It’s Saturday—one of those brutally cold days in January—and Emily M. Thompson ’18 does not feel like getting out of bed.
Thompson has not wanted to pull off her comforter to brave the chill outside for a week. She hasn’t showered in a while either, staying curled in gray sweatpants with “Harvard” painted in crimson down one leg; her long blonde hair is oily. And she’s been crying. Crying for hours every day, tears streaming down her cheeks at an impossible rate.
She manages to sleep only a couple of hours a night, passing time listening to her mom breathing through the phone—a literal lifeline. It’s Thompson’s insurance that she won’t do anything “dumb.”
This particular Saturday, her roommate finds her in their Canaday bathroom leaning over the sink. In the throes of hysteria, Thompson doesn’t recall much about their interaction, but she knows one thing: This is the moment she cracked.
“Emily, you need to go to UHS now.”
Thompson’s fingers have already flicked through the web pages listing Harvard’s mental health resources. She has set up a preliminary phone call with Harvard University Health Services, but it’s still a couple days away. Thompson, who was known as “Smiley Emily” in what now seems like a past life, looks at her roommate, ready to resist.
“I got myself into Harvard,” Thompson remembers thinking. “I can make myself happy.”
Turns out, it’s not that simple.
Thompson’s experience is not an isolated incident. Students across the College struggle under the surface, often silently. Taylor G. Ladd ’18 has a family history of depression, but she did not experience it—the loneliness, the melancholy, the disinterest—until she arrived on campus.
“The competitive nature of the school made me think that I wasn’t doing enough, and wasn’t involved in enough, and wasn’t achieving enough, and wasn’t getting high enough grades,” Ladd says. “All that kind of wore on me, and my mental state deteriorated over time. … I felt like I was the only one for a while.”
“Things sometimes just cause a little break, or a little crack in the armor, that can magnify and just sort of build up,” Barann says.
And then there’s Anna, a bubbly sophomore with bouncy brown curls, who asked to be identified by only her first name because she does not want to be publicly associated with her illness. She felt the social pressures of Harvard kick in when she arrived, exposing symptoms of her anxiety disorder. Emotions she had worked hard to get under control before starting college suddenly resurfaced.
“Once I got here, I felt pretty alone,” she remembers. “We’re all in our own bubbles where we think that there’s something super wrong with us, and we’re the only people going through it.”
Such is the Harvard Condition—the appearance of normalcy but the reality of distress. It’s exacerbated by the pressure, stress, and competition that can find its way into every nook and cranny of the College experience, and it’s not as easily alleviated by an ice cream study break as some may hope.
While nearly all Harvard students have found themselves reeling under pressure at one time or another, the manifestations of mental distress vary in severity. For some students, this sense of helplessness leads to a discrepancy between how they present themselves and how they really feel, a divide often widest for those who arrive on campus with a history of mental health struggles. Though the University offers a wide range of resources for those students, some still suffer, hesitant to reach out for help due to the stigma surrounding mental illness and discouraged by the perceived barriers to professional care.
When high achievers are plopped en masse into a pressure cooker, some are bound to melt. Some blame the stigma surrounding mental illness, others the pressure of the Harvard environment.
Keeping students physically and emotionally healthy, University President Drew G. Faust says, is one of Harvard’s top priorities. Families from Seattle to Shanghai entrust their students to the school, aware that it will test them academically and mentally. As Harvard encourages students to challenge themselves, Faust says managing the stress so common to college students is important.
Addressing the issue of mental health on campuses is difficult. Psychology professor Shelley Carson says the nation has seen an “explosion of depression” on campuses for several reasons. According to Carson, Harvard students with depression and other disorders can access a wide range of treatment options that enable them to function normally. Carson also sites the intensity of the Harvard environment as a factor in amplifying mental health difficulties.
“Students come with jaw-dropping intelligence and academic performance, and relatively less mature emotional skills, and that leaves them vulnerable when they have intense negative experiences,” says Paul Barreira, the director of UHS. “Being smart doesn’t help you.”
Most students come to Harvard with resumes chock-full of accolades and honors. A subset of freshmen also arrive with mental health challenges.
In a UHS survey sent to all incoming freshmen this fall, about a quarter of respondents reported they have had some type of mental disorder in their lifetime, according to Barreira. Though 10 percent of students report on the anonymous UHS survey that they currently have a diagnosed mental disorder, far fewer make that known to UHS, Barreira says. The practice of concealing mental health problems has begun even before students enter their freshman dorms for the first time.
