Jack Adam

When Anna Hope Emerson ’20 was in the second semester of her first year at Yale, her Google Drive was filled with other people’s stories. She had just published an op-ed in the News detailing her own experiences with mental illness in college. She had struggled to make it to classes and meals, and had undergone a weeklong hospitalization. In her column, she urged her classmates to similarly seek help when they needed it. “If you take away anything from my experience, let it be this,” she wrote. “Don’t put off taking care of yourself. Reaching out for help when you need it doesn’t make you weak; it makes you brave.”

After her op-ed was published last January, Emerson received an outpouring of support from members of the Yale community: Students, professors and even teaching fellows reached out to her to thank her for opening up. Some of them said they had struggled with mental illness, too. She noticed an overwhelming need “of people wanting someone to listen to them, and wanting a place to vocalize what they’d gone through.” So, she began to solicit personal narratives, collecting them on her Google Drive. The stories led her to launch The Layer this year, a publication dedicated to stories and art centered around mental health and well-being on campus.

Emerson’s own experience and the stories she collected are part of a much larger conversation surrounding mental health and mental illness on campus. Student groups that sprouted up in recent years have worked to make policies, raise awareness and decrease stigma around these issues. Campus publications at Yale, including the News, have extensively covered issues of mental health and illness among the student body, often with a focus on the stressors of campus life and critiques of the mental health system at Yale Mental Health & Counseling. The Yale administration has focused numerous efforts on mental health and well-being schoolwide, including the Yale Well campaign. “Psychology and the Good Life,” Silliman Head of College Laurie Santos’ immensely popular happiness class, was picked up by media outlets like The New York Times.

The conversation at Yale echoes the explosion of dialogue on the national level about mental health and mental illness on campus. And for good reason — experts agree that college students are seeking mental counseling at increasing rates. In its 2017 annual report, the Center for Collegiate Mental Health found increases in rates of anxiety and depression among college students — although rates of other mental illnesses were flat or decreasing. The numbers at Yale echo this trend: According to University spokesman Tom Conroy, over 50 percent of undergraduate students use Mental Health and Counseling services over their four years here. The rate of students seeking treatment rose 10 percent two years ago and 11 percent last year, with an expected increase of 15 percent this year.

In an email to the student body on Wednesday, Paul Genecin, the director of Yale Health, updated members of the Yale community on this increase in the numbers of students accessing mental health care. He noted that the numbers at Yale are reflective of a national trend and cited a decrease in stigma as part of the reason for the increased rates. He also informed students that Mental Health and Counseling will hire four new clinicians starting in the summer of 2018.

Students across the country are seeking treatment for mental health issues at higher rates. But experts say that this does not necessarily mean more students are suffering from mental illness than have in the past.

“There is a clear increase in prevalence rates of depression,” said Jutta Joormann, a clinical psychology professor at Yale. But Joormann said that a number of factors could explain the rise, including increased openness surrounding mental illness, more willingness on the part of students to seek mental health care and improvements in diagnostic implements.

Amy Alexander, co-chair of the American Psychiatric Association’s College Mental Health Caucus, said that in the past, someone with a severe or diagnosable mental illness may not have been able to attend college at all. In that way, the increase in usage of mental health resources on college campuses “might be a positive thing.” Alexander also said that people are, in general, seeking mental health treatment earlier than they have in the past, and that stigma surrounding mental illness, though still present, has lessened.

Dylan Gee, an assistant psychology professor at Yale who studies anxiety in children and adolescents, agreed that it can be hard to “disentangle” whether or not the increase in students seeking care for mental health issues stems from an increase in rates of mental illness or from other factors, like an increase in students’ willingness and ability to reach out for help.

“I think the jury’s kind of still out on that,” she said.

Further complicating the issue is the fact that the late teens and early twenties are sometimes ages at which young adults are diagnosed with mental illnesses for the first time, Alexander said. Gee, for example, studies interactions between the amygdala and the prefrontal cortex that take place during childhood and adolescence to try to understand why many anxiety disorders emerge during those periods of life.

“We know that frontolimbic circuitry that underlies anxiety undergoes dynamic changes across childhood and adolescence and that likely relates to why we see increased risk,” she said.

