CHAPTER 4

Vacuum

When Ashley was a student at Penn State, she was unhappy, out of place—a feeling that started the day she arrived on campus. During her first semester, she would spend the weekdays at school trying as best she could to make it work, then right after her final class on Friday, she would drive home to Allendale—three and a half hours each way. Once she turned onto her street and walked in the door of the house, she felt like her old self again—happy, carefree, stable.

Maddy was a junior in high school then, Mackenzie a freshman. Maddy could not comprehend that Ashley did not love college. Even though nothing Ashley said could make her understand, Maddy still pressed her, asking questions as if her older sister’s life was a social science experiment.

“So, just to clarify, you’re telling me you don’t like college,” Maddy said.

“Yes.”

“Huh,” said Maddy.

Of course, once Madison was a few months into her own freshman year, she started asking Ashley different questions about how she had felt at Penn State, and, more important, how she had felt when she wasn’t at Penn State.

“Tell me again: What was it like when you were at school?” Maddy asked.

“I was just unhappy; I didn’t feel like myself.”

“Okay, and how did you feel when you came home?”

“Happy—like myself again.”

Maddy looked down. “Oh,” she whispered.

Madison was trying to decide whether transferring was the solution. Everyone in her immediate family seemed to believe she just needed to leave Penn. They had all come up with the same superficial solution: a change of scenery, trading the inner-city vibe of Penn for something more laid-back, maybe in the South. Maddy went back and forth. She was texting all her high school friends, even the ones she wasn’t that close to, about how much she hated Penn. Yet when Maddy heard that Jim was telling his buddies she wasn’t enjoying school, she went to Stacy and said, “Please tell Dad not to do that.”

Maddy seemed intent on controlling her own message, even if she had a tenuous grip on what that message was. Part of her wanted to believe the solution was as simple as transferring, but when she tested that logic with Ashley, she found it wanting.

“And how do you feel when you’re at school?” Ashley would ask Maddy.

“I hate it.”

“Okay, but then when you come home, how do you feel?”

“I’m still unhappy,” Madison would say. “Nothing seems to make it better.”

“That’s just not how I felt at Penn State. I knew the problem was with the school, because the second I left campus, I was happy again.”

“I’m not happy anywhere.”

“That’s different.”

“Yeah, it is.”

Maddy didn’t want to leave Penn since she knew the unhappiness was not simply environmental. She knew that whatever she was suffering from was being carried inside her. Escaping it—escaping herself—was impossible; everywhere she went, the unhappiness came, too. What if she did trick herself into believing a different set of buildings and new logo would fix what was happening? What if she did transfer, but then nothing changed? What if she was walking around that new school, the pain as sharp as ever? That would be scarier than never leaving Penn at all. Living with a ghost is frightening enough, but if you change houses to escape it and the ghost is present in the new space, then you’ve confirmed that it’s not the house the ghost is haunting. It’s you.

But neither could Maddy dismiss transferring. Maybe, she kept telling herself, she had it wrong; maybe transferring would be just the thing, despite evidence to the contrary. Maddy wasn’t sure how to make herself feel better. She knew what used to make her happy: a finely tuned balance of sports, school, and friends. In high school she was a champ at all three, and each fueled the others. After a night of partying, she liked getting up to run, to sweat out the alcohol; then that afternoon she’d spend a few hours studying, decompressing. Each part was connected to the next, like a spiral staircase that seemed to lead always higher. In high school she even had time for herself, to draw and read, to write down quotes, to be inside her own head without an agenda.

This is what she wanted at Penn, and Madison continued to try to find each part and connect them. But instead of everything building toward something better, something more whole, it felt like everything was unraveling. She would get up early for morning practice only to arrive at classes feeling zapped of energy, which caused her anxiety about how she would make it through afternoon practice. At afternoon practice, she would stress about what she might have missed in class because she was tired, and by the time the day’s obligations were over, she had little energy left to go out and develop the kind of natural, easy friendships she’d had in high school.

At first she convinced herself the problem was time management—specifically, her own sloppy time management. Madison believed she just had to plan better. If she wanted to be happy, she would need to be more diligent about her pursuit of it. So she started blocking off time on her schedule for each endeavor. Of course, happiness is often most elusive to those actively chasing it, but that didn’t stop Maddy from trying. She and Ingrid would often have sessions when Maddy clearly explained the objectives of each part of the day: practices, classes, studying, socializing. The whole thing felt color-coded, like blocks of time on a child’s calendar. Routine had always comforted her. Perhaps now it would save her.

