What’s Missing in Conversations about Libraries and Mental Illness
In Brief
It is inevitable that public librarians interact with mentally ill patrons daily. We do our best to help find information and connect patrons to resources, where appropriate. What is missing from these conversations is that mentally ill librarians exist too. We often mask our own mental health struggles for the sake of helping patrons, or maybe because of sanism and stigma amongst coworkers. Mentally ill librarians deserve to be open about their experiences if they desire. It is not two absolute groups of the well versus the “crazy.” Mental health is fluid, and sometimes even the helpers struggle too.
Introduction
I am a mentally ill library professional, and every day I interact with mentally ill patrons. Outwardly, especially to my coworkers, I don’t seem mentally ill. I am exceptionally “high functioning,” though I know many, especially in the autistic community, dislike that term. I am intelligent, productive, and organized. Others prefer the term high-masking, and that more accurately applies to my experience as well. I may be struggling on the inside, but I mask and hide these symptoms externally. I am often pretending to not be mentally ill. Even therapists, doctors, and other mental health professionals frequently fail to recognize when I am suffering. Sometimes the more I am struggling, the more outwardly fine I seem. This was especially true in high school when I earned perfect grades as a result of my obsessive-compulsive disorder (OCD). It seemed like I was thriving, but in reality, I was incredibly stressed and felt like I had to be perfect. Masking for me is a major symptom.
My own mental illnesses, especially anxiety and OCD, still come up in hidden ways while I’m at work. I have written about this more extensively on my own blog, My OCD Voice, but to summarize, I fear doing something morally or ethically wrong. What if I say something that offends a patron? What if I am careless and incorrectly handle personal patron information? I greatly fear accidentally harming others by doing something wrong. Responsibility terrifies me, such as when I am the only full-time staff member for the Adult Services floor on certain evenings. This is even though I have shown time and time again that I am more than capable of handling responsibility, and handling it well at that. I’m open to talking about these fears and experiences with anyone who wants to know more, but if I don’t bring it up, they wouldn’t know.
You cannot tell from my outwardly calm demeanor whether I am actually calm that day or I am having an incredibly anxious day. I’ve had a few panic attacks at work, and no one would know, unless I told them. You cannot see my history of severe depression on my face. You cannot see the medications I rely on taking each day to function. You cannot see my OCD, and though I consider myself in recovery now, at its worst it required temporarily leaving school for residential treatment. You cannot see that in college I was hospitalized four times on inpatient psychiatric units for suicidal ideation. You cannot see these things because I consistently seem fine. Unless I voice these aspects of my past and present, no one would know I am mentally ill. Coworkers do not know. Patrons do not know. So the assumption is I am not part of that group.
Working with the Public
I work at a public library. We are open and available to, of course, the public. Every day, it is statistically highly likely I interact with patrons, who like me, are very good at masking or otherwise hiding symptoms. I also interact with patrons who display more socially obvious signs of mental illness. I have presented at the International OCD Foundation Annual Conferences in person and online several times. Six years ago, I founded Not Alone Notes, a nonprofit mailing free, encouraging notes to others with OCD. I also served an AmeriCorps term in 2019 teaching Mental Health First Aid courses to rural communities in Central Illinois. Though I am not a mental health professional and cannot diagnose or treat someone, I’ve had enough experience in the field to recognize signs of when someone may be experiencing mental illness.
Library professionals interact every day with patrons externally demonstrating symptoms of mental illness. There is compassion. There are attempts to connect patrons to resources. And there is sometimes also stigma and bias, even when there are good intentions. I define stigma and bias as these negative perceptions we may hold, without even realizing we hold them. They can come from a variety of places. What have we been taught from our own families or backgrounds? What have we seen on television? Are we afraid of the mentally ill? Have we ever knowingly met someone who identifies as and who we would consider mentally ill? We all have met someone, but knowingly is the keyword.
