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Half of all graduate and professional students experience depression at some point.  In the spring of 2007, in my second year of medical school, I was one of them. I was first diagnosed with depression as a first-year medical student; looking back, I had probably been dealing with it for a few years before that, but didn't realize it at the time.

One of the most difficult things to do when depressed is to seek help, and as my story illustrates, a hugely important step toward encouraging those with depression to seek help is to take away the stigma that surrounds depression and other mental illnesses, and to guarantee the rights of people with mental illness.

For the most part, I handled my depresson fairly well at first. I don't want to minimize the impact that it has on anyone's life, but this was only a prelude, not the real nightmare. In part because medical schools have been very proactive about raising awareness about depression and encouraging students with depression to get help, I was seeing both a talk therapist and a psychiatrist by the end of my first year, and staying functional enough to handle the stress of medical school for the most part. There were periods when I stared at the ceiling for hours on end, or stayed in bed and missed class, or suffered from insomnia, or became ill because of my irregular sleep schedule, but I managed.

To be sure, the stress had started to get to me close to the end of second year, as Step 1 of the board exams approached. At one point I became frustrated enough to kick my desk during a break in class, not realizing at the time that it would come back to haunt me a week later.  Knowing that I probably needed some time away, I had already requested a leave of absence between second and third years. I planned to get through Step 1, then spend a year getting my life in order, then return and finish out medical school.  Given the level of stress and prevalence of depression in medical schools, this kind of thing isn't uncommon at all.

But then everything changed in an instant.

I hardly noticed the Virginia Tech massacre when it happened.  I overslept badly on April 16, 2007, enough to miss class entirely. I heard something about it on the radio while driving later in the day, but went on with my life. Truth be told, I had plenty of other things to think about at the time. But the next morning, Virginia Tech became the pivotal moment in my life. That was the morning I found I was suspended indefinitely and banned from the campus, pending investigation of some vague allegation of endangering the campus.

I was able to piece together the chain of events some months later from the university's documents. It turned out that someone else in my class had e-mailed university administrators, claiming that because I was Asian-American, male, and probably depressed, I might fit the same profile as the Virginia Tech gunman. The paper trail showed that, on the basis of that evidence, the fact that I had once kicked a desk, and nothing else whatsoever, someone decided that I was a threat to the entire campus, and suspended me the same day.

I thought at first it would blow over in a day or two. I was mistaken.  At the end of the week, my classmates received an e-mail reading that I had been banned from the campus for their safety – and it turned out that the medical school itself had not even known that I was suspended at all. Over the next six months the dean of the medical school, to her credit, repeatedly called the main campus to object, and was alternately told that the matter was none of her business, or that they would get back to her “tomorrow.”  Meanwhile, I was never given a chance to defend myself, or even told specifically what I was accused of.

It took six months to find a lawyer who was interested in taking my case. I called quite a few; several said I probably had a strong case but declined to take it. I think there were three major reasons. First, they might not want to take on a major university with a lot of resources. Second, I was a student, with a very limited budget, and might not be able to pay. (As it was, when I finally found a lawyer who would take my case, my mother had to fly in from Texas to guarantee payment in case my check bounced.) Finally, and perhaps most importantly, many attorneys won't touch mental health issues with a ten-foot pole. Some may not understand mental health issues, others may lack confidence in their ability to understand mental health issues, and still others may simply think they can't reliably convince a judge or jury. The most interesting thing here is how quickly the university backpedaled once I had a lawyer – within hours after a single phone call, before we so much as started drafting a complaint, I was reinstated and the suspension was changed retroactively to a leave of absence.  The fact that I had legal representation was what did it.  Until that point I think they had hoped I would go away quietly.

But even with that saga being over, the nightmare didn't end. It's hard to overstate how devastating that kind of blow can be. In the space of a few days I lost most of my support network, and most of the friends I was still seeing disappeared as soon as word got out that I was looking for a lawyer. I spent most of a year hiding under the bed, convinced that everyone thought I was some kind of monster. I stopped playing soccer, ate all the time, and put on more than 50 pounds in a year, going from athletic to borderline obese. My apartment became hopelessly cluttered.  I had been a violist and composer in my spare time; that fell by the wayside too.

In retrospect, I'm not really that sure whether my friends disappeared, or I hid from them. Probably a little of both.  I certainly didn't make a whole lot of effort to reach out.

I should mention that I survived that chapter of my life mostly because of the efforts of R, another medical student who had herself experienced severe depression in the past.  R called as often as she could to let me know I wasn't alone and offer a sympathetic ear.  She was the one who first suggested that I should find a lawyer, and while everyone else tried to avoid getting involved, she gave me a whole list of lawyers that her family knew and she thought might take my case. Even as I became terrified of everyone else, I never became scared of R, because she reached out to me in my worst moment. She believed in me when I didn't believe in myself, and that's exactly what I needed most.

