Beyond the Campus Counseling Center

Lisa

Before we start, please know that this episode discusses mental health issues, including suicide.

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So, at the beginning of the school year, I was really frustrated by my institution asking faculty to become, essentially, mental health responders. We were asked to spend hours in training when we are already pretty overwhelmed. And it kind of felt like the university was taking the mental health crisis and dropping it at the feet of instructors. Honestly, I'm still a little annoyed by this, but I've actually changed my perspective a little bit.

Gary

I've been rather intentional at relying less on the phrase "mental health". Mostly, because as soon as we employ the term "mental health" or "mental health issues" something happens where the automatic reaction is to refer to a licensed clinician.

Lisa

This is Gary Glass. He's the director of counseling and career services at Oxford College of Emory University. And he and his staff are...

Gary

...exhausted. Uh, we're exhausted. There are folks who are leaving in numbers we’ve never seen before. It isn't just the work. I can handle the number of therapy appointments that I'm providing every week. It isn't just the work. It's the line out the door that seems like it's never-ending and the sense that we are, the ones that they need.

Lisa

When I first heard Gary talk about the stress he and his staff were under, I was sitting in my office watching him on a webinar. And look, I'm not the kind of person who is like, honestly, easily engrossed by a webinar, especially these days. But what he was saying, oh my gosh, it really just hit me because the longer the line is outside of Gary's door, the higher the fear that something really bad could happen.

Gary

I think we are among those that can help, but it's the responsibility for the, the state of our students and the ever-perpetual fear that a tragedy of suicide or homicide is going to immediately link back to "was the counseling center not getting students in soon enough?"

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Lisa

I'm Lisa Levinstein and my long-time co-host, Nan Enstad, has stepped away from the show. So today on Collegeland, I'm flying solo. At the end of the show, I'll be talking to a wonderful professor who's taking mental health seriously in her classroom. But first my conversation with Gary Glass.

Gary's been working in college counseling centers for over 20 years when he started “mental health" wasn't even a term they'd really use that much and they definitely didn't have lines out the doors. He actually had to walk around campus and recruit students to use their service. Today things are so different. A 2020 study found that nearly 40% of college students experience depression and 13% have had suicidal ideations. And Gary is seeing more and more students, many of them self-diagnosed. And he thinks one of the first ways to address the mental health crisis might be changing how we talk about it.

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Gary

I prefer to, to talk, not about how pervasive depression and anxiety are, I like to talk about how pervasive, scared and lonely, and tired are. And that's not saying that there is no such thing as depression and anxiety, but since those terms are losing meaning more each day, we're also losing the ability to go from what I call a "recognize and refer" model-"oh, I recognize those are the signs and symptoms of depression that the counseling center warned us about, you know, refer them to counseling"- from a "recognize and refer" to a "recognize and relate," shifting from "you really need to talk to a professional" to "I can relate to that. I can relate to that." And talking to a professional may still be relevant, it may still be helpful. But I'm hoping that we can think about adding or at least restoring the, “I can relate” that reduces the isolation, which can lead to a lot of the loneliness, which shows up as depression.

Now we're in a place where almost anything can be narrated as a mental health problem. I do think we have reduced stigma, but my problem with it is this, this dichotomous way in which we go about assessing this: "Am I depressed or not?"; "Do I have an eating disorder or not?" And then there's varying levels of stigma in different communities, but my concern is that as long as we stay in this dichotomous mindset, we don't get curious about “what does this even refer to?” For one person, the depression has more to do with an exhaustion of 18 years of striving for excellence. For another the depression has more to do with navigating all of the different ways in which it's harder to carry around the identities that they carry.

For another, it's much more of a, of a chemical, uh, a neurological issue where the serotonin and the norepinephrine levels are just different. And so if we can become more curious about what is actually pressing us down, I think we will become much more curious about how we can address this problem besides another 50-minute therapy appointment that takes two weeks to get.

Lisa

I mean, isn't that part of your profession, in a sense? Like, I'm just saying like the, that the need to diagnose, you know, like you decide an eating disorder has these characteristics, and if you meet five of the six or whatever it is, then you get that diagnosis and that's important for billing and insurance and all of these things. So it seems like part of that idea comes from this kind of professional relationship that is also highly medicalized, right?

