Penn mental health
Jayna Wallace / Billy Penn