Postsecondary Students and Bipolar Disorder:
Final Frontier or Lethal Cocktail?

Karen Reynolds
Assistant Professor
Faculty of Education
University of Regina
Email: Karen.Reynolds@uregina.ca

...Jonathon said the time had come to return to the Flock. "We're not ready," said Henry Calvin Gull. "We're not welcome! We're Outcast! We can't force ourselves to go where we're not welcome, can we?" "We're free to go where we wish and to be what we are," Jonathon answered, and he lifted from the sand and turned east, toward the home grounds of the Flock. (Bach, 1970, p. 104)

Mental illness is leaving the closet. Films like "A Beautiful Mind" and "Girl Interrupted" promoted empathy for individuals diagnosed with schizophrenia and depression. Television shows such as "CSI," "Law and Order," and "Six Feet Under" portray victims of bipolar disorder in a relatively sympathetic manner. In contrast, movies like "Silence of the Lambs" and the "Psycho" series characterized mentally ill individuals as crazed and dangerous. Stigma associated with mental illness ranges from blatant discrimination to veiled tolerance. According to Simmie and Nunnes (2001) the most devastating aspect of stigma is that it pre-judges an individual with little or no knowledge of the person.

...misconceptions are automatically applied, denying the person any opportunity to disprove them. When that happens to a person again and again, it's not unusual for them to internalize that stigma and start losing hope. When hope diminishes, so do the odds of retuning to sound mental health. (p. 301)

In this paper, I explore experiences of a group of postsecondary students diagnosed with bipolar disorder. Within this context, I examine how stigma associated with mental illness impacts identity, learning, and achievement. In addition, I look at ways in which faculty might support students diagnosed with bipolar disorder. The study took place at the University of Regina, Saskatchewan, Canada. The University of Regina is committed to equity for academically qualified special needs students in terms of access to educational opportunity.

What Is Bipolar Disorder?

Next time you see a Hollywood movie about 'crazy' people, or laugh about someone being in the psych. ward, please don't judge that person. He or she could very well be walking down the same university hallway you are, or sitting next to you in class. (Interview, April, 2003)

The American Psychiatric Association's (2000) "Diagnostic and Statistical Manual of Mental Disorders" states that defining features of bipolar disorder or manic depression are represented by mood swings from depression to mania and vice-versa. Bipolar I is characterized by alternating cycles of mania and depression. Bipolar 11 consists of depression and hypomania. Bipolar 111 describes individuals who are treated for depression and whose condition seems to be related to bipolar disorder. Cyclothymiacs is distinguished by chronic mood swings that do not approach the severity of mania or depression. Rapid-cycling bipolar disorder is identified when an individual experiences four or more occurrences of mania, hypomania, depression, or mixed state in a year (Mondimore, 1999). Manic states vary in terms of intensity and manifestation. One or more of the following symptoms tend to characterize manic episodes.

Elated, euphoric mood, irritable mood, grandiosity...racing thoughts, increased energy level, decreased need for sleep, erratic appetite, increased libido, grandiose delusions, hallucinations. (Mondimore, 1999, p. 10)

Definitive causes of bipolar disorder are not known. With limited causal evidence, physicians rely on symptoms to diagnose the disease (Simmie & Nunes, 2001). Approximately one person in every hundred is Bipolar (Watson, 2003). Eighteen tends to be the average age of onset for bipolar 1 and twenty-two for bipolar 11 (Barlow & Durand, 2002); a common age range for postsecondary undergraduate students. Milder mood swings tend to precede onset of the disease. Approximately 35% of bipolar disorder cases begin during late adolescence (Edwards, 2002). There is no cure.

Recent studies of brain function and bipolar disorder indicate damage to the prefrontal cortex. Neurons are compromised in their ability to carry oxygen, glucose and anti-infectious agents in the bloodstream; brain damage results. Impairments to learning and achievement may consist of difficulties pertaining to short-term memory, task completion, concentration, focus, and information processing skills (Torrey & Knable, 2002).

The search for a bipolar gene has been tempered by awareness that environmental influences impact the disorder (Watson, 2003). When studies of human potential privilege genetic influences over environmental considerations, hereditarian beliefs tend to prevail. The following excerpt recounts how genetic research regarding Schizophrenia led to a call for sterilization of individuals with the disease.

