Ways to Prevent Workplace Bullying in the Academy

On the post Workplace Bullying in the Academy I did not discuss what could have been done differently by the people involved in the bullying situation.  Here, we will have that discussion and a more general one about what can be done to prevent bullying in the academic workplace.

Before beginning the discussion, I will mention a useful resource:
The International Conference on Workplace Bullying and Harassment
This is the premier academic conference on bullying in the workplace, and serves as a useful source of references to the academic literature.

I like the description of bullying in the conclusion of Prevalence, antecedents, and effects of workplace bullying: A review.  I will quote M. Razzaghian and A. Shah here:

"Bullying is a chronic problem and has a negative
implication for the well-being of employees. Therefore,
individuals subjected to such behaviors are likely to show
increased levels of anxiety, depression and a negative
overall mental health. It can be concluded in light of the
literature reviewed that bullying does not refer to a single
negative behavior, but occurs frequently with increasing
severity over time. The persistence of such negative
behavior builds a constant distress within the individual
leaving that person helpless and unable to cope with it.
Probably, the bully’s intention is to suppress the target to
such an extent that he or she is under constant mental
pressure and ultimately becomes dysfunctional in the
workplace. The negative flashbacks of these events
make it more difficult for the victims to concentrate or
even find suitable words to express their feelings for that
situation. However, it has also been established that the
relationship between the bully and the target is influenced
by personality characteristics an individual carries. The
combined effect of all these facts are a vicious cycle in
which, the more a victim is bullied, the more are his or
her chances of being bullied again and again."

There seem to be a few suggestions of how to ameliorate bullying.  The good people at The Boss Whispering Institute seem to believe in taking forceful leaders and teaching them how to be considerate of their employees.  Other people such as the writer of The Complexity of Academic Bullying in response to Academic Bullies seem not to believe in labeling people as bullies, because of the potential for turning the designated bully into a victim.  (See my other posts for further discussion: Workplace Bullying in the Academy and Student Bullying in the Academy.)  Other people advocate coping skills such as having boundaries and telling the other involved parties what behaviors are acceptable and which are not (Victim).  Yet other people advocate training employees to identify workplace bullying (Beating Workplace Bullying).  Presumably there needs to be a component of the training that addresses how to handle bullying once it is identified.

I am an advocate of some of these methods and not of others.  I do not believe in labelling people in a bullying situation as bullies and targets, because I believe these roles can be temporary and unintentional.  Furthermore, I believe that both bully and target might believe that they are suffering harm from the situation.  I agree with one of the authors above who does not believe in labeling bullies due to the potential for turning a bully into a target.  I think one of the best methods would be to promote a culture that values fair treatment of everyone while training  employees to look for the harm caused by bullying situations and then to look for ways to constructively solve the problems.  This perspective allows for all participants to express their views and to hope for resolution in a classic mediation type scenario.  I believe that the programs that train bosses to be more empathetic are potentially very useful, though I do not know much about their efficacy.

What can the harmed person do?
One approach is to try a mediation, either a self-mediated or independently mediate discussion with the people with whom their is conflict.  While such an approach may de-escalate the situation, it is also possible that the bullying may escalate despite a mediation attempt.  In the example given previously (Workplace Bullying in the Academy), my friend attempted a self-mediated discussion which only resulted in ridicule.

Another option is to leave the bullying situation; this is similar to someone leaving a domestic abuse situation.  In the example of my friend, this was the solution that they chose, although my friend's low power position in graduate school made the politics slightly tricky.  I believe that walking away can be the ultimate expression of free will in a negative situation.  Avoiding potential negative health consequences of staying might well out-weigh any career sacrifices that are made by walking away.

Some people believe in teaching coping skills to the harmed person.  While coping skills are typically helpful, I do not see how a person can employ such skills when they feel that they have no power to effect any change in the situation.  My friend, who has excellent conflict resolution skills was unable to deal with the bullying situation, because people's perspectives regarding the situation were too entrenched.

What do I think academia should do?
I would like to see the academy adopt training programs for professors and staff that are centered around how to recognize and prevent bullying between all members of the academy, between students, between professors and students, between staff, and between staff and professors.  Such a training program would necessarily be comprehensive and might take 1-2 days to teach the necessary skills.  It seems useful to teach bridge building techniques as taught in workshops by the National Coalition Building Institute.  Such methods would teach people how to connect and talk with other people who potentially have different perspectives from themselves.  This is a necessary skill for anyone seeking to defuse a bullying situation.

