For college students

When asked to think about a mental health resource, society has filled in that schematic category with some kind of institutionalized, specialized, well-educated expert. We are told that there are people out there who know about this kind of thing, who will intervene and help us out. In grade school, you would make your way down to the front office, explain yourself to gatekeeper of student affairs (the secretary) and you would be referred someone who would take charge in the matter, like the nurse or school counselor. To a child with any confusion or problem: reach out, talk to someone, “go tell an adult.”

Now we grow up and mature and stray away from adult answers in adolescence by finding our own voice, our alternative answers and seeking contact and support from our friends and romantic partners. Life opens its arms, age invites freedom and the struggles are balanced by novelty and excitement. For the most part, we figure out ways to cope and process the strange or painful, and eventually previous troubles lessen their grip on our spirit and become part of our unique personal history. We look forward.

Until the next challenge hits like a tidal wave and shakes us to our core. In a world where social contact is morphing in shape and frequency, our generation is confronted with entirely new challenges in day to day modern culture. Where the majority of individuals now have a cyber-persona in addition to their physical selves, where reality marches on in one’s waking hours and also snatched and frozen in pieces of immortality by photographs, videos, social networking sites, blogs, – and not to mention all the collected and saved data as well as internet history – we are in a constant-transient state.

With such a rapidly connected and changing reality, novelty is the norm. The brain is filtering sensory stimuli at a faster and faster rate, far surpassing the information that is received, transmitted and processed. Naturally reactionary struggles ensue. External forces push internal drives to produce oscillating shifts of power. The individual takes on characters and social roles throughout development to meet basic needs, responsibilities and important connections with others. Every culture in the world, from the island warriors of Papua New Guinea to the sadhus of India to the soft civilians of industrialized Florida, there exists madness or some kind of manifestation of mental pain. Within every cultural context there is a unique expression of mental pain and suffering, linguistically, artistically, superficially or spiritually. Physical pain has its remedy, however mental pain’s remedy is often placed in the hands of authority figures, of politically structured engines of knowledge that will point the finger to causal reassurance.

When mental fragmentation occurs, when reality breaks down and is replaced by emotional pain, internal voices, severe paranoia, repetitive thoughts and negativity, the self is no longer whole. As social beings, one must reach out and hold onto reality in order to sustain life. A mental health resource is a socially acceptable term for something or someone to hold onto in this time, to grasp and acquire new knowledge to make meaning of current existence and ideally, to bring about change. Resources can be a simple google or library search of psychological literature, picking up a good book or a paint brush, talking to a close friend or simply petting a friendly animal.

However often reality does not meet with the ideal social influence and advice, friends cannot be bothered or burdened, and communication and expression of mental distress may be incredibly difficult. An individual may not even know what is happening let alone how to explain what is going on with them. College men and women face very different social expectations of how to express themselves, in joy, grief, excitement, love, health and sickness. Compounded by cultural differences in expressing mental state of mind, a students’ mental health may be further burdened with troubles with family, finances, childhood trauma or political or social discrimination. Family may not be the optimal support system, as autonomy and future goals become more important for the young American adult.

Student life at the University of Miami is dynamic and about as diverse as any college experience. Although not much of a college town, UM offers a wide variety of campus experiences, classes, clubs, athletics, creative outlets and social interactions. The microcosm of campus life is abound with opportunities but the semester’s grind can be relentless, professors pile on work, exams, papers and it often, and understandably, becomes overwhelming. Mounting stress may create a state of crisis, and for struggling students in need of help. So where does a struggling student go in a time of crisis? In such a situation, the go-to place they tell you since day one of freshman orientation is the Counseling Center. As large and well-funded as the University of Miami is, the UM Counseling Center is tucked away on the bottom floor of one of the old buildings across from Eaton Residential College marked by a small sign. I visited on a hot, sticky Wednesday afternoon to meet with Kirk McClellan, the Assistant Director to talk about their services, stigma, and the student body.

