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Students dissatisfied with CAPS as demand rises

in News by

Last semester, a psychiatrist at Worth Health Center prescribed Calla Bush St. George ’20 SSRI inhibitors to help cope with anxiety. She began taking the medication on Jan 28.  A week into the course, she awoke to intense nausea and depression.

“I just wanted a therapist, a professional, to give me their opinion on what I was doing [considering dropping the medication]. I was spending 16 to 18 hours per day sleeping and still feeling exhausted. It was absolutely insane,” Bush said.

By chance, Bush had an appointment scheduled at CAPS the next day. But the appointment she had scheduled with her normal psychiatrist was canceled due to a family emergency. So, Bush scheduled a walk-in appointment at 4 p.m. for that coming Thursday.

Upon arriving at her walk-in appointment, Bush was juggled between psychiatrists and psychologists, only getting 10 to 15 minutes with each before having to wait in the hallway when their scheduled appointments would disrupt her session. According to Bush, there was no additional staff to meet with her.

“They didn’t have anyone to see me between the times of their other appointments,” she said.

At nearly 6 p.m., Bush was told to go over to Worth Health Center and talk to the staff there.

“I had probably been at the Worth-CAPS building for two hours,” she said.

A nurse at Worth took her blood pressure and other vital signs—which was the extent of the examination.

“I wanted to be reassured by somebody that it would be okay,” Bush said. “I was thoroughly disappointed by the whole experience.”

For some students, like Bush, access to mental health services on campus has been a continual source of frustration. Why this is the case is not entirely clear, although according to CAPS, there has been a recent spike in student demand. At this point in the semester, student demand for CAPS services has increased by approximately 30 percent compared to all of the last academic year, according to CAPS director Dr. David Ramirez.  Ramirez listed several reasons why he believes student demand for CAPS has risen, including the threat of economic disenfranchisement and deportation.

“People are upset, families are living in fear. There was a thing in the news last night about how students from Latino families who were U.S. citizens and under no threat of being thrown out of the country are more fearful and more depressed on NBC News. There was a study … [that] showed just having connections to vulnerable populations makes you more vulnerable, makes you more fearful,” he said.

While CAPS has seen a steady uptick in student demand over the last couple of years, the magnitude of this year’s increase may indicate something more dramatic taking place. Ramirez said that CAPS keeps tabs on how many students in the graduating class have been to CAPS by the time they reach graduation.

“We track at graduation the number of students who have been to CAPS … that number was a stable one-third of the graduates. Then a couple of years ago it jumped to half,” Ramirez said.

The number of groups and administrators that refer students to CAPS has gone up, according to Ramirez.

“We are on a lot more people’s radar… There are more entities in the college community that are looking out for students, and looking out for students who have concerns, who are using CAPS as their go-to referral source,” he said.

Ramirez also believes it is becoming more acceptable to use CAPS at the college.

“Where we used to worry about barriers to utilization, about people feeling afraid or ashamed, and I think for some students that is still problematic,” he said. What we see now is students telling each other ‘I am going to CAPS, you should go!’ They are encouraging one another.”

CAPS saw 476 students last academic year. As of last Friday, CAPS has scheduled 492 students for this academic year. Ramirez predicts that CAPS will see as many as 600 students by the semester’s end.

CAPS employs 13 clinicians but has only nine offices, one of which is occupied by CAPS administrative assistant Terry McGrath. In 2004, the Worth-CAPS complex underwent a multimillion-dollar renovation. The number of CAPS clinical rooms went from four to eight. Director Ramirez says he regularly gives up his office space so other staff members can use it meet with students.

CAPS hired an additional three clinicians last semester on a part-time basis and switched to a digital scheduling system to better meet student demand. It is their mission to provide an “unlimited amount of psychological support for students,” according to Ramirez.  In keeping with that philosophy, last semester CAPS implemented a 24 hour CAPS On Call system, so that students in crisis can talk to a therapist at any time. The college pays for the system, and even students studying abroad make use of it, Ramirez mentioned. Another priority this year has been making sure students can walk into CAPS without an appointment.

However,  it is unclear whether  CAPS has adopted a policy of offering students weekly or bi-monthly appointments. Ramirez said that CAPS instituted a new policy the fourth week of last semester: incoming students would start out meeting with a therapist bi-monthly.

“CAPS is a community resource, and so there is only one of us, and there is this large community, and so we’ve made changes. We’ve had to ask students to be thoughtful about their use of CAPS and be prepared to share CAPS with one another,” he said. “Because there is only so much of an increase that you can impose upon … an essentially limited resource, with a certain number of offices and hours.”

The quality of CAPS and the appropriation of resources has elicited debate among students. The Daily Gazette article titled “Dean Braun’s Wellbeing Committee Unfocused on CAPS and Worth, Buys Soundproof Chairs” drove students to ask why the committee was spending funds on what students have begun to call “cocoon chairs” rather than on improving CAPS. The Ad Hoc Committee on Wellbeing, Belonging, and Social Life does not, however, have any say over CAPS spending, although they are both overseen by Dean of Students Liz Braun.

However, Ramirez feels that CAPS does not lack funding and that Dean Braun has always been receptive to CAPS budget requests.

“Dean Braun has always supported spending the money provided, that [I], the director, has thought the college [needed it].  I have had tremendous support … the constraint is really how to operationalize that,” he said.

Cassandra Stone ’20, a student representative of the Ad Hoc committee, wrote in the comment section of the Daily Gazette article, “I find that the title of this article, as well as its contents (primarily by way of omission), are misleading.”

When asked if the Ad Hoc Committee should be more focused on CAPS, Director Ramirez said that expansion of mental health services on campus has a physical limit.

“When deans say there isn’t a constraint [on providing unlimited support to students], it’s true, but there is also reality. A reality of limits,” Ramirez said.

For at least one student, CAPS policy changes came as an unwanted surprise. Abby* was told by her psychiatrist last semester that they might have to stop their weekly visits this semester, and switch to every other week.

“I was seeing my CAPS therapist, and she mentioned that next semester—so this semester—I might need to change my weekly appointments to every other week instead. And she said that they wouldn’t necessarily force me to change my hours, but because there were more students trying to meet with therapists that … it would help other students,” Abby said.

After hearing this information, Abby voiced her discontent.

“At the time I really didn’t want to do that. So I just told her point blank I really, really would like to keep coming every week because it’s been really helpful. And she said for my situation that that would probably be acceptable if she was able to talk to the person who organizes all the appointments.”

Questions arise whether it was clear to students who actively use CAPS that the visitation policy was changed.

“[My therapist] said that she technically wasn’t supposed to be spreading that sort of information to students because she didn’t want to freak people out. When I asked about CAPS capacity to take on students, she said that I should talk to the person above her and express that to them,” Abby said.