Focusing on short-term situation specific factors will not alter the institutional-level factors that help initiate bullying situations.  The institution is responsible for establishing a culture of respect and the leadership of universities must set the example of respectful behavior and treatment of all employees and students.  This includes taking seriously complaints about bullying situations, and establishing anonymous surveys to assess under reported bullying situations.  The faculty must be involved in this effort as they are in positions to demonstrate a respectful culture to both other staff and to students.

All of these efforts should be evaluated and reassessed to see if they are working.  The anonymous surveys can be re-administered to see if there is a decrease in reported bullying situations.  The training of faculty and staff can be further adjusted if a large enough reduction is not observed.

Workplace Bullying in the Academy

Following on the last post about student-on-student bullying, this post discusses workplace bullying situations of the faculty and graduate student variety.  I will say up-front that this is a topic about which I try to be objective, but my experience as student with low power inherently influences my viewpoint.  I will tell the story of a friend who experienced psychological harm as result, and this undoubtedly influences my subjectivity.  Also, there may be some missing details and some awkward phrasing designed to hide peoples identities.

This bullying situation involves faculty and graduate students, so why do I call it workplace bullying?  I call it this, because graduate students in the sciences are typically paid by their faculty advisors to do research.  This is an employment situation where the faculty advisor is the boss and the student is the employee.  Some faculty advisors are extremely collegial with their students and treat them as almost equal proto-researchers.  But other faculty advisors perform the boss role.  Like any employment situation this usually works out quite well.  However, there are times that bullying situations arise.  While it is possible for a faculty advisor to feel harassed and bullied by their students, we tend to hear of situations where the student gets harmed.  However please keep in mind that there are infamous examples of students trying to kill their advisors, so the potential for bullying is certainly not unidirectional.

As before in Student Bullying in the Academy, I will try to avoid discussions of bullies and targets.  I think it is most productive to discuss the harm that results from bullying situations and to talk constructively about what could have been done differently.  This way of discussing bullying opens the conversation to include aggression by individuals who are not always aggressors or who may not have the intent to harm.  Since the target can only perceive intent through the actions of another, this means that the target and bully experiences might not agree.  This perspective also opens possibility that the target might as an aggressor either in retaliation or ignorance.  And the aggressor might be responding to a perceived harm done to them by the target either through action or inaction.

Many, sometimes contradictory, descriptions of bullying exist.  I prefer the description given in Prevalence, antecedents, and effects of workplace bullying: A review which says that bullying can be

"described in terms of: the intentionality of the behavior; the frequency (for example, weekly) and the duration (for example, about six months) of such behaviors; the targets’ reaction(s) to that situation; a perceived imbalance and misuse of power between perpetrator and target; inadequate support; and inability of the target to defend him or herself in that situation, where they have to
face constant negative social interactions, badgering, insulting remarks, and intense pressure. This
strengthens the aspect of power imbalance between the perpetrator and the targets as the perpetrator is believed to be in a position of strength as compared to the victim."  

There are two aspects of this description on which I will provide my opinion, the first is intent which was covered above and the second is frequency which need not be frequent if the person suffering harm has been severely harmed. Because the threshold for harm is lowered, and an aggressor can provoke harm easily with relatively benign or infrequent stimulus.

An Example
In presenting this scenario, I am inherently influenced by having only heard one side.  Because of this I will be presenting what happened to the best of my knowledge.

My friend was approaching their final years in graduate school and had two faculty advisors.  One of these had just moved to a different school.  My friend had gotten along well with both their advisors and had only received one performance-related request of something to change--one advisor had mentioned that my friend did not communicate well enough what was being working on.  Another aspect of this situation is that advisor had a collegial style of working while the other advisor had an boss-employee model of working.

The event that triggered the bullying situation was when the collegial advisor told my friend that they were not working hard enough and that they were lazy.  My friend asked when the problem started and got no answer.  There was no attempt to assess where my friend might be at or what they were doing.  They were also told that the advisor might not write a recommendation letter in support of applications for post-doctoral positions.

