It’s not that I’m trying to figure out a way to kill myself — that I have already decided. Rather, I am building up the courage to actually do it: to turn left onto the expressway instead of right, to unbuckle my seat belt, to flatten the accelerator pedal, to rocket my sister’s black VW Golf into oncoming traffic.
On each of three nights, I leave my house wordless, get in the car, and drive around for an hour. I turn my phone off so my parents cannot contact me. The first night, I return a video to Blockbuster. The next, I drive by some friends’ houses. Invariably, though, my final stop is the intersection of Glasscock Road and Expressway 83. I press my palms hard against the steering wheel, tears streaming down my face. I want so badly to translate my despair and frustration into that final action — that one turn that will complete my existence.
Just turn the wheel left.
And then I turn right. I make the drive back home. Walk into my house. 10 p.m. My parents beg me to break my silence. “Please talk to us, Jaime. You haven’t said a word to us for days. Please. We love you.” I head to my room. Lock the door. Go to sleep.
I guess I’ll just try again tomorrow.
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Seven months ago, the suicide of Cameron Dabaghi ’11 — a passionate East Asian Studies major and skilled tennis player — shook Yale University. Cameron’s death was the third on campus last year but represented the first suicide of an enrolled Yale student in 11 years. This past July, Sang-Ohk Shim GRD ’10, a Ph.D. candidate in Cell Biology, also died of an apparent suicide. She had been receiving psychiatric treatment for depression before her death.
These incidents brought Yale into the fold of a serious national problem. According to the American Foundation for Suicide Prevention, suicide is the second leading cause of death among college students. Moreover, more than fifty percent of college students have thought about suicide, and fifteen percent have seriously considered attempts, based on a survey presented at the 2008 American Psychological Association convention. What can be done to prevent these staggering statistics from becoming realities?
Yale offers counseling services through the Chaplain’s Office and Walden Peer Counseling, but the primary source for mental health treatment on campus is Yale HEALTH’s Department of Mental Health and Counseling, which celebrated its 85th anniversary this year. The department, located on the third floor of the new Yale HEALTH Center at 55 Lock Street, treats a range of issues including sexual assault, eating disorders, substance abuse, anxiety, and depression.
Dr. Lorraine Siggins, the department’s Chief Psychiatrist, explained in an e-mail that between 17 and 22 percent of students uses Mental Health and Counseling resources each year. “More surprising,” she claimed, is the fact that 48 percent of an undergraduate class consults the department over their four years on campus.
Siggins believes that these numbers are a testament to the efficacy of the university’s mental health offerings. “The figures are probably influenced by the number of services offered and the high number of counseling sessions that are available,” she wrote. “Yale has more [resources] available than most other universities.”
But does it have enough? Studies have shown that mental health illnesses among college students across the nation have become increasingly more serious over the past decade, and in the past year, concern over mental health awareness and reform has grown on campus. In the wake of suicide at Yale, many wonder: can the university do more to better protect its students’ mental health?
Angela Lee ’11 first visited the Department of Mental Health and Counseling, in what was then called Yale University Health Services (YUHS), her sophomore year. After spending two weeks early in the semester in Yale New Haven’s ICU for an illness that doctors were never able to diagnose, Angela returned to school amidst a slew of extracurricular obligations and five course credits-worth of unfinished work. Following a teary breakdown while studying for an exam, Angela sought the advice of her dean, who led her to YUHS mental health facilities.
All Yale students, undergraduate and graduate, are entitled to free, confidential counseling at Yale HEALTH’s Mental Health and Counseling Center, regardless of their health plan. The official policy provides students with a “course of brief therapy,” which typically lasts a semester. However, Dr. Paul Genecin, Director of Yale HEALTH, clarified that there is no cap on the number of visits students are entitled to through the Yale Health Plan, and that the course of treatment depends on the severity of the case.
All students need to do to begin treatment is call the Department of Mental Health and Counseling at 203-432-0290 to schedule an initial evaluative appointment, which according to the website should take place within a few days of calling in, or on the same day if the situation is urgent. Yale HEALTH also offers an anonymous online screening to help students determine whether they should seek counsel. Approximately 25 therapists make up the Mental Health and Counseling staff. Students are assigned to a therapist but can choose whether they want to work with a psychologist, psychiatrist, or social worker. An acute care psychiatrist is also on call 24/7 to respond to emergency situations.