The father of psychiatric genetics, Ernst Rudin...arguing on the basis of statistics collected by co-workers advocated the eugenic sterilization of schizophrenics. When Hitler came to power in 1933...Professor Rudin served on a panel, with Heinrich Himmler as head of the Task force of Heredity Experts who drew up the German sterilization law of 1933. (Rose, Lewontin & Kamin, p. 207, 1984)

Franz Kallman, a student of Rudin, and president of the "American Society for Human Genetics" was a strong proponent of sterilization for Schizophrenics. Some people worry that discovery of a bipolar gene might resurrect forced sterilization practices for victims of the disorder.

Even though the disease appears to have a genetic component, it is equally important to acknowledge that environmental influences positively affect cognitive, psychomotor, and affective development. Postsecondary education can be a field rich with opportunities for students diagnosed with bipolar disorder. Within this context, appropriate program modifications may positively mediate learning and achievement of students diagnosed with bipolar disorder. According to Wendell (1996),

Neither impairment nor disability can be defined purely in biomedical terms, because social arrangements and expectations make essential contributions to impairment and disability, and to their absence. ... Social arrangements can make a biological condition more or less relevant to almost any situation. (p. 35)

Social arrangements may be interpreted as program modifications within academic settings that increase access to learning and achievement for students identified with one or more learning disabilities. In the next section, I look at ways in which university policy pertaining to special needs students may support learning and achievement of individuals diagnosed with bipolar disorder.

University Policy and Special Needs Students

Students with a variety of disabilities participate in programs at the University of Regina. An individual's learning needs can be identified by a qualified health professional and processed by the student and a representative from the Learning Disabilities Office. Program modifications may consist of permission to write tests and exams in a room with limited distractions, take examinations orally, seek extensions for assignments, engage the assistance of a note-taker, utilize a personal reader, tape-record lectures, and acquire copies of overhead projector materials. University policy indicates that students are responsible for course content and for progressing towards greater independence in making decisions regarding their involvement at the university (Mader, 1993).

Faculty can refuse to implement one or more modifications if he or she believes that course standards will be compromised. When a student is denied access to modifications, he or she can arrange for a meeting with the Department Head and instructor to explore alternatives. If this approach fails, the student may appeal her or his case to the Dean of the instructor's faculty. The Coordinator of Special Needs Services is available to facilitate the appeal process. Students diagnosed with bipolar disorder are presently eligible for support from the Learning Disabilities Office (Mader, 2003).

University policy pertaining to students with special needs draws its definition of disability from the Saskatchewan Human Rights Code. The second half of the definition echoes characteristics of bipolar disorder. Within this context, the disorder may be interpreted as a disability.

Disability means:

Any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness and, without limiting the generality of the foregoing includes:

• epilepsy; any degree of paralysis; amputation; lack of physical coordination; blindness or visual impairment; deafness or hearing impairment; muteness or speech impediment; or physical reliance on a guide dog, wheelchair, or other appliance or device;

or (ii) any of:

• a condition of mental retardation or impairment;
• a learning disability or a dysfunction in one or more of the processes involved in the comprehension or use of symbols or spoken language;
• a mental disorder, where "mental disorder" means a disorder of thought, perception, feelings or behaviour that impairs a person's:
  1. judgment
  2. capacity to recognize reality
  3. ability to associate with others; or
  4. ability to meet the ordinary demands of life. (Mader, 2003, p. 23)

Numbers of students diagnosed with bipolar disorder and using the services of the Disability Office appear to be low. In the Winter 2002 semester, two hundred and eight students were known to the office (D. Mader, personal communication, November 27, 2003). Only two were diagnosed with bipolar disorder. Forty students were classified as learning disabled and sixty-two individuals were identified with Attention Deficit Hyperactivity Disorder (ADHD). Such a low incidence of bipolar disorder might be influenced by several factors. First, stigma of mental illness keeps some students from revealing their diagnosis. Second, advanced research into co morbidity between bipolar disorder and ADHD points to a relationship between the disorders (Torrey & Knable, 2002). Third, when learning disability is classified separately from a mental illness like bipolar disorder, then the numbers not only reduce but they also obscure incidence of bipolar disorder.

The Purpose and Context of the Study

...mental illness advocacy is the civil rights movement of the new century. (Waltz, 2002, p. 296)

The case study situates issues pertaining to learning and achievement within the context of a group of university students with a diagnosis or suspected diagnosis of bipolar disorder. Case study research is useful because it represents an approach to empirical inquiry that examines a particular context in detail (Yin, 1994). According to Marshall and Rossman (1989), "the strength of qualitative studies should be demonstrated for research that is exploratory or descriptive, and stresses the importance of context, setting and subject's frame of reference" (p. 46).

