The challenge of attending college while dealing with chronic health problems should not be underestimated. Of course, I did.

I began college in rather unique circumstances. I have fibromyalgia, which is almost unheard of among two populations: young people and men. I happen to belong to both. I also had a spinal defect that was causing progressive neurological problems, and which needed two surgeries to correct just as I was starting to adjust to college life. And, as is typical of people with chronic illness in general and fibromyalgia in particular, I had a host of psychological problems ranging from depression and anxiety to imposter syndrome. Its taken me five years, but Ive approached some measure of success in balancing the demands of Willamettes biology program and the restrictions my body imposes on me. It goes against many facets of my personality to give advice on surviving college as a chronically ill student. Im hardly the poster child for healthy management of a disability. My training in scientific reasoning points out that Im an anecdote and drawing conclusions from my situation is statistically unjustifiable. Theres also a little voice in my head, the inner puritan Ive been trying to exorcise for years, saying that suffering is meant to be private and that all this amounts to a sort of selfindulgent whining. But ultimately medicineand living, for that matterare arts and not sciences, as much about the outlier as the mean, and it may be that my observations can inform someone in similar circumstances. So, here is the advice I never got. Decide early on what youre going to give up. Dont imagine that you wont have to give something up; even the perfectly healthy students do. (Of course, the perfectly healthy students typically gave up sleep, which is absolutely not an option for me and probably isnt for most people with chronic illness.) The reason for choosing what to give up early is that choices made as you go are rarely optimal. I was lucky; the activity that naturally fell out was socializing and I am very introverted, able to survive on the little socialization I got in class and at work. (Perhaps lucky isnt the best word; abnormal is probably more appropriate.) Most people who followed my path and accidentally failed to socialize would not have fared so well. I probably would have fared better if Id instead sacrificed computer games or my news addiction, but I never weighed my options and never considered my choice until Id already made it. See a psychologist or counselor regardless of whether you have an organic mental illness. In my case, I have organic mental illnessesmajor depressive disorder, social anxiety disorder, and depersonalization disorderwhich are generally well controlled with medication, but I also had to deal with psychological problems arising from my illness impinging on my collegiate responsibilities. Anxiety over trying to catch up after being too tired to get out of bed for a week. Stress from a month of feeling sick and having half as much time to do work because of an increased need for sleep. Guilt at having to give up positions of responsibility in clubs and organizations or inconveniencing professors by needing to make up tests or labs. Frustration at the disconnect between my capacity to understand material and my inability to excel in class. Every student has to deal with psychological challenges and stressors, but the unrelenting deluge facing students with chronic illness warrants professional attention.

Never assume that you can accurately assess the amount of work you can do. This is one of those bits of knowledge Im hesitant to share because I suspect its rather unique to me. When Im not struggling with an acute bout of depression, I have a rather outsized ego. Ive learned to moderate my opinions of, for example, my musical ability, but I still consistently overestimate the amount the amount of work I can do and the responsibilities I can take on before overextending myself and crashing. Im starting to ask people I trust and who know me wellusually my parentswhether Im really capable of taking on new responsibilities. I share this despite my misgivings because research keeps piling up to support the idea that Im not alone in my capacity for self-delusion. It seems that overestimating ones abilities is as fundamental to human psychology as language, tribalism, or a sweet tooth: a full 94% of professors believe they are above average teachers, and it seems that an inflated sense of self-worth is necessary for normal psychological functioning. Be a rational consumer of health advice. People with chronic illness are perfect targets for woo. Most chronic illnesses (including fibromyalgia) have no cure, little in the way of treatment, and an enormous impact on daily living. No wonder so many turn to chiropractic or acupuncture. Resist the urge. First, so-called alternative medicine is far from safe. Acupuncture has been known for years to spread hepatitis and MRSA, and chiropractic rather regularly causes stroke. Herbal medicines in particular pose a danger to people with chronic illness. I have not been on fewer than three prescription medications since I was in elementary school; at times Ive been on as many as seven. I know people who are on 15 or more. Medicines regulated by the FDA (also known as real medicines) have data on interactionsfor example, certain migraine treatments should never be taken with many antidepressants. Natural medicines dont have such data. Or perhaps I should say, they dont have such data until they kill somebody. St. Johns wort is a weed often used to treat mild depression. Theres even been some evidence that it does work. Unfortunately, it also causes antiretrovirals (particularly HIV antiretrovirals), benzodiazapines (which I have used to treat my worst fibromyalgia symptoms), and immunosupressants (used to treat a number of chronic conditions) to be excreted far too quickly and so not work. And thats just the interactions that have caused serious problems in enough people to enable scientific study. And its just one herb. The standard addendum to the quack Miranda warning on herbal medicines tell your doctor about any herbal supplements you take is virtually pointless because we have no idea which herbal medicines interact with which prescription drugs. Another point against credulously trying alternative treatments is that critical thinking is hard. Humans are just not wired to think scientifically: we fall for appeals to authority or to popularity, we are swayed by anecdotes, and we misinterpret regression to the mean as getting better. As a student, and especially as a science student, it is essential to exercise critical thinking and skepticism as often as possible. Trying to be skeptical in the classroom and open-minded outside it is a recipe for cognitive dissonance. Its far better to refuse a treatment that will at best provide one with a placebo effect than to try to reconcile a love of science and unscientific treatments. Use any advantage you have. Im talking about both internal and external advantages. Some people disdain those who would withdraw from a course because its not going well and they think

their GPA will plummet. This is absurd. Withdraw from courses that are too hard for you to manage. Take advantage of tutoring (again, this is advice I wish I had been given). Push professors and administrators (especially administrators) for the reasonable accommodations that are guaranteed under the Americans with Disabilities Act. Finally, dont be afraid to cheat a little. I dont mean academic dishonesty; I mean shortcuts that will get you through class without knowing all the material. Talking to other students who have been successful in school while dealing with disabilities, one of the things we have in common is using our giftsand anyone who has made it to college with a chronic illness is gifted in some wayto make things easier. I have a talent for connecting random facts that makes it possible to draw connections from a subject I know little about to one Im more familiar with. Ive used this more times than I can count to survive class discussions when Ive been too sick to read the material as much as I should have. There are, needless to say, many pieces of advice I left out, mostly because I received them from other people when I was starting college. (That is not to say I followed it all. If I were to write a piece entitled Good advice I didnt follow, it would be 20 pages long.) These are, though, the most important lessons I was never taught.