(Dis)order in the Classroom:
Institutions of Higher Education and the Inclusion of Mental Illness
in the Americans with Disabilities Act
The passage of the Americans with Disabilities Act of 1990, though a victory for all citizens with disabilities, significantly impacted the lives of those with anxiety disorders and affective illness. Congress’s failed attempts to exclude the category of “mental illness” from the ADA’s definition of disability resulted in the identification of a third category alongside physical and mental—psychological disabilities. Unfortunately, discrimination against those living with a mental illness generally fails to be recognized as discrimination at all. In the following essay I have used the University of Massachusetts, Amherst, as my primary focus in representing a real-world example. My research has led me to believe that psychological disabilities are generally not treated with the same care as other disabilities. President John F. Kennedy, in a 1963 speech, proclaimed that “we must act to bestow the full benefits of our society to those who suffer from mental disabilities [and] to prevent occurrence of mental illness…wherever and whenever possible... to restore and revitalize their lives through better health programs and strengthened educational…services” (Frank & Glied, 2006, 140). In lieu of these two discoveries, I came to wonder specifically whether the anti-discrimination legislation of the ADA protects, or rather fails to protect, the psychologically disabled in institutions of higher learning. As it turns out, Kennedy’s dreams were not realized until nearly two decades later.
President George Bush signed the Americans with Disabilities Act into law on July 26, 1990, while promising the crowd gathered around him that “with today’s signing of the landmark Americans with Disabilities Act, every man, woman and child with a disability can pass through once-closed doors into a bright new era of equality, independence, and freedom” (Stefan, 2001, xii). Though meant in a more theoretical tone, his words ignorantly reflect the most-common image conjured up by the public in regards to the ADA—handicap accessible entrances to all buildings. The Americans with Disabilities Act defines a “disability” as a physical or mental impairment that substantially limits one or more major life functions, such as walking, seeing, hearing, learning, speaking, breathing, caring for oneself, sitting, standing, or lifting. Not all disabilities are easily identifiable; over seventy-four percent of all Americans live with hidden, or “invisible,” disabilities (Castaneda, Hopkins, & Peters, 2010, 457). An observer cannot see or presume any evidence of a disability from an encounter with a person suffering from the following mental illnesses: learning disorders (LD), ADHD, Post Traumatic Stress Disorder (PTSD), affective illness and anxiety disorders. These, too, fall under ADA coverage.
Long before the fight towards identifying mental illness as a legitimate disability, the Rehabilitation Act of 1973 considered the disabled a class of people for the first time in Congressional legislation. How is it possible that the disabled population had no advocacy for their own class status until this point? Stigmas in American culture previously placed cultural and gender identities foremost, considering one’s disability a secondary, extraneous matter. For example, before 1973 I would have been considered a “disabled Caucasian female;” after 1973, my identity as a psychologically disabled person becomes primary. This slight change in identification essentially creates a new class in the population—the disabled—overnight, through Congressional legislation rather than the grassroots and student organizations common among other social justice movements. Another reason for the previous lack of class status results from this inability to coagulate the large numbers of disabilities, for each comprises a separate condition with an already established, albeit smaller, group identity. In most cases, associations or foundations continue to advocate as the official representative for those with that particular condition. With each disability standing on its own, rather than a piece of the larger whole, this internal segregation combines with segregation from the larger society to overwhelm advocates demanding their constitutional rights as a fortified social class, the disabled. The loudest objections to Section 504 of the Rehabilitation Act came from higher education. Section 504 extended civil rights to people with disabilities, thus widening the disabled’s access to institutions of higher learning. Author Susan Stefan, in Unequal Rights: Discrimination Against People with Mental Disabilities and the Americans with Disabilities Act, finds the backlash from universities particularly interesting, as the “basic thrust of the regulations is much less intrusive to higher education than it is to elementary and secondary, or even employment” (308). By the time the ADA passed, colleges and universities had been prohibited from discriminating against applicants, students, and staff on the basis of disability for over a decade.
