JOANNE IS A PSYCHOLOGIST COLLEAGUE OF MINE, AND I WANT to conclude by telling you about a conversation we had. We spoke about the omission at our center of questions about sexually transmitted diseases and abortions, and I shared my belief that this omission was unwise.
“Do you ask about them?” I asked, nervously.
“Of course I do! Every time. Otherwise I may be missing something big in the history.”
“Well, duh,” we laughed together, in understood agreement. “Of course it’s important to know if someone has herpes—it could be the whole reason behind their depression!”
We touched on some other charged subjects and found that we were in agreement on those, too: we’d always do what was best for our patients, but wouldn’t necessarily publicize it. We then wondered how it could be that for years we worked side by side, yet this revealing exchange hadn’t occurred earlier.
“Isn’t it crazy,” I said, “that we feel uncomfortable talking about these things?”
“Yes,” she sighed. “But that’s the way it is here. What can we do?”
Joanne sounded demoralized, and I gathered she was resigned to the situation. I know the feeling. But with the parade of Heathers, Staceys, and countless other calamities through my office, resignation is no longer an option. What can be done that I may stay true to my oath, “to prevent disease whenever I can,” without worry of being discovered? What prevented Joanne and me from speaking years ago, and once we finally did, why did it feel like a confession, made in hushed tones, behind a closed door?
It was fear: we were afraid of challenging the entrenched dogma of our profession. The concerns Joanne and I shared about our patients—the physical and emotional harm of the anything-goes mentality, the devastating consequences of abortion, hookups, and STDs—are not politically correct. We feared sharing our views in an atmosphere perceived as intolerant; we were not prepared to risk malignment or ostracism.
What an outrage! Doesn’t this preposterous situation in itself speak volumes about the alarming state of affairs we’re in?
Like a patient unaware of his illness, the first step is acknowledgment that all is not well. We must recognize that campus counseling (in fact, all of mental health) as it now stands has been hijacked by repressive, radical ideologies. Open discussion is suppressed. Those who dissent are intimidated and silenced. Ideological diversity is nonexistent.
The next step is to realize that these radical agendas—promoted in the name of patient welfare and positive social change—are a prescription for disaster.
I fear that until we wake up, we will continue to puzzle over the campus epidemics of depression, eating disorders, cutting, and suicide. To be sure, the reasons for student distress are sometimes complex, but to the list of contributing factors we must add the campus culture of permissiveness, experimentation, androgeny, and spiritual bankruptcy. And we must see, as well, how this culture pervades our work.
That day seems far away. The authors of the recent Harvard book1 about campus health, mentioned previously, see it differently. “This is a book about the extraordinary increase in serious mental illness on college campuses today and what we can do about it,” the authors write. To their credit, they are right on target to acknowledge “gender differences” in relationships, and the negative consequences of promiscuity. They also mention the “tremendous emotional pain”2 of unwanted pregnancy and abortion.
Great so far, but then they toe the line. Here we go again, with the same old mantras: students must get enough sleep and exercise, eat well (“substitute whole wheat bread for white bread, have a bowl of fortified cereal instead of a bagel or doughnut”), organize their time, stay in touch with family…Come on, Harvard expert, get real. You know a majority of students seeking our help are young women, 3 and that many tell stories like Heather and Olivia. You know that they are more susceptible to heartbreak and microbes, and when added to the stress of finals and sleep deprivation, it’s often these that push them over the edge. Aren’t your patients emptying tissue boxes like mine, miserable about their poor choices and abnormal Paps?
Forget the whole wheat bread. It’s time we turn our attention to deeper matters. So many young women at a critical stage of their development come to us in crisis and tell us their secrets. At my center, almost 70 percent of patients are women. They are vulnerable, and have much to lose. What we say, or don’t say, will have far-reaching effects: the responsibility is awesome.
Instead of offering platitudes, tell the freshman or sophomore who has turned to you about oxytocin. Describe the hidden epidemic of STDs and the dangers of casual liaisons, even with latex. Suggest that she wait, and find the intimacy she really wants, the kind that’s meaningful and lasting. Care for her according to her needs, without the false notions of a modern ideology; be a real feminist.
But then again, maybe you want to keep your job. Lawrence Summers, ex-president of Harvard, suggested that the minds of men and women may be different. That’s how he became ex-president.
If we want to be successful in confronting the mental and physical health crisis of students, we need straight talk with all the sobering facts. We need a single agenda, and it has nothing to do with personal freedom or withholding judgment. It would start with expressing our belief in the tremendous potential of youth, and a vote of confidence in their ability to make wise decisions. The message would be: you are responsible for yourselves and you will determine your futures. The decisions you make each day make a difference. One way we differ from animals is having our heads above our hearts; the brain can control the heart and its urges. Sure, it’s difficult; sure, it’s an ideal; but we want you to strive for it. You can do this; you can change. We have faith in you.
That’s a message that elevates and inspires young people, and that’s the sort of message we lack on our campuses. Instead, we offer “Sex-Tac-Toe,”4 condom races, 5 and students in banana costumes6 handing out free birth control. Is this the best we can do? If we are juvenile, why should they behave like grown-ups?
We should expect more from our patients, but at the same time, we must recognize their vulnerability and the opportunity to make a difference.