Participants learned about the research from posters that I put up in the Faculty of Education, Library, Cafeterias, Student Services and Student Health Centers. Interested individuals telephoned my office to schedule an interview. Participants were selected from volunteers who had received a diagnosis of bipolar disorder from a physician, were under medical care, and could articulate their experiences. Seven individuals took part in the study; four women and three men.

I interviewed most participants twice; two individuals wanted to be interviewed in excess of three times. All were given the option of more sessions. Interviews were informally structured and taped for later transcription. I chose this data-collection technique because the informally structured interview helped me to gather information about an individual's standpoint regarding particular issues. Interviews were conversational and offered participants flexibility to explore and articulate insights and concerns.

Each interview was approximately one and one-half to two hours long. The following questions served as guides to discussion of major issues: a. How does bipolar disorder affect your learning and achievement? b. What types of educational accommodations support your learning needs? c. How does bipolar disorder impact your identity? How does the disorder affect your relationships with peers? d. Can you describe your experiences with faculty regarding your learning needs? At regular intervals in the interview process, I asked participants to clarify their interpretations and concerns. I verified my understanding of their comments by restating them to participants and asking if what I said was an accurate reflection of their perspectives. When they answered in the affirmative, we proceeded with our discussion. When they disagreed, we renegotiated our comments until we were satisfied that I understood their intentions. Each participant was invited to edit her or his interview transcripts; to add, delete, and clarify statements. According to Silverman (1993) this approach to respondentvalidation offered a suitable form of validation for the logic of the study.

Data-analysis focused on identifying key themes and categories pertaining to the experiences of students. Content analysis techniques were used to generate findings and corroborate multiple perspectives associated with themes and categories. I chose the criteria of transferability as a measure of the study's potential usefulness to other researchers (Lincoln & Guba, 1985). That is, whether or not the study is transferable to another context is a question that must be determined by those who are interested in contemplating such a possibility.

The interpretational framework for the research was influenced by Bourdieu's (1986a) theory of "capital" or power. He suggests that various forms of capital mediate human activity; in particular, "social capital," "cultural capital," "institutionalized cultural capital," and "symbolic capital." According to Bourdieu, social capital consists of power to engage in group membership and valued relationships. Cultural capital refers to dispositions and access to goods and services associated with the dominant group in society. Institutionalized cultural capital can be understood as high marks and grades within educational settings. Symbolic capital represents the power to acquire recognition and acceptance in society (Bourdieu, 1989d). All four forms of capital represent power to acquire significant relationships, educational certificates/degrees, gainful employment, housing, positive identity, and community membership. Fields represent arenas of unequal power relations among people competing for capital or the major stakes in a field.

Bourdieu (1974) describes ability to learn and achieve in terms of cultural capital. Socio-economic, cultural, and social privileges can have high exchange value for academic success. He explains that conceptions of high ability in schools may institutionalize and foster discrimination. Bourdieu claims that, "by awarding allegedly impartial qualifications...(the school) transforms de facto inequalities into de jure ones. (pp. 115-116). Within this context, access to appropriate program modifications represent important capital for postsecondary students diagnosed with bipolar disorder.

Bourdieu (1992) sees forces involved in determining the major stake or capital in a field as structuring procedures and actions by which people produce, obtain, and convert capital. He is particularly interested in forces that shape means by which capital is produced, distributed, and exchanged in a field. In the education field, high marks and grades or objectified cultural capital, can have important exchange value for access to further education, certification, social status, membership in valued groups, and possibly even employment. Within this context, the playing is not level. Some students are privileged over others in their access to educational opportunities. For example, the stigma of mental illness fosters discrimination against individuals diagnosed with bipolar disorder.

From Bourdieu's (1986a) standpoint, forces involved in defining the major stake or capital in a field structure means and practices by which people generate, acquire, and convert capital. Policy-makers, educators, and academics at provincial, regional, district frame the major stake in the field of education, and local levels. Marks and grades tend to frame achievement and act as gatekeepers to learning opportunities. Within this context, appropriate program supports for student's special needs may positively mediate access to achievement and learning. From this viewpoint, learning and achievement are socially situated within settings characterized by unequal relations of power among people engaged in purposeful activity. In the next section, I describe major themes associated with struggle for acceptance, learning, and achievement from students' perspectives. The discussion begins with an anonymous portrayal of participants.

