Crisis U

Step by well-meaning step, colleges are being transformed into something more akin to mental health wards than citadels of learning.

By Hara Estroff Marano, published on September 1, 2015 - last reviewed on June 10, 2016

It was 3:18 in the morning. The dorm was quiet. Alyssa had sunk to the floor, not far from her bed. First to hit was a tsunami of nausea. Then her heart began galloping; she thought it might explode. Her breath came in staccato gasps. And her arms shook so implacably it took her minutes to type: “My…boyfriend…is…breaking…up…with…me…life…sucks…i…suck…i…feel…like…killing…myself.” 

Whether troubled Facebook posts or middle-of-the-night cries to independent support services like Crisis Text Line, such messages, along with class absences, disturbing writing in course assignments, or direct threats to fac­ulty, are a new common core of college life, where students in a fragile state of mind, like Alyssa, may be spotted by Students of Concern committees and funneled off for help. For increasing numbers of students all across the United States, disappointment now balloons into distress and thoughts of suicide. Lacking any means of emotion regulation and generationally bred on the immediacy of having needs met, they know no middle psychic ground: Mere frustration catapults them into crisis. 

“Problems are more urgent than ever,” says Philip Meilman, professor of psychology at Georgetown University and director of its campus counseling center. When he took his first post after earning his doctorate four decades ago, he says, counseling centers mostly saw collegians struggling with developmental issues—homesickness, relationship breakups, lack of life direction. “That’s not what we see today,” he reports. “Students have more overwhelming concerns: ‘I’m cutting.’ ‘I’m anorexic.’ ‘I’m suicidal.’ ‘I’m alcoholic.’ ‘I’m bipolar.’ Or combinations thereof.” Developmental problems have not gone away, they are just masked by more pressing turmoil. 

Nationally, 22 percent of collegians now seek therapy or counseling each year, reports Daniel Eisenberg, an economist at the University of Michigan whose Healthy Minds Study annually samples 160,000 students around the country. The number of those in counseling varies from campus to campus depending on its culture—10 percent at some large schools, nearly 50 percent at some small, private ones. The figure has been steadily growing for two decades and shows no signs of slowing.

Educators contend that students arrive at college psychically burned out from building portfolios of excellence, primed to crumble at the first significant disappointment they encounter. According to Benjamin Locke, associate director for clinical services at Penn State, one in three students now starts college with a prior diagnosis of mental disorder. Academic or social stress, late-night cram sessions, any disruption of routine in the looser-than-home campus environment can shatter their stability. 

Photograph by Adam Levey

Ten percent of those seeking services in 2014 had previously been hospitalized for mental health concerns, says Locke, who as head of the Center for Collegiate Mental Health (CCMH) compiles an an­nual report summarizing counseling-center intake data from more than 100,000 students at 140 schools. Eisenberg’s Healthy Minds Study indicates that 19 percent of all college students regularly take psychotropic meds—antidepressants, anxiolytics, and stimulants such as Adderall.  

Distress on campus takes a variety of forms, but far and away the leading concern in 2015 is anxiety—54 percent of all college students report feeling overwhelming anxiety, up from 46.4 percent in 2010, according to the latest semiannual survey conducted by the American College Health Association. That wasn’t always the case. 

Until recently, anxiety vied with disabling depression and relationship problems. But about five years ago, campus psychologists agree, anxiety began outstripping other concerns. And each year the divide increases, says Micky Sharma, director of student counseling at Ohio State University and president of the Association of University and College Counseling Center Directors. “For 47 percent of clients seeking counseling—which is available in seven languages—anxiety is the primary complaint. Students feel overwhelmed. They can’t manage.” In Cornell University’s latest survey of students, 38 percent of undergraduates said that they had been unable to function academically for more than a week. Anxiety is a byproduct of thinking, but it is incapacitating without the ability to apply critical thinking skills to emotional reactions. 

Angst has long afflicted those of college age; but once it had an intellectual, existential cast. Now it is primarily emotional. By some psychic sleight, common life dilemmas have become mental disorders.