Having heard largely negativity associated with the Counseling Center, I sat in the waiting room staring at the confetti of paper pamphlets on every imaginable “mental illness” with great apprehension. Mr. McClellan arrived within five minutes, dressed professionally, with perfect blonde wavy hair and kind blue eyes. He greeted me warmly and we proceeded into his office to chat, me on the couch and he in the facing chair with a yellow legal pad. I felt like I was in for a therapy session, until I pulled out my ARC-borrowed tape recorder and questions and he immediately reiterated that our conversation would be totally confidential. He joked about seeing a spread in the Miami Hurricane and I reassured him it would only turn up on wordpress. I began by asking him about his job at the Counseling Center. Having briefly spoken about my project on the phone, he launched right in, speaking quickly and efficiently.

Mr. McClellan is currently filling in for the director, as she retired last year, by managing university crisis situations and primary duties. He is on call 24/7, most of his time is spent doing clinical work, as they are significantly understaffed. They have seven full time licensed clinicians and three pre-doctoral interns.
Their mission is to “get them through their academic career, in a productive and enjoyable way. And in that spirit we do anything that’s crisis in nature… related to the university environment, but we do brief solution-focused therapy.”  A lot of times students have a lot more significant issues that require ongoing treatment, so they do a lot of referrals. The Counseling Center face very big budget constraints, he says but they are a big priority for the University in light of recent mass shootings.” They are working to improve and expand their services in physical space, staff and services. He comments that they are converting the utility closet to accommodate the newest psychologist on staff. They need to double the staff to meet national accreditation of counseling centers, who require one counselor per 1500 students. The Counseling Center is housed under the Department of Student Affairs, although he stressed that they are neutral party between the student body and the University’s administration. They use a short term model, where they will meet with a student in crisis, do a psych evaluation and hold therapy sessions once every two weeks (due to time and money limitations), and “hook people up with services to get through their academic career.” He tells me they do a lot of referrals, as more and more students are coming to the university counseling centers with a long history of counseling. They are used to the “more intensive model” (i.e. in depth therapy sessions) so “a big service is referrals” to mental health professionals in the community. “The stigma is lessening,” he tells me.

All therapy services are free, except for seeing the psychiatrist, but that is also free with student health insurance. Students can only be prescribed medication by the Counseling Center’s psychiatrist if they have had therapy sessions with them for one month. Students seeking help meet with a counselor in a “Walk-in,” an immediate therapy session for a “crisis that can’t wait,” where they do a brief evaluation so as to determine they are not a danger to themselves or others. An “intake” is a previously scheduled appointment, very high in demand, where they meet with a therapist, discuss their background and personal history and develop a treatment plan. “We decide if its appropriate to treat here at the Counseling  Center or we refer them off. It’s very easy process, the initial intake process is a pretty big barrier then from there it’s pretty smooth process.” He tells me that the Counseling Center “has to appear neutral, unbiased and not advocating for the university…We’re here for students, students have to come to us, we can’t go out and get them.” The Dean of Students is in charge of campus security, with the expectation that students are emotionally prepared to be at school.

Mr. McClellan is the first to bring up “Baker Acting” someone when I ask about third parties contacting them to intervene with someone suffering from mental pain. He cites an example of a student will be Baker Acted by the Police Department, and the Counseling Center is not involved at all. The University will involve the Counseling Center to determine if a student is “stable enough to come back to campus.” Then the Director will administer a mandated psychiatric examination, but he stresses their assessment is “only one of the larger determining party.” He says typically the way it happens is someone comes to the counseling center and makes it known that they are in imminent danger of hurting themselves or others. If they are suicidal, they must verbally communicate a plan of action to carry out their intention. Expressing suicidal thoughts would be a case of an immediate intake, where the therapist cancels all other engagements and attends to their crisis. He told me that about three to six University of Miami students is Baker Acted a year.

Obviously this would be the worst-case scenario for a student in mental distress. The qualifier is “danger to self or others,” The law is also used as a verb: to Baker Act someone, means to legally and involuntarily send them to the hospital.

A bit of background: The Florida Mental Health Act, or Baker Act was enacted in 1971, and is a statute allowing for involuntary commitment for up to 72 hours in a secure psychiatric facility. Licensed mental health professional or a member of the Police Department have the right to “Baker Act” someone. They must have evidence that the person: 1) has a mental illness (as defined by the Baker Act) and 2) is a harm to self, is a harm to others, or self neglect. In 2009, 136,120 people were Baker Acted in the state of Florida (most recent available statistics from the Baker Act Reporting Center). The breakdown reveals that an equal proportion of licensed mental health professionals and police officers initiated the Baker Act (about 48%). Miami-Dade County had the largest percentage of Baker Act cases at 12% (16,672 people).

