Student Narratives of Mental Illness

Nathaniel Sawyer is a recent graduate who majored in Interdisciplinary Studies of Science and Society and Human Health. He was awarded a Fall 2016 Independent Grant which he used to conduct research on navigating mental health resources at Emory under Dr. Kim Loudermilk. 

For the Fall 2016 semester, my research has so far centered on collecting and analyzing student oral histories of their experiences navigating mental health concerns at Emory University so as to better understand the health outcomes, positive or negative, that are being seen by individuals who are struggling with poor mental health who come into contact with Emory’s mental health resources—the centerpiece being Emory’s Counseling and Psychological Services (CAPS). A large reason for my interest in both this method and this particular line of inquiry is the existence of a data gap in the evaluation of the efficacy of university mental health systems, both at Emory and at other higher education institutions across the nation. Previous mental health task reports internal to Emory, as well as the general academic literature base, tend to focus on quantifiable metrics of “success”: utilization rates, timely access to services, and staff to student ratio. As such, in-depth qualitative, and quality-focused evaluations of student experiences with resources that are supposed to support their mental health are absent—and as such, the most relevant stakeholders are being unintentionally excluded from having their voices heard and communicated in an impactful, effective way.

The need for more effective qualitative feedback mechanisms to review the effectiveness of CAPS sessions beyond just whether students make it in the door or not has been consistently emphasized by internal task force reports but seemingly with little tangible change that has been either effective or transparent to students. And this “data gap” may leave key policymakers and mental health professionals at Emory with huge “blind spots” that aren’t being addressed. For example, whereas Emory’s 2013 award from the Jed Foundation nationally recognizing its mental health programs may suggest that students have adequate mental health support, the most consistent finding from the anonymous interviews I have conducted with students is that their experiences were quite far from award-winning—generally ineffective at best, and more often than not actively counterproductive.  

Drawing from my interviews with students, I’ve come to see that well-intentioned structures can either explicitly or implicitly reify problematic tropes of stigma, reinforcing the very psychological issues that brought students there in the first place. Many students have expressed feeling uncared for—simply another “patient” in a long waiting list of numbers who may or may not be more “serious” than them. Others have spoken very candidly about therapy experiences that were profoundly isolating, alienating, and invalidating. More than three different individuals at CAPS at different points in time mentioned this problem as the most salient aspect of their CAPS experience.

Perhaps the biggest challenge in beginning to analyze the still-developing picture that the interviews were providing me was attempting to settle on some sort of framework of where “mental illness” begins and ends. Indeed, many students who seek psychological help during their time at Emory do not have formal clinical diagnoses. But the interviews revealed that a strictly diagnosis-based metric of “mental illness” that merits support from the school in an effective manner oftentimes becomes a point of internal invalidation and self-imposed stigma. “A lot of other people have it worse than I do, I just need to be better and try harder, I’m fine…” are all too common tropes. These feelings of “impostor syndrome” are compounded by the guilt of “taking up a slot” at CAPS; all students are aware of the catastrophically large waiting list. “What if my appointment means someone who is suicidal doesn’t get treated?”

To that end, a framework that foregrounds the importance of supporting those who are experiencing mental illness, rather than only those with “clinically-diagnosed” diseases is absolutely crucial for capturing an accurate picture of the extent, and nuance, of the ways that incapacitating psychological anguish is affecting Emory students. With this in mind, I was very lucky to be able to work with my faculty advisor and some other professors—including a professor who works at the CDC in behavioral health—to really tease out a working model that can illuminate what’s going on with students and mental health beyond the demand and utilization statistics. We eventually came to a working model of poor mental health as co-produced by a dialectical relationship between an individual and their environment—there are embodied components of the mental illness experience situated within the individual but the configuration of resources, communities of support, and the discourse that we use to talk about all of these issues all play an enormous role in affecting the individual’s health outcome. Within this framework, the individual’s ability to prevent mental health issues, recover from mental health issues, and, at worst, manage mental health issues is not only a matter of the individual’s biomedical situation but is also determined by the efficacy of the structures of (intended) support that they are embedded in. From this light, as public health models instruct us to see, issues of overstretch, accessibility, and sometimes neglect of quality of care at CAPS and other mental health resources at Emory constitute a network of resources that serve as structural determinants of students’ mental health, good or bad. Thus, the urgency of the large swaths of mental health support gaps that continue to grow each and every day represents a moral imperative for administrative action: there is no “neutral” option here if mental illness, and its severity, isn’t merely situated within the individual but exists in an ecological relationship that includes university resources and policies.

As part of my research project, I have been working with some of the students I’ve been interviewing in addition to a collective of artists that explicitly focus on mental health destigmatizing mental health through art to produce a platform and performance for these “mental health narratives” to be expressed, circulated, and sustained. It has been wonderful to see students so receptive to the idea of producing a public work that can transmit their voices and experiences far beyond an anonymous tape recorder. We are currently working on the production of a “Mental Health Monologues,” similar to the famous production “The Vagina Monologues,” that will consist entirely of student-written experiences with mental illness at university, emphasizing the pluralities of experiences that share commonalities, have important differences to highlight, and intersect with other salient identities. Shorter, smaller spoken word performances are being showcased at College Council’s annual CultureShock performance showcase in addition to being featured in a partnership event between Emory Dark Arts, a mental health arts collective, and TEDx Emory—a venue that was created also as the direct result of this project.

This process has been an intensive one, requiring hours of preparation, background research, interviewing, and analyzing. But one aspect of this project that has made the effort all worth it is that the method of data collection that I’ve been working with—in-depth semi-structured interviews—has really offered those with stories they wish to share but with no place to share them a small, but important platform. And slowly, story-by-story, the picture becomes a bit clearer, a bit more accurate, and (hopefully) a bit less stigmatizing as individuals begin to see that their experiences never mean they’re alone.

Visit the Undergraduate Research Programs website to learn more about applying for Independent Research Grants.