An informal Phoenix online poll conducted last week produced striking results. Of 185 respondents — about 12% of the student body — 54% reported that they had suffered from anxiety and/or depression while at Swarthmore, while 58% disagreed that stress, anxiety, and/or depression are necessary byproducts of receiving a rigorous education. Despite Swarthmore’s famously high retention rate, about 35% of respondents had considered transferring. And 18% of respondents admitted to having had suicidal thoughts while on campus. These results, unscientific as they may be, suggest that the time is right for a sustained discussion of mental health.
Among those who have heard of Swarthmore, perceptions similar to “everyone there is overworked and depressed” are not rare. The college ratings book America’s Douchiest Colleges introduces Swarthmore with not one but eight frowny faces, which, one learns upon consulting the glossary of icons in the front, indicate that potential students should “get ready to study like [they] go to Swarthmore.” Graffiti on the walls of the student radio station at Reed College — a school frequently compared to Swarthmore in terms of academic rigor but more recently known for its pervasive drug culture — include a piece that reads “Have fun—otherwise we’re just Swarthmore.” In 2010 The Huffington Post named Swarthmore the most grueling college in America.
There are, of course, some outliers. Last August the Daily Beast published a set of college rankings, including one listing the “Colleges with the Happiest Students,” in which Swarthmore was ranked 8th. A similar study performed the previous year by Center for College Affordability and Productivity placed Swarthmore second. Both lists attracted ridicule for an array of pretty obvious flaws — the latter wasn’t so much a ‘study’ as a list of colleges in order of retention rates, and the Daily Beast placed similar emphasis on that metric, as well as post-graduation satisfaction — but the responses they provoked were instructive. “Daily Gazette” comments on the issue were generally bemused and dismissive of the studies’ findings. Some even seemed defensive, as if the college’s essential reputation for producing moody Marxists and eternally dissatisfied activists were on trial. Or, in the words of one College Confidential commenter: “We may be most satisfied after college, BUT SWATTIES ARE NOT THE HAPPIEST WHILE AT SWARTHMORE. But we were happy. It’s complicated.”
Complicated it may be, but the fact that Swarthmore’s storied “gruelingness” is a point of pride for students, that misery becomes fodder for games and constant sleep-deprived stress an assumed norm, threatens to marginalize voices of genuine misery or inner distress, to make anxiety and unhappiness “not a big deal,” subject to competition — and ultimately to trivialize real issues surrounding mental health.
In a “Daily Gazette” op-ed last semester, Rafi Ellenson ’16 wrote: “For a school that prides itself on emphasizing the life of the mind, there seems to be remarkably little discussion here at Swarthmore about the mind misbehaving, or acting in off or unusual ways.” It is from this view that this series will move.
Ivory Tower, Millennial Edition
A 2010 New York Times article entitled “Mental Health Needs Seen Growing at Colleges” documented a dramatic rise in college students coping with “serious mental illness”: national surveys indicate that the proportion of patients at college mental health centers in this category has more than doubled in the last decade, up to roughly half of all visitors. The article attributed this spike to a range of factors, including an increasing willingness to discuss previously taboo issues and the increasing use of powerful psychotropic medications that enable students who would otherwise likely have been unable to function effectively in a college setting to go to college.
Amid this evolving mental health landscape, driven students at the nation’s most competitive institutions face a range of additional pressures, distractions and temptations, due in part to relatively recent technological and medical changes, as well as a changing academic culture increasingly defined by perpetual activity and a competitive obsession with overcommitment — taking on the largest course load and most grinding array of extracurricular activities imaginable.
A 2010 article in Harvard Magazine entitled “Nonstop” portrayed a snapshot of this cultural shift: this is the playdate generation, groomed to experience time and life as a blank calendar awaiting careful segmentation into precisely calibrated blocks — for activities, work, and perhaps a few for sleep and friends. Harvard students, the article claims, are forced to compete in an environment where the expectation is that you do “3000 things at 150 percent.” This culture of maniacal achievement comes with obvious downsides: “The paradox is that students now live in such a blur of activity that idle moments for … introspection are vanishing.”