I’ve heard the word “crazy” used in the workroom after a particularly difficult interaction. “Crazy” is a common word in everyday conversation. I don’t think we will rid the English language of that colloquialism. It’s hurtful though because it is dehumanizing and othering to people who experience mental illness. To me, even once is one too many times to use this word towards a person. I’ve also watched staff groan at answering certain phone calls because a patron may ramble about non-library-related business for twenty minutes. I’ve seen staff baffled or even scared by someone talking to themselves, even though they weren’t harming anyone else around them.
I know my behavior with patrons is not perfect or even prejudice-free either. We all make mistakes due to the biases and stereotypes we have learned from society. I bring these instances up because I want to continually improve the culture of library professionals towards those with mental illnesses. There is always room for more education and training.
These moments are examples of how prejudice prevented library workers from focusing on what the patron needed specifically. Did they need to firmly, but respectfully, be reminded of library use policies? Did they need to make a phone call to a friend or shelter? Did they just need to talk to someone for a few minutes? When we focus on the need, then we can focus on ways to effectively and efficiently address these needs, or to even recognize that we are not able to fill these needs, and then refer to someone else or another organization who can.
A False Dichotomy
There seems to be an assumption that there are people like me who are fine and passing and probably just overly anxious. We can work and function in society, and you wouldn’t even know we have a psychiatric diagnosis. We aren’t who most people mean when they say mental illness. We aren’t part of that group.
Then there are stereotypes of the people who are really “sick” and “crazy” and “seriously ill.” We see people mumbling or shouting or carrying a dozen bags. With these people, the symptoms are “obvious,” and the mental illness is “real.” This is who society often means as part of that group.
What this dichotomy misses though is that mental illness is a spectrum and fluid, with potential symptoms extending in all directions. Some psychiatric disorders are visible, and others are invisible. The visibility of symptoms does not reflect the severity of the illness, someone’s level of internal struggle, or how much help or accommodations they may need. You often cannot tell if someone is ill, unless they tell you.
Individual experiences can also change by the day. Many people who are disabled identify as dynamically disabled. Symptoms change every day, if not every hour. There is not a line to cross where before you were actually fine, and now you are actually mentally ill. I too have been seriously mentally ill in my past. I hope not, but maybe someday I will be that ill again. Not to mention, mental illness is incredibly common. According to a study published in The Lancet Psychiatry by Dr. John J. McGrath et al., half of the world’s population will experience a mental health disorder at some point in their lifetime. In the United States alone, according to the Center for Disease Control (CDC), more than one in five adults live with a mental illness. How can I both convince those around me that I am mentally ill too, that I count, while at the same time advocating that others are not “crazy”? How can I be open about my experiences with mental illness, to validate my experiences of mental illness, while also maintaining that is not my whole identity?
How library staff treat mentally ill patrons matters. All patrons deserve our assistance and service. They have to follow our user conduct policies, and sometimes a lack of following them, like stealing or repeatedly creating messes in bathrooms, can lead to temporary suspensions. But these instances are rare. Even in these cases, the patrons still deserve respect and dignity when enforcing those policies. Most of the time, I see that respect and dignity from colleagues. I see the good intentions and the service. But sometimes there is still prejudice. The frustration and overwhelm of the day or the week can allow words like “crazy” to slip out.
How library staff treat mentally ill patrons matters also for the mentally ill coworkers who are watching. Mentally ill patrons exist. Mentally ill staff exist. Perhaps under different circumstances, we could easily be in each other’s shoes. We shouldn’t take that lightly. I very much see myself in these struggling patrons. In a different world, that could have been me. I can mask, but that doesn’t negate my mentally ill status and identity. We are on the same spectrum. So when you call them “crazy,” you are saying that to me too.
I know I am privileged to have had access to therapy, intensive treatment, hospitalizations, support from family and friends, and continued access to medication. These factors are a huge part of how I am able to cope and function so well, like having a full-time job and attending graduate school in library science, or other activities like participating in community theater and running my own mental health nonprofit. Without these supports, would I be the library patron having a panic attack while on a public computer instead of privately in the workroom?