Findings from the Student Interviews

Participants:

a) Female, 24; diagnosed at age 21; possible ADHD at 14 or 15; one suicide attempt; on medication; finished professional degree; in long-term relationship.

b) Male, 26; diagnosed ADHD, Obsessive Compulsive Disorder, physicians suspect bipolar disorder; one suicide attempt; on medication; pursuing undergraduate degree, in second year; separated; sees four-year-old son regularly.

c) Female, 21; bipolar disorder diagnosed at 19 years of age following suicide attempt that resulted in hospitalization in psychiatric ward; on medication; third year student in professional degree; married.

d) Male, 33; diagnosed with bipolar disorder, on medication, separated; visits twelve-year-old daughter; pursuing second professional degree.

e) Female, 19; Bipolar disorder diagnosed during three week stay in a psychiatric ward of hospital followed by several weeks of day patient treatment. Discharged in mid-July 2003. Has not attempted suicide but has thought about it. Second year student in professional degree; has steady boyfriend.

g) Male, mid-twenties; diagnosed with bipolar disorder, has been a student since fall 2001 in Arts Program.

h) Female, 23; physicians suspect bipolar disorder; pursuing second professional degree; in long-term relationship.

Major Themes

Content analysis and triangulation of interview transcriptions generated three major themes that consisted of identity, stigma, learning, and achievement. Following is a discussion of each theme from participants' perspectives. Participants' comments were drawn from interviews conducted during April, September and October 1993.

Identity:

One student explained that she welcomed the label, bipolar disorder.

I was relieved to get a label that I could then research and learn about. To some people I am now able to say, 'this is why I did this. This is why I hurt you.' For that reason, in their perception of me I'm glad to have that label. (Interview, April, 2003)

Several students saw the bipolar label as limiting. They resisted being classified in terms of a psychiatric disorder.

Bipolar people already have a problem with defining themselves. It takes a lot of energy to define you in a day, let alone forever. (Interview, April, 2003)

I would like to be labeled anything else (but bipolar)...at a time when I'm trying to find my sense of self. (Interview, April, 2003)

I think that if I wasn't in this position [university student] right now I would be devastated by the fact that, 'I'm worthless.' I'm even Bipolar. Like I can't do anything right. I can't even be a normal person. (Interview, April, 2003)

When students don't get the help they need stress levels increase. Stress can trigger partial to full episodes of depression and [hypo]mania. (Interview, April, 2003)

Stigmatization and low self-esteem contributed to suicidal thoughts and behaviours for one participant.

I had a major depressive episode when I was sixteen years old and it lasted probably a good year and it ended with me trying to commit suicide. ... From seventeen on I never got any help for anything, until I was twenty. (Interview, April, 2003)

Not only did the stigma associated with a psychiatric label impact negatively on an individual's sense of self, but medications also interrupted intrapersonal and interpersonal growth.

Medications help stabilize moods on the one hand and suppress personality on the other. ... Part of my personality is gone. (Interview, April, 2003)

Threat of relapse did not ease participants' reluctance to take medication. Students explained that they missed the highs associated with hypomania and mania. Although medication had a stabilizing effect on mood swings, it appeared to obstruct creative ideation. Students explained that they felt tired and were less productive when taking medication. Some individuals commented that they completed more assignments satisfactorily and on time when they were in a hypomanic state.

Participants wanted to party like their peers; they wanted to drink and stay up late. Students understood that alcohol and lack of sleep contributed to relapse. Young women in the study also worried that they would not be able to have children. They heard from a variety of sources including family, friends, and boyfriends that the genetic component of bipolar disorder made it unwise to reproduce. That is, they might give birth to a baby with bipolar disorder. Several participants heard that medication might contribute to birth defects. Two individuals considered going off medication during pregnancy. However, they worried about the threat of relapse and subsequent harm to the fetus.

Stigma:

Participants worried that the stigma associated with mental illness negatively influenced their relationships with family, friends, peers, and faculty. Proactive isolation consisted of community members openly avoiding and even shunning an individual diagnosed with bipolar disorder. The individual withdrawing into silence and/or resorting to deception characterized reactive isolation. Most participants were afraid to tell faculty about their diagnosis. One pre-intern student explained how she felt when an unidentified source told her that a faculty member stated that individuals identified with bipolar disorder should not be teachers. Prior to the event, she had shared her diagnosis with the instructor.

Okay so we're talking about this stigma and a certain teacher that doesn't think that people like me should be teaching. He wouldn't say that about people with cancer, he wouldn't say that about people with Crone's Disease, he wouldn't be able to say that about a certain culture, and we shouldn't be able to say that about women or men or anything else and of course it's exactly along the same line. ... He's never seen what I do with kids...and I'm not bragging but I'm good with kids.