However, there are students like Natasha Markov-Riss ’20 who have had positive experiences with the current state of Worth and CAPS.

“Worth has always done everything I needed it to do for me. I got a great flu shot, very competent nurses, and the CAPS person I saw [was] very personable, very helpful. I felt heard and I felt helped although I cannot speak for other people,”  Markov-Riss said.

CAPS plans on expanding next semester to two additional rooms on campus, which would provide an additional 50 hours per week of counseling services. This would be in addition to the 225 hours of face-to-face counseling CAPS currently provides each week, according to Ramirez.

The answer to why there has been a 30 percent increase in student demand this semester remains mostly opaque. In the meantime, students continue to ask for improvements in mental health facilities and administrators continue to promise to meet those demands. It appears that supply has not yet to have caught up with that demand.

*Names were changed to preserve the identity of the people involved.

Edit: A psychiatrist’s name was removed.

Letter to the Editor: Worried About How You Look?

in Letter to the Editor/Open Letter/Opinions by

I wish that my son could tell his own story, but he can’t, so I will try for him, perhaps to give courage to others who are in the grip of the illness that cut his life short at the age of 24.

“It’s odd,” I mentioned to my then-18-year-old’s therapist. “Nathaniel shaves with the lights out in the bathroom and the door propped open to let in a little light from the hallway.” The therapist’s eyes widened with sudden understanding and alarm.

“It’s BDD — Body Dysmorphic Disorder,” she blurted out.

The moment plays in slow motion in my head, locked in my memory. BDD? Never heard of it. I had no idea what she was talking about, but it did not sound good.

As soon as we got home, I ordered Katharine Phillips’ seminal book about BDD, “The Broken Mirror,” and read it in one sitting. When I finished, I knew this was the disorder Nathaniel had been suffering from since age 11 when he first became anxious, and that we were in for a rough ride. It had already been hard, and it got harder — much harder.

Our six-foot four, handsome, intelligent, and incredibly funny son was wrestling with an inner demon that I could not fathom and could hardly bear living with. If it was torture for us, his family, it was unmitigated hell for him. He hated his appearance and was convinced that his skin was defective — “hideous, disgusting” were the words he used. Yet he had a beautiful complexion, and by anyone’s standard, he was handsome. A shaving nick or a minor blemish would keep him indoors for days, or he would cover them up with tiny pieces of bandage so that he could bear to go out. The focus was mostly his skin, but when he was younger, the worries had shifted: he thought the roll of flesh on his tummy was too pronounced (“But you are a growing boy!” I would say), the shadows under his eyes were too dark (“But everyone has them!”), his hair had to be just so (“Do you need all that gel?”). He compared himself with his younger sister, wanted to be her weight and keep up with her level of activity to satisfy an inner command. He was victimized by narratives in his head that dictated he cover up blemishes, exercise compulsively, or compete with his beloved sister. There is no logic to BDD, so no logical argument or reassurance helped.

Nathaniel was the kind of kid growing up that other kids wanted to hang out with. Inventive, smart, full of ideas for games and imaginary play. He never lacked friends. His teachers loved him because he did his school work to perfection and participated fully in class. A natural athlete, he was an avid soccer player and later cross country runner. And sense of humor? He could mimic anyone and would leave us in stitches. Once he invented an on-the-spot musical that he sang on a family car trip to our endless amusement. He could even turn criticism into comedy. While out driving once, he said calmly, “Mom, it’s a source of great comfort to me to know that if you ever have an accident and lose an arm, you won’t have to change your driving habits.” I burst out laughing, but the message got through; I have been driving with two hands on the wheel ever since.

When he first became ill in fifth grade, it was as if a bomb had dropped from the sky and blown our delightful son into an alternate reality. He ran one, two, then three times a day, virtually stopped eating, and lost so much weight that he had to be hospitalized. SSRI medication helped, and from then on, he began seeing therapists regularly. The diagnoses ranged from anorexia to OCD to school anxiety to social anxiety to generalized anxiety disorder, but he didn’t get the correct BDD diagnosis until seven years later.

BDD, an OCD spectrum disorder, is more prevalent than many realize.  Two to four percent of the population suffer from it, with the highest proportion among college age students, yet many mental health providers do not know of the disorder or how to treat it. Convinced that they are ugly, sufferers often get stuck in the mirror or avoid mirrors completely, compare themselves to others, skip social situations due to concerns about how they look, and spend hours trying to “fix” or cover up flaws that others see as insignificant or non-existent. The focus is most often the face (nose, skin, hair), but sufferers can be paralyzed with concern about any part of the body. Not remotely like vanity, this crushing preoccupation with appearance can disrupt schooling, make employment difficult, and strain relationships. The suicide rate is the highest of any brain disorder — higher than for those with severe depression or schizophrenia.

Having a name for a brain disorder, sadly, doesn’t disarm the demon any more than knowing that you have diabetes improves your insulin levels. But it did lead us to skilled practitioners. Drs. Katharine Phillips, Michael Jenike, Tamar Chansky ’84, and Marty Franklin all had their times with Nathaniel, trying to help his mind find the space and energy to combat BDD’s onslaught. He tried various SSRI medications and many combinations of medications, which sometimes provided relief. Cognitive Behavior Therapy and Exposure and Response Prevention strategies — the gold standard of treatment — were only slightly helpful.

As he grew older and his symptoms intensified, he had to leave high school and earn his diploma from home. Some days he couldn’t leave the house, although he managed to work part time and found joy in coaching middle school cross country and teaching in an after-school program. By his mid-twenties, he was still living at home and could see no promise in his future. He watched his sister and friends go off to college, find partners, launch their careers. “BDD is my only companion,” he told me once. “It dictates my entire day, from the second I get up, until I go to sleep — the only time I get any relief. I would not wish this on my worst enemy.” He ended his life in 2011.

Very few people understand brain disorders, and even some people who knew Nathaniel didn’t fully grasp that his condition was not caused by faulty reasoning or an inability to face life’s challenges. Because BDD is under-recognized and under-diagnosed, my family and I have devoted much of our time to raise awareness and funds for research. Recent fMRI studies at UCLA have discovered that the brains of those with BDD process facial images on the left side of the visual cortex instead of the right, like the rest of the population. The brains of those with anorexia show the same anomaly, suggesting that sufferers focus on tiny details of appearance and not the whole picture. More research will determine if this finding is causal or correlative, but it points to anatomical factors involved in BDD and suggests that visual re-training in treatment might help. Genetics and social/environmental triggers also play a role, but the pathway of the disorder is not yet fully understood.

Brain-circuit-based therapies such as Transcranial Magnetic Stimulation, currently in wide use for depression, and Deep Brain Stimulation using implanted electrodes to stimulate areas of the brain — similar to the treatment used for Parkinson’s disease — may hold promise for those with severe BDD, but more research is needed.

