“I just want you to know that if I die right now, I love you.”
On the day before her chemistry final, Emily, a sophomore whose name has been changed to maintain confidentiality, sent this text message to her mother.
Convinced she was having a heart attack, Emily rushed to Health Services. She was brought to a nurse’s station. Her vital signs were normal, and, according to the electrocardiogram results, so was her heart. A doctor told her what she was experiencing was a panic attack — something she had never felt before.
Emily did not have another panic attack until she went home for winter break. Soon, she was having them up to five times a day. “There was no trigger whatsoever,” she said. “It just happened so abruptly, and I had no time to adjust.”
“My left arm and shoulder area would be in pain,” Emily said. “The sensations of an elephant sitting on your chest … that huge income of pressure all of a sudden would happen to me.”
Panic disorder, characterized by unanticipated episodes of mild to severe panic attacks, is an anxiety disorder. Others include generalized anxiety disorder, obsessive-compulsive disorder and phobias. Anxiety affects approximately 40 million adults, making it the most common mental illness in the United States, according to the Anxiety and Depression Association of America.
Candace, a senior whose name has been changed to maintain confidentiality, described her anxiety, which peaked during her sophomore year, as an “inability to relax.”
“Every time I tried to relax a muscle, 10 others would scrunch up. I felt like I could never sit still, let go or breathe freely.”
“I would say anxiety is one of the most common — if not the most common — things that we see here,” said Sherri Nelson, director of Psychological Services. The National Alliance on Mental Illness reports that more than 11 percent of college students have been diagnosed with or treated for anxiety in the past year.
Anxiety is about anticipating danger without evidence that it will actually occur, said Tamar Chansky, a licensed psychologist, adding that panic attacks are the body’s way of testing its fight-or-flight response without warning.
While many people may use the words “anxiety” and “stress” interchangeably, there is a difference. “The average student has too much to do all the time. They may be stressed about that, but anxiety takes it further where you start to invent scenarios and consequences that are outside the script of what’s happening,” Chansky added.
Throughout the undergraduate experience, students feel academic, social, economic and familial pressures. First-years experience stress as they transition to college, while seniors feel pressure when thinking about graduate schools or job options, said Maria Suarez, associate dean and director of student support services at the Office of Student Life.
A ‘complex picture’
“Everyone in my family has some sort of anxiety. It’s just something we have and we just kind of deal with it,” said Patrick LaChance ’16. “I know it’s definitely genetic.”
LaChance has dealt with both generalized and social anxiety all his life. “I’m always just alert and hyper-vigilant. I’m a leg shaker and a finger player,” he said. “With social anxiety, it’s a worry about doing something wrong in front of a group of people.”
LaChance has never asked a question in class and probably never will. He fears crowds, airport security lines and talking on the phone — so much so that he will prepare for 10 minutes to go through a crowd at a party or jump in the closet when a friend answers his phone call.
Students “all live in an environment where there are exams and social pressures,” Suarez said. “I think that certainly exacerbates the situation and makes non-diagnosable anxiety an issue.”
While genetics is just one piece of the “complex picture” of anxiety, others include temperament, reactivity and experience with trauma or stress, Chansky said.
Though many people in her family have anxiety, Emily said her disorder and phobias were not triggered by any traumatic life event. Instead, they just “came out of nowhere,” she said.
“‘Psychological disorder’ is equated to ‘crazy’ in our society,” Maria Orbay-Cerrato ’16 said. “Trying to break that down is important.”
Orbay-Cerrato experienced her first panic attack in fourth grade, in the middle of practicing a Christmas carol in school.
“My vision was going black, and I was thinking, ‘I’m going to die,’” she said.
Orbay-Cerrato avoided visiting psychologists because she told herself that she did not need it. “It took me a while to come to terms with it.”
Most women in Orbay-Cerrato’s family have anxiety issues, she said. Women are twice as likely as men to have an anxiety disorder, according to the ADAA.
“When anxiety makes you feel bad on a consistent basis or interferes with your function, that’s a time … to bring in an outside consultant, and that’s sort of who we are,” Nelson said.
About 16 to 17 percent of students visit Psych Services every year.
Many students give Psych Services — and the University at large — mixed reviews on its handling of student anxiety issues.
“How can you justify telling someone who called in an emergency situation that the soonest you can see them is in two weeks?” Candace asked, adding that a college’s psychological care should be focused on handling crises as they arise.
While Psych Services provides students with seven free therapy sessions per academic year, Nelson said the office is currently understaffed and in the process of hiring another therapist.
Though the school has room for improvement, “Brown is doing a better job than other places in terms of dealing with anxiety,” said Lianne Blinn ’15.
“The woman that I worked with was super helpful and noninvasive, and she really understood Brown students’ problems,” said Liz Studlick ’16, a Herald copy editor, who was diagnosed with generalized anxiety disorder last year.
Studlick said she was upset when her free sessions ran out, but she understands why the policy is in place. “Psych Services is kind of there to push you to find someone else that works for you on a regular basis,” she added.
Emily returned to school a week late for her spring semester.
“I was okay for a few days, then it sort of spiraled out of control,” she said.