In general, social justice movements arise from oppressed groups seeking an end to the daily discrimination they must face. Disability oppression, or ableism, describes the systematic discrimination and exclusion of people who live with developmental, medical, neurological, physical, and psychological disabilities. Like other forms of oppression, ableism functions on multiple levels—individual, institutional, and cultural—to the advantage of people who are temporarily able-bodied and at the disadvantage of people with disabilities. Used purposefully, the term “temporarily able-bodied” raises awareness that people without disabilities may become disabled later in life—for instance, soldiers returning from the front with post-traumatic stress disorder. The voices of advocates rallying against ableism reached Washington D.C., and, on September 25, 2008, Congress amended the Americans with Disabilities Act by expanding the basic definition of disability and the protection available. The amendment expanded the definition of “major life activities” to include the previously omitted areas of learning, reading, concentrating, thinking, communicating, and working. These particular areas allowed the inclusion of many mental illnesses in relation to the school setting. This amendment also better defined “substantially limits,” for the ADA now covers “major bodily functions” such as compromised functions of the immune system due to HIV or AIDS. Further, the amendment specifies that episodic conditions or conditions in remission apply as long as, when active, the disability impairs a major life function. Many psychological disorders involve periods of remission or occur in sporadic bursts, making this an important change for the psychologically disabled. The amended Americans with Disabilities Act now recognizes many more types of disabilities than the original—a list which encompasses the approximately sixteen-percent of Americans who have a disability (Davis, 2010, 482).
The Americans with Disabilities Act identifies the category of “mental illness” to include learning disorders, ADHD, alcohol and substance dependence/abuse, anxiety disorders and affective illness. Affective illness and anxiety disorders comprise nearly the most common diagnostic category of mental illness, second only to the category of “alcohol and substance dependence/abuse” (Gordon & Keiser, 1998, 154). The ADA makes it explicitly clear that substance abuse is not included in their umbrella definition of justifiable psychological disorders, dedicating multiple sections within the Act to identifying this particular exception. Besides psychoactive substance abuse disorders caused by the current use of illegal drugs, the following conditions do not constitute a legal disability under the ADA: common personality traits; environment, cultural, or economic disadvantages; advanced age or personal attributes, such as hair color; compulsive gambling; kleptomania; pyromania, and; sexual behavior disorders including transvestitism, homosexuality, bisexuality, pedophilia, exhibitionism, and voyeurism (Gordon & Keiser, 1998, 77). On the other hand, all anxiety disorders are justifiable, and include panic disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, social phobias, specific phobias, and post-traumatic stress disorder (PTSD). Affective illness, commonly referred to as mood disorders, encompasses major depressive disorder (MDD), dysthymic disorder, cyclothymic disorder, and bipolar disorder (BPD). As a member of both, diagnosed with obsessive-compulsive disorder and bipolar disorder, my research focused primarily on these two subcategories.
A disabled student must provide extensive documentation of his or her illness in an ADA accommodation request. Alongside the ADA, the Individuals with Disabilities Education Act requires schools to provide appropriate education in the least restrictive environment. Requests made may be made to assist the disabled student in the classroom, including standardized testing of any kind. The description of current symptoms alone does not count as acceptable documentation. Supportive documentation—age of onset, course of illness, and illness-specific assessments are just three examples—provides external validation of the disorder. Abigail Sullivan Moore (2010) suggests in her New York Times article, “Accommodations Angst,” to collect past report cards, letters from babysitters, notes from child care centers showing difficulty at recess, and other “creative” items to strengthen an accommodation request (13). Though not required in all circumstances, assessments of ADA requests often ask for a psychiatric interview, for it strengthens the diagnosis immensely. Documenting anxiety disorders and affective illness includes substantiating the existence of a full-fledged mood and/or anxiety disorder as regulated by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). A psychiatrist must then document the functional impairment caused by the disorder. A number of restrictions exist when documenting the functional impairment, including the use of diagnostic-specific rating scales to show the extent to which the illness relates to or causes a “pervasive and disabling impairment” (Gordon & Keiser, 1998, 161). A written explanation of the requested accommodation, and how it specifically remedies the disability due to illness, covers the third and final part of the process. Unfortunately, accommodations do not exist for a number of well-documented psychological disabilities, even though the individual falls within ADA coverage.
