Students in Crisis: “It’s So Easy to Disappear”

Depression and anxiety on college campuses have risen to epidemic proportions. There are a variety of suspected causes for the alarming trend, which is supported by numerous studies, including a February 2010 Healthy Minds Study finding that 20 percent of BU students surveyed fit the criteria for anxiety or depression.

Yesterday we began a three-part series examining depression and anxiety among BU students. Part one offered an overview and a look at what’s behind the increase and who is most at risk. In part two, we show the faces of depression and anxiety through a series of candid interviews with students. The series concludes with information on how to get help, what that help involves, and how some students suffering from depression and anxiety—treatable conditions—have found hope, and a way out.

Zachary Barnard was a high-achieving, openly gay high school student who graduated cum laude from a private country day school in Savannah, Ga., when he began freshman year at BU. Leaving his friends and family behind, Barnard found himself feeling increasingly frustrated and dejected. He started sleeping through classes and eventually decided to drop one. Spending weekends in his Bay State Road room, he did nothing but sleep, watch TV, and eat. Sometimes he numbed his pain with alcohol. He gained almost 60 pounds.

“It was gradual, but it got worse and worse,” says Barnard (CAS’13), who is majoring in music. “I questioned my friendships. I’d go weeks without calling my parents, who had always been my sounding board. I stopped responding to my mom’s emails. I felt myself losing control.” He eventually opened up to his religion professor, who urged him to see a therapist. His parents agreed.

Barnard now knows that he is one of the many students at BU and other universities who have suffered from the diagnosable and treatable illness depression. In a national survey conducted by the American College Health Association in spring 2010, nearly 29,000 college students said they felt so depressed they couldn’t function. Another 46,000 felt overwhelming anxiety. At BU last year, more than 10,000 students received help, mostly for depression and anxiety, at Student Health Services Behavioral Medicine.

Among the symptoms of depression are feelings of sadness and emptiness, fatigue, changes in appetite, and a loss of energy that can make the smallest task seem difficult. Depression is not a sign of weakness, and is no more a reflection on a person’s character than, say, diabetes or hay fever. It is more persistent, stubborn, and debilitating than a rotten day or a difficult week, and despite what many people say, it is not something a person can “snap out of.” When it comes to the nearly one in five BU students believed to be suffering mild to severe depression, the staff at Behavioral Medicine have a mantra: “Tell someone.” BU is a big place, “so huge,” as one student who recently went for counseling there put it, “that it’s easy to disappear without anyone noticing.”

If a person suspects he or she is depressed, says David Seeman, a Behavioral Medicine therapist, “a key first step is often to apply to ourselves the same compassion we might extend to a friend who is suffering, and recognize that suffering is universally human, and thus we can allow ourselves to go and ask for help.”

Gina,* in her last year of a master’s program, was sleeping more than ever, but in her waking hours her mind raced and she was anxious and irritable, barking at her roommates over unwashed dishes. “The smallest thing would get me upset,” she says. “I’d ask myself, am I depressed, and then decide I wasn’t—I was getting out of bed, I still had an appetite.” Although she faced major life decisions—the fate of a long relationship and the prospect of finding a job—Gina knew it wasn’t normal to be that unhappy and moody. It went on for two months before she turned to Behavioral Medicine.

Stress comes with the territory for most doctoral students, especially when facing the two-steps-forward, one-step-back pitfalls of laboratory research. In the fourth year of her PhD studies, 26-year-old Deborah* assumed she was up to the challenge, until it hit her how huge a commitment she’d made and how she was growing less confident that she was up to it. “I had this panicked feeling,” she recalls. “For me it was the stress of not knowing if I made a good choice—four years into it and my project wasn’t going well.” Engaged to a man living in another state, Deborah also worried that her PhD work would carry into her mid-30s and force her to choose between her degree and starting a family. She worried that if she quit she’d be considered a failure. “I was a mess,” she says. “I cried all the time and could barely get myself out of bed. I had an upset stomach. I got to a point where I thought, I can’t do this anymore; something has to change.”

She didn’t know it at the time, but Deborah was clearly experiencing several of the symptoms on the list: feelings of worthlessness or guilt, blaming yourself when things aren’t going right, indecisiveness, distractibility, trouble concentrating.

