PrintLast year I served as editor-in-chief of the Columbia Daily Spectator. It’s a title that has a nice ring to it, and I had a great experience. But as my year as editor progressed, I became aware that the mild depression I’d had for years was intensifying. I had a breakdown last summer and have since become fascinated with mental health care, as part of a junket through support networks, therapy, medication, and self-care.
EIC, Interrupted
I felt the first extended period of sadness about 11 years ago, when I moved from England to the United States. Back then the melancholy was disconcerting, but it also had a cyclical, seasonal aspect that made it tolerable. I was a kid, and the random dejection felt like an aberration.
As I grew older and became more concerned about these feelings, I still resisted seeking help. I figured that everyone must be kind of crazy, so why seek treatment? I was also afraid of mistakenly exaggerating my symptoms, since I had no basis for comparison. And, of course, I was scared and ashamed. I did well enough academically in high school and my underclassman years, so I didn’t see therapy as a high priority in my busy schedule. I tried to deal with the sadness myself, working to see the glass half full. But sometimes, you can’t just think yourself out of a funk. Eventually, amid the year-long stress of Spectator and a summer spent alone and far from home, it was too much to take.
Many nights I rolled around in bed, unable to sleep. I fought against my mind’s own impulses. A random thought, the beginning notion of a dream, or remembering a forgotten and unfinished task—each led to hasty conclusions of despair, guilt, extreme feelings of sadness. I tossed and turned but could not shake it; the pain was like a bad itch that you can’t quite locate.
Disorientation, uncertainty, confusion—these words don’t just describe moods, but also epistemological and sensory mistrust, a disconnect between outside stimuli and my brain. So I would sit and look out at Morningside Park through the small amount of space my window could open, waiting for the sun to rise.
There’s a horrifying irony to depression. It is essentially an irrational mechanism, rooted in the chemical and neurological. And yet it often projects a twisted and cruel line of reasoning, within which relatively minor troubles transform into major disruptions. The vicious cycle seems tautological. I am fearfully aware that one day I may no longer be able to elude its cold grip.
And here’s the thing: I’m just a mild case. And, of course, I’m just one in many.
Stigma and Subjectivity: Perceptions of Depression at Columbia
A lot of students on campus deal with mental illness. I am narrowing my focus down to depression, not addressing such topics as bipolar disorder, substance abuse, eating disorders, learning disabilities, OCD, or the issue of suicide. There are too many questions to ask, and experts disagree not only on how to treat mental illness, but also on how to document, classify, and diagnose it. Understanding depression is difficult—neither the depressed nor their doctors can fully grasp it.
Does feeling like shit equal depression? It’s a question with which doctors, therapists, legislators, and interest groups continue to contend. The definition in the Diagnostic and Statistical Manual of Mental Disorders, the industry standard, encapsulates and acknowledges the diversity and vagueness of mood disorders, within which the umbrella term “depression” is one sub-set.
Spectator reporters have been conducting a survey to learn more about how students view or experience the symptoms, diagnosis, treatment, and perception of depression on campus. The findings will serve for an occasional series set to run in the Spec in the coming weeks, which will delve deeper into campus mental health issues. While compiling this survey, I became interested in exploring these issues through a subjective lens, not merely with facts and figures.
The more than 150 students we surveyed in the course of this article estimate that anywhere from 0.5 percent to 100 percent of Columbians have experienced symptoms of depression. Clearly, the condition is not understood the same way by everyone. Many respondents distinguish the disease from its symptoms. Their estimates of how many students suffer from symptoms averages out to about 24 percent, with about half of them reporting having experienced symptoms of depression at some point in their lives.
Most respondents note the sense of vulnerability that comes with revealing what some perceive as a weakness. “I don’t have experience talking/hearing about this, but I would imagine it is a difficult topic to bring up,” writes Julina Guo, a sophomore in Columbia College. “Columbia/Barnard students pride themselves on being self-sufficient and independent.”
Some simply trivialize the phenomenon. “No one wants to talk to a downer,” writes one respondent.
We like to think of Columbians as enlightened, but in the echo chamber of our self-consciousness, these voices—or the fear of them—carry a lot of weight.
Perhaps these few disdainful voices ring so loudly because people aren’t talking about mental health that much. Out of 162 respondents, less than 15 find that students are comfortable talking about mental illness with others. The overwhelming majority of respondents blames this taboo on a stigma on campus against mental illness.