This was a situation of intense pressure from which my friend did not think they could escape.  Not only were career aspirations on the line, but as always my friend had a thesis to write which required their advisor's support. As typical in academia my friend was not told what was expected of them or how to retrieve the situation, but they decided the solution was to sacrifice their holidays to finishing a project that was half finished.

This gambit paid off.  My friend finished the project, submitted the paper, and had a successful meeting with their committee.  At this point my friend's advisor seemed very happy with their work and was told that it was good.  This should be the end of the story, however, it was not since a second bullying situation arose that may or may not have been related to the first situation.

My friend had decided that visiting their other advisor would be a good idea, so they arranged a 2 month visit to that advisor's lab.  No sooner had my friend arrived than that advisor took my friend into  confidence and started saying how the advisor was doing as little as possible to organize an event.  This way, the advisor could get credit for organizing the event without it taking up much time.  My friend was horrified, because they knew who would pick up the pieces: the staff.  My friend was also encouraged to manage collaborations with other colleagues so that my friend could minimize their contribution.  Again, my friend was horrified, because this was the antithesis of what they believe in.  Despite my friend's opinion of professed attempts to manipulate other people, they did their best to perform their role in the research project while continuing to work on their thesis projects.

My friend was also told that two of the students had been goofing off.  The students were threatened with the advisor taking away their project and giving it to my friend.  My friend did not find this amusing neither as a threat nor as a potential work-load increase.  My friend was quite disturbed that this comment transformed their social position from being a friendly outsider to being a threatening outsider.

From there things continued to deteriorate.  My friend received a threat that if they weren't productive enough, one of their projects would get taken away and given to someone who could do it.  They experienced sexual harassment perpetrated by the advisor--a reference on the part of the advisor to the potential for a sexual relationship between my friend and the advisor.  They had a rocky relationship with another member of the group  who added to the stress by arbitrarily mirroring the gestures of my friend and by seeming to enact a now-I-like-you now-I-do-not relationship.  This person repeatedly presented a catch-22 to my friend on the point of whether the advisor was a good person.  The stress of not knowing whether this student was a friend coupled with either an ambiguous threat or an ambiguous opportunity to support compounded the stress of the other interactions.

The advisor decided that since the project was not progressing rapidly enough, the students should stay up nights until it was finished.  The advisor did seem to have the philosophy that he should be there with them and that if he could handle being awake so could they.  Unfortunately, the power difference in the situation played a key role.  Over the course of two weeks, my friend watched their two colleagues get warn down and increasingly discouraged.  It got the point where my friend begged the advisor to stop making the students work so hard but was told that the students deserved it.

This last was too much for my friend.  They had been in this situation a short time, but it followed on the stress that had previously occurred.  My friend experience intense sleep-disrupting anxiety for the first time in their life.  They were extremely scared, and they had very negative opinions about their colleagues.  Indeed, my friend ended up interpreting the second bullying situation as being the result of the first.  This made these two incidences, one with each advisor, into one continuous bullying situation for my friend, regardless of the intent of the people involved.

My friend believes that the stress of this situation caused the onset of a sever psychological disorder.  While some people might be tempted to claim that such a disorder might be the source of an invented story about bullying, I would remind them that to jump to conclusions when they were not there is discrimination.  While hasty conclusions are dangerous, questions are always welcome.  My friend's perspective, no matter how it came about, is a valid experience of the world.  I would urge people to remember that it is more productive to entertain everyone's perspective and to constructively find ways to change situations.  It is also very important that people in positions of power consider carefully how their actions might influence those with less power, particularly since bullying situations and harm can occur without the intent to harm by anyone involved.

For this reason, I will not jump to conclusions about the motives of the people involved.  They had their own performance pressures to deal with, and they had other people to keep happy.  However, I do think many people could have acted in more constructive ways even to achieve the same performance outcomes.  Indeed, if there had been fewer threats, less harassment, and fewer negative social interactions, in the second situation my friend believed they would have been more productive.  As things happened, my friend wasted many weeks being too distracted and scared to work productively.  Similarly, the students with the second situation who stayed up nights might have also been more productive if they were not hounded into sleepless nights spent working.