Everyone agrees: Much of the anxiety is socially driven. “Students feel inept about romantic relationships,” observes David Wallace, head of counseling at the University of Missouri. Students have difficulties establishing relationships, handling conflict within them, and enduring breakups. The anguish is always hyperacute, and it spreads to almost all areas of life. 

Self-harm is a staple of dorm life, and Eisenberg finds that nearly one in five students engages in cutting, burning, or other form of self-mutilation. According to the 2014 CCMH study, 24 percent of students purposely injure themselves without the intent to kill themselves. The number is slowly increasing, up from 21 percent in 2008. 

Experts find it difficult to pinpoint why. It may be that lacking the ability to emotionally regulate themselves, students feel things especially intensely—beyond their ability to articulate their feelings. In general, says Paul Grayson, head of counseling at New York’s Marymount College, “there’s more acting out of distress. Earlier cohorts were more internally tormented.”

Photograph by Adam Levey

Anomie in the Hall of Mirrors 

Students come to college not merely in an era of high general expectation of success but having nurtured their own hopes for nearly two decades; almost everything in their life has been geared toward college, or at least getting in. The more selective the college, the more students arrive with feelings of inadequacy, afraid their admission was a clerical error. Having had—or been allowed to have—few disappointments in their overparented, overtrophied lives, many have not learned to handle difficulty. In the absence of skills to dispel disappointment, difficulty becomes catastrophe.  

In addition, lives are now presented publicly, stripped of the anxiety that churns beneath. “It’s generational,” says a Brown University student. “We are obsessed with social media. But it magnifies the comparison factor.” At a school with so many talented students, she says, almost everyone is stuck in negative self-evaluation—trapped in a hall of mirrors. Social connection is as necessary as air for health. But “we have to acknowledge it now has a dark side,” says Gregory Eells, director of the campus counseling center at Cornell University. 

The dark side came glaringly into focus with the 2014 suicide of Madison Holleran. A star athlete in high school, Holleran had accepted an offer from the University of Pennsylvania to run track. But like many freshmen at competitive colleges, she had trouble adjusting to a school full of standouts, although she pulled off a 3.5 GPA her first semester. 

She was, by all accounts, a perfectionist, unused to stumbles or even confusion. She had yet to get the knack of balancing schoolwork and training; it made her deeply unhappy, afraid of failing. There were the expectations of adoring parents, not to mention her own. Her high-school friends, scattered at colleges, all seemed so happy on Facebook. And the Penn upperclassmen she followed on Instagram—their lives were so picture-perfect. She couldn’t get past the sharp contrast between their images and her inner reality. 

A week after the start of her second semester—the return from breaks is now the cruelest time for student mental health—Holleran took a running leap over a barrier and off the roof of a parking garage in Philadelphia. “I don’t know who I am anymore. trying. trying. trying,” said the note she left in her dorm room. “I’m sorry. I love you … sorry again… sorry again… sorry again… How did this happen?” One day she seemed happy, the next day she seemed sad, and the day after that she was dead, said one of her sisters.  

Disturbing as it always is, and especially tragic on the threshold of adulthood, suicide is still rare among collegians—roughly one in every 10,000 students. Suicide is rarer still among college athletes. But the Penn death—one of a cluster of four that year—is emblematic of the new constellation of forces playing havoc with the already frail psyches of today’s students, and reflects growing concern as to just how vigilant college communities should be. Mandated student-leave policies and parent notification practices, potentially violating federal privacy requirements, are contentious issues on today’s campuses. 

“Holleran’s suicide is a cautionary tale,” says Brian Tompkins, associate athletic director at Yale. “Our campus is full of people who have her struggles. Everyone so profoundly misread her. Instagram is a live account of what’s going on. But it undermines students by highlighting how normal and even happy everyone else seems in contrast to oneself; it reinforces isolation.” 

At the Ivies and other elite schools, populated primarily by those from a narrow band of the achievement spectrum, “weakness has to be invisible,” says a Princeton student. “You have to come off as infallible in all domains and to appear effortlessly excellent.” Students at Penn openly speak of the phenomenon as putting on a “Penn face,” although their glibness makes it no easier to crack. 