Shawna,* a 20-year-old undergraduate, felt a different kind of pressure. Driven as both a student and an athlete, she always felt anxious. “I didn’t think it was a problem,” she says, because a little anxiety is expected when you’re a member of the athletic community and have to balance class work, practice, and games. But when she contacted Behavioral Medicine about grief counseling after a loss experienced by a close friend, Shawna realized after a few counseling sessions how she let things “build and build and build, and when the tears come out it’s overwhelming.” She had to face the fact that she hadn’t had a good night’s sleep in months, and that wasn’t normal for her. “I’d get anxiety attacks when something didn’t go right,” she says.

Shawna already had a name for her problem: anxiety. But until she began counseling she didn’t know that the problem is an illness—a treatable one. Hers were among the major symptoms of anxiety disorder, which, according to the National Institute of Mental Health (NIMH), affects about 19 million Americans between the ages of 18 and 54. Often paired with depression, anxiety is the number-one mental health problem in the United States today. It is characterized by constant worrying or obsession about small or large concerns, restlessness and feeling keyed up or on edge, and trouble sleeping.

When the Persian poet Rumi wrote, ”Why do you stay in prison when the door is so wide open?” he could have been offering a working definition of depression. Former BU student Alice* had felt trapped in her own mind since age 13. She felt insecure and alone, and by the time she turned 15, “the dips into melancholia became longer and more frequent until I finally reached rock bottom.” She began to cut herself as a form of self-punishment. “It became a release for my frustrations,” she says, “a way to force myself out of the numbness that I felt.” She ate less and less, cried herself to sleep, and began to imagine what it would feel like to die. One day, after a bad fight with her mother, Alice grabbed a razor and pressed it to her arm.

This is major depression at its worst. Suicide is the third leading cause of death among people ages 15 to 24, and a major risk factor is depression, according to the NIMH. Fortunately, Alice couldn’t go through with it, and the next day her mother arranged a visit to a therapist recommended by their family doctor. Like many freshmen, Alice arrived at BU with a diagnosis of depression and saw a therapist at Behavioral Medicine routinely until she transferred after sophomore year. “Depression is a lifelong battle,” she says. “I thought for the longest time that asking for help was a sign of weakness, but through the years I’ve learned that it is actually a testament to one’s strength.”

All of these students suffered, but all of them are fortunate, because they found their way to professional counselors who put them on the road to health. Zachary Barnard is seeing a Cambridge psychiatrist twice a week and taking an antidepressant. “I’m making an effort to be a lot more honest with myself, and losing the sense that something’s wrong with me,” he says. Enamored of ethnomusicology, which “speaks directly to everything” about himself, he has found a release in writing for his blog. “It’s to explore the world and how I’m experiencing it,” says Barnard, who now runs, works out at the gym, and looks toward the future, as he puts it, with enthusiasm and optimism.

After visiting a therapist at Behavioral Medicine for several months, Gina was feeling better able to cope and decided not to return for a while. “I feel like part of the reason I do okay now is I’ve made a lot of life changes,” she says. “I go to the gym, do yoga once a week, and made some friendship choices, leaving some people behind. At my last visit I felt, I’m okay. When you say you’re in therapy, some people think you’re one step away from a mental institution, but I had a friend say that she went and it really helped her.” Her friend told her not to give up, and after her second visit Gina began to feel at ease. “The therapist told me so many people feel the same way as I did,” she recalls. “I was normal.”

At first, Deborah, too, was reluctant to get help. “My mom has always had the opinion that going to therapy means something’s wrong with you,” she says. But after much thought, Deborah came to the conclusion that struggling through by herself, if it were possible, would take far too long. In therapy at Behavioral Medicine, she and her psychiatrist decided that a very low dose of an antidepressant might help. That and talk therapy have made “a huge difference,” she says, although she understands that she is likely to be coping with depression on and off throughout her life. Now in the throes of her doctoral thesis, Deborah is still under a lot of stress, “but I can handle it much better,” she says. “My stomach is great. Everything is worlds better.”

As for Shawna, she says she’s learned to deal with stress a little better. “My personal opinion is that everyone could benefit from therapy,” she says. “And athletes have a lot of pressure, even if they don’t have a disorder.” Her words echo what the other students expressed in their own way, and what Behavioral Medicine counselors want everyone to know: “It definitely helps to talk to someone.”

*These students agreed to speak to BU Today anonymously.

Those interested in seeking free, confidential mental health counseling can contact Student Health Services Behavioral Medicine, the Center for Psychiatric Rehabilitation, and the Samaritans of Boston suicide hotline.

Susan Seligson can be reached at sueselig@bu.edu.

Tomorrow, BU Today will publish “Climbing Out,” part three of the three-part “Students in Crisis” series.