Everything was in her control, except the one thing that wasn’t: this pain that had embedded itself inside her, somewhere she could not find, and no matter how tightly she controlled everything else, it wouldn’t go away. Where she may have exerted the most control was in her social accounts—her favorite being Instagram. Unforeseen variables consistently affected her daily game plan, her life at Penn, but she had end-to-end control over the images that told the story of her life. Even if Madison was not having the college experience everyone told her she should be having, she could certainly make it seem like she was.

“Love when Ma Jimbo comes to watch.” (Madison Holleran)

In life, counterintuitive correlations exist between a number of behaviors: we often assume that those who speak highly of themselves do so because they possess a wealth of self-confidence. Of course, bragging is often just a hollow stand-in, a kind of scarecrow meant to distract from the gnawing reality of insecurity. We often label someone who loves going out dancing and drinking a free spirit, when often they’re trying to escape feeling trapped. Things are rarely as they seem, especially if overcompensation distorts the image we’re presented. This is also true for Instagram: the more polished and put-together someone seems—everything lovely and beautiful and just as it should be—perhaps the more likely something vital is falling apart just offscreen.

At Penn, Maddy used to work out with her friend Ashley Montgomery, who also ran track for the Quakers. On off days, they would go to the gym together or go running outside. Once, in mid-November, the two of them went for a run through the Penn campus. Madison spotted a quote, part of a mural, on the side of a building. She asked Ashley if she could stop and take a picture, which she uploaded to Instagram. A minute later, the two continued running. A few hours afterward, when Ashley went to Instagram to see the picture, the image was gone. Madison had deleted it. This happened another time, too, with another quote; this one Madison uploaded from the gym while they were both working out.

What exactly was the correlation between the two deleted posts, Ashley can’t say for certain. Maybe the quotes were too negative, too preachy; or maybe they too accurately reflected an internal struggle Madison quickly realized she didn’t want others to see. Then again, maybe it was nothing of the kind; maybe she just didn’t like the look of the pictures—they didn’t measure up. Something may have felt off about them, and that she could not abide.

As November wore on, Maddy became increasingly anxious and uneasy, but her family and friends weren’t raising a red flag. They were aware—how could they not be?—that freshman year at Penn was not going as Maddy had expected and that she was struggling with that reality. She texted her parents frequently—or rather, her parents texted her and she responded. But she didn’t call them multiple times a day, as did some of her classmates.

Her life had always gone as Maddy expected it would go, as she predicted and willed, despite her near-constant worrying that it would not. Perhaps, her parents thought, she had started to believe that that’s how life worked. There was a sense in her family that maybe Maddy would learn a crucial life lesson: how to navigate life when it didn’t seem to yield.

Also, the Hollerans had four other kids to worry about. Carli was married, and she and her husband, Scott, were expecting their first child, a boy, in just a few weeks. Ashley was now happily settled at the University of Alabama, which she loved. And Mackenzie and Brendan were both at Northern Highlands, where each played several sports and did everything else young teenagers do.

Maddy was, of course, a priority, but there was no shortage of kids to check in on, to keep safe. Stacy and Jim knew that their middle daughter needed help, but they figured they would work with Madison over the coming months to try to understand what might make her happy. When it came to Madison’s troubles, they both felt they had one commodity in abundance: time.

By Thanksgiving break, Maddy’s anxiety and unease were morphing into something she couldn’t name, and she was visibly struggling to stay present in the moment. Jim and Ashley, who had flown home from Alabama, drove to Philadelphia on Tuesday to pick her up for the holiday. She didn’t have to return to Philly until Sunday, yet from the moment she sat down in the car, Madison was already projecting five days into the future and anticipating the sadness that returning to campus would bring. “This week is going to go too quickly,” she told her dad before it had even begun.

Maddy was trying to solve the problem on her own. She had always been an incongruous blend of independence and dependence, which most of her friends and family actually found quite charming. She never leaned on anyone else for her homework, and she self-motivated with nearly everything she did. And yet she never got her driver’s license. Almost every other kid in Allendale was at the DMV on their sixteenth birthday, but Maddy let that day come and go—then every day after it. She didn’t think she would be very good at driving, and the way she saw it, failing the driving test would be worse than never taking it. But also, she just didn’t see the need. All her friends could drive. She never found herself stranded anywhere, wishing she could drive, and she liked how it connected their group—everyone always planning who would pick up whom and when.

