Charlotte and Grace have a lot in common. They don’t know each other and they probably never will.
Those aren’t their real names.
They’re both tall, brunette Weinberg juniors (Grace is in the process of transferring out of Medill), and they both took medical leaves for at least a quarter from Northwestern because of struggles with their mental health.
But their stories are very different.
Grace speaks confidently and lucidly about her struggles with major depressive disorder. She was diagnosed February of her freshman year and attributes her feelings of resignation to her perfectionist tendencies. She pauses before answering my questions, trying to express what happened during her darkest moment in words that make sense.
“It feels like you’re not yourself,” she says. “You feel like you’re not worthy of achieving the goals you have. I thought that intrinsically I’m just worthless, and I can’t do what I want to do.”
Grace is taking two classes this spring, after spending three quarters — Summer, Fall and Winter — at home. She says she’s glad to return to campus.
“It feels excellent to be back and know that it’s different than the way it was before,” Grace says. “It’s good to know that you also have people looking out for you this time.”
It’s clear that Charlotte is nervous to talk to me. She scratches her back with her right arm as she thinks of how to answer each question.
Although never formally diagnosed, Charlotte has experienced problems with anxiety since elementary school. But the panic attacks started making regular appearances her sophomore year of college.
“You can’t explain it to people, because there’s never a rational time to have a panic attack,” she says. “They’re not fun. Everything just kind of closes in and you kind of black out a little bit, and you can’t sit in class when you’re freaking out like that.”
Each time she says the words “psychiatrist” and “depression,” her voice gets lower. She speaks almost in a whisper, as if she’s telling a secret. Essentially, she is.
During a particularly bad panic attack Winter Quarter, Charlotte went to a crisis appointment at Northwestern Counseling and Psychological Services, which led her to withdraw from her classes for a quarter.
After talking for about half an hour, she closes our conversation with a nervous laugh. “I hope you don’t think I’m too much of a basket case.”
Talking to them individually, it’s clear that Charlotte and Grace are at different stages of recovery, and have gone through different processes to get to where they are now. But their situations aren’t unique. Toils with mental health are frequently brushed under the rug by students and faculty alike, treated as secrets mentioned only behind closed doors.
Over the past year, 1,891 students sought help for mental health issues at CAPS, according to Assistant Director for Community Relations Dr. Wei-Jen Huang. The No. 1 reason students cited for enlisting help from CAPS was academic concerns.
“I would say this is a problem at all the top schools in the country,” Huang says. “Whenever we have very intense academic demands, of course the stress affects students’ mental health.”
Is school making us sick in the head?
It’s a well-known fact that high levels of stress are closely linked to a number of mental and physical health problems like insomnia, anxiety and depression. It makes sense that students in a university environment, where stress levels can become overwhelmingly high, have increased occurrences of mental health issues compared to the rest of the population.
About 53 percent of college students reported above average or tremendous levels of stress in the past year, according to the American College Health Association’s Fall 2011 National College Health Assessment.
The NCHA showed that 19 percent of college students said they had been diagnosed with depression at some point in their lives. This is more than double the national average of 9 percent, according to the Centers of Disease Control and Prevention’s Behavioral Risk Factor Surveillance System survey data from 2006 and 2008.
Because the quarter system at Northwestern is more fast-paced than many other universities’ semester systems, it can cause additional anxiety for students, especially those who already have mental health issues, according to Mimi Landau, a licensed clinical social worker based in downtown Evanston.
Landau, who works with students and got her bachelor’s degree in Psychology from Northwestern, says the quarter system is less forgiving for students who may be going through mental or physical health issues.
“Students who do have mental health issues, if they need more extensive treatment, then they often have to pull out [of school] for the whole quarter,” Landau says. “If they miss a week of class, they can catch up on the semester system, but in the quarter system they may have to drop a class, which can produce a sense of failure.”
Charlotte says Northwestern’s four classes per quarter system has caused her tremendous anxiety. After taking a medical leave during Winter Quarter of her sophomore year, Charlotte signed up for four classes in the spring.
“I felt a lot of pressure to sign up for four classes, because I thought I was taking it too easy if I just took three,” Charlotte remembers. “I ended up dropping one of my classes, and then in the fall [of junior year], I dropped another one.”
Huang points out that other universities on the quarter system, like Dartmouth College and the University of Chicago, only require students to take three courses per quarter, as opposed to Northwestern’s standard four. By the time Northwestern students graduate, they’ll have taken about 20 percent more classes than their semester system counterparts, but they also will have taken on average 10 more classes than students on the three class per quarter system.
