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Treating the Campus
When I first began working as a psychologist at a university counseling center in 1996, the conversation in the profession was focused on how more students than ever were seeking counseling center services on campuses across the country. Also true back then was the alarm that they were doing so with a greater severity of problems. 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 presenting problems.  

Perhaps, it is time to question the efficiency and efficacy of our approach. While it is painfully cliché to employ the adage that the definition of insanity is repeating the same thing over and over and expecting a different result, it’s particularly ironic that this cliché does seem to apply to addressing mental health on college campuses. 

To be sure, much of what occurs in there requires the years of training needed to address the complexities of trauma, the subtleties of identity development, and the intricacies of the healing and growing processes of college students. Also, there is no denying that many students do meet the criteria for various diagnoses related to Depression, Anxiety Disorders, Eating Disorders, addictions, and Psychotic Disorders. However, there are also many students receiving 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 these 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 they live in, the intersecting identities they carry, their thoughts, their emotions, and the memories and aspirations these students hold as they navigate through the challenges of their lives. In framing all of these in terms of psychological disorders, are we reducing the self-efficacy of other campus professionals (not to mention fellow students) to play a part in the healing and growing of our students toward mental health and overall thriving?  

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 with concepts to accompany “illness”, such as injury, wound, virus, infection, scrape and bruise, all with varying levels of severity, acuity and chronicity… 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. This dichotomy leaves the community feeling untrained to deal with anything that suggests that a student is not completely fine, where simply the shedding of tears results in a prompt referral to counseling services.
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. In doing so, we locate the overall challenge in a medical sphere that requires us to delegate the response to a small number of licensed mental health professionals on campus. That response then becomes mystified in a cloak of confidentiality, with colleagues across the campus and parents across the world being frustrated with the limited (if any) communication 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. This is largely because we continue to emphasize the need for specialized training while chanting confidentiality mantras, mystifying what happens in therapy sessions.
There are some pervasive norms and mindsets that inform how students enter colleges, move through their academic careers, and segue into the larger world that awaits them. There are repeated mantras on how to earn success, gain status, and navigate an increasingly competitive world.   In fact, there are increasing messages that emphasize a competitive world, forgetting the wisdom associated with one that relies more on collaboration and connection.  How often do we find ourselves and our clients bombarded with messages and norms that involve....

  • An over-emphasis on certainty and control?
  • The worship of the quantified?
  • The banishment of vulnerability?
  • The continued de-valuation of the Feminine (or anything that is not hyper-masculine)?
  • Perpetual distraction from the present?
  • Hurtful marginalization of Other?
  • Over-idealized and un-examined pursuit (or maintenance) of power and social status. 

There are two inevitable consequences of these permeating mindsets, both of which serve to fuel the mindsets in an increasing spiral: a lonely loss of nuance in students’ lives and a pervasive fear of an all-defining failure.  

While “afraid” and “lonely” are certainly appropriate topics for 50-minute weekly counseling sessions, they are also much easier for the lay public to also talk about than the various mental illness 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…just maybe, we can discover that we already have more of the needed resources on college campuses to address much of the challenges our students face. Through increased training across departments on college campuses or simply through a little moral courage, human beings on campus 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 paradigms may link to psychological disorders, and human beings can extend the caring and wisdom of the 50 minute hour into the students’ home: the college campus. 

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. 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, perhaps the condition of the fish will change because we’ve finally started treating the water. 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 study body. If this can happen, perhaps 20 years from now, counseling centers and mental health providers won’t still be reacting to a crisis that was, largely, self-sustaining...not to mention fulfilling the cliché adage that defines insanity.
Perhaps, it is time to shift away from the emphasis on individuals with diagnoses as a way of describing this crisis toward elaborating on the crisis facing society, often amplified on college campuses.

What if society has the psychological disorder? 
What if we began prioritize our efforts toward treating the community? 

What if we actually moved beyond educating the campus about mental illness and began to actually emphasize the ways we extend the therapy to the campus?