Emotional Wellness in University Students

Dec / 19 / 2012 Leave a response

 

 

Mental health of university students has been a recent issue of concern. The use of campus counseling and mental health services has increased dramatically over the past ten years.  There has been a growing tendency, especially in students coming from the United States, for students to have received diagnoses, and medication, but to have received little proper care for their emotional difficulties. Of the 6,000 students treated at the McGill Mental Health Service over the past five years, less than 20% were deemed to have a clear diagnosis of a severe Axis I mental disorder, though most students did have serious symptoms of anxiety or depression. The reliance on quick diagnoses appears for the most part to be a reaction to limited treatment resources, and marketing ploys by pharmaceutical companies.  It also appears fit with our society’s interest in quick fixes, rather than addressing underlying problems.  From a student mental health perspective, it makes more sense to first think of students’ problems from an emotional wellness perspective, using DSM diagnoses secondly as a guideline.

The fundamental psychological needs that lead to emotional well-being are frequently weakened in many of the students appearing for emotional help.  These needs may be as simple and common as proper sleep hygiene, or related to complex developmental issues.  Often living on their own for the first time, many students have difficulty recognizing their psychological and health needs.  Their desire to test their independence may leave them ignoring basic health requirements. As well, their desire to fit into their peer group may prevent them from attending to their personal needs.  The lack of ability to balance these aspects of life will be more pronounced in students who have not felt well integrated into family and community life.  From the time of birth, sufficient emotional responsiveness and structure, both at home and in the community, is required for an individual to grow up feeling secure and confident.  When these aspects are present, a person will feel both a sense of their own worth, and a strong attachment to family, friends and community. 

A major concern these days is the apparent weak attachment that many young people have to adult authority figures in their lives.  Many young adults appear to see the adults in their lives as serving a functional, rather than an emotional role in their lives.  This appears to be a reflection of the type of relationships that they have had with adult figures throughout their lives.  Parents are often busy or overwhelmed these days, with the percentage of children growing up in traditional families falling.  Only a minority of children or adolescents has regular dinners as a family.  The time available for family members to emotionally connect appears to be diminished.  At the same time, there has been heightened anxiety among parents about their children’s performance.  Children tend to be signed up, transported, assessed, diagnosed, tutored, and pressured unlike any previous generation.  This combination of less emotional connection and higher performance demands appears to lead to an anxious, functional view of life.  The resultant sense that value in life is connected primarily to one’s continually reassessed performance, rather than to emotional attachment, results directly in fragile self-esteem.  This fragility often surfaces in university, where competition rises, marks tend to drop, external relationships become more important, and the need for reliance on one’s ability to function emotionally increases.  Weaker attachments, combined with a belief that even at relatively young ages one should be able to function with little support, often result in self-blame and depression when one begins to have difficulty in managing life.  This self-blame is frequently expressed when students coming for help state, “I feel depressed for no reason”.  This sense of having something fundamentally wrong with themselves, then often leads to a search for a diagnosis and medical treatment.

A lack of awareness of one’s fundamental emotional needs can also lead to confusion between traits and disorders. Every individual has certain personality traits that may be advantageous under certain conditions, but cause some difficulty in others.  For example, some people are very good multi-taskers. They can switch quickly from one focus to another, but may be somewhat distractible when just having one aspect that needs attention.  A student like this who also has poor sleep habits, frequently takes recreational drugs, and is feeling anxious, may appear as having a serious attention problem.  Similarly, students who tend to be high-strung, may appear highly anxious if they are not getting adequate sleep and their normal support network is removed.  It is crucial when working with students to understand, and help them understand, what are their normal traits and emotional needs.

In assessing emotional wellness in students one should start with the basics, assessing present lifestyle and habits, and looking at recent changes that may be causing difficulty. One then assesses the quality of present and past relationships with an emphasis on the nature of an individual’s attachments throughout their life.  The effect of present relationships is generally important to a student’s sense of well-being. Identifying and validating emotional needs will frequently lead to a calming of the immediate upset. 