So if the intense quarter system is to blame for students’ stress and mental health problems, why doesn’t the school switch to semesters? In 1966, such a proposal was made by a Student Planning Commission and was shot down by the student body, according to Huang.
When Morton Schapiro became president of the university in 2009, there was talk of reviewing Northwestern’s academic calendar, but he took no definitive action.
“I do know that it is a question President Schapiro has been asking of students this fall,” Dean of Students Burgwell Howard told North by Northwestern in 2010. “I think he has been a bit surprised at how wedded students have been to the quarter system.”
The results of these failed attempts to reform the quarter system suggest the dilemma of the chicken or the egg: Are students stressed because of the rigor of Northwestern’s quarter system, or do students who thrive under stress choose its demanding curriculum?
“I don’t know if it’s necessarily just the quarter system that makes Northwestern a place where students are prone to mental stressors,” says Lisa Velkoff, co-president of NU Active Minds, a student group with the goal of removing the stigma associated with mental disorders. “I think it’s just a very competitive environment, and we’re all involved in a million different things, and we all take really hard classes, and we all are perfectionists who don’t want to fail at anything. All of those things can be really hard on us.”
The Weinberg junior says that it’s also the stigma attached to mental health issues at Northwestern that prevent students from seeking help to promote a healthier lifestyle.
Swept under the rug
“There’s no Essential NU on your mental health, or your emotional well-being,” Grace says. “I think it’s pretty crucial at a place like this.”
Grace says when she finally began talking about her depression, she was surprised to find out how many people were going through the same problems she was, or felt the way she did.
“I was amazed that the more people I told, the more people I discovered have similar problems or feelings, whether in high school or now,” she says. “But no one really talks about it to each other at Northwestern. If they’re going to [talk about it] it’ll be in secret, or they’ll talk to CAPS, but there’s no really united feeling about it.”
Velkoff says people are afraid to talk about mental health because it’s customary in society to keep it quiet. NU Active Minds struggles with getting students to start a dialogue about mental health.
“We try to take an approach that mental health is everyone’s concern, whether you’re in therapy or seeing a psychiatrist or whether you’ve never had any kind of mental problem in your life,” Velkoff says. “You still have mental health and you have to take care of that in whatever way is best for you: exercise, stress management, time management, having good social support.”
The administration faces another problem in trying to tackle the topic of mental health, which is how to address student issues without scaring off prospective students, including those who want to take medical leave, notes Assistant Dean of Students Betsi Burns.
Velkoff acknowledges encountering this problem with NU Active Minds, and says the group seeks to alleviate the concern through a future project. With the help of CAPS, they hope to create a series of firesides on issues like stress and time management, helping a friend in need, healthy eating in the dining halls and fostering positive relationships.
“We don’t want to necessarily say that while you’re[at Northwestern] you’re going to get really stressed out and you might have anxiety and you might get depressed,” Velkoff says. “But we’re trying to just offer techniques for avoiding those things and having Northwestern and college be the best thing it can be.”
Gender gap
Weinberg junior James* says he fell into a deep, debilitating state of psychosis when he was serving a mission for the Church of Jesus Christ of Latter-day Saints the summer after his sophomore year. James says he’d always been familiar with anxiety and stress, but he had never felt anything like the depression he encountered on the trip.
“About three and a half months into [the mission], one day I sit down and suddenly this force of overwhelming power and hopelessness sweeps my body,” James says. “I became paralyzed; I don’t know how to explain it. I knew anxiety, I knew stress. This was totally different.”
The panic disorder forced James to retire from the mission, and he began seeing a psychiatrist when he returned home. He discovered he had unusually high spikes in levels of adrenaline and dopamine in his system, which his doctor said accounted for his drive and focus, but also depleted his serotonin supply, causing his depressive incident.
“He told me, ‘It got to the point that your serotonin levels got so low, practically to zero, that your mind just shut down and you were stuck in this mental hell, essentially, and you had no control over it,’” James says.
When he returned to campus this spring, James sent an email to his fraternity, explaining what had happened to him. Many of his fraternity members had been confused about why he returned from his mission so early.
“I was never worried about what people thought of me, because I had no control over it,” James says. “And I was never really one to care about people’s opinion of me if they’re people I don’t really care about.”
But in general, many sources including James say male students are less likely to be vocal about their mental health.
Although data shows women are diagnosed with depression and anxiety more often than men, about 40 percent of students who sought help from CAPS were male, according to Huang. It’s difficult to pinpoint the exact reason for the discrepancy.
“I think in general men are able to better handle things alone,” James says. “But because of that general trend, and the awareness of that general trend, men have a pride issue.”