“I think your experience with the Mental Health Department really depends on who you’re assigned to work with,” Angela said. “It’s very luck of the draw. I’m sure there are some clinicians there who are great at listening and offering real solutions, but there are also some people who just sit there and don’t do anything.”
Angela was altogether disappointed with her experience at YUHS Mental Health, finding that her treatment made her feel worse, not better. “Every time I would walk out of the psychiatrist’s office I’d feel bad, even though there was nothing to feel bad about.” She was also frustrated that her therapist continually suggested she start taking medication to solve her emotional problems, even though she had made clear on her first visit that this was not a route she would ever consider.
After two months of therapy, Angela decided to terminate her treatment. She believes that the support of her close friends was what finally relieved her of her negative emotions. For many students who turn to Yale HEALTH resources, she suggests, “we don’t need someone with an M.D. or even a Psy.D. to help us cope with the stress of school. I had a stronger friend base at the end of sophomore year. I honestly think that for many people, if you find good friends, that can be enough.”
“I think the reason there’s this idea of a feeling of general unhappiness with Yale’s mental health services is that if you’re unhappy about something you’ll tell ten people,” says Dr. Carole Goldberg, a Yale HEALTH psychologist and the faculty adviser for Walden Peer Counseling. “If you’re happy with it, though, you’ll only tell two.”
Angela is not the only student to speak up about her discontent with Yale’s mental health offerings. Sally, who asked that her name be changed to protect her privacy, also decided to end her mental health treatment on campus.
From the outset, Sally, who was suffering from an eating disorder, found herself uncomfortable with her YUHS psychologist’s attitude toward treatment. “She basically told me that I only had a limited number of personal sessions — she really emphasized that point a lot. It was really alienating.” When the psychologist suggested that she join a group therapy session, Sally was hesitant, explaining that she didn’t feel ready for a group environment. Nonetheless, she agreed to receive more information about group therapy, but no one ever contacted her.
Sally was also dissatisfied with her therapist’s manner of counseling. She described an instance where the psychologist pointed out that according to the Body Mass Index, Sally was of a healthy weight. “For a person who has these problems, having someone take out a weight chart and tell me that it says I’m healthy is one of the worst things you can possibly do. It came across as her telling me I was a failure. Someone who’s trained to deal with these kinds of problems ought to know not to do that and that it’s not really about weight itself.”
After this experience Sally decided to hold off on further visits to the psychologist. However, several months later, she decided that her eating disorder needed critical attention and tried once more with YUHS. Last spring, she called again to arrange an appointment but was not able to set an appointment date for within thirty days of her call-in. She returned to YUHS for her scheduled visit only to be turned away by the receptionist — her appointment would have to be rescheduled for an even further date.
Fed up, Sally declined to reschedule and began researching the possibility of mental health resources outside of Yale. She scheduled an appointment with Dr. Laurie Grunebaum, a psychologist independent of Yale University, who confirmed that she sees “quite a number” of Yale students in her New Haven clinic. Sally reported her experience with Grunebaum has proved vastly more effective than her experience with YUHS. “What Dr. Grunebaum emphasized was that though the nature of the illness is related to food, weight, body image, it’s really about coping with emotions,” she said. “She’s helped me so much.”
For students like Angela and Sally, Yale has failed to meet their mental health needs. Other students, too, have complained about Yale’s offerings. One student interviewed felt that Yale’s services alienate those who have relatively minor mental health needs, asserting that you will only be taken seriously as a patient if your case is extreme. Another student, on the other hand, felt that Yale is unfit to handle extreme cases: “Yale isn’t equipped to carry out the services that they claim to provide,” this student, who has taken time off from Yale for mental health reasons and asked to remain anonymous to protect her privacy, said. “It’s just really important that the students don’t rely on the university.”
After that third night, my dad finally manages to bring me out of my silence. There is no moment of epiphany allowing me to understand that my situation can be helped. I just get tired of not telling anyone about the turmoil raging within me. I let him take me to get something to eat.