For example, say a twenty-four-year-old woman comes in for her annual exam. In addition to a discussion of diet, exercise, and sexual orientation, she should be asked if motherhood is on her list of life goals. If it is, she needs to understand some basic statistics. 7 She should be cautioned about media attention paid to women having their first child in their forties—often those mothers have no genetic relationship with their babies, and their fertilization procedures may have cost more than their student loans. She should learn that fertility declines at thirty, and be warned that she could be exploited by businesses such as egg freezing. It won’t hurt for her to keep this information in the back of her mind as she makes decisions about relationships and career.
Inform young people about HIV without distortion, and to those with risky behaviors, convey the moral obligation to be tested. Provide explicit information that may be disturbing. Nature exists; if you don’t like what biology suggests about your ideology, maybe it’s time to take another look at your ideology.
STDs: Sound an alarm that’s explicit and matter-of-fact. Allow me to say to the Brians and Heathers in my practice: Your behaviors are hazardous; you are jeopardizing your health. Here’s why and here’s how to avoid them. Doctor’s orders! Vaccines are great, but relying on biotechnology to protect us from risky behaviors is foolish.
Campus mental health must wake up to the reality that many students who come to us have an STD. It could be warts, herpes, or “just” an abnormal Pap—don’t underestimate how devastating these may be. Mind you: like sexual abuse in childhood, having an STD may be a secret that students won’t share unless we ask. 8 It’s essential, therefore to include questions about STDs in our intakes, and keep these epidemics in mind as we consider students’ depression, worrying, and poor self-esteem.
Include evidence that sometimes screening tests aren’t accurate, and antibiotics may not always cure. And in designing the pamphlets meant to warn, please omit the suggestive photos. 9 There’s no romance in bacterial infection. Think instead of the anti-tobacco ads—the Marlboro Man saying, “Bob, I’ve got emphysema.”
There’s nothing wrong with fear, if it is based in reality; we use it all the time in health. Here’s a list (partial, I’m sure) of things we’re told to fear: secondhand smoke, MSG, extra pounds, pesticides, saturated fats, Ritalin and Adder-all, seesaws, dodge ball, sitting in the sun. And how about the “anybody can get AIDS” myth, and the needless anxiety that results? I don’t hear anyone complaining about “fear tactics” there.
Acknowledge gender differences. If you doubt these exist, pick up a recent textbook on the subject edited by a Columbia University expert—it covers everything from humor to gallbladders. “…women differ from men in significant ways in every system of the body,” the author writes. “It’s a little like the California gold rush: Everywhere you look, a new fact, unique to one of the sexes, is apparent.”10 Be careful: the book weighs ten pounds. Or you may want to take a look at As Nature Made Him: The Boy Who Was Raised as a Girl11—required reading for anyone who believes the hoax that nurture is stronger than nature. The blurring of differences between male and female is a radical agenda unsupported by hard science.
To our colleges and universities: stop the normalization of behaviors that many therapists—not to mention parents of your students—consider depraved. Again, that this even needs to be said is indicative of the sad state we’re in.
Admit the trauma, to some women and some men, of abortion. Reach out to those for whom the experience has not been an opportunity for “growth and maturation.”12 Provide a support group; at the very least ask about it!
The exaggerated place of sexuality is grotesque13 and destructive. We are not defined by our urges—straight, gay, lesbian, or bi. What sort of message is that to our youth? We are defined by something more essential, uplifting, and transcendent. I fear this ideology that enshrines the body (health, appearance, physical pleasure) and abandons the soul (meaning, self-sacrifice, family, church).
Recognize that for many students, faith may be a tool to promote mental health. In sorting out the dilemma of suicides on campus, consider if perhaps the soullessness and angst of secularism contributes. When patients struggle with suicide, discussion of ultimate issues like meaning, purpose, and God are imperative. Acknowledge the benefits of self-restraint in areas other than diet, tobacco, and alcohol. Self-discipline exists outside the cafeteria and the gym.
And one last thing: don’t tell me how to speak and what to think—I do that just fine, thank you.
You probably want to know how all these stories end. I’ll tell you what I know: Heather realized her “friend with benefits” had nothing to do with friendship or benefits. Stacey has a type of HPV that can cause cancer; she’ll need a Pap every six months for the next two years. Brian reassured me he’d be careful, but, as far as I know, he never went for testing. Amanda is forty-one and no closer to motherhood than she was at thirty-eight. Ned paid for private therapy, because there wasn’t anyone on our staff who shared his values. Sarah was thrilled to have her sixth child, and never went to law school. Sophia is HIV negative, and is getting a divorce. Kelly was placed on medication, but never came back to see me.
In 1997 I went to the annual meeting of the American Academy of Child and Adolescent Psychiatry. The Belgian film Ma Vie en Rose was shown and discussed. It told the story of a boy distressed by his boyness, who yearned only for female things: pink toile dresses, earrings, lipstick. Ludovic insisted that he is a girl, that he would grow breasts and menstruate, and someday be someone’s bride. As a result, he and his family suffered humiliation and disdain; his father lost his job. It was a superb film and it evoked compassion for the boy and his family.
The discussion that followed focused on Ludovic’s victimization in a society with rigid definitions of male and female. If his culture did not insist on a black-and-white understanding of sexuality, my colleagues argued, he would have had an easier time. The implication was that society must change.
I raised my hand to say that it was the boy who was disordered, not society. I looked around and listened. It dawned on me that my comment would not be well received. I didn’t have the guts to be the sole challenger, and I lowered my hand.
Nine years later, my hand is up again.