A Case for Strengths-Based Diagnosis

[Obligatory disclaimer that I am not (yet) a licensed therapist and that the following is my personal opinion, informed by practice and academic study.]

Recently in a class on adult psychopathology, my professor was discussing the strengths and weaknesses of the DSM (Diagnostic and Statistical Manual of Mental Disorders), the text used to diagnose mental illnesses and categorize them for the purposes such as research, insurance billing, and sharing information among professionals.

One of the weaknesses he mentioned was one I’d actually never heard before: that the way the DSM diagnosis is written and shared does not include any space for also “diagnosing” the client’s strengths.

At first, this seemed irrelevant to me, not in the sense that thinking about your client’s strengths is not important, but in the sense that I didn’t see how it matters for a diagnosis. It almost seemed a little patronizing: “Yes, you have major depressive disorder and social phobia, but hey, at least you seem like you’re pretty resourceful and good at expressing yourself!”

But then I rethought that.

Here’s an example of a DSM-V diagnosis:

296.35 (F33.41) Major depressive disorder, early onset, recurrent episode, in partial remission, with atypical features

300.4 (F34.1) Persistent depressive disorder, early onset, with atypical features, with intermittent major depressive episodes, without current episode, moderate

V62.89 (Z60.0) Phase of life problem

It’s honestly difficult for me to imagine looking at this information with anything other than relief. For me, diagnosis has always meant one thing first and foremost: You’re not a terrible person; you just have an illness.

But to other people, seeing something like this can communicate a whole lot else. You’re sick. You’re fucked up. There is nothing redeeming about you. You can’t do something as simple as not being so sad. This is especially true when someone is already predisposed to interpret information about themselves in a negative light, because, well, that’s what mental illness always does.

In that moment, it can be really helpful to have confirmation–not just from a friend or loved one, but from a professional whose job it is to assess you–that you do have strengths and positive qualities.

So, here are some reasons incorporating strengths into diagnoses might be a really good thing.

  1. Giving hope and affirmation to the client.

Just like it can be nice to go get a dental checkup and hear, “You’ve been doing a great job at preventing cavities, but you need to floss more consistently in order to keep your gums from getting irritated,” it can be nice to hear, “Based on what you’ve told me, I believe that you’ve had a major depressive episode for the past few months. However, you’ve clearly been very good at reaching out to friends and family for support, and it sounds like you have a lot of people rooting for you to get better.”

Therapists and psychiatrists say “nice” things like this all the time, but writing it down as part of a diagnosis might be symbolically meaningful. To the client, that communicates the fact that their strengths are just as important as their diagnosis–important enough to be written on the form or in the chart. It shows that their mental healthcare provider, whom they might feel shy around or even judged by, does see them as a whole human being with strengths as well as a diagnosable illness.

  1. Providing possible avenues for treatment.

A psychiatrist may diagnose a client and then refer them to a therapist (therapy combined with medication tends to be more effective than either in isolation). Now what? The therapist can look at the diagnosis, or ask the client what it is, and proceed from there.

What if the diagnosis included something like, “Client reports that volunteer work helps them distract themselves from symptoms, and that writing in a journal has occasionally been helpful”? The therapist now has some potential ways to help the client. Or the diagnosis might include, “Despite severe symptoms, client shows a high level of insight about the possible origins of their depression.” The therapist now knows that lack of self-awareness isn’t the problem–symptom management might be.

I continue to be amazed that none of my therapists ever asked me if there’s any way I could incorporate writing into my depression recovery, or if there are any ways I’ve been incorporating it already. Writing is my life. Usually I’ve either said as much in therapy, or I haven’t because nobody ever asked me what I like to do or what makes me feel good. Why not?

  1. Reducing negative bias from providers.

I can’t make definitive statements without more research, but based on what I understand about bias, I can imagine that consistently viewing a client as “major depressive disorder with atypical features and moderate persistent depressive disorder” does things to one’s perception of that person. Not positive things.

It is difficult (if not impossible) to effectively help someone you view as deficient or weak. First of all, your likely pessimism about the person’s recovery will almost certainly be perceived (and possibly internalized) by them. Second, any roadblocks that come up in treatment will likely be interpreted as “resistance” or “not really wanting to get better” or “not being ready to do the work of therapy.” In fact, maybe it’s that your approach isn’t actually helpful to them. Third, without a conscious awareness of the person’s strengths and assets, what exactly are you using to help them recover? Therapy isn’t about “healing” people so much as helping them discover their own resources and help themselves. If you don’t even know what those might be, how could you possibly help the client see them?