There is a real stigma with mental disease and working with children because 'Oh my God you're crazy and you're working with my kids!' It comes from the history of mental disease. It's a history of intolerance. It's the same as gay teachers. I don't care one iota if the teacher's gay if he's going to show up every day and teach my kid what he's supposed to teach my kid. ... You wouldn't be able to tell someone that you can't be a teacher because you're gay; but mental disease is different! (Interview, September, 2003)

It was not uncommon for students in the study to compare being bipolar with being gay. They assumed that gay and lesbian students enjoyed more rights and freedoms than students diagnosed with a mental illness.

Participants explained that they experienced isolation when they were unable to talk openly their disorder. Within this context, they found it difficult to reach out to peers and faculty for support.

Bipolar can make me feel very isolated. People want to know why I am sad. When you can't give them an answer or explanation, you feel so cut off and different from them. (Interview, April, 2003)

Best not to tell about a disorder unless one is going to feel badly about deceiving another individual. (Interview, April, 2003)

Most participants said that they experienced one or more instances of discrimination in the university system.

There was one class. A lot of people knew about me and it was like I was a leper. I was really left out of a lot of things. When it came to labs, nobody wants you as a partner when they think you're a nut case. ... I did a lot of my labs alone when it called for two people. And I'd look across and some people were in teams of three. ... The teacher's not saying anything. I'm sitting here. I guess I have to do it on my own. (Interview, April, 2003)

I'm very comfortable with Aboriginal and mainly Vietnamese and Chinese (students). They don't judge. ... I've noticed with the Vietnamese cultures, the Chinese cultures, and Aboriginals that nobody gets left behind. (Interview, April, 2003)

Learning and Achievement:

Participants in the study were high achievers before the onset of bipolar disorder. Post onset of the disorder, they experienced learning difficulties characterized by impaired memory retention, concentration, focus, organization, and information-processing skills. One individual explained that her overall average dropped from 85% prior to onset of the disorder, to mid-60% post-onset. For some students, side effects of bipolar disorder became noticeable during university studies.

People...sometimes have lived their life having a disorder and knowing it and don't discover it until they hit university. Three of my cousins have already had that problem. Each one of them hit a bipolar point and had to go on lithium (and) are starting to find success now. (Interview, April, 2003)

Participants also experienced difficulties with learning and achievement with and without medication. Although medication helped to stabilize moods, it tended to provide little or no support in terms of cognition.

[Off medication] the way ideas come to you...they just suddenly appear as a spark in your brain. [On medication] there's nothing firing off there. There's something missing. My writing is gone. And I act, and it's gone. (Interview, April, 2003)

Sometimes I feel that if I were not bipolar my marks would be higher in school. I would be able to concentrate better. I would have better reading comprehension. I wouldn't forget everything right away. I would have the energy to get to my schoolwork right away instead of procrastinating. (Interview, April, 2003)

Several participants explained that diverse instructional strategies and program modifications increased their access to learning and achievement.

I seem to have a low attention span, and this is difficult if you have somebody who's going to be up there just lecturing at you all the time. Like I love these classes where they have power point or they have notes on the overhead or even you get the notes and you can add more to it. ... If I lose track of what we are talking about I'm not totally lost. (Interview, April, 2003)

It's hard to sit there and do lots and lots of readings. All of a sudden I'll be done the page and I don't remember what I read. I have to make sure that the place is quiet, that I'm not distracted. I can't just sit there and read two chapters. Like I have maybe read half of Chapter 1, take a little break, and go for a walk. You can't just sit there because you won't comprehend it at all. (Interview, April, 2003)

Small classes have helped a lot. ... A large lecture hall is not a place where you usually do a lot of interaction. (Interview, April, 2003)

One student recalled the impact of a professor's positive response to his disability.

Well, he (professor) knew about my disorder and he put his hand on my shoulder, 'I understand. I've got a nephew who's exactly the same way.' After that I was comfortable with that and his teaching methods. (Interview, April, 2003)

The student added that she felt relaxed in the field and was highly organized during pre-internship and internship.

I am much more relaxed in the field partly because I am very very confident. ... I'm very organized. ... I like to know where I'm starting and where I'm going. And not necessarily that everything's planned down to the last day but just that, 'Okay I need to accomplish these six things if we're going to get this stuff done.' (Interview, September, 2003)

Not all students diagnosed with bipolar disorder had access to program modifications. Several individuals were afraid to disclose their diagnosis. Faculty members denied some students access to program modifications. Other students were unaware of services for students with disabilities. In the following excerpts, participants describe how they coped without the support of program modifications.

