No Psycho Singles, But Counseling Galore

When J. Daniel Delgado '93 returned to Harvard after a semester away, he went to the Bureau of Study Counsel for academic advising even though he had "no real crisis."

"I knew that I'd be dealing with many of the same academic issues I faced before I took time off, and I wanted to get a handle on them," Delgado says.

The counseling he received there, Delgado says, helped him to find that handle. "It allowed me to focus on what interested me at school, to invest better emotionally in my work and to apply my energy in specific channels," he says.

Though few talk about it as openly as Delgado, many undergraduates seek counseling at one or more of Harvard's mental health care facilities during their years at the College.

"When students come to college, they're exposed to issues they hadn't dealt with before: separation issues, having to deal with a new environment, and individuation, forming your own priorities," says Dr. Randolph Catlin, chief of the University Health Services (UHS) mental health division.

These types of concerns are universal, says Charles P. Ducey, director of the Bureau of Study Counsel.

"I think all students, all of us, have natural emotional concerns about our lives in general, so I don't think of there being a segregated group of people with mental health disturbances," Ducey says.

"New experiences and demands... are generally challenging and exciting opportunities, but they can be difficult to bear sometimes," Ducey notes.

But being at a place like Harvard can have significant impact on how students deal with their concerns, says Catlin of UHS.

"I think there's a higher incidence of stress here. People here tend to see themselves as very competent, and it's hard for many to deal with the fact that they don't stand out any more," says Catlin.

"At Harvard, if you want something, you to go after it. This can cause people to feel very stressed," the psychiatrist adds.

Students at Harvard who seek counseling for their problems have several options. For professional counseling, they can go to Mental Health Services at University Health Services or the Bureau of Study Counsel.

For peer counseling, they can turn to groups like Room 13, Peer Contraceptive Counselors, Response, Eating Concerns Hotline and Outreach (ECHO) and Contact, depending on their particular concern.

Last year, close to 16,000 mental health visits were made to UHS, according to the division's annual report. Undergraduates made up 19 percent of the total, or about 3,000 visits.

At the Bureau of Study Counsel last year, nearly 700 students sought individual counseling.

According to Catlin, the average undergraduate visitor to UHS Mental Health Services is meeting with a professional for the first time and needs only five or six visits to straighten out his or her concerns.

"The typical student is someone in sophomore year saying that he's having difficulty concentrating on work, he's losing interest in courses, he's concerned with an ongoing relationship," Catlin says.

"Students want to talk about concerns and priorities. We try to help them understand what goes into these situations. Medication is sometimes used but that's usually not the case," Catlin says.

Students come to the Bureau of Study Counsel with more than just classroom concerns, Ducey says.

"Because of the bureau's name, students think about us as the place to go for academic difficulties," Ducey says. While that is an "adequate" perception, Ducey notes that many students also come in to discuss broader personal concerns.

"These include pain over the breakup of a relationship, difficulty with eating and food, difficulty in freeing oneself from family expectations, or not feeling like going on anymore with life," he says.

The Bureau of Study Counsel also offers workshops and groups on such topics as group dynamics, "creative relating," anger and men--"Being a man today can be terribly confusing," one sign reads.

Both Catlin and Ducey stress that all consultations with professionals at the Bureau and at Mental Health Services are strictly confidential.

The two services deal with many of the same issues, and Ducey says that which one students choose has to do with such factors as their referral source and whether they define their problems in medical or non-medical terms.

In addition, some make their choices based on the different atmospheres of the two centers--"warm, welcoming, informal or professional, medical, modern," Ducey says.

But Catlin maintains that Mental Health Services is informal too, saying, "We're friendly and supportive. We talk back."

Students are usually just looking for someone to talk to, Catlin and Ducey say. But both centers see some students who have more serious problems.

"Maybe 5 percent of the people we see are diagnosed with serious psychological problems," Catlin says.

"The two most common ones are bipolar depression, or manic depression, and the more serious, less common problems of a schizophrenic type," Catlin says. "These students have illusions, hear voices, experience paranoia and don't function very well. They usually need time off."

Catlin says that the two main reasons for hospitalization are suicidal, or acutely psychotic, tendencies. But such incidents are quite rare, he says.

The Bureau of Study Counsel also sees students with more serious disturbances, Ducey says, but takes a somewhat different approach in treatment.

"We tend not to use diagnosis here," Ducey says. While he asserts that the bureau sees students with "as serious and difficult problems as UHS does," he says, "We're not oriented towards labelling those problems."

But one junior in Adams House, speaking on condition of anonymity, says that he found the Bureau's approach "off-putting" for being even as clinical as it is.