In mid-November, Maddy decided to make a counseling appointment with Penn’s Counseling and Psychological Services. She did not tell her high school friends, or her parents, that she was reaching out to get help. She sat with her MacBook Pro and researched the protocol for setting up an appointment, and quickly discovered that the first step was booking an initial screening, a session in which she would talk with someone about what was bothering her so the counselor could assess what kind of help she needed. Maddy had assumed she could see someone the next day, or at least that same week, but in fact the first opening in the system was approximately two weeks away. If her symptoms were time sensitive, if she were desperate, she could have skipped places in the line, but she was not sure she qualified. Maddy accepted the standard initial appointment, waited her turn, and continued trying to fight through whatever this was.

When the date finally came, she was actually hopeful, filled with a belief that the therapist might know exactly how to help, some special trick in the way a physical therapist can soothe a sore muscle or a coach can find just the right game plan. Maybe, Maddy thought, an outsider could see an angle she had missed. No, obviously the therapist couldn’t fix everything, but perhaps she could set her on a course toward full health.

The meeting was nothing like what she’d hoped. She felt the therapist had standard questions she asked of every student who walked into the office, and none of them seemed to get at the gravity, the depth, of Madison’s situation. Have you ever been homesick before? How many times a day do you call your parents? Are you making sure you’re eating three meals a day? The meeting, she would tell her family over Thanksgiving, seemed pointless. She understood that homesickness and stress were common issues among college freshmen, but she could not reconcile that those were her issues, because how she felt did not feel common at all. The way Madison felt was extraordinary—and not in a good way.

She tried to convey this to her family over Thanksgiving. She was much better at expressing her feelings in writing, always had been. But that week, she tried to make them understand that something significant was going on.

They started to get it.

Madison was focused and diligent, but in high school she had also been silly and goofy. She was usually smiling, loved dancing and singing in the car when she was with her friends, and also making silly faces for Snapchat. She would often retreat into herself when parents were around. But when it was just her friends, she was usually open and connected. That version of Maddy was not the one who showed up for Thanksgiving. At some point during that week, while the family was in the living room watching one of their shows and the rest of the kids were joking and laughing, Madison was simply sitting there, staring at the screen but not really watching.

“You never smile anymore,” Brendan finally said, more as observation than criticism. “You never laugh anymore.”

Madison just nodded.

Theirs wasn’t the kind of house in which you could hide how you were feeling or what you were doing. It was a cozy little two-story home at the end of a dead-end road, and if you were singing in the shower upstairs, everyone would hear. The place was bursting at the seams—especially during the holidays, when all the kids were home.

Madison sat at the table with Carli and Scott after Thanksgiving dinner. The long wooden table occupied almost the entire space of the eat-in kitchen, with the wall-length window looking out onto the backyard, the soccer goal, and the horse pasture beyond. Maddy had spent hundreds of mornings at that table, eating cereal or peanut butter and bananas. And she had spent countless evenings there studying, eventually closing her books to join Mackenzie just a few yards away, where they would watch The Voice or American Idol.

That afternoon, the three of them began talking. Carli, like the rest of the family, was not overly concerned, and felt this challenge, a little bit of turmoil, could be good for her sister. “This is normal,” Carli told her younger sister. “People leave home, they’re unhappy, they transfer—they figure it out.” Madison shook her head: “It’s not normal. It’s not normal to feel like this.”

To some degree, Maddy had an easier time showing her vulnerability to her family than to her friends. Still, opening up was not, in general, a comfortable state for her—or, really, for any teenager. Those years are often spent pretending you’ve developed a tough exterior, because you think you’re expected to have one and because you haven’t yet realized that a tough exterior isn’t actually an asset. Maddy thought being a college student was synonymous with being an adult, which somehow was supposed to be synonymous with individual problem solving—a mistake we all make and most of us recover from.

All of Maddy’s high school friends were home for the holiday. Emma was back from Boston College for a few days, Jackie from Princeton, Justine Moran from Marquette, MJ White from Villanova, Brooke Holle from Holy Cross. Except for Brooke, who had fallen in love with her school and team right away, the common theme among them was disappointment and melancholy. College was not as expected. Jackie even told Maddy that she had seen a therapist at Princeton, which empowered Maddy to tell Jackie that she had done the same at Penn but that she hadn’t connected with the counselor.

