Coming of Age on Zoloft (32 page)

Second, said Ramirez, students are often understandably confused about what’s pathological. Mental disorder is a convenient, available explanation for all kinds of trouble, and he often sees students reaching for it, or accepting it when it is suggested to them. Such suggestions are everywhere. Students have family members and friends who use medications. They are exposed to on-campus screening days for depression and other mental disorders, events that are often sponsored by pharmaceutical companies.
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They hear stories about ancestors who were considered to be ‘crazy’; knowing that mental illness runs in families, they worry that it’s going to happen to them. Often a student will come to Ramirez because someone else has labeled them. “I can’t tell you the number of people who come in because someone’s told them they have ADD,” he said. “Because, what? Yes, they have attention and concentration problems. But they haven’t slept in a week!” All of these examples are signs of a broader cultural shift that has blurred the line between mental illness and the baseline quotient of sadness, anxiety, and stress that into each life must fall. “Things that we didn’t used to think of as being psychiatric disorders are now considered to be psychiatric problems,” Ramirez said. “There’s been kind of a pathologization of life itself.”

All in all, Ramirez told me, students haven’t changed since he first got into the field. Throughout his two decades in school counseling, students have presented with a remarkably stable set of cares. “The concerns that people have—‘Am I going to be loved? Am I going to be successful? What’s life all about?’ ”—these, Ramirez says, are the questions that students have always asked, in their million different ways. What’s different today is that students are much more likely to attach these questions, and their worries around them, to the idea of diagnosable mental illness.

I told Ramirez about something I’d been mulling over since reading Julia Lurie, Madrianne, and Jessica’s articles. It had struck me that students are very able to talk about “stress,” and very able to talk about “mental health issues” (even if it’s in the context of bemoaning low awareness), but that there didn’t seem to be much conversation about negative feelings outside of the rubric of mental health. I had been surprised to find what I would consider “ordinary” feelings lumped in with clinical mental problems: in Madrianne and Jessica’s article, depression, anxiety, and eating disorders were name-checked as “mental health issues,” but so were insomnia, fights with roommates, romantic breakups, and the sensation of being misunderstood. Ramirez agreed. In the context of a culture where many of the “baseline phenomena” of life have come to be considered symptoms of illness, he said, there’s a lot of confusion about what is and isn’t acceptable to feel. “Young people aren’t sure how to think about their distress,” he said. “There’s almost not a language for normal distress.”

The loss of a vocabulary for normal distress is accompanied by a loss of perspective. Much of what Ramirez says he does as a counselor is to try to help students think through what the stressors in their lives are, to try to figure out for themselves the boundary between understandable amounts of strife and real pathology. “We try to contextualize it,” he said. Plenty of times, it will turn out that students were laboring under burdens they hadn’t really considered before. “Sometimes you get someone saying ‘Yeah, now that I think of it, my favorite grandfather
did
just die, and I didn’t get to go home for the funeral.’ Just terrible things, that if the pace of their life doesn’t allow for the integration of these experiences, then it’s a problem.” If a student’s feelings appear to be in a normal range, says Ramirez, “we ask, ‘considering all these things that are depressing you, what is your expectation of how you
should
be feeling right now?’ ”

Learning why you feel the way you feel is a skill that has to be acquired. Most students don’t come to college with an advanced understanding of the forces at work on them. “If you could do some kind of regression analysis of lines that people have said in counseling,” Ramirez said, “probably one of the most frequently uttered phrases would be something like, ‘I don’t know what’s wrong with me; I have everything a person could want in life, and I’m still depressed.’ ” Many psychiatrists would take such a statement at face value—feeling bad without reason equals depression—but Ramirez thinks it’s more complicated than that. Especially at a school like Swarthmore, students are often conscious of their own privilege. They’ve been groomed all their lives for college, and they may have no idea why they suddenly feel let down or lost. Ramirez thinks there are plenty of reasons, up to and including the enormous value placed on getting into a good school, but says that students looking for an explanation are often inclined to find it in the idea of a mood disorder or other inner problem.