“Jaime, tell me honestly, are you thinking about killing yourself?”
I struggle to answer. How can I tell Dad that I want to kill myself? I can’t. He’ll be disappointed. He’ll think I’m insane. There’s no way he can understand what I’m feeling right now. I can’t tell him.
In a cracked voice: “Yeah.” Tears. Mine.
“Alright, well we need to go see a psychiatrist.” No admonishment. No bewilderment. No disappointment. No notable outburst of emotion at all.
“Jaime, everyone thinks about suicide at some point. Anyone who tells you they haven’t is a fucking liar.”
Dad gets it.
I spend the next two hours just letting my dad know what is wrong in my life and why I feel unequipped to handle it all. I tell him about the rumors that have begun circulating at school after an unhappy breakup. I receive the inquiries daily: “Aren’t you that asshole that broke up with Karen because you think she’s stupid?” “No, that’s a lie. I never said such a thing to her.” I tell him about the academic competitor turning to deception to try and lower my GPA. I relay to him my anxieties in their full force, and he listens.
That’s what I needed all along: someone to understand.
For Timeica Bethel ’11, Yale’s Mental Health and Counseling services provided her with someone to understand. Timeica sought help her sophomore year after she found herself becoming very solitary. She was sleeping continuously, missing classes, and did not want to talk to others.
“The first few weeks of my therapy mostly involved me crying, trying to figure out my sadness. Dr. Goldberg talked me through my life. We talked about everything: family, my life before Yale, my friends at home, my boyfriend. I poured out everything to her in those sessions.”
For Timeica, talking to Dr. Carole Goldberg, her YUHS psychologist, provided invaluable relief for her emotional stress. Timeica felt that the stigma associated with discussing mental health issues made it impossible to turn to her parents: “My parents wouldn’t be able to understand or support me. They would tell me to pray more.”
Timeica thinks what people need for successful treatment of depression and anxiety is empowering feedback. She related with enthusiasm Goldberg’s effectiveness at listening and helping her come to her own conclusions about her situation. As Timeica put it: “Dr. Goldberg responds, but I’m figuring it out for myself.”
Following Cameron’s suicide, the Department of Mental Health and Counseling took emergency measures to increase the availability of therapists to students in order to help them cope with the loss and prevent “copy cat suicides.” Mental health clinicians were physically sent to each residential college to interact with students. According to Genecin, the measures taken by Mental Health and Counseling were typical for the situation. He described a 2003 car crash in which three Yale students were killed, and just as with Cameron’s suicide, clinicians were sent to the residential colleges to help students deal with the losses.
These expanded mental health services following Cameron’s death were temporary steps targeting the immediate effects of an isolated incident. But members of the Yale College Council took Cameron’s death — in addition to the deaths of Andre Narcisse ’12 and Annie Le GRD ’13 last year — as an impetus to evaluate and work long-term to reform Yale’s mental health offerings and culture of mental health.
“A lot happened last year; I saw firsthand how bowled over people were by everything that was going on,” said Annie Shi ’12, the vice president of the YCC. Mental health became a central issue in the spring YCC elections last spring, and Annie now heads the YCC mental health project group. She recognizes that there are some things the YCC has no control over. “Time delays” in setting up appointments — a common complaint against Yale HEALTH’s services that proved to be a problem for Sally but not Angela or Timeica — “aren’t something YCC can really help with. Things of that nature are out of our hands, but it’s still something we’d like to ask the administration about.”
However, she feels that there is still much the YCC can do to effect change and in particular is hoping to reduce the stigma that surrounds using mental health services. “The culture at Yale is one of anonymity. You don’t want people to know you’re going to counseling. There’s definitely a lack of individual openness about mental health issues,” Annie said.
To combat the lack of mental health discussion at Yale, the YCC project group is collaborating with Mind Matters, a student mental heath awareness group, to plan a poster campaign akin to the “Get Tested” STD-testing awareness campaign of last year. The posters will feature photos of students who have utilized Yale HEALTH mental health services along with an indicative caption. “We think that putting a recognizable face to the issue might help de-stigmatize it,” Annie said.