Each of them took turns sharing their own stories from the first three months of school, with most of them touching on the same overarching theme: Ugh, this is hard; I hope it gets better. Within that context, nothing Maddy shared over Thanksgiving about how she was feeling drastically separated her from the group. They all knew she was struggling; but so were they, and when you’re stuck in the valley, it’s difficult to see that perhaps some peaks are sharper, higher, and more dangerous than others. In fact, when you’re in the valley, it’s difficult to look up at all. Putting one foot in front of the other is hard enough. “Everybody was a little bit rocky—you’re the new kid at school—so it was hard to think about having to go back to college, to keep balancing school and track,” Emma said. “We were all kind of like, ‘This isn’t exactly what we expected it to be like, but we have to go back and figure it out.’ And Maddy and I were both upset with everything.”

When she was with her friends, Madison found it much easier to pretend she was mostly fine. She had always been the axis around which all of them rotated, the one who directed their social calendar, made sure they ended up at the right parties. Maddy was always on her grind, when it came to both work and play. Their friend group was seven strong: Maddy was the glue. Emma was down-to-earth, genuine, an Energizer Bunny. Jackie was adventurous and spontaneous. Brooke was easygoing and carefree. Erin was work hard–play hard, like Maddy, and always up for anything. MJ was a perfectionist, also like Maddy, and her parents were the strictest. Justine was sarcastic and funny. She and MJ split the “mom” role within the group, looking out for everyone and sometimes passing on social events because they were homebodies.

Maddy had always enjoyed going out, just like any teenager. But that holiday season, according to her friends, her partying took on an edge. Her parents had never worried about Maddy’s social life, because she had never let it interfere with her schoolwork or her athletics. They knew their daughter partied, but they always said, “She plays hard, but she works hard, too.”

Jim and Stacy were surprised at how quickly college had overwhelmed their daughter. “I was definitely caught off guard, because it just wasn’t her,” Stacy said. “I don’t know, all she talked about was going to Penn, and how excited she was about it, and then here she was, and it was just not what she was expecting.”

That week, they recognized that she needed to see somebody, a professional, not someone associated with the school but somebody with more experience dealing with serious mental health crises. “We saw a big change over Thanksgiving,” Jim said. “I think everything got really serious. There was a shift. She had so much anxiety. It was still in the vein of ‘I’m not enjoying this.’ But you could also sense it was more.” They found Maddy a therapist near Allendale, and she never used Penn counseling again.

Jim and Ashley drove Madison back to Penn on Sunday. The traffic on I-95 was bumper-to-bumper. Madison seemed anxious. More storm clouds had rolled in: finals. They were now only two weeks away, and she had no idea what to expect.

 

Active Minds

I am driving to Philadelphia to meet with the Penn students who lead the school’s chapter of Active Minds, a national organization whose mission statement includes the following: “empowering students to change the perception about mental health on college campuses.”

The four of us meet on the ground floor of a dormitory. We pull together two circular tables, make a figure eight, then pull up chairs at odd angles. There is much ground to cover. I want their thoughts on what life is like at Penn; whether they believe the environment at Penn is different from that at other schools; and if so, how?

I am here because Madison wanted to be, but couldn’t. One night, Madison scrolled through a list of clubs at Penn. She wanted to see what else the school had to offer. She was daydreaming about the free time she would have if she stopped running, and what she might do with it. As she read through the list, she considered the description of each club and took screenshots of the ones that interested her. She clustered the images on the bottom right of her desktop: Penn Fashion Collective, Christian Students at Penn, Art Club, AsOne Global at Penn, and Active Minds.

Then she texted Ingrid:

Maddy: Just went through an entire list of all the clubs at Penn. Got some solid options.

Ingrid: What clubs stuck out to you?

Maddy: Penn fashion collective, Christian students at penn, art club, AsOne global at penn.

Notice anything missing?

This omission is not at all surprising. A gulf seems to exist, into which thousands of college students are falling. Some are trying to get help, but the right kind of help isn’t available. Some aren’t even trying, because college is supposedly about being cool and having fun, and admitting feelings of anxiety, sadness, and helplessness seems like the opposite. Attending a meeting about mental health doesn’t carry the same social currency as going to a frat party and posting an awesome picture on Instagram. Others know they need help, commit to finding it, and get better. But many, like Maddy, are stuck in a gray area: aware that they need something and vaguely reaching for it, but not really sure what’s going on inside them.

