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"We Just Can't Have You Here"
January 24, 2014 3:23 PM   Subscribe

“What makes you think I will be safer away from school, away from my support system?” School was my stimulation, my passion and my reason for getting up in the morning. “Well the truth is,” he says, “we don’t necessarily think you’ll be safer at home. But we just can’t have you here.” (article contains description of cutting behavior)
posted by dsfan (54 comments total) 23 users marked this as a favorite

 
Is there any society on Earth within which it is ok to not be ok? All the world's a stage, and it's fucking sad.
posted by spicynuts at 3:36 PM on January 24 [7 favorites]


I'm really glad the writer is okay, because a lot of that treatment is fucking abysmal. The idea that they are sending her back home without any real regard to what her home situation is like-- that fucking sucks. That's bullshit. That's a great way to send people dealing with the aftermath of abuse and how that affects your adult life back into the abusive situations that sent them for mental health care in the first place. It's what happens when Cover Your Ass is barely even about liability and instead is just about getting people with problems out of your hair.

The fact that this basically got her kicked out of school and that there was no actual protection or guarantee that she'd be able to get back is fucking bullshit. It means people have a huge incentive to hide their problems and power through, which in a high stress environment is the kind of thing that leads people to self-medicate and commit suicide. (Not that it wouldn't do that in less stressful environments, but a high stakes, high stress one full of young people living on their own for the first time seems even worse than that.)

The idea that you can basically kick a student out of school for health problems is completely fucked up, infuriating and awful.
posted by NoraReed at 3:39 PM on January 24 [10 favorites]


It means people have a huge incentive to hide their problems and power through

How is this any different from any other aspect of life?
posted by spicynuts at 3:46 PM on January 24


Is there any society on Earth within which it is ok to not be ok?

There are towns within.
posted by Mblue at 3:48 PM on January 24 [1 favorite]


This way of treating mental health is sadly common among school administrations. It dovetails in a particularly horrible way with the abysmal handling of sexual assault: often perpetrators go unpunished because of a supposed lack of evidence, while victims are effectively expelled if they can't cope well enough, or make the mistake of revealing too much to college mental health services.
posted by vogon_poet at 3:50 PM on January 24 [7 favorites]


How is this any different from any other aspect of life?

For most adults your healthcare provider isn't also your employer and your landlord, which shifts the incentives somewhat.
posted by dsfan at 3:50 PM on January 24 [26 favorites]


Fuck them and fuck their little showoff Disneyland plastic education utopia. What hateful, hateful shit this is.
posted by Myca at 3:50 PM on January 24 [7 favorites]


How is this any different from any other aspect of life?

When people have access to adequate healthcare and protection they are more likely to stop doing things that may be exacerbating their health problems and seek treatment. For example, if you are a worker in a dangerous environment that causes you to hurt yourself in some way, you're a lot more likely to go to a doctor, take some time off and get treatment for that injury if you know your job is going to be there when you get back and they aren't going to use that as an excuse to fire you.

Treat mental health issues as if they are actual health issues and this becomes a lot clearer.
posted by NoraReed at 3:52 PM on January 24 [10 favorites]


I feel like I heard about something similar to this occurring at Yale before, actually... What uncaring assholes.
posted by limeonaire at 3:57 PM on January 24


How is this any different from any other aspect of life?


Because residential colleges are such an all-encompassing experience, and because the students who live, work, and study in them are at a common age of onset for several serious, chronic mental illnesses, it seems like they should be different in this aspect.
posted by lunasol at 3:57 PM on January 24 [10 favorites]


My question was not an excuse for Yale's behavior, by the way. It was more of a 'mental health is poorly handled by society as a whole' type of comment.
posted by spicynuts at 3:58 PM on January 24


I just finished reading this story, as well, about a badly (to say the least) handled mental health crisis of a student athlete at University of Missouri.

