It Does Not (Just) Get Better by Jo Breit

CW: mentions suicidal thoughts, self-harm, depression.

If you are a young researcher (maybe a student or a postdoc), struggling with anxiety and depression, maybe you think it will get better once I graduate, or maybe you think it will get better once I get a postdoc with a fancy group, or it will get better once I get a paper in a prestigious journal, or it will get better once I get a tenure track faculty position

I am here to tell you that those things will not make it better. I have been there, thought those thoughts, and achieved those goals. My depression and anxiety are still here.

Maybe you can yourself recognize that you once thought that it will get better once I get into grad school or once I pass my quals and now that you have achieved those goals you are still struggling.

I have struggled with depression all my adult life

I was in therapy and heavily medicated by the time I was 20. At the time, I was told I was bipolar. Later, I was told other diagnoses, including being told that I had a personality disorder. But none of these labels ever fit me. I would sit in group therapy, with all these other people who shared a label with me and feel no more kinship with them than with anyone else (my heart often broke for them, for their stories, for their struggles, but I felt different).

My doctors and therapists would tell me my case was not typical, but I still technically fit the profile of whichever diagnostic they were pinning on me at the time. Finally, last year, after decades of dealing with the mental health industrial complex, I realized that I am autistic. I realized it first on social media, reading a thread by an autistic person. And, for the first time, I felt it matched. Later, I had a professional validate this diagnostic, and finally I have a label that makes sense.

In retrospect, it is clear how autism has colored my life and my mental health in particular. From how seriously I took some hobbies (which I would now refer to as special interests) to how I had a years-long episode of autistic burnout—I am still recovering from that. Autistic burnout is a specific manifestation of burnout and one of its characteristics is that the autistic person partially loses their ability to “mask”. Masking is pretending to fit in and having less ability to mask makes one feel or come across as “more autistic.”

Being autistic does not mean that I do not suffer from depression. In fact, autistics are at higher risk for depression than allistics (non-autistic individuals). However, autism changes my experience of depression and how I should approach it. For example, I sometimes want to lie down in the dark in silence. Before, I might have interpreted this as a symptom of depression and tried to rouse myself. Nowadays, I will interpret it as reducing sensory overload and allow myself that rest.

Professional success has not helped, but other things have

I have achieved more than my fair share of professional success. I have a tenure-track position at a good university. I have obtained grant funding and attracted students and postdocs to my research group, I have published in the highest-profile journals. Yet, this success has not made much of a difference to my mental health. I do not have tenure yet, but I would be very surprised if it turned out that tenure finally made the difference and brought happiness, that finally stopped me from crying late at night while everyone else in the house sleeps.

If achieving the basic professional goals has not helped, what has? Number one has been medication. However, finding the medication that works for me, with tolerable side effects, took years.

I used have cycles where I would start taking medication when I was doing very poorly and obsessed with suicidal thoughts. I would then feel better, I would stop engaging in self-harm, but struggle with the side effects. So, I would eventually stop taking the pills. Sometimes I did this against the advice of doctors, but they were not the ones gaining weight or feeling sluggish or without their libido. Many doctors were downright dismissive of my complaints about the side effects. More than once, I nodded agreement in their office while being politely talked down to, knowing already that I would not fill the prescription they were handing me, I would instead stop the medication and perhaps not return to that doctor’s office again. Six months later, I would be back where I started: struggling with depression and barely able to function.

Eventually, I found a doctor that took my concerns seriously and was willing to tune the medication and the dosage with me. Right now, I take a 150mg of Wellbutrin per day. This is a low dose: I even recognize that is too low to be fully effective, but it is tolerable. For me, right now, that is the right balance.

The second thing that has helped has been talk therapy. There is often a notion that talk therapy is inherently superior to medication, even morally better, but this is not always the case: again, it is important to find the right person and fit. Sometimes, therapists bring their own biases into the therapy.

For example, I had a therapist who helped me extensively with how to deal with my alexithymia. This refers to difficulty in identifying emotions; and is very common in autistics (although not exclusive to us, I had not been diagnosed autistic at the time). However, his conservatism sometimes shined through when we discussed my sexual life (I am polyamorous). He did try to say the right things (“well, if it’s consensual, I guess that is okay”), but his feelings still shone through and this made me hesitant to discuss an important part of my life. When I later moved and had to find a new therapist, I explicitly looked for one that advertised themselves as comfortable with polyamory (perhaps not coincidentally, this therapist is also autistic).

Academic career pressures and mental health interact as well. They interact when our academic success is used to deny us diagnoses and services. Autism is still often thought of as a learning disability, which some therapists will interpret to mean that is someone is academically successful they are ipso facto not autistic (I know of others who faced similar barrier for accessing ADHD treatments).

I also remember a therapist who wanted to convince me to take on a less stressful job. I do not wish to deny anyone that choice, but I do not think it was the right one for me. If mental health has been called the sports injury of academia, imagine if sports doctors had as their first piece of advice “have you considered not competing in your sport?”

On the other hand, there are some mental health advantages to academia. One of the enduring banes of my existence is sleep disturbances (which includes both bouts of insomnia and bouts of oversleeping), which can be further exacerbated by medication (the Welbutrin I now take intensifies the insomnia; anti-psychotics have resulted in not being able to wake up early). In this case, the joke that “academia is great because of the flexibility of working the 80 hours of the week you choose” becomes true. Unlike in other jobs, I can show up to work late one day or work in the middle of the night when I wake up at 2am. This may seem frivolous, but I truly do not know whether I would be able to keep a regular schedule at a “typical job.”

The final thing that has made a big difference has been having better personal relationships. This has not happened by accident, but through work and growth. For me, it took realizing that the relationship structure that fits me best is not traditional monogamy and working to understand how I can have the relationships that bring me joy and fulfilment in an way that is done with integrity. It will be different for everyone (and it can change throughout your life), but finding out what you want and communicating it to others with respect and kindness is hard work. Working out how you can bring others happiness without losing yourself in the process is hard work. Emotional labor is labor.

It did get better

It did get better. But it was not handing in my thesis or getting the next publication that made a difference. It was the medication and the hard work of therapy and relationship improvement that eased the depression.

Not cured it, though. I have seen some people suffer from depression and be cured of it and I realize that this is possible. But I have been fighting this monster (depression) for decades and I fully expect to still be struggling with it in ten years.

I know that any victories against the monster will not come from finishing that manuscript or from the journal accepting it. Victories only come from fighting the monster directly, not hoping that the monster will not follow you to your next job.

Jo Breit is the pseudonym of a tenure track faculty member in a STEM field. They can be reached at