Stories from CAPS Users: Combating Mental Health Stigma (Part I: Domestic Students)

Editor’s note: This article was initially published in The Daily Gazette, Swarthmore’s online, daily newspaper founded in Fall 1996. As of Fall 2018, the DG has merged with The Phoenix. See the about page to read more about the DG.

I’ve conducted interviews with four users of Swarthmore’s Counseling and Psychological Services (CAPS) from backgrounds that stigmatized conversations around mental health and investigated how they found their way to counseling. Below is the first section, which focuses on the experience of three domestic (non-international) students. Two of the names (Bella and Zoe) are pseudonyms adopted to protect the students’ privacy.  

Bella first realized she needed mental health counseling when she was in high school. Her struggles with her sexuality led to what she describes as a “tumultuous” relationship with her family; she also felt that keeping this struggle a secret created a barrier between herself and many of her friends at school. It was evident to the people who saw her struggle that she needed more help than she was getting. She was urged to go meet with her school counselor. However, having been raised in a family that had very limited exposure to mental health and therapy, she was very hesitant.

“What ultimately drove me to go to the guidance counselor was that I had this friend and we both were people who had been told that we should go to the counselor, but neither of us wanted to do it. So we basically made a pact that we would both go, and that was what ended up convincing me to go,” she said.

Coming to Swarthmore, however, revived Bella’s old uncertainties. The stories about the intimidatingly long waitlist at CAPS made her feel like her own problems were not serious or worthy enough of taking resources away from someone who might need it more. It was not until her sophomore year, when she realized that she could no longer finish her work or go about her life efficiently, that she finally reached out to CAPS.

As of now, Bella has been going to CAPS for nearly a year and a half. Although her first counselor was not helpful and nearly made her give up going to CAPS entirely, a sense of “desperation” and a need to “make sure that [she] was going to get through the year” prompted her to stay on the program. With her current therapist, she feels much more comfortable with confiding in her therapist the information that leads to her struggles.

While Bella’s high school experience helped inform her expectations for counseling—and to some degree made her trust the effectiveness of CAPS despite the initial difficulties—Zoe was completely new to the idea. Zoe had been struggling for a long time with what was eventually diagnosed as anxiety and depression—a struggle she later traced back to middle school, where she was badly bullied . When college finally presented her with the opportunity of counseling, however, she shunned it.

There were three main reasons why Zoe didn’t want to go to counseling, her struggles notwithstanding. One influence was cultural: Zoe grew up in a community with paradoxical attitudes regarding therapy, simultaneously seeing it as something that only people with “very serious” problems seek out and also as something that is fundamentally ineffective.

“I was part of a culture where it was like, ‘you must have some real problems if you’re talking to a therapist’ and ‘if you’re just talking to someone, you should be able to talk to anyone.’ Or ‘it’s not that big of deal. [Therapists] are not really doing anything to help you.’,” she said.

Another influence was familial: raised in a single-parent household, Zoe very much looks up to her mother’s strength, independence, and self-sufficiency.

“I watched my mom do everything. There was no moment where she said: ‘man, being a single mom with a job, working full-time is so tough. I just can’t do this.’ No, she just did everything,” Zoe said. “She was so strong. This shows me that strength is doing everything and not telling people when you’re upset and when you’re hurt. You should just get over it and you should just do what you have to do to get things done.”

The third reason was related to Zoe’s own values and aspirations. Zoe’s admiration and appreciation for her mother’s strength deeply influences how she conducts herself as a person. To Zoe, asking for help from others is equivalent to not being strong enough to take care of herself. She describes herself as “prideful,” someone whom others may call on for help, but who never calls others for the same help. For her friends, she is a reliable confidant; at the same time, she never allows her own moments of weakness show, fearing, almost dreading, that she will “overburden” her friends with her own life and problems. In addition to her own background and personality, however, Zoe also reported a sense of unworthiness similar to what Bella initially expressed:

“Even when I hadn’t gotten my license because driving made me so anxious that I stopped going to class and didn’t take my driver’s test—I was so anxious—but even then I didn’t think that that was a warrant of any kind of me going to CAPS. I thought that people with worst problems, people with more important problems deserve to go to CAPS more than I did,” she said.