If you think you may have BDD, or know someone who might be struggling with appearance concerns that interfere with daily functioning, don’t hesitate to reach out to a therapist at the college health center. The International OCD Foundation website has a large section devoted to BDD where you can learn more about the disorder. If you want to read more about Nathaniel, the website Walkingwithnathaniel.org details our family’s journey more fully.

Nathaniel knew that after he died, we would wonder what we could have done differently. “Please don’t,” he wrote in the letter he left us. “We were all doing the best we could and there is no regret in that.” No regret, but no silence, and no stigma either. Please spread the word about BDD, and get help for yourself or others who might need it. No one should have to struggle with this devastating illness alone. I know that is what Nathaniel would say.

Judy Nicholson Asselin ’75

Mental Health Mondays Matter

in Campus Journal by

Disclaimer: there may be Play-Doh and considerable amounts of chocolate, but this is not a preschool play date. It’s a supportive environment. It’s a place where conflicted college students can come and share their experiences. In short, it’s Mental Health Mondays, a peer counseling initiative born from Speak2Swatties. And you should come.

I will freely admit I raised an eyebrow when I first heard about this event. Coloring sheets? (Further misery for those of us who could never color within the lines.) Discussing one’s issues with peers on a campus so small that they are probably involved in them anyways? I felt it was a poor substitute for CAPS. But then, of course, I am one of the few people lucky enough to have regular appointments.

So I came in with a healthy dose of skepticism, but I was pleasantly surprised. Even though this was just the first meeting, I would encourage my fellow Swatties to come. The organizers made it clear they are not a feel-good attempt at substituting actual counseling. “I read last year’s self-study report … Swat has a pretty high rate of depression and anxiety,” explained Faye Ma ‘19, one of the organizers.
“We completely support CAPS … we’re like a middle ground between CAPS and students,” organizer Lamoni Lucas ’17 made it clear. All organizers agree that CAPS appointments are hard to get. Therefore, Speak2Swatties tries to keep the conversation about mental health going, and Mental Health Mondays is one of its most recent initiatives. It allows students to discuss their feeling with peers who may have been in the same situation as them.

Mental Health Mondays are every other week, 8 to 9 pm, in Clothier 301 (thank you for giving me the chance to discover that there a Clothier 3rd floor exists). It was started within Speak2Swatties by students interested in promoting “active listening,” a that concept shows up regularly throughout the hour. I still don’t fully understand the concept, but everyone listened to each other respectfully for an hour in a confidential setting. Respectful, supportive questions were asked. It felt like a safe environment to discuss personal issues with people who cared, and were listening not because they were paid to do so, but because they were concerned and recognized that we all have problems in common. If that’s what active listening means, I’m on board.

Although today’s topic was about relationships – Valentine’s Day oblige – there was less heart-to-heart discussion of our personal relationships than I expected. The evening got pretty philosophical. We discussed the foundations of a good relationship (among other things: comfort, trust, support, independence and dependence), and the obstacles to relationships at Swarthmore (academic pressure, time commitments, and the campus’ painfully small size). What personal stories we did get were not “ten-minute monologues about your life” (Carina Debuque ’20, one of the organizers, warned us to avoid those). They were real moments that illustrated the larger themes we discussed — helpful and sincere.

The Swatties present were open and emotional, but the space felt low-pressure and welcoming. It was like a friendly gathering around cookies and tea (and Play-Doh. Admire the art I was inspired to create below). It is genuinely relaxing to discuss what’s going on in your life with non-judgmental, helpful peers who aren’t involved in your daily life; people you’re in no way connected to, except by a desire to talk and listen. There was also discussion of formal, long-term goals for Mental Health Mondays as an initiative, such as increasing intersectionality, advocating for ending stigma around mental illness, and increasing the visibility of mental health resources on campus.

No, I didn’t come out of this evening fully enlightened, or feeling an overwhelming sense of well-being. But, simply put, it was nice. I spoke to people and listened to them. We shared, and I discovered that we all have similar issues and problems. Plus, I got free chocolate and finally heard a successful Screw Your Roommate story. My cynicism has been conquered. This isn’t revolutionary group therapy, but it’s a group of supportive people who will listen and not judge. And sometimes, that’s enough.

Mental health is not a joke

in Opinions/Staff Editorials by

All across the nation, we are facing a mental health epidemic. According to the American College Health Association, colleges and universities have reported over 50 percent of their students feeling overwhelming anxiety and 32 percent of their students reporting feeling “so depressed that it was difficult to function.” Yet, despite its widespread effects, mental health remains an under-addressed issue that is often ignored or left in secret. Even at Swarthmore, despite our liberal arts mission to encourage students to “prepare themselves for full, balanced lives,” mental health and self-care are often the ignored components of this mission.  We at the Phoenix believe it is the responsibility of the college to take on the task of ensuring all students can equitably access their educations and lives.

We cannot pretend Swarthmore students are immune from these mental health issues.  One can easily see this epidemic by looking at the full capacity issues within our Counseling and Psychological Services, as reported by Leo Elliot ’18 on March 17, 2016 in the Phoenix. Even with resources like CAPS, the campus still struggles to understand the severity of these problems or the need to increase our services for these issues. The Swarthmore community has students making emergency appointments with CAPS, only for these same students to return to studying in McCabe until 2am. The community has students crying in the bathroom and then returning to a seminar an hour later. Some students can barely get out of bed in the morning, yet still force themselves to turn in their problem sets or else face horrible self-criticism for not completing their assignment on time.

We at the Phoenix must emphasize that this is not healthy. It is not healthy to push one’s body to the breaking point, to recognize when one’s body and one’s mind needs to rest, but to keep forcing oneself forward anyway. Yet, students continue to push themselves past the breaking point because, on this campus, having a mental illness is not an excuse to miss class. Many students won’t even take a sick day for the flu, let alone a mental health day to take care of themselves. It is imperative that college staff and faculty recognize that feeling unsafe is a valid cause for academic accommodations. Students also need to recognize that not doing work due to serious mental health problems is not irresponsible as it is different from skipping class because they stayed up too late procrastinating. Too many students on campus feel embarrassed to admit they cannot finish all of their assignments and readings and push themselves too far. We at the Phoenix emphasize that our campus needs to reach a point where students with mental health problems feel comfortable seeking the treatment they need, even if that treatment is a simple break. Just as importantly,  the broader community needs to be able to respect these decisions.

While we at the Phoenix recognize that the college has made a lot of progress with regards to increasing conversations about mental health on campus, we also recognize that many more actions need to be taken and that we are not yet a supportive and accommodating campus for people with mental health concerns on campus.