Many therapists try to think of their clients’ positive traits in addition to their “negative” ones. However, formalizing and structuring this process as part of a diagnosis might make it sink in better, and become more embedded in one’s general impression of a person. The questions we generally have to ask while diagnosing someone are fairly negatively oriented–”Do you ever have trouble falling asleep? How often? To what extent does this impact your daily life?”. What if we also asked, “What helps you sleep better? How do you cope with being tired after a night of insomnia?” Maybe that can help shift a therapist’s perspective of this person from “insomniac” to “person with difficulty sleeping, who has reached out to friends for help with daily tasks.”

  1. Preventing provider burnout.

I dislike talking about my work because people are consistently amazed at it in a way that annoys me. “How could you deal with hearing these awful things?” they ask. “Isn’t it really depressing to work with all these people?” It isn’t, because thanks to my training, I’ve internalized a strengths-based perspective. When I think about the people I’ve worked with, I don’t see poor suffering depressives and trauma victims. I see resilient, determined individuals who are working to overcome their challenges in the best ways they can.

I think that some people in this field burn out because they can only see the suffering and the oppression and the unfairness of it. I also see those things, obviously, because they’re sort of a big deal. But if that’s all you see when you sit with a client, not only will that be reflected in your treatment of them, but it’ll also impact your own ability to persevere.

If every time a therapist made a diagnosis, they had to intentionally remind themselves of the client’s strengths, that might go a far way in helping them remember that there is hope and everything is not absolutely bad.

As I’ve mentioned, plenty of mental health professionals already incorporate a strengths-based perspective into their work. But this is more common in areas like social work, where diagnosis is rarely used and actually often criticized, anyway. I certainly don’t remember any of my psychiatrists or PhD-level therapists spending any time asking me about my strengths or coping strategies. They gave me my diagnosis, and that was mainly it as far as assessment goes.

One might argue that strengths assessment has no place in the DSM because it needs to be standardized and reliable. However, reliability may be a problem for the DSM regardless, meaning that different professionals assessing the same client may disagree in their DSM-based diagnosis.

One might also argue that the DSM is “about” mental disorders, not “about” a client’s overall set of traits or strengths. I’ll grant that. Regardless, I think that formally incorporating individual strengths into clinical assessments in therapy and psychiatry may be helpful. May be.

Against Role Models

Whenever a famous person does something of which the general public disapproves, much is often made of that person’s status as a “role model” and how it influences the public’s judgment of their behavior, and whether or not it is time to revoke that status.

It seems that celebrities cannot escape being seen as “role models” no matter what made them famous. We expect an athlete or a singer or an actor to be good at not just sports or singing or acting, but at upstanding, ethical behavior, too. The assumption is that children should look up to these figures not just because they represent talent and achievement that (supposedly) comes from lots of hard work and sacrifice, but because their behavior in the rest of their lives is something to emulate, too.

This makes sense to an extent. We know that children learn by modeling the behavior of adults, and we want them to have adults whose behavior they can model. While a parent is normally the one expected to serve that function, most parents hope for their children to achieve more than they (the parents) have been able to in their own lives. Choosing and fixating upon a random successful but unknown doctor or lawyer or scientist or writer seems odd, but famous people already serve the role of entertaining the public simply by existing. So, perhaps some parents hope that celebrities can be good role models for their children and inspire them to both professional and personal success.

In fact, there is absolutely no reason why someone’s success at sports or music should be taken to mean that that person’s treatment of others is just as admirable. There’s no reason why being a great actor means you keep your promises to your partners and respect the law. There’s no reason why being in a famous band means you are very careful about your health and avoid dangerous drugs. Expecting celebrities to be able to model these types of “good behavior” makes no sense.

And even when we try to see someone as a role model in a specific domain only, it never seems to quite work. We fall victim to black-and-white thinking–people are either “good” or “bad,” and if a talented, successful athlete cheats on his wife, he goes from “good” to “bad” very quickly. Even though many people cheat, and even though occasional bad behavior doesn’t necessarily mean someone is a “bad person.”

The expectation of being a role model places undue pressures on celebrities, especially women. Tracy Moore writes:

Critiquing famous (or any) women’s behavior in terms of whether what they do is good for the girls or not is a sticky trap. It prevents them from being complicated, actual people working themselves out — you know, individuals? The thing we want women to be seen as? It keeps us in an endless loop of chasing after this One Correct Way for Women to Conduct Themselves. It’s exhausting, and I refuse to buy into it, and I don’t want to help christen it.