"I was really shocked when I first went in for counseling," says the junior. "I wanted very practical suggestions about note-taking and time management. And the counselors at the bureau ask you how studying makes you feel."

The different mental health resources at Harvard work well with each other, directors say. They refer students to each other, consult with each other and discuss counseling strategies.

"Students often come to both the bureau and Mental Health Services, or to the peer counseling groups and the bureau. It's sometimes useful to get help at different places," Ducey says.

Students who direct, and consult with, the peer counseling groups say that these services have a unique appeal, especially for those who are unsure about seeking counseling.

"We at Room 13 are peers. We're Joe Blow or Jane Blow from your section," says Brian T. Kim '93, co-director of Room 13. "It's easier for students to talk to us...We're closer to student problems."

The Adams House junior, who talked to Contact--which counsels students on issues of sexuality and sexual orientation--agrees that talking to peers can be easier.

"It was such an obviously caring, safe environment. I felt really good about coming out and about the issues we examined at Contact," he says.

"I was surprised by the high level of counseling that comes from a peer group. I went in with a lot of preconceptions," he says.

In addition to the student element, Kim points out another advantage of peer counseling groups: late-night schedules.

"During the day, students are busy. But at night, peer groups come into play--it's a big time for students to call in," Kim says.

However, peer counselors do not establish extended relationships with those who contact them, Kim says.

"We're not there for long term, one-on-one counseling. We're a one-time deal. We don't want people calling in regularly," Kim says. For longer-term counseling, peer groups refer students to professional sources, he says.

The popularity of peer counseling groups does not reflect any problems with professional counseling, said Nadja B. Gould, a clinical social worker at Mental Health Services who supervises four peer counseling groups.

"There is a kind of complementary relationship with Mental Health Services and peer counseling groups," says Gould, calling the peer counseling groups "more like an arm of Mental Health Services."

"Peer groups are an extremely important resource for students who feel timid or uncertain about coming to Mental Health Services," she says.

Traditional views of mental health care hold that a certain social stigma is attached to seeing a professional counselor. But Catlin, who has been with Mental Health Services for 25 years, says that is no longer the case.

"There's no real stigma," Catlin says. "That's really not the way Mental Health Services is seen by the student body, although some parents might think differently."

Catlin adds, "For a while it was even in vogue to say, `What, you don't have a shrink at Mental Health Services?."'

But not everyone agrees that attitudes have changed.

"Like it or not, people retain a stigma about professional counseling, seeing a therapist," said Kim of Room 13.

Kim said that a relative lack of stigma associated with peer group counseling is one of several advantages services like Room 13 have over the professional centers.

If such a stigma does persist, it does so in part because students get inaccurate ideas about psychotherapy from television and movies, Ducey says.

"Please don't believe television or the movies about what psychology is like. We [at the Bureau of Study Counsel] don't do any of that self-affirmation stuff," Ducey says, referring to the Stuart Smalley self-affirmation skits on Saturday Night Live.

"When I'm in pain, I don't want people to tell me I'm okay. I can't imagine how that helps anyone," Ducey says.

In fact, many students are misinformed not just about psychology in general, but about psychology at Harvard. Longstanding student rumor has it that undergraduates with mental health problems are placed in "psycho singles," but Catlin said that Mental Health Services does not involve itself in housing issues.

"We at Mental Health Services try to stay out of the moving business. Occasionally we'll be asked about whether a student requires a single room. There are occasions when it's done, but it's pretty rare. Singles aren't really assigned on the basis of this kind of issue," said Catlin.

Another student rumor--that a student can "sick out" of an exam by claiming to have a mental health problem, as opposed to a physical ailment like a stomach ache or headache--is true, said Catlin.

"Someone can come to us at the time of the exam, not before. They're seen by a clinician who uses his or her judgment as to how serious the symptoms are that would affect the student's taking the exam."

"People can lie, but we try to investigate to get the clinical view," Catlin says. "We can't be sure if it's being faked, but we remind students that make-up exams are much harder, that you'll have other things to deal with when the make-up exam rolls around."

But other rumors--such as the tale that the sickout policy was instituted when a student committed suicide after being refused exemption from an exam--are untrue, Catlin says.

The persistence of such rumors may indicate that most students are not all that well-informed about mental health resources and treatment policies.

Many students only come into contact with counseling services when they are at or near a crisis point, and some, like Delgado, say they believe counselors could be doing more to make students aware of what resources exist.

"Advising should be more aggressive," Delgado says. "Harvard is sort of a swim-or-drown place. The availability of counseling services shouldn't be in that same arena."