We at the Phoenix urge the college to take action in several capacities. First, the college should provide professional development for faculty and staff on supporting the mental health of students. While many professors have created individual policies for accommodating mental health issues, a professional development training would standardize this process, decreasing the frustrations felt by students when one professor may make accommodations and another is unwilling to do so. This would also help instill confidence within the student body. If students know that their professors are aware of how to handle these issues, they may be more willing to approach them with their problems instead of suffering in silence.

We at the Phoenix are aware that professors are not counselors and we are not asking for them to serve as one. Rather, we are asking that professors understand the significance of mental health issues and are able to point students to appropriate resources and self-care practices.

Furthermore, we at the Phoenix urge the college to implement more open-campus discussions around mental illness. The college should work more closely with existing mental health groups, like Speak2Swatties or support groups led by CAPS and Worth Health Center, to share these resources with more students or expand the programming provided. They could also implement more discussions through better educating Residential Assistants, Diversity Peer Advisors, or Student Academic Mentors on how to discuss mental health. Finally, mental health could be featured as a special topic during campus initiatives, like a Coffee Talk, to help bring the issue to the forefront of campus.

A mental illness is not something that can be beaten with sheer willpower. It is not something that can be wished away, but instead takes time and effort to work through. By the college taking mental health issues more seriously, not only will the students who suffer benefit,  but so will the community at large. One cannot fully contribute to the campus around them if they are struggling with health issues. In order for students to receive the best education possible, and to contribute the most to campus and society, they must first have the resources to best care for their own mental health without feeling guilty for doing so.

CAPS experiences strain under increased demand

in Around Campus/News by

Over the past few years, the college has seen a strong upswing in student use of counseling and psychological resources. While the long-term national trend has been for growth in use of these resources, the demand at Swarthmore has picked up in the past few years. As this demand has continued to rise, the resources that CAPS is able to offer have shown strain.

Interest in student mental health sparked last semester after the release of the campus climate survey. Only 64% of students reported feeling “very comfortable” or “comfortable” with the campus climate, compared to a typical rate of around 80% for schools surveyed by the independent contractor hired for the job, Rankin & Associates. 41% of respondents reported having “seriously considered” leaving the college.

Student use of CAPS has risen steadily over the past five years. The 2014-2015 academic year marked a 52% growth in number of students served over the 2009-2010 year. In 2012, during the middle of that growth period, CAPS was expanded from four to eight offices. In 2014-2015, the number of students served was 426, and those students attended 4,296 sessions in total. In recent years, the average number of visits per patient has risen from 6 or 7 to 10.

CAPS use has grown especially rapidly this year, causing a greater strain than usual on resources, earlier in the year than usual. According to Director of CAPS Dr. David Ramirez, in most years, CAPS use steadily increases from the beginning of the fall semester through the spring. The CAPS office houses eight counselors, who can offer around 200 hours of therapy every week. When demand outpaces the service that the full-time employees can provide, CAPS uses a contingency fund to bring on extra counselors part-time. According to Ramirez, CAPS normally uses this money sometime in the Spring semester. This year, a part-time counselor was hired by the end of September.

In general, Ramirez is confident in the college’s funding of the services his department provides. “If I exceed the amount in my budget, the college will cover it… they just get that money from somewhere, ” he said. “I don’t know what it looks like at that level but I’ve never been told, ‘you’ve got to stop doing this, stop hiring extra people.’ I’ve been told, ‘do what you’ve got to do.”

Often, though, funding is not the problem.  “The college is very supportive in terms of providing the monetary resources to hire people, the constraint we operate under is space, basically. We are operating to full capacity,” he said.

As demand increases, students who want to schedule consistent meetings increasingly need to apply at the very beginning of the semester. Of the six students interviewed for the article, all but two reported scheduling their meetings at the very beginning of the semester. As the semester goes on, meetings are more difficult to come by, and a consistent or long-term schedule is especially difficult.

Kat Galvis Rodríguez ’17 described her difficulty setting up appointments even fairly early into the semester: “It was so hard to get an appointment so I wouldn’t use it very often because the appointment times I would get were just really inconvenient for my schedule,” she said. “As an incoming freshman you don’t know how high in demand CAPS is until you try to make an appointment two weeks in or three weeks into the semester and realize that they are all booked.” During her sophomore year, Galvis remained on the waiting list for two months. She noted, though, that the office has recently been open later in the day, which works better for her schedule.

CAPS maintains a scheduling list to handle students waiting for appointments. According to Dr. Ramirez, CAPS only considers the list to be an actual waiting list if it takes more than two weeks to schedule an appointment.

Even more than the normal counseling, CAPS’ psychiatric service faces high demand. Under normal conditions, the school’s psychiatrist Dr. Hewitt is only at school on Tuesdays and Thursdays for about ten hours each week. Like the flexible counselor hire, Dr. Hewitt can and often does work more hours in response to high demand, but only within a limited range due to time constraints.

Like other resources, the psychiatrist has faced a particularly straining demand this year. According to Ramirez, the Psychiatrist will often see between 55 and 60 students in a year. As of last week, he has already seen 88 students this year.

“We’re like the people at the bottom of the roller coaster holding on, like, ‘OK. How is this going to go?’” joked Ramirez, “I have a plan, I’m the director, I’m responsible for seeing all this stuff through. But in our world there’s just a lot of unpredictability.”

On top of his availability, Ramirez explained, there are limits to how late in the semester the psychiatrist can be of help to certain students. For most medications, patients need to be professionally observed during the initial trial period. Towards the end of the semester, starting students on a new medication is often not viable. In the fall, the cut-off point is before Thanksgiving break.

As a result of this high demand, CAPS has encouraged students who need more frequent psychiatric care than the college can provide to seek care off-campus. Students with this kind of need who do not have the resources for a private psychiatrist, though, are usually treated in-house. Ramirez noted that even for those who can afford it, finding a psychiatrist nearby can take a long time.

One student, Henry*, described an experience of considering quitting psychiatry appointments with Dr. Hewitt. As of right now, Henry regularly sees both the psychiatrist and a counselor. Diagnosed with bipolar disorder when he was 15, Henry has been on the same medication regimen for two and a half years. For much of that time, his condition has been stable but . At one point, he felt that his healthcare need was mostly clinical, and pursued the option of quitting his talk therapy appointments since he felt that he did not need them as much as other people. When he mentioned this idea to CAPS, they raised the option of him not seeing Dr. Hewitt either, and returning to clinical care with his nurse practitioner back home. Though he did not feel like anyone was pressuring him towards any one decision, he felt that the suggestion might be related to high demand of services.

“I don’t know that the reason that they suggested I could go off-campus for services was because they were trying to free up room to free up more appointments, because they were experiencing high demand. But I think that that could be a way that they can kind of manage the demand that they have.”

