You do not become schizophrenic overnight. When I began to hear voices, I told myself that it was some peculiar coping mechanism that was benign and would soon go away. Around the same time I had been in an accident, was dealing with a family crisis, and as a corollary was off-and-on homeless for a few weeks. Such occurrences would make anyone momentarily mad, right? This is what I told the social worker the first time I went to Harvard University Health Services. I was depressed: These were odd shock symptoms that would heal and fade away like bruises. We never talked about the voices. It was a topic that terrified me, and she was no more eager to ask me about them. She encouraged me to drink chamomile tea and to practice breathing exercises to cope with stress.
I knew I needed more help than tea, but as a poor, financially independent student from a poor family, my options were limited. I was lucky to enroll in a research study that gave me psychotherapy in exchange for serving as guinea pig for new social workers. By October 2012, I was seeing a therapist at least three times a week and sleeping the rest of the time to hide from the voices, which were getting worse and handicapping my ability to listen to my own stream of consciousness. Have you ever tried writing a paper when roommates are having a loud conversation? Now imagine they are screaming at you. This is how I feel every day. I experienced other symptoms I did not expect, such as forgetting words, and instead of my once photographic memory, I often cannot remember in the evening what I did in the morning.
December came, and with it, exams and final papers. I had to pull endless all-nighters to complete the work I had missed, and forsaking sleep meant that I was abandoning the only effective refuge I had from my screaming demons. I survived by the compassion of my roommates, who made sure I was eating and would hold and soothe me when things became unbearable. After exams, I was supposed to start antipsychotics. I was surprised to find out that my insurance company would not cover the drug, which cost $850 a month. I successfully petitioned to have the drug partially covered by insurance; still, $650 a month.
Even on full financial aid, I work two jobs to pay for my education, and there is no money to spare. I wrote to my financial aid officer, and he still has not responded. I made an appointment with the patient advocate, but because I am not on Harvard’s student insurance plan, nothing could be done. My resident dean could apply for a special fund, but only after my financial aid officer officially refuses my petition.
Two months have passed. What can I do? My resident dean, academic advisor, and psychiatrist strongly encourage me to take the semester off. I want to, but my family situation makes living at home a non-option. Where else can I go? I am too sick regularly to be in class; how can I hold a job? I decided to stay as I fight for treatment. Harvard may not be willing to pay for treatment, but at least as a student I hope that they are too afraid of bad publicity to let me die should I need hospitalization. At least here I have food and housing through financial aid. As a student on leave, I would have no such reluctant advocate. I am lucky to have enrolled in a trial that pays for a month’s treatment, but I have no idea from where the money will come next month. I just know that I would not have survived the last month without treatment.
What they never tell you about schizophrenia is that you never really believe it, internalize it, identify with it. Mornings are agonizing because every day in the haze of waking up I briefly remember all over again who I am and what I have lost. I remember the friends that I am terrified will see me differently if I tell them; I remember that on my bad days I scare people in class and on the subway; I remember that the academic career for which I had worked is now improbable. I remember that the measure of success for too many of my days will be that I have not killed myself.
So Harvard, friends, peers, anyone who might be reading this: I am asking you to advocate for me and the other statistically 70 or so students here who are struggling with schizophrenia or other acute illnesses. The average age of onset for schizophrenia is 18 for men and 25 for women, meaning that it often occurs during college. Most of you who are reading this assume that Harvard provides some end-of-the-line safety net for poor students in such calamitous circumstances and that Harvard would never let a student fail, drop out, or not receive medical care for lack of money. I write to assure you that there is no end in sight to the falling. I can apply for $5,000 to study bat droppings over the summer, but there is no application to pay for the treatment that enables me to function. Dear Harvard College Research Program, will you finance an application for me to study the effect of treatment on the schizophrenic brain? I know just the test subject.
Scientists have not yet decoded the medical and psychiatric workings of schizophrenia, but there are a few obvious reforms Harvard could implement that would allow students like me to have the support and treatment we need to succeed and survive. These policy changes need to be implemented transparently: Currently, most leave of absence and mental health policy is nebulous, unofficial, unpublished, and only policy-as-practiced through the decisions of the Administrative Board.
First, Harvard should guarantee that anyone who seeks treatment be able to see a therapist within a week, and if desired, to see a therapist on a weekly basis. Currently wait times can be as long as a month, and anecdotal evidence from friends and a conversation with a Harvard therapist suggest that they are pressured to cap the number of appointments covered by Harvard insurance. While Harvard has taken steps forward in covering up to 24 visits to outside providers, Harvard can continue this progress by hiring enough therapists at HUHS to meet student need and covering as many outside visits as are recommended by the therapist.
Second, Harvard should abolish the present oft-coerced leave of absence imposed on students who admit themselves to the infirmary. Students who decide to go on leave are often unaware that in order to return, they must prove that they have held a job or internship and that they have been seeking treatment. The burden of this policy falls brutally on students from poor backgrounds, students lacking robust health insurance, and students with unstable family situations. Ironically, these are the very students who are more likely to have experienced trauma.
This policy typifies the hostility with which mental illness is treated by the Harvard administration. The administration is pursuing what can—despite the University’s belief to the contrary—only be described as punitive courses of action that do not take into consideration the wellbeing of students. If your financial situation is such that Harvard is your only hope for treatment, your options are to seek immediate help and forego longer-term treatment or to try to fight through the darkest nights in hopes that maybe things will get better. I have lost too many friends at Harvard who did not survive that fight. An alternative option would be to implement a program for students on financial aid: Give us housing, allow us to stay with the therapists who know us best, and finance the program through a combination of grants, subsidized loans, and a work program.
Third, the administration should guarantee reasonable turnaround times for decisions from the Financial Aid Office in emergency situations, institute a reasonable cap on health spending in a given year, and provide grants for any additional amount for students on financial aid. Need-blind financial aid allows me to attend Harvard regardless of my financial situation; it should also allow me to stay regardless of a treatable medical condition.
In a recent letter, Dean of the College Evelynn M. Hammonds encouraged students to “not suffer in silence. We are here to support you.” I was not silent: I sought and was refused help. I am asking you to join me in a loud appeal to the administration for quality mental health support. If there really is such a thing as a Harvard community, then our shared resources should be allocated according to our values. If Harvard is willing to cut hot breakfast to restructure its budget, then surely mental health is important enough for us to demand adequate resources and to implement serious and necessary reforms.
This is not crazy talk, but I am mad. We can do better.
—The writer can be reached at firstname.lastname@example.org.
Editors’ Note: We made the decision to run this op-ed anonymously due to the private and intensely personal nature of its content. It is our hope that this piece will bring to light issues that affect many members of our community and inform campus-wide conversations on mental health and health services at Harvard.
—Marina N. Bolotnikova and Michael F. Cotter, Editorial Chairs
—Robert S. Samuels, President