Most students coming to college today are highly achievement-oriented and have grown up with competition. Competitiveness matters to mental health, says Julie Posselt, an assistant professor of education at the University of Michigan—but in distinctly surprising ways. It’s not the selectivity of the school that matters. In fact, in analyzing data from over 40,000 undergraduates in the Healthy Minds Study, she discovered that anxiety is actually more prevalent in institutions that are less selective with respect to admissions. 

What is linked to distress is how much competition students face in their classes. Of course, some competitiveness is good, a spur to excellence, but there is a threshold at which it begins to have negative psychological effects and shifts motivation from learning to performance. “It depends on how the professor runs the class,” Posselt says. “How much test-to-test performance anxiety is there?” Such practices as grading on a curve, for example, exaggerate small differences in high performance and pit students against each other. “Perceived competitiveness increases by 40 percent the odds of positively screening for depression,” Posselt finds. “Students who reported that their classes were ‘very competitive’ had 70 percent higher odds of screening positive for anxiety.”

Here’s the catch: If students felt their classmates were more teammates than rivals, more collaborative than cutthroat, they were spared the negative mental health effects of competition. “Peer support mitigates the effect of competitiveness.” Unfortunately, Posselt notes, the more colleges are attuned to their status rankings, “the less likely they are to address the effects of competition.”

Photograph by Adam Levey

Sex, Drugs, and Rock ’n’  Roll

Make no mistake: Drinking has long been a part of campus life. But drinking has moved beyond beer to hard liquor, which is such a staple of campus life that more than a dozen universities, from Alabama to Wisconsin, license their logo to Kraft, Jell-O’s manufacturer, to market insignia-embossed molds for making tasty shots. 

And drinking is now particularly goal-directed. In the “old days,” drinking was done in a general spirit of euphoria, observes Lee Keyes, director of campus counseling at the University of Alabama. “Today it’s aimed at the obliteration of consciousness. That’s a reflection of the degree of anxiety of today’s students, especially in social environments.” 

A 2013 survey conducted by 34th Street Magazine, the arts and culture arm of Penn’s Daily Pennsylvanian, revealed that 71 percent of Penn students get blackout drunk at least once in college; 28 percent get blackout drunk at least once or twice a month. For 24 percent of students, blacking out is the goal. It’s an inverted world in which the path to pleasure is passing out. 

“At the end of the week, we all turn to alcohol,” says an Ivy League student. “And we drink to get smashed. We work hard during the week. I want to distance myself from my work and my problems. The goal is to let loose for a night.” What’s more, “People feel they can talk more to others if they show up drunk. If you’re sober, you feel you may not enjoy yourself as much.”

A big part of the shift, says Yale’s Tompkins, is that “students mistake pleasure for happiness. And they pursue pleasure to such excess that it winds up making them less happy. Thinking they know how to find pleasure leads them to alcohol, which leads them into casual sex situations that become problematic.” 

The players in this contemporary drama are the outsize stress students now perceive; the drinking and especially binge-drinking that is an accepted part of campus life; the rise in status of women, including gender ratio shifts on campus; the nature of dating in the 21st century; and the pluses and minuses of casual sex.

“The number one date rape drug is vodka,” says Holly Rider-Milkovich, director of the University of Michigan’s sexual awareness and prevention program. “Vodka is cheap. You can drink less of it and get drunk faster, which is of concern to women: It minimizes calorie intake.”

Students are often fully aware of the risks of mixing alcohol with sex. “We struggle with relationships,” says the Brown student. “It’s especially difficult for women. Lots of women students want respect and a stable relationship. But they believe that hooking up is what you do. Then they get depressed. You wake up on a Saturday morning and you feel empty, regretting what you did the night before.”

Neither are males necessarily well served by hooking up. “It doesn’t feel like an adequate interaction for either.” says Barbara Thomas, head of counseling at the University of San Francisco.  “It’s not deeply satisfying. Neither knows what the relationship is.” Further, the dating app Tinder is used on many campuses. “You text a guy at 1 a.m. He texts back, ‘Why don’t you come over.’ You go home with someone you don’t know much about.” Most hooking up occurs during freshman year, notes the Brown student. Older students tend to settle more into relationships.