Coming back took a lifetime.  Losing a career almost entirely didn't help. In theory, I could have returned to medical school, but I knew that it would be hard to get a fair evaluation after threatening a lawsuit, and I found that medical students are all but prohibited from transferring. (In retrospect, I'm glad I decided not to go back – as recently as this May, I heard that some members of the medical school faculty were still convinced that I had actually been homicidal.)

I don't know when I first heard about the Bazelon Center for Mental Health Law, but when I did, I found that my treatment was not by any means unique.  Many colleges and universities respond similarly to students with reported mental illness.  The general idea seems to be to try to avoid liability rather than to act in the student's best interests – they're under the impression that, if anything happens, they're not liable as long as it doesn't happen on campus. I thought back to my own struggles and how I spent six months fruitlessly calling one lawyer after another, and in that moment I knew exactly what I wanted to do with my life: help fill the need for legal representation for people with mental illness.

I was virtually unemployable at that point, but eventually ended up taking night classes through UC Extension. Part of the reason was that my health insurance required me to maintain at least part-time student status. For the first year or two I withdrew from as many classes as I finished.  There wasn't any real focus at first, since I was mostly trying to get back into social situations again, but I eventually gravitated toward the certificate program in Healthcare Leadership and Management, because it was at least somewhat related toward my new goals. I also started writing policy papers for the American Medical Student Association, focusing then on regulations to implement the newly-passed mental health parity law. That said, until only about a year ago, studying part-time and not working was about as much as I could handle.

I procrastinated until almost the last minute before starting on the whole process of applying to law schools.  Mostly I was still afraid anyone I asked for a recommendation letter would bite my head off.  Once I started asking for recommendations, it got easier. As it turned out, it was the process of writing and submitting law school applications that pulled me out of the depths of depression. Perhaps it was having a sense of purpose again. Perhaps it was the knowledge that three people had thought highly enough of me to write recommendation letters – or at least didn't hate me. Perhaps it was the realization that I was actually taking steps to change my life. Even before my first acceptance letter arrived, I was optimistic for the first time in what seemed like forever.

I'm now writing this diary during breaks from studying for my first semester exams at the University of the Pacific, McGeorge School of Law.  All the pieces eventually fell into place this spring: with a full-tuition scholarship, I can afford to spend an entire career doing public interest work without worrying about debt.

I'm under no illusions about where I am now. I realize I'm not entirely back yet – not even functioning at the same level I was while depressed and in medical school. I'm still taking fairly large doses of Prozac. I still have days when I struggle to get out of bed, and days when I'm too busy staring at the ceiling to get any actual work done. But it's a relief to be moving forward again, and for now, that's all I'm asking for. I've taken up both music and soccer again, as much as I can on a law school schedule.

A fair number of my classmates are aware that I left medical school because of discrimination. Few are aware of how far I sank afterward, though I'm sure that anyone putting themselves in my shoes would have at least some idea.

I'd like to close with a little discussion of disability rights as they relate to mental illness. What makes the stigma of mental illness so insidious is that it is so often a hidden disability.  People with more visible disabilities gained acceptance by being seen living and functioning, in the workplace and in public. This was what made the ADA so successful at changing public attitudes toward disability. But this is also where it gets tricky with mental illness: it's only visible if we're open about it, and if we're open about it we often end up being immediately stereotyped as “crazy” or “dangerous.”  I don't think there's an easy answer to this problem, other than the slow process of educating the public.  I personally decided, when I finally got around to applying to law schools, to disregard common wisdom and make my personal statement about depression and stigma. I decided early on that any law school that had took issue with it was somewhere I didn't want to go. I still make no secret of my continuing struggle with depression. I don't advertise it, but I won't deny it either.  At some point, I think, it becomes obvious that I'm not insane and not a danger to people around me.

To be sure, we've come a long way in securing mental disability rights.  As recently as the 1980s, it was considered acceptable to fire an employee or expel a student simply for being diagnosed with a mental illness, without even any allegation of dangerousness. Today, it is clearly prohibited by the ADA; the challenge is no longer creating a legal right but protecting a legal right that already exists.  People who are discriminated against on the basis of mental illness are put in the difficult situation of having to enforce their own rights – and from my own experience, I would have had a hard time doing so unaided when I was barely functioning.  Those of us who know we have mental illness need to be aware of our rights before anything happens to aggravate our conditions – and those who have friends and family struggling with mental illness also need to keep an eye open.

For more information on mental health and civil rights, I highly recommend the Bazelon Center's website.  The policy newsletter there, in particular, is the best way I've found to keep track of changes in mental health policy.

Originally posted to DrPlacebo on Sun Nov 28, 2010 at 02:23 PM PST.

Also republished by KosAbility.

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