My understanding is that universities started taking a much more self-interested (and cruel) approach to mental health crises after an infamous immolation suicide at MIT in 2002. The title of a NYT piece speaks volumes: Who Was Responsible For Elizabeth Shin? (Shortly before that was a gruesome murder-suicide at Harvard which also brought up liability issues that made universities squirrely about protecting corporate interests at all costs.)
posted by blue suede stockings at 3:59 PM on January 24 [2 favorites]


I had a friend in undergrad- this was maybe ten years ago- who had some serious issues that she dealt with through self-harm; one time she ended up in the hospital, and somebody at the hospital somehow notified the university that she'd shown up with her arms a bloody mess, and after being discharged, she was... well, not administratively kicked out, but it was made entirely clear that if she didn't withdraw she'd be expelled. Last I heard she was living the life she'd been at college to avoid, which is one of the saddest things I've had occasion to dwell on in a good while.
posted by Pope Guilty at 4:04 PM on January 24


...and here's the outcome to the litigation in the Shin case at MIT, which had a chilling effect on college administrators (and lawyers) everywhere....this explains why it was allowed.
posted by blue suede stockings at 4:05 PM on January 24 [2 favorites]


Reading the article, it sounds like the university policies worked and her earlier self assessment of needing to stay in school wasn't accurate:

After a year spent focusing solely on my health and well-being, I find myself, though not perfectly balanced, resting closer to my ideal center.

She was hurting herself and contemplating suicide. Universities are not psychiatric institutions (though as she points out neither are they necessarily healthy places to be) and our expectations of their ability to provide care for someone in serious distress need to be realistic.

I was in school about twenty years ago an fat that time I think schools were too slow to notice students in serious distress or to do anything, including assess who was too unhealthy to remain I the academic environment. I'm sure Yale is imperfect at this, but it sounds more proactive than my memories of college.
posted by Dip Flash at 4:14 PM on January 24 [8 favorites]


This kind of nonsense is inevitably going on a lot more than we know, because few people have the guts to speak out about their own experiences. After all, the whole point of these practices is to remove these students from the school environment, sending them away so they, by definition, can't complain about their treatment. The fact that the comments of this article are filled with dozens of similar stories is just the tip of the iceberg.

And this is what happens at an absurdly wealthy Ivy League school with top dollar student mental health services where the University also runs its own psych hospital. What kind of "care" do you think is happening at schools farther down the wealth and prestige ladder?
posted by zachlipton at 4:18 PM on January 24


I just finished reading this story, as well, about a badly (to say the least) handled mental health crisis of a student athlete at University of Missouri.

This is so awful!

.
posted by limeonaire at 4:26 PM on January 24 [1 favorite]


Happened at RISD, too.

When I was in college, I didn't tell my counselor quite how bad things were for me. Now I'm starting to feel like I had a narrow escape- I had to drop out anyway, but at least I wasn't involuntarily taken to a mental hospital.
posted by insufficient data at 4:38 PM on January 24


She was hurting herself and contemplating suicide. Universities are not psychiatric institutions (though as she points out neither are they necessarily healthy places to be) and our expectations of their ability to provide care for someone in serious distress need to be realistic.

I agree, to a point. But consider what it would look like if Yale treated one of its tenured professors the same way they treated Rachel Williams here. Imagine if that professor was forced to leave the institution by an administrator he never even met based only on psychiatric records. After being locked up for a week in a Yale-operated hospital where he received basically no treatment, he gets handed a cardboard box and given a few hours to move out of his Yale-owned house. In order to try to come back, he has to pay a $50 application fee (WTF?), reapply for his old job, submit recommendations from clinical professionals, obtain professional references again, prove that he taught two classes at a community college somewhere, fly out at his own expense to interview with people who can't be bothered to show up, and beg for his job back.

If that happened, our professor would be thinking lawsuit time, with good reason. It's utterly disgraceful to kick someone out of school for being sick, then demand that they pay you for the privilege of convincing them that you're well enough to come back.

Now, to fully complete the thought experiment, let's pretend our dear professor didn't slash his own leg with a knife one night at home, but instead fainted in the middle of the lecture hall. After being rushed to the hospital (and given ready access to a phone to speak to his loved ones), he is diagnosed with some form of cancer. He'd probably be given ample paid leave, with continuing coverage under Yale's health plan to pay the medical bills. Yale would likely hold his position for him for at least two years and he'd receive a decent chunk of his salary through disability insurance once paid leave ended. When he felt well enough to resume his job, a doctor's note is probably all that would be required and maybe not even that. If he needed a limited workload or modified duties, I'm sure Yale would be reasonably accommodating.