I also think it insults girls, who are more individual, and already far more developed as people than we give them credit for by treating them like blank slates who will copy and absorb every thing they ever see on command. That may be true for fashion, and I’m not disputing that teens copy famous people’s behavior too (and yes I’m staring down a princess phase with a toddler), but that doesn’t mean they instantly absorb the values and ideology of everyone they admire.

What I want is for women to be seen as human, which means, flawed, misguided, shitty, awesome, talented, cool, all of the above. In order to be treated like equal people, we have to have the latitude to have the same range of profound greatness and disturbing awfulness as men. We have to be ordinary, boring, fascinating, idiotic and brilliant.

Moore notes that female celebrities seem to bear a greater burden for Making Sure Our Children Turn Out Okay than male ones do, and male celebrities do seem to have an easier time recovering from Scandals with their popularity mostly intact (see: Bill Clinton, Charlie Sheen, Chris Brown, R. Kelly).

And what about non-celebrities? What happens when they’re expected to be role models?

I don’t know how this plays out in other professions or contexts, but within social work and mental healthcare, there is an immense amount of pressure put on professionals to be role models. We’ve talked about this in my social work classes.

People look to social workers and mental health professionals for more than just “help me fix my brain bugs.” They also look to them as examples of how to live well, and they often expect them to be wearing the same professional “face” even if they encounter them randomly outside of the office.

Our professors ask us what we would do if we encountered a client, say, at a bar or on public transit or even at a party. How would we manage their expectations of us with our desire to behave as we usually would at a bar or on the subway or at a party? Would it harm our relationships with our clients if they saw us acting like, well, normal people?

It’s true that if our clients think that we’re always the way we are in a session–calm, empathic, curious, mature, “wise”–it might disturb them to see us drinking at a bar or kissing a significant other in public or dancing at a party. They might wonder if we’re “faking” when we’re in a session with them. They might wonder who we “really” are.

For some professionals, this seems to be enough of a reason to significantly alter their behavior if they see a client out in public, or leave a bar or party where a client happens to be. They might even consider whether or not doing things like going to bars and parties after hours is even compatible with who they are as professionals.

When we discussed this in class, I was glad that most of my classmates reacted with minor indignation. Why should we be expected to be professional 24/7? Why does everyone else get to take off their work persona when they leave the office, but we don’t? Why is it our fault if our clients judge us as immature or irresponsible just because we go to bars on the weekends?

I think there are two reasons why expecting therapists to act like therapists 24/7 is harmful. One is that, on the individual level, it’s stressful and takes a toll on one’s mental health and freedom to live life the way they want to. Deciding to be a therapist should not be a life sentence to never behave like a normal person outside of work again. That’s too much of a burden for someone whose work is already very stressful and difficult.

Second, part of our role as mental health professionals is encouraging clients to think rationally, accurately, and adaptively about other people and their relationships with them. “This person is drinking at a bar therefore they are immature and I can’t trust them as my therapist” is not a rational, accurate, or adaptive thought. (Well, it could be accurate, but you’d need more evidence to come to that conclusion.) Neither is, “This person is behaving differently after hours than they are at work, and therefore the way they behave at work is totally fake and they’re just lying to me.”

But speaking as someone who’s been on both sides of that relationship, I have to say that we are really, really patronizing our clients if we think that they are incapable of realizing that we have selves outside of the office. We are treating them like children if we presume that they need to be carefully prevented from seeing any part of our non-therapist persona, including kissing a partner in public or getting tipsy at a bar.

But it’s possible that some clients might be confused or bothered by seeing a therapist acting non-therapisty out in public. I think that the best course of action then is to discuss that in therapy, not laboriously alter one’s public behavior so that such an issue never comes up to begin with.

Because our classes are mostly discussion-based and there’s little in the social work code of ethics about situations like this (dual relationships, though, are a different matter), my professor never gave a definitive answer on whether or not we should endeavor to be role models to our clients no matter where we encounter them. His intent, I think, was mostly to spark discussion and let us know that this is something to consider.

The examples of celebrities and mental health professionals are two very different examples, but my conclusion is largely the same for each: being expected to be a “role model” in every context, at work and outside of it, in one’s chosen domain (be it sports or entertaining or counseling) and in every other domain in which it’s possible to judge a person’s behavior, is too much.