Gary

Yeah. Yeah, absolutely. And I want us to be able to help the students with a bulimia. I want us to help the students who are, who are navigating horrible, horrendous traumas in their lives. However, even those students and a lot of the students who do not meet the criteria for these disorders who are taking up many, many therapy appointments because it's also just narrated as depression and anxiety, in fact, there's a particular anxiety diagnosis, generalized "anxiety disorder." But when we look at what they're anxious about, it would be really interesting to see how many hours in any counseling center’s week of appointments are taken up by things that are directly coming from the culture around grades. How many of them are coming from the fear of just being lonely and other people knowing that I don't have friends? I always say my biggest frustration is that because of confidentiality, which of course we need, I can't introduce my 10:00 AM appointment to my 2:00 PM. The, the number of things that our students that are struggling with that are a reflection of the campus cultures they come from the social realities that we all deal with. Those are so numerous.

Lisa What Gary's talking about here flipped a switch for me. There are two dimensions of the campus mental health crisis, the people who are suicidal, who have severe eating disorders, who have schizophrenia, the people Gary fears are falling through the cracks, ut Gary's also concerned about the many, many people who are suffering from problems that are also extremely widespread. I mean, think about it, we've all lived through a pandemic and we know it disproportionately affected those who are already marginalized and there's been so much exposure to horrific violence against people of color. Not to mention the ordinary pressures of being a student, the papers that are due, the exams that need to be taken. So when you combine the pressure of the culture at large and the pressures of the university, you have this perfect storm of conditions to make people anxious and depressed, and isolated. But what if, instead of making an appointment at a counseling center, we started talking to each other?

Gary If we could reduce the demand for services even by just 10% with folks who could simply have a conversation in the form of mentoring, we will discover that mentoring is often therapeutic in ways we haven't appreciated. And that friendship is inherently therapeutic in ways that we haven't appreciated. That might allow us to offer more sessions to those who have trauma backgrounds or who are facing, uh, much more, uh, impairment and, and threat out there.

Lisa

And then you are seeing the number of those students significantly increase as well?

Gary I remember in the 1980s, when I was an undergraduate at UNC Greensboro, actually I remember the word "codependent" started be everywhere. And so what I think is we are seeing more students with these more severe struggles. How much of that is that there's more language around that and so the self-diagnosis is just more frequent. But even, even those are losing meaning, because I think with our emphasis on trauma-informed care, we are approaching a point where we may not all be talking about the same clinical situations when we use the term trauma in the same way that I think depression and anxiety are, are losing their meeting in the lay public. But yes, I do think they are increasing. Uh, but I also think that they are increasing because, uh, there's more hostility or at least more access to hostility and when we think about just the, the amount of time that, that our college students spend just through their phones, which are with them 24 hours a day, it seems reasonable to expect that that's going to increase both the distress and the awareness of the distress.

Lisa

You know, there may be many dimensions of the mental health crisis, but the bottom line is that the number of students suffering in one way or another is escalating.

This semester, I've had more students crying in my office and actually breaking down during my classes than ever before, not to mention all the late and missed assignments. I mean, in some way or other students keep telling us that they aren't okay, while the university keeps pushing us to return to normal, whatever that means. So I asked Gary what he thought faculty should do.

Gary

One of the problems in higher education is that students are less interested in learning much of the time and more interested in simply completing coursework towards earning credentials. So that's one thing faculty can do is let me acknowledge grades matter but if they're going to matter, let's talk about what they actually mean and the actual impact they will have. The number of students who think a "C" in their first year of college is going to derail their entire careers… Faculty can have those conversations and you never have to mention counseling or mental health.

The other thing that I think faculty can do, is when they notice that their students are stressed because you do you notice when they're more stressed, particularly around midterms, just acknowledge "this is stressful, college is stressful." There are predominant mindsets that on one hand seem to be the recipe for success, but they also overlap with a lot of the symptoms of depression, anxiety, disordered eating, you name it.

There's an impatience to reach success by the twenties that goes against everything we know about learning and life. If we can just return to the idealistic notions of higher education prepares us for life by preparing us to think, teaching us to relate, towards building confidence, that we will build a life as opposed to offering credentials that will earn us access.

We have an overemphasis on control and certainty. You have to have as much control, uh, uncertainty is a bad thing. That's one that's underlying just about every student and faculty, and staff member for that matter, that struggles with what we like to call "anxiety" because we've somehow banished the word "worry." So, an overemphasis on certainty and control within that is, what I call "over-worship of the quantified"- GPA, number of followers, number of likes... The institutions themselves fall into this as we get concerned with where we are in the state or the national rankings; a banishment of vulnerability, this sort of never-let-them-see-you-sweat mentality; marginalization of other, and I think that that refers to some of the social ills that we've been dealing with forever: racism, misogyny, homophobia, this sort of toxic masculinity, uh, and a devaluation of the feminine.

