When Dark Moments Strike Bright Minds

Statistics can't tell the whole story, but they're a starting point. College students in the United States are struggling more than ever, but for this community, William & Mary has a plan. And it's a lot more than just a stiff upper lip.

// GLORIFYING STRESS
There's no denying that William & Mary students are impressive: every year, numbers sprout up about their sparkling median SAT score and high class rankings. If they're bound for any upper-tier American university, the life of a modern 18-year-old is often a mix of impressive achievements and the inevitable stressors that comes along with them.

"With regard to this particular generation, they had to push so hard to get here that often by the time they arrive at college, there are already some signs of stress showing in their physical being, but their emotional health as well," says Warrenetta Mann, director of W&M's Counseling Center.

"William & Mary students are extremely motivated, type-A students who have spent their entire lives preparing for bright futures," says one recent graduate. "The fear that getting help might somehow deter that bright future - either by delaying graduation or somehow 'staining' their image of perfection with a stigma - far outweighs the desire to get help."

The Counseling Center's staff members are equipped to handle a wide variety of issues common to college students: relationship and family challenges, academic and personal stress, identity development and personal growth. But Mann says that many of the concerns students bring to her stem from a change in the wider culture.

"Some of the things like unstructured time and imaginative play activities that we had generations ago aren't as much a part of our children's lives anymore," says Mann. "Things are much more structured. They rely as children much more on the adults around them to tell them 'here's how you should be spending your time,' and then when they get to college, we kind of pull that all away again."

When these students finally arrive on campus at age 17 or 18, the degree of new choices can be overwhelming. Students use the term "FOMO," or "Fear of Missing Out," to describe the mad impulse, for example, to sign up for as many of W&M's 400-plus student organizations as they can during orientation.

"There's a lot of overcommitment from the fear of missing out, so people are vulnerable to saying yes to anything that would be an opportunity that would touch their values," says Kelly Crace. "They do it in an unbridled way, of just saying yes to everything that would connect for them."

Crace is associate vice president for health and wellness, and has been a psychologist for 25 years. In that time, he's learned that fear-based decision-making is the root of many students' stresses. It's part of a theory that explains why a lot of high achievers always overcommit, procrastinate and worry.

"We are a community of very caring people," adds Crace. "Anytime you care, you open the portal to fear because everything we care about has some uncertainty."

Caring about a person or a thing, he says, opens us up to vulnerability. For many people, this leads to fear of losing the thing we care about. To cope, we turn to control (like perfectionism) or avoidance (like procrastination).

"Through perfectionism and procrastination, our talented students that come here have attained excellence with that model," Crace says. "They have been able to control a lot. They have been able to step away and then step in at the last minute and pull it off. They have excelled at that."

Crace pauses. "It's also what keeps us stuck at good - it's a plateau effect." Eventually, he says, students hit the ceiling. They just can't pull another all-nighter. They swear off procrastination forever… until the next paper is due. Students say that they mostly turn to each other for help and advice - it's what they're used to - but many of them wind up on Mann's doorstep at the Counseling Center.

"Our students' sense of responsibility and obligation and achievement often doesn't allow them to pull back very quickly," she says. "If a student gets in over their head, they're going to try to meet that obligation by pushing themselves harder and harder."

The term on-campus for the social currency of stress has become "bragplaining": a way to compete with other students for the least amount of sleep or the highest number of obligations. Keeping up with the Joneses (or Blairs, or Millingtons) can take a severe toll. And competition doesn't stop at graduation: over half of Millennials say that interest in their work is "extremely important," according to a recent Gallup poll. And an influential company like Google only hires .02 percent of applicants on average; many nonprofits get hundreds of applications per opening. Losing a step in college might feel like losing out on some imagined future.

"They're trying to maximize their life instead of trying to optimize it," says Eric Garrison M.A.Ed. '94, an assistant director of health promotion at W&M. "I had a student a couple of weeks ago who was sent to me wanting to know what the minimum number of sleep hours he could get and what's the maximum number of 5-Hour Energy Drinks that he can drink. I thought, 'we need to flip that conversation.'"