A final reason holding people up as “role models” is harmful: the criteria by which we judge them are largely based on social norms, which can be a very poor barometer for determining how ethical an action is. That’s why, when Miley Cyrus was vilified for her performance at the VMAs and reprimanded by many commentators for not being a good enough “role model,” the focus of most of the criticism was not the racism inherent in her performance, but the fact that she dressed revealingly and shook her ass. And she shook it…at a married man! How dare she. The married man, by the way, made a clear show of enjoying it, and he’s the one who’s married. And the one who sings a song about “blurred lines.”

It’s also why, when Kristen Stewart cheated on Robert Pattinson (to whom she was not married) with Rupert Sanders (who is married), it was Stewart on whom the majority of the public opprobrium fell, and who was finally compelled to publicly apologize. (A hopefully unnecessary disclaimer: I think breaking a promise to a partner is wrong, but I also wish people didn’t make promises they couldn’t keep in the first place, and I don’t think cheating is the worst thing a person could do and I don’t think a person who cheats owes an apology to anyone but the person they cheated on.)

And women of color in particular are held to impossibly high standards as “role models,” as public reactions to Beyonce and Rihanna attest.

Sometimes the intersections between the expectation of role model behavior and various types of prejudice affect people’s livelihoods in really crappy ways. To return to the example of therapists, I’ve been reading this blog by a woman who is studying to be a therapist and also works as a stripper. The faculty of her program are pressuring her to either quit sex work or leave the program, because doing both is necessarily an ethical violation. They also told her that being a stripper “contributes to further injustice in the world,”  and is therefore incompatible with her other role as a therapist.

That’s a slightly different type of role model that she’s being expected to perform, but that demand that therapists be perfect in every aspect of their lives is still there. The role of therapist is supposed to take precedence over everything else she may want to do in her life, including making enough money to get by and finish her education. And in this case, these expectations are intersecting with stigma and prejudice against sex workers.

So, whether you’re a celebrity or just a regular person trying to make the world better, it’s rarely a neutral expectation that one be a “role model.” Like all social expectations do, it comes along with lots of baggage. And it’s incredible how often, for women, being a “role model” means having no sexuality.

Children may need adults to look up to and clients may need therapists to learn from, but that’s not a good enough reason, in my opinion, to expect or demand perfection from people.

I think a more realistic view is that almost everyone can teach us something, and almost everyone has done things we probably shouldn’t emulate*.


*And to be clear, wearing revealing clothing and/or being a sex worker are not the sorts of things I’m particularly desperate to discourage.

On Being A Bit Of A Stereotype

It’s not exactly a secret that social work is an extremely gendered profession. About 86% of MSW students are women, and the percentage of licensed social workers who are women varies by age from 100% of those who are 25 and under to 75% of those who are 65 and over. This should come as no surprise. Social work requires excellent listening skills, lots of empathy, willingness to work for little money and advancement opportunity–traits and interests that women are socialized to have.

Of course, I have thought it all through and realized that gendered expectations played absolutely no role in my decision to study social work and that I, unlike the rest of these people, am going into it simply because this is Who I Really Am. And frankly, I’m offended that you’d even think that I’m going into this field for bullshit reasons like that. I chose it completely on my own.

Just kidding! It never works like that. Of course gender plays a role.

Ironically, the story starts with me being the exact opposite of who I supposedly needed to be. For most of my childhood, adults were always telling me that I was immature, selfish, insensitive, blunt, and socially inept. That I never put anyone’s needs before my own. That I never appreciated the people in my life enough.

So for a while I didn’t understand how it could be that as a young adult, I’ve suddenly become the opposite of that. When did this miraculous transformation happen? Why didn’t anybody tell me?

Of course, kids change as they grow up, and qualities like selfishness, insensitivity, and, obviously, immaturity are sort of hallmark traits of childhood. Maybe I really was all of these things. Maybe I was even all of these things more than most children were. Hell if I know.

But here’s the thing. Although nobody ever sat me down and was like, “You need to become more sensitive and empathic and self-sacrificing because you are female,” I nevertheless got that message for a number of reasons. First of all, when boys did something insensitive or immature or socially inept to me, I was informed that “boys will be boys.” (This is a dangerous thing to tell children for all sorts of reasons.) Second, I knew plenty of boys, and none of them were ever being exhorted to be more sensitive and to consider others’ needs before their own. (If anything, they were being exhorted to be less sensitive, which is also a problem.)

So it’s quite likely that I’ve become the way I am now partially as a way of compensating for those (perceived or actual) flaws, and that this way of compensating just happens to be perfectly aligned with certain gendered expectations about personality traits and career paths.

Well, now what? Should I abandon my dream job because it’s feminine? Am I a bad feminist unless I force myself to study math or science instead? Should I cultivate a persona of not giving a fuck about people?


