Coming of Age on Zoloft (31 page)

I wondered whether these stories were true. What role did medication play on campus now, and what did students’ attitudes toward it augur for the future? College, of course, isn’t the only environment where young people use medication; it takes place in high schools and middle schools, and among young adults who don’t attend college as well as those who do. But college remains one of the places where medication use is most concentrated and visible. There is a grain of truth to the idea that the affluent families who aspire to send their kids to private colleges are especially enthusiastic consumers of psychiatric ser-vices. For me, the question possessed the lure of returning to a once-familiar place to see what had changed in my absence. I decided to investigate how people more than ten years younger than I am think and feel about medication by visiting a college whose size and orientation reminded me a little bit of my own.

MADRIANNE WONG IS
a senior at Swarthmore College in Swarthmore, Pennsylvania, a small commuter town about half an hour from Philadelphia. I met up with her one afternoon in the campus library, a structure whose wood and stone interior reminded me a little of Frank Lloyd Wright’s prairie architecture. We located each other by text message, and she came and joined me in a comfortable newspaper reading room. She greeted me warmly, said she had just come back from a run, and then sank into the armchair opposite mine. Her black skirt, torn black tights, and chunky asymmetrical haircut provided a pleasantly punky counterpoint to her instantly friendly demeanor.

Madrianne was the codirector of a campus group that offers free peer counseling to students. I found her through an article that she and her fellow director, junior Jessica Schleider, had published in the
Daily Gazette
, Swarthmore’s online newspaper. Madrianne and Jessica believe that mental health issues are a growing problem on campus. They think that these problems are exacerbated by stress and academic pressure. But they also blame what they describe as a pervasive ethic of self-presentation on campus—in their article they call it a “culture of silence”—which demands that students appear not to have any problems at all. “There’s an ideal of having everything together,” Madrianne elaborated for me. “And everything encompasses not just academics; it’s also social life; it’s also, at least here, social activism, and it’s also about looking good.”

Students do feel comfortable talking about stress, Madrianne said, but only in a heroic mode—it’s okay to complain about how much work you have to do, if it’s in the context of describing how you were able to pull everything off at the last minute. Other negative feelings don’t get talked about at all. “Being at Swarthmore,” she said, “there’s just this expectation of mental strength and resilience.” It’s an expectation that makes students loath to admit to any vulnerabilities, insecurities, or bona fide mental problems, even with close friends. “If you’re here,” said Madrianne, “you must perform—otherwise, there’s this running joke about who the admissions mistake is.” She and Jessica blame the “culture of silence” at Swarthmore for making students’ mental problems worse. “At some point or another,” they wrote in their
Daily Gazette
article, “all Swatties face issues, large and small. We can’t sleep; we fight with roommates; we break up and are broken up with. We worry for troubled friends. We feel overwhelmed, inadequate, or misunderstood; we experience depression, anxiety, and eating disorders. Most dangerously, we fear being judged for our struggling . . . as a result, we don’t share, and we feel alone.”
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Madrianne and Jessica weren’t the first to point out a campus taboo against seeming anything short of perfect. In fact, they borrowed the phrase “culture of silence” from an article penned earlier that year by a Yale senior named Julia Lurie. In her piece, Lurie described Yale as a place in which mental problems were both ubiquitous and undiscussed. She wrote of laboring to turn herself into the Yale ideal, someone not just academically on top of things, but also popular, socially engaged, worldly, ambitious, involved in interesting and unique extracurriculars. Outwardly she had succeeded in transforming herself into the multipotent model student; she was the type of girl who “makes intelligent-sounding comments in seminar and the professor nods, but you can see she’s checking her e-mail—you wonder how she’s following the conversation.” How surprised her classmates would be, she confessed, if they could see the other Julia Lurie, the one who was anything but effortless, the girl who “takes her Zoloft and a sleeping pill” each night, then “writhes in hot, silent tears, white-knuckled, feeling like she could scream.”
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The larger point of Lurie’s piece was that emotional hypocrisy was endemic on campus: we all know nobody’s perfect, but at Yale, no one will admit that they’re not. As a result, people suffer in silence. She closed the article with a call for increased honesty and greater mental health awareness on campus.