But if sex is easier to come by, committed relationships are harder to get. There are now 60 women to every 40 men on campus. Highly selective schools maintain more of a gender balance; they simply have a deeper pool of males to draw from. But the skewed gender makeup of college life, many psychologists believe, also shifts relationships onto men’s terms. 

Women on campus increasingly feel they are in an untenable sexual spot. “The women on my campus are more put-together than the men, physically and psychologically,” says the Brown student. “They’re fit. They’re focused on appearance. They’re more socially adept. The guys function like they did in high school.” Emory University anthropologist Melvin Konner concurs. “Boys and men are reeling from the shock of having women surpass them,” he says. By classic gender math, the paucity of suitable males favors their choosiness. That, too, fuels casual relationships, which give rise to so much relationship angst.

To some extent, women are in a bind. With ambitions unleashed, many put serious romance on hold, observes Marymount’s Grayson. Hooking up seems like a workable holding action. “Problems arise,” he explains, “when students think they want no ties but it turns out that’s not how they feel.”

Social scientists debate whether the shifting gender ratio also promotes rape. What is not in debate is that sexual misconduct is stirred by the cocktail of heavy drinking, declining social skills, and the prevalence of sexual regret. “I hear a lot about remorseful interactions,” says Thomas. “Many would fit the legal definition of acquaintance rape. I am often the person labeling it for students.” Sex post facto.

Colleges are required by federal law to investigate all allegations of rape. But what follows is usually an unsatisfying mess, because it is impossible for colleges—anyone, really—to arbitrate when emotional relationships sour. Or to see clearly through the alcoholic haze that surrounds so many incidents. Victims and accusers sue each other and universities, and few female students believe that colleges examine the issues with an eye to their best interests. “Colleges could be more honest,” says one student. “Decisions not to prosecute perpetrators are often a way to manage statistics.” Rider-Milkovich says bluntly, “System responses don’t always have the well-being of students in mind.”

No one knows for sure how common sexual misconduct is on college campuses. In a recent survey, 11 percent of University of Michigan students reported some form of nonconsensual sexual behavior—touching, kissing, fondling, penetration. The issue is highly incendiary. 

It troubles Rider-Milkovich that students use alcohol to facilitate sexual expression, and so she is testing a campaign to inform them that “You don’t have to be buzzed to express interest.” If she could teach students one thing, she says, it’s to identify and speak up for what they want in a relationship. Relationship Remix workshops now offered to first-year students in campus residence halls do just that.

The Ward

Step by well-meaning step, campuses are being transformed into something more akin to mental health wards than citadels of learning. Colleges are already the largest employer of psychologists in the country. But now, personnel and administrators from all walks of campus life are conscripted into the business, subjected to training in how to spot students who could cause trouble, to themselves or others.

Yale’s Tompkins reports that coaches now spend as much time soothing the hurt feelings of the few athletes who don’t make a travel squad as they do preparing for competition the majority who make the cut. “The focus now is how not to damage the fragile emotional state of students or their vulnerable sense of self,” says Tompkins. “Ego strength is so lacking that even in the face of objective evidence of recent athletic performance—video footage—they say, ‘It can’t be my fault, because nothing has ever been my fault. It must be the coaching.’” The days of the coach as a person with a whistle and a clipboard are gone, notes Tompkins. “We are now compassionate caregivers.”

As colleges cater to their charges, some interventions in fact abet the very psychic frailty that is transforming campus life. Much has been made of “trigger warnings,” attempts to shield students from material that might rekindle trauma memories or otherwise offend vulnerabilities, in which case they can retreat to designated “safe rooms.” At Rutgers, one student cited the “disturbing narrative” of “suicidal inclinations” in Virginia Woolf’s Mrs. Dalloway, the “gory misogynistic violence” in The Great Gatsby, and more. Students at campuses from the University of California at Santa Barbara to George Washington University have called for such warnings, and schools have complied by developing official policies on them.