Rates of depression and anxiety among college students are higher than ever. The specific numbers vary, depending on the study, but all show a disturbing trend. According to the American College Health Association, the suicide rate among fifteen-to twenty-four-year-olds has tripled since the 1950s. An annual survey of college freshmen found that 30 percent reported feeling overwhelmed, with that number rising to 40.5 percent among women. This is the highest percentage registered since the survey started in 1985, at which point the numbers were approximately half what they are now. One study found that an average high school student today likely deals with as much anxiety as did a psychiatric patient in the 1950s.

The numbers are eye-opening everywhere you look: 95 percent of college counseling directors said students with significant psychological problems constitute a major concern. From 1994 to 2012, the percentage of college students who sought help and were prescribed psychiatric medications rose from 9 percent (in 1994) to 17 percent (in 2000) to 20 percent (in 2003) to 25 percent (in 2006), a number that stabilized through 2012.

And here’s a particularly problematic statistic: according to the National Alliance on Mental Illness, while 7 percent of parents reported their college students experiencing mental health issues, fully 50 percent of students rated their mental health below average or poor. In other words, even those closest to college kids often have no clue how they’re really feeling. The data, the papers, the surveys—they go on for hundreds of pages. And they all point to the same conclusion: a serious mental health issue exists on our college campuses.

Over the past fifteen years or so, therapists have been processing what they’ve been seeing and hearing. And they talk about these issues in ways that feel very human, very real. In response to the transcript of an NPR episode from 2015, “Colleges Face Soaring Mental Health Demands,” a therapist with more than twenty years of experience and a student at the University of Maryland posted the following messages.

Lisa, therapist: I believe I am/we are seeing the result of the so-called “Race to Nowhere”—the achievement/status driven culture that our kids are raised in. My clients have spent their childhoods and in particular their adolescences putting their healthy development on hold, coached and managed by parents who are so fearful and anxious about helping their children succeed that there is simply no room for their children, my clients, to begin to know themselves. When they arrive at college, the wheels come off. They are so hard on themselves, and so out of touch with what they really care about—discovering their true interests is a foreign concept. There is such a push for perfection that normal life skills (learning time management, healthy sleep habits, adult responsibilities) are not in place. Substance abuse and other methods of self-medicating are rampant. Most of my students text with their parents multiple times a day and parents regularly run interference for them. Combine this with the incessant comparisons students make of themselves to others via social media, financial burdens and dread of graduation (for after a lifetime of curated education, graduation feels like falling off a cliff) and you have a perfect storm.

DrHibiscus: I am currently a student at the University of Maryland who suffers from anxiety and depression…

I am sick and tired of hearing the facile, tired response that my generation is “soft” and has been ill equipped by coddling “helicopter parents.” My parents, and those of my peers do not fit this straw man caricature and my peers are extremely hard-working, intelligent, and ambitious. I went to weekly group therapy provided by my school’s Counseling Center last year. What I learned about myself and about my peers was that our main source of stress was that we were simply not allowed to be human… My generation is not suffering because we didn’t learn how to lose a game of flag football. We’re suffering because everything we do is filtered through a lens of consumerism. We see ourselves as “products” to be “branded” and “marketed” in all venues of our lives: social, romantic, and professional. This has been a mindset inculcated into us from an early age.

EVERYTHING we do is seen as instrumental towards marketing ourselves for the college admission boards, or for the job market, or to help us rush a fraternity or sorority, or to help us win friends, or to help us be a more attractive potential partner. You see the capitalist worldview has infiltrated our psychology, and our sense of self-worth. And it is toxic. It results in fear of being ourselves and following what we really want to do. It results in micro-managing every aspect of our lives to best effect so that it looks good for Facebook or LinkedIn or Tinder. It results in constant comparisons with our peers (which causes depression) and catastrophizing of any potential dent to our marketability (which results in anxiety). Essentially, it results in a dehumanized mindset.

Of course depression and anxiety are rampant.

In 2014, Penn commissioned a task force to assess the climate on campus and how this climate might affect students. The eight-page report used the term “destructive perfectionism” and observed that “the drive for academic excellence along with the perception that in order to be successful one needs to hold leadership roles in multiple realms contributes to the amount of stress and distress experienced by Penn students.”

