Q&A: Career Aspirations for People with Serious Mental Disorders

Ye Pogue is a health care economist at RTI specializing in evaluating quality of care for healthcare organizations, and health service research for behavioral health. She is also an advocate for people with serious mental illness – a position that stems from her own experience with bipolar disorder. Recently, she published a first-person column in the journal Psychiatric Services, titled Career Aspirations for People With Serious Mental Disorders. In the column, she shares her reflections on the stigma and discrimination associated with serious mental illness, and how her experiences shape her career aspirations.

We sat down with Ye to discuss how the piece came to be, and her hopes for an evolving workplace culture in which all individuals feel free to thrive.

Q&A with Ye Pogue

Sharing a diagnosis of serious mental illness can lead to stigma and even discrimination, as you point out in your published piece. Tell us how you decided to write about your experience in a public forum.

Last year, I read a book titled "Beyond Schizophrenia: Living and Working with a Serious Mental Illness" by health economist Marjorie L. Baldwin. In her book, she concluded that to debunk the stigma associated with serious mental disorders, such as being dangerous and incapable, individuals with serious mental disorders need to demonstrate that many of us actually occupy valuable positions in society, for example, holding full-time competitive jobs, so that the general public will gradually change their opinions. The more of us who hide our conditions, the more we push ourselves to the margin and allow serious mental disorders to be reported in tragedies and suffering only. Then I realized that disclosing my condition is, in fact, a public good in itself. Based on my five-year experience of working at RTI, I feel we are a very inclusive organization, so I feel comfortable disclosing my condition in a public forum.

Tell us about the process of writing a perspective piece like this one and how it compares to publishing a more typical academic article.

There is still a lot of fear when writing and submitting articles like this one. I wrote another column for Psychiatric Services last year, and I spent some time debating whether I should use a pseudonym. I thought it would be a fairly simple decision, but when you really start to think about the potential repercussions, it becomes more complex. In the future, if I need to apply for another job position, people researching my background will find my diagnosis even before they meet me in an interview. What type of assumptions and biases would this knowledge bring into the hiring process? I don't worry too much about people who already know me developing biases because of this new revelation. The fear is more about the unknown in the wild. I eventually decided to use my real name because if a person with a Ph.D. degree in this field is too afraid to use their real name, it will reinforce despair and be a great disservice to people living with serious mental disorders.

When I write articles like this, it requires a lot of soul searching, and I am very cautious with the words I use and the examples I choose to avoid exacerbating stigma. In contrast, while writing typical academic articles, I am much more detached. However, there are good things about writing such articles; it feels liberating when confronting one's fear.

How do you integrate your passion for greater understanding of serious mental illness with your research into the healthcare system?

The current health service research increasingly values the lived experiences of persons with mental illnesses. I know some research groups have started to include "experts by experience," who were formerly simply referred to as patients. Because I live with this condition, I have seen the cracks and obstacles in many systems outside healthcare, such as education, employment, and immigration, which are difficult for my peers without serious mental disorders to see. My condition gives me unique perspectives. In current health service research, scholars are beginning to pay attention to systems and the intersection of systems when addressing health inequity. Health equity is a very polarized topic when certain research frameworks are used. Because of my experience, I can understand why some scholars use specific phrases and concepts, such as power and oppression, which are considered provocative and divisive for many. I may not necessarily agree with their frameworks, but I can see where they come from, allowing me to explain the healthcare system flaws behind these frameworks to people who seem to disagree with health equity, so that they could understand.

You note that “the desired outcome for persons with serious mental illness is remission and a high level of social functioning. Holding a full-time, mainstream, competitive job is like the Holy Grail.” Have you had any experiences that helped you see beyond these basic expectations?

Over the years, I have realized that I react to conflicts and "crises" differently from most people. When people run away from conflicts, I run toward them, trying to help different parties find common ground. Additionally, when I find something interesting, my interest is more potent than that of others, and it usually lasts longer as well. I used to think this was just a personality trait, but it really has something to do with bipolar disorder – people like me seek excitement and feel strongly about things. This makes me think that maybe I can do something that other people may find too troublesome and avoid doing. It means that if planned well, I and many people like me can find a niche in our career development and compensate for our weaknesses caused by mental illnesses. However, society's expectations for us are basic, focusing on our shortcomings rather than our strengths, not to mention unique talents.

I have read many first-person accounts written by a variety of people living with different mental illnesses. I have found extraordinary resilience in them. These accounts are so encouraging, and I believe that if our symptoms are under control, the resilience gained by coping with mental disorders may help us go beyond societal expectations.

How has writing this piece changed your answer to your project director’s original question: ‘What is your career aspiration?’

After doing much soul-searching and completing this piece, I found that I want to live more authentically, rather than pretending to be someone else. I want to embrace my passion more and be braver. I come from China, a culture where you are expected to conform to the "norm," and people pay a lot of attention to how others perceive them. I find that I care less about these expectations in the corporate setting now. If people think I am a little eccentric or outside the "norm," as long as I am not creating tension or causing problems within my team, I do not worry as much about what others think of me. I may speak up more or try something that I used to avoid. Regarding career aspirations specifically, I am more honest about what I want, rather than what people believe I want. As a result, I have ended up meeting new people and being exposed to more exciting ideas. I spent years trying to be "normal" in terms of career development, doing what Ph.D. graduates are supposed to do. Now, I want to follow my heart to work in the way I feel is most helpful and play to my strengths.