The YCC project group and Mind Matters have several other awareness projects in the works. Mind Matters is working on a mental health newsletter to be distributed to Yale students, and the YCC is thinking about asking college masters to give a number of free meal swipes to designated therapists so they might familiarize themselves with the residential colleges and their respective students.
As for Yale HEALTH, according to Genecin, the Department of Mental Health and Counseling is “fully staffed” with no plans for expansion.
“So Jaime, for this first visit I have to ask you some initial evaluation questions; I know you’re just here to get a prescription, but bear with me. It shouldn’t take long.”
I’m four weeks into my freshman year at Yale, and I’m visiting the Yale HEALTH Mental Health Department for my diagnostic appointment to continue the psychiatric treatment that I began back home after opening up to my dad.
Dr. Mulkeen is young. I’m unsurprised to discover later that it is only her fourth year as a psychiatrist. But I decide quickly that I like this woman. She listens and watches intently as I tear up while telling her about my plan for suicide my senior year; her face is quite visibly concerned. She doesn’t say a lot, but I can feel that she cares.
My emotional state has been the most important aspect of my move to Yale for my parents. Beyond grades, classes, dorm furnishings, flights — all that matters is that I feel good about what I am doing.
“What good is it to go to an awesome school like Yale if you aren’t going to feel good about being there?” I hear my dad’s voice echoing against the walls of my skull as I walk out of the health center. It’s a warm Thursday afternoon. I think about my place here at this school, what I want out of my time at Yale, what all students should want, really.
And I can see that my dad is right.
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Eating Disorders: A Host of Unanswered Questions
— Sarah Atkins
I see sick people. I see them in my classes, obsessively circling their tiny wrists with their fingers as they sit through lectures. I see them walking across campus, their clothes hanging so unnaturally it looks like a wire hanger lies beneath them rather than a human being. I see them in the dining halls, inspecting the nutrition facts a little too closely, picking just a little too much at their small plates of food. I see them anywhere and everywhere. These people all suffer from a common category of illness: eating disorders. I would know; I had one.
I struggled with anorexia nervosa my entire sophomore year of high school. Eating disorders are much more prevalent in people with certain personality traits, traits that are unfortunately characteristic of overachievers like Yalies. These include a need to please others, perfectionism, high expectations from family, and struggles with demands to be more independent and self-sufficient. College students are also particularly vulnerable to eating disorders due to academic stress and major lifestyle changes that come with moving away from home. According to the National Institute of Mental Health, an estimated 10 percent of female college students suffers from a clinical or sub-clinical eating disorder. Of these, over half suffer from bulimia nervosa.
Many question whether or not one can “suffer” from an eating disorder or if an eating disorder can even be considered a mental health issue. Is it a behavioral choice rather than a medical condition? Dr. Kathryn Henderson of the Rudd Center for Food Policy and Obesity states that “most mental health disorders have a behavioral component” and that the characteristic failure to engage in health-promoting behaviors is “not a choice” on the part of those suffering from eating disorders. Dr. Henderson served as the Clinical Director of the Yale Center for Eating and Weight Disorders from 2003 to 2008, becoming the Director of School and Community Initiatives at the Rudd Center after the original center closed in 2008. While Henderson acknowledges that the closing of the Yale Center for Eating and Weight Disorders “took away a valuable resource” for students, the Rudd Center as well as the Department of Mental Health at Yale HEALTH continue to provide information and help for those with eating disorders. The Rudd Center specifically targets food addiction and obesity while the Department of Mental Health deals more specifically with eating disorders and their treatment.
The evidence of my struggle with anorexia cannot be wiped away. There will always be the memories, the pictures, and the child-sized clothing in the back of my closet. But I don’t let it define me. While I can’t — and don’t — pretend it didn’t happen, I refuse to let that part of my past shape my future. Instead, I like to think that it was a painful, year-long lesson from which I’m still learning. I can still only describe my own experience as having two personalities: one domineering, compelling me to avoid eating, and the other, my timid original self, forced into silence. With time, maybe I’ll be able look back on that period of darkness and divine more answers to those questions that I have never been able to answer about myself. Because that is the only other way I can describe my struggle: when my mind became a question instead of an answer.