What’s Missing
Conversation exists about how library staff can best help and support mentally ill or even just mentally struggling patrons, though even that literature is limited. For example, what training can librarians undergo to learn more about helping patrons? My library has implemented the Ryan Dowd Homeless Training, which isn’t exactly mental health focused, but it is definitely adjacent. I’ve seen positive outcomes from this training, such as staff focusing on getting what Dowd calls “pennies in the cup.” Introduce yourself by name, ask the patron’s name, make eye contact, smile. Get to know them, so if there is conflict, you already have had several positive interactions banked up.
I wonder if we should hire social workers in public libraries. I’m hoping to take the Library Social Work class in my MLIS graduate program at the University of Illinois before I graduate next spring. What programming can be organized to provide connection to resources? And on the day to day, what are the best ways to, for example, approach someone who is loudly shouting at themselves to tone down their volume a touch?
The former Association of Specialized and Cooperative Library Agencies (ASCLA) division of the American Library Association (ALA) published Guidelines for Library Services for People with Mental Illnesses in 2007 and a revised tip sheet in 2010, though both are no longer available online. These publications are helpful movements towards addressing these questions and helping mentally ill library patrons.
What I am not seeing though is much literature about mentally ill library staff and librarians themselves. I recently read the anthology LIS Interrupted: Intersections of Mental Illness and Library Work, edited by Miranda Dube and Carrie Wade. This book was validating that others are open about working in a library with a mental illness. In it, Stephanie S. Rosen wrote about library work as a “caring profession,” and how to do that care in a way that cares for yourself too. Alice Bennett wrote about disclosing mental illness as a privilege, since there can be discriminatory consequences in some contexts. Separately, JJ Pionke has written about working in a library with post-traumatic stress disorder (PTSD), a largely invisible disability for him, and trying to seek accommodations. There has also been some research about perceptions of mental illness among academic library staff, revealing that stigma can prevent disclosing mental illness.
Mentally ill library staff exist, yet vocational awe has created a version of libraries where we can only be the “sane helpers.” We can be expected to be put together and give our all to help. And there is a sense, whether recognized or not, that because as librarians we can help someone, we are better than them or not mentally ill. This all feeds into that false dichotomy.
I thankfully don’t experience this pressure to always help at my workplace. Taking care of yourself is heavily encouraged. This includes taking breaks, not checking emails when off work, and staying home if you are sick, physically or emotionally. I have taken a mental health day before, and no one batted an eye when I said that as my reason for calling out sick. As library professionals, of course we want to help patrons, but we also must take care of ourselves.
Being solely viewed as the helpers is unrealistic and unfair. It forces masking of our own symptoms, always pretending to be fine. It erases our experiences and reduces comfort seeking accommodations we may need at work. OCD is protected under the Americans with Disabilities Act (ADA). I personally don’t seek accommodations at work, but I could and maybe someday I will. Ignoring that OCD and other psychiatric disorders are protected under ADA and other aspects of being seen as just helpers furthers the illusion that there is a dichotomy: “we are totally well and you are mentally ill.” In reality, it is not us versus them, or even us helping them. Mental illness affects both patrons and librarians, visibly and invisibly. Perceptions of mental health are ever changing, and hopefully the conversations about it can keep changing too.
Perhaps because of our similar experiences, mentally ill staff are better able to help mentally ill patrons. With or without more training, we already have a deeper understanding of symptoms and the experiences of mentally ill patrons. Of course, no two peoples’ experiences are exactly the same, but we can relate to one another. We have been there too. I also wonder if I were to disclose my mentally ill identity and more obviously wear it “on my sleeve,” could that make a patron feel more comfortable asking for resources? Does my disclosing help coworkers feel more comfortable accessing resources for them as staff? I have seen at least this somewhat playout. When I mention I have OCD, some coworkers ask thoughtful questions. Some go on to say “me too.”
