At Yale, therapy has its limitations

Most likely, the experience of mental health care at Yale these days cannot be summed up by a single anorexic’s story.

It is a complicated scene of unprecedented demand on a limited system, where one-sixth of the University’s population is triaged and treated in an arguably model college health care facility. It is many anonymous stories, good and bad, statistics, reliable and not, and comments from administrators, guarded and practical.

Nevertheless, a single story can do much to explain what goes on inside the grey low-rise on Hillhouse Avenue.

Take, for example, Ren Johns ’04.

Getting started

After dinner in the Ezra Stiles College dining hall, Johns started at the beginning: a sick grandfather, picky eating habits in high school, an ever-tightening weight loss policy (“5 pounds good, 10 pounds better”), and so on.

She was never diagnosed, but friends were concerned, and her painted fingers started to look a little bony.

Flash forward to Yale: long hours at the Yale University Dramatic Association, a grandfather getting sicker, new concerned friends. She was eating around 900 calories a day, she said; most eat 2,000. By October 2000, she’d realized she needed therapy.

“It being free and here and easy to get in touch with,” Johns said, “was very key to my starting to get professional help.”

She paused to try to explain the way smart people deal with the onset of anorexia, conscious of it all the time and largely powerless.

“It’s hard to be a reasonably intelligent person with an eating disorder,” said Johns, one of Rumpus’ 50 Most Beautiful People this year. “Some people think anorexics just don’t realize what they’re doing to themselves, but that’s not true at all. There’s lots of guilt and frustration. I mean, there are kids starving and you can’t even get down a piece of chicken.”

It’s this cognitive dissonance, she said, that aggravates mental illness and makes the sufferer feel increasingly isolated.

“You so desperately want to be ‘normal,'” she said. “The whole mindset is very counterproductive.”

Ten to 15 pounds lighter after the first month of school, Johns contacted a designated eating disorder representative, and made an appointment for a preliminary evaluation.

Waiting

One junior, who asked that her name be withheld, has been through six therapists at Mental Hygiene, looking for one whose style matched her own. She said that she has a number of friends who have been through the system, and that without exception, each found herself waiting by the phone for a therapist’s call.

“I’ve heard so many complaints about it,” the student said. “[University Health Services] will have a consultation and people get so frustrated because when they finally decide to go, they feel like they really really need the therapy. Three weeks later seems so long under the circumstances.”

“The most frequent complaint I get is the gap between initial intake and assignment of a therapist,” said Paul Genecin, the director of UHS. “The issue is we’re always defaulting to the most serious cases.”

Johns said she waited a week or two, deemed not the most critical and not the least after her first visit.

Unlike Yale, neither Harvard nor Princeton has consultations, and the directors of both health service clinics said many students are assigned a permanent therapist within a week of calling. But Genecin said Yale’s system, albeit slower, is valuable because students start with care providers hand-selected to suit them.

One on one

Before the middle of her first semester at Yale, Johns, who played Kate in the Dramat’s production of “The Taming of the Shrew” and is now an alto in the Yale Women’s Slavic Chorus, added individual therapy to her new college list of extracurriculars.

But because of limited resources, there is a fixed number of visits students are allowed in a year: 12. After one semester of meetings, decisions are made on a case by case basis to determine if and how a patient should continue therapy, Genecin said.

“It’s kind of funny knowing you’re running out of time,” Johns said. “The reality of being a paying patient would creep up, and I’d think, ‘Oh no, I only have a couple of weeks left, I better say what I have to say now.'”

The situation is no different around most of the Ivy League where students are limited to 10 or 12 meetings before being referred to private care providers or told to come back next year.

Harvard, though, whose mental health staff comes to total around 17 full-time employees — just under Yale’s number, which hovers between 18 and 20 — does not have a set limit, said Richard Kadison, the chief of their mental health services.

Frequently, he said, students come in more than 12 times, but unlike Yale students, they don’t have the guarantee of weekly visits.

