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When I first began working as a university psychologist in 1996, much of our professional conversation was focused on how more students than ever were seeking counseling center services on campuses across the country -- and how their problems were increasingly severe.
Throughout these 20 years, colleges and universities have increased staff at counseling centers, most have added some variation of “students of concern” monitoring teams and many have added case managers to help coordinate the various components of students’ academic and social lives while they are in treatment for a mental health problem.
Still, two decades later, the alarm bells are sounding louder than ever -- well beyond the professional spheres and into the public discourse. College mental health professionals cannot keep up with the ever-increasing demand for mental health services and the ever-increasing severity of problems that students are presenting. While many campuses across the country have already begun to include efforts aimed at the entire campus community, perhaps we need to shift the way we think about student struggle and mental health toward empowering community transformation.
Much of what occurs in a counseling session requires years of training to address the complexities of trauma, the subtleties of identity development and the intricacies of the healing and growing processes of college students. There is no denying that many students meet the criteria for various diagnoses related to depression, anxiety disorders, eating disorders, addictions and psychotic disorders. But many students also receive services for problems that their counselors would not characterize as mental illness. What happens in therapy is an exploration of the themes and narratives underlying those diagnoses, through assessment of students’ daily thoughts, behaviors, relationships, histories and the often-intense fluctuations of their emotions. Then, depending on the theoretical orientation of the therapist, those conversations lead to topics such as exploring the world that students live in, the intersecting identities they carry, their thoughts, their emotions and the memories and aspirations they hold as they navigate through the challenges of their lives.
In framing all of these challenges in terms of mental health issues, are we reducing the role that other campus professionals -- not to mention fellow students -- can play in our students’ healing and growth?
At issue isn’t simply another critique of the medical model. Rather, it’s a critique of the lack of nuance in the discussion about what our students are dealing with. Even the medical model, when applied to physical impairments, has more flexibility of language when it comes to defining “illness,” such as injury, wound, virus, infection, scrape and bruise -- all with varying levels of severity, acuity and chronicity, and with some not needing a medical professional’s attention. When it comes to mental health, however, the public dialogue seems to focus on the limiting dichotomy of health and illness, employing the all-or-nothing thinking that characterizes many of the psychological disorders that our students face. That dichotomy leaves the campus community feeling untrained to deal with anything that suggests that a student is not completely fine, when many students’ struggles are just about being scared or lonely.
The typical way of addressing mental health challenges on campuses continues to involve naming the problems in terms of diagnoses such as depression, anxiety disorders, eating disorders and various addictions. Doing so requires us to delegate the response to a small number of licensed mental health professionals at the institution. That response then becomes hidden in a cloak of confidentiality, with colleagues across the campus and parents around the world left frustrated by the limited communication -- if any -- from mental health professionals about the students everyone is worried about.
What has not made it into the national conversation about this problem is what actually happens in those therapy sessions. That is largely because we continue to emphasize the need for more clinicians with specialized training while chanting confidentiality mantras, mystifying what occurs in such sessions.
While fear and loneliness are certainly appropriate topics for 50-minute weekly counseling sessions, they are also much easier for the lay public to talk about than the various medical diagnoses that currently dominate our discussions about mental health. If we expand the conversation regarding these normal human experiences, with a greater emphasis on community and connection than on "mental health," then maybe we can discover that we already have more of the needed resources on college campuses to address many of the challenges our students face. Through increased training across departments at our colleges and universities, or simply through a little moral courage, people on our campuses can have intricate conversations to improve students’ lives -- emotionally, interpersonally and spiritually. It’s likely that, in organic ways, such conversations would lead to greater awareness about how some prevailing mind-sets may link to the stress and distress of our students.
These are the mind-sets that consistently emerge from students in counseling sessions and are readily recognized in various outreach programs by faculty, student affairs colleagues, parents and student leaders across various campus arenas. At the core of these mind-sets is a mentality of pursuing a vaguely defined success, fueled by a perpetual fear of failure. These mind-sets usually mandate a level of certainty and control that nobody can possess. They banish the vulnerability that everybody feels and promote a competitiveness that divides the world into winners and losers, privileging conformity to those who hold power and status while marginalizing those identified as other. In a constant flurry of such mind-sets, feeling lonely and scared is almost inevitable. And they are probably issues that virtually everyone at the institution can relate to, so caring conversations on how they impact all of us can extend at least some of the support and wisdom of a 50-minute therapy session into the broader campus community.
Like every initial session with a stranger in counseling sessions, there will be some awkwardness. Research shows, however, that it’s not the clinical approach of the therapist that determines the therapy outcome. Rather, it’s the quality of the therapeutic relationship, which usually begins with a little discomfort. If we can make more of these therapeutic relationships through the staff members of various identity centers on campus, leadership development offices, career development centers and academic advising arenas, it can help to change the campus culture. More of these themes and paradigms can be explored, intentionally and organically, with student affairs deans, religious life staff and clergy, faculty mentors, and residence life staff, not to mention the already naturally gifted listeners in the student body. By trying to get these conversations to happen in the community, it spreads organically without the stigma of a mental health issue.
For example, in the mid-2000s, Duke University’s counseling center worked to combat a success mind-set of “effortless perfection” that resulted in a lot of loneliness not shared outside of therapy sessions. After some initial consultation, another department created the Duke Authenticity Project. In addition, persistent efforts toward challenging the taboo on vulnerability led to a Me Too campaign aimed at reducing loneliness. The campaign had some independent spin-off efforts from different student groups, including the Me Too Monologues, launching dramatized performances of student struggles, and the campus student film organization, which created a short film to support the messaging of that original campaign. Similar outreach to graduate students led to the organization of a community of support that addressed graduate student struggles: GradConvos.
At Oxford College of Emory University, similar approaches resulted in Hearing Voices, a theater performance, now in its second year of portraying student struggles in human rather than clinical terms, and talk-backs that engage the students in conversation with each other on their common struggles. Several years ago, the University of Connecticut’s counseling center aimed efforts toward promoting “connection” and introduced the UConn Swing Journal, which has grown to include engagement from all areas of the university community.
More recently, at Oxford, we’ve been combating various nuances of loneliness by addressing some social norms and campus mind-sets related to competitiveness and “the overglorification of busy.” This effort involves various campus life partners, the chaplain’s office and academic affairs staff. It also includes faculty members who can engage students in scholarly inquiry as well as personal reflection on loneliness, authenticity and stress in various contexts.
Another dimension of this includes repetitive messages that address fear and loneliness by highlighting a particular notion of self-care, one that is contextualized in a competitive setting. The aim is to prompt the campus community, especially students, to deconstruct the pervasive mind-sets that can negatively impact their daily experience and move toward bringing about change, as a community. The Student Government Association now plans to develop efforts of their own that align with these messages, and the Center for Healthful Living at the college also recently introduced a “Collaboration Over Competition” mind-set program.
The construct of “mental health” is certainly useful and necessary. But it may be that we have much to gain from also considering the mentality of a community in our conversation about the mental health of the individual. If this can happen, perhaps 20 years from now, instead of talking about how overloaded campus counseling centers are, we’ll be talking about how therapeutic campuses and supportive communities can deepen the benefits of a high-quality education, as colleges and universities deepen their missions to enhance the world we all live in.