I found the Baker Act Quality Improvement Committee’s minutes online from January 2011. The Committee is comprised of twenty-one members of equal numbers of men and women. In the hour and twenty minute meeting, there was no use of the word “people,” patients was used twice in reference to the meaning of the term “adults screened,” which they agreed should be everyone that comes through the door of a psychiatric facility. New business to be discussed by future new subcommittees (yet to be formed) were the set of Stabilization Guidelines, the Discharge Process and “Lessons Learned” (no specification of what this meant). The three-page report mostly referred to future organization and issues to be discussed at the next meeting in March (of which there was no record).

So these are the people in power, they’re paid to think about the Baker Act, but it is disturbingly clear the empathetic, human side is missing.

I spoke to two interns on campus and a member of UM Police Department, asking them their thoughts on the Baker Act. They all told me that the Baker Act was a necessity. The police officer understandably had his safety blinders on, and told me many times people can be psychotic that they don’t realize what harm they pose to themselves. He said many people actually appreciate the intervention, and willingly go with the police to the hospital to see a doctor.

I can understand why society has created and supported this collective intervention to act on behalf of the individual. But there is a severe disconnect between thought and action. Public perception does not have a grasp on what it means to be in mental pain. Stripping someone of their autonomy and involuntarily committing them to a psychiatric facility is not the answer for a troubled UM student. Although the University makes concessions for people who need to take “medical leave,” which is absolutely confidential and includes all mental illnesses as well as physical illnesses, there are few supportive steps for students prior to this. The Baker Act is an incredible violation of basic civil rights. It is a political extension of our cultural amnesia, the legal remedy to banish the ugly and unpleasant from our lives: “Out of sight our of mind.” This brings to mind something Professor Pompele said in the beginning of the semester, society tends to oscillate between listening to and silencing the mentally ill. The Baker Act, and its threatening presence, is a silencer. Its existence is supposed to contribute to campus safety, but is it really protecting students?

Knowing that we are all capable of madness, that we all have a critical psychological threshold, we are all equally viable candidates to be Baker Acted – contained, silenced, transported away – is the knowledge of this possibility safe?

My impression of the Counseling Center was drastically improved, thanks to Kirk McClellan. Our conversation continued for an hour and a half, ranging from theory of psychotherapy, to the mental health repercussions of Facebook, to gender differences in mental stress and coping to the hypothetical CVS-style access to psychotropic medication. Mr. McClellan was adamantly against such an easy access model, citing brain damage as the main reason it would be dangerous.Not a surprisingly he saw it as a safety risk, people are not competent enough to have that responsibility. It is a direct violation of the authority of his education and expertise, but he took it pretty well.

Walking away, it is clear that the “licensed health professional” does the job because they want to help people, they want to make a difference in peoples lives by communicating an outside perspective in the cognitive-behavioral, psychoanalytical, therapy model. And that’s precisely it. They are trained in a specific framework of how to define and approach someone with mental pain – with a goal-oriented, rational schema of what a “normal” student is and what should be done to regain that “normalcy.”

The idea of seeking help in the University setting is riddled with standards of conduct, although openly discussing personal psychology is more acceptable now than in the past. But students face the stigma of socially acceptable struggles to have in college. It is challenging to internally define what is going on in one’s emotional life, let alone accurately communicate that to a complete stranger sitting in the Counseling Center. In this interaction there are a million assumptions made by both parties, expectations from the struggling student and from the clinical professional based on their own experience and cultural background.

The Counseling Center is caught in the middle of meeting students’ needs and meeting the institutional, administrative needs of the University. The bureaucracy asks for definitive cause-effect programs that show results, budget efficiently and continue the American expectation of “constantly improving” the mental health of the student body. With time and budget constraints, their model puts efficiency before sensitivity to student’s vulnerability. It is unfortunate but disturbingly common in our culture.