She called EMS frequently and was often brought to the hospital. During one of her hospital stays, Suarez visited her and recommended that she take a medical leave.
Suarez told Emily that if she require her to go on leave, she would. The news was hard to hear, but Emily agreed she was not functional enough to continue the semester.
About 20 percent of the 50 to 65 people on medical leave are dealing with anxiety issues, Suarez said.
“On an individual level, the University goes to great lengths to help a student who is struggling with anxiety,” Nelson said, adding that Brown has a “deep safety net” for troubled students.
“I’ve always been an anxious person, but the actual OCD didn’t rise up to the surface until second semester my first year,” Denise Ramirez ’17 said, adding that she had a rough time adjusting to college life and the rigor of coursework. Seventy-five percent of people with anxiety disorders will see symptoms before age 22, according to the ADAA.
The University is “going to worry about liability. You are just a case that they’ll have to deal with, as opposed to an individual,” Ramirez said.
“Medical leaves are recommended to be two full semesters,” Suarez said. “We want students to take full advantage of time away and have a sustained period of stability before they return.”
“They just wanted me out of their hair,” Emily said. “They never checked up on me, and they just seemed to not care about how I was doing.”
The University’s guidelines are that students should be in treatment the entire time they are on leave, Suarez said.
Emily started “intense treatment” immediately after leaving Brown, including cognitive behavioral therapy and mindfulness training. “For people who do not have the financial means that I have, what are they supposed to do with their time off?” Emily said.
Ramirez applied to return to school after one semester of absence but was denied. “They said that I wasn’t stable enough yet,” she said.
A multidisciplinary committee — composed of members from Health Services, Psych Services, the Office of the Dean of the College, the Office of Student Life and Student and Employment Accessibility Services — reviews each student’s application carefully, Suarez said.
Emily also tried to reapply after one semester and was denied. Feeling ready to return, Emily then responded with an appeal that the University later claimed to have lost, she said. After re-sending her paperwork, Emily was approved to return in fall 2013.
Once readmitted, Emily also found out that she was no longer in the Program for Liberal Medical Education. “I had to finish my fall semester, get good grades and then reapply to (PLME),” she said. “Talk about pressure.”
The effects of substance
“Psych Services is relatively anti-medication,” Studlick said, adding that the office’s therapists are not quick to push or prescribe medication. “My parents said (medication) can mess you up so much more.”
And students are divided on whether medication is the best treatment option for anxiety.
Emily — who has not had a panic attack for seven months with the exclusion of a manageable one in December — feels better now in part due to the Zoloft she was prescribed. “The medication was a godsend,” she said, adding that she is “very conservative as far as medication goes. I think it should be a last resort.”
Diane, a sophomore whose name has been changed to maintain confidentiality, was put on Klonopin and Xanax to help with her panic attacks.
“I love taking medicine and automatically feeling less anxious and twitchy,” Diane said. She currently takes pills only when prescribed, but there have been times in the past when she “just wanted to be put to sleep.” Diane said she would wake up after taking more than her prescribed dose and feel like there were no thoughts going through her mind.
“I was just living. I wasn’t responding to anything. I was just there,” she said. “I almost felt like I would rather feel nothing than feel what I was feeling — anxious.”
Diane currently attends therapy for her disorders, though her mother does not agree with all the messages she is receiving. At home, to deal with her mother, Diane occasionally “sneaks alcohol out of the bar.”
For LaChance, drinking allows him to talk to people and say things he wouldn’t normally say due to his social anxiety, he said.
Alcohol in social situations “might make it easier, but one of the aftereffects is anxiety,” Nelson said.
At school, Diane does not use alcohol to cope with her anxiety. In fact, many students say their panic attacks are easily triggered by alcohol and marijuana.
The Princeton Review ranked Brown as number one on a list of colleges with the happiest students in 2009 and 2010.
“It’s a double-edged sword in a way,” Nelson said. “For the students who don’t feel happy, they feel like everyone else is happy. It makes them feel isolated and alone.”
Mental health, including anxiety, is something you can’t see compared to identity, race or gender, said Sophia Liang ’15, who is a student volunteer for the Samaritans of Rhode Island, an organization dedicated to suicide prevention and mental health awareness. “Usually people with a mental illness or condition are pretty good at hiding it too.”
And while students may admit they are stressed, they less often admit that they experience anxiety or have an anxiety disorder.
According to NAMI, stigma is the number one reason why students do not seek help for their anxiety.
Anxiety “is talked about in a light, joking manner. As far as actual, more severe cases such as anxiety disorders are concerned, I don’t think they’re talked about nearly enough,” Emily said.
Brown’s chapter of Active Minds was formed in fall 2012. The organization’s goal is to reduce the stigma around mental health, Blinn said.
Ramirez said the University should be more vocal about the resources available to students. Students “shouldn’t be ashamed to take these resources,” she added.
“I feel as though our students are feeling less stigmatized about mental health than we, as a society, have in the past,” Suarez said. “We are much more aware and informed.”
“There’s room for improvement … even at how we talk to one another,” Candace said. “I want to be part of the solution and not part of the problem, which is silence.”