It begins with a form. There are several, all different colors. On the back of the yellow one, two columns of text sidle up to neat boxes: “Check all that apply.” Stress, depression, anxiety, insomnia, sexual assault, relationship troubles, and loneliness are just a few of the options.
Faced with identifying the common threads in your own thought process, you ink in the appropriate boxes and fill out the rest of your information while classical music plays in the background and a water feature quietly trickles in the corner. Every so often, you nervously scan the faces of those around you. Some of them are filling out the same forms on identical clipboards, while others distract themselves with a book or a phone, veterans of the system.
That’s what an initial visit to Georgetown’s Counseling and Psychiatric Services is like. On the outside, such a visit may appear trivial or commonplace, no different from the typical routine for a doctor’s appointment—but the decision to seek out CAPS at all can be monumental. To those affected, recognizing and addressing a mental health problem carries far greater weight than does of a physical disorder, since the stigma surrounding mental health is so deeply entrenched in our society.
“The mind is you, so to say that you are diseased is a very different thing from saying that the body that your mind and soul inhabit is diseased,” said Jack*, a junior in the College.
That kind of inextricable relationship between mental illness and the mind that it infiltrates—that place where personality, fear, and desire reside—takes part in breeding the common misconception that such problems constitute a fundamental flaw that can be attributed to personal shortcomings. It’s an attitude that forces the issue under the table, isolating the students who deal with these problems.
“If you’re seeing a mental health professional, there is an otherness attached,” said Jack, who has been going to CAPS since freshman year. “The strangest moments were when I saw people I knew and recognized.”
Amy*, a junior in the College, echoed a similar sentiment.
“It’s not that you look down upon people that go to CAPS, but you kind of whisper about it and judge them a little bit,” she said. “I don’t want to go to CAPS and see people I know there.”
Though she has never been diagnosed or sought treatment, Amy believes she has Obsessive Compulsive Disorder, a serious condition that is often misunderstood and trivialized. Stereotypically associated with obsessive cleanliness or idiosyncratic habits like an inability to touch the cracks in the sidewalk, OCD can also be characterized by intrusive thoughts of violence or sex. Such is the case for Amy, who fights such invasions daily.
“I always struggled with the thoughts because I never understood where they came from or what it meant to have them,” she said. “I’d be waiting for the metro and thinking of pushing someone onto the tracks. I’d never do that, but why would I think it if I weren’t capable of it?”
Amy’s choice not to seek out CAPS for help with OCD stems from her relationship with the disorder. Constantly battling for control over her own thoughts, she prefers to tackle them on her own rather than seek professional help.
“I’ve gotten into this habit of making everything look good from the outside, so no one knows I have OCD. Going to CAPS would mean admitting that it’s an actual issue. I’m convincing myself that I can handle it on my own,” she said.
Speaking to Amy, I would never have been able to suspect otherwise. She’s open and animated, frequently smiling as she describes all that’s going on beneath the surface, including thoughts of suicide. As I wonder at the distinction between these outer and inner selves, I remember my senior year of high school, when my best friend, who also has OCD, attempted suicide and spent a week in a mental hospital. I did not find out until months later. Snapping back to Amy in front of me, who has stopped talking, I turn to my notes and continue. Does the mythology surrounding mental health make it more difficult to speak up about these issues?
“In my experience, when people talk about mental health, they talk about depression, and people are conditioned to think that depression is one of the most serious mental health issues,” she said. “When I’ve told people I’ve had issues with OCD, they laugh it off.”
According to last year’s National Alliance on Mental Illness survey of college students, 27 percent of respondents reported problems with depression, 24 percent with bipolar disorder, and 12 percent with various disorders like OCD and autism. The rest of the spectrum included anxiety, schizophrenia, PTSD, ADHD, and substance abuse. 36 percent of respondents said that social stigma was the greatest barrier to accessing mental health services and support. In many ways, Georgetown’s high-achieving culture bolsters this stigma.