None of these concerns are unique to William & Mary; another prestigious school calls it the "duck syndrome," paddling furiously underwater while seeming effortless on the surface. The 2014 National Survey of College Counseling Centers (NSCCC) stated that nearly every center director reported a continued increase in the number of psychologically challenged students. When everything becomes too much, some young people turn to alcohol, drugs, eating disorders, self-mutilation or worse to release some of the pressure. William & Mary is no worse off than many other peer institutions, but the problems are still serious and in need of attention.

// LIGHT IN DARKNESS
For a student on the autism spectrum or with a mental illness diagnosis, the challenges of being a competitive, successful and healthy college student can be significantly magnified. At William & Mary and other universities, the undergraduate years can be when the first signs of more serious conditions emerge.

"It's important to recognize there's a difference between the normal emotional range that is the disruptive part of early adolescence and emerging adulthood, and what we're talking about: when something moves into a clinical range," says Crace. "We have to pay attention to it, we have to be serious about it, we have to help a person be ready and engage in developing their readiness for treatment."

One of the strengths of a small and tight-knit place like William & Mary's is the ability - and responsibility - of every member to take part. That means fellow students, faculty, staff and administrators all have a role to play.

"I do a little section on it in class and then I'd say, 'if you know someone you're concerned about, just see me after class or come by and I'll try to help them get some help," says Tracy Cross, Jody and Layton Smith Professor of Psychology and Gifted Education. "Every time I did that lecture, five or six of the kids would come and see me and they would start telling me about their friend, and then they'd immediately in most cases talk about themselves."

Cross is also executive director of William & Mary's Center for Gifted Education and director of the new Institute for Research on Suicide Among Gifted Students. Like many faculty, Cross is part of the community response to emerging mental health concerns. Every entering student completes a mental health assessment, and residence hall staff is trained to recognize warning signs from the very beginning. Health Outreach Peer Educators (HOPE) are trained extensively to provide the community with education and help with prevention. Once the College becomes aware of a student's mental illness symptoms, the Care Support group in the Dean of Students Office contacts the student and connects them with available resources and support. A care team is also established to develop a wellness plan and track a student's treatment and progress with his or her mental health care providers. Free rides are available to off-campus sites when the right treatment is not available nearby. Students who are concerned about one of their peers can submit their concerns anonymously online. Walk-in clinical intake at the Counseling Center today has no waitlist. A 24-hour hotline is available for counseling when W&M's center is closed, and coordination is ongoing with local law enforcement and crisis treatment centers when concerns arise.

"There are people who are able to be healthy and thrive here on campus that would not have been able to 10 or 15 years ago, because of treatment options, because of our understanding, because of early diagnosis," says Crace. "We're getting more and more students coming into school saying 'I have this diagnosis' because they got it assessed earlier."

Usually, the plan means working with campus resources, including the Counseling Center. Ninety-five percent of students who have used the counseling center say they would recommend it to their friends. But sometimes students are referred to local professionals around Williamsburg. Ongoing correspondence between the student, his or her care team and any other professionals can help bridge the gaps between care in the student's hometown, during their time in Williamsburg and eventually beyond.

William & Mary's first full-time psychiatrist, Patricia Roy, was hired in February, and has been seeing the student population with fresh eyes almost all year.

"I think there's a very good awareness and openness to mental health services with the students I've encountered," she says. "But a lot of students are struggling with depression, anxiety and mood disorders, which is, I think, reflective of the broader population."

The 2014 NSCCC survey reported that 52 percent of people who seek college counseling center service have severe psychological problems, and a steadily increasing number of them arrive on campus on psychiatric medication. One of the major risk factors associated with mental illness is a lack of compliance with that medication.

"If a student gets in over their head, they're going to try to meet that obligation by pushing themselves harder and harder

"Individuals who commit to [treatment] can live healthy lives with a mental health condition," says Crace. "The challenge is, at times the mental health condition impairs their ability to actually be compliant with treatment."