So many times during a test...you're so frazzled because everybody else is making noise and you read the same question like five times over and you're just like, 'Oh I wish everybody would be quiet and I wish you could take it by yourself. (Interview, April, 2003)

One individual who recently completed fieldwork commented that she learned to lie her way through her degree program.

I lie a lot and act a lot. I wish that I didn't just learn how to lie [about incomplete work]. I would make a story. I've made up tons. (Interview, April, 2003)

The student bitterly recalled telling a professor that an assignment was late because she recently learned that her mother had cancer. The professor replied that her mother's cancer was not an excuse for lateness. The young woman reasoned that if cancer did not qualify for consideration, then bipolar disorder was definitely out.

I personally wouldn't feel comfortable talking to any of my professors, even if I were having a problem and wanted an accommodation for it. (Interview, April, 2003)

One student explained that learning to cope with a disability took time.

You don't get through your problems with your disorder over night. And life's still going on around you. So whether you're sitting in a corner depressed or feeling like crying, your assignments are still there; our teachers and fellow students are still going on. So there's that additional pressure, 'Okay I've got to get through this so that I can get to this.' And it does not happen right away. And you miss a week in a university; you could be hurting a little there. (Interview, April, 2003)

Discussion of Findings

When I examined participants' comments in terms of Bourdieu's (1986a) theory of "capital," I gained a deeper understanding of the role that unequal relations of power played in their access to learning and achievement. Within this context, key themes consisting of identity, stigma, learning, and achievement signaled sites of struggle among students and faculty for recognition, acceptance and equitable access to educational opportunity.

Numerous Canadians identified with bipolar disorder choose not to disclose their diagnosis to family, friends, teachers and co-workers (Simmie & Nunes, 2001).

Not surprisingly, students in the study did not talk publicly about their disorder. They feared that the stigma of mental illness might contribute to rejection and even ridicule by peers and Faculty. Porter (2002) describes the power of stigma to impact membership in society and identity in the following excerpt.

Stigmatizing -- the creation of spoiled identity -- involves projecting onto an individual or group judgments as to what is inferior, repugnant, or disgraceful. It may translate disgust into the disgusting and fears into the fearful, first by singling out difference, next by calling it inferiority, and finally by blaming 'victims' for their otherness. (Porter, 2002, p.62)

According to Bourdieu (1989d), some individuals willingly participate in their oppression. Participants who refused to disclose their disorder to a Learning Disabilities Officer and/or faculty member might be regarded as unwilling participants in their marginalization. Effects of marginalization on a student's identity and access to education ranged from social isolation to partial or full denial of program modifications. Students were clear that they needed support from faculty to succeed in their chosen fields of study. Several participants commented that cooperation among health professionals, the Learning Disabilities office and faculty was critical to their learning and achievement.

Participants assumed that stigma associated with bipolar disorder compromised their access to learning and achievement. When a student feared disclosing her or his special needs to Faculty, appropriate program modifications were not identified. He or she struggled to learn and compete for marks and grades or institutionalized cultural capital, without needed supports.

Students explained that ability to concentrate and process information improved when faculty used a variety of instructional strategies. These strategies were characterized by active learning in the form of cooperative group work, discussion, problem-solving activities, projects, and presentations. Task completion was enhanced when faculty partitioned assignment deadlines into smaller units. Performance on tests and exams improved when students completed tests and exams in quiet settings with few distractions. Not all characteristicsof bipolar disorder were alleviated by medication. Medication generated a variety of side effects. For example, lithium tended to stabilize moods but contributed to fatigue. Program modifications might address side effects of medications.

Four out of seven participants thought about or attempted suicide. Suicide is a serious problem for all concerned about students diagnosed with bipolar disorder. According to Mondimore (1999), rates of suicide among individuals identified with bipolar disorder may be thirty to eighty times higher than observed in the general population. Suicidal thoughts and behaviours represent serious symptoms of the illness. Contributing factors consist of stress, isolation, loneliness, low self-esteem, stigmatization, learning difficulties, poor marks and grades, substance abuse, depression, sleep disorders, hopelessness, unemployment and poverty (Simmie & Nunes, 2001). Appropriate educational modifications for students diagnosed with bipolar disorder may reduce incidence of relapse and possibly even suicidal ideation and behaviours; in Bourdieuian (1986a) terms, program modifications represent a form of cultural capital that may have high exchange value for marks, grades, diplomas, and mental health.

