Harvard's Busy Mental Health Bureaucracy

More Students Want More Therapy, And Nobody Knows Why

There has been a subtle but visible increase in the number of Harvard-Radcliffe undergraduates seeking therapy and counseling over the past five years. The number of student visits to the Psychology Service of the University Health Services has more than tripled since 1969, with a 20 per cent increase within the past year. In the Psychiatric Service, the average number of sessions per patient has noticeably risen within the past three years. And at the Bureau of Study Counsel, the number of undergraduates counseled jumped 73 per cent in two years.

The reasons that Harvard professionals give for this change have nothing to do with the students themselves. Instead, we are meant to understand the increase as a result of changes in service.

The Counseling Service of the Bureau of Study Counsel, which basically deals with the same student concerns as the UHS Psychology Service, attributes its increase in number of undergraduates to its staff, its relation to freshmen advisers, and a small brochure that briefly explains the bureau's function and is distributed among students and faculty.

Officials at the psychology service cite a number of factors to explain the larger number of student visits: its training program for graduate students, an expanded group and couples therapy program, and a greater degree of staff involvement in the Harvard community, where members of the service are associated with Harvard Houses and can thereby make more contacts for referrals.

In the 1972-73 annual report of the University Health Services, Warren E.C. Wacker, director of the UHS, explains that increases or decreases in utilization of the psychiatric service can never be fully understood: "Probably no change, whether it be up or down, is of special significance unless it takes form as a definite pattern for at least an academic generation. When this will occur is a matter of speculation, but when it does, it will have happened without apparent cause...'"


It is easy enough to understand that there can be no absolute reason for the increase in utilization of the UHS and Bureau of Study Council, particularly in psychiatry and psychology. The pains, concerns and problems of Harvard-Radcliffe students are infinite and cannot be quantified for the sake of reason, as much as one would like to try. Still, as William Perry, director of the Bureau of Study Counsel, points out in the 1973-74 annual report of the Bureau, "The pain of the most distressed students, being atypical in intensity and varied in origin, may not be very informative about the general--except that there seemed to be more of it."

But it is apparent that external goings-on at Harvard have changed drastically. Five years ago, student activism was still alive and supposedly represented a release in which students could externalize their anxieties. Today, student activism lies dormant as the number of clubbies grows, along with the resurrection of Harvard's only fraternity house, which died in 1969. In a sense, the undergraduate psyche has been driven back to where it was in the early '60s--pent up and anxious. As the 1972-73 UHS annual report observed:

Depression and anxiety again appeared to be the most usual symptom formations patients brought to us. Thus, we noted a return to these commonplace and endemic problems at rates of incidence that were much like those regularly seen in the past except during the years when acting-out instead of internalizing conflict was so much in vogue.

But there have been changes in the mental health situation at Harvard. Many undergraduates are now both overly concerned about the confidentiality of their visits (thanks to the "Plumbers" case) and are realistically concerned about making a success of their own individual lives--something which "hasn't been an issue for Harvard before," says Elizabeth Reid, associate psychiatrist to the UHS. "There were very few Harvard graduates driving cabs ten years ago," she says. "In the spring last year, I saw an awful lot of seniors who were feeling terribly upset because they couldn't find anybody who wanted to hire them. That's a general anxiety throughout everybody, and that all of the undergraduates are aware of. Their chances of getting into medical school or law school or graduate school or getting a job that will interest them--that's very anxiety provoking and not at all neurotic."

What becomes clear, then, in a world of unstable economy, is a new concern about the future among Harvard-Radliffe students. And the future-oriented concerns seem to occur earlier and earlier in undergraduate life. During the 1973-74 academic year, sophomores had a higher percentage of student visits at the psychiatric servies than did any other class. And coincidentally or not, the same class had a higher proportion of premeds than any other class at Harvard.

Besides the undergraduates who have difficulties dealing with anxieties, whether they be future-oriented or not, there are those who simply cannot cope at Harvard and need to be hospitalized. The number of Harvard-Radcliffe students who have been hospitalized for psychiatric reasons has varied very little over the past ten years. There are typically about 30 such hospitalizations per year. The only significant increase of admissions to outside hospitals occured during the 1965-66 academic year when 54 such hospitalizations were made. This increase among undergraduates was due to a virtual elimination of leaves of absence for men who would have lost their student deferment if they took time off from school.

Unlike the relatively steady rate of hospitalization, the suicide rate at Harvard has decreased somewhat in recent years. In his study of suicide at Harvard, William Temby, former assistant psychiatirst to the UHS, found in 1961 that the suicide rate at Harvard was approximately 1.5 each year for every 10,000 students. That was about 50 per cent higher than that of the American population at large. Since that time, the suicide rate has dropped off slightly. Last year, two students and on Faculty member committeed suicide.

Perhaps the most striking fact that arises in evaluating the current mental health situation at Harvard-Radcliffe is this: there were proportionally twice as many women as men using the psychiatric services at the UHS during the 1973-74 academic year. 16.4 per cent of the total Radcliffe population sought psychiatric help as opposed to 7.7 per cent of the Harvard population. And at the Bureau of Study Counsel, the most marked increase in the number of undergraduates counseled in the past two years is among women--from 104 to 247, or 137 per cent. The numbers for men rose from 277 to 413, or 46 per cent.

The numbers read loud, but not so clear. Certainly, the situation is not specific to Radcliffe women. Within the American population at large, there are more women than men in therapy. But why the over-whelming 2:1 proportion in psychiatry at the UHS, and why the dramatic increase in women at the Bureau? The answer seems to be anyone's guess.

"We just don't know the answer," says Elizabeth Reid. "It's just as simple as that. The reasons now are different than they would have been ten years ago. But we don't really know whether it's that these are inside reasons that have nothing to do with the world at large or whether women feel more comfortable coming to seek help than men. It's also conceivable that being a woman nowadays is more complicated than being a man."