A history of mental illness, studies show, is one of the strongest predictors of suicide among college students. For a school that mourned the loss of several students to suicide during the 2014-15 academic year, the topic draws out unimaginable pain and mourning.
"Each individual student is chosen to be here for a reason," says Vice President for Student Affairs Ginger Ambler '88, Ph.D. '06. "Every student matters, and the loss of one student is a piercing wound to our community."

It's clear from talking to Ambler and anyone who touches student health that, when a student takes his or her own life, the pain is deeply personal, and the causes are not often known and rarely publicized. Every case is treated individually, and information is released with the consent of the student's family.

The Centers for Disease Control reported an average of 11 suicides among every 100,000 15-24 year-olds nationally in 2013. On a 13-year timescale to account for the population size, William & Mary is reflective of that average, in spite of the persistent notion that the College is a "suicide school." But after a devastating year like 2014-15, statistics are no comfort and can unintentionally trivialize immense personal grief.

"It's emotionally battering - it's excruciating - to deal with one loss," says Ambler. "If you have more than one loss in a period of time affecting the same campus community, there's a magnitude of emotion there that has to be tended to. It requires a lot of care and attention from faculty and from staff, and it requires a lot of individual students to support one another."

Any single student death, Ambler says, creates a ripple effect throughout the community and is a reminder of how closely linked the different parts of campus are. That same community, sensitive as it is, can provide strength and comfort in the aftermath of crisis.

For students with mental illness at William & Mary, there is always hope: alongside improved treatments and wider service offerings, part of the reason for the national increase in college students seeking mental health care is access. Even as recently as a decade ago, many students wouldn't consider a primarily residential campus like William & Mary's; it's too far away from the care and support networks they had already developed. Now, campus counseling services are more robust and treatment is more adaptable. More kinds of students can call the College home.

// BOUNCING BACK
"Students know they're stuck - they just want to learn how to get unstuck," says Kelly Crace. "They know their resilience is somewhat compromised, and they want to learn about how to benefit from that." Since Crace has introduced resilience-based training programs at William & Mary based on his own research, over 3,000 people on campus have voluntarily participated.

That degree of self-awareness is common among high-achieving college students everywhere. Crace and Tracy Cross have served on a number of committees on student health over the years, representing an important collaboration between College staff and its faculty.

"It's been among conversations between student-affairs people at other universities outside of William & Mary for almost two decades now," says Cross. "My friends in that part of the world were becoming concerned that the students coming through - while more advanced in some ways academically and intellectually - weren't as resilient as people. They were being knocked down more easily."

This, Cross says, relates both to the overwhelmedness of a major life transition like college as well as to the shock some students feel at entering a community of their peers for the first time. The opportunities - FOMO, again - for friendship, dating, belonging and achievement are mind-boggling. But even though the stress can be significant for a wide variety of students, not everyone is affected the same way.

"There are a lot of very well students here who are being very intentional in their wellness," says Crace. "They're thriving and they're very quiet about it, because they will tell me they feel marginalized. That if they tell their friends, 'no, I didn't stay up all night; no, I went and exercised; no, I had a good meal,' they feel judged."
In a fear-based state of "having to" do things, some students don't like the reminder that stress coping mechanisms can sometimes be a choice.

"Clearly people don't leave their struggles as individual people at the door when they come to William & Mary, so they bring them in," adds Cross. "And there are a good many that are natural, to the extent that they're accustomed to certain kinds of rigor, they're going to make certain transitions more easily."

Cross, like Crace, is pleased to see some of the messages about resilience come from students themselves. When upperclassmen recently met with incoming freshmen at the School of Education, Cross saw the older students dissuading the newcomers from taking on too much, too fast.

"In the seven years I've been here, this is the first time that the recent graduates are saying, 'don't overwhelm yourself by pursuing things just within your grasp,'" says Cross. "For some of them, that's what they've done. That's one of the adjustments that some of them make."