Universities can have a significant impact on an individual’s emotional development.  The university period is a time when students are consolidating their adult identity.  It is crucial that universities envision themselves as institutions responsible for both intellectual and emotional development.  From the moment a student first enters a university, it should be clear that the hallmarks of healthy family environments are embodied in the university atmosphere.  Clear, consistent rules and expectations, along with strong support structures should be evident in orientation sessions and promoted in all aspects of university life.  The development of strong mentoring relationships should be a priority for universities. No student should graduate without feeling that they were well known by at least one professor.  Student Services should also play a strong role in providing both supportive and mentoring relationships.  The availability of easily accessible psychological support is crucial in a university population.  Ideally, psychological support should be available through multiple points of entry, such as Counselling and Mental Health services, as well as Residences, Deans’ offices, Health, Disability, Chaplaincy, First Year, Financial, Peer Support, and other specialized services.  While there are many pressures facing students during their university years, this time should also be an oasis for students.  It can provide an opportunity for individuals to consolidate strengths and to surmount emotional difficulties.  As universities strive to emulate healthy, progressive societies, students can develop strong identities both as individuals and as members of their community.

 

Norman Hoffman, M.D., F.R.C.P.C

Director.  Studentmentalhealth.ca

   

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The Northern University Illinois Shooting: Over Reliance on Medication May Cause Death

Dec / 19 / 2012 Leave a response

The headlines seemed to say it all. A top student recently stopped taking his medication, became irritable and killed five other students.  Another tragedy caused by non-compliance with highly effective mental health treatment.  On further investigation a more complex picture emerges. Steven Kazmierczak had serious emotional difficulties since high school, and was treated at both a residential school and a mental health facility for issues related to “unruly behavior” and self-injury.  It appears that he had been on anti-depressant medication since that time. What is unclear is whether he had received any other form of treatment over the past years.  The use of anti-depressant medication has tripled over the past ten years, often for off-label indications. Recent investigations have shown that the effectiveness claimed for these medications even in clear severe depression may be suspect.  As mental health problems seem to rise, the tendency to treat complex emotional problems primarily with medication has increased.  Research indicates that anti-depressant medication has limited effectiveness in people with personality disorders or problems related to trauma or neglect. There are no long term studies on the effectiveness of SSRI’s in these complex problems. The picture that is appearing of Steven Kazmierczak of having problems with anger, relationships and impulsivity, combined with self-injury, fascination with violent images, and inconsistent work history is likely indicative of a severe personality disorder.  This does not mean that drugs like Prozac are not useful in the treatment of personality disorders when used as an adjunct to therapy.  At least in the short term, medication may decrease angst, anxiety, impulsivity and self-injury in some people. From a clinical perspective in many individuals, SSRIs appear to primarily have a non-specific mood dampening effect. It is possible that it is largely this effect that results in the marginal difference between placebo and medication in drug studies.  Patients frequently comment on this effect in describing SSRIs as being containing or numbing of emotion. For some people this effect is productive, as taking the edge of extreme anxiety or angst can help a person function better both in life and in therapy.  Other people feel uncomfortable with having their emotions numbed, and describe feeling a sense of inner pain that is denied an outlet. People who self-injure often describe either a sense of intense angst that is relieved by the cutting, or a sense of feeling dead inside and needing to feel pain and see blood in order to feel alive. SSRI’s may control the need to cut in some people, though in those who are already feel a sense of deadness, medication may actually increase self-injury.   Steven Kazmierczak is reported to have felt that the medication he was taking left him feeling like a zombie.  The numbing of emotional pain can have negative effects on a person’s emotional growth as it can remove, both from the patient and the treating physician, the incentive to deal with underlying issues.  In Steven Kazmierczak, his underlying problems with anger, relationships and self-injury clearly just went underground for some years. Perhaps he was able to sublimate these issues into concern about social justice and his work on self-injury in inmates.  His issues were bound to resurface, as these deep traumas do not disappear easily.  His tattooing his arms with horrific images was evidence of a return of self-injury and anger, as was the increasing trouble he had in being able to sustain stability in a working environment.  His actions of February 14th appear to have been well planned, and probably evolved well before he stopped taking his medication.  It is more likely that he wanted to go out of this world not feeling like a zombie than it is that being off his medication precipitated his actions.  As a society, if we continue to focus on just treating superficial symptoms with marginally effective medication, then it is likely that we will be faced with the consequences of troubled minds left to their own resources to deal with complex problems.

