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Mental Health and College Students: A Conversation

A conversation about college students and mental health.

Recently I received a call from Mike Veny, a leading mental health lecturer who is working to reduce the stigma associated with mental health issues. He called me because he wanted to get my thoughts about mental health and college students and how he might guide students in college toward maintaining their mental health. It seemed to be a helpful conversation, so I decided translate the essence of the exchange. This is the first installment of what will be a two part post.

Mike Veny
Source: Mike Veny

Mike: I am interested in learning more about mental health issues on college campuses. I have heard that mental health difficulties are increasing for college students. Is that accurate?

Gregg: Definitely. There is a strong sense that there are declining levels of resilience and lots of data point to increases in mental health problems. Let me put it this way. When I was in college in the late 1980s, about 10 to 15% of the kids would have been struggling with what I would call clinically significant mental health problems. Now that figure is more like 30 to 35%. Something like a three hundred percent increase. Given the incredible toll that poor mental health has on folks, this is a really significant issue.

Mike: Wow, that is huge. Do you have any idea about what is causing this increase?

Gregg: Well, it likely is the result of lots of things. I did a blog that offered 17 different causes; let me hit the main ones here. First and foremost, we should note that Western society in general has seen a significant increase in levels of stress, anxiety and depression over the last several decades. So it looks like it is a more general increase, rather than something with just college students. Also there recently have been much higher levels of economic uncertainty. There is also a sense of much higher levels of competition, which combine with the jobs picture gives many folks a sense of serious achievement pressures. It is also the case that our society has been radically changed in recent years by social media, smart phones, and other technologies and that might be fundamentally changing our natures in ways that might not be good for mental health. There is also good reason to believe that this generation has been coddled a bit by hovering, overprotective parents and educational systems that did not allow kids to develop what I call “emotional callouses”. That is, they have been protected from negative feelings rather than been taught how to effectively deal with them. Another problem is that there has been a “medicalization” of negative feelings, such that many folks think of them as diseases you need to take pills for. Finally, it is also the case that folks may well be more willing to disclose their negative feelings than in the past, which might account for some of the differences.

Mike: What advice do you have for college students to maintain their mental health?

Gregg: That is a pretty broad question. My first basic piece of advice—and this is to everyone not just college students—is that we need to have a basic shared understanding of what mental health IS.

Mike: Okay, then, how do you think about mental health?

Gregg: The first thing that we need to have a basic awareness of our human psychology; that is, we need to understand what the key domains are and how they are related. At a minimum, you need three things: 1) A working map of human consciousness; 2) an understanding of the core psychosocial need; and 3) an understanding of the developmental and social context. Once you understand these pieces you can see why some folks are in a state of mental health and harmony and others are not.

Mike: What do you mean by a working map of human consciousness? That sounds kind of complicated.

Gregg: I don’t think it is super complicated. There are three domains of human consciousness. The first domain is the domain of experience; that is, your experiential self. This includes your sensations and perceptions, your drives and motives, and your emotions and feelings about being in the world. It is your embodied sense of being. The second domain is your private narrator. This is the talking portion of your consciousness, the part that uses language to describe and explain what is happening and why. This part is “self-conscious” and it interprets, evaluates and develops stories about both the external and internal world. Third, there is your public self. Your public self is the domain that you share with others, and involves how you hope or imagine others will experience you.

Mike: I think I am following. I can get that there is stuff that I feel inside, there are the thoughts I have with words, and there is my public self-image. Is that it?

Gregg: The last point about the human consciousness system that we must understand that there is filtering between these domains. That is, as almost everyone can relate, we sometimes filter our private thoughts and feelings from others. And, we also need to realize, as Freud pointed out, there is often filtering between our self-consciousness narrator and our subconscious feeling system. So the map is that there are these three domains and filters in between them. I have a diagram of this that helps.

Gregg Henriques
Map of Human Consciousness
Source: Gregg Henriques

Mike: Ok, that seems to make sense. What does this have to do with mental health?

Gregg: We are getting to that. Optimal mental health is largely about harmony between these systems, whereas mental illness is largely about disharmony, conflict and dysfunction between them. But in order to understand why that is the case, you need to understand the second key piece of the puzzle of human psychology, our core need for relational value.

Mike: Tell me about that.

Gregg: Relational value is the core human need to be known and valued by self and important others. Important others are people in your life that you care about, respect and depend on. As deeply social creatures, it is crucial at every phase in our life that we have a strong sense that important people in our lives both value us and deeply know who we are. It is a core human need, and if it is not met, then we experience emotional distress. If it is met, then we will generally feel emotional fulfillment.