Joseph Davis is a sociology professor at the University of Virginia. For several years he has been conducting a study of undergraduates’ attitudes toward antidepressants and ADHD medications, interviewing dozens of students indepth about their use of these drugs. In his research, Davis has noticed a pattern similar to the one that Madrianne Wong and Julia Lurie describe, in which undergraduates at elite schools spoke of a need to seem “flawless.” He talked to student after student who described feeling an urgent need to live up to their “full potential,” a state that those students often conceived of in confusingly nebulous terms.
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The students told Davis that they did not feel comfortable confiding their doubts and anxieties to their friends. Unsurprisingly, many of them were unaware that other students also experienced performance anxiety or felt dissatisfied with themselves.

Davis uses the term “the achieving self” to describe the ideal to which these students strive.
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The achieving self possesses a number of impressive qualities that are hard enough to attain on their own, and sometimes actually contradict one another. “While proactive, aggressive, and impressive,” he writes, “this self is also easy-going, nondefensive, flexible, resilient, and resourceful.”
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Davis believes that some students use psychiatric medication partly in an attempt to conform to the demands of the achieving self, including its prohibition against the expression of negative feelings including “discouragement and loneliness, nervousness and insecurity, jealousy and emotional vulnerability, shame and humiliation, regret and self-blame.”
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A Swarthmore student named Michelle, who uses antidepressants, put the same thought to me in a different way. When I asked her whether she felt that there was a stigma on campus attached to taking medication, she replied, “I don’t feel like the stigma is necessarily against the drug aspect of it. The stigma is just against feeling bad. Because if you’re on drugs, but you seem to be totally fine, then whatever. My roommate is also on a medication for anxiety, and we talk about it very cavalierly—like, ‘Oh yeah, I’m going to take my meds now; I’ll go crazy if I don’t, ha ha.’ It’s just kind of tossed around. And I’ve heard that happening with other people too, not just my close friends. So there definitely is a pressure to sort of be perfectly competent in everything, but it has a weird relationship with the antidepressant aspect of it.”

Madrianne, Jessica, Julia Lurie, and Joseph Davis all describe a world in which medications are thought of not necessarily as treating well-defined mental illnesses, but are seen as a way of easing pressure and of saving face in a public environment that demands a smooth self-presentation. Jessica Schleider told me that she believes a lot of people take medication almost prophylactically, to ensure that they’re able to perform up to their own highest standards. “The way [medications] are seen on campus is like, ‘If I’m taking them, then I’ll be fine,’ ” she said. “ ‘Now I’ll be on top of things. Now I’ll have no excuse.’ ”

Though students don’t often talk to one another about their vulnerabilities, Madrianne and Jessica gain a unique vantage point through their work as peer counselors. Madrianne told me that students often say they’re confused about whether any given feeling they’re having is a sign of illness, and whether or not they need or would benefit from medication. In a world where everyone else puts on a perfect face, it’s difficult or impossible to know when your own bad feelings cross over the line from normal to abnormal. “People are always wondering whether they’re experiencing something they shouldn’t be,” she said, “or if the way they are feeling is wrong.” She told me that one of the questions students ask her most frequently is whether or not they should go to counseling ser-vices and “get a label”—be diagnosed and possibly get a prescription for the problem. Jessica also noted that she’s observed students feeling unsure about diagnosis and medication. “Nobody sleeps in college, right?” she said. “Everyone’s stressed-out. Everyone gets sad. And everyone knows that drugs are an option. So it’s just confusing to people. Like, ‘Should I really pursue this? Am I sick enough for this? Am I sick at all? Is this really what sick is?’”