College is a time of transition. Students are adjusting to living away from their families for the first time, while juggling demanding workloads, social lives, and extracurriculars — all in an environment typically far less structured than their homes.

Emerson said though she had struggled with mental illness in high school, the coping mechanisms that she had in place, like relying on old friends and being an athlete, were “really thrown off” when she came to Yale. Numerous students interviewed for this article mentioned the same phenomenon, either from their own personal experiences or those of their friends.

When asked to describe Yale’s campus culture within the context of mental health, almost every student and administrator I spoke to mentioned the fast pace and sheer intensity of life here. They spoke of a wide-reaching pressure to excel which extended not only to academics, but also to extracurriculars, resume-building and social lives.

Max Sauberman ’18, a first-year counselor in Pauli Murray college, said that from the moment students step on campus, they are faced with a “laundry list” of things to do and get exposed to, though not necessarily in a negative way. Sauberman listed extracurriculars — in particular the infamous Extracurricular Bazaar — intense pressure to socialize with anyone and everyone, and a “constellation of advisors” —  FroCos, deans, heads of college — that students have to familiarize themselves with.

“The general perception is that everyone around you kind of already has it figured out,” Sauberman said, adding that he hopes to normalize the idea that for some students it takes time — even years — to identify their path at Yale.

Sita Strother ’20, who is an outreach coordinator for The Layer, mentioned the “sheer number of opportunities” at Yale as a source of stress for students. “That’s the wonderful thing about this school,” she said. “But it’s a blessing and a curse.”

Strother, who had recently suffered a concussion, said that at Yale, “there isn’t much room even to have physical health complications.” Strother noted the difficulty of making time to take care of herself. “I’ve been struggling with this concussion, which isn’t a mental health issue,” she said. “But, you know, similar to mental health it’s a debilitation … and as soon as one thing slips everything else cascades down, it’s like a domino effect.”

Summer Wu ’18, a Morse FroCo, mentioned a culture of busyness, in which students are rushing from place to place without taking time to check in with themselves. “I think it’s easy to start taking Yale for granted,” she said, adding that she had gone abroad during her sophomore year. “Grinding through this place for four years in a row is really, really tough.”

Head of Pierson College Stephen Davis said he has seen students “entrapped” by the expectations that they have set for themselves. He said the high expectations set at Yale sometimes create a situation in which “we don’t allow ourselves space to do the kind of work where we bump our heads up against ourselves, where we struggle.”

Jennifer Cha ’18, a FroCo in Branford, said she thought it was possible and acceptable to opt out of this aspect of Yale culture, particularly as an upperclassman. “If you’re not that type of person, I think over the four years, people’s true colors come out, and you see a greater variety in people that you interact with. I think that’s comforting.”

One aspect of this all-in culture is Yale’s image as a “happy” school. It is a narrative that most students said they recognized and one the administration certainly does not try to discourage. In a survey released this month by the News, almost 70 percent of 1,299 respondents — who made up about one-quarter of the undergraduate population — said that they were either “happy” or “extremely happy” at Yale. And overwhelmingly, students and administrators interviewed for this article said that the narrative of a happy Yale was based, at least partially, in reality.

Santos wrote in an email to the News that she thinks Yale is happier than “a lot” of other Ivy League schools. “That doesn’t mean our culture is perfect,” she wrote. “And I personally still think we need lots of improvement.”

Associate Vice President of Student Life Burgwell Howard similarly explained to the News that he believed Yale students were in fact happier than students at some of Yale’s peer institutions. He pointed toward the residential college system, and the support students receive from their deans and heads of college, as a potential reason for this difference. Howard also mentioned the extensive support available to students, often from their peers, including FroCos, Peer Liaisons, pre-orientation leaders, Walden Peer counselors and Communication and Consent Educators.

Davis agreed, saying that there was a “community mindedness” at Yale, fostered in part by the residential college system, “that is marked in comparison with other institutions.” At the same time, he said, Yale is not perfect. “There are times when we don’t fulfill our aspirations,” he said. “And times when we mess up and don’t get it right.”