There are many library professionals ready to be open about their stories with mental illness, either with coworkers in person or more anonymously online. Either avenue is acceptable, and not sharing your story is also a valid choice. Disclosure should always be optional, and disclosure is not necessary for someone’s own journey or recovery. But those of us who want to share, we are ready and capable to speak about these topics and our personal experiences. We are ready to have these conversations in the workroom, to openly take mental health days when we need them, and to better help patrons because of these lived experiences. The real question is how can we create a space where our mentally ill coworkers and selves feel like we have the space to share our voices.
Acknowledgments
I would like to thank Internal Peer Reviewers, Jessica Schomberg and Brea McQueen; External Peer Reviewer, Alice Bennett; and Publishing Editor, Jaena Rae Cabrera for their thoughtful and thorough work in helping revise this piece. I would also like to thank Laura Golaszewski and Rachel Park, for providing feedback on this piece before submission, and Professor Katie Chamberlain Kritikos for introducing me to In the Library with the Lead Pipe in class.
References
About mental health. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/mentalhealth/learn/
Alvares, G. (2019, July 11). Why we should stop using the term “high functioning autism.” Autism Awareness Australia. https://www.autismawareness.com.au/aupdate/why-we-should-stop-using-the-term-high-functioning-autism
Burns, E. & Green. K.E.C. (2019). Academic librarians’ experiences and perceptions on mental illness stigma and the workplace. College & Research Libraries, 80(5), 638. https://doi.org/10.5860/crl.80.5.638.
Dube, M., & Wade, C. (Eds.). (2021). LIS interrupted: Intersections of mental illness and library work. Litwin Books: Library Juice Press.
Ettarh, F. (2018, January 10). Vocational awe and librarianship: The lies we tell ourselves. In The Library With The Lead Pipe. https://www.inthelibrarywiththeleadpipe.org/2018/vocational-awe/
Homeless Training. https://homelesslibrary.com/
IOCDF Conference Series. International OCD Foundation. https://iocdf.org/programs/conferences/
McGrath, J.J., Al-Hamzawi, A., Alonso, J., Altwaijri, Y. Andrade, L.H., Bromet, E.J., Bruffaerts, R., Caldas de Almeida, J.M., Chardoul, S., Chiu, W.T., Degenhardt, L., Demler, O.V., Ferry, F., Gureje, O., Haro, J.M., Karam, E.G., Karam, G., Khaled, S.M., Kovess-Masfety,V.,…Zaslavsky, A.M. (2023). Age of onset and cumulative risk of mental disorder: A cross-national analysis of population surveys from 29 countries. The Lancet Psychiatry, 10(9), 668-681. https://doi.org/10.1016/S2215-0366(23)00193-1
Not Alone Notes. https://notalonenotes.org/
Pionke, JJ. (2019). The impact of disbelief: On being a library employee with a disability. Library Trends, 67(3), 423-435. https://doi.org/10.1353/lib.2019.0004.
Rondinelli, M. (2023, October 17). How OCD affects me at work. My OCD Voice. https://myocdvoice.com/2023/10/17/how-ocd-affects-me-at-work/
Sarmento, I.M. Dynamic disability. DisArt. https://www.disartnow.org/journal/dynamic-disability/
Spencer, M.M. Americans with Disabilities Act: The law and tips for working people with OCD. Internatijonal OCD Foundation. https://iocdf.org/expert-opinions/expert-opinion-americans-with-disabilities-act/
In the Library with the Lead Pipe welcomes substantive discussion about the content of published articles. This includes critical feedback. However, comments that are personal attacks or harassment will not be posted. All comments are moderated before posting to ensure that they comply with the Code of Conduct. The editorial board reviews comments on an infrequent schedule (and sometimes WordPress eats comments), so if you have submitted a comment that abides by the Code of Conduct and it hasn’t been posted within a week, please email us at itlwtlp at gmail dot com!
Brava, Morgan! This article is informative, thought-provoking, and deeply compassionate. I feel confident it will encourage conversations and create positive change.