But comparisons are difficult between these closely tied schools because Harvard’s mental health network is split in two, with their University Health Services’ division seeing only 500 undergraduates, while Yale’s UHS handles nearly twice that.

“For a number of reasons, we see a large number of students,” said Lorraine Siggins, chief psychiatrist of Mental Hygiene. “Those who come in first semester are seen until January, and many of our students feel fine then about waiting until next year, coming back then, and sometimes they touch base with their therapist on a less frequent basis.”

“If a student wants to stay on longer,” she continued, “we really talk with them about that, but by and large we do have people stick with about a semester.”

Johns said she and her therapist found a way to have more regular meetings by stretching the system.

“My therapist and I had to sort of play fast and loose with the regulations so I could keep seeing her. I saw her weekly through the first semester, then that tapered down, then we called it ‘touching base with group.’ It was partly because I didn’t need to see her and partly because there’s not the coverage,” she said. And for a year, she added, it worked pretty well.

Genecin estimated that between three and five members of the staff, around 25 percent, leave and are replaced each year. Siggins said it’s usually closer to one or two a year.

With the ebb and flow of therapists went Johns’ freshman year psychiatrist. She was assigned a new one this fall, and the disjunction has made for frustrating redundancy, she said.

“Sometimes I feel like I’m spinning my wheels through stuff I already worked through just to catch her up,” she said, but moved on quickly to talk about “group,” which she began second semester last year to compensate for the compulsory reduction in “one on one” therapy.

“Group” is a collective weekly meeting, a program for which, unlike individual therapy, there is relatively — some say unfortunately — low demand at Yale.

Group

“For the right kind of student,” Genecin said, “group can have great therapeutic benefits. For a student sitting behind a computer screen doing math at 4 or 5 in the morning, for example, you get a feeling for who else might be out there, going through what you’re going through.”

“In fact,” he continued, “it may be the method of choice. It’s a shame we don’t have more groups.” The reason for that, he said, is a combination of Yalies’ impression that personal therapy is better and their reluctance to discuss problems with collections of peers.

Some students do not take kindly to the imposed ending of their private sessions. One sophomore, echoing the sentiments of a number of his Yale College peers, said he felt he had been pressured in group, calling it “just horrible.”

As Johns tells it, however, group was a very good thing last year when she was being weaned off of one on one counseling.

“Seeing other people committed to getting better makes you more committed,” she said. “And it’s really, really nice to feel you’re not crazy. And it’s so nice when you feel so isolated in this one aspect to realize that it’s OK, that I’m not the only one.”

Though not because of high capacity, group too has had its problems, said Johns. For one, her group leader left at the end of last year as well, and again, she said, it made for repetition and confusion: group didn’t start this year until right before Thanksgiving break, and the worksheets and exercises, though very helpful when done initially, are the same as before.

“It’s sometimes hard to get motivated when I feel like, ‘well, I did that last year,'” she said. “And you don’t want to be that person in group who’s always saying, “Last year someone brought up something really interesting about this.'”

Taboo

After almost two full years in the UHS system, Johns praises and criticizes it evenhandedly overall. What concerns her, though, is that even with so many students seeking therapy, mental illness is still taboo on campus.

“Mental Hygiene is this dark building far away, and I don’t think that’s helping anyone,” she said. “This doesn’t have to be a scary or damning thing.”

Regardless of the program’s merits, Siggins said support for the mentally ill at Yale does not end at her clinic’s doors.

“Yale is certainly a competitive university,” she said. “But at the same time, our students really do look out for each other.”

Tomorrow: Is Yale hazardous to your mental health?

Due to limited resources, Yale’s mental health services limits students to only 12 therapist visits each year. Appointments with doctors in Mental Hygiene are in high demand, and students are often forced to wait several weeks before an initial therapist visit.
Kerry Shapleigh
Due to limited resources, Yale’s mental health services limits students to only 12 therapist visits each year. Appointments with doctors in Mental Hygiene are in high demand, and students are often forced to wait several weeks before an initial therapist visit.

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