Recently, CAPS has begun requiring that students have already met with a counselor several times before requesting a new appointment with the psychiatrist.

Earlier this year, Galvis encountered this rule for the first time. Galvis decided to schedule an appointment with Dr. Hewitt one night after seeing her talk therapist, but she had not talked with her therapist about making that appointment. As a result, she needed to wait the whole week to schedule her appointment. The next week, she had a bad mental health episode, and ended up in the hospital, where she received medication. After the hospitalization, she had an emergency appointment with Dr. Hewitt to check-in. Though it is not clear that knowing about the rule change would have allowed her to get an earlier appointment, Galvis said that she experience wished there were more resources

“It cost a lot of money, even with school insurance, but I had no other option at that point…” she said. “That’s a situation that could have been prevented if there were more resources at CAPS.” Like the extra counselor hire, Ramirez has funds to hire a short-term employee who is authorized to write prescriptions. This January, CAPS started to use this option.

Galvis emphasized, though, her overwhelming positive experience with Dr. Hewitt. Unlike counselors, who often change, he has been a consistent familiar face at CAPS.

“Even with all of that… he’s really responsive by email, so if I have questions about my medication I can always e-mail him, which hasn’t been the case for other psychiatrists,” said Galvis. But I also just feel like he has a lot of students doing that all the time. He’s amazing, he’s the best psychiatrist I’ve ever had. I just don’t know how he’s the only one who handles — I don’t even know how many students go through him.”

Ramirez pointed to several trends that have encouraged the high level of recent resource use besides declining student mental health. He mentioned the overall increase in the student body, the increase in the number of incoming students who have already received mental health care of some kind, and a perceived decrease in the stigma of using CAPS as contributing factors.

“We used to have this goal, 10-15 years ago to reduce the stigma of going to CAPS, to lower the barriers, to try to make it easier if people didn’t want to come, if they had to be talked into it,” he explained. “That’s kind of totally gone away. CAPS just seems way more approachable now. So that’s a success, in terms of a cultural phenomenon.”

With the recent addition of administrators in the OSE, the Title IX office, and the Health Center who interact with students on a regular basis, Ramirez also said that more students are being directed to CAPS.

“There’s a lot of feeding that’s going into CAPS. It’s a very good system. It’s stimulated a lot more utilization,” he said.

Additionally, the college offers CAPS patients more leniency than some other undergraduate institutions. Unlike many peers, the college does not place a limit on how many meetings a student can schedule in a semester. The college also does not charge students for missed appointments, which occurs at other institutions. Missed appointments, according to Ramirez, are a universally frequent event at undergraduate institutions. In 2014-2015, CAPS scheduled 5,650 appointments, but only 4,296 were used.

Several students interviewed for the article reported feeling guilty about missing appointments and about taking up space in general, but missing appointments can also be dangerous. Henry relies fairly heavily on reliably having his medication. Most students who get their medication at Worth have their prescriptions delivered from Rite-Aid. Henry expressed frustration with this process, and specifically Rite-Aid.

“[Rite-Aid] just takes an unreasonable amount of time to fill and deliver prescriptions. It has taken over a week before for me to have my prescription after I drop it off at Worth.” Henry described instances where he had to rent a Zipcar and drive to Rite-Aid to get his prescription on time.

With delays from Rite-Aid, Henry has on occasion had difficulty filling his prescription after missing appointments. Each time, though, he said that CAPS has worked around and resolved the issue.

Galvis described her own experience feeling guilt about the use of CAPS resources. “One of the reasons I stopped using CAPS at one point was because, miraculously, I was okay at Swat. I wasn’t going through anything traumatic, my disorder wasn’t extremely bad. And so I remember thinking, ‘I shouldn’t be using CAPS right now because there are so many people on this campus who need it, and aren’t getting it because I have the appointment slot. If I’m okay, then I should just give up this appointment slot so that somebody else could have it,” she said. By this reasoning, she quit her sessions at the time.

“Lo and behold I found myself four weeks later in crisis. Because that’s not how counseling works. You can’t just go as needed. You need to go consistently for it to work,” she said.

Besides limiting access to resources, higher demand can also change the quality of the resources themselves. Student demand may affect, for instance, how consistently a given student can see the same therapist from semester to semester, especially if certain therapists are particularly popular. Continuity can be very important for therapy, and switching therapists is often difficult. Galvis expressed the difficulty she faced when she found out at the end of her Freshman year that the counselor she had been seeing was going away.

“It’s such a long term process of trying to get to know someone and open up to someone and have them hear your story, and kind of build that trust and have that relationship with someone,” she said. “To spend a whole year trying to do that, and to find out you have to try someone else and you have to do that process again… that takes up at least the first four sessions.”

Mark*, a student who has seen the same counselor for almost two years, expressed that this continuity was very important to him.

“There are sort of two things that are lost, at least in my experience. One is the ability of the person to have an intuition for what’s going, or to see a pattern in the things you’re worried about,” he said. “The second thing that’s lost, which is maybe a certain type of therapy, is the sort of therapy where you really dig into familial stuff or more deep-seeded things. I don’t think generally people feel comfortable talking about that sort of thing in any real way with a stranger.”

These more subtle, qualitative changes occur on the administrative end as well. Describing the limitations of the flexible hire system, Ramirez emphasized the importance of team-work among CAPS counselors.

“The downside to having to hire another person is that our model of clinical work is collaboration. We rely a lot on being able to communicate. Staff with supervisors, I supervise everybody, there’s another layer of supervision that supervises the more junior people. We all interact with Dr. Hewitt,” he said. “That’s already 10 clinicians. I am very reluctant to add another person. It’s not like we’re digging a ditch: ‘ok, you. Go dig over there.’ It’s not that easy. There’s a lot of coordination that has to go on. So we’re ready, if we need to add another human being to the system. But I try to keep it to a limit.”

Sex and the Swattie

in Campus Journal/Columns/Sex and the Swattie by

 

Hi, friends.

This is a sex column, and I’m going to be talking about sex today, but not as a good thing.

I’ve had a very unhealthy relationship, often addiction-like, with sex, that I still sometimes fight to overcome. This column is going to be about that, and how I fell into it, mostly because of how out of touch I was with my body and my transness. It’s also going to be about how I fight it, mostly by trying to be positive about my body.

I’ve never been super comfortable with my body. My feelings about it live on a spectrum that ranges from it triggering me through hatred to a fearful momentary pride I feel the need to hide.

On worse days, this feels reasonable. It tells people I’m a gender I’m not. Most times, it fails to carry me upstairs. It’s marked with reminders of the trauma I carry. It’s consistently rated as either fit for consumption or not worth respect. It seems like everything around me wants my body and I to not get along.