MANY OF THE
students who wonder whether or not they need a mental health diagnosis end up in the office of David Ramirez, director of Swarthmore’s Counseling and Psychological Ser-vices, or CAPS. I met Ramirez in the building that houses the counseling center, a large stone cottage with a peaked roof; his office was spacious but cluttered with a pleasantly random assortment of institutional upholstered furniture. Ramirez, who has been the director of CAPS for seventeen years, has short black hair that is flecked with a little gray. He wore two-tone plastic glasses, a fleece vest, and black hiking boots; before he worked in college mental health, he told me, he used to lead outdoor trips for emotionally disturbed middle school students. It was spring break, the first time all semester that Ramirez had had a free moment: CAPS, for reasons he didn’t completely understand, had been overwhelmed for months. “It’s freaky, actually,” he said.

I asked Ramirez whether there’d really been an upsurge in the amount of mental illness on campus, and he said there had. “There’s no doubt about that,” he said. “It’s a cultural phenomenon.” The college years have always been a period when a number of mental illnesses often manifest for the first time; it’s a classic age for the first psychotic breaks of schizophrenia or bipolar disorder. But Ramirez believes that serious issues are truly on the rise: “The number of people and the intensity of problems have both increased over time,” he said. Past suicide attempts, he told me, are a gauge; over the years, he’s seen more and more students who made previous attempts on their own lives, as high school, middle school, or even elementary school students. Some experts believe that at least part of the perceived increase in mental illness on college campuses is due to a hopeful trend—a product of the fact that more vigorous treatment has meant that kids who once might not have been able to go away to college can now leave home and attend the school of their choice.

Like other college mental health center directors I spoke to, Ramirez also agreed that academic stress has increased over time. Madrianne and a couple of other students had already told me stories about how little they sleep—a seemingly even-keeled senior averred that he made it through his first three years at Swarthmore on about four hours a night—and Ramirez added that if he could make one intervention on campus to better the mental health of all, he’d choose improved “sleep hygiene” in a heartbeat. Gary Margolis, who has headed the counseling center at Middlebury College for thirty-eight years, said he’d absolutely watched the demands on the quality and quantity of student academic work and extracurricular engagement increase during his career. Nor have the changes been confined to elite institutions. A school counselor at a tier-two regional university told me much the same thing. “There does seem to be a lot more pressure than there was even when I was in school [ten to fifteen years ago],” she said. “It feels like the rat race has sped up.”

While he acknowledges the stress that students are under, Ramirez cautioned that it would be a mistake to make a simple equation between increased pressure on campus and increased mental illness. Stress doesn’t cause serious mental disorder, and removing a mentally ill person from a stressful environment won’t make their illness go away. That said, Ramirez believes that stress exacerbates mental health problems on campus, intensifying the distress that students do feel, and influencing the kind of help that they decide to seek.

For one thing, he noted, stress contributes to a pervasive feeling of urgency, so that students who feel bad are in an extreme hurry to feel better. This can mean that students who come to CAPS feel motivated to get a prescription for a medication, because they perceive it as the fastest way to recover. Other counseling center directors I talked to noted the same shift. “When a student’s upset, they’re upset in the moment,” said Vivien Chan, chief of mental health ser-vices at U.C. Irvine. “It’s very dissatisfying to tell a student to come back tomorrow, or wait two weeks. Because two weeks to a college student, that’s a lifetime.” Gary Margolis of Middlebury added that “students come to counseling expecting that something quick is going to happen that’s going to change how they feel.” He said that a preference for medication over counseling is often conditioned by the fact that students don’t feel like they can afford the loss of engagement from their work or activities that might occur while they wait for talk therapy to make a difference. Taking time to process feelings has come to seem like a quaint notion, an indulgence as outdated as nine hours of sleep or a just-for-fun elective. Even Madrianne, who does not use antidepressants and feels ambivalent about diagnostic labeling, snorted at the labor-intensive approach that campus counseling centers were once known for. “The amount of time you spend in counseling—who has that much time?” she said. “Finding an hour to have lunch with someone, it’s—I mean, there’s a bunch of points against getting help that isn’t a quick fix.”