Like Bourdieu's (1986a) theory of capital, Wertsch's (1995) concept of "mediational means" strengthens support for program modifications. Mediational means can be understood as language and tools that bridge peoples' actions and settings in which they are used. Within this context, appropriate and effective program modifications offer students diagnosed with a disability access to valuable resources in terms of their learning and achievement. Wertsch is clear about a need for differentiated means of instruction and learning to increase achievement. He illustrates his point by describing how a change from wooden to fiberglass poles increased vaulting performance. The example illustrates how changes to mediational means positively influence actions of individuals participating in purposeful activities. Within this context, program modifications support and even increase learning and achievement for students with disabilities. Participants pointed out that access to program modifications such as personal readers, note-takers, tape-recorders, modified timelines/deadlines for assignments, and alternate sites for completion of tests and exams, positively mediated their performance.

Overall, participants wanted to be fully recognized and accepted members of the university community. They wanted a voice in decisions that affected their access to education. Some wanted a review of criteria pertaining to admissibility of program modifications from perspectives of people directly involved. Participants agreed that appropriate and effective modifications to course work were fundamental to their academic success. Wertsch (1991) describes the power of cultural tools such as program modification to positively mediate performance in the following excerpt.

We can never 'speak from nowhere,' given that we can speak (or more broadly, act) only by invoking mediational means that are available in the 'cultural tool kit' provided by the sociocultural setting in which we operate. (Wertsch, 1991, p. 25)

Within this context, identity, learning, and achievement were situated within, and by, access to cultural tools such as language and other mediating means. When a student's access to mediational means or program modifications was limited or even denied, her or his sense of self and participation in a course was compromised.

Concluding Comments

Although the study reported in this paper is limited in that it involved only seven postsecondary students, the experiences described may have some value for others who seek to gain deeper insights into educational experiences of postsecondary students diagnosed with bipolar disorder. The education field was not level for participants in the study. Side effects of the disorder and medications placed participants at a disadvantage and even at risk in terms of their learning and achievement compared to peers.

Students shared a common concern; that it be okay to be bipolar. Participants agreed that stereotypical attitudes towards people with certain psychiatric diagnoses should be eliminated. Their concerns are supported by recent research regarding stigmatizing effects of mental illness. In 1993-94, an Ontario branch of the Canadian Mental Health Association researched attitudes towards mental illness among a group of mental health workers (Simmie & Nunnes, 2001). Findings of the study indicated that participants assumed that people diagnosed with a mental illness:

Are dangerous or violent - 88%
Lack intelligence or are developmentally handicapped - 40%
Cannot function/cannot hold a job/have nothing to contribute - 32%
Lack willpower/are weak/or lazy - 24%
Are unpredictable/can't be trusted - 20%
Are to blame/should shape up - 20%
(Simmie & Nunnes, 2001, p. 297)

Participants recommended that public education and professional development regarding bipolar disorder be carried out within and across faculties and student groups. A primary objective of the activity would be to reduce stigma by informing faculty and students about causes, characteristics, medication, learning, achievement, and life-style issues associated with the disorder. Several participants offered to help develop and implement a public education campaign. Students believed that the university community could work together to reduce the stigmatizing effects of bipolar disorder. They added that all students should be aware that victims of bipolar disorder might qualify for support from the Learning Disabilities Office at the University of Regina. Several participants suggested that the counseling office might provide access to a psychiatrist to support students diagnosed with a mental illness. They explained that peer counseling was not designed to address psychiatric illnesses like bipolar disorder.

Students perceived the stigma of mental illness to be the most debilitating influence on their quality of life. A recent graduate commented that, "the first thing that has to happen is we need to make it okay to have bipolar disorder. Because if you can't make it okay, then you can't help anybody, because they're not going to say anything" (Interview, April, 2003). Caplan (1995) underscores the importance of self-determination for victims of mental illness in the following excerpt.

If we allow others to decide whether or not we are normal, we lose the power to define, to judge, and often, to respect ourselves... classifying people as normal or abnormal is a major enterprise that is carried out on many levels, from the American Psychiatric Association to school personnel to next-door neighbours. (p.1)

According to Kay Redfield Jamison (1995), international authority and researcher on mood disorders, there is no comfortable way to disclose the Disorder to others. She explains that "despite the fact that most people that I have told have been very understanding...I remain haunted by those occasions when the response was unkind, condescending, or lacking in even a semblance of empathy" (p. 199).

Participants wanted access to program modifications that offered support for learning disabilities associated with bipolar disorder; they wanted a level playing field. Bourdieu's (1990) game metaphor helped me to further understand students' concerns that they receive fair access to appropriate learning environments and competition for high marks and grades. Upon graduation they hoped for equitable access to society's goods and services. According to Bourdieu, some people are better equipped to engage with the educational field than others. Differences among family backgrounds in terms of beliefs, values, structural characteristics, language, cognition, emotional stability, mental health, and physical capabilities, tended to privilege some people and not others in their competition for education and gainful employment.