“[Students are] worried before they get here [that] the administration of the College would know, and it would interfere with their getting integrated into the community,” adds Barreira, who also serves on the Admissions Committee. “They feel stigmatized.”
For some, mental distress progresses beyond depression. Six percent reported experiencing suicidal thoughts in their lifetime. Of those students, 33 percent—19 freshmen—said in the survey they had at one time made a suicide plan. Eleven members of the freshman class reported that they had attempted suicide before coming to Harvard.
When these students muster up the courage and energy to reach out, the mental health services Harvard offers come in different shapes and sizes; these also provide varying degrees of relief.
Harvard offers students a host of mental health resources that are organized into three broad prongs: professionals, peers, and residential supporters. The professionals include staff members at UHS and the Bureau of Study Counsel—Harvard’s academic counseling resource. They tend to take students with formally diagnosed mental illnesses, offering a variety of options for treatment, including urgent mental care, regular therapy, and group sessions. Peer counseling group members are trained to provide support to students struggling with life at Harvard. The third avenue for help, residential supporters, includes all in-House deans, proctors, tutors, and advisers, who often serve as a liaison between students and the professional resources.
Mental health challenges by no means represent a Harvard-exclusive problem—they persist here as in other schools. But stress levels are slightly higher. Thirty-seven percent of College students surveyed in a UHS poll reported that stress affected their academic performance in the 2012-2013 academic year. This statistic is significantly higher than the national average that year—29 percent—as surveyed by the National College Health Assessment.
“There’s so much pressure and stress at colleges, especially at Harvard. We see that it’s impacting students and actually causing people to become depressed,” Carson says.
Emotional instability is an invisible struggle affecting students in all stages of their Harvard journey. Diagnosed or not, the Harvard Condition looms.
Many students and Harvard officials cite the stigmatization of mental health issues as the most significant barrier to entry in the mental health community.
“Despite this access to resources, there’s this stigma that nobody wants to get help because they don’t want to admit they have a problem,” Thompson says.
Typically, Harvard students experiencing an emotional struggle will simply push through it, says Luke L. Pizzato ’16, co-director of Room 13. As a result, students are less willing to seek help for mental health challenges, which are sometimes seen as akin to failure.
The most dangerous hurdle is the norm of concealing emotions. While some students may project the image that they are doing “terrific,” Barreira says, this is oftentimes an illusion.
“Inside they’re drowning, but they don’t share it with with anybody,” Barreira says. “It’s the Facebook self versus the private self. Students who have a big gap there are more vulnerable.”
Despite attempts to break barriers, the stigma surrounding mental health persists. Students often feel they are too busy to talk about their emotional distress, or they think their friends are too busy to listen. This mentality—that everyone is “Doing fine, how about you?”—can make it challenging and intimidating for students to open up about problems they’re facing.
Once students do reach out for help, they often find themselves on the fourth floor of the Smith Campus Center. There, most are able to connect with a UHS clinician or counselor.
Ninety percent of students who visited UHS last year reported that they “were helped with their primary concern”—a proportion Barreira says is comparatively good. Of students who sought more consistent help, 76 percent said they had a sufficient number of sessions. The average student makes six to seven visits annually, but Barreira adds that that number is typically skewed by the extremes of one-off and weekly sessions.
Students who do come to UHS encounter a team of well-qualified staff members. Composed of 30 professionals, including eight medical doctors, 16 licensed social workers, and four with doctoral degrees in psychology, UHS mental health services is responsible for providing mental health care for the 20,000 students enrolled at the University. Last academic year, it served 1,388 undergraduates—a number that has stayed relatively constant over the years, according to Barreira.
Over the next couple of years, UHS mental health services will add at least three more full-time counselors, according to Barreira, and will reorganize to offer a consolidated 24-hour urgent care location for both medical and mental health services on the fifth floor of the Smith Campus Center. Barreira also hopes to restore a training program for psychologists and social workers that the hospital was forced to stall during the financial crisis.
Around 40 percent of students at the College have used UHS mental health services—whether on a regular basis or for a one-time drop in—over their four years. Between 20 and 25 percent of undergraduates visit the mental health services each year.