So why exactly would Yale and other schools like it rush to kick out and treat one of its students with a mental illness so horribly, but would lavish such compassion and accommodation upon a professor with a physical illness?
posted by zachlipton at 4:51 PM on January 24 [19 favorites]


*We love you and want you and will provide for you and protect you, as long as you don’t get sick.*

Oh, yeah. Not just Yale, and not just mental illness, either. And at the undergrad level, it's not even you they want; it's your tuition (even if you're not paying it yourself, they can't put the money in that fund without a student registered in that spot. And they don't want a student they have to expend more than the minimum effort on). Totally been there.
posted by The Underpants Monster at 4:52 PM on January 24


I showed up at my college's mental health service with what was probably the most textbook presentation of clinical depression even possible. No one took me seriously and I ended up being sent away for a semester on academic probation.

No, the college wasn't my parent or doctor. But I needed help during a period in life when a lot of young people first get depressed and lack the tools to understand what is happening to them. The college required us to have insurance and mental health care would've been covered, but like so many students I was left to fend for myself and couldn't just power my way out of it. It saddens me that this is still going on.
posted by 1adam12 at 4:53 PM on January 24 [2 favorites]


As a result of the Shin case, MIT massively expanded its mental health services and made them essentially free for students. MIT didn't do what Yale did handle correctly which was to ask their mental health cases to take time away from the university. I think Yale handled it wrong by making the readmission process so onerous, but being a full time student at a university while treating your own serious mental health issues is not good for the university, the classmates, or the student herself.

"You should take some time off" should apply to serious mental health issues as much as it applies to people who have serious academic problems.

The author rightfully takes issue with the prevailing culture in which people pretend to be "ok" and continue I as normal at Yale when they are clearly not ok. But admitting that you're "not ok" many times goes hand in hand with admitting that you need time away.
posted by deanc at 5:03 PM on January 24 [3 favorites]


Is there any society on Earth within which it is ok to not be ok? All the world's a stage, and it's fucking sad.

Is there any society where the punished aren't punished? The rewarded rewarded?

Never, ever allow an institution other than your own doctors and specialists know about your mental problems, mood disorders, unpopular feelings. If you play that game you will always lose.
posted by Teakettle at 5:07 PM on January 24 [17 favorites]


I get the impression that students should *not* engage with their schools mental health system.

According to one of his lawyers, Karen Bower, of the Bazelon Center for Mental Health, caregivers at GW Hospital promptly informed university officials of Nott’s request for psychiatric help. Within 12 hours of his hospital admission, she says, Nott was given a disciplinary letter barring him from his dorm. And within about 36 hours, George Washington leveled disciplinary charges against Nott and told him he had to withdraw from the university or face suspension, expulsion and/or criminal charges. - http://www.insidehighered.com/news/2006/03/13/counseling#ixzz2rMrltFBy
posted by el io at 5:08 PM on January 24


If this was my child, I would be very distressed that her university decided to keep her on campus or in its hospital. Unless she was of age or an emancipated minor, I think her parents are probably better at evaluating a course of treatment. And if Yale had kept her, put her back in her house and she injured or killed herself, you can bet a lawsuit would follow.
posted by Ideefixe at 5:10 PM on January 24 [1 favorite]


It's a university: Almost no-one is a minor.
posted by Justinian at 5:17 PM on January 24


Unless she was of age or an emancipated minor

Most college students are of age (18) even if they are subsidized by parents financially, including medical/mental health insurance. Which doesn't mean parents aren't or shouldn't be concerned, but the legal issues around disclosure of and decisionmaking about mental health status for university students are complicated.

Even so, the story sucks and is more about CYA than helping the student as a member of the community.
posted by immlass at 5:17 PM on January 24


I went to boarding school in high school, and there was a lot of this sort of thing.

So heartwrenching.
posted by Sara C. at 5:29 PM on January 24


They treated her like it was the 19th Century and she had tuberculosis.

Makes me wonder whether the infamous 'naked picture' required of all incoming freshmen (and women) until relatively recently was a comparatively benign vestige of an inspection you had to pass in the old days.

