Coming of Age on Zoloft (33 page)

Without a doubt, the SSRI revolution has brought about some positive changes on campuses. Gary Margolis of Middlebury pointed out to me that in the 1960s, before colleges generally had counseling centers of any kind, students with mental or emotional problems had little choice but to “suffer silently,” self-medicate with alcohol, drugs, or food, or withdraw from school. “Some of those students disappeared, literally,” he said. “I can remember classmates who were present, and then all of a sudden you realized that they weren’t in the dorm, they weren’t in class. They had withdrawn, without any explanation.”

But it’s clear that the increase in medication use at colleges reflects more than just a surge in cases of serious mental illness. A portion of the rise is guided by factors that Madrianne Wong and Jessica Schleider were well aware of: an environment in which, because of a variety of factors converging—from a national context where emotions once regarded as everyday nuisances are now seen as signs of disease, to a local context where students don’t share with one another their negative feelings and thus come to believe that they’re alone in them, to a high-pressure academic climate that can exacerbate medium-size problems into big ones and prevent students from taking the time to reflect and integrate—students become inclined to interpret their distress as a mental disorder, and to reach out for medication or have medication suggested to them as the cure.

AND WELL, YOU
might ask, so what? If these medications are safe—and they’re fairly safe—and if they make the stressful life of a college student easier to bear, then what’s the harm?

I can think of a few places to look. The first is back to the idea of a “culture of silence.” Keeping quiet with peers enforces unrealistic expectations, in a kind of feedback loop: students who can’t share their doubts and insecurities don’t know that other students also feel bad, so they assume that their own bad feelings must be abnormal, which makes those feelings worse and harder to open up about. Inasmuch as psychiatric drug use helps students to live up to the mandates of the “achieving self,” it also helps to keep the culture of silence strong and in place, and may preclude conversations that could lead to more realistic expectations about feelings and accomplishments. (Madrianne Wong, Jessica Schleider, and Julia Lurie called for greater “mental health awareness” to address the culture of silence, but I wasn’t sure their impulse was exactly the right one. Awareness is important, but it seems to me that it’s precisely the tendency to define all emotional difficulties as “signs of mental disorder” that makes it harder for students to share their feelings and to experience the resulting sense of camaraderie.)

Second, medications can harm if the hurried approach to recovery that they represent discourages students from taking a deeper look at what’s wrong. Away from the routines defined by home and family, college students must start to explore the way that the choices they make in their personal lives, and the care they take of their bodies, make them feel. But the view that comes along with medication— that many negative feelings and physical limitations are symptoms of illness—can discourage students from learning how to make these connections and deprive them of a chance to discover more autonomous or creative ways of dealing with their problems. Gertrude Carter of Bennington and her staff psychiatrist, Jeffrey Winseman, made just that point in a 2001 article in the
Chronicle of Higher Education
. They were troubled by the stream of students coming through their office doors who already took medication habitually; many had had their prescriptions renewed for years on end without complaint. Carter and Winseman weren’t against medication as part of a thoughtful treatment plan, but they were highly critical of the “medication only” approach they saw signs of. “If we respond to our students’ pain in purely biological terms,” they wrote, “we exclude the potential for change through the understanding of meaningful experiences.”

Third, psychiatric medication teaches students to look for the source of their pain inside of themselves, not in the world they live in. Joseph Davis believes that much of the distress that students suffer is produced by their environment—specifically, by the notable increase in pressure to perform that has affected college, high school, and even elementary school students in recent decades. In his research, he has found that students are seldom aware of the forces that operate on them, and that students who use medication are especially likely to define their problems as unique and arising from within. “There’s a tendency to take on any kind of failure or problem as though there’s something wrong with you, that you’re broken or something like that,” he said. “Student after student would come in [to be interviewed], saying almost identical things, but then attribute it to ‘there’s something wrong with me,’ or ‘this is just something of mine, I was born this way.’ And you wished they could hear each other talking.”

Davis knows, from the times he’s presented his research to young audiences, how reassuring students find it to learn that they’re not alone in their feelings, and that some of their anxie-ties might be situational and not just innate. “I think it does give people more of a sense of agency,” he said. “If you know you’re under certain kinds of pressures, you may be able to address them more directly, or feel less threatened by them.” If someone feels bad for a reason, it doesn’t seem right or even particularly helpful to inform them that they are suffering from a chemical imbalance. It might even be socially conservative. As the cultural critic Matthew Crawford wrote recently, tracing all psychic unease back to individual biology “seems to neutralize any impulse to criticize the world”—and such criticism, after all, can be considered one main goal of a liberal education.
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Finally, the question of criticizing the world, or the wisdom of locating the problem in one’s environment versus locating the problem in oneself, is especially important in light of the fact that a majority of the young people who use antidepressants are girls. It’s no accident that a majority of the examples in this chapter—and in this book—have been female. In childhood, boys’ and girls’ rates of depression are comparable, but around age twelve or thirteen, girls surge ahead; for the rest of the life span, women experience about twice as much depression as men.
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There are many theories to explain why this might be, and some of the strong ones are social. Researchers and psychologists have pegged the higher rate of girls’ and womens’ depression to everything from greater incidence of childhood sexual abuse,
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to a culture that encourages girls and women to be polite and “nice” all the time and squelch expressions of anger and aggression. (It is certainly interesting that the great self-squelching project documented by psychologists like Carol Gilligan, Lyn Mikel Brown, and Mary Pipher occurs during the junior high years,
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the same time when girls’ rates of depression begin their upward climb.) Another factor is the prevalence of eating disorders and body-image problems among girls and young women (studies show that up to 64 percent of college women display disordered eating patterns,
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and I was struck that a majority of the college-aged women I spoke to mentioned body image as a significant psychological stressor). In 2011, a UCLA researcher named Linda Sax found that there is a gender gap in self-reported mental well-being among incoming college freshmen, with female students claiming lower levels of mental wellness than male ones; Sax found that this gap has actually been growing larger over the last twenty-five years.
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Though college women earn better grades and graduate at higher rates than their male counterparts, they consistently estimate their academic abilities lower than men do, and the difference in confidence between men and women increases during college.
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Young women who are depressed, for any reason, need help and care. But if girls suffer psychologically in part because they try hard to be perfect and pleasant, learning to hide their feelings of anger and sadness even from themselves, then a culture in which we “treat” young women’s sadness by telling them that it’s a disorder that arises from within their own minds seems likely to reinforce these harmful dynamics, not fix them. Psychiatry has a long, unfortunate history of pathologizing women. The SSRI era, with its stated commitment to science, carried at least an implicit promise that old, sexist categories like “hysteria” would be left behind in favor of a more empirical approach. We need to remain vigilant to the possibility that the transformation hasn’t been complete, partly by not being too quick to hand girls a cure that reduces their suffering to native craziness.
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Young women deserve good treatment. But the best treatment will not discourage them from thinking critically about the extraordinary, changing, sometimes conflicting expectations that shape the experience of modern womanhood, and the ways that these expectations fit into the larger picture of mental health.