James finds it easier and more productive to talk to his female friends about his issues with mental health.
“I’m very open with women because they’re much more supportive,” James says. “But my guy friends, they don’t really want to hear it. I think they just don’t want unnecessary emotion in life. It’s unclear to me, too.”
Taking time off
Grace took her first medical leave of absence during Spring of her freshman year, enrolling part-time at the end of the quarter. CAPS recommended Grace take two quarters off — Summer and Fall — for a mental health medical leave. Although she returned to school earlier than CAPS suggested, Fall Quarter of her sophomore year, Grace says she wasn’t ready to come back so soon and took a subsequent leave that summer, this time for a year.
“It took a year and a half for me to finally accept that I had to take a break,” Grace says. “I didn’t even truthfully admit it until then. It took that long.”
Many students aren’t familiar with the process of taking medical leave. Velkoff says she didn’t know it was a possibility until one of her friends took time off.
The first step to taking time off is meeting with CAPS. After an initial interview with a CAPS staff member, the student is referred to the Dean of Students Office, where Betsi Burns finalizes the paperwork and makes necessary arrangements with University Residential Life and the dean of the student’s school.
“We try to make it case by case, and individualize it to the students as much as possible, making sure that they feel supported,” Burns says.
The system of medical leaves for mental health reasons is intended to help students get healthy by removing them from the stress of academic life.
“Northwestern is so high-stress and if you aren’t on your A Game, it can really trigger other things,” Burns says. “[The school is] not going anywhere, we’re going to be here, so take the time, get healthy, and come back so you can have a really great experience here.”
Grace says that it was hard to accept that she needed to take time off, because she saw it as an obstacle that would delay her future plans. She thinks part of the reason she came back earlier than recommended during her first medical leave was because she didn’t want to fall behind.
“Going on medical leave was almost like a punishment for me,” Grace says. “I didn’t think it would be beneficial for me to take this time off. I still struggle with that now. It’s like, well, I took time off, I’ll have to graduate later — things didn’t work out the way they were supposed to.”
During her second medical leave, Grace says she stepped back and looked at her problems objectively. This made a major difference.
“For the most part, the pressure cooker atmosphere of Northwestern was not present,” Grace says. “These were issues that I wouldn’t be able to work through if that was influencing me. Also, I just took time to realize who I was as a person and not as an achiever.”
The process of returning to campus the second time was more tedious, according to Grace. She spent the majority of her time trying to persuade people she was ready to return a quarter early, so she could enroll in classes this spring. Ultimately, Burns makes the final decision when a student requests to come back to campus.
In order to be reinstated after a medical leave, students must provide CAPS with a detailed summary of treatment they received during their leave, including “confirmation of the student’s ability and readiness to successfully transition back into the university” and a “treatment plan or recommendations for student once s/he has returned to campus,” as stated in the Northwestern University Medical Leave of Absence Protocol form.
“[Students are] required to meet with me once or twice a quarter at a minimum to make sure they’re transitioning back, they have a support plan in place and they’re utilizing all the resources they have available here,” Burns says.
In the past two years, the number of students who took advantage of medical leaves for mental health reasons has gone up, according to Burns. She also notes the process has become more “accessible and transparent” to students.
Landau says she thinks the increase may be the result of increased awareness of young people’s mental health.
“There’s more diagnosing, and mental health is not quite as stigmatized,” Landau says. “I think the combination of people being much more aware of mental health issues in young people and schools trying to better serve those students are all various factors.”
A person, not an achiever
Taking time off can be an effective way for students to reevaluate the kind of person they want to be outside of Northwestern, Grace says. Her time off gave her a better appreciation for the non-academic aspects of her life, like her relationships with family and friends.
“It helped me see other parts of me as valuable, like how I interact with people and the compassion I have for things,” Grace says. “When you’re at Northwestern, you think about how you do on tests or how you write or how you read or how you memorize things. You don’t think about being a good person. It’s definitely something I learned. You go from feeling like a robot to feeling like a human being.”
Huang says one of the most important things he’s learned in his work as a love, relationship, intimacy and emotional intelligence specialist is the importance of our meaningful connections with people.
“We need to work on our ability to care and listen to our fellow students and never allow efficiency to sacrifice our relationships,” Huang says. “So many students complain because Northwestern doesn’t really have enough down time for students to connect. Friendship is not something that can be forced and rushed. We really need to have some relaxation so we can — have fun and actually listen to each other.”
Editor's note: The subject interviewed in the paragraph titled "Gender Gap" has asked for their name to be anonymized. This request was granted on July 28, 2016.