The Americans with Disabilities Act applies to a broad spectrum of disabilities and impairments in a wide variety of situations, making access to reliable legal consultation extremely important. A vast majority of ADA claims in higher education are based on learning and psychiatric disorders. Though varying between settings, physical disabilities generally make up only one quarter of the claims—the rest find “substantial limitations” in his or her ability to learn (Gordon & Keiser, 1998, 154). Over the past few years, the existence of overstatements and exaggerations in accommodation requests turned into an endemic problem. Authors Gordon and Keiser (1998) point out that “nowhere is temptation for overstatement greater or diagnostic boundaries more blurry than for the categories of mood and anxiety disorders” (167). The percentage of sufficiently documented and substantiated accommodation requests remains lower among these two groups than any other diagnostic category.
Accommodations requested by students with psychiatric disabilities, along with those requested by students with learning disabilities, often cause resentment. Other students see these accommodations, such as extended testing time, as advantages they too would find helpful. In regards to the accommodations allowed under the ADA for test-taking situations, adjustment reactions, stress reactions, anxiety or depression limited to, or a reaction to, these situations do not suffice justification. Testing organizations, such as the SAT and the ACT, “have long feared that unmerited accommodations… undermine their exams’ integrity,” and testers scrutinize students with above-average scoring, “wondering how a student can do so well and be significantly restricted” (Moore, 2010, 12). Susan Michaelson, ACT’s manager of test accommodations, told the New York Times that “because the ACT is outcome neutral, we are not looking to maximize a student’s performance so that they can do the best they can…we are looking to provide equal access” (Moore, 2010, 12).
Authors Pliner & Johnson (2010) point out in their article, “Historical, Theoretical, and Foundational Principles of Universal Instructional Design in Education,” that “although institutes of higher education serve an increasingly diverse student body, they have traditionally been resistant to change, especially in accommodating the needs of students marked as minorities”—this includes disabled students (474). In order to create truly inclusive environments and truly provide all disabled students an education in the least restrictive environment, the system of higher education must be totally reconfigured. Pliner & Johnson later address the necessary changes that would require shifts in educational practices ranging from the application and admittance process, the curriculums and pedagogical practices used in the classrooms and lecture halls to post-graduate career placement. Changes toward inclusion in all aspects must occur.
Despite reluctant accommodations for equal access in education, a study during the late-1990s by the U.S. Department of Education found that only twenty-five percent of students with disabilities graduated with a standard diploma, and only twenty-two percent labeled with emotional issues (Castaneda, Hopkins, & Peters, 2010, 460). For those who do graduate, the Americans with Disabilities Act does provide some coverage in future employment, but the accommodations become much stricter and claim forms more rigid. Gordon & Keiser (1998) aptly point out the demands of “work life in the real world rarely allow for extra time” (xii). With their income only half the national average, the poverty rate is three times higher among working-age adults with disabilities (Davis, 2010, 482). Even then, only seventy-two percent of the disabled are employed (Davis, 2010, 482). Discrimination, in the context of employment, means the exclusion or differential treatment based on something other than occupational qualifications. The Federal Equal Employment Opportunity (EEO) laws, specifically Title VII of the Civil Rights Act of 1964, the Discrimination and Employment Act of 1967 (ADEA), and the ADA, make it illegal to discriminate against “covered persons”—referring to the various classes of individuals covered under the rigid restrictions of the ADA—in “covered situations,” which include: hiring and firing; compensation, assignment, or classification of employees; transfer, promotion, layoff, or recall; job advertisements; recruitment; testing; use of company facilities; training and apprenticeship programs; fringe benefits; pay, retirement plans, and disability leave; and other terms and conditions specific to a position of employment (Reed & Silver, 2003, 430).
Title I of the Americans with Disabilities Act (ADA) prohibits employment discrimination on the basis of a disability if the potential employee meets all requirements and can perform the duties necessary for the position. An employer cannot ask job applicants to disclose information about the existence, nature, or severity of a disability, but instead may ask about their capability of performing tasks related to the position for which they applied. When I worked at American Eagle, a clothing store, my managers never found out about my mental illness. The topic absent from the application, it also never came up in the interview for the position of a sales associate. For some positions, a company may condition a job offer on the results of a job-relevant medical examination, but only if such an exam is required for all entering employees.