Oh well, mens sana in corpore sano forever in the incubator of our governing elite.
posted by jamjam at 5:30 PM on January 24


My understanding is that universities started taking a much more self-interested (and cruel) approach to mental health crises after an infamous immolation suicide at MIT in 2002. The title of a NYT piece speaks volumes: Who Was Responsible For Elizabeth Shin? (Shortly before that was a gruesome murder-suicide at Harvard which also brought up liability issues that made universities squirrely about protecting corporate interests at all costs.)
I'm pretty sure this sort of policy predates that. I knew someone who was treated similarly at a different Ivy in the early '90s.
posted by ArbitraryAndCapricious at 5:46 PM on January 24


I was in a situation similar to hers.

I think things like: what if she'd been more sick two years earlier and had a bad year of high school? There are plenty of people who get sick and could never make it to Yale. It's okay to not be ready for school. Ableism is so prevalent, I feel like she is just really seeing it for the first time.
posted by bleep-blop at 5:55 PM on January 24 [1 favorite]


I had serious mental health issues in college.
I got lots of treatment through the college services. However

1) I voluntarily admitted myself to a hospital when needed. And I vetted hospitals to get appropriate treatment (this meant traveling out of state)
2) I was doing very well in school (> 3.5 GPA)
3) Did not have a personality disorder.
4) Never needed medical attention.
5) I was also very aware of the boundaries that led to inpatient admission, and I followed them strictly if I was going to go, it was going to be on my own terms.
6) I have no substance abuse issues.

In fact, I got my scholarship renewed after a semester when I had to medically withdraw (I needed over a month of inpatient treatment). I had to submit medical documentation (including my Dx's) and was approved.

However- I did develop an eating disorder in college. If I had EVER passed out on campus (which, never happened!) I would have 1) lost my college job, 2) been asked to leave campus housing and 3)would have most likely been unable to complete school without treatment. Fortunately I did end up getting treatment right after I graduated. Many individuals at the university did not think that I had an eating disorder because I weighed a normal weight when I started reporting my symptoms and restrictive behaviors. Well, by the time a year had rolled around, I was anorexic weight. Because the university was so unresponsive, I ended up getting treatment off campus. I'm glad they didn't take me seriously (and kick me out!)but I'm also sad that they refused to identify the problem before I had done some serious damage to my body.

I do think schools should focus on encouraging students to seek treatment when appropriate and take care of themselves, even if it means time off. But having to reapply to the program seems ridiculous. Also, taking away resources (like, oh you can't see your college therapist, because you can't be a student! you don't have insurance anymore because you aren't a student, but you need costly medical services to get better) is unhealthy for the student! I also think people need navigation to appropriate and effective treatment. Not all mental hospitals are the same. Some have specialties and high quality services, others are just holding cells. It really is in the best interest to have people go to hospitals that will be effective for their conditions and not to whatever hospital is the closest. I think my university handled it well when I was hospitalized during the semester. I was allowed to retrieve my things once I was released, I was allowed to submit paperwork for my withdrawal (and allowed to take incomplete if I thought that was possible) and I was given options. I chose to leave, I chose to not live on campus, I chose to come back the next semester, no problems.
posted by AlexiaSky at 6:00 PM on January 24 [2 favorites]


Universities aren't hospitals, but many people with mental health problems are not helped much by hospitals. A few are, and that's great. But most of us need help learning to exist in the world as it is. Give me time away from school, work, and financial responsibilities, and I guess I feel okay as long as I can keep myself sufficiently distracted. On the other hand, my life is not at all helped by this because I cannot spend the rest of my life away from school, work, and financial responsibilities.

The tough part here is that it's inconsistent. For every school that's horrible about this, some are quite good. I got excellent care while I was in law school at a no-name state school in the middle of nowhere, including the best therapist I've ever had. They couldn't do my ADD meds because of school policy, so they helped me work out an arrangement with the local free clinic system until I could pay for my current psychiatrist, who I've been seeing since. They kept me focused on functional skills because their focus was on making sure that said no-name state school kept its retention numbers up. I had always done well academically, but I did so despite never doing a bit of studying; the help I got through counseling services got me through 1L in the top 15% when studying was suddenly not optional and I was having panic attacks two and three times a day.

But Yale's not worried about poor retention numbers, Yale is worried about one reputation, theirs. Unfortunately, I think that matters. Confidentiality ought to be strict, with this, and the decision about leaving school really ought to be between the individual and his or her doctor(s).
posted by Sequence at 6:06 PM on January 24 [3 favorites]


Student treatment records are regulated by FRRPA, not HIPAA. That's the only reason that Yale-New Haven could discuss Williams' case with the Yale administrators that decided to send her away.