When thinking about this disconnect between “normal” and “abnormal,” “sick” and “well,” and the individual against larger society, one short, famous feminist idea is evident: the personal is political. The basis of all social ideas, issues, progress and challenges at large is the individual. People come to the University of Miami to pursue their education, expand their mind and future opportunities. These years are the most memorable because of the intense social connection, both positive and negative. It is important to remember that everyone faces unique challenges, there is no way to compare or equate the sources or results of personal trials. In times of great mental pain and profound need of love and support, it is always good to remember that people are out there that wholeheartedly want to give it. They may have alternate unconscious motives, but the overlying intent is true: no one wants others to suffer and there are people ready to help.

In my opinion, the very best mental health resource is picking up the phone and calling your mother. Sure, it may not be the perfect soothing remedy, but a mother is the one person in the entire world that whole-heartedly cares about one’s health and wellbeing. Having conceived you in love, having born, bathed and nurtured your physical, emotional and intellectual wellness everyday until adulthood, your mom is in the best position to understand your emotional pain. And if nothing is urgently wrong at the moment, call your family anyway.

Mania

Mania is a word heard often in our fast-paced, cyber-pumped, fad-crazed popular culture. Where new information is a mouse-click away, ideas are generated and published to the world in a matter of seconds, the new and exciting can be personal or shared and validated by the collective. From humanity springs a well of energy, varied individually, that is channeled into work, projects, sports, or social, familial or community activities that are practical, healthy and actively entertaining. We all have our own interesting hobbies, ways to express fun and connect with others – past times are the essence of physical and mental well-being.

The passionate, the enthusiastic, the active and motivated are encouraged and congratulated as “go-getters.” With the abundance of informative and entertaining stimuli out there, multi-tasking has become an art form. Distractions are abundant. Performance is expected, at high or low degrees, but at a constant. The life force of our globalized modern world can be overwhelming, in addition to the internal, sporatic, emotional tides of mood in individual mental life.

We could call this collective energy a life force we each possess. But as we age, this life force is disciplined, divided and channeled into “appropriate” and “inappropriate” as sanctioned by cultural norms. There is bull-fighting, extreme sports like BMX, surfing, skydiving, kiteboarding and bungee jumping. There is a party culture designed to rock the senses all night long, raves, night clubs, music festivals, and light shows coupled with mind-blowing drugs. People exert their bodies in triathlons, marathons and extreme mountaineering. Religions all over the world practice traditions of joyous worship in religious festivals, sacred rituals, possession, fasting, silence, isolation and suffering. Are these people considered insane?

School is the battleground for learning “good” and “bad” behavior. In the first exposure to structured group activities and goal oriented thinking, children learn how they can have a positive or negative effect on those around them. School requires the formation of an entirely new set of coping mechanisms, where children must learn how to assert themselves while submitting to the power hierarchy.

Small children are taught the difference and separation between play time and work time and through praise and punishment they are socialized to adapt the social skills and utilize them to adjust to the demands of their environment.

Without a doubt, cooperation is a remarkable human gift and fundamental to the fabric of society. Selflessness, compassion, and the ability to work peacefully together, however, are ongoing triumphs and challenges and often squashed instead of fostered through discipline and rigid structure. Look at the American prison system, the university systems, hospital and insurance industries – all these designs struggle to balance liberation and organization.

The initial exposure to schedules, rules, authority, sitting still and quietly, listening to teachers, following directions, forming lines and accumulating points to mark scholastic achievement is difficult for most of us. Everyone has a memory of “getting into trouble” in their school days, when he or she felt the weight of power pushed against the drive of free will. Systematic punishment and reward conditions us to subdue manic energy, while permitting socially sanctioned, gendered expressive outlets. This draws questions of the healthy extent of social learning and the direction we are headed: what is “civilized” and what is “wild” behavior? How do we agree on these constructs?

Some do not fall in line so well, some remain drawing outside the lines and march to their own drum. Perhaps overwhelmed by the life force, perhaps neurologically wired to function actively higher than average, and clinically diagnosed as mania, the ragingly excitable human phenomenon is deplorably paired with severe depression.

Categorized as a mood disorder by the DSM-IV, Bipolar Disorder includes two types. Bipolar 1 is characterized as “one or more Manic or Mixed episodes, usually accompanied by Major Depressive Episodes.” Bipolar II, often considered the less severe of the two, is describes as “one or more major depressive episodes accompanied by at least one or more hypomanic episode.”