Sometimes when you realize that you’ve been doing something largely because it’s gendered, you lose the impulse to do it. For instance, even though I still like makeup, I wear it very rarely now that I realize that I only felt expected to spend time and money on it because, well, I’m female. However, realizing that being female probably played a huge role in my career decision hasn’t dampened my passion for it at all. It really depends.

Leaving aside for now the fact that I’ll be able to do more for individual women and for women’s rights as a social worker than I could in most other jobs, to claim that I now need to realign my personality to make it non-gendered would be to, well, miss the point of feminism.

In a previous post about feminist criticism, I wrote:

For me, the most important insight that feminism has given me is that we do not live, love, consume, and decide in a vacuum; we do so under the influence of society. That doesn’t mean we don’t have “free will” (and I do hate to get into that debate), but it does mean that we might not always be aware of all of the reasons for which we want (or don’t want) to do something. We will probably never be able to disentangle ourselves from the influence of society, and that’s fine. What’s important to me is to be aware of what some of those influences might be.

I think a lot of people are reluctant to admit that things like gender roles have played a part in their choices because people like to think that we have Complete Total Free Will. While that’s arguable (just please don’t do it on my blog because I find it so damn boring), I think it’s best to view sociocultural influences as just that–influences, not determinants.

For instance, nobody would think it controversial to assume, say, that they enjoy spicy food because that’s what they were always served at home growing up, rather than because there is some intrinsic aspect of their being that “naturally” prefers spicy food. Nobody would be appalled if you suggested that maybe the reason they can’t stand nasty Chicago winters is because they spent the first 20 years of their life in Florida.

With choices a bit more loaded than what food you eat and what weather you like, though, it gets tricky. Why does anyone prefer any particular occupation? We like to think–unless, that is, we are blatantly choosing a career for its status or earning potential–that occupational choices are indicative of Who We Really Are Deep Down. The first question adults ask each other is often, “What do you do?” A question that we often ask children is, “Who do you want to be when you grow up?” Note the particular construction of that question as it’s often asked: What do you want to be, not What do you want to do or What job do you want to have. In some ways, I think, this reflects the fact that we view a person’s job as a reflection of who they are as a person, not necessarily as a reflection of a lot of complicated factors including who they are as a person, what opportunities they had growing up, what they were encouraged to do by friends, family, and communities, how much money they could afford to spend on education, and other factors that are external to your own unique personality traits, skills, and interests.

Of course, on some level, everyone knows this. It’s not like people don’t realize that a lot more goes into choosing an occupation than just personal characteristics. But it’s one thing to admit to yourself that you can’t really be a doctor because you can’t afford the education, and another to admit to yourself that you don’t really want to be a doctor because you have, to some extent, internalized gender stereotypes that make that choice seem…wrong to you.

So, let me reiterate: there is nothing intrinsically “wrong” with being affected by gender roles or with admitting (to yourself or others) that you’ve been affected by gender roles. You are not a bad person if you’re affected by them. It’s not a sign of “weakness” in the sense that strong people resist gender roles and weak people cannot resist gender roles. There are probably many factors influencing one’s willingness and ability to resist them, and I doubt that whatever the hell “strength” even is has much to do with it.

I do think that being honest with yourself is important, though, and I think critically examining your own preferences and desires makes you more self-aware and interpersonally effective. And only you can do that for yourself. If I meet a woman who wants to be a model or a man who wants to be a football player, it’s categorically not my place to presume that they’re choosing these paths because of gender roles. I might suspect so, because it’s a fairly likely (partial) explanation, but people know themselves best.

They don’t always know themselves very well, but they still know themselves best.

In a post about women who change their names to their husbands’ after marrying, Kate Harding responds to those who claim that this is still a feminist choice:

Look, you’re a feminist who, in this particular case, made the non-feminist choice. That’s all. I assume it was the right choice for you, or you wouldn’t have done it, and that’s fine! But feminism is not, in fact, all about choosing your choice. It is mostly about recognizing when things are fucked up for women at the societal level, and talking about that, and trying to change it. So sometimes, even when a decision is right for you, you still need to recognize that you made that decision within a social context that overwhelmingly supports your choice, and punishes women who make a different one.

There are parallels between this and my career choice. I recognize that, as a woman, social work is a much easier choice than it would be for a man, or than it would be for a woman to choose engineering or pro sports. (Of course, it’s a very difficult path for other reasons, but that’s not what I’m talking about.) Social work is a profession to which women who wanted to work in mental healthcare have historically been relegated because they were not allowed into professional psychology/psychiatry. That doesn’t make it any less a good choice for me. It’s just something I want to be mindful of.