The event that finally convinced Zoe to seek counseling—the event that “earned [her] the right to go to CAPS”—was one that simultaneously broke her. During the summer of 2017, Zoe experienced a violent, traumatic event in her own house that left her with symptoms of PTSD.

“I could not go from one day to another like a normal person because I felt like a ghost. This event happened over the summer, but I immediately came back to Swarthmore and had to write papers and sit in class like a normal student—like everything was fine. My professors had no idea—but I wasn’t sleeping. I cried all the time and I felt lost and sad,” Zoe said. “It was pure desperation that drove me to CAPS. There wasn’t anything special about CAPS that convinced me to go. I actually didn’t have any other choice but to go to CAPS because I couldn’t continue trying to live with these symptoms and these issues. I needed someone to tell me how to work through them. I didn’t know how they’re going to go about doing that. I didn’t know if they’re going to make me do shock therapy, or if I just talk about or retell a story. Every time I’m in there I don’t know what to expect. But I didn’t care. I didn’t care what we did. I just wanted to feel better. I wanted to stop having nightmares. I wanted to stop crying all the time.”

During her interview, Zoe highlighted the uniqueness of her case, heavily emphasizing that it shouldn’t take a “tremendously awful” experience for people to seek counseling, and expressed a sense of regret for not reaching out for help sooner.

“It really took a mountain to get me into CAPS, and I really should’ve been there the whole time. There was nothing about what I was experiencing before [the event] that made me less worthy to get the kind of help that I needed,” she said. “Everyone is worthy to have that kind of help. There’s nothing that you could do that makes you less worthy.”

Going to CAPS seems to have changed Zoe’s understanding of what counseling entails.  However, when asked, had this event not happened, would anything else have convinced her to go to CAPS, Zoe immediately shook her head:

“There’s such a stigma,” she paused, but finally said: “I needed someone to give me a push, someone who says, ‘I think you should go to CAPS.’ While my friends recognized that there was a problem, they didn’t know what to do, and I couldn’t ask them to help me in that way because people don’t want to be invasive. But some people, they need that. I needed that. You don’t need to be pushy, like ‘OK, well right now we’re going to sign you up for CAPS.’ But you can say ‘I’m your friend. I care about you. Is there anything that I can do for you that you need, because I want to help you and I don’t know how to.’ I think more people should be aware that there are people who need things that they don’t know how to ask for. Suffering, though, suffering helps you gain empathy.”

During their interviews, Bella and Zoe touched on the empowering element of confidentiality. Confidentiality provides Bella with a choice of imparting information: while she is comfortable with sharing her CAPS conversations with her friends, she doesn’t feel obliged to discuss her therapy with her parents. Zoe, on the other hand, feels liberated by the strict confidentiality provided by CAPS, luxuriating in her capability of keeping her counseling private and going about her daily life smoothly.

For Lisa Shen ’21, however, the confidentiality provided by CAPS, though empowering, also symbolizes a deep sense of solitude and isolation.

Lisa had been trying to receive therapy since she studied psychology in high school, when she recognized that her textbook’s descriptions of mental illnesses echoed the frustrating thoughts and behaviors that pestered her since 8th grade; her intuitive self-diagnosis was officially confirmed by a psychiatrist at CAPS to be OCD. During her years in high school, however, Lisa felt increasingly isolated, confused, and defeated.

“Because I come from a low-income background, I knew that I couldn’t afford counseling, which is fairly expensive,” she said. “But I think one of the reasons why I never met up with my high school psychologist was because my school only had one counsellor available, and my friends told me it wasn’t really effective, it was like a conversation with a teacher. At that time I didn’t feel like it was worth the time. I had a lot of tests to study for, so I prioritized my studying over self-care. I didn’t realize how important it was to prioritize my mental health over everything else.”

Lisa had no way of relieving her accumulated stress due to her mental health condition. She also needed to constantly battle her own devastating uncertainty of whether she was suffering from a condition or if she was not strong enough to handle problems that everyone else also goes through. These uncertainties, coupled with intense academic pressure, perpetuated a “self-defeating cycle” of confusion and despair throughout Lisa’s last year in high school.