This presents an interesting contradiction: a lot of people suffer from symptoms, and yet, despite the fact that most respondents seem comfortable discussing depression, only a few indicate that the topic is an open one on campus. What is tolerated intellectually is still not embraced publicly.
And beyond the minority that trivializes the illness, students suffering from depression are also uncomfortable talking to the more friendly majority. One sophomore notes how even those sympathetic to her illness can be difficult to talk to: “I do not think others will understand if they do not feel the same.”
Other respondents echo that fear. The ineffability of the condition can create a communication breakdown, and the students may also carry a fear of being defined by their illness.
Many Columbia students appear comfortable discussing depression on a survey, many suffer from symptoms, and many seem aware of a taboo over the subject. Given the prevalence of depression, and general sympathy for the condition, it shouldn’t be so difficult to talk about this topic. There seems to exist, then, a multi-faceted paradox between the discourse about Columbia as an open campus and the deeply rooted stigmas against depression. The root of this contradiction might be the ineffability of the disease. It’s hard to describe, it’s hard to communicate. And that contributes to the isolation of those suffering from it.
Treating the Ineffable
Like dark matter, we don’t understand fully how this state of mind—and this state of the brain—works. We know that chemical imbalances are a major factor, as are one’s environment and experience. Psychiatrists prescribe medication sometimes as swiftly as after a 40-minute conversation, aided only by a therapist’s notes and the patient’s description of the symptoms—a description that we’ve seen can be difficult to pin down. Patients have very little context within which to place their experience. Partly as a result of this, and partly as a result of the complexity of our brains and personalities, the best a doctor can do is measure the intensity of a small portion of potential indicators and symptoms.
Just as there’s no blanket understanding of depression, there’s no blanket cure. Most treatments of depression involve a combination of therapies: psychoanalysis à la Woody Allen-era New York City still enjoys its popularity, but treatment is more practical and utilitarian today. A results-oriented, mish-mash of counseling, behavioral therapy, analysis, and medication is the routine way of tackling symptoms.
Another barrier to treatment in college is that many behavioral symptoms of depression appear to be behavioral symptoms of, well, college. Seemingly everyone’s up late, not sleeping enough, and taking on too much work. Columbia’s decentralized organization, the autonomy the school breeds, and other things specific to our campus can make it difficult to notice if a person is withdrawing socially. Both the good student and the poor student can skip class for a week and lie in bed. It’s just hard to tell the difference between who’s lazy and who’s depressed.
The Tentacles of Mental Care
Given the complexity of the issue, it seems clear that there’s only so much the University can do to create a safe environment. The institution offers many services, but it must seek a balance between protecting itself in terms of liability and caring for its students.
CPS (Columbia Psychological Services) has a staff of about 25 psychologists and psychiatrists, and is widely regarded as one of the best mental-health programs of the Ivy League schools. The addition of satellite counseling centers in residence halls and the availability of an on-call clinician after business hours have received well deserved praise. In 2006, the Spectator reported that 23 percent of Barnard students had sought guidance from Furman Counseling Center, and that 15 to 16 percent of Columbia University
students entered counseling services each year.
“Is that because there are many more students who have problems worthy of counseling, or that the stigma has somewhat been mitigated to seek counseling? Is it a product of the access we think we’ve created or the diversification of the staff? I don’t think anyone can answer those questions,” CPS director Richard Eichler said at the time.
Expanded programming on campus looks to address issues like stress or relationships that can contribute to depression. CPS sponsors workshops on issues ranging from relationship problems or procrastination to living with a chronic medical condition or body-image concerns. Every Wednesday, Furman offers stress-management training.
Even as it offers more diverse services, Columbia’s vast mental-health infrastructure remains overwhelmed, especially during the short, cold days of winter. With the staff stretched thin, it can often be difficult to get an appointment. “If you don’t want to off yourself they won’t see you for three weeks,” one student writes.
Indeed, respondents’ one significant complaint about CPS is that the office can seem impersonal, even insensitive. Faced with limited resources, the staff must prioritize some cases over others. The only constant feature of my therapy sessions, I’ve found, is that my therapist must ask me once per meeting whether I’ve had suicidal thoughts. As an unintended consequence, the prioritization of suicide risk over other symptoms could potentially lead to a hierarchy that discourages those who suffer mild symptoms from seeking help. But with the whole enterprise strained, it’s hard to argue against a triage that favors those with the most severe, immediate symptoms.
Despite the recognition CPS and Furman have received, students identify a few things that detract from the services. Few respondents place blame on CPS or Furman, but a majority suggests that the administration should better publicize on-campus resources. More publicity helps confront stigma, those surveyed write, while also making it easier for students to know where to get help.
“CPS is not well presented,” one student writes. “You literally have to search for information and it’s difficult to figure out what level of care our student medical fees entitle us to.”
Those who do make it to CPS are limited to 10 sessions. After that, you are referred out and had better have good health insurance, though Columbia will cover a portion of the cost of outside services. A junior who was quickly referred off-campus says the school helped him find an affordable counselor. “Experience = good: they directed me to a good psychologist that the CU insurance covers, and to a sliding-scale psychiatrist.”
Some respondents suggest that the number of sessions should be extended. Students’ other ideas for what could be done on campus to improve the current fight against this condition trend toward raising awareness of the disease, and easing the pressure of academic life. “It is farfetched,” Nick Fuca, a post-bac student, writes, “but make the university less competitive and more cooperative.”
One respondent writes that there may be an endemic fear of not graduating on time, and that Columbia could work to deemphasize that timeline. “Encourage them to take a lighter workload if necessary,” he writes. “Don’t have Columbia administration breathing down your neck to kick you out after 4 yrs regardless.”
Relatedly, our survey finds that some students are cautious of getting help because they know that University-mandated medical leave could potentially be on the table. (These leaves, it should be noted, are rare.)
As far as the campus is concerned, it seems a strong portion of students feel like depression isn’t well represented in the public dialogue. This silence, on top of the successful, if limited, reach of on-campus services, constrains Columbia’s ability to ameliorate the problem.
And some students just say they want to avoid the baggage of professional help. “People are afraid of being pulled into the treatment octopus,” notes one respondent. “It has tentacles of long waits, judgmental friends, and a long, drawn-out process of recovery.”
Stigma Overrides Confidentiality
Students list many reasons for not seeking counseling. Most distinguish the disease from its symptoms, and acknowledge that for most people only the latter can be treated. Many who have not sought treatment say they’ve discovered their own methods and routines for coping. Others cite the inconvenience of adding more to already busy schedules, uncertainty as to whether they have the condition, and a lack of faith that things can get better. Many opt to share their struggles with friends in lieu of seeking professional help.
The overwhelming majority of students, though, see embarrassment, shame, and fear of rejection as the prime factors that more people do not get help—even though therapy itself is confidential. In fact, less than 10 percent of those surveyed do not mention stigma in some form.
One junior writes: “There is a real perception that if you’re depressed, it must be your fault, there is something wrong with you, rather than an attitude of ‘I’m feeling overwhelmed and depressed at the moment. I think I’ll talk to someone.’”
“Stigma is very prevalent, people feel like being unhealthy equals weakness,” Sam Rennebohm, a senior in the School of General Studies, says.
I know I felt that stigma—I didn’t seek help until I was truly dysfunctional. I was sleeping all day and my sense of reality began to rupture. Waking up regularly at sundown with a dozen missed calls, I only sought help in September because I wanted to make it to October.
With the therapist, I’ve mostly followed a simple strategy—I ramble on about what I think may or may not be causing me to feel this or that way, she picks up on patterns of topics, and we go deeper into those issues. It’s useful to have a conversation devoted solely to what I’m thinking and feeling. I’m also on two medications, neither at a particularly strong dose. Now I can sleep, at least on the good days. Even on the bad ones, at least I stay away from that little window.
This program of self-care I have alluded to is crucial. I use the term slightly sardonically—you must indeed help yourself to start getting better, and no one can force you to take that first step to help yourself. But it requires so much more than just attention to one’s self: you can’t just will your way to a cure. There seems to be the perception here that with a little willpower, you can “snap out of it.” You can’t. But you do need to be invested in improving.
Just as there is no way to neatly describe depression, there is no quick fix to the problem. If a patient feels a bit better after getting started, it’s never clear where the finish line is.
And that’s what students seeking help need to remember. It’s a long-term process, and there’s no quick fix. There are setbacks. But if, as Rennebohm suggests, we can change the culture from one of stigma to one in which we privilege emotional, social, and psychological development as much as intellectual education, perhaps the suffocating fear of seeking help will ebb.