“We like to look like we’re the perfect candidates for everything—a job, an internship, a marriage,” Amy said. “Admitting that you struggle with mental health issues means admitting that you’re not the perfect candidate, and that makes you look weaker.”
In October, CAPS was awarded the JedCampus Seal by the Jed Foundation, a nonprofit organization “working to promote emotional health and prevent suicide among college students.” CAPS was received the award after completing a self-assessment on multiple criteria, including “increasing help-seeking behavior,” “developing life skills and promoting social networks,” and “educating gatekeepers on campus.”
Every year, roughly 10 percent of students go to CAPS for help, according to Phil Meilman, the center’s director, while 25 percent will seek out these services over the course of their college careers.
“We provided over 10,000 visits to more than 1,600 students last year, not including the number of students we reached through our outreach efforts,” Meilman wrote in an email to the Voice. “The number of students to whom we provide clinical service, the number of sessions, and the number of people reached through our outreach efforts have grown substantially in the last eight years.” For Jack, that kind of growth in demand shows in recognizable ways.
“The waiting room seems to be a lot fuller these days,” he said. “The vibe I get is that they’re at capacity.”
During the second semester of his sophomore year, Jack went on a leave of absence after suffering from depression and having problems with classes. Diagnosed with Generalized Anxiety Disorder, he also deals with anxiety-related compulsions like repetitively pulling out his hair.
Speaking in a crowded Starbucks, he rhythmically taps his leg. I do not notice this until later in our conversation, when he points it out to me.
“Issues of mental health always crop up during times of great stress, and the recession is a perfect example,” he said. “The resources for coping go down because the money isn’t as flush, but the need goes up just as supply gets harder to deal with.”
Under CAPS’s current protocol, every student is allowed three sessions before having to pay. With Student Health Insurance, $10 co-payments are required for weekly services. Jack noted how he wouldn’t have been able to get adequate treatment without the coverage provided by the Affordable Care Act.
Moreover, the Obama administration announced new regulations that would require health insurance providers to recognize full parity between benefits and treatment for both mental and physical health issues.
The challenges most students have found with CAPS, however, have little to do with money and everything to do with a more verbal form of exchange.
It was almost two years after first experiencing symptoms of depression that Joe Donovan (SFS ’13) came to CAPS. Unable to recognize the illness in himself at first, he saw it as a personal failing that he needed to overcome by simply working harder.
“Half of me was saying that this is a serious thing you need to pay attention to and other half said, no, this is self-pity,” he said. “There is no trauma that has happened and no terrible thing that you’ve been through, so you need to suck it up.”
At his lowest points, Donovan was unable to muster the energy necessary to complete the smallest tasks, much less seek out the necessary help.
“The first thing that depression takes away is the ability to reach out,” he said. “It takes away the energy and ability to do what you need.”
When he finally did go to CAPS, however, he was met with a disheartening reception. Because he could not point to a specific event or cause of his illness, Donovan’s therapist was confused about why he was feeling depressed.
Lydia Brown (COL ’15), a disability rights activist, noted that this is a common experience for students with less prevalent disorders than depression, including mental disorders such as autism. “CAPS is not equipped to be responsive to a broad range of services,” she said. “There is a lack of welcoming reception and knowledge about many different disorders, which can be detrimental to the point of forcing some students to leave.”
Based on her own experiences and those of others she knows, Brown concludes that the treatment style of CAPS is inflexible and medicalized rather than tailored to fit the individual patient’s needs, as she believes it should be.
“Mental health services need to be person-centered, so that they’re less about trying to fix you and more about finding ways to support you,” she said.
Bill*, an autistic Ph.D student in the History Department I interviewed in connection with Brown, was denied treatment from CAPS altogether. After going to them to refill his medical prescriptions, he was referred to the Student Health Center, which then sent Bill back to CAPS.
“I was told, ‘We don’t deal with autism disorders,’” Bill said. “It is emotionally exhausting to be tossed around like that, and I came to the conclusion that any future dealings with CAPS would be bad for my mental health.”