According to Bourdieu (1990) and Wertsch (1991; 1995) learning, and achievement are socially situated within settings characterized by unequal relations of power among people engaged in purposeful activity. Within this context, I appreciate the political significance of participants' concerns. Students diagnosed with bipolar disorder need access to appropriate and effective program modifications. Without such assistance, students diagnosed with bipolar disorder may be limited and even denied in terms of equitable access to educational opportunities.

By sunrise there were nearly a thousand birds standing outside the circle of students. ... They didn't care whether they were seen or not, and they listened, trying to understand Jonathon Seagull. He spoke of very simple things -- that it is right for a gull to fly, that freedom is the very nature of...being, that whatever stands against that freedom just be set aside, be it ritual or superstition or limitation in any form. (Bach, 1970, pp. 113-114)

References

Bach, R. (1970).

Jonathan livingston seagull: A story. New York: Avon Books

 

Bourdieu, P. (1986a).

The forms of capital, in Richardson, J.G. (Ed.), Handbook of theory and research for the sociology of education (pp. 241-258). New York: Greenwood Press.

 

Bourdieu, P. (1974).

The school as a conservative force: Scholastic and cultural inequalities. In Eggleston, J. (Ed.), Contemporary research in the sociology of education. London: Methuen.

 

Bourdieu, P. (1989d).

Social space and symbolic power. Sociological Theory, 7(1), 14-25.

 

Caplan, P. (1995).

They say you're crazy: How the world's most powerful psychiatrists decide who's normal. Don-Mills, ON: Addison-Wesley.

 

Edwards, V. (2002).

Depression and bipolar disorders. Toronto: Key Porter Books.

 

Eggleston, J. (Ed.).

Contemporary research in the sociology of education. London: Methuen.

 

Jamison, K. R. (1995).

An unquiet mind: A memoir of moods and madness. New York: Random House.

 

Lincoln, Y. & Guba, E. (1985).

Naturalistic inquiry. California: SAGE Publications.

 

Lincoln, Y. & Guba, E. (1985).

Establishing trustworthiness. In Lincoln, Y. and Guba, E. Naturalistic inquiry (pp. 289-331). California: SAGE Publications.

 

Mader, D. (2003).

Disability resource office: A guide for students, faculty and staff. Regina, Saskatchewan, Canada: University of Regina.

 

Marshall, C. & Rossman, G. (1989).

Designing qualitative research. London: SAGE.

 

Mondimore, F. M. (1999).

Bipolar disorder: A guide for patients and families. Baltimore: The Johns Hopkins University Press.

 

Porter, R. (2002).

Madness: A brief history. Oxford: Oxford University Press.

 

Richardson, P. (1986a).

Handbook of theory and research for the sociology of education. New York: Greenwood Press.

 

Rose, S., Lewontin, R. & Kamin, L. (1984).

Not in our genes: Biology, ideology and human nature. Toronto: Penguin Books.

 

Silverman, D. (1993).

Interpreting qualitative data: Methods for analyzing talk, text, and interaction. California: SAGE Publications.

 

Simmie, S. & Nunnes, J. (2001).

The last taboo: A survival guide to mental health care in Canada. Toronto:McClelland & Stewart Ltd.

 

Torrey, E. F. & Knable M. B. (2002).

 

Surviving manic depression: A manual on bipolar disorder for patients, families and providers. New York: Basic Books.

 

Waltz, M. (2002).

Adult Bipolar disorders: Understanding your diagnosis and getting help. Cambridge: O'Reilly.

 

Watson, J. D. (2003).

DNA: The secret of life. New York: Random House.

 

Wendell, S. (1996).

The rejected body: Feminist philosophical reflections on disability. New York: Routledge.

 

Wertsch, J. (1991).

Voices of the mind: A sociocultural approach to mediated action. Cambridge: Harvard University Press.

 

Wertsch, J. del Rio, Pablo & Alvarez, Amelia (Eds.). (1995).

Sociocultural studies of mind. New York: Cambridge University press.

 

Wertsch, J. (1995).

The need for action in sociocultural research . In Wertsch, James, del Rio, Pablo, and Alvarez, Amelia (Eds.), Sociocultural studies of mind (pp. 56-74). New York: Cambridge University Press.

 

Yin, R. K. (1994).

Case study research: Design and methods (2nd. ed.). London: SAGE Publications.