In response to this article, Stanford professor Terry Castle penned a Chronicle of Higher Education op-ed provocatively titled “The Case for Breaking Up With Your Parents,” in which she argues in part that the close parental involvement enabled by cell phones — a phenomenon stunningly common among her undergraduates — delays the skepticism toward or resistance to received knowledge and authority that she describes as an “absolute precondition, now more than ever, for intellectual and emotional freedom.”
Moreover, there is increasing evidence that this constant digital connection can have profound psychological consequences. A growing body of research shows that persistent Internet use can lead to psychological changes similar to those produced by drug addiction, potentially leading to intensified depression and periods of mania. And last May, The Atlantic published a widely circulated cover article called “Is Facebook Making Us Lonely?,” which surveyed recent research pointing to the potential psychological consequences of social media — including the seemingly paradoxical conclusion that the constant connection may be making us more lonely: “Facebook denies us a pleasure whose profundity we had underestimated, the chance to forget about ourselves for a while, the chance to disconnect.”
If there are analogs to addiction in the rhetoric of technology’s routine interventions in college life, the massive rise in the off-label, illicit use of Adderall, Ritalin, and a variety of other stimulants commonly used to treat ADHD — some studies now put the use of Adderall among college students as high as 34.5% — as “study drugs” (essentially cognitive steroids for busy college students), has an even higher potential to tangibly and immediately impact the focus and scope of college mental health services.
A 2009 New Yorker article entitled “Brain Gain: The underground world of ‘neuroenhancing’ drugs” examined the common uses, ethics and additional problems surrounding these stimulants, which it characterized as “drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted.” An article published in the Times this past week called “Drowned in a Stream of Prescriptions” vividly depicted the potentially drastic mental health consequences of persistent Adderall abuse. An article in this issue of The Phoenix surveys its presence at Swarthmore.
Mental Health Services at Swarthmore
Swarthmore’s Counseling and Psychological Services (CAPS) is one of only a handful of college counseling centers in North America that offers unlimited free counseling to students. As the demand for college mental health services grows nationally, a similar explosion has been underway at Swarthmore.
According to CAPS Director Dr. David Ramirez, the percentage of students who had used CAPS at least once by graduation used to hover around 30%. In recent years, however, the number has begun steadily increasing. Now, it is around 38%.
Other metrics depict an even more dramatic increase in the demand for psychological health services. On the first day of classes last semester — Labor Day — CAPS recorded around 73 individual contacts from students seeking appointments. And this past semester alone CAPS saw the same number of students that they had seen in the entire 2007-2008 academic year.
What is driving this increased demand? Dr. Ramirez believes that “there are multiple variables involved.”
“Culturally, overall, more students who have serious mental health challenges have been able to be accommodated earlier in life, starting in preschool, with supportive ancillary services to keep them viable as students, so that when they get to college they continue to need those services,” he said.
“It’s a time of great stress, for a lot of people,” continued Dr. Ramirez. “A lot of people’s families are stressed and those things can reverberate and affect students in their time here.”
In addition, however, Dr. Ramirez sees the increase in demand for CAPS as a possible signal that seeking counseling no longer carries as powerful a stigma as it once did. “We used to worry a lot about barriers to seeking treatment and about the stigma of receiving mental health services. In the last three years, the tremendous increase in the use of our service has led me to think that perhaps we have succeeded … in to a certain extent destigmatizing the behavior of asking for help,” he said.
In recent years and in response to this increased demand for services, CAPS has undergone a substantial change in its staffing structure. In the past, CAPS was staffed by a mixture of senior licensed staff and clinical interns, students in their last years of graduate school who had prior clinical experience and were working toward their full license. In the spring when CAPS typically became busier, CAPS usually hired a group of independent, fully licensed practitioners to supplement the year-round staff.