This last quote is essentially a description of the “Penn Face,” which is the phrase used to describe the culture of appearing effortlessly perfect. It’s a concept that the three leaders of Active Minds very much want to talk about. All experienced it, and continue experiencing it, and all believe that variations of the concept likely exist on campuses across the country. Each of the three students at the table—Kathryn DeWitt, Peter Moon, Devanshi Mehta—reached out to Active Minds because they were struggling to varying degrees with their emotional and mental well-being. And the climate at Penn contributed to that struggle.

Devanshi: I think Penn students coined the phrase “Penn Face” to represent how everyone gives off a certain image of being okay, and having everything together, and almost, like, say, even though I’m stressed, I still have time to have a perfect social life, perfect grades, to join all these clubs, and I’m super successful. But in reality people are stressed, and do feel alone, and it’s important to address those things.

Peter: Picture a duck, and below the surface they are scrambling for their lives, but above the water everything appears peaceful—not a care in the world. That’s Penn Face.

Kathryn: I think Penn Face also comes from the expectations we have for ourselves, and that people around us have for us at an Ivy League university—you’re supposed to be having the best four years of your life. We get this messaging everywhere. And having a hard time is not part of that messaging, which perpetuates the belief that “I’m not okay” must mean that something is wrong with you instead of something a lot of people might feel.

Devanshi: Ivy League schools compile all the top students in one place and then all of a sudden you look left and right and you’re like, “Everyone is my clone.” I literally got here and I was like, “I’m not unique, I am not special, I am just like everyone else.” The culture here, the first week of school, the library is packed, everyone is studying. That was my identity in high school—she’s a hard worker. And I came here and it’s like, “Who am I?” And it manifested itself in anxiety and sadness. I didn’t feel comfortable with who I was anymore.

(Here, Devanshi is cutting to the core of something specific. On one hand, the job of parents is to make their child feel special and unique, as if they can do anything they put their mind to. After all, if our parents don’t believe in us, who will? But instilling those beliefs in a child is healthy only if balanced with a reality check about what the world is like, about how hard and difficult it can be, and about how few people will likely ascribe those same qualities of uniqueness and wonder to you. Somewhere along the way, we’ve started to believe that delivering this second message is cruel. But it’s not. Cruelty is offering either message—without the other.)

Kathryn: It’s like, if you have a sprained ankle, you can say that you have one and people say, “Yeah, that makes sense why you’re in pain right now.” But if you say you’re depressed, nobody really wants to talk about that, or believe it’s a real thing. Also, the competition here is awful.

Peter: And it’s made harder because the person you perceive yourself as competing with is trying so hard to be modest about it, like it’s no big deal.

Devanshi: Just so nonchalant about it.

Devanshi: And it’s a very preprofessional school. You’re put into this environment where people don’t just have their major figured out, but supposedly have their life figured out—even the next ten years planned out. So if you don’t, it’s like, “Well, what am I even doing?”

As a freshman in 2014, Kathryn actually planned her suicide. She had written dozens of goodbye letters to friends and family; she’d even picked the location. “It’s never just one thing that leads someone to that place,” she said. “It’s multiple factors. It felt like everyone else had their lives together and no one else was feeling so alone, struggling so much, and having all these identity questions. I didn’t see a way out. I didn’t see a way to live up to my expectations, my parents’ expectations, my friends’ expectations.”

But then in the days before she could carry out her plan, the resident advisor in her dorm—the same one where Madison lived, in fact—staged an intervention. The woman did so because everyone in the dorm was discussing warning signs of depression. Essentially, they were on high alert. Kathryn took a leave of absence and returned to Penn a year later. In the time since, she’s read everything she can about mental health, including the current state of college counseling—at Penn and elsewhere.

In the past three years, Penn has improved its counseling system. The upgrade was in response to the fact that six students, including Madison, died by suicide during a thirteen-month period, from 2013 to 2014. The tragedies led to a task force, which led to the hiring of additional counselors and the counseling center moving to a bigger space. The improvements allowed the school to cut its wait time for an initial appointment from 13.2 days (the average from 2012 to 2013) to just two to three. Yet even as Penn has attempted to improve its counseling services, as well as to acknowledge its on-campus culture, suicides have continued: six additional students have taken their lives since 2014, approximately twice the national average.

