beating the blind spots

BY REBECCA HEILWEIL

*Names changed to protect sources’ identities.

Anna’s* dark brown locks end with uniform bleach-blonde tips that stretch over her shoulder. Her black dress and moon-white face stick out in the new spring weather. Anna’s shoes are steel-toed and thick. They make her happy. It’s her sophomore spring of college, and things are going well.

When Anna was accepted into the University of Pennsylvania, she already knew her diagnoses by heart. Depression, Anxiety and Obsessive Compulsive Disorder. She didn’t think there was anything new to learn in college: transitioning would be easy.

Though the number of suicides at Penn has only increased, they also reflect a national norm. At least 20% of American youth suffer from a diagnosable mental disorder, while suicide constitutes the death of 11% of teenage deaths, according to the Center for Disease Control.

But only a year earlier, Penn had seen the latest of its suicide streak. By Anna’s sophomore spring, the school had seen two more.

Anna’s plan for care was fuzzy, but simple: a phone call with her therapist from home every few weeks, continuing her medication, and finally escaping high school.

And when she came to college in the fall of 2014, things only seemed like new start. This was her freshman year at Penn, not her suffocating high school in Florida. An Ivy League school nestled in a vibrant city was everything she ever wanted.

But only a year earlier, Penn had seen the latest of its suicide streak. By Anna’s sophomore spring, the school had lost two more students to suicide.

In what has now been called an epidemic, Anna’s story is not a failure, though far from a success story. Rather, her case exemplifies how students who arrive at Penn with mental illnesses are continuously failed at the margins.

After the death of Madison Holleran, a pretty, talented track star, the coverage of Penn’s suicide streak became a national story. Suicides at Penn made the pages of the New York Times, Philadelphia Magazine and ESPN, while the school’s local college reporters struggled to find their footing reporting on such a sensitive topic.

Then, Spring Fling followed. Then, finals. Then, graduation. Then, summer. By late May, the discussion had faded from view.

Over the years, debates over the causes of mental illness have at times saturated discussion at Penn. At others, the topic is pushed to the back of the students’ minds. Today, mental health at Penn has grown into a cycle of activism and acquiescence.

Madison Holleran’s family was relatively eager to advocate for change in the Penn community. Other parents have been more silent.

In early 2016, Olivia Kong, a Wharton junior, committed suicide. Whether she had been to Counseling and Psychological Services (CAPS), Penn’s mental health service for students, and a previous history of mental illness, remain undisclosed.

Immediately, students launched into an internal discussion about mental health at Penn. Some criticized the University’s uneven approach to announcing Kong’s passing. Others again critiqued the “work-hard, play-hard” stereotype they believe exacerbates the stresses of the prestigious Ivy League school. A popular Change.org petition circulated through social media, calling for increased administrative attention to mental health. A mental health-oriented student group appeared on Fox News.

Then, Spring Fling followed. Then, finals. Then, graduation. Then, summer. By late May, the discussion had faded from view.

Anna was not officially diagnosed until she was a sophomore in high school. “[But] looking back, I notice things,” she says.

In the first grade, she was frustrated by blue highlighters. Highlighters were supposed to be yellow, and the unfamiliar was disconcerting. When defeats in elementary school tic-tac-toe games triggered break-downs, Anna’s parents sent her to a therapist. After one session, they stopped.

By middle school, losing was a source of anxiety and sadness. When Anna struck out at softball practice, a source of refuge, she almost always cried. Her team coach pleaded, “It’s just a game.” It didn’t matter, but it did.

She stopped taking her daily pills, and spent a week mentally oscillating in suicidal thoughts.

During freshman summer of high school, Anna became disillusioned and distant, and spent the summer camped in her bedroom, unhappy. Her pediatrician had prescribed Prozac. When it made her feel like a robot, she switched to Zoloft.

Anna’s case was not uncommon. Depression affects about 6% of adults in the U.S., and 4% of eight to fifteen year olds, according to the National Institute for Mental Health. Meanwhile, anxiety disorders can affect almost 20% of the adult population in a given year.