Which is ridiculous, of course, because my body is not it’s own entity. It shapes and is shaped by my experiences. It’s a part of me, it’s the only reason I exist, and it feels like I SHOULD know that and love it for it, but most times, I don’t.

I’ve gotten a lot better at it, though, than I was before.

And how that started had a lot to do with sex. The first time I realised my body could be attractive to other people, I was surprised but convinced it was because they didn’t know what it really looked like. But then they did, and found it attractive anyway, and I was shocked. I didn’t know how to deal with this information, but eventually I took it to mean that I was maybe at least a little attractive. And that made me significantly happier.

Obviously, I don’t recommend this route to greater body positivity. It was so flawed and trouble ridden. Needing external sources of approval for your body is already inherently bad, but can lead to so many more devastating circumstances. For me, it led to an addiction-like need for sex, because the lack of it was devastating, and I couldn’t focus on anything else when I wanted it. It didn’t make me happy, either, almost every time, it left me feeling sad and strangely hollow, crying into my pillow. It felt terrible and I knew it was really bad for me, and I kept swearing to never do it again, but as much as I tried to not do it, I kept giving in.  I stopped putting effort into making or maintaining friendships, until hook-ups were basically my only social interactions, a very lonely way to be a first semester college student.

Fortunately, I eventually realised this and connected the dots. I took a step back and realised that I needed to love, hell, at the very least accept, myself because of who I was, not because people wanted to have sex with me. Which, you know, should have been obvious, particularly given all the talks I’d had with other people about that and my general reputation of being a feminist killjoy. But it wasn’t, and that was really scary to accept. A lot of CAPS took me to a place where I could take a step back from everything and try to figure out ways to break the unhealthy pattern.

The first thing I did was get a vibrator. I did not think that was ideal, since it tied my worth to sex-things, but at least it was viewing myself and my body as sexual, and capable of feeling pleasure rather than being sexy and giving it, so I was A Real Live Human. It was also a comparatively easy thing to do, and an important step back from texting hook-ups when I knew it would be terrible for me to. Also, it was really fun. Vibrators are incredible and I love them and I could (and probably will) do an entire column about them, so I’m going to keep this short.

Vibrators revolutionised how I felt about my body. When I first started using them, I was a trans person who didn’t know the word for my gender and was flailing around, trying to be a cis girl, and sex, even the best kind, came with more than a hint of uncomfortable feminising of my body. Up until that point, masturbation felt like a replacement or copy of sex with other people, something that was meant to feel like The Real Deal and hence did the same thing. Vibrators changed this entirely. They were a way for my body to be sexual without being femme.  Manual masturbation did not frequently lead to orgasms for me, and while sometimes, that was fine, other times it was very frustrating. Vibrators were 90% guaranteed pleasure I felt like I deserved. It was wonderfully freeing.

I was a lot more excited about my body, which meant I started looking at it more. Not with stomach sucked in and flattering clothes and scars and stretch marks hidden away, but naked in mirrors, often dancing. Not looking to see how sexy I could be, but how much fun I could have. That helped me decide that I really like clothes that  are flowy and swoosh when I spin, websites advising me against them be damned. It also showed that I actually didn’t need anyone else present for my body to feel and be great!

It was a surprisingly large realisation for me that my body could be a source of happiness for me. I could do so much cool stuff with it! Like wear blue lipstick, or shave some of my hair and then have a fuzzy head I could pet if there was a shortage of puppies, or wear clothes that don’t match. Being less uncomfortable with my body made it so much easier to approach and pursue friendships with people who didn’t validate it by having sex with me, which led to an incredible support network of great humans.

Even though it sounds like that when I write it out, this hasn’t been anything close to a linear journey. It’s been very rollercoaster-like, affected by things like weight changes, general mental health levels, how cute my outfit feels that day, the weather, literally so many things. I feel vastly differently about my body from day to day, and I figured it was just random for a while, but I’ve been paying attention to the patterns, and the lows are definitely getting less low, and the highs more high.

 

College self study results reveal discontent among students, faculty, staff

in News by

On Friday, during two separate presentations in the Lang Performing Arts Center, Dr. Sue Rankin, principal researcher at the consulting firm Rankin & Associates, revealed to students, faculty and staff the results of the college’s Self-Study on Learning, Working, and Living. The survey, which was available online to faculty, staff, and students at the college from March 11th to April 15th of last spring, contained 100 survey items – both qualitative and quantitative – to determine what Rankin & Associates call “campus climate,” or “the current attitudes, behaviors, standards and practices of employees and students of an institution.” While the survey revealed that campus climate at the college is largely consistent with trends across other institutions of higher education, the college was an outlier in many respects with exceptionally high rates of mental illness, financial hardship for students caused by traveling home for breaks, and pressure on staff to work extra hours unpaid.

“A survey like this hasn’t happened at Swarthmore in the past,” explained Diane Anderson, Dean of Academic Affairs at the college. “It was something that grew out of having a Dean of Diversity, Inclusion, and Community Development who was really invested in these issues. I’m also not going to pretend that the spring of 2013 didn’t happen and didn’t influence the construction of the survey.”

According to Anderson, both former Dean of Diversity, Inclusion, and Community Development Lili Rodriguez and the concerned students of the “spring of our discontent,” referring to the spring of 2013, expressed a need to provide a forum to hear the perspectives of the diverse constituencies that comprise the wider campus community in order to understand how different groups and identities experience the college.

“I’m going to go out on a limb and call it a really sweet spot of opportunity to be the best that we can be, to be the model of a community that knows itself,” Anderson explained. “We need to set up a process to keep examining ourselves but to do something about this self, a self that has room for improvement.”

By soliciting responses from the entire student, faculty, and staff populations, the Rankin & Associates survey provides a snapshot of collective impressions as well as the thoughts and perceptions of particular individuals, which can be used to inform the development of strategic initiatives and potential best practices for addressing challenges.

In total, 980 faculty, staff, and students responded to the survey for a campus-wide response rate of 38%. According to Rankin, this rate was on par with that of other colleges and universities where Rankin & Associates administered self-studies. Because the number is over 30%, the survey can be considered generalizable to the experiences of the larger campus population.

While the survey results reveal that a moderate majority of students, faculty, and staff feel generally comfortable with the living, learning, and working environments at the college, they also indicate that on the whole, respondents felt less comfortable than their peers at other colleges and universities. 64% of all respondents indicated being “comfortable” or “very comfortable” with the campus climate at the college, which – while indicative of general satisfaction – is a notably lower rate of comfort than that of most other surveyed institutions.

“Usually these numbers are more around 80%,” explained Rankin. “At some schools, we had response rates of comfort as high as 88%, so Swarthmore is definitely on the lower end of the spectrum.”