As demand for psychological services grew, however, CAPS was forced to hire these contractors earlier and earlier. Eventually, the contractors were hired as early as fall, and became what Dr. Ramirez describes as a “de facto staff, who were here on an adjunct basis.” Around three years ago, in part to ensure greater continuity of service, he decided to restructure the staffing system, so that the positions previously filled by independent contractors became year-round positions staffed by postgraduate fellows.
This decision drew a certain amount of criticism at the time, spurred by the perception that CAPS was replacing licensed counselors with interns, and the concern that little to no oversight existed. Dr. Ramirez refutes this characterization. “Everyone’s always supervised,” he said. “Even the senior staff are supervised by me.”
Negative perceptions of CAPS persist, largely due to the view that many clinical interns are insufficiently prepared for the tough and widely varied work of counseling college students. I spoke to four students who have formerly used or continue to use CAPS. They expressed somewhat mixed but frequently positive views of the service. All but one wished to remain anonymous.
Student #1 came to Swarthmore with a previously diagnosed eating disorder, but when she visited CAPS midway through the semester after barely eating for two weeks, her counselor told her, in essence, that he didn’t see what was wrong: “The second time he basically said, ‘I don’t really see what’s wrong, I’m not really getting it.’ I was very open, I disclosed all the issues, I said ‘I’ve lost 10 pounds in 2 weeks, I haven’t eaten more than 500 calories a day’ and he said ‘It sounds just like typical coping behaviours. To me you’re functioning so I’m not really understanding the issue.’ … I met with him two more times, and the only good thing he did was refer me to the nutritionist.”
After meeting with the college nutritionist — who told her that she could have been admitted to a hospital — she was able to obtain adequate help, but she says, “I had a huge advantage because I knew, I had a diagnosis, and I had a history. But if someone else didn’t know anything they could have died in that same position where he’s basically telling you that despite these huge red flags, objectively disordered behaviors, that you’re ok! … besides the nutritionist, there’s no support for eating disorders on this campus.”
Her primary concerns with CAPS mirror those voiced by many others. “I think the problem is that a lot of colleges say, ‘We can only deal with short term issues, situational stuff,’ but Swarthmore says that they can, and I don’t think they can.” She acknowledges that CAPS nevertheless provides a valuable service, as long as “you go in cautiously and know that psychologists don’t know everything.”
Student #2 was unsatisfied with her counselor’s expectations that their time together would be spent progressing toward a specific, straightforward goal. “She wanted to have very clear-cut goals for our time together. … Every day when I would come back the new week she just expected that whatever I wanted to talk to her about that day would be very coherent with what I told her the very first day, and if it strayed in any way she’d always pull out that sheet of paper and be like ‘But your original goals, how do we solve these?’ I didn’t know how to explain to her that I wasn’t just a well-delineated person who had one set of issues that I consistently wanted to address.” She hasn’t been back since, but has considered trying CAPS again with a different counselor.
Student #3 has had three counselors over her time at Swarthmore. Her first was initially a positive experience, but, she says, “once I had worked through those initial issues, they started going a little crazy with psychoanalysis, which was not the best experience honestly. I ended up no longer seeing them because I felt that they had insulted me, in the things they would find in my problems.” Still, she says, “the great thing with CAPS is that you can switch therapists,” and her experiences since have been positive.
Student #4 has also had three counselors over his time at Swarthmore. The first, an intern, was excellent, but the second, who came from the same program, “was horrible. It’s really important for a therapist to make you feel accepted and supported and I didn’t get the sense that she even liked me. She was very cold.” His third and current counselor, however, is “excellent,” and his view of the service as a whole remains largely positive: “CAPS is excellent.”
This semester, CAPS will be starting a new series of group therapy sessions, which they hope will help satisfy student demand for some alternative forms of counseling. In this vein, next week’s article will focus on alternative psychological resources on campus, including Speak 2 Swatties and the newly emphasized wellness initiative.
*Name has been changed