Lifestyle boosts are also popular: At Cornell, a school known for its campus cuisine, chefs will prepare students gluten-free nibbles at any hour.  Then there’s “puppy day,” a now-common event on American campuses, aimed at relieving stress during finals. Administrators arrange for local residents or animal shelters to provide puppies for students to pet. Two thousand students turned up at one such event at UC Davis, the second largest gathering there for any cause in recent years. “It provides the comfort of something you normally get only at home,” says a student.

Such gestures simply infantilize students, says Eells. “Colleges compete for students and cater to them as consumers, rather than challenge them. They rob students of a sense of efficacy.” 

Deliverance

All the fragility and coddling notwithstanding, few of those who tend to the recurring distress of students think them inherently disturbed. “I’m concerned about everything being pathologized,” says Missouri’s Wallace. Even students whose crises merit diagnostic labels and prescriptions can learn coping skills for life. “We’re pulling people out of the river when we need to be stopping them upstream.” 

Shaken by a cluster of suicides in 2010, Cornell put forth a strategic plan declaring that it is now “the obligation of the university” to help students learn life skills, Eells says. Colleges will have to shift from protecting students from imagined harm to making them psychologically stronger, something many parents have not taken on.

Photograph by Adam Levey

And so “resilience” has become the word du jour on campuses nationwide. Some concerned individuals, like Steven Brown, head of campus counseling at East Tennessee State University, have created their own home-grown courses to teach students the emotional skills they think will save them from their disregulated selves. All students entering Penn State take an online mental health course before arriving on campus. Incoming students at Washington State get to focus on substance use and sexual decision making in Booze, Sex & Reality Checks workshops. Harvard targets academics more. It has created a website, The Success-Failure Project, specifically to let students know the world doesn’t end if they mess up; it features stories of faculty stars who stumbled or were rejected along the way. Renowned geneticist George Church, for example, recounts that he repeated ninth grade and flunked out of Duke. But no one yet knows what the essential ingredients are for a program that will enable students to thrive.

Which is why everyone has their eyes on Elizabeth Gong-Guy, former head of campus counseling, recently promoted to a new position, executive director of student resilience at UCLA, the largest school (42,000 students) in the largest higher-ed system (190,000 students) in the U.S. As resilience czar, Gong-Guy is charged with formulating and testing programs to restore to a generation of students bred to believe that failure is not an option the ability to cope with disappointments and undo the damage done by a generation of well-meaning adults. 

“I see students increasingly struggle with getting through higher education,” says Gong-Guy. “Many come from families where they have not been allowed to develop stress tolerance. Some of the coping with their own emotions is developmentally delayed. And now they’re having to focus on them while also functioning at a high level academically.” Whatever else the program does, it will address skills of communication, conflict resolution, negotiating diversity, and spirituality as well as emotion regulation and distress tolerance.

Just Who Are the Strong Ones?

The best models of resilience may already exist on campus, although college officials may not yet recognize them as such. They are the more than 5 million first-generation collegians, many from immigrant families, some so poor they can’t afford textbooks. They have endured homelessness, hunger, and other hardships unknown to their 16 million peers—and still managed to get themselves to college, typically without much parental input and often without any adult guidance at all. 

Hung Pham is one of them. The son of Vietnamese immigrants, he grew up in Vallejo, California, a city so economically marginal it declared bankruptcy in 2008. For Pham, that meant no computers, textbooks rotated with another school, and few AP courses. 

He arrived at Yale in the fall of 2011 feeling “underprepared, underprivileged, disadvantaged, and ashamed of my background.” He didn’t know how to ask for help—didn’t even know he could.  “I didn’t really know how to write an essay. I didn’t know Yale has a writing center,” he recalls.

He majored in art history and took the full load of premed courses, too, because he intends to be a doctor, and worked as an emergency medical technician to send money home.  In the fall of his sophomore year, he was working 19 hours a week, Yale’s limit—California had cut his family’s food stamps and there were three siblings at home—and was losing traction in that most challenging but necessary of premed courses, organic chemistry. 