If a member of the faculty had sought treatment at the hospital owned by her employer, and been removed from her post as a result of the diagnosis, the resulting fines would have been spectacular. If an MD I went to for treatment openly told me that he was making a care decision that he know would be worse for me, in order to avoid complications for the community around me, I'd be incensed, and I suspect an ethics board might agree

Being a student and getting treated by your educational institution creates a breach in the privacy defenses that should surround medical records. I can't say whether this was allowed because of cynical political calculation or due to misguided belief in the institutions' willingness to place student's needs first. But in every way large and small, US colleges and universities show that they will value the slightest impact to the smallest aspect of their own institutional well-being over the most serious threats to student safety. Ask anyone who's had the misfortune to be the victim of a crime on campus, or any of a thousand other harms whose disclosure could embarrass the school.

This being the case, students need to know. Students are much better guided to do everything they can to deny the college even more authority in their lives, since the college can't be trusted to use that authority in the student's interest. If you're a on campus and you're unfortunate enough to need a cop, call the real cops. If you need healthcare, walk into town and see a real, doctor who works for you first, not the dean.

Students, your school is probably already your educator, your landlord, your employer, and a good chunk of your local government. You see how well it handles many of those roles. Do you really want to invite it to be your doctor, your lawyer, or your law-enforcement, too?
posted by CHoldredge at 6:24 PM on January 24 [4 favorites]


Why the hell should a college be a medical and mental health services provider? That seems like an absurd amount of mission creep.
posted by ThatFuzzyBastard at 8:20 PM on January 24


[Comment deleted; either leave the thread alone or make an effort to look like you are not trolling.]
posted by LobsterMitten at 8:25 PM on January 24


I am baffled that so many of you seem to think this is a moral failing on the part of Yale. It is not. It is a math problem, one of liability. On the one hand, everyone bitches about the tuition at top tier private universities; on the other, I'd guess that more than half the time when a student commits suicide, the family sues. The university cannot win.

I think the policy of readmission after an academic break and intensive therapy is responsible, sound, and fair.
posted by DarlingBri at 8:38 PM on January 24 [2 favorites]


Why the hell should a college be a medical and mental health services provider? That seems like an absurd amount of mission creep.
They shouldn't be. They also shouldn't kick students out while they are seeking help from appropriate providers. The issue is that colleges are afraid that they're going to be sued if someone dies on campus, so they do things that in most other circumstances would probably be seen to violate all sorts of anti-discrimination laws.
posted by ArbitraryAndCapricious at 8:39 PM on January 24


They could also save a lot of money by not hiring women of childbearing age who are likely to want maternity leave or people with chronic illnesses who might drive up the cost of insurance. I don't think it's ethical to condone discrimination just because it might save money.
posted by ArbitraryAndCapricious at 8:42 PM on January 24 [5 favorites]


My last comment was poorly put, so I'll try to restate...

Severe depression is incredibly alienating. And having been on both the receiving and the suffering end of it, I feel pretty confident in saying that one of the appalling things about it is that you simply do not---can not---register other people's feelings or thoughts as real. Other people are just part of the grey mass of awful that makes life such an unpleasant place to be.

The author is pretty clearly still in a very bad place, and part of what makes that clear is her inability to see herself through anyone else's eyes. She brings up the story of bleeding through her dress as an illustration of how badly she was feeling. But she seems incapable of imagining what kind of decisions the school's administrators had to make when confronted by a student---one of the thousands of students whose education they are responsible for---who was willing to deploy severe violence as a sort of rhetorical device.

Her sense of personal importance is characteristic of both depressives and Yalies. And it's making her blame the school for not doing everything they could do to accomodate her, regardless of the consequences for other students, who might find it a little difficult to learn next to someone who's bleeding into her seat.
posted by ThatFuzzyBastard at 8:42 PM on January 24 [6 favorites]


From a Mefite who wishes to remain anonymous:
I went to a small state university. I had something of a nervous breakdown in my last semester of college because of stresses related to finding a new job, moving, having to meet new people, etc. I started having constant, overwhelming anxiety about it, to the point where I was wondering if I'd ever be able to hold down a job, or, I dunno, have one goddamn day that wasn't a desperate slog just to get through it.