Mania is euphoria, grandiousity, and intellectual expansion without apparent limits. But mania is also recklessness, frenzied and even dangerous. In his memoir Electroboy, self proclaimed professional patient Andy Behrman describes the experience:

Bipolar disorder is about buying a dozen bottles of Heinz ketchup and all eight bottles of Windex in stock at the Food Emporium on Broadway at 4:00 a.m., flying from Zurich to the Bahamas and back to Zurich in three days to balance the hot and cold weather (my sweet and sour theory of bipolar disorder), carrying $20,000 in $100 bills in your shoes into the country on your way back from Tokyo, and picking out the person sitting six seats away at the bar to have sex with only because he or she happens to be sitting there. It’s about blips and burps of madness, moments of absolute delusion, bliss, and irrational and dangerous choices made in order to heighten pleasure and excitement and to ensure a sense of control. The symptoms of bipolar disorder come in different strengths and sizes. Most days I need to be as manic as possible to come as close as I can to destruction, to get a real good high — a $25,000 shopping spree, a four-day drug binge, or a trip around the world.
— Electroboy: A Memoir of Mania

Perhaps mania is beyond the pursuit of happiness, chasing our wildest dreams, it is the pursuit of ecstasy. Free of rationale, it is a state of eluding hard-driven adherence to the logic of action equals reaction, and beyond even the human constants like sleep and meals. Behrman describes spending sprees and decisions based on, what some would say, a flippant whim. But he is steered by a different compass, a balance achieved not by the checkbook but by intuitional, sensory drives – an emotional temperature not shared by anyone else. He refers to the push to self-destruct, to defy boundaries and the limits of excitement to “ensure the sense of control.” Mental illness is often defined and dismissed as behavior that is “out of control,” but in reality, it may be a state of weighing power. Control is elusive, often more apparent when absent, creating more of an overwhelming presence in absence. Individualism associates control with power, but power is also joy, it is excitement, elation, appreciation, creativity, strength, ingenuity and agency. Maybe mania is a drive of the spirit to be monumental, to be epic, to live and breathe all the possibilities of the world.

On the popular blog Breaking Bipolar, Juliet writes of her mania:

Manic episodes for me start out like a powerful rush of ecstasy. One experiences certain bravado and elevated esteem. I feel creative, intuitive, and giddy. I’ve functioned on a level of working 12-hour plus days with little or no sleep for long periods of time because I have “projects” in my mind. Sleep eventually ceases for the most part. I become much more chatty then usual and will converse with just about anyone. The need to be heard is exhausting. I’ve become so intoxicated on occasions that I have “blacked out” and had no memory of my actions. I do remember one episode when I was manic that I drank to excess and played a piano at my place of business (hotel) until 5AM in the morning. The funny thing is, I don’t play the piano. I ran the risk of disturbing sleeping guests and being fired. I have spent thousands of dollars on trips, cars, clothes, etc., etc.”

Living the life purely of the human will is a compelling experience. Juliet is overwhelmed with projects that she ceases the need to sleep. Alcohol provides the release in that it blurs the line of responsibility and she blacks out her own actions. Clinicians speak of such grandiosity as self-explanatorily self-deprecating and it is a symptom in many personality disorders in the DSM. Most commonly associated with “narcissistic personality disorder,” why is this grand feeling of flying high seen as dangerous?

Juliet continues:

My energy is monumental. I’m a seductress with an alluring grin. My discretion is reckless at best. I can’t even keep up with all the ideas floating around in my head. This level can continue for a good period of time…then things change.

No doubt living the life purely of the human will is powerful. The energy is electrifying and expansive, yet cannot last forever. The slide from mania can be sudden or gradual, but the racing mind becomes fragmented.

The active bipolar writer and mental illness advocate Natasha Tracy describes the prison of the manic mind,

The hypomanic mind isn’t like a single life happening all at once, it’s like every life happening all at once in a tiny, tinny, echoing room. Hypomania is like having ball-bearings bouncing around inside my skull faster and harder and fast and hard and faster and harder. Hitting each other, making divots on the inside of my skull, becoming interior decorators. Fragmented, distracted thoughts. Sentence fragments. Problem grammar.  No capital letters. No punctuation.