Her parents expected her to manage her own medication, providing little supervision. But by her junior year’s winter break, Anna’s mental health reached its breaking point.

She stopped taking her daily pills, and spent a week mentally oscillating in suicidal thoughts.

“There was a point where I had intentions of possibly harming myself to the point of not being alive anymore,” she says.

When her mom walked in and interrupted what Anna now calls a “spectacle,” she was thankfully stopped.

For the following days, Anna’s mother took off work, refusing to leave to her side. She quickly initiated a family search for a permanent therapist. They wouldn’t mess up this time.

Penn students struggle to identify the causes of mental illness, a question that has intersected with campus social justice movements, religious communities and academic structures. Peers swing back and forth between how they define mental illness, finding  a home somewhere between biological fate and cultural conditioning. Mental health is seen as a product of “Penn Face,” genetic predestination, or something in between.

Loosely defined, “Penn Face” is students’ tendency to hide their suffering.  On the outside, they are optimistic, accomplished, and driven. On the inside, they have unspoken and unacknowledged failures, bad days, and trip-ups.

Many see “Penn Face” as a useful way to explain the mental health culture on campus. In order to deal with struggles like anxiety and depression, Penn needs to be less cutthroat and more open. Stifled and stigmatized, the closeted environment earned the pages of The New York Times.

But Penn is not alone in this supposed phenomenon.  At Stanford, students have “Duck Syndrome.” For Duke women, it’s the struggle to be “effortlessly” perfect and pretty.” Similar cultures also permeate at schools like Harvard and Cornell. For the Philadelphia-Ivy, it’s”Penn Face.”

Yet recently, students have taken to critiquing the concept, filling the opinion pages of the Daily Pennsylvanian, the campus newspaper.

Penn student and writer Katiera Sordjan wrote, “Mental illness is not something that is purely brought on by a stressful course or competitive peers. Your classmates who have been struggling with illness may have been doing so since they were teenagers, matriculating in the midst of anxiety and other mood disorders. Your classmates may begin exhibiting schizophrenic symptoms not because of their workload, but because their genetic codes destined them to fall ill in their 20s.”

Alec Ward, another Daily Pennsylvania columnist known for taking relatively conservative stances in comparison to the liberal-leaning Penn, wrote, “A culture can no more cause a person to develop clinical depression than it can give them the flu. Students would not cease to be affected by depression and anxiety disorders if prevailing attitudes on campus were less stress-inducing.” Instead, Ward placed the failure of Penn’s mental health culture as originating in the stigma against pursuing care, rather than an initial cause for mental illness itself.

For students like Anna, who had diagnoses long before coming to college, the debate over whether Penn’s culture causes mental illness is difficult to engage.

Once at Penn, Anna’s previously bi-weekly, in-person meetings back home with her new therapist had transitioned to the occasional, monthly phone-call. Throughout her freshman fall, neither Anna nor her therapist made plans to transition her to a Philadelphia-based mental healthcare provider. “Coming to college was busy,” Anna says.

And the excitement of freshman fall was consuming: Anna had made new friends in her dorm, joined the literary community on campus, and for the first time, felt like she was fitting in. “I didn’t think that things would go away, but I assumed things would get dramatically better. And things got dramatically better. I am a million times happier than I was two years ago,” she says.

By late November, the phone calls, planned over text-message, had stopped.

Jack, like Anna, was diagnosed with depression before coming to Penn. He was nerdy, donning straight  hair and a humble assortment of tee-shirts. Accepted early decision, he was figuring out his own  philosophical views, while getting closer to the students he’d befriended on his hall.

As a high school senior living in New Jersey, a short train ride away from Penn, he didn’t anticipate that coming to college would challenge his mental health.

Jack says feeling a “lack of autonomy” triggered his call for help. After an initial visit to a psychiatrist, he was prescribed Lexapro, a common SSRI, and directed to see a therapist every two weeks.