When students first want to schedule an appointment with UHS mental health services, they are prompted to request a phone consultation. Promised to occur no more than 48 hours after initial contact, the consultation is intended to help UHS staff members provide students with tailor-made solutions and courses for treatment. At the end of the call, the UHS representative then makes a recommendation to the student, which could range from an immediate appointment for urgent cases to a referral to the Bureau of Study Counsel.
A majority of patients—65 percent—are seen within five business days of scheduling an appointment, according to UHS statistics. Lewis says that this time frame is UHS’s goal for care. The remaining third of students seeking counseling are not seen until over a week after they first request help. Thirty-two percent of students are seen between six and 10 business days after the phone triage, and 2 percent do not receive an appointment until 11 to 15 business days later.
UHS will often refer students seeking more regular counseling to an outside therapist. This enables UHS to increase its capacity for care. Maureen Rezendes, the associate chief of counseling and mental health services, says there are at least 50 in-network providers within a one-mile radius of Harvard with availability.
Sarah Rodriguez ’18 took a month off of school during her sophomore year of high school while suffering from depression. During her senior year of high school, she finally found her footing and looked forward to her next chapter. From Greenwich, Conn., a common hometown of Harvard students, Rodriguez arrived equipped with a support system—her two best friends who were also admitted—and felt “fortunate” that she already knew a number of her classmates.
Rodriguez reached out to UHS, but claims that it took two weeks to schedule an appointment.
While students can walk into UHS at any time for urgent care mental health-related purposes, UHS staffers generally recommend calling for an appointment first. Some students, many of whom only find the motivation to call UHS during a moment of crisis, find the wait discouraging. For those at their tipping point, it can be “scary to not be counseled in that moment,” according to Stephanie L. Deccy ’17, a student mental health liaison.
Beyond the wait, the phone consultation itself can be seen as an impediment. Though 72 percent of students who responded to a UHS patient satisfaction survey reported that they thought the phone consultation was “good or very good,” some students call it a barrier to entry. Rodriguez cites the call, which asks a series of preliminary questions without offering counseling over the phone, as one of the reasons she hesitated to schedule a conversation. So did Thompson, Anna, and William F. Morris '17.
“I was so freaking depressed, and when you’re depressed and you’re down, how are you going to get the energy to have a 30-minute phone consultation about an issue that’s very sensitive?” Morris says.
Still, Barreira has confidence that the phone call model works, saying he “can’t imagine getting rid of the phone triage as a way to identify students and get them in efficiently.”
After students utilize counseling services or get a referral to another doctor, UHS mental promises to follow-up with patients to make sure they get the care they need. All the counselors follow up within a month, according to Rezendes.
The procedure, though, for ensuring that counselors follow up with each student does not include an automated system for checking in with patients after they receive care, and busy therapists can sometimes forget to check in with students. UHS did not follow up with Ladd after her appointment, she says.
Follow-up is particularly critical for students whom UHS refers to outside care—these patients are given a list of names of Cambridge counselors to call, and are trusted to reach out if they do not find one that suits their needs. But even Barreira says he finds it “really hard for [him] to remember” to follow-up with students he refers to other clinics. Anna says that UHS did not follow up with her after they referred her to outside care, though she did find a therapist she calls “awesome” and very supportive.
Waverley He ’18, a Health Pal for Kirkland House, and Kevin C. Ma ’17, an Asian American mental health advocate, expressed concern over a lack of cultural diversity on the staff at UHS. On top of what He calls Harvard’s culture of “competitively enjoying life,” cultural stigma—in which mental illness is an abnormality or sign of weakness—affects some students more deeply.
He and Ma suggest that cultural stigmas can make it more difficult for some students, such as some of Asian descent, to open to their parents, and reaching out for help is easier when they can connect with someone from a similar background. “I know a lot of students would feel more comfortable speaking to someone of the same cultural background,” He says.
Though students point to perceived flaws in UHS’s approach, Barreira says the health service could accommodate more students satisfactorily if they engaged more broadly with mental health issues.
“Should UHS be the only place that deals with students in distress, or should we be creating a community that is more supportive?” Barreira asks. “Not every distress requires a clinician.”
Photos of flowers, sunsets, and beaches dress the peachy walls of a small room in Thayer basement. Pebbles wait to be turned over in jittery palms, and a giant stuffed tiger perches atop a couch. A half-eaten chocolate chip coffee cake slowly stiffens on a table nearby.