Mike: I can definitely relate to that. I certainly want people to respect and care about me.

Gregg: Yes, being cared about is crucial. Let me emphasize here though that it is also crucial that folks also feel that they are known, at least by those who are important to them. You see, I have worked with folks who feel valued. However, they also believe that they are valued because they are imposters. That is, they are liked and cared for because they are faking it and they fear that if they were truly known they would be rejected. It is the sense of being an imposter that leaves many people to feel empty and distressed inside. Now, with these two pieces in hand, we are starting to get a key handle on mental health issues as I see them.

Mike: Did you say that relational value also included knowing and valuing yourself?

Gregg: Yes, I am glad you noticed that. In psychology, this is the concept of self-esteem. As children grow they begin to develop an inner audience of self. That is, they begin to realize they can think about who they are and have opinions about whether or not they like themselves generally and in specific domains. This capacity really takes off in adolescence. Knowing and valuing one’s self is a key aspect of relational value as I see it.

Mike: You said there were three pieces, right? Human consciousness and the core need to be known and valued by self and others. Then you said something about context.

Gregg: Yes, that is right. So, to get my basic framework for mental health, you take the map of human consciousness and you think about the need for relational value and then you put that in a developmental and social context. In other words, you ask: Where did this person come from, what were their early experiences like, and what is their social, cultural and relational context now? Consider, for example, that the experience of being known and valued comes first from others, most notably in the form of our early attachments to care takers. If our early care takers are attuned to our needs and show us that we matter to them, then a secure foundation is formed for our relationship system. If not, then we might develop an insecure relationship system. If you have an insecure relationship system that can cause you to feel very differently in your relationships than if you have a secure one. The point I am making is that the history and development of the experience of relational value is absolutely essential. And, of course, so is the current social context. So, I want to understand the person’s relationship context and the extent to which the individual is feeling known and valued in key domains. The major social domains are: 1) family of origin/current family; 2) romantic partners; 3) friends; and 4) groups that folks identify with. So the question is: To what extent does an individual have social influence and feel relational value in these various domains, and what have they experienced in the past?

Mike: So can you tell me how this all relates to mental health?

Gregg: Let’s start with the obvious, and that is the link between relational value and mental health. This should be pretty clear at the extreme low end of relational value. If someone starts out life with parents who neglect them or regularly physically abuse them and then they have poor relations with peers and never find a romantic partner nor a group that they feel solidarity with, then it is almost guaranteed they will end up as a distressed, distraught, suffering individual with poor psychological well-being. I think that is pretty straight forward.

Mike: I can follow that.

Gregg: Good. But most college students, even students who are struggling, were not brutally abused by their parents and completely rejected by their friends. So there is definitely something else going on. This is where the connection between relational value needs and the three domains of consciousness come into play.

To see this clearly, let me tell you the story of Amber, a client I worked with. Amber was loved and cared for by her parents. However, Amber did not really feel known by her parents. And in Amber’s family, negative emotions were not really expressed or shared. Instead, everyone just acted happy and if conflicts started to emerge, they were quickly swept under the rug. In middle school, Amber started feeling lots of anxiety about whether she was fitting in and whether she would be liked by her peers. But she couldn’t tell anyone that because she felt like it would be upsetting. So she created a public persona that she was happy and she just went along with what either her family or her friends were doing. Deep inside, however, she felt alone and alienated from everyone. And she was very upset with herself for feeling bad inside. She thought everyone else was happy-go-lucky. So she hid how she was truly feeling and she wondered why she was such a basket case and hated that she was that way. So the private narrator portion turned against her “feeling” self and she blamed herself for being a problem. When Amber came to college, she had been feeling like an imposter already for several years. But then she got confronted with all the stressors of college. She had been able to get good grades in high school, which was one area in which she could tell herself she had some true worth and value. But in college she found herself struggling with Cs, which caused her to flip out and ultimately have an emotional breakdown, which is when I came into the picture.

I hope you can see a couple of things with this story. First, mental health is not just about surface behaviors and whether or not things look ok in appearances. Rather mental health is about the harmony between the domains of consciousness and the experience of relational value. Amber experienced massive amounts of internal disharmony between her experiential self, her narrator, and the public image she was trying to maintain. She did not feel known and valued by either herself or important others. And then her inner narrator turned against her experiential self and she became a critic of her feelings and felt like an imposter socially. When that interacted with a performance stressor, she had a breakdown and became clinically depressed.