I started going to my university's counseling service. After an in-take appointment, I met weekly with a counselor that they matched me with until the end of the semester, about two month. It was so good for me. My counselor was a really good fit, and they helped think about and manage my anxiety (which has been a big deal in my life since my early teens) in different ways.

I'm feeling a lot better now, (this happened about 6 months ago) although not quite 100%. I really don't know where I would be if I hadn't been able to get free counseling.

So at least some schools do a very good job of providing mental health care to some students. I find the idea of just straight-up telling students, as blanket advice, "don't use your school's mental health services" to be too narrow. Some schools do a good job at this. Lots of people go to those schools and can't afford to get help elsewhere. Telling those students to go see a "real doctor" instead is unhelpful.
posted by LobsterMitten at 9:02 PM on January 24 [5 favorites]


I seriously doubt she was self-harming as a "rhetorical device".
posted by NoraReed at 9:26 PM on January 24 [2 favorites]


But she seems incapable of imagining what kind of decisions the school's administrators had to make when confronted by a student---one of the thousands of students whose education they are responsible for---who was willing to deploy severe violence as a sort of rhetorical device.

As a coping device. (One that is not without risk, but it's a coping method, not a suicide attempt -- it's a way not to try to kill yourself.) Which she probably didn't realise would stain her dress, and which she then dealt with by speaking to her counsellor.
posted by jeather at 9:29 PM on January 24 [1 favorite]


I didn't really want to go this far earlier, but. I hope the header of the thread was trigger-warning enough, but I feel compelled to point out that self-harm can be and often is entirely separate from any suicidal impulses. Pain causes the body to produce its endogenous opioids. It is not unlike the fact that a lot of people with mental health problems also develop drug addictions, in that it's very hard to stop once you've started because you don't have another way to feel better. It's ugly, but to be quite frank it's legal and I think people should be a hell of a lot less judgmental about it. The only thing I consider to be really wrong with it is that it often doesn't work very well.

It's treated like it's just a short jump away from actually killing yourself, but it's not. It is, at times, a way of pulling oneself back from such feelings by getting some pain relief. But for me, as an adolescent, it was a way of stemming panic attacks. It's got fewer side effects than binge drinking or taking someone else's Vicodin, both of which I saw plenty of in college. It's something a lot of people, especially young women, have done at some point or another. It needs to stop being seen by people who don't do it as some kind of mental health nuclear weapon. I replaced it with sugar and ten years or so in I'm still trying to quit that. I'm not trying to say anybody needs to like it, but there is no reason to target people who self-injure for this sort of treatment, especially not when they're making the attempt to handle it responsibly, when you're not kicking out every other person with mental health trouble and a maladaptive coping mechanism. All it's doing is training people to be more secretive about it, and yes, I'm pretty sure that's all they really want, to never have such raw evidence of unhappiness on display in such a rarefied environment.
posted by Sequence at 11:05 PM on January 24 [8 favorites]


I suffered from depression and anxiety for most of my time at Cambridge University. When it finally came to a head, I (like the anon above) was provided with as much free counselling as I needed and had the sense that my college director of studies, my tutor, my doctor and my counsellor all had my back and wanted me to be able to stay. I wish I'd asked for help a lot sooner, frankly. I'd like to repeat that some universities do handle mental health issues well.

Like other commenters, I get the sense that Yale was justified in requiring this student to leave temporarily to recover her health (and an extra year or two before you graduate is no big deal at all in the long run -- something else I wish I'd known sooner). It seems that they could really improve the way they communicate this to the students, though, and the support they offer them.
posted by daisyk at 1:44 AM on January 25 [1 favorite]


Treat mental health issues as if they are actual health issues

Yes. This please. Too often mental illnesses are treated as some sort of moral failing. The stigma sucks. There's so much misunderstanding about mental illness, when it's really very simple: you're sick, and you need a doctor.
posted by feckless fecal fear mongering at 5:45 AM on January 25


How the fucking hell is this legal under the ADA
posted by angrycat at 6:16 AM on January 25 [1 favorite]


She was exhibiting self-harm behaviors, she had suicidal ideation, and she had a plan for killing herself. This is the recipe that gets you involuntarily sent to a psyche ward. Once she reported this to a counselor, that counselor, ethically and professionally had no choice but to initiate action to ensure this young woman's safety.