This is the counseling area of Room 13, a confidential space where undergraduate peer counselors wait in pairs for student drop-ins from 7 p.m. to 7 a.m. every night of the week to listen to the troubles and concerns of any student who walks in the door. The Room is billed as non-judgemental and non-directive—meaning the counselors refrain from offering advice, instead hoping to provide emotional support and prompt self-reflection for the student.
“I think there’s this huge middle area of students who are maybe having a tough time here and … are afraid that going to a clinician means something about who they are as if it’s crossing some threshold.” says Andrew Kim ’16, a co-director of Room 13. “When we counsel, we’re sort of thinking about what issue is this person dealing—it academic, is it social, and they’re sort of examining those feelings.”
Room 13 is one of several resources, driven by both peers and professionals, students can turn to if UHS does not offer services that fit their needs.
Students who feel they are unprepared academically have access to one of the specialized resources Harvard offers. The Bureau of Study Counsel, which was part of UHS but has recently moved under College purview, provides support to students with academic and other issues. It puts particular emphasis on helping freshmen adapt to the college workflow, according to Abigail Lipson, the Bureau’s director.
William Morris, a small town Georgia native who was diagnosed with a mental disorder in middle school, struggled to find a sense of belonging at Harvard, feeling that he was unequipped to tackle the academic rigors of Harvard. Though he had overcome one serious mental obstacle, upon arriving at Harvard, he was faced with another. His emotional instability was rooted in the academic insecurity he felt when he arrived.
Morris used BSC’s resources to learn research techniques that helped him with schoolwork. This resource is one that Freshman resident dean for Ivy Yard Michael C. Ranen says he often recommends to students looking for academic help.
“My biggest fear is that a student is going to try to deal with their health issues by themselves and not asking for help,” Ranen says.
Harvard’s House proctors, tutors, Peer Advising Fellows, and resident deans acts as another mental health resource, acting as liaisons between students and professional resources. They also work with the Student Mental Health Liaisons, a peer organization that runs freshman workshops during orientation week. The most common reason people cite for not wanting to seek help, says SMHL co-president Hannah Rasmussen ’16, is that resources are not perceived to work.
“When we talk to freshmen, a lot of people will generally [say] it’s shameful to go seek help or there are a lot of cultural stigmas that are tied into seeking help for mental health,” says Rasmussen, an inactive Crimson multimedia editor. “We try to emphasize that it is a brave thing to go seek help.”
Current seniors have received a tragic, sobering wake up call about the gravity of mental health seven times during their Harvard experience—an average of once a semester.
“I am writing with heartbreaking news,” Dean of the College Rakesh Khurana wrote to the student body in September, reporting the death of Luke Z. Tang ’18. That death was ruled a suicide, as were the deaths of Andrew Sun ’16, Stephen Rose ’06, Cote K. Laramie ’14, Philip V. Streich ’13, and Joanna Y. Li ’12.
Meanwhile, UHS counselors also assembled, ready to embrace a grieving College. Students welcomed the support—UHS took 413 mental health-related telephone consults during the first three weeks of the semester to accommodate students, seeing a “rapid” increase in visits, according to Barreira. Barreira calls the University response to suicide on campus—extensive outreach to any student who might be even tangentially affected—“terrific.”
After the undeniably tragic loss of a student’s death, loved ones often experience denial. After a suicide, grief-stricken parents often ask the University to not refer to the loss as such, a request the school has made a commitment to honor, according to Barreira.
“So now we’re in this incredibly awkward place where some students may have read a suicide note, some students may have heard through somewhere or other that the student was found in the House,” Barreira says. “There’s general knowledge that this person died from suicide.”
Despite students’ unspoken understanding of the cause of death, students often tiptoe around the taboo subject, a supposedly rare occurrence. But suicide is heartbreakingly common among adolescents—it’s the second leading cause of death of 15- to 24-year-olds, according to a 2013 report from the Centers for Disease Control and Prevention.
Eappen, who in addition to counseling at Room 13 is a clinical psychiatry concentrator writing his senior thesis on suicide, says this avoidance of discussing suicide may further stigmatize mental illness and emotional distress.
“To relate to someone who is suicidal might be shameful, and that might actually be preventing people from getting help,” Eappen says.