In addition to these sources of stress, Lisa also told of the cultural pressure she felt from her community and family, which exacerbated her sense of isolation.

Lisa described her Californian high school to be a highly competitive, “conservative compared to Swat” public school with a large Asian American population—particularly first-generation children of Chinese immigrants. All the parents seemed to know each other, and the community felt very enclosed. Lisa believed that ignorance of the science behind mental health conditions, which was a result of many of the older generations’ cultural upbringing, had filtered down to her generation. She felt the stigma associated with mental health problems, and avoided the discussion with her peers or her parents.

“It was very difficult. I didn’t know who to turn to. I didn’t know what resources to turn to besides that one ineffective counselor. I didn’t talk to my parents, who didn’t really understand the concept behind OCD and what triggered my symptoms—I didn’t even talk to my dad about it, but I eventually talked to my mom during my last year in high school,” Lisa said. “She didn’t really understand, and she said ‘if you can’t concentrate, you should get more sleep.’ Yes, sleeping more is a good idea in general, but it doesn’t solve my specific problem.”

Lisa has found support in CAPS since the beginning of her freshman year, seeing a psychologist at first, then switching to a psychiatrist, and has been adjusting to her new medication for the last couple of months. Despite finally getting help, Lisa’s sense of isolation continues, as it is still hard to make her family understand her situation as thoroughly as she wants—a frustrating and upsetting struggle.

“After I was on medication, I tried to explain the science of this process to my mother and why I am doing it. I think she was definitely hesitant, and she definitely underestimated the severity of these OCD symptoms, which was frustrating,” Lisa said. “But despite not understanding the science, she told me she trusted my judgement, and that she trusted Swarthmore. That’s why she was ultimately supportive.”

Having an official diagnosis from a certified psychiatrist definitely helped Lisa gain some understanding from her family. Lisa also described the relief she felt when she got her official diagnosis.

“I think getting professionally diagnosed was one of the biggest relief. To receive affirmation that “no, you are not going crazy, this is actually a disorder that you’re suffering from.” To receive confirmation of that gave me hope, and I was informed of what the treatment options are,” she said.

Through going to CAPS, Bella, Zoe, and Lisa have developed unique and unprecedented spaces that allow them to process their individual problems in sometimes surprisingly (almost terrifyingly) honest and vulnerable ways. Developing these spaces is not easy, and finding a comfortable fit with the right CAPS counsellor seems crucial to building the necessary trust for one to open up. Bella was initially unsuccessful: a lot of her problems are connected to her sexuality, and she had a hard time relating to her first therapist, whose communication style didn’t really work for her, leaving her feeling unwilling to disclose the most important information that causes her struggles. But more or less, they seem to find their way to a unique space that is about their lives yet separate from their lives, which allows them to open up without fear of judgement or overburdening another person. In the words of Zoe:

“I don’t have a lot of relationships like what I have with my therapist. I feel like my therapist knows what’s happening in my life better than friends that I’ve had for years because I’ve been able to talk to my therapist about things that I had been too shy or nervous or ashamed to tell my friends. My therapist’s job is to have a whole hour that is only dedicated to listening to whatever thing I’m talking about. It’s really helpful to me because it’s an activity that would usually make me guilty. But I don’t feel guilty.”

And in the words of Lisa:

“My expectations for CAPS were that I was going to be able to speak with somebody who could help me pinpoint the exact reasons why I didn’t feel like I was myself anymore. I wanted to speak with somebody who was not going to judge the irrational thoughts that were in my head, especially the thoughts that might be embarrassing. My symptoms themselves were very embarrassing, but the precise thoughts that triggered them were humiliating. I knew that if I was going to tell somebody, that person better be open-minded and not judgemental. And I believe that CAPS did just that,” Lisa paused, adding, “If I’m going to be nitpicky about the body language of my counselor sometimes, I can go on about that, but I know that my therapist is not perfect. In terms of giving me what I needed—Yes, CAPS gave me what I needed.”