Student Bullying in the Academy

Bullying has become a hot topic in the last 10 years with an increase in awareness at the harm that it causes.  The word bullying usually brings to mind scenarios involving school-aged children.  While bullying is certainly a problem with that age group it is also a problem with other age groups, including undergraduate students, staff, and academics.  The subject of this post is student-on-student bullying at the undergraduate level.

What is bullying?  

For the purposes of this blog, I will define bullying as a situation in which one or more individuals faces constant negative social interactions badgering, insulting remarks, and intense pressure with an inability to defend him or herself in that situation.  This a slight modification of the definition of bullying in Prevalence, antecedents, and effects of workplace bullying: A review by M. Razzaghian and A. Shah.  The definition of bullying is much debated and many descriptions of it exist. Several differences between my definition and Razzaghian and Shah's is that I do not mention bullies and targets or power differences.  This is because I believe bullying can occur in the presence of temporary power differences which might be political or might include the difference in the number of people on each side of the issue.  I also believe that bullies can bully bullies and that anyone can temporarily act as an aggressor.  In short, I do not believe that it is useful to label people as all good or all bad.  As a result I will talk about bullying as a situation which harms some individuals, and I will try to avoid labelling certain individuals as aggressors or targets.  And, I will acknowledge that these rolls might change and that they depend heavily on the perspective of the observer.  I will focus on the harm done to some of the individuals involved in the situation.

An Example of Bullying

I was involved in this bullying situation as a TA for a course that had a large group project involving 7 students.  My roll was to act as a project manager that was a consultant and and advisor, not a team leader.  The students were to select their own rolls and organize their contributions for the successful completion of the project.  Without my knowing, early in the project the group fractured with 2 students  committed to one version of the project and 5 students committed to another version of the project.  From my post-analysis of the situation, it appears that was the event that sparked communication difficulties and exclusionary behaviors on the part of the 5 against the 2.  The 2 students were left out of critical group discussions and were ostracized by the rest of the group even to the point of being given demeaning nicknames.  The point at which I found out about this, was when I informed the whole group that they were under preforming relative to the group size (unbeknownst to me this was because the potential contributions of two group members were being aborted).  This is when I heard accusations that the 2 students were not working or contributing.  Following my comments, the 5 students felt like the 2 under performers were endangering the success of the project and endangering their grades.  Knowing that one side's story is often only half the story, I met one-on-one with all the students to hear their version.  This is where the above description and observations were derived from.

After hearing all the students' stories, I decided to emphasize how the students could correct the situation, by communicating more.  On this point I received a lot of resistance from the group leader who I saw as leading the communication difficulties.  I encouraged them to actually let the 2 students participate.   With 1 week left in the class, the group selected and assigned a task to the 2 students.  In the end, the 2 students almost got their contribution finished, but not quite partially due to a lack of communication from the other group members.  The students were graded by me and by each other.  Due to my opinion of the conflict the performance grade for the group was low.  Due to the 5 students grading the 2 students and the imbalance in numbers, the 2 students got quite low grades.  As far as I know, the sabotaged contributions and the unfair grades were the largest harms that resulted from the situation.  If there was also psychological harm, I was not told about it.  (But because of stigma, it is not surprising that nobody brought this up.)

Even though I tried to prevent and repair some of the damage, I made mistakes.  I was the only person in the position to do something with the authority to do something.  At the time I thought the arrangement of a contribution by the 2 students in the last week with a doable task was reasonable.  However, I did not factor into the equation the pressure, the potential ill effects of the interpersonal difficulties which started at the beginning of the project, or the potential for continued sabotage at the end of the term.  I also should have noted that the 2 students were the outsiders from the beginning due to their ethnic background and their English skills.  If I had been watching for these things, I might have found out about the problem earlier in the term when something could have been done.  

I have also concluded that students should not grade each other.  The problem is that it opens the process up to petty politics and means that the majority group has power over the minority group.  While competition can be a force for good, students who gang up on each other, demean each other, and sabotage each other are involved in bullying situation.  This sort of behavior has no place in a respectful classroom.

Stigma

Part of the purpose of this blog is to fight stigma and misunderstandings.  One of the common misunderstandings is that there is a connection between violence and mental illness.  We see this now in the news in the discussions about shootings and what to do about them.  The NRA is currently supporting the existence of a national registry of shame: a list of people with mental illnesses.  Their call is predicated on the misconception of mentally ill people being violent.  Another common misunderstanding is that mentally ill people are mentally incapacitated.  While it may be true that some very severely afflicted individuals struggle with mental capacity due to their illness, the vast majority of the mentally ill are no different than anyone else in regards to intelligence.  We run the gamut from less to more intelligent just like the general members of the population.