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Why 20 innocent school children are dead

Dec / 17 / 2012 Leave a response

School shootings are happening with alarming and devastating frequency. Each times explanations are sought, but no answers are found. Important, though superficial, aspects, such as the obvious lack of gun control, possible bullying, or mental illness are often pointed to, yet fail to really elucidate the fundamental causes that may lead to a person needing to commit mass murder.

The reason for this disturbing phenomenon may lie in our basic nature.  While we tend to like to think of ourselves as individuals, humans are basically social animals. Our brains have evolved over hundreds of thousands of years to feel and respond to our social milieu as much, or even more so, as we are capable of responding as individuals.  Traditional psychoanalytic theory tends to place our emotional development as individuals as primary, with our early attachments with parental figures as being fundamental to the development of our self-concept.  In this view, our sense of ourselves as social beings have been seen as then deriving from the internalized sense of these primary attachments. This implies that for an individual’s sense of his social world to be grossly disturbed, his early life experience with his primary caretakers would have to have been severely compromised.  Social psychology has certainly described how social pressures and one’s inner view of social norms often dictate social behaviour. Our view of the development of our sense of our social self requires a deeper understanding. The importance and power of social relationships, suggests that our internalized view of our social self may develop as a parallel line of psychological development to our internalized sense of ourselves as individuals.  This internalized view of the social world, and one’s place in that world, would evolve by the psychological integration of our social experiences bit by bit.  These internalized aspects of social experience could be called social introjects, analogous to the concept of introjects as an aspect of individual development.  In this model, these two parallel lines of development could have a protective effect if only one fails, or could have a compounding damaging effect if both fail.  Over the past thirty years, from a clinical perspective, it does appear that clinicians are seeing higher degrees of individual disturbance with less family pathology.  This might be due to increasing fragility in the internal development of one’s social self.

There is no way of fully understanding Adam Lanza.  Describing him as having Asperger’s Syndrome or developmental problems is fairly meaningless, as people with these types of common problems do not tend to commit mass murder more than other people.  His mother’s reported preparing for economic catastrophe may be evidence of long-standing underlying issues in her that might have affected Adam through his life, but this would only explain one aspect of the picture. It is not unreasonable to speculate that Adam had feelings of rage both against his mother and against school aged kids.  The murderous expression of these two separate feelings of rage may say a lot about two factors, the individual relationships and the social relationships, that appear to have gone significantly wrong in Adam’s life.

The picture that is emerging is of a not so atypical family that places an emphasis on achievement and social appearances, but may not have been able to emotionally meet the needs of a bright but awkward child.  The mother may have had her own issues about the fragility of the world, with some possible paranoid or hostile trends, yet tried to be an involved mother.  Adam’s early sense of the social world may have been one of some degree of emotional emptiness, high competitiveness and social isolation. This child then goes to primary school where these experience, and resulting negative social introjects are reinforced.  Reaching adolescence, a time where the development of one’s internalized social image reaches a pinnacle, life begins to fall apart for Adam.  His successful brother goes off to university, and parental strife becomes more apparent.  For an individual with a poor sense of his place in the social world, the structure of that world such as the rules and routine of school and of family life could give some sense of belonging, despite a growing awareness of his not fitting in with typical adolescents.  High school ends for Adam with his parents getting divorced. All routine structure is lost.  The anxious traits that might have been felt in his mother from early on become more pronounced.  Feeling increasingly isolated and rejected, he seeks some sense of belonging through some form of Internet group, yet this endeavour just adds to his alienation from the real social world. As any sense of ever belonging fades, he finally cracks, needing to express his rage, going back to scenes of his wounds and ending his pain.

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