A Rant About People Who Smugly Inform Me That My Career Will Not Make Me Very Much Money

Warning: this will be a rant. So it’s not very nice.

When you’re about to graduate from college, people tend to ask you what you’re planning on doing with yourself afterwards. So I often tell people that I’m going to grad school to study social work.

Most people respond to this positively or at least neutrally, but there is a substantial minority of people do not. Every so often I’ll run into a dude (it’s usually a dude)–he might have an MBA or plans to get one, and he sneers at me, flashing his Rolex, and says, “Social work, huh? Not gonna make a lot of money with that, are you?”

For starters, I just want to point out that this is a really quick way to reveal yourself to be a douchebag. You might not care that you’re revealing yourself as a douchebag, but then again, you might, especially since the way that this usually goes is that you’re flirting with me and perhaps hoping I’ll be impressed with your business acumen and earning potential. Nope!

In any case, though, I don’t understand why people think this is appropriate. How much money someone makes is a private matter, and you’d never think to make a comment like this to someone who’s already well into their career. But young people, apparently, do not deserve that sort of courtesy, so you should definitely feel free to pry into our financial situation at any time.

(To be clear: unless you are my parents, or other people from whom I might ever conceivably ask to borrow money, how much I make currently or in the future is none of your business.)

And I know everyone who makes these comments probably thinks they’re being incredibly original and edgy, but actually, people who go into fields like mine meet these douchebags all the time, so we’re quite aware of what people think about our earning potential. Even if we didn’t, though, it might shock you to know that people research these things when they make decisions about their career! Yup, college students planning for the future. Imagine that. When I was deciding about grad school, I checked starting and median salaries for people with the degree and license I hoped to get, including specifically in New York City. I also figured out how much my education will cost and now know how much and for how long I can expect to pay back my grad school loans.

Is this information pleasant? No, not really. But I already know it, and you don’t need to remind me. I’ll do just fine without your (random stranger’s) advice.

What’s funny is that some people seem completely incapable of realizing that not everyone cares all that much about how much money they make. I mean, yes, people should probably plan to be able to live on what they’ll be making. But that’s about all I care about that. Will I be able to live reasonably on it? Will I be able to occasionally buy myself nice things or take trips? Yup. It’d be nice to have more money, but I’m sure there are plenty of high-powered doctors and lawyers who would say that it’d be nice to work a few less hours. Just like they chose to make that tradeoff, I’m choosing to make this one.

It’s also important to note that I get very different responses when I say that I’m getting a degree in social work than when I say I’m going to be a therapist. In fact, I’m doing both; I’m getting that degree in order to be a more effective and more intersectional therapist. But when I tell people that I’m studying to become a therapist, that conjures up images of helping middle-class white ladies deal with their divorces. When I tell people I’m studying social work, that conjures up very different images. And generally they involve not making very much money.

There are, in fact, many things you can say when someone tells you they’re going to study social work that are not “Pfft, not gonna make a lot of money with that, are you?”. Here are a few:

  • “Wow, that must be a difficult job. What made you decide to go into that field?”
  • “Which populations would you want to work with?”
  • “Do you want to open a private practice someday?”
  • “Would you ever want to do social work research?”
  • “So what is social work, exactly?”

Yes, you can have a conversation that’s not just about money! So if the first thing you can think of to say about my career plans is that, surprise surprise, they won’t make me much money, I feel sorry for you. Because not only are you a douchebag, but you’re a pretty unimaginative one at that, since it’s apparently impossible for you to even entertain the notion that there’s more to choosing a career than choosing how much money you’d like to make.

[storytime] How I Quit the Senior Thesis

Ever since I was little, I held a belief shared by many gifted kids–gifted kids who grow into overachieving teenagers and then sleepless college students and then budding doctors, lawyers, engineers, researchers, businesspeople, or just those legions of people who wear tailored suits and work in tall office buildings in lower Manhattan and do stuff with money on computers or something.

That belief was this: you must do everything you are capable of. Anything less than that, and you’re “selling yourself short.”

You must participate in every science fair. You must take every honors class. You must play every sport your body can reasonably perform. You must accept every social invitation you are offered. You must matriculate at the most elite college to which you are accepted. You must have as many majors and minors as you can fit into your schedule, and you must have as many leadership positions you can get yourself accepted for.