One very large consequence of stigma is that people who need help may not be willing to seek help.  Here we are not talking about the issue of people who ask for help not getting it, but about the people who are so interested in separating themselves from stigma that they do not recognize that they need help.  A very insightful post on this topic is available:
When Mental Illness Stigma Turns Inward

Hopefully we can all contribute to decreasing stigma by  confronting misconceptions, participating in our communities, and talking to our families.

My Diagnosis or Lack of One

I have mentioned that my psychiatric disorder seems to most closely resemble bipolar.  I am being as precise as possible when I say 'seems' and 'resembles'.

The one thing that all my doctors and I can agree on is that I do have an episodic psychiatric disorder characterized by depression, anxiety, and paranoia.  However, I have received a range of opinions about what I might have and have gotten 3-4 different diagnoses depending on whether a vaguely stated opinion from a doctor that I had a 2 hour conversation with can be considered a diagnosis.  At this point I have seen a total of 7 doctors.  Some of these doctors I saw for an hour and others I saw for over a year.  I am grateful that I do not have 7 different diagnoses, because some of these doctors were wise enough to refrain from offering an opinion.  The closest to a common denominator for the diagnoses is 'bipolar NOS'.  However, I do not mean to say that all the doctors necessarily agreed with this.

Reliability
For this reason, I say that my bipolar diagnosis is not reliable.  I would define a reliable diagnosis for a person as one which is repeatable in that a new doctor would be likely to make the same diagnosis for that person.  As my experience indicates, this is certainly not the case with my diagnosis.  I hope that science can one day produce tests that will conclusively determine just what I have.  Until then I will say that I may have bipolar.

Accepting a Diagnosis
A charge that is often leveled against people like me is that we are 'refusing to accept our diagnosis' or that we are 'in denial'.  Indeed, I do not feel compelled to argue against these people as their tendency to jump to conclusions is devoid of reason.  But all the same, I will say a few words on this topics.

I argue that I am not in denial, because I accept that I have a psychiatric disorder, and have since the very beginning.  I was the one who first noticed problems, because I was closest to the problems.  And, I continue to be the person to first notice recurrences of the problems.  My current focus is on treatment, the success of which I define as a short-term mental stability.  I argue that I would neither notice my symptoms, nor be interested in treatment if I were 'in denial'.

I do, however, believe strongly in the accepting ambiguities that are caused by the limits of human knowledge.  I have accepted that my diagnosis is unknown and unreliable.  This helps make it possible for me to keep an open mind and to consider treatment methods that are typically applied to a variety of disorders.

The Institutionalized Academic

The name of this blog refers to the mental institutions and my professional role in the academy.  We consider these two aspects of the title.

Mental Institutions
My relationship to mental institutions is surprisingly complex given that I have never been in one.  I have had relatives who have been irreparably harmed by their visits to mental institutions and their encounters with involuntary treatment.  I have also had relatives who have worked in mental institutions and their descriptions of the inhumanity of the environment are disheartening.  I believe that these institutions are insidiously harmful to both the patients and the people who work there.  I believe it is much better to treat people at home surrounded by their support system than to potentially mistreat them in an institution.

Thankfully, I have not been hospitalized.  I find that having a reliable doctor to call can be more effective and provide faster treatment than a hospital.  I fear ending up in a hospital, because of the ease with which one can become an involuntary patient and a prisoner.  I also fear ending up in a hospital, because my accustomed surroundings and familiar behaviours would not be available.  Can you imagine me carrying my laptop into a mental hospital and asking for internet access?  How else would I be able to work?

The Academic
I mentioned briefly in the welcome post that part of the purpose of this blog is to educate people about psychiatric disorders and university life.  The most important point of the blog is that there are successful academics that have these disorders and that people with these disorders are normal people.