According to Rankin, when this data is broken down into constituent groups, the responses appear more concerning, revealing the need to address the discomfort felt by some particularly vulnerable constituencies at the college.

“Several groups indicated that they were significantly less comfortable on campus than the majority,” Rankin said. “This matches the literature on this where historically underserved groups feel less comfortable than others.”

As Rankin explained, differentiating respondents by gender identity, racial identity, sexual identity, and disability status revealed that several key constituencies reported feeling less comfortable with the campus, workplace, and classroom environments than their majority counterparts. In particular, trans faculty and students, faculty and students of color, and LGBQ faculty and students, and faculty and students with multiple disabilities all felt significantly less comfortable in the classroom than did their cisgender, white, heterosexual, and non-disabled peers.

Divergent rates of comfort among disabled students were particularly concerning to Rankin. 25% of all respondents indicated having one or more disabilities that substantially affected learning, working, or living activities. Most striking for Rankin was the fact that an exceptionally high 15% of respondents indicated having a mental illness, making the college’s mental health profile a notable deviation from the trends observed at other institutions.

“A significant percentage of people reported having a psychological condition, particularly anxiety and depression,” Rankin said. “This was an outlier. Nowhere else that we surveyed was there such a high rate of mental illness. While this could be in part because there is a tolerant and accepting culture around mental illness at Swarthmore, so people feel more comfortable talking about mental illness, it’s still important to look at. There are many people here with diagnosed mental illnesses…and this impacts their experiences on campus both academically and otherwise.”

Furthermore, according to Rankin, the fact that a vast majority of students also reported being overburdened with assignments and stressed by a desire to perform academically was heavily correlated with the high rates of mental illness reported. Only 60% of students said that they felt they were performing up to their full academic potential, while only 54% of students felt that they were performing as well as they had anticipated that they would academically. 23% of students reported that they had considered leaving the college because of the workload.

“It’s not that Swarthmore is academically rigorous – because that’s what we’re here for – but come on, we’re killing them,” Rankin said. “Pulling an all nighter is part of college, but pulling an all nighter multiple times throughout the week is too much. It’s taking its toll. Reading the qualitative responses you can see that their self esteem is in their shoe laces around academics. They get a B+, and they’re freaking out. We have to find a medium. Students are succeeding, but it’s killing them.”

The burdens of the high workload fell most heavily on students of color, first generation students, and low income students, all of whom had significantly lower rates of perceived academic success than their wealthier, white peers. For example, only 8% of respondents of color, 11% of low income students, and an unmeasurably small percentage of first generation students indicated that they strongly agreed with the statement “I have performed academically as well as I anticipated I would.” Almost double the number of students of color who said they “strongly agreed” with this statement said that they in fact “strongly disagreed.”

Low income students, first generation students, and students of color also faced financial hardships that many of their majority counterparts did not face. Most of these hardships, such as affording tuition and affording books, mirrored trends of financial inaccessibility seen at other surveyed institutions, however, the college was unique in the difficulty that many students reported facing in regards to shouldering the cost of traveling home over breaks.

“Swarthmore is an outlier in the high expense of traveling home for vacations,” Rankin said. “23% said they experienced financial hardship in this area, and many students said in the qualitative section that they were homeless over breaks. That’s an actionable item, I think.”

According to Anderson, while data regarding these “exceptional” and “outlier” features of the college’s climate are undoubtedly concerning in that they reveal certain hardships unique to the college, they do not come as a shock to most administrators.

“It’s not surprising,” said Anderson. “And I say that as somebody in the Dean’s Office who works with students who struggle with such issues as health challenges and the hidden costs of college every day. What’s important now is that it’s logged and its quantifiable. Students leave every four years, so you have to make sure that when you have data like these…and when you lift up those challenges you don’t put them behind a curtain. You keep them lifted up and you get them into the world of problem solving.”

As Anderson explained, however, addressing concerns particular to students is just one of the many necessary steps of addressing overall campus climate. Faculty – and particularly staff – perceptions of working at the college must also be addressed in order to foster meaningful environmental change.

The self-study revealed that while most faculty and staff felt that the college was supportive of flexible work schedules, that their opinions were respected in college committees, and that they had supervisors who gave them career advice and guidance when they asked, many important issues were raised in regards to salaries, discrimination and harassment, hiring practices, equipment quality, opportunities for upward mobility, and benefits such as childcare.

Many staff reported being intimidated or bullied, targeted by derogatory remarks, feeling ignored or excluded, or experiencing a hostile work environment. 44% of staff affirmed that they had experienced “exclusionary, intimidating, offensive, and/or hostile conduct,” while in the workplace, and while most of this conduct came from fellow co-workers, 8% came from students. According to Rankin, the rate at which staff indicated being discriminated against or harassed due to their position was the same as the rate at which trans respondents reported being discriminated against or harassed for their sexual identity.

In the qualitative comments section of the survey, staff members reported being “pushed,” “shoved,” “yelled at,” and having their desk slammed angrily by a supervisor. Many staff members also indicated feeling actively excluded from community events and disregarded by faculty. One staff respondent reported being barred by faculty from attending a reception following an open lecture, while another reported a lack of collaboration and coordination between faculty and staff.

“Staff are routinely dismissed by faculty,” another respondent explained. “I’ve never experienced the level of dismissal from faculty that I have here.”

Rankin explained that while such environmental trends were typical of all of the institutions she had surveyed, they were incredibly harmful to the larger functioning of the campus community.

“When staff don’t feel included in the community, they miss more days of work and perform less on their jobs,” Rankin explained. “We underutilize staff brain power in higher education. Our staff are brilliant and we don’t use that.”

Anderson agreed.

“I’ve always believed that institutions do best by the people they serve if the people who are working in those institutions are feeling valued and fulfilled in the work that they do,” Anderson said. “A lot of people are doing a whole lot of good and hard work in this institution, but aren’t feeling valued.”

On the whole, faculty and staff felt that too much was being asked of them without sufficient compensation. 30% of staff reported being asked to work extra hours without pay, making the college an outlier, according to Rankin, in comparison to other surveyed institutions where staff felt significantly less burdened by uncompensated overtime.

Faculty also felt unfairly pressured to damage their work-life balance by attending community events, lectures, and committee meetings outside of normal hours that interfered with their childcare or eldercare responsibilities. Overall, 60% of staff and 61% of faculty indicated having seriously considered leaving the college within the past year.

While the data provided by the Rankin & Associates report appears to offer a somewhat negative portrait of the living, learning, and working environments at the college, Rankin cautioned against taking the data as a complete or wholly representative diagnosis of campus climate. Rankin expressed many of the survey’s limitations including a low response rate amongst students, a disproportionately high proportion of white, female respondents in comparison with actual campus demographics, and the inevitabilities of selection bias. Despite these shortcomings, however, Rankin explained that the data reported should not be discounted.