So last spring I applied and got into the honors program in psychology. This meant that I would spend my senior year designing, carrying out, and writing up my own research study. At the time I was still under the impression that I wanted to pursue a PhD in clinical psychology, so this was obviously something I felt I should do.

I was at least mildly excited about it, at first, or at least made a good imitation of being excited. I don’t remember which it was anymore.

But in any case, things soon deteriorated. I discovered that I would not be able to do the study I originally designed about the stigma of mental illness–a topic I care deeply about–because none of the faculty members who study it were able to advise my project for various reasons. I tried to find a different lab to work in, but literally every single professor whose work I found interesting–and there are quite a few–was either already advising too many other honors students or had a requirement that you needed to have worked in their lab first or whatever.

So I ended up in a lab that deals with something I knew little about and that had very little relevance to my future career–cultural neuroscience. Fascinating stuff, but difficult and unrewarding. I couldn’t understand half the words that came out of my adviser’s mouth. What little willingness I had to go through with the program faded away. But still, I did not quit it.

The reasons I gave myself and others for not quitting are interesting mainly due to their blatant inaccuracy:

  • I felt that the department would be annoyed with me, but that’s silly since I was told I could withdraw at any time, and besides, if I quit that would free up resources for others.
  • I worried that this would somehow hurt my chances for admission into graduate school, which is even sillier because I’m applying to do a masters in social work, where nobody will care about my lack of research experience (particularly not in cultural neuroscience).
  • My parents told me not to, but so they did with journalism, and I quit that anyway and never looked back.
  • And, perhaps most importantly, I thought that quitting would make me a failure, even though that’s just obviously false.

As it turns out, what it came down to wasn’t any logical reason, but rather a sense of obligation, an invisible hand shoving me forward into doing things that I have no interest in and that bring me little or no benefit.

It is incredible to me how powerful that force was. I have always stubbornly persevered when it comes to getting the things I want, but apparently not getting things I don’t want is a different story.

Several agonizing weeks went by and then The Weekend happened. The Weekend was this past weekend. I saw an amazing speaker talk about microaggressions. I spent hours with friends. I laid around in bed in the mornings. I had a friend visit–someone I care about deeply and am now proud to call more than just a friend.

And at one point, I was sitting in the living room looking at my two bookshelves, which are full of unread books that are calling my name. (A small sample: When Everything Changed, Microaggressions, Outdated, Delusions of Gender, Sex at Dawn, and Thinking Fast and Slow.) I often wonder when I’ll be able to read them. But this time, for some reason, the question took on a new urgency: Seriously, though, when the fuck am I going to read these amazing books?

And it hit me that for the first time, academics doesn’t have to define me anymore. It doesn’t have to be My Thing. I don’t have to throw myself into the work to forget the fact that I have no real friends and no actual meaning to my life, because suddenly, I do.

I have new friends all over the country who are quickly starting to feel like old friends. I have my writing and this blog, which is growing in popularity and bringing me even more good friends and interesting people to talk to. I have the work that I do with sexual and mental health–I could write a whole post about the projects I’m working on and how much they mean to me. I have a new partner I adore, who supported me through this decision rather than pushing me to do and be everything.

This city, this city I used to hate so much, is growing more beautiful and homey to me every day. We spend our weekends out in its streets and thrift stores and cafes and apartments. As the weather grows colder, my heart grows warmer.

The thing is, I can do and be a whole lot of things. If I really wanted to, I could do this thesis. (I could also get a PhD, which I recently decided not to–a decision that parallels this one in many ways.) In the grand scheme of things, a year is not that long of a time to do something I don’t like and don’t need (assuming, of course, that my mental health would survive the year-long onslaught, which I doubt).

I could toil away at it and add another line to my resume, not because this will help me get into a social work program or accomplish any of my actual goals, but just so I could feel a little bit smarter and more accomplished.

But why?

Life is just too fucking short.

It’s too short for this kind of crap.

And so I quit.

More Than Just a Body With a Broken Brain: Why I'm Choosing Social Work

It would be nice to be called “Doctor.”

It would be nice to be paid a very high salary and have a stable job, and to be able to produce an official piece of paper proving that I am Smart.

It would be nice to be published in prestigious journals, to receive emails from others curious about my work. It would be nice to be quoted in newspapers and magazines as an Expert.

It would be nice to be part of the elite–the less than 1% of Americans who have a doctorate.

It would be nice, but it won’t be me. At least, not for a while.

Until recently, I left unquestioned the notion that I want a PhD in clinical psychology. I just wanted it. Why? Well, it would allow me to be a therapist, which is what I want. I would get paid a lot. It would carry prestige.