The author of this piece sounds like she does not quite have the perspective to reflect on her experiences during this time in a way that helps her understand why everyone else responded the way they did. I hope her recovery is swift and total.

I have had similar experiences as the author. From the outside no one can understand what you "really" mean by your behavior; and to risk anything but the standard procedure (get you where you can't hurt yourself) is to risk the worst possible outcome. Psych wards do not feel like caring places, and they are not a fun place to be. They are not places for treatment, they are places of stabilization - the goal is to get you stable, and then let you out so your treatment can begin. There is not a lot of productive treatment that can happen in an emergency psych ward. So although they feel uncaring, if you are sent there it is because people care about you - they don't want you to die, and they are worried you might.

This is my opinion: part of recovery from severe depression requires accepting responsibility for your self care. You have to choose: either I am responsible for my behavior and I am going to do what I need to to do care for myself so I can be safe and hopefully even happy, or I can abrogate my responsibility for my behavior and thus also many of my rights as an adult. Living as a regular person requires being responsible for your behavior.

People who have suicidal depression can obviously live as regular people. In my case it has required being extra responsible - I have a lot less "fun" than other people my age, I rarely drink or stay out late and exercise every day and eat my veggies. I don't drink coffee and I go to the doctor for every injury or illness (then spend hours on the phone negotiating costs) and I take my meds and when I am feeling rough I make a therapy appointment and show up. I have to be my own advocate often. It took ten years to learn how to do all of this.

It's hard work. It's my responsibility though, to myself, to those around me, to my friends and family and co-workers who cannot see in my brain and only see my behaviors and grow worried and scared if I behave in ways they don't understand.

Depression is very self-centering. But in the end we have to behave in ways that allow people to trust us. Our full participation in society is dependent on that trust. Yale was right to ask her to leave - they could not trust her to behave safely. The story about the dress is revealing. How would it be to other students who knew her, who may have cared about her, to teachers or staff who saw her, to see her in that dress and not know that she was safe, and to not be able to do anything? How would it be for them, if she had not been made safe, to find out later that the worst had happened, after seeing her in that dress? This is not about hiding her. Probably some other students in her classroom had trouble with their mental health as well. They deserve a safe environment too. As a student at Yale the woman is part of a wider community.

One of my favorite reliefs from the suicidal depression is not being self-centered like that anymore, being able to understand how I connect to the wider world. Not being alone. I wish this young woman the best of recoveries and eventual peace and happiness.
posted by ProtoStar at 7:01 AM on January 25 [14 favorites]


but I feel compelled to point out that self-harm can be and often is entirely separate from any suicidal impulses.

In the article she does both (cutting herself and considering suicide). I can't speak for Yale or for her experience, but what I've seen in schools is that low-level self harm is dealt with like depression, with a mix of on-campus and off-campus medical help, and a medical leave only if the person is not improving and the problem is interfering with the educational process. An intention or serious consideration of suicide or hurting other people is dealt with (appropriately) as an actual emergency, with the person often removed from the situation until they can show that things have changed and they are able to return to school without a risk of harming self or others.

Schools drop the ball on this all the time -- the easiest examples are the class action lawsuits over crappy and illegal responses to sexual assault and other victim-blaming and -harming policies -- but in the article in this FPP this is what happened and the school, broadly speaking, behaved appropriately and the system worked.

But consider what it would look like if Yale treated one of its tenured professors the same way they treated Rachel Williams here. Imagine if that professor was forced to leave the institution by an administrator he never even met based only on psychiatric records.

Anecdotally, I certainly know of professors who have been forced to take time off for mental health reasons. It's also a misrepresentation to say that she was forced to leave based on medical records -- once she said she was currently considering suicide, she triggered a full administrative response, probably with every high level student affairs administrator involved.

How the fucking hell is this legal under the ADA

ADA requires reasonable accommodation. It does not require you to keep someone on campus who is considering killing themselves or others.
posted by Dip Flash at 7:03 AM on January 25 [1 favorite]


I think some people are missing how profoundly cruel this policy used to be.