BEFORE GETTING IN
my rental car for the drive back to New York, I spent a while walking around the Swarthmore campus. It was dark by then, and clear, with a moon. The grounds seemed quiet without students, but here and there I heard voices, a snatch of laughter. Light and music drifted out of the second-story window of a stone dorm. By any measure, it was a beautiful place. But like all campuses, it was part of the world and fully permeable to its problems.

I thought that it would be nice to imagine a world in which the pressures on college students would slacken—where students would feel as though they had enough time to get a good night’s sleep, or spend a couple weeks weathering a breakup or a fight in the expectation that the feelings would fade over time. I wished that students could better understand the structures that condition their lives, but I saw that even if that were possible, they might not be able to do much with the knowledge. Medications do fill a need, and it seems only reasonable to assume that they’ll keep on filling it.

And maybe that doesn’t need to be a catastrophe. I’ve spoken about the tyranny of perfectionism and the ways in which medication can enforce it, both for individuals and communities. But it doesn’t have to. As I walked, I thought back to my own conversation earlier that day with Nicole, a Swarthmore student I sat with over coffee, beside the plate glass windows of the new science center near the back of campus. Nicole was her own kind of perfect girl, in an intellectual Swarthmore mode. She was an honors student at work on her biochemistry thesis; she played music in a chamber group, spent the summer doing original research at an oceanographic laboratory in California, took the train to Philadelphia to attend genetics grand rounds at the children’s hospital, and was involved in a couple of campus groups. She told me she had wanted to do medical research since she was in the third grade. After graduation, she would begin applying to MD/PhD programs in her field.

Nicole’s antidepressant story began the summer after her freshman year. She went through a bad breakup and spent the end of the season crying and too anxious to eat. The next semester she struggled in classes, developed a stomach problem, and got cut from the varsity soccer team.

Her mother took her to a psychiatrist back home in Minnesota over winter break. The psychiatrist put her on Lexapro. “It was a relief to be diagnosed,” Nicole said. “I had a lot of pressure on myself to achieve, and when I failed my standards, I got really ripped up about it, and I just thought that I was a failure. So when I got diagnosed, all I could think was, ‘It’s not my fault.’ ”

Nicole went to CAPS once for counseling but says that, as someone who’s interested in biological medicine, “I didn’t really know if counseling was going to make a difference. And I’m afraid my skepticism may have communicated itself to my counselor. She actually told me that she felt uncomfortable because she felt like I was judging her. Anyway, I didn’t get a lot out of it.” She never went back.

She did find the Lexapro helpful. The medication “gave me a floor,” Nicole said, “where my emotions couldn’t go lower than that.” On the other hand, she “took myself off” Lexapro after five months because she felt it was negatively impacting her academic performance. “I decided that it was making me gray out, like apathy. I just didn’t care if I got my work in on time.” But by that point, her life had stabilized, and she felt as though the worst of the depression had gone. She says that she’s glad to be off medication, but she’s deeply grateful that it was there for her when she needed it. “I only wish it had been caught earlier,” she says of her depression, using the biomedical language that she prefers.

Nicole ascribed wholeheartedly to the biochemical interpretation of depression, but she didn’t see that view as an invitation not to explore the way the world, or her choices in it, makes her feel. If anything, it’s the opposite: because she is prone to depression, Nicole said, she has to be vigilant and take good care of herself. “I employ a lot of strategies to make sure that the depression doesn’t come back,” she told me. She described surrounding herself with positive people, monitoring her own thought patterns, and making sure she spends enough social time with her chamber group. “I think isolation is a huge component” of depression, she said. “A lot of us are introverts, and it’s easy to hide in your room.”

Nicole spoke of her depression and treatment as a learning experience. In particular, she said, it helped her gain some perspective on the culture of perfection and her own expectations of herself. In addition to making her take her own needs more seriously, her experience with depression helped her to see through the bright and shining myth of the perfect student. “Everyone’s so ambitious when they get here,” she told me. “They think they can do everything. And the college says ‘Yeah, you can do everything!’ But you can’t.” Still highly driven today, Nicole said that now she understands the difference between excellence, which is real, and flawlessness, which can’t be. “Until I fell apart and put myself together I could not accept that being good at something was enough,” she said. “I had to be the best. And you can never be the best. Not without falling apart.”