Lisa

This idea of vulnerability and control being at odds is so important. And it's one of the ways that mental illness becomes a systemic problem. If our culture only values productivity, well, I mean, everybody's mental health is going to suffer for me. This all ties back to the idea of care. Higher education is talking a lot about creating a "culture of care" at the same time that we're undergoing budget cuts, laying people off, and having this intense push to conduct "business as usual" in a time that seems anything but normal. I asked Gary if this type of disconnect, you know, using the right words, but with no meaningful actions, I asked him if this was part of the larger problem.

Gary What I think we often miss, institutionally, is naming what undermines the things that have allowed us to just naturally be a caring culture. If we don't address some of the sort of toxic competitiveness that's pervasive we are forcing our students and our faculty and staff to choose between wellbeing and productivity or success. Because the reason that we even need a mantra of "culture of care" is that somehow we have all become so disconnected from our natural tendency to do.

So I'm all for a “culture of care," but I, I, my hope is that we can do that by restoring nuance in communities that tend to rely overwhelmingly on these false dichotomies: success/failure, good/bad, right/wrong, failure... you know, and re-ignite curiosity. That's what educators and therapists have in common, we reignite curiosity. And I think that that relocates us to our natural tendency because we'll be curious about each other, but if we simply promote care without actually addressing what undermines it, what are the barriers to us doing that? Then, I think we'll just keep repeating ourselves and we'll have another few "wellness pies" and "wellness wheels" and, and our students are far more alert to this. They, they are far more challenging institutions to say, "how dare you, uh, tell me that you want me to have 'wellbeing' when you ask so much of me in terms of all of this." And I think that that again reflects a misalignment between the endeavor of pursuing, uh, college degree and all of the work that goes into providing students with an education.

Lisa What do you think about the new emphasis, well, I don't know how new it is on "self-care" as a kind of message that we are, we hear a lot about that...?

Gary

What I think is nice about the concept is that it is encouraging a bit more attention to being in a world that demands doing, doing, doing, doing, doing, and it invites a little bit more kindness, uh, to those of us who are struggling with everything from the pursuit of our goals, to navigating the oppressive forces of this world. Because survival is a inherently stressful place to be. But if I am engaging in self-care without attention to how we are engaging in community care and taking care of each other, then I think it, it can become, uh, something that just replicates structures of privilege. Solidarity is far more necessary than self-care because it does two things. It reduces the marginalizing forces that enhance isolation and a sense of "I don't belong." And it reemphasizes that the problems are systemic. I think the last several years, the activism that we've seen has actually produced incoming college students that are far more versed in systemic oppression than a lot of our, uh, senior professionals working in higher ed.

But I do think we still have a lot of work to do because our higher education structures, our social realities, can really cause folks to self-blame when they're struggling.

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And so, this is where my passion to really think about mental anguish as something that can be addressed beyond the clinical hour. Because at the end of the day, I'm treating the consequences of racism, misogyny, homophobia, wealth disparities, religious intolerance. There's a joke in our department that we need to put a particular professor on the payroll who teaches in, uh, the, the same, uh, program title that you have, uh, Gender Studies, Women's and Gender Studies, the number of things that come up in her lectures that help students recognize "there's nothing wrong with me, this is, these are systemic forces that are causing me to question who I am and what I'm worth." Race, Class, and Gender Studies are among the more therapeutic ones, Sociology, Cultural Anthropology. I have an undergraduate degree in English. I use my undergraduate degree in English far more than I do my training and my doctoral level in psychology because it is so much more nuanced than the highly clinical, medicalized way that we're approaching it.

Maybe what we really need is to think more about the world that we're in and our place in the world, and that it's not just a liberal arts education, but a liberating arts education.

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Lisa

As the director of the Women's Gender and Sexuality Studies at UNCG, I love hearing Gary say that our classes could be liberating for students. Because I see it happen! And actually, we have a professor just like the one Gary described, someone who opens students’ eyes to larger social issues while also being really mindful of their individual experiences, including their mental health. Her name is Tiffany Holland. And if I sound like I'm gushing a bit, well, I am! Tiffany teaches our Feminist Theory class and she's a good friend of mine. She and I have been talking about students' mental health since the early days of the pandemic, so after I talked to Gary, I called her...