Resilience is at the center of the College's efforts to transform campus culture away from stress and "bragplaining" toward a more complete picture of student wellness. It won't change overnight, but many students are optimistic.

"Throughout my time at William & Mary," says Kelly Gorman '16, "it was invigorating to see new conversations begin and take the campus by storm, and the collaborative, caring and productive responses by students, faculty, staff and administration that ensued to relentlessly improve our community's wellness."

Anna Wong '17, for her part, co-presented at an event called "Re-envisioning the TWAMP" - an acronym for "Typical William And Mary Person."

"We don't have to be known for being stressed," she says. "We can be known for being resilient; it's like a paradigm shift. Stress is natural; that shows that we care. But how can we show that we're strong in the face of it?"

Focusing on improving student resilience has obvious benefits for the daily lives of young people who will be better equipped to handle smaller crises, but it will also make counselors on campus more available for the bigger problems. Stress is unavoidable, but there are many ways to reduce its impact.

"One thing I have learned: what's most important is that each person find what works for them," says Gorman. "I have seen peers who go to the gym when they are really stressed or upset, others who get coffee with friends, write jokes and do stand-up comedy, and also pour themselves into advocacy work to help others."

William & Mary does offer a wide variety of wellness options. As director of campus recreation, Linda Knight manages an array of sports and fitness initiatives, but also extols the benefits of the great outdoors matter-of-factly: if you take a walk in the woods once in a while, it clears your head and resets your perspective. It can do wonders for students who may feel depressed or occasionally outmatched by the demands of a William & Mary education.

"There are a lot of studies about it," she says. "When you're out in nature, your whole wellbeing feels better. Birds chirping, the sunrise, a nice breeze - there's a lot to that."

Knight also points out that Campus Rec sends trained professionals from the counseling center on hikes. At the end of a long day, having good listeners join you around the campfire can make all the difference in the world.

// MULTIDIMENSIONAL WELLNESS
At a living, breathing university like William & Mary, it can be challenging to promote healthy mental habits and resilience, especially when different aspects of care are housed in distant corners of campus. The McLeod Tyler Wellness Center aims to fix that. Thanks in part to a generous $1.5 million gift from Bee McLeod '83, M.B.A. ' 91 and Goody Tyler HON '11, the center will rise in the space left behind by the Lodges and become a central part of the student experience at William & Mary. The McLeod Tyler Center will combine the student health center, counseling center, the office of health promotion, recreational and wellness programs and a new Center for Mindfulness and Authentic Excellence under one roof.

Authentic excellence combines the most important messages that William & Mary is trying to send to students: that they can develop skills that make them more resilient, more true to their own values and healthier across the board.

"That's a values-based approach to understanding self and we want to provide opportunities to students to really reflect on what matters most to them," says Ginger Ambler. "What are the values that are guiding their behavior? That's part of that self-awareness, but that also plays into helping students make critical decisions. If they have too many activities on their plate and have to let something go, how do they decide what they're going to stay committed to and what they're going to stop doing? Hopefully they'll make those decisions not based on fear, but based on what matters to them."

A student entering the building for a counseling appointment might come across previously unconsidered yoga classes, acupuncture or mindfulness seminars. Each is a component of building a sense that total wellness is a lifestyle and a habit. If we only focus on students in the moments they are most at-risk, says Crace, we miss the chance to reduce that risk before it even happens.

"If people walk by that building and see it as a clinic - that is, a place to go to only when something is wrong with me - then we have failed in that message," says Crace. "If it's a message that is an opportunity for students to learn more about wellness, about excellence, about flourishing and figuring what that looks like for them, then that's what we hope for. No matter what reason they might go into the building, be it curiosity or getting an allergy shot, I want them to leave feeling like something big is going on here."

What's outlined here isn't comprehensive, but it's progress. A different set of challenges for the modern student requires a new approach - the solutions of yesterday don't apply. And for a generation that needs more help than ever, innovation, treatment and insight can improve wellness and save lives.