RAMIREZ’S COMMENT ABOUT
a regression analysis immediately brought to mind my interview with Caitlin. Caitlin attends a large private university in the Northeast. She is nineteen years old and a sophomore. On the phone, she sounded perky, warm, and agreeable. She described herself as “really outgoing” and mentioned that she was involved in a lot of activities at school: she gave campus tours, worked an additional job at the library coffee shop, belonged to a ser-vice fraternity, and headed up the school’s chapter of UNICEF. She was on the go from 9:00
A.M.
to 10:00
P.M
. or later every day, she said, and that’s the way she liked it. She told me that she’s not the kind of person anyone expects to have depression. “The couple people I have told, it throws them off,” she said.

College started well for Caitlin. “I made some good friends,” she said. “I was getting involved in a ton of stuff. I was happy with how everything was going. I even liked my classes.” She told me that she had been looking forward to college for a long time, not least because it meant an opportunity to get away from home. “My mom and I really don’t get along,” Caitlin said. “So in high school, I’d be fine at school, I’d be fine with my friends, and then I’d come home. And it was whenever I came in contact with my mom, I started having, I called them ‘dark spirals.’ I would start to feel a depression whenever I was around her.” She was eager to get to college because she expected that getting out of the house would bring her dark spirals to an end.

But at college, though Caitlin was often happy, sometimes her mood would deteriorate and “it all just felt like shit.” I asked her why, and she replied, in words much like the ones David Ramirez had described hearing from his students, “I think that’s kind of what the issue was. I
should
have been happy.” She had been counting on distance from her mother to make things better, and she felt worried and discouraged that it hadn’t completely worked. “It was hard to handle the fact that it wasn’t just my mom, and I couldn’t just remove myself from the situation, but rather there was something bigger or worse,” Caitlin said. In college, during the bad times, Caitlin could imagine hurting herself in some way, and even though “I knew that I really wasn’t going to,” the thoughts were disturbing.

Toward the end of her first year, Caitlin said, “I remember there was one day when I decided to go [to the psychiatrist]. I had, like, an emotional breakdown. It was the end of my freshman year in college, right at the end of the year, getting ready to go home. And for some reason I just had a really rough night. I was sitting on the edge of my bed, and bawling my eyes out. Just sitting there thinking, ‘There’s nothing wrong with my life, so why am I feeling like this?’ ”

Back at home, Caitlin sought out a psychiatrist who gave her a prescription for an antidepressant. When we talked, she had been on it for about six months. She told me she thought the medication was helping, but she didn’t sound entirely sure. “I mean, I definitely can notice it,” she said. “So I think it’s working. But who knows?” She told me she didn’t especially enjoy taking medication, and that she hopes she won’t have to continue forever.

What struck me about Caitlin’s story was how many things she did have to feel bad about, even if she didn’t recognize them. She had conflict with her mother. As the youngest child of the family, she felt that both of her parents babied her. She wanted to let them know that she was her own person now, but she also confessed that she “hates confrontation,” so she was having a hard time figuring out how to express her feelings of independence. She was experimenting with abandoning her parents’ Catholic faith but didn’t feel she could tell them about that either. She was tremendously busy with school. And she was dealing with the developmental and separation tasks that all college students must deal with. The fact that those tasks are ubiquitous doesn’t make them any less daunting. Gertrude Carter, a psychologist who headed the student mental health ser-vice at Bennington College for many years, told me she believes that most college students are in a state of grief when they arrive at college, or fall into one soon after. “No matter what, there are losses,” she said. “You leave your friends, you leave your family. You’re on your own in a completely alien environment, and it’s supposed to be just wonderful, but it often isn’t.” The challenge of this dislocation seems obvious to me now, as an older person, but I remember being as blind to it then as Caitlin seemed to be.

I thought that it made sense for Caitlin’s distress to come to a head on the eve of her return home for the summer, but that’s not how she saw it. It was clear that seeing a psychiatrist had been a way for her to take herself seriously and express the independence that she craved from her parents, who she said did not approve of her decision to take medication. But like the students Ramirez described, she didn’t have a language for normal distress. In fact, the explanation Caitlin gave of how she was able to feel happy one moment and depressed the next was that “for me, maybe there’s some bipolar thing in there too.”