During the development of disability discrimination and mental health laws, discussion took place around the issue of stigma and its effects on people suffering from a psychological disability. Today, the manifestations of these stigmas into discriminatory practices have become widespread. Congressional efforts to address this specific form of discrimination include the ADA and the Fair Housing Amendments Act of 1988. In particular, the Americans with Disabilities Act remains a useful tool in addressing claims of discrimination in employment and the workplace; however, many filers criticize how “mental illness claims…are less successful than physical disability claims” (Reed & Silver, 2003, 460). Illustrating this fact, from ninety to ninety-eight percent of discrimination cases brought to court under the ADA have been lost (Davis, 2010, 482). Further, many advocacy groups believe the ADA should amend specific requirements for the equity of benefits available for physical ailments and mental health care. Repeatedly, the courts have rejected legislation redressing the difference in the benefits between physical and mental health.
The University Health Services (UHS) allocates only a small portion of its funding to the mental health department. The main UHS building, remodeled in 2010, sits on the edge of campus. Mental Health Services (MHS) resides in the older Hills North building. I have frequently had education classes and discussions for history courses in Hills South, the adjoining section of the building. Students consistently flow in and out, making the entrance MHS not-so-confidential.
Even though the building sits wide out in the open, discussion about mental health rarely surfaces among the campus population. “While information and advice about these topics are distributed freely across campus, the issue of student mental health is rarely talked about,” and “remains one that students have to research on their own, leaving many feeling isolated” (Wahlman, 2008, 5). However, student correspondent for the Daily Collegian Liz Wahlman did mention in her 2008 article, “UHS Mental Health falls short for some: Students’ mental health issues seem small of UMass’s big campus,” that MHS actively tries to combat the stigma of students with mental illnesses feeling alone through its use of the new triage system, designed by the University’s own Director of Mental Health Services Harry Rockland-Miller (5). Under this system, when a student calls for an appointment, he or she is given a fifteen-minute evaluation over the phone with a senior clinician. This determines the urgency of the appointment and books a counseling session accordingly.
The lack of funding becomes apparent in the availability of resources as well. The overall size of UMass becomes an issue, and with only a small staff available, accommodating all the students who request appoints remains a difficult task. Liz Wahlman (2008) discovered on the University’s campus that “many students believe that the services UHS Mental Health provides are not meeting their needs” and a group of former MHS patients all expressed dissatisfaction with their experience (5). Lynette Bloise, the associate director of MHS, responded to Wahlman in a “Letter to the Editor” titled, “Clarity of Mind.” Bloise (2008) cites that “in the most recent study, 98.8 percent of respondents said they were able to reach MHS by phone,” and “97.6 percent felt their clinician was helpful in addressing their problems or concerns.” The later also appeared in Wahlman’s description of MHS to the Daily Collegian, stating that students often get referred to graduate psychology students for counseling sessions. A significant finding, Bloise’s response also points out that the survey found 95.5 percent of their current clientele would recommend MHS to a friend (Bloise, 2008).
As a current college student, I cherish the protection afforded by the Americans with Disabilities Act more than most. Academic accommodations allow me to successfully attend the University of Massachusetts, Amherst. I became interested in whether the Americans with Disabilities Act of 1990 assisted in protecting a disabled student’s right to an equal education across the board. Did this anti-discrimination legislation succeed or fail in giving the psychologically disabled students at institutions of higher learning suffice justice in the classroom? Mental illness competes with the larger categories of physical and mental disabilities for ADA accommodations. As a result, or a lack of dependability, it took the EEOC, Equal Employment Opportunity Commission, seven years to issue guidelines for mental condition (Gordon & Keiser, 1998, 154). Does that constitute as protection? Even with the 2008 amendment, do holes still exist in the ADA’s definitions? Maintaining equality remains difficult because the laws and regulations themselves remain open to interpretation and the diagnostic criteria for most disorders ambiguous. President Kennedy, ahead of his time in 1963, told the nation that “we must act to bestow the full benefits of our society to those who suffer from mental disabilities,” and President George Bush finally brought these wishes to fruition in 1990 (Frank & Glied, 2006, 140). However, have the American people entered what President Bush called “a new era of equality, independence, and freedom”? (Stefan, 2001, xii).
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