As I progress from graduate student to post-doctoral fellow, I have gained more responsibility.  As a graduate student, I had undergraduate students come out to me as having psychiatric disorders, and I admired their bravery.  But I was not fully responsible for their progress in class, as I worked under a professor.  Now, as a post-doctoral fellow, I am responsible for mentoring several students and am responsible for teaching a class.  It is my responsibility to help look out for students who are unwell and to help provide them resources.

Through all this, I carry my own experiences with depression, anxiety, and paranoia, and I encounter the misconceptions of other people.  I routinely hear the implication that people with mental illness are dangerous or scary.  I hear from colleagues that they do not know what to do with a troubled student.  Or they tell me stories of the suicidal student that they had to deal with.  Other times, I see systems that universities have put in place to deal with these students, and I profoundly disagree with them.  Yet I feel tongue-tied, because to speak up, to come out about the challenges that I face, means my colleagues will apply their misconceptions to me in potentially damaging ways.

I hope to use this blog as a forum to discus what I cannot say to my colleagues.  I will write about these issues as they come up, and maintain the anonymity of myself and any other characters that appear here.

Alcohol and Bipolar

The Literature

Alcohol and bipolar is a topic about which there seems to be much confusion.  There is a little-understood known correlation between alcohol abuse and bipolar disorder [Regier et al. 1990, Kessler et al. 1996].  "These studies show that about 50% of individuals with bipolar disorder also manifest alcohol abuse or dependence and altogether about 75% have a substance use disorder. [Lydall et al. 2011]"

There are several things to note here.  First, this statement is about alcohol abuse and dependency which is the consumption of alcohol to the extent that it harms ones health and social obligations, the craving of alcohol, and the inability to limit its use.  This statement says nothing about moderate drinkers.  Second, this should not be taken to mean that alcohol abuse is causative of bipolar, since a correlation does not imply causation [correlation and causation].  For example asthma and socioeconomic status are correlated, but it is commonly thought that there are environmental factors which explain the trend [Almqvist et al. 2005].

The correlation between alcohol abuse and bipolar could have many explanations [Sonne and Brady 2002].  Alcohol abuse could cause bipolar, bipolar could cause alcohol abuse, or there could be a third factor such as genetics which is causing both.

The case for alcohol abuse causing bipolar is circumstantial and somewhat misleading.  The argument rests on studies done of substance abuse which includes cocaine abuse as well as alcohol abuse.  It should be clear that the mind-altering substances could produce results that are not generally applicable to alcohol abuse.  In other words, if the same study was done while considering only alcohol abuse, the correlation might disappear or be less strong. Additionally, the study authors themselves admit that "the effects of drugs of abuse, particularly with chronic use, can mimic nearly any psychiatric disorder."  At any rate, the results of these studies should be carefully considered since they show a correlation between a worse disease course and substance abuse [Sonne et al. 1994, Sonne and Brady 1999].    Again, all the caveats about drawing conclusions from correlations also apply to these studies. Additionally, it is known that treatment resistant forms of bipolar are more correlated with alcohol abuse, potentially providing a third explanation for disease-course correlation.  This suggests that the type of bipolar is predictive of both disease course and alcohol abuse, in turn suggesting that effective treatment of bipolar might alleviate both disease course and alcohol abuse.

The case for bipolar causing alcohol abuse is also circumstantial, but at least the studies are done for alcohol abuse and not substance abuse.  There are several studies indicating that alcohol abusers with bipolar recover better from alcoholism than other alcoholics [for discussion see Sonne and Brady 2002].  This leads to the additional explanation that "bipolar patients may use alcohol primarily as a means to medicate their affective symptoms, and if their bipolar symptoms are adequately treated, they are able to stop abusing alcohol."

The case for bipolar and alcohol abuse being influenced by a third factor is strong.  There was a recent study showing that there are underlying genetic factors that strongly correlates with alcoholism in people with bipolar [Lydall et al. 2011].  The wording may be awkward, but it is precise.  The study was performed on a group of individuals (n=1016), some with bipolar alcoholism (143) and some bipolar non-alcoholics (363), and some control nonbipolar non-alcoholics (510).  Then the genes known to be correlated with alcoholism were tested for correlation in the bipolar alcoholics vs. the controls and the bipolar non-alcoholics vs the controls.  They then looked for genes with a higher correlation in the bipolar alcoholics than in the bipolar non-alcoholics.  These are the genes that would predict risk for alcoholism for people with bipolar.  It turns out that they also found some of the alcoholism genes were also associated with bipolar in the bipolar non-alcoholics.  This indicates that those alcoholism genes are also risk factors for bipolar (independent of alcoholism).  The study authors reached the conclusion that "the relationship between bipolar and unipolar affective disorder and alcohol dependence is bidirectional (Sonne and Brady, 2002) and there is little room for doubt that the two disorders have reciprocal effects on each other."