But is this narrative of a happy Yale inherently at odds with the campus dialogue surrounding mental health and mental illness? Overwhelmingly, the students I spoke with said that the two narratives could coexist, but emphasized that the existence of the happy-Yale narrative puts added pressure on those who feel they are failing to match up to the ideal.

Emerson called the happy-Yale narrative a “double-edged sword.” When she spoke of her personal ordeal of dealing with mental illness her freshman year, she said she felt like she was the only person who was struggling.

When Jodie Foster ’85 accepted the Yale Undergraduates’ Lifetime Achievement Award in Battell Chapel Thursday, Yale College Council President Matt Guido ’19 asked her about her perspective on mental health issues at Yale and on college campuses in general. Foster, who also spoke of her own struggles with anxiety while at Yale, advised students to talk with others about what they were going through. Finding someone to share trying moments with, Foster said, “diffuses the part of depression that makes you feel so solitary.”

Sabrina Bustamante ’20, editor-in-chief of The Layer, said that she thought Yale students were “significantly happier” than students at other schools. At the same time, she said, buying into the narrative of the perpetually happy Yalie can be harmful. “I mean, the narrative is obviously a fallacy, because the problem with saying a place is perfect is that nothing is ever perfect.”

When asked, a number of students said that if there were any element of campus culture at Yale that was unique, it would be this pressure to be happy. “The problem here is that the culture of perfection and the culture of happiness kind of converge,” Bustamante said. “And it becomes a culture of be perfect and be happy, whereas I think at other schools there’s kind of this implicit assumption that yeah, you’ll work really hard and you’ll be perfect, but you don’t necessarily have to be happy.”

Though campus dialogue tends to conflate the two issues, some noted the differences between general mental health and well-being and diagnosable mental illness, two issues that are intimately intertwined. When determining what constitutes a diagnosable mental illness, mental health care providers typically look at the degree of interference with one’s life. Everyone experiences a certain degree of anxiety, for example, but someone whose anxiety begins to interrupt with the course of their daily routine may have a disorder.

That is not to say that diagnosable mental illnesses are uncommon — they are quite the opposite. According to Joormann, almost 50 percent of the general population will at some point during their lives fulfill the criteria for a disorder.

Bustamante spoke of what she called a “middle ground” — students who were not suffering from serious, diagnosable mental illness, but who nevertheless struggled with mental health or general well-being. Bustamante said that until recently, this “middle ground” had been ignored by campus dialogue. “Either you’re severely depressed or you’re perfect,” she characterized the narrative. “That isn’t what happens here.”

Sreeja Kodali ’18, co-president of Mind Matters, a mental health and advocacy group at Yale, said the group had made a deliberate shift over the last couple of years to focus more on mental illness destigmatization than mental wellness promotion. The decision was made, she said, keeping in mind the ecosystem of different mental health groups and initiatives on campus.

“We felt we could best supplement that by shining a light on mental illness,” Kodali added.

Arielle Baskin-Sommers, a Yale psychology professor, said it was “probably untrue” that all students who seek mental health services are suffering from a severe mental health disorder. But, she added, “You shouldn’t need an official diagnosis to need care,” noting that many colleges are forced to triage students when it comes to mental health services, putting those who are suffering from severe disorders first. “What does that mean for students who aren’t quite as severe yet?” she asked, adding that colleges could focus on adding a variety of different mental health resources for students. At Yale, she said, this could include a mental health counselor based in every residential college.

Much of the media coverage of mental health on college campuses has centered around elite institutions. The narrative often goes that students at these institutions are facing unique, intense pressures and are therefore more susceptible to mental illness. To a certain degree, this narrative resonates with some students and professors. Many mentioned imposter syndrome and the inherent competition that can come with being at a school full of high-achieving young adults. A number of students and experts mentioned the shock of someone who was a “shining star” in high school all of a sudden being placed somewhere where they are, for all intents and purposes, average.

Experts and students alike, though, are generally hesitant to say that the state of mental health on elite campuses is different in any significant way from the state of mental health at colleges nationwide.

