Print“Sometimes it feels like we’re all living in a Prozac nation. The United States of Depression,” says Elizabeth, a Harvard college student, in a scene in Prozac Nation, a film released in 2001. Depression, substance abuse, and mental and eating disorders are more heavily reported by students than ever before, according to a 2002 article in Psychiatric News. Why?
A set of tragedies stemming from a student’s mental illness have occured on campuses in the past 10 years: Cornell, MIT, NYU, and Columbia have all been sites of relatively recent student suicides. And at the root of almost every one of these tragedies, it seems, is mental illness. Is there something about college that triggers the onset of a mental illness?
The American College Health Association reported in 2004 that 50 percent of college women and 40 percent of college men surveyed claimed to have been so depressed they could “barely function” at some point, and that 14.9 percent of those students had been diagnosed with clinical depression at least once.
Depression, and the challenges of coping with a mental disorder while simultaneously making the transition from high school to college life are struggles that Haley Moon, a junior in BC, finds all too familiar. A Mississippi native diagnosed with post-traumatic stress disorder and depression after Hurricane Katrina, Moon called the transition from home to college “nerve-wracking” and “scary,” but managed to cope with her illness in creative and innovative ways. Her methods included writing a book that chronicled her experiences with adolescent depression as well as the experiences of others, entitled Katrina Tears. But her support system at school enabled her to cope with the demands of a full-time college career, and the care required to recover from her PTSD and depression.
“I think that social support is very important whenever anyone is suffering from a mental disorder,” she says. “You can be your own source of confidence and love, but when you have people who can empathize with you, you realize that whatever [health issues] you’re going through may be different, but it’s OK to be going through it. And instead of judging people with problems that you don’t have, you should support them through those problems and appreciate the strength that it requires to go through them, and help be a source of that strength.”
In addition, maintaining her level of involvement in extracurricular activities provided Moon with a welcome consistency.
“I was trying to be the good Barnard student who just did everything. So I stayed involved and that gave me consistency. I wanted to keep the hobbies I had at home here in New York, and that helped a lot,” she says.
Moon continued, “There are definitely days when I do get really upset and I feel like I’m relapsing, but I realized that everyone has those days and it’s OK. Also, my physician is just a phone call away, and she reminds me that I’m not relapsing and that it’s perfectly normal to have a bad day.”
One point of debate is whether students are truly suffering from more severe psychological problems than ever before, or whether they are simply more educated and aware of their mental health needs, and thus, more likely to report any problems that might arise.
Some psychologists claim that the greater use of campus resources and psychological services indicate that students are more self-aware, and that the social stigma surrounding mental illness is gradually dissipating, which could contribute to increased numbers.
On the other end, a USA Today article, “Mental illness on campus: A quiet danger no longer,”claims that the transition to higher education, with its sleep deprivation, pressure-cooker environment, and social challenges, can exacerbate the symptoms of an already existing mental disorder. Some also attribute the rise in mental illness diagnoses to the greater diversity of schools today, which naturally creates a more representative sample of the population.
The simple answer, perhaps, is that both factors contribute. According to Martha Kitzrow’s article in a NASPA journal in 2003, students are using more psychological resources at their schools than ever before, and they are indeed coming to school with more emotional damage under their belt, and more pressures and challenges to overcome, including alcohol use and abuse, sex, divorce, and family dysfunction.
Still others, such as University of Michigan assistant professor Daniel Eisenberg, are careful to note that mental disorders are still underreported, and often go untreated. According to Eisenberg’s study, cited in Science Daily, “anywhere from 37 to 84 percent of students didn’t seek treatment” for their disorders, depending on the disorder from which the student suffered.