But gradually my resolve started to break down and I started to wonder, Why?

I discovered that I disliked research. When I told people this, they were often shocked. But aren’t you curious? Don’t you care why people think and feel the way they do? Don’t you want to understand?

Yes, I am, and I do. I’m deeply curious. That’s why I read voraciously. And I am more than happy to read all the answers to my questions when they’re published rather than to work long days in a basement lab somewhere.

I can do research, I’m sure. But it’s not what I love, and there are others who want this much more.

The turning point came when I attended a panel of graduate students in psychology, along with an admissions person for a doctoral program in clinical psych. They all told us that when we apply for grad school, our entire resume and personal statement should discuss nothing but our research experience. Everything else I’ve done wouldn’t even matter–not the year I spent as an RA, not the three years I’ve spent as a member (and, then, a leader) in a sexual health and assault peer education group, not the summer I volunteered at a camp for at-risk kids in New York, not the initiative I started to implement a peer listening program at Northwestern, not my internship at the National Alliance on Mental Illness.

I shouldn’t even include it, they told me, because it would annoy the admissions people.

The work that I love, the lives that I hope I’ve changed–it would be an annoyance.

At first, I thought it wasn’t a big deal. Who cares what I put on my application as long as I get in?

But then I learned more. I learned that I probably wouldn’t be accepted if I admitted that my goal is to be a therapist, because they want to spend their money on someone who would bring prestige to their institution by publishing research. I realized that I would have nobody to turn to for support–no mentors–because I’d have to hide my dreams from them. I learned that clinical training in clinical psych programs is mostly lacking (ironically), so I wouldn’t be learning the practical skills that I need to help people.

And, most of all, I understood that my time in graduate school would be miserable beyond belief, because I would be living a lie, facing extreme pressure to publish or perish, and wasting at least five or six years of my life. During that time, my life would be completely on hold–I wouldn’t be able to move, work, or start a family, if the opportunity presented itself.

The future that I had once dreamed about turned into a nightmare.

It was then that I finally stopped listening to my professors–who, of course, all have PhDs–and listened instead to the friends and family I have who actually are therapists, or hoping to get there. And increasingly I understood that a masters in social work would be a better option.

MSW programs emphasize learning practical skills, and many of them have you start a clinical internship as soon as you start the program, because the best way to learn is by experience. They understand that people aren’t just isolated brains inside bodies, that circumstances affect individuals and that psychological problems aren’t always caused by faulty brain chemistry. They emphasize understanding societal inequality, working with marginalized groups, and picking up where clinical psychology leaves off.

I’ve been told that I’m “too smart” for a masters in social work, that I will be “offended” when I see how little they pay me. People who say these things must not know me very well. Although I wanted a PhD before, I’ve never really needed my career to make me feel important. I don’t need to be important. I just need to be helpful.

As for “too smart,” that’s ridiculous. The helping professions need more smart people.

The truth is that, in my hour of need, it wasn’t a man with a white lab coat and a doctorate who saved me. It was–as corny as this is going to sound–the social justice movement. That was what finally taught me that my feelings are justified, that my thoughts have merit, that my words matter.

I finally learned to see myself as more than just a body with a broken brain. I’m a whole person enmeshed in particular circumstances, and the interaction between the two has made me who I am now.

I still agree with what I’ve written before. Medication can be useful. Therapy works. Psychiatric labels are important.

But my strengths and goals require a different sort of education than what I could receive in a doctoral program, and they point me to a different sort of career than a PhD would prepare me for.

True, I’ll earn less money. There will be hard times. There will, I’m sure, be bureaucracy, budget cuts, and crappy bosses.  There will be days when I don’t love it.

But there will not be days when I’m living a lie. There will not be days when I’m sitting in an expensive lab at a prestigious university, doing work that may be meaningful, that may get published, that may be improved upon, that may someday, maybe, help someone. Maybe.

And I have nothing but respect for people who want to do that. I admire that, and maybe someday I’ll return to school for a PhD. But at this stage in my life, it’s just not for me. After all, I can always get a PhD; what I can’t do is unget one and unwaste all that time.

I don’t expect every single day to be productive, every session to help every client. But I do expect that at the end of my life I will be able to look back and know beyond a doubt that, in my own way, I changed things for the better.

That’s why I’m choosing social work.

P.S. A little disclaimer–I’m not looking for any comments on how I’m wrong about the doctoral route or why I should reconsider my decision. There’s a lot more than went into it than I could even discuss here, and there are enough Older and Wiser People trying to tell me how to live as is. Thanks. :)