“Even though only 510 students responded, if even 10 of those students say they have been sexually assaulted or they have felt discriminated against, or they can’t afford to go home over break, and they feel that the administration isn’t addressing those things, that’s something I want to know,” Rankin said.

Anderson agreed.

“We often think of self selection as an opportunity for people to tell a bad story, complain, or voice a concern, but so what?” she said. “What if there is self selection in who took the survey? Would that make their reporting and their experiences invalid? Not to me. Somebody asked me if the numbers in general don’t diverge that much from other colleges and universities then maybe that’s what humans do. It made me think as a parent when my kids would come home and say ‘You should let me do this because this is what everybody else does.’ Is that good enough for Swarthmore, a place that prides itself on social justice and a very well articulated mission of inclusivity and diversity?”

Moving forward, Anderson explained, there will be meetings between faculty, staff, and students to discuss how these data can inform where the college can improve and install new best practices to address the concerns revealed by the survey. According to Anderson, before the end of the 2015-2016 academic year, the college has promised to institute three to four concrete actions directly aimed at improving campus climate. In addition, further emphasis will be placed on fostering collaboration between different constituencies, putting staff, faculty, and students together in conversation to address problems that affect the whole community.

“I can’t do it alone, the working group can’t, Sue Rankin can’t, senior leadership can’t, students can’t, no one can do this alone,” Anderson said. “Two heads really are better than one. This is going to take work and it’s going to take listening. We are very analytical people here. We know how to critique, but the challenge now is to generate and create.”

 

Moving from “Take care of yourself” to “How can I help?”

in Columns/Opinions by

I was diagnosed with an anxiety disorder when I was nine years old. Ever since then, I’ve battled to balance it so it doesn’t overwhelm me, to organize it so I can better manage it, and to know enough about myself to predict when it’s going to get bad and take preventative measures. In order to live with it as peacefully as possible, I’ve absorbed it as a part of my personality; there are certain things I do or don’t do specifically because of anxiety, just as there are certain things I do or don’t do because I like the color blue and I don’t like rollerblading. Of course, you could argue that I like blue because it’s calm, and that I do not like rollerblading because the prospect of fast movement makes me anxious—my personality is a network of likes and dislikes, habits and taboos, that are enmeshed in and influenced by my particular mental health condition. Anxiety is a part of who I am. This, at least, is the mindset with which I first entered college a little over a year ago. I was  soon to learn about — and grow skeptical of — the role of Disabilities Services at Swarthmore.

Disabilities Services and the practice of asking students with disabilities to officially document their conditions in order to receive accommodations isn’t badly intended; far from it, under the umbrella of the Americans with Disabilities Act (ADA), it is designed to protect students’ rights. It’s meant to prevent discrimination against students with disabilities by making sure the school complies with federal standards for providing services to these students. In order to ensure compliance, the administration must document these disabilities; the process is necessarily bureaucratic. But one aspect of bureaucratizing mental health registration is that it marks mental health issues as formal and clinical, conditions that must be processed administratively and secretly, minimizing spaces for informal and open dialogue about those issues in the context of everyday life. It enforces the idea that students must leave their condition in a box in an administrative office, and keep it separate from their academic world.

As I got ready for my first semester at Swarthmore, I didn’t look into documenting my disability to receive accommodations through Disabilities Services. Part of the reason for this is that I’d gone to a very small, independent high school, where I felt as if I could speak to my teachers directly if mental health was an issue that came up, and – in an environment of care and mutual trust – receive an extension for a paper or be able to miss a class to calm myself down. I expected, at a small college like Swarthmore, an environment that was more formal than my high school in its enforcement of deadlines and attendance, but still one of trust and openness. I assumed that my professors would feel as comfortable directly discussing mental health as I was. I didn’t want to register my disability, because I didn’t feel I needed an official nod from the administration to validate my condition. I saw myself as the keeper of my own condition, the only person who knew its contradictions and idiosyncrasies, and the only person who could appropriately convey its significance to my professors, on an as-needed basis.

But when I didn’t register my condition through Disabilities, I was expected, at least academically, to operate as if I didn’t have that condition at all. The school had become the entity that validated (or failed to validate) my mental health concern, and when problems arose that I needed help with, I had no official papers to back up my experience. During my worst week of the semester, when circumstances exacerbated my anxiety to the point where I couldn’t sleep, I jotted an email to my professors, explaining the situation. They were perfectly understanding, and nothing more. They extended deadlines at my request. They told me to take care of myself. They didn’t say anything else, because beyond that, we’re not supposed to talk about it. I didn’t feel that first semester as though there were any adults who cared about me on campus, who wanted to help me out of the quicksand I felt I was sinking in.

Some students don’t feel comfortable talking openly about mental health, and for them, keeping that subject compartmentalized within an administrative service works best; I respect that completely. But I do think that, for students like me, my relationship with my anxiety at Swarthmore would improve in an environment in which professors outside of the administration were available, if asked, to play a role beyond telling us to take care of ourselves. An environment that fostered open dialogue about mental health – where I could drop by a professor’s office hours and, when they asked “How are you?” I could answer “Not great, my [insert mental health condition] has been bad lately” — would be one in which I felt freed of a false distinction between my presented academic self and the self that’s feeling lost and scared on the inside.

My experience is that there are two sides to the coin of a mental health problem. On the one hand, mental health issues are medical issues: they perhaps need to be discussed with doctors, treated, and considered as illnesses that people have, separate from who they are. I think there’s another side of illness, though, that can be viewed as just another aspect of a person, something that is often incredibly difficult to get up and deal with every day, but also something that can be positive, an asset, something to be proud of.

My anxiety gets in the way of my life every day, and forces me to cope with emotions and sensations I never asked for and don’t want — I have the right to register this officially with the college and treat it as the illness it is. But it’s also the reason I can perceive easily if I’m feeling off or unhappy in a situation, a perception that allows me to leave situations I don’t want to be in; it’s the magnifying glass that makes small moments of excitement (going into Philadelphia, trying soup dumplings) thrilling and adventurous, adding a layer of prickly joy to my life that I wouldn’t otherwise experience. It’s part of my personality sometimes, and sometimes I like it that way. This side of the coin must be understood in the complex intersection of personality and condition, that muddy intersection where I like blue and I don’t like rollerblading.

What would Swarthmore look like if students who didn’t want to register their disability officially could discuss it informally with administrators and professors and work out a solution together? If professors moved beyond “Take care of yourself” and instead asked “How can I help?” For me, at least, it would create a much-needed space for that muddy intersection. A school where my professors didn’t separate my academic self from my anxious self would be one in which I felt appreciated and understood, and would seek to appreciate and understand in turn.

 

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