IF ANTIDEPRESSANTS ARE
helping to blur the distinction between ordinary and pathological feelings on college campuses, so are the psychostimulant medications that are prescribed for ADHD. Their use as study drugs has grabbed a lot of headlines in recent years: a dose will allow you to stay up all night, keeping your eyes glued to your books, while you write that long-procrastinated paper. Though it is hard to track exactly, says Vivien Chan of U.C. Irvine, misuse of prescription stimulants on college campuses is rampant. Students, she said, describe acquiring these drugs as “effortless”; the library is often a hot spot for sales, though it’s likely that most students don’t have to go much farther than a few doors down their dormitory hallway.

Chan told me that the abuse of Adderall and other psychostimulants is at least partly due to legitimate confusion on the part of students about what constitutes a normal ability to focus. “I think college is tough,” she said. “The students are under tremendous pressure. Almost all of them feel like they could be studying better, or studying more. It’s really easy for everybody to be worried about keeping up and paying attention. Of a hundred students who walk into my clinic, if you ask them whether they have problems with concentration, 99 percent of them are going to say yes.” At Irvine, she sees a steady stream of students who confide in her that they somehow obtained an Adderall pill, that it really helped them, and by the way, they’ve always kind of had trouble concentrating, and does she think they might have ADHD? Chan gently tries to tell students whom she believes don’t need stimulants that they aren’t necessary. But she concedes that the call can be a difficult one to make, since like all mental disorders, there’s no objective test for ADHD.

Kristin, twenty-two, who graduated last year from a university in the South, takes Adderall on her doctor’s orders and believes that she needs it—but in general, she said, she sees school stress playing into people’s decisions to use pharmaceuticals, both prescribed and diverted. She believes that some people turn to medication to deal with problems that might be manageable in other ways, if not for the pace and pressure of school. “I don’t know how many people are on [medication] because they really need it,” she said. “But it’s easy for the doctor to say ‘Why don’t we put you on this and see how you do.’ Because when you’re in college, you can’t stop and figure things out. I think that a lot of people, in terms of personal physical and mental health, should take a break between years of college.” But that isn’t always possible, and medication can help students endure. Now that she’s graduated, Kristin explained, “I definitely feel far less anxiety just not having any school to deal with.” Work and social stress, she said, are easy in comparison. When I asked her what made academic stress different, she exclaimed, “Everyone tells you that school’s going to determine the rest of your life! It just starts to build up after a while.”

Small colleges aren’t the only places where students are confused about how they ought to feel, and look to medication as a way to function as highly as they think they should. The week after I visited Swarthmore, I stopped in to see a psychiatrist who works in a private practice in Manhattan, and treats many college students and recent grads. “I feel like the expectations that a lot of patients have seem to be unrealistic,” she said,

in the sense of “I should be able to work fourteen hours a day, and then go out and have a social life, and maintain a certain weight, and not be exhausted.” The number of people who come in here and tell me that they don’t sleep well or they never have enough energy, and then when you review what their day is like—there seems to be a disconnect between [what they expect and] what is possible, what one can possibly do in a day. There’s a sense that they’re turning to pharmaceuticals to make something possible that’s not healthy or normal.

She added that she often felt surprised by how little sense the young adults she sees have of what constitute normal, healthy routines, or of the way they can expect their behavior to influence how they feel. “A lot of [street] drug use has become so normalized that many people don’t understand that if you are severely depressed and you have trouble functioning already, that smoking pot all day long is not going to help that,” she said. She is alarmed by the number of students who think they ought to be able to work all day every day, party each night, and still feel okay—and who define their inability to do that as a problem to be solved through medication. “It’s surprising to me the things that people come in to talk to me about,” she mused. “A lot of it is issues that, if people had internalized more normal routines earlier in life—I mean, do you really need me to tell you that you should be sleeping seven hours a night? That you should eat three times a day?”