required "orientation" would result in pedagogically undermining the academic integrity of the program. Therefore, the proposed accommodation was unreasonable. The court found the defendant’s argument the more compelling argument. The court denied the plaintiff’s request.
Clearly, this case differs from Doe v. New York University in that here the plaintiff’s pathology is active. He is currently experiencing his debilitating anxiety. With Doe, however, she was asymptomatic at the time of her claim. The concern with Doe was her propensity for future pathological behavior.
One important implication that potentially derives from this current case, however, is the court’s position on technological interventions as a possible "reasonable accommodation." The court took the position of the college that teleconferencing would erode the academic integrity of the curriculum. The concern that arises is whether college administrators may be afforded the opportunity to declare that any technological intervention—like teleconferencing—compromises the pedagogical quality of their program. But, as more classrooms become standardized with this sort of costly technology, the reasonableness of using such technology as an accommodation increases as does the cost of applying it to the home of a single agoraphobic.
Larson v. Snow College: U.S. District Court (2000)
The plaintiff, Ms. Michelle Larson, brought suit against her former college—Snow College—claiming that the college violated her civil rights and discriminated against her in violation of the ADA. In the fall of 1996, Ms. Larson experienced what is vaguely described as "mental health problems" (Larson v. Snow College, 2000, p.1290) causing her to seek professional mental health treatment. Upon her return back to Snow College two days latter, the college administration required that Ms. Larson sign a "Wellness Contract." The contract required, among other criteria, that Ms. Larson be placed on probation of social activities, academic probation, and be relieved of her position as Vice-President of the student government. Ms. Larson’s complaint alleges that the college employed the use of the Wellness Contract "… as a mechanism to keep her from associating with fellow students and student government officers, to stop her from exercising her free speech rights, and to control her behavior and spy on her while she was in the privacy of her school living quarters" (Larson v. Snow College, 2000, p. 1290).
At this time, Ms. Larson’s compliant has not been resolved by the court. It is ongoing; however, the allegations expressed in the lawsuit provide another level of discussion to the stigmatization the mentally ill face in access to higher education. Access does not merely involve admittance to the classroom, but access also involves passage to those activities typically associated with the status of student—such as student government involvement and dorm room life. Restricting her access to these activities renders Ms. Larson as a marginal student—a stigmatized student.
Davis v. University of North Carolina: U.S. Court of Appeals (2001)
Ms. Davis brought suit against the University of North Carolina (UNC) following the university’s actions to have her removed from a teaching certification program. Ms. Davis was previously diagnosed with Dissociative Identity Disorder (DID). DID refers to a condition were the patient experiences marked changes in personality and memory without any apparent organic explanation (American Psychiatric Association, 2000). In Ms. Davis’ case, she experienced occasional blackouts.
It would appear logical based on the facts so far given that UNC was acting within the guidelines of RA and ADA to deny Ms. Davis continued admission in the program. It is necessary for a teacher working with small children not to experience blackouts to ensure the safety of her students. Such a limitation cannot reasonably be accommodated. However, what is alarming about this case is how the appeals courts interpreted Ms. Davis’ DID diagnosis. The court argued that RA and ADA did not apply to this case because a psychiatric condition such as DID is too ambiguous to be recognized as a legitimate diagnosis. "Davis has failed to make a prima facie showing that she is disabled within the meaning of the ADA or the Rehabilitation Act …" (Davis v. University of North Carolina, 2001, p. 102).
DID is a recognized by the American Psychiatric Association as a legitimate disorder. It is correct that DID is diagnosed entirely on subjective criteria; however, this is the case with almost all mental illnesses such as depression, mania, schizophrenia, and somatoform disorders The concern raised here is the court’s judgment is determining one disorder legitimate and another illegitimate.
Analysis and Suggestions for Ameliorating Accessibility for the Mentally Ill
Lessons Being Taught
In conclusion, it appears that institutions of higher education have within the United States employed the use of federal protections, specifically the Rehabilitation Act and the Americans with Disabilities Act, for those dealing with the effects of a mental illness in such a way as to restrict accessibility. Again, it is not my position that institutions of higher education deliberately attempt to restrict assess, seek to discriminate, punish, or humiliate the mentally ill. Rather, institutions of higher education serve as reflections of the larger social system. Such actions find deep roots in the values and belief systems within the larger culture. This point may help to explain the various examples of discrimination and inaccessibility discussed in the previous section of this paper, but it does not serve as an excuse for such behavior, nor rationalize its continuation. Institutions of higher education must be concerned with the lessons it teaches to its students through both the formal curriculum within the classroom and the informal curriculum taking the form of administrative policy on the college campus. What then are the lessons being taught to students on college and university campuses?
First, the mentally ill are perceived to be dangerous; higher education administration needs to protect their faculty and students from potentially dangerous people. It can be argued that it was Doe’s and Boyle’s perceived possibility for violence that may have motivated the administration’s policy actions against these students. Was the administration correct in holding such fears? Do the mentally ill have a greater propensity for violence? Are such fears rooted in reality or myth?