Suicidal students can show a number of symptoms, according to Carson, including withdrawal from friends, classes, or activities, losing interest in activities, sleeping either a lot or not at all, and feeling worthless. But some students hide their emotions in a self-destructive way.
Though Harvard generally refrains from discussing suicide in so many words—usually at the request of the family—Khurana says the College is “trying to address it head on.” Some students think University representatives could do more.
“Every time something like this happens, there are students who speak out and call for administrative action, and there’s always some sort of temporary rise in support, but then it kind of dies down,” He says. “It just seems like the administration might not be doing enough.”
Taylor Ladd is used to occasional stormy weather. A top performer on the women’s sailing team, she spends her time tacking across the cool water of the Charles River Basin. In this environment, Ladd harnesses the natural forces around her, in total control of the boat.
Though administrators say they are doing their best to offer resources that are comforting and helpful, Ladd did not find a support outlet that fit her needs. She scheduled a phone consultation with UHS, but the call was canceled. Ladd felt reluctant to visit a peer counseling group, fearing she might run into a person she knew. She attended the SMHL workshop during freshman week, but that was before college intensified, and signs of depression set in. By late fall, information relayed there had slipped her memory.
Eventually, she saw a counselor at UHS—just once. It was not the right treatment for her, she says. Yet she could not shake the depressive state she endured. She thought she was alone in the struggle.
“I didn’t get into whatever, I’m not doing well in sailing, and now my therapist hates me too,” she says she thought to herself.
Feeling isolated but unwilling to reach out for help, Ladd decided to create her own support group in the form of a Facebook page called “How Was Your Day Harvard?” The page posts stories of students—in their own words, using their real name—and their struggles with mental health, a project Ladd hopes will help mitigate the stigma surrounding mental health.
Ladd received an outpouring of support after she published the page, reaffirming what she has found to be a truth at Harvard: People are accepting and supportive of mental disorders when they are out in the open.
Cameron Nieters ’18 reevaluated her mental health situation after hearing about Tang’s death. Nieters’s trials with emotional distress began her freshman year, when she started experiencing a mood she “didn’t understand.” At first, she attributed it to external factors—she injured her hip playing basketball for the varsity team and had to watch from the bench for six months—but her constant unhappiness confused her.
When she arrived back at school this year, though, things took a turn for the worse. Trying to balance a hectic schedule with class, homework, and basketball, she started to sink back into what she remembers as “a pretty bad place.”
“It was just a really demanding schedule and it brought back some of those feelings that I thought were gone,” Nieters said. “I tried to deal with them on my own, thinking the medication would help.”
And then in mid-September, she got Khurana’s email—the “Community Message” about Luke Tang’s passing. Head spinning, Nieters decided to try UHS again.
“I was like, okay, I want to go get help because I don’t think that’s ever going to be me, but I’m scared... What if?”
Talking to a therapist on the phone lifted her spirits. She then went in for another appointment, this time with a different counselor. The two clicked, and Nieters has been feeling more at ease.
Nieters posted on Facebook about her mental health journey in “How Was Your Day Harvard?” a few weeks ago. She has found the process of talking about her illness freeing.
“Once it’s known to other people, it’s been such an accepting environment for me,” she says. “I think it’s just making it known to other people that’s the hard part.”
Emily Thompson reaches for her winter coat, ready to surrender.
In the first few weeks of therapy at UHS, Thompson still feels lost, dropping into the emergency care unit whenever a wave of depression overtakes her. It happens randomly, at any time of day. Weeks later, she fills a prescription to regulate her mood—a choice she has resisted for a long time, fearing the stigma associated with medication.
With therapy and medicine, she starts to feel better. After a constant string of “terrible” days, some of them, she recalls, begin to look more positive.
Student advocates, therapists, deans, and other professionals implore students to talk about their emotional distresses and to get help if they feel they need it. The focus: maximizing opportunities for recovery.
But students struggling to navigate the system say there is work to be done to improve the approaches to help. They call for barriers to entry to fall. Resources to be allocated. Cultural diversity to become a priority. Stigma to be diminished.
“Day to day nothing seemed better,” Thompson says. “But looking back, everything had changed.”
And the Harvard Condition goes into remission.
—Celeste M. Mendoza and Daphne C. Thompson contributed to the reporting of this story.