Within thirty minutes, he was walked back to King’s Court English House, a Penn dining hall a few blocks. He hoped food would help his sight, but his eyes only worsened.

He returned to his dorm on 34th Street, and quickly swallowed a pill.

Over the summer, Jack’s doctor expressed some interest in his continuing care at Penn, once he began classes. But plans were never made to contact CAPS, and he was not referred to a provider closer to campus.

Jack believed that the therapy he received over the summer had given him the tools to manage his own mental health. “On my own.”

Only weeks into school, Jack decided that he no longer liked how the Lexapro made him feel. He was frustrated by his inability to experience emotions the way he used to, a common side-effect of Lexapro.

“They did go into a decent amount of detail. I was told some people feel ‘empty’ after taking this medication because they don’t feel like they had the same emotions in the past.”

He spoke to his psychiatrist, who recommended steadily decreasing his medication. But weaning off of an antidepressant is a tricky business; to go too fast can risk insomnia, nausea, chills, and electric shock sensations.

In the cool sunlight of September, Jack realized he’d paced himself wrong. As he rallied a tennis ball across the courts of  Penn Park, his eyesight began to fail. At first, small dots blurred his vision; he told his friends from his dorm that he needed a glass of water. He thought water could help. It didn’t.

Within thirty minutes, he was walked back to King’s Court English House, a Penn dining hall a few blocks away. He hoped food would help his sight, but his eyes only worsened.

He returned to his dorm on 34th Street, and quickly swallowed a pill.

The next day, Jack walked into CAPS for a triage appointment. The psychiatrist expressed concern regarding his withdrawal symptoms and told Jack they would hopefully be gone within a week, Jack says he never received a follow-up email checking in. He hasn’t returned to CAPS since.

“It’s not you, it’s the SSRIs,” Anna once told a lover.

Penn is a Playboy-approved “top-party school,” where free time is an endeavor of its own. At college parties, alcohol is aplenty and young people let loose professionally. Fraternities serve beer by the barrel. Downtown, affluent and international students dress to the nines. 34th Street Magazine, a campus arts and culture magazine, found in a crowdsourced survey that almost 90% of students who filled out its survey had had sex. Meanwhile, student groups regularly binge drink at popular Philadelphia BYOB restaurants, while more independent students smoke weed near the lake behind the Medical School. At the “social Ivy,” cocaine and adderall are available to those who seek it. Fake IDs are an industry.

At Penn, students must make careful decisions regarding drugs, sex and alcohol. For those taking mental health and other medications, these choices can be  life-threatening.

Anna had been on medication long before she ever had ever thought about sleeping with someone in college. And by the time she got to Penn, it was hard for Anna to gauge how the medication could affect her libido. She had friends on mental health medications who struggled with sexual performance, but weighing her own sexual satisfaction with the potential side-effects of her drugs was difficult.

When her doctor doubled her Zoloft prescription, the changes were drastic.

College was also harder in other ways.“No one ever told me about serotonin syndrome,” Anna writes in a Facebook message.

“I’m not sure if I really know how my medication affects drinking, because like, these are all things I started when I was 16,” she says. Anna said she knew that she was supposed to be careful with alcohol, but felt uncomfortable bringing up drinking with her pediatrician, while her mother was in the room.

When the body consumes multiple drugs, it risks an excess of serotonin that can be fatal. Symptoms can stretch from muscle rigidity to seizures, according to the Mayo Clinic. These dangers are exacerbated when young people consume illegal drugs, such as MDMA, known as “Molly,” and ecstasy, and often go unreported to personal doctors.

Anna admits to tripping on acid occasionally, which her medications can make less intense. Though when she was younger, Anna says she never discussed weed and drinking with her doctor.

“I’m not sure I know how my medication is affected by weed and stuff,” she said. “Because I started them when I was sixteen.”

The effects of illegal drugs on mental health medication vary significantly. They’re also difficult study, despite usage being incredibly common.

The National Institute on Drug Abuse’s 2015 survey found that 64% of high school seniors had drank alcohol, 49% had used “illicit drugs,”45% had consumed marijuana, and 18% had used non-prescribed medication.