No matter the height of euphoria, the individual is never isolated and the mental fragments are coupled with social repercussions. But where is the line between euphoria and danger? Is it the irrationality of mania that people have such an adverse reaction to? Why do the social consequences characterize a mental illness? Mania induces public fear because of its potential effect on this individual’s life. But in all rationality, one cannot characterize the whole by the sum of its parts.

Mental illness is publically discussed as typified by risk and chaos, under the umbrella phrase “danger to self or others.” Public perception sees madness as the entirety of the individual and they are instantly seen as uncontrolled, helpless, anxious, reckless or ludicrous. Society’s fear is confirmed by the mentally ill perpetrator whose dangerous antics could always have been prevented, had someone noticed and sounded the alarm. The sensation-seeking media fuels our cultural obsession with safety, but there are clear differences between harming oneself and harming others. Physical violence or self-inflicted harm is clearly destructive and obviously discouraged by society at large. Once again we see mental pain or harm is lumped into the same social and legal category yet handled very differently by our culture. Some “mental illnesses” are too private to talk about, to be handled in the home or with a private therapist (i.e. schizophrenia, depression, bipolar, anorexia or bulimia) while others are publically acknowledged, given space for discussion and treatment applauded (i.e. alcoholism, autism, obsessive compulsive disorder).

Popular literature takes a warning tone, however, cautioning against the potential untold insecurity of bipolar to finances, relationships and health.

According to David J Miklowitz, Ph.D. in The Bipolar Disorder Survival Guide:

“A manic episode can wreak havoc with a person’s life. It can drain finances, ruin marriages and long-term relationships, destroy a person’s physical health, produce legal problems, and lead to loss of employment. It can lead to loss of life. The fall-out can be long-lasting: William Coryell and his colleagues at the University of Iowa Medical Center (1993) found that the social and job-related effects of a manic episode are observable for after five years after the episode has resolved itself.”

How can one lead a happy, healthy lifestyle with a diagnosis that they may potentially (and permanently) ruin their own life? Miklowitz is describing the fall out of the clash between the individual and societal wills, but how did manic euphoria induce such negativity?

The prominant writer and contenderof bipolar stigma regarding hypersexuality, Carlton Davis describes the duality of the mental state.

Safety and risk define the two poles. Safety defines what is revealed in everyday life. The bipolar person appears normal. He or she can operate like other people: hold down a job, have a place to live, even carry on what appears to be a normal relationship. Risk, however, is the big attraction. The bipolar person is lured to that risk, which can be fulfilled easily in the night time. To be outside the boundaries of society is trilling, and that trill is often sexual. Isn’t this what we often find out about rapists and the pedophiliac? They have ordinary lives laced with times of extreme behavior. Perhaps that is why so many sexual abusers are labeled bipolar.

In my own case the sexual adventures, which I have recounted in vivid detail in my book, “Bipolar Bare“, were associated both with both mania and depression. A depressed rage would come over me, where I sought out high risk behavior in bathhouses. I wished to kill myself through contracting AIDS. I would go into periods where I thought my life worthless, and vile. The more I sought out sex in gay bathhouses the worse I felt about myself, but I hid this behind a façade of normality. I acted and dressed like a professional during the day, and at night during those times of extreme depression I would go out looking for sex. I didn’t do this when I was not depressed. I acted like a heterosexual male dating women and loving their company. But I could never get into a meaningful relationship because I had this secret life which occurred during my depressions. I was addicted to marijuana at this time. Stoned it was easy to overcome my inhibitions about homosexuality so that as my cyclical depressions arose I could operate on my hidden fantasies. Gay sex was the behavior I loved and hated at the same time.

Davis’ story incorporates the reality of mania in daily adult life in the United States. He blended normal, socially sanctioned existence with the wild pursuits of pleasure, risk, passion and danger. Mania is commonly associated with sexual deviance, as mania is expressed emotionally, physically, mentally, sexually, or spiritually.

We are all capable of approaching the wild highs of mania. Each of us have experienced a taste of subtler forms of such euphoria. Without a doubt, mania comes with a price. But in order to move beyond social stigma, anxiety, loneliness and cynicism we must make an effort to extend paradigms of the appropriate mental and emotional life to realize the full breadth and range of humanity.

20/20 hindsight or preventable? Jared Lee Loughner

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