Mike: That is a pretty powerful model. I am thinking of my own life and lots of that makes a ton of sense. Does this model help us understand why we are seeing such increases in mental health problems?

Gregg: I think so. Central to the model is that idea that confusion and uncertainty will create filtering and disharmony. And so, we can ask: Is this a time of confusion and uncertainty? Indeed, I think we are living in one of the most psychologically confusing times in history. This is true for several reasons.

First, the age of technology is giving instant access to information about everything one could imagine. Thus, we are primed for information overload.

Second, we have largely lost or are losing our grand narratives that have historically given our lives meaning. At a population level, the US is making a transition from traditional Christian narratives to secular narratives and this trend is accelerating, especially for college students. As a secular individual myself, I don’t necessarily think this is a bad thing, but I do think it is confusing and I believe religion serves as a psychological balm for many people. But this loss of a narrative is not just about religion. It can be seen at the political level, where the political parties are as conflicted and polarized as ever. And it can be seen in the university, where universities no longer teach about things like moral character or how to life a good, meaningful life, but instead simply teach students about facts in the world and about how to acquire instrumental knowledge and skills to make money in a consumer-driven, materialistic society. In addition, knowledge at the university level is incredibly fragmented and confusing.

Third, I think our society has become more open and tolerant of both distressing feelings and disadvantaged individuals. I believe this is largely a very good thing. Certainly, the fact that our society no longer encourages explicit discriminatory practices and has, as its ideal, equal civil rights for all is a wonderful development. But with this move toward progressive openness have come a number of complex challenges. One very complex issue is that there is a fine line between working very hard to root out injustices and being sensitive to issues of minority or disability status or disaffected individuals and creating a culture of victimhood whereby the message is that if you feel like you have been aggrieved, you have been aggrieved, and you are justified in righting that wrong.

Fourth, I think psychology and psychiatry have done a lousy job educating folks about their psychology and the nature of mental health and illness. The idea that the mental health-illness continuum is about brain malfunction is one of the most dangerous ideas of our time. Think about this from the perspective of the story of Amber. The message to Amber would have been: "Your negative feelings were caused by a chemical imbalance. They were the problem and if you take this pill, then we should eliminate them." Of course, they were not really the problem, but just a symptom of the problem. So, psychiatry and Big Pharma and the insurance companies are peddling much misguided information about what I call neurotic problems.

Psychology has not been much better. It found, very consistent with what I mentioned above, that self-esteem is deeply associated with mental health. But the message that got out was that parents or teachers needed to protect kid’s self-esteem. So we created “self-esteem nation”, where you are told not to criticize kids or always look for the positive or every kid gets a trophy or whatever. This, of course, completely reinforces kid’s sense that they are fragile and it also completely reinforces filtering, and the sense that everyone is an imposter, just saying what people want to hear rather than figuring out how to be authentic. Another even bigger problem is that psychological knowledge is very fragmented and psychologists have not been effective in educating folks about human psychology. Instead, what is presented in Psychology 101 is just a long, complicated list of subjects, variables, and findings. You do not get a model of how people actually work.

Mike: That is quite some list. You really are painting quite a picture here. My goal was to help communicate to college students what they might do to maintain their mental health. I think I am starting to understand how you see mental health. Does this map that you have laid out provide suggestions for what to do?

Gregg: I warned you it was complicated and had lots of part to it. I do have suggestions for what we should do, but this conversation is getting long, so let’s break it up into a second conversation. Right now, the take home points are that college student mental health (and the mental health of our population at large) appears to be deteriorating. The numbers of college students with significant problems are about at 30% as a conservative figure, but that is three times the number that it was three decades ago.

If we are going to address this problem we first and foremost need awareness of what is going on and why. That is, we need a basic map of human psychology. I spelled out the three key elements: 1) the map of human consciousness; 2) the core need for relational value; and 3) the developmental and social context. We need to realize how and why mental health difficulties emerge as a consequence of disharmony between the domains of human consciousness in the context of relational value dynamics. Importantly, that disharmony is often the result of confusion and uncertainty. Finally, we need to recognize why it makes sense that we are seeing this rise in mental health problems because there are many forces that are creating more and more confusion and uncertainty. As long as we have this background, then we can start to shift more to understand how we need to educate folks about what they can do to help themselves navigate these complex waters.

Mike: I look forward to learning some more concrete things we might do to foster and maintain mental health.

Gregg: Great. Let’s continue this conversation.

(See here for part II).

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