Researchers addressing this question would conclude that such fears are seated more in myth than in reality (see Angermeyer, 2000; Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999; Taylor & Monahan, 1996). Those with mental illness pose no meaningful addition of risk to the physical safety of the general population. Angermeyer even goes as far to say that strangers "…appear to be at an even lower risk of being violently attacked by someone suffering from severe mental disorder than by someone who is mentally healthy" (2000, p. 63). Public perception, however, would suggest otherwise. Perhaps, the public’s fear of violence at the hands of the mentally ill is a false projection instituted by the media. As Mulvey and Fardella (2000) argue, the media provides disproportional coverage of isolated acts of violence by the mentally ill creating in the public a misrepresented belief that all mentally ill people must behave similarly. The public has demonstrated a clear absence of comfort with being physically near people known to have a history with mental illness (Link et al., 1999). Unfortunately, it does not appear that these views of the general public will ameliorate soon. Rather, "… research suggests that stereotypes of dangerousness are actually on the increase and that the stigma of mental illness remains a powerfully detrimental feature of the lives of people with such conditions" (Link et al., 1999, p. 1328).
There is a second lesson seen creeping though these profiled court cases. The mentally ill are not capable of functioning in society at an adequate level. Thus, what the mentally ill have to contribute to society is little at best. They can’t ever function at a level necessary to perform as academics, physicians, lawyers, or artists. Certainly for many of those who experience mental illness, their ability to function is inhibited to a great extent. But, this is not always the case. History has shown us otherwise. There are countless examples of those with mental illness that have overcome their symptoms, participated and contributed much to the betterment of society.
As a psychotherapist, I have learned as much from my patients on the realities of life and psychological functioning as I ever have from textbooks and lectures. As Kay Redfield Jamison notes when sharing about her own personal experience with Bipolar Disorder:
Suggestions for Policy Reform The countless hypomanias, and mania itself, all have brought into my life a different level of sensing and feeling and thinking, Even when I have been most psychotic—delusional, hallucinating, frenzied—I have been aware of finding new corners in my mind and heart… I cannot imagine becoming jaded to life, because I know of those limitless corners, with their limitless views. (1995, p. 218-219)
In this final section, two suggestions are offered for the purpose of promoting positive social change. First, higher education administration needs to focus their concerns on behaviors, not diagnosis. A diagnosis is not, in and of itself, a clear predictor for future behavior. One’s current and most recent behavior is a better predictor. Asking an admissions candidate about his or her past psychiatric history does not paint as clear of a picture as asking behaviorally relevant questions. In short, any questioning should focus attention on the student’s capacity to carryout his or her academic responsibilities (Alikhan, 2001).
A second substantial way higher education can address the concerns raised in this paper would be to lobby and advocate more strenuously to professional licensure agencies and associations at both the national and state levels. The extent of discrimination faced by the asymptomatic or former mental patients from state bar examiners, for example, is even more severe than those discriminations faced within academia. As Alikhan points out, only seven state bar associations have forgone mental health questioning all together as part of the bar application process, but 32 states still engage in a wide range of inquiry as to an applicant’s mental health history (2001). Applicants could face discriminatory questions such as "Have you, within the past five years, been treated or counseled for a mental, emotional or nervous disorder" (Alikhan, 2001, p. 159). As Reske explains, one of basic assumptions for employing broad questioning to bar applicants has been the belief that having sought treatment for a mental condition poses a greater danger to the public’s safety both physically and professionally (1995). "[T]he bar is feeding stereotypes which pervade society, including an attitude that those who seek psychological counseling are deviant, weak, or prone to error" (Alikhan, 2001, p. 163).
Such a rationale is misguided on several accounts. First, as previously stated, the mentally ill—even those actively experiencing psychosis—pose no significant risk to the safety of the rest of us. Second, such broad inquiry may fail to take into consideration the extensive range of mental conditions that are legitimately recognized by the American Psychiatric Association (APiA). The extent of possible mental illness that one could be diagnosed with is perhaps broader than the degree of questioning by state bar examiners. For instance, the APiA’s primary classification system used to diagnosis psychopathology—The Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition—Text Revision—includes the following diagnostic labels: Nicotine Dependence, Parent-Child Relational Problem, and Caffeine Dependence (2000). For example, if one has been prescribed Zyban by the their physician to help them stop smoking, one has technically been treated for a recognized psychiatric condition. Finally, this rationale discourages people from seeking help. "[M]ental health inquires might keep people from seeking counseling or treatment, or cause those in treatment to be ‘less than totally candid with their therapist’ for fear of disclosure" (Reske, 1995, p. 24).
At some level we are all different and face the possibility of discrimination and unfair treatment based on our differences whether they be the color of our skin, gender, religion, disability, or place of national origin. For the mentally ill, however, such discrimination appears to be more inherent within the subtleness of daily social life. Discrimination for the mentally ill is not a discrete event.
It is vital to point out that, in spite of its ideals, institutions of higher education also play a role in the continuation of stigma and discrimination of the mentally ill on college and university campuses. Such actions are not intentional, but nonetheless they are present, and lives are impacted as a result. If the goal of education is to assist in fostering independence, compassion, creativity, and excellence in students, it is vital for higher education to be fully aware of its own limitations and strive for excellence in seeking resolution.
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