This problem, this crush of struggling students, is not unique to Penn. Colleges across the country are dealing with an overload of cases. The counseling centers of many universities are staffed and funded at essentially the same level they were twenty years ago, before the rise in the number of students with mental health issues. For a long time, college counseling centers were adequate. Students who needed help with issues big or small could easily schedule an appointment. Over the past ten years, though, on many college campuses these spaces have morphed into the equivalent of an overtrafficked emergency room. According to the American Psychological Association, 76.6 percent of counseling center directors said they are having to reduce the number of visits with noncrisis patients in order to cope with the growing number of cases. There’s a name for that practice: it’s called triage.

Exactly when do our young people have time to develop their own sense of self? When are they able to be alone, to understand how they think, what they really want—without the pretense of how it might look on a college application?

And we’re not just talking high school students; this practice of hovering often begins before they’ve learned how to write. Kids used to grow up in the neighborhood—on the block or in the parks, playing games with other kids. These games had rules, but the kids themselves determined them, flexing their imaginations. Social scientists call these activities—capture the flag, bike races, pickup baseball games—“free play,” and it’s been steadily decreasing since the 1950s. Scientists have also noted a correlation between the decreasing amount of childhood free play—any play not directed by adults—and the increasing rates of anxiety and depression among kids. As free play decreases, anxiety increases. Correlation does not equal causation, but considering that free play helps kids develop their sense of self, their problem-solving abilities, their ability to self-soothe, and their ability to play well with others, it’s not a stretch to see why scientists believe the decrease in free play is possibly affecting their mental health.

In the article “The Decline of Play and the Rise of Pathology,” which appeared in the American Journal of Play, author Peter Gray cites the work of psychologist Jean Twenge, who discusses how too many kids are chasing goals over which they have minimal control. Gray writes:

Developing competence at an activity that one enjoys, making friends, finding meaning in life, and pursuing a heartfelt religious path are examples of intrinsic goals. Getting high grades in school, making lots of money, achieving high status, and looking good to others are examples of extrinsic goals. Twenge argues convincingly that there has been a continual shift away from intrinsic toward extrinsic values in the culture at large and among young people in particular, promoted in part by the mass marketing of consumer goods through television and other media. She refers also to evidence that the pursuit of extrinsic goals at the expense of intrinsic goals correlates with anxiety and depression. It seems reasonable that this would be true.

Gray later writes: “Humans are extraordinarily adaptive to changes in their living conditions, but not infinitely so.” Now add in social media. Is there anything you have less control over than how many likes you receive on a photo? As scholar William Deresiewicz has written, we have created a generation of world-class hoop jumpers, of “excellent sheep,” of young people who know what they’re supposed to say, but not necessarily why they’re saying it. We’re teaching young people what to think, but not how to think. Deresiewicz writes:

Introspection means talking to yourself, and one of the best ways of talking to yourself is by talking to another person. One other person you can trust, one other person to whom you can unfold your soul. One other person you feel safe enough with to allow you to acknowledge things—to acknowledge things to yourself—that you otherwise can’t. Doubts you aren’t supposed to have, questions you aren’t supposed to ask. Feelings or opinions that would get you laughed at by the group or reprimanded by the authorities.

This is what we call thinking out loud, discovering what you believe in the course of articulating it. But it takes just as much time and just as much patience as solitude in the strict sense. And our new electronic world has disrupted it just as violently. Instead of having one or two true friends that we can sit and talk to for three hours at a time, we have 968 “friends” that we never actually talk to; instead we just bounce one-line messages off them a hundred times a day. This is not friendship, this is distraction.

Kathryn, the Penn student who works with Active Minds, is sitting across from me. She has brought printouts, all kinds of information she wants to share, numbers and studies and articles. She has thought of all the angles affecting this issue, the collision of events that has brought us here. Sometimes it seems as if an easy answer is just around the corner, but then when you get there, a switchback appears.

She knows that, back when she was a freshman, having someone to whom she could unfold her soul would have made life easier. But who finds that person within months of arriving in a new city, at a new school? Who can find a soul mate when her own soul is still such a work in progress?

“Nobody here knows you from before, knows who you are and how you act,” Kathryn said. “So nobody really knows if you’re different, or if there’s something really wrong, because the truth is, they don’t know you at all.”

At least now, Kathryn has the friends sitting around this table. And while that does not make everything better, it does make one thing better. She knows for certain she is not the only one feeling this way.