One of the first provisions of Obamacare was that all young adults under 26 had to be permitted to be covered by their parents' insurance. That went into effect in 2010. Before that, most insurance plans stipulated that young adult children could only be covered if they were enrolled in school or college full-time. Students who dropped below full-time or took a leave of absence from school were often booted off of their parents' insurance. When I started my current job, my supervisor told me that I could feel comforted that most of my mistakes wouldn't kill anyone, but that I really, literally could kill a student by letting him or her go below full-time without checking on insurance issues. We helped lot of very sick students, who definitely would have been better off taking some time off, stay in school so they could maintain their insurance coverage. And basically, Yale (and other elite schools') policy was the opposite of what I was trained to do: it meant that a lot of students were denied of insurance coverage during an acute medical crisis and that when they were able to get insurance again, they would have a preexisting condition which would be excluded. That's not true now, for which I am eternally grateful, but this policy originated well before 2010.

I definitely am not suggesting that students should avoid mental health services provided by their colleges and universities. I refer students to those services all the time and have a lot of faith in them at my institution. I just think that some institutions have had policies towards some manifestations of mental illness (which seem primarily to be self-injury, suicide attempts, and eating disorders) that really aren't about the best interests of students and which sometimes go against the best interests of students in pretty profound ways.
posted by ArbitraryAndCapricious at 7:07 AM on January 25 [5 favorites]


My conditions reqired way more than my mental health system at my college could really provide. I went through some major long term trauma and had severe PTSD as a result among other things like disoccociation, and a eating disorder...though mostly these were really manifestations of me trying to control PTSD symtoms. Most schools are equipped to handle rather standard depression and anxiety, adjustment disorders, general life stressors. They are not equipped to deal with long term trauma. And I think that is okay.

Someone commented that hospitals are for stableization and not treatment. When you have really good insurance and some ivestigation skills there are programs out there that do provide treatment. The last place I stayed at even allowed access to cell phones in the evening. We had therapy 5 days a week. I saw a psychiatrist 5 days a week. There were groups that were relevant. There was outside time every day. Yes it was still a psychiatric hospital but I felt respected and that their mission was to release me back in the world not only with a medication adjustment but to give me coping skills and help me figure out hat led to the crisis so I wouldn't have to come back. This 3 week stay was followed up with almost 6 months of high quality PHP.

But this isn't possible for people on poor/no insurance. Giving people subpar care in the name of stabilization is just wrong but it happens in America all the time.
posted by AlexiaSky at 7:35 AM on January 25 [1 favorite]


Yo, I get that the school can't keep her in the dorm if she expresses suicidal ideation. I don't see where her permanent withdrawal and the summary method with which she was released from her hospital (because of her non-student status) was required, and certainly a link could be made between the school's decisively washing its hands of her and potential further harm.

It seemed to me that the school was trying to get her out of its hair as soon as possible, and while I recognize the legal incentive for this (Yale might face liability for her harm to herself and others). That doesn't make it more palatable that, say, she was given a very limited time to pack up her stuff (unsupervised) and get gone.
posted by angrycat at 9:10 AM on January 25


I just think that some institutions have had policies towards some manifestations of mental illness (which seem primarily to be self-injury, suicide attempts, and eating disorders)

I somehow doubt that is coincidental that eating disorders and self-injury -- which we can call female-identified maladaptive coping methods -- have more harsh penalties than binge drinking or drug abuse.

Note that she wasn't suicidal, she had had suicidal thoughts but did not mention that she had a plan and specifically said that she had not attempted nor was she planning to attempt suicide. Maybe -- maybe -- her depression meant that she should not be in the dorms. It's hard to say, but it's pretty clear that the doctors didn't kick her out of school (not just the dorms, the school!) because it was bad for her to be there but because it was bad for Yale.
posted by jeather at 10:52 AM on January 25


Well yeah---the doctors don't work for her, they work for Yale. This is why the talk in this thread about how a professor with mental health issues would be treated is so irrelevant. Students are not employees of the university, they are customers (or "clients" if you prefer). And Yale's whole business model is one of refusing service to a great many potential customers, the better to increase perceived value for those who are served. A business will of course try to please its customers as best it can. But if one customer is driving away others, they will of course choose their own good over another's. As anyone would.
posted by ThatFuzzyBastard at 9:08 AM on January 26


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