“It was the darkest part of my life. I really needed to do well in that class,” he recalls. “I was putting lots of effort into the problem sets, but the night before each test, I worked a big shift. The day before finals, I told my professor I didn’t think it was worth it to take the exam. He stood up, shook my hand, said, ‘I respect you for all you’re doing,’ and let me drop his course.” Pham was astounded. “Here was this white male at this institution made by white people for white people supporting my decision to drop his own course—and being proud of me for doing so.” 

The full blast of enlightenment didn’t hit until well into his final semester. Over a late-winter weekend, Brown University hosted the first 1vyG, a conference of first-generation college students; more than 200 came. In a workshop, Pham heard that the hardships he endured could be seen as an asset, that adversity had bred an array of résumé-worthy skills—grit, resourcefulness, self-sufficiency, even knowing how to do his own laundry. 

“I found it shocking,” Pham says. “Most of the conversations about first-generation students are deficit-based. They focus on what is lacking, what are the holes to be filled. It’s always about what’s not there. And that is never empowering,” especially on a campus dominated by tradition and privilege. For sure, he was not as prepared as fellow students for discussions of Marx and Kant. “But my work ethic helped bring me up to speed.” Pham’s view of himself was transformed. “I realize now that I have valuable skills that others don’t.” 

It’s not that first-generation students glide through college. But they have their strengths, generally hidden even from themselves in an atmosphere that foregrounds their weaknesses.

Pham is not the only one to shift his thinking about just who the resilient ones are. Here’s the way a senior executive at one of America’s foremost investment banking houses puts it: “I hire lots of kids, and I won’t hire any more of the ‘fancy kids.’ I now hire only the children of immigrants. They didn’t have parents running interference for them. They’re good at figuring things out. They had to learn how to cope on their own.” 

And yet, by focusing so intently on their deficiencies, and seeing only the need to remedy what’s missing, colleges manage to rob such kids of a positive view of themselves. As if more proof were needed that those who mean only the best for America’s young can wind up bringing out the worst in them.

This is a fictititious diploma; any resemblance to a real institution is unintended. Photo by Adam Levey

How Students (And the Rest of Us) Misunderstand Stress  

On whatever faultlines collegiate psyches fracture, the precipitant is always stress—actually, the perception of stress. In the absence of basic coping skills, everything is a stressor. Even so, stress is not always what it’s cracked up to be. It’s not that academics have become more stressful, as indexed by time spent studying or grade inflation. The typical grade at Harvard is now an A, up from C+ 50 years ago; the average GPA at the University of Virginia has risen from 3.06 to 3.29 over the past 21 years.  But students talk about stress more.  It’s the new badge of college attendance. 

College students mostly regard stress as a plague. Americans generally are encouraged to view stress as one of our top health problems, a source not only of headaches and high blood pressure but diabetes and depression. Stanford psychologist Alia Crum has gathered evidence that all the alarm creates a mind-set that stress is negative—which paradoxically gives rise to its harmful effects on the mind and body.

There is a huge amount of research showing that stress enhances cognitive performance: It focuses attention, speeds up cognitive processing, and allows the mind to take in gobs of new information. It makes experience more salient, adding a sense of meaning and source of learning, growth, and progress. After all, the psychophysiological activation known as the stress response has been conserved through evolution to help us meet the unpredictable demands life throws our way.

Crum’s work finds that people who see stress as an enhancing challenge recruit a set of positive emotions. Those positive emotions allow them to engage in demanding activities without experiencing the debilitating effects of stress on body systems; they blunt cortisol reactivity. What’s more, stress actually emboldens them, motivating them to face and engage in challenges, not run from them. 

Crum and colleagues developed a three-minute video explaining the value of stress and tested it on employees of a major financial firm. In the Journal of Personality and Social Psychology, they report that it’s possible to change beliefs about stress quite readily, and doing so brings about improvements in psychological functioning and work performance. 

But in a world of many distractions and few coping skills, a dire view of stress may be the spur some students need: “It can help you focus,” says a Princeton student. “It’s almost like a drug. You use it and you like the results so you keep loading things on to build up the pressure, although it can get to the point of burden. It’s a double-edged sword.”

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