Lisa Mooney, the Director of the Addiction Medicine Clinic at the University of California, Los Angeles says the interactions between “street drugs” and antidepressants can cause seizures, brain injuries, blood pressure problems, and over-sedation.

Meanwhile, online forums like “Drugs Forum” and “Blue Light,” allow online users to share their own experiences, guessing at the effects of   their own personal concoctions.

Jack adds that he “did some research online and it said that if I stopped taking medication the day before taking harder drugs,” the let-down would be easier. He comments that people who take MDMA are encouraged “to use antidepressants afterwards to mitigate the damage done to serotonin receptors.”

Jacks says he had “No discussion of the medication’s interaction with alcohol. I made it clear to my doctor that I used cannabis, and he said that wasn’t an issue.”

But drugs follow people to the death.

According to 2010 data from the National Violent Death Reporting System, “33.4% of suicide decedents tested positive for alcohol, 23.8% for antidepressants, and 20.0% for opiates, including heroin and prescription pain killers.”

In Capogiro, a small cafe nestled under a luxury apartment complex and popular salad bar, Anna fussed with an Italian gelato. With black and blue walls, a marble counter-top adorned by biscotti and baked goods, and large glass windows overlooking the top of Penn’s campus, the cafe is everything an aspiring writer could hope for in college.

But on the late March afternoon, Anna founder herself overwhelmed by the conversation occurring there. Sitting with two friends, a lengthy conversation on internships, resumés and the intricacies of cover letters was isolating.

The first: too busy with assignments. He couldn’t that night. The second: stuck in sorority pledging.  By a third dial, Anna finally had a companion headed to her room. That evening, she called the emergency Penn number.

Their dialogue was disconnecting for Anna, so far away from the conversations with English majors she’d dreamed about in high school. She wanted radical philosophy and artistic discussion, and a back-and-forth about landing a prestigious internship was anything but.

And the daily grind of Penn life had been weighing on her. After a string of illnesses, including a long recovery from mono, Anna’s life had become a balancing act. A shifting friend group and the recent flooding of her dorm room had only added to her anxiety.

Her thoughts that night were not about Penn culture, or even her friends. Anna emphasizes that she later found friends more suited to her taste, what she recognizes as  a common phase in one’s first college year. 

When reminiscing now, Anna is careful with her words. “People don’t commit suicide because of internships.” Pre-professionalism is a frustrating cultural phenomenon, but for her, it was simply one thing among many that pushed her over the edge.

Returning home from the cafe, Anna’s feelings of being an outcast only grew. She’d been relocated to a temporary dorm after the flood; her stuff was a mess. She had a writing contest submission due.

Sitting on a foreign floor, Anna’s suicidal thoughts began creeping back. In a haste, she called friends to come talk. She knew she needed help.

The first call: too busy with assignments. He couldn’t that night. The second: stuck in a sorority pledging event. By a third dial, Anna finally had a companion headed to her room. That evening, she called the emergency Penn number.

The lengths schools go to prepare students with mental illnesses for college vary. In the midst of packing toothpaste and extra binders, preparing orientation materials, and last-minute class registration, it is challenging to make mental health a priority.

“I think I didn’t understand the ramifications of being someone who even if all my dreams come true, I’m always going to have tendencies to be anxious and depressed,” Anna says. “If I could go back in time, I would have made more immediate plans.”

In May of 2015, ESPN reported that when, in 2014, Madison Holleran’s dad asked if she was on top of finding herself a therapist for her freshman year, she said she would get around to it. She told her father,”No, but don’t worry, Daddy, I’ll find one.”

A few weeks later, CAPS had referred Anna to local therapists to see regularly. Eventually, she found someone she liked. A year later, she’s doing better. She’s alive.

Mental health is the kind of thing that falls through the cracks. Follow-up appointments morph into un-dialed phone calls. A lost email, a new patient. Something, anything, more time consuming takes priority.

Then, someone dies.

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