Like Bill, Jack also experienced problems in dealings between CAPS and other on-campus institutions. On the tail-end of his leave of absence last summer, he was led to believe that he could come back to campus, but his dean, who declined to comment, had a different notion of what requirements he needed to meet in order to return. Jack ended up having to write a 1,000-word petition to return to Georgetown.
“There need to be more open lines of communication and a more efficient, transparent relationship between academic issues, administrative issues, and mental health,” he said. “If you don’t foster that kind of communication, you are left wondering.”
In addition, Jack emphasized the need for helping students to navigate the various mental health resources available to them.
“Yes, we should fight the stigma, but in the meantime, make sure people know what options are available to them and help people navigate those options. There are so many ways of dealing with it that if you don’t know how, you’re going to have trouble. [Finding support] was more difficult than it had to be.”
The conversation about mental health on campus, though rarely occurring around dinner tables at Leo’s, has been extended to the classroom through the Engelhard Project, which was started in 2005 to integrate health and wellness topics into the curriculum.
Emphasizing the importance of providing these resources in a setting where students can become informed about mental health issues behind the veil of anonymity, Engelhard Fellow and Biology Professor Maria Donoghue said that the greatest barrier to giving students the resources they need is the fear that they will be judged for seeking them out.
“We need to convince students that admitting that they have a problem can benefit them in the long run. How do we persuade students that seeking help can make them whole, and that they can still be loved?” she asked.
In the past few weeks, Georgetown University Student Association has been looking into ways to decrease that stigma by increasing outreach efforts on behalf of CAPS. According to Ken Nunnenkamp (MSB ’16), co-chair of GUSA’s Intellectual Health Committee, and Bridget Morton (MSB ’16), the committee’s CAPS liaison, they plan to use their positions as student leaders to make these resources more normalized.
“Students tend to listen to other students, so having students publicize these services can help break down any remaining barriers,” Nunnenkamp said. For Donovan, however, the most powerful remedy of all can be found in a group setting. Though conceding on the necessity of therapy, he advocates a more empathetic, community-based form of support.
“Therapy is incredibly important, but it’s also one-directional. The most meaningful thing for me has been making connections on a personal level—mutual vulnerability is important to not get trapped in negative patterns of thought.”
When asked what institutional change would best improve the culture surrounding mental health on campus, Donovan said that a similar approach on a broader, university-wide level would be most effective.
\“For Georgetown to make meaningful strides in this area, there needs to be a space created where it can be okay to share,” he said. “We have a shared responsibility to shift the culture so it’s not the people that are struggling that have to be self-advocates, because they have to carry too much of a weight as it is.”
Sitting in the corner of Sellinger, he gestures around the crowded room to demonstrate the significant likelihood that someone around us is dealing with mental illness. It’s a common observation, but one that’s difficult to understand beyond an intellectual level. On his sweatshirt, golden letters spell out a familiar adage: “Not all who wander are lost.” I wonder if he wore it with a purpose in mind.
* – Indicates a name has been changed.
It’s hearbreaking to me that the young woman with OCD won’t seek help. My son developed OCD so severe (while in college) that he could not even eat. With the right therapy (a type of Cognitive Behavioral Therapy known as Exposure and Response Prevention therapy) he reclaimed his life, graduated college, and is now living life to the fullest. OCD, no matter how severe, is treatable, and I talk about anything and everything to do with the disorder on my blog at: http://www.ocdtalk.wordpress.com.
My son has been diagnosed with schizoaffective disorder, ADD and auditory processing disability…..he refuses to take meds…..he can’t stay with them long enough to get them tweaked at the right dosage.. the hurtful judgment that goes on within a family (siblings who don’t understand) is very painful. It breaks my heart to see him so unhappy. We have applied for Medicaid and are waiting the long waiting game to get approved. He is suffering and I’m going under caring for him. It’s affecting my health to a great degree….but I will not put him on the street. Afterall, it’s not his