“There may be factors about attending college at a place like Yale that could compound some of these stressors, but I think on the whole they’re likely to be more universal,” Gee said.

In 2017, researchers at Georgia Institute of Technology found evidence that may suggest the contrary. In a unique study involving the creation of a mental health index of over 100 schools using posts on those schools’ subpages on Reddit, the researchers found that students at elite institutions may be better off in terms of mental well-being than college students in general.

“We know it doesn’t align with some of the popular narrative,” said Munmun De Choudhury, who led the study. De Choudhury hypothesized that mental health issues might be more “expected” at highly ranked institutions, and that because of this, the topic might not come up as much in online conversation. Conversely, she said, another hypothesis is that there is more stigma surrounding mental health issues at elite institutions, which also might make students less likely to talk about them online.

The study found evidence that students who attend schools with higher tuition also do better on issues of mental wellness. This, De Choudhury said, is likely due to the fact that these students tend to be wealthier, and are thus are more likely to have a robust financial support system which can act as a buffer against mental health issues.

As more students reach out for campus mental health services, colleges across the country are struggling to keep up. A frequent critique of Yale Mental Health and Counseling has been the long wait times some students say they are faced with when they try to access a therapist. Students I spoke to at multiple schools said they or their friends have run into similar problems.

Sauberman said he had witnessed this phenomenon at Yale as a FroCo. “I hate having to say that to students,” he said, as he described telling his first years that they may face wait times of weeks before seeing a counselor.

Howard told the News that clinicians at Yale Health are “challenged” to keep up with rising demand. “This increased demand comes from both undergraduates and grad and professional schools, and unlike some other institutions, we try not to direct students to community providers as it is often more convenient for the students to remain on campus, and because our providers can give a great quality and continuity of care,” he wrote in an email.

“The unfortunate downside to all of this can be long wait times for students who are not in acute need for support — those students definitely receive the necessary treatment,” he added.

Matthew Flathers, a junior at Brown who is a co-coordinator of the university’s chapter of Project LETS, a mental illness advocacy group, said the challenge of long wait times is not a unique one. “A lot of colleges have really long wait times,” he said. “Or they have counseling services that are too small or not diverse enough.” Flathers added that many college mental health services are based on a short-term model, designed to take students in for a short period of time and then outsource them elsewhere.

Rylee Park, a sophomore at the University of Pennsylvania who is a co-coordinator of Project LETS there, echoed Flathers’ concerns. She said that Counseling and Psychological Services at Penn has a “bad reputation” among students because they have caps on the number of visits a student is allowed to have.

“The limit is something students are very aware of,” she said.

Jordan Singer, a junior at Columbia and a member of the student council’s Mental Health Task Force, said that in her work, she has learned that students who do not engage with university resources have a less favorable impression of them than those that do. Still, she said, “That’s not to say there isn’t room for improvement.”

Many of the Yale students I spoke with hesitated to criticize Mental Health and Counseling for fear of discouraging students from seeking help, although a critique many of them made was that the service was understaffed. Others emphasized that they had had positive experiences with the service.

“For me personally, I’ve only had really good experiences,” Emerson said, noting that Mental Health and Counseling had allowed her to meet regularly with both a psychologist and a psychiatrist, and that her treatment was never a “financial burden,” because Mental Health and Counseling is free for students. Strother, too, said that she had had positive experiences with Mental Health and Counseling. Because the event that led her to seek counseling was sudden and traumatic, she was able to see a therapist right away. However, she said, she had a friend who waited a month and a half to get an appointment after their initial evaluation.

The students I interviewed for this article spoke earnestly about destigmatizing mental illness and changing the ways in which mental health is talked about on campus. As a group, they seemed cautiously optimistic about the future of mental health at Yale, despite frustrations with campus culture and administrative policy. Many advocated for a less narrow view of what mental health and mental illness look like.

Sarah Naco ’18, a FroCo in Jonathan Edwards college, said it was important to acknowledge both the happiness that students feel at Yale and the challenges they face. “Perhaps people do generally feel happy here,” she said. “It’s important to also normalize struggles and mental illness as something that is not necessarily abnormal.”

Talia Soglin | talia.soglin@yale.edu