Hi, Tiffany!

Tiffany

Hey Lisa!.

Lisa

So, Tiffany, this whole episode is about student mental health and it's just so much reminding me of that story you told me about your first day of classes this semester. So now I need you to tell it on the record.

Tiffany

Sure! First, let me say it was a mess, or rather I was a mess. My class meets at 9:30 in the morning, I had to cancel the very first class session of the new semester because my entire household had been taken out by some kind of virus that was not COVID but still knocked us all out for about almost two weeks. My kids who are in second grade have remote learning again after their winter break. So it's all just felt like March 2020, all over again in our house, my syllabus was still not completely ready, my kids were off the chain, and I had to basically abandon my partner with them while I rushed to campus. I get to my car and I have to immediately turn back around because I don't have my keys or my phone. My partner meets me at the door. I can hear one of my kids screaming at his brother and my partner is just holding my keys and phone out to me with this like shell-shocked expression. Okay. So I'm now late to campus and, as you know, trying to park on our campus at the start of the semester is always a beast. So, I'm like circling the streets, finalizing my lesson plan in my head and watching the clock just keep creeping towards 9:30. I'm five minutes late to class, which, you know, is actually pretty okay, all things considered, but I'm sweating and out of breath. And then I'm like meeting my students for the first time I run up to the computer to log on and I can't pull up my agenda or my account because now I can't find my phone. And you need a phone, so the university's network can text you a code just so you can do your job, right? I know I didn't leave my phone at home because remember my partner handed me my phone, but I have no idea where it is now. So I'm just old school writing on the chalkboard, trying to remember all that I wanted to do this day.

So, okay. At this time, I just stopped, Lisa. I cannot fake what a hot mess I am at this point. Right. So I just take a breath. I look at my students and I can't read their expressions, right, because of the mask, you know? And I think I say something like, "yeah, so I'm a mess, welcome. We're going to start with introductions, but I'm going to start." And I tell them my morning and I ask them how they're coping through all of the world as it is right now. And we took the first 20 minutes or so openly talking about how we all have been coping with everything. And I had already implemented an opening activity about creating an accessible space for the course. I asked them two questions in addition to their names and pronouns: “where are we right now?” And “what do we want to?” The conversation was brilliant, Lisa, the students were really honest about how much they have been struggling and how much they continue to struggle. They shared their own hot mess stories. And within less than 20 minutes, we were teasing each other, laughing, and making community. We talked about being charitable with each other and with ourselves during the semester, we promised regular check-ins to assess if we were doing okay. But I did ask them, look, when you email me for an extension or whatever, don't start with, "I don't know what's going on, I just don't know why I'm struggling." And instead, just remember we are all struggling, but most importantly, just communicate with me. I asked him not to go into hiding because of shame. Then when we finally got to the lesson of the day, which was about their past experiences with theory and how to approach difficult texts, they were like mad engaged, Lisa. I mean, they were making connections, actively listening to each other, asking follow-up questions, all those outcomes you want from a class, you know? And now I'm just bragging, okay, but also totally telling you the truth when the seventy-five minutes were up. And, um, I'm not lying about half the class said, "oh man," because we were just killing it. I felt like a rockstar or like a rainbow unicorn, magical teacher or something.

Lisa

You totally are a rockstar. You modeled vulnerability, you got the students involved in creating a culture of care, and you did all of that on the first day of classes.

Tiffany

Yeah, no, I really was, thank you. And I was really killing it. And we've continued that throughout the semester and in some ways we're lucky because, um, you and I, because our discipline is committed to like feminist practice in our scholarship and our teaching, and I'm thankful that I have that tradition to lean into at this particular historical moment.

Lisa

Me too! So, Tiffany, what do you think about this idea of mental health problems like depression and anxiety being systemic? I mean, I think we're seeing that on our campuses for sure. And while, you know, I understand what Gary is saying: the fix can't necessarily be putting everyone into intense therapy when you consider what systemic actually means. I mean, the fix is even harder to fix is dismantling racism and free-market capitalism. And even if we just look at the campus level, the fix requires combating the emphasis on professionalization rather than lifelong learning and free inquiry.