The final topic that we know little about is the interaction between alcohol and medications for bipolar. Most psychotropic medications include a warning about alcohol consumption.  However, I have been unable to find a study which points to what bad effects or interactions might actually occur.  There is not a citation for this, but one doctor explained to me that the main concern is that the liver might be overworked since both alcohol and psychotropic medications both cause the liver to work hard.  The potential for harm to the liver seem to be a good reason to not drink large quantities of alcohol while on psychotropic medications.  While little is known about drug interactions of alcohol and psychotropic medications, there is something known about the effectiveness of treatment for different groups of substance abusers [Sonne and Brady. 2002].  It would seem that choice of medication should be tailored if one is a substance abuser.

In summary, we have many hypotheses about the known correlation between alcohol abuse and bipolar.  We have very few solid conclusions, at this point, and more research needs to be done.  Finally, all the existing conclusions are about alcohol abuse or alcoholism and are not about moderate drinking.  We know very little about how moderate drinking might interact with bipolar disorder, because studies on those topics have not been done.  We also do not know if there are drug interactions between alcohol and psychotropic medications.


My Choices

My statement of what I do should not be taken as a judgement of what other people should do.  There are many ways to deal with alcohol from alcoholism to abstinence.  I am not advocating for any particular choice for anyone else.  I am not advocating for illicit drug use, as this discussion is restricted to alcohol.  I am not advocating binge drinking, as there is a lot of strong evidence that binge drinking is dangerous.  My comments about what I do are limited to myself, and not a judgement of what other people should or should not do.

I choose to drink occasionally at home and in social settings.  By occasionally, I mean that most of my drinking falls in the moderate category and occasionally I abstain.  (Moderate drinking is defined as at most one drink per day for women and at most two drinks per day for men.)  I never drink and drive.  I do not appear to experience any alcohol cravings, and nobody has had reason to tell me that my drinking habits are harmful.  I understand that other people interact with alcohol differently than I do, and my choices regarding alcohol are not a judgement on what they should do.

I would like to see more studies done on the effect of moderate drinking for people with bipolar.  We know that in general populations, wine and beer have been shown to have benefits to the heart when consumed in moderation [Klatsky et al, 1997].  It seems to be unknown how frequently alcohol can be consumed before the risks of alcohol consumption out-weigh the health benefits.  On the subject of bipolar and alcohol, it is unknown at what consumption levels the health benefits out-weigh the elevated risk of developing alcoholism.

Welcome

Welcome to the Institutionalized Academic: the ups and downs of a closeted academic with a psychiatric disorder.

Who am I?  I am currently a post-doctoral fellow in the sciences at a large research university.  My psychiatric troubles began in graduate school with depression and eventually progressed to something more serious.  Despite this I completed graduate school and continue to do well as an academic.

Why am I closeted?  The stigma about psychiatric disorders and the misinformation surrounding them is astounding.  My one attempt to talk with a colleague while not a disaster was unfortunate in the misunderstandings that surfaced.  I have concluded that if I am to have any semblance of a normal career, I should not talk about the difficulties that I face.  Perhaps one day, when my career is secure, I will reconsider this and perhaps come out as some others have done.

What psychiatric disorder do I have?  Unfortunately science is not progressed the point that my difficulties can be named with certainty.  It would seem that what I have is similar to bipolar, but perhaps also different.

Why a blog?  As an academic, I am often troubled by mental health dialogue that lacks in scientific rigour.  As a so called 'high functioning' person with a psychiatric disorder, I am frequently discouraged by the stigma that colors most discussion about psychiatric disorders.  The stigma even colors the discussions that occur in support groups online.  With this blog I hope to encourage rigorous scientific discussions and education to reduce stigma.

Is my name real? No. I choose to write using a pseudonym to preserve my identity.  So, do not expect to find me with a Google search of my pseudonym.