Journalist and mental health activist Robert David Jaffee believes the increase in prevalence of mental illness reflects the fact that we are over-diagnosing patients. In response to the veritable explosion of diagnoses like “video game performance-related depression” and “eco-anxiety,” and what he calls diagnoses du jour like obsessive-compulsive disorder and attention deficit disorder. Jaffee argues that our society has become obsessed with fad-induced disorders, technology-related issues that cheapen the true meaning of mental health problems, creating a diagnosis for every slight problem of every shape and shade, no matter how it comes and goes with time. His claim, then, is that the over-diagnosis of both children and adults and the current fashion of being diagnosed, is detrimental to those patients who have undergone true trauma and who have deep-seated, recurring problems that disrupt their lives and the lives of their loved ones.
Louis Menand, in an article in the New Yorker, points out the fact that there are clear incentives for pharmaceutical companies to press for increased diagnoses in order to bolster sales of medication. Between 1988, the year after Prozac was approved by the FDA, and 2000, adult use of antidepressants almost tripled. By 2005, one out of every 10 Americans had a prescription for an antidepressant.
Some even argue, as Jerome Wakefield and Allan Horwitz do in an article titled “The Loss of Sadness,” that depression, a common diagnosis, has been recently redefined to include feelings of “normal sadness.” Menand notes that people take antidepressants for all sorts of reasons, including eating disorders, panic attacks, premature ejaculation, and alcoholism.
Furthermore, Gary Greenberg questions, in his latest book Manufacturing Depression, why there is a need to “pathologize” depression as an abnormal condition. Isn’t depression just a “sane response to a crazy world,” he asks? The infatuation with biological determinants of human feelings and behavior is, according to Menand, perhaps a way of compartmentalizing one’s illness, and relegating all agency to genetics, effectively allowing one to say, “I’m just an organism, and my depression is just a chemical thing.”
Still others such as the National Alliance on Mental Illness, however, maintain the position that students are under-educated when it comes to mental disorders, that they are often under-reported and go untreated, and that parents and students alike are unaware of the possible dangers of this lack of education. Using bipolar disorder as an example of this grave recurrent problem, the Alliance cites a report that states that 35 percent of parents, and 48 percent of students, believe that bipolar disorder is due to a “character flaw or weak will power” rather than a true problem.
Even if depression is over-diagnosed, and antidepressants overly prescribed, is this necessarily a bad thing? Many do report that they feel better when they take drugs that affect serotonin and other brain chemicals. Even if the change is simply a placebo effect, would one deny someone the possibility of feeling, even if only temporarily, better? The fact is that we, for some reason or another, look down on “shortcuts.” Psychiatrist Gerald Klerman calls this view “pharmacological Calvinism” which basically holds that happiness is not worth anything unless you have worked for it, so one shouldn’t take shortcuts to happiness. We admire the person who struggles with fear and overcomes it more than the person who has no fear in the first place.
The debates over the diagnoses of mental illnesses, while important and intriguing, are, at the end of the day, generally unhelpful to those who are suffering and are searching for practical solutions. For students who do indeed suffer from a mental disorder, the question arises: “What is the tipping point?” — when a student physically hurts him or herself?
The importance of a social support system for the maintenance of mental health has been established in many recent studies. According to the National Alliance on Mental Illness, students are far more likely to go to a peer or friend with a problem than to a teacher, counselor, or family member. More importantly, as Moon suggested, a social support system is invaluable in terms of the self-esteem it gives to students in a time of transition and, often, turmoil. One study by Jennifer Hefner and Eisenberg found that 31 percent of students with low quality social support “screened positive” for depression, while only 5 percent of those with high quality support did, and 10 percent of students with low social support had suicidal thoughts in the month prior, versus only 1 percent of students with high support. Social support in general was associated with a lower probability of depression, suicidal thoughts, anxiety, eating disorders, and self-injury.
Perhaps mental disorders can’t be prevented, but with the support of peers, and the foundation of psychological resources in schools, they can be dealt with more effectively. For Columbia and Barnard students, CPS, Furman, and Nightline offer free counseling services, serving as part of the social support network that students need. However, there is a difference between functional and structural support; functional support refers to the quality of relationships, while structural support refers to their very existence. Are Columbia’s professional psychological services better categorized as a source of “functional” or “structural” support? This is a question that will be explored, among others, in the April 8 issue of The Eye.