Tiffany

Yeah. So that's all we have to do, Lisa, we just got to dismantle racism and capitalism? Yeah, the problem is huge for sure. So while we do have to address all those challenges, I think that faculty can play at least a small role in turning the tide. But listen, Lisa, I promise this doesn't mean I'm going to tell you that you have to sign up for a bunch of weekend retreats or after-hour trainings, instead…

Lisa

Yeah, no. I do not do pajamas with my colleagues, like no way not happening,

Tiffany
So, right. So instead we need to double down on building community in the classroom so that students will stay, right? We need to remember the point of education, and I'm talking the big "E" education, the social good of education. That is not so students can pay tuition it's so that they can sharpen their skills to think of new ways to get out of this hellscape we're in right now. Can we also just take a moment to recognize that the people tasked with addressing the student mental health crisis are folks also in a mental health crisis. Faculty and staff are also overwhelmed and burned out. A solution of community, of interdependence, has the potential to make everyone's lives and jobs easier. What do we do about the fact that some students are not showing up for classes or are repeatedly asking for extensions on their work, or the ones who are silent in-class discussion and are just disappearing? Do we just keep it moving, move on to the next unit? Go ahead and give that midterm that we know they're under-prepared for or too exhausted to even take? Do we as profs even have the bandwidth to grade those midterms, if, and when we get them? Dude, can we just all take a collective breath and just assess what we're doing right now?

Lisa

[laughs] Uh, collective breath. Yeah. Right. I mean, that seems like the antithesis of what most people on campus are doing right now. Instead, we're like in overdrive, trying to crunch the numbers, and figure out why students are struggling. I mean, I cannot tell you how many statistical analyses and graphs and charts I've seen. I mean, as far as I know, none of the people doing these statistical studies have actually just kind of taken a breath and sat down, talked with students, talked with professors to see like, what is actually happening. Though, you know, I am not sure we can actually completely let faculty off the hook when we're talking about the collective breath. I mean, there's a real culture of workaholism in academia, I mean, I know so many people who feel guilty if they aren't working, basically all the time, like including weekends and evenings. And I mean, Tiffany, what do we say also to those professors who say they can't take a breath in their teaching because I mean, "what would happen to rigor?" Or those who are worried that we do students a disservice by not preparing them for what will be expected of them when they get out of school in the job market or, you know, "the real world?"

Tiffany

First, okay. I hate those arguments. Okay? So our students are now in the real world. The academy is the real world and what is more rigorous than trying to get a degree during a global pandemic, a struggling economy, war, and social and political unrest? Really, like what is more rigorous? Our students who continue to show up in whatever capacity they can are superheroes right now. If they can actually finish it with a degree, will I care if they remember some specific date? No. Nah! Like, I want them to feel an investment in solving all the ills and confident that they have the skills and knowledge to do so. So do we have time for me to tell you a little victory about our students actually being superheroes?

Lisa

Yes! Please! We need these victories!

Tiffany

So at one of the institutions where I teach our Student Senate sent out a survey right before spring break about student needs. Overwhelmingly students reported, um, being burned out, uh, motivated, stressed out, depressed, anxious. Everything that faculty and staff are experiencing right now, right? So the Student Senate collected the data, wrote up a report of their findings and then approached the provost and the faculty Senate proposing a campus-wide wellness day the week before spring break. Now we'll note that there was some faculty pushback: "why have a wellness day right before the break, especially when the semester has already been disrupted?", "why can't students just take an absence and then learn that their actions may have consequences?" No, this is for real, some of the feedback that faculty provided, I just saw it so differently. Our students were legit doing the thing. The big "E" education thing. They were social scientists and agents of change, right? Like they're collecting and interpreting data, assessing and addressing needs, approaching and trying to influence people with power, and building community while they did it. It was like, it was awesome!

Lisa

So what happened? Did, did you have a wellness day?

Tiffany

Of course not, Lisa! No! The administration left it up to the individual professors. Many of whom did offer their students. I canceled all my classes, um, at both my institutions. So only one school day, but I also gave a wellness day to my other students.

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I told my students to take a walk, hang out with friends or just nap, because that was what I was planning to do. I cut some of the readings from my syllabus. And you know what, for that day, we were all good.

Credits:

Collegeland is produced by Craig Eley (EE-lee) and Jade Iseri (EYE-siri) Ramos (RAH-mos). Danyel Ferrari (DaeN-YEHL fer-AH-ree) is our researcher and publicist. Tiffany Holland was our guest. Music in this episode is from blue dot sessions. A special thanks to UNC Greensboro for their support. Collegeland was hosted today by me, Lisa Levinstein, and was created with Nan Enstad.

If you've made it this far and liked what you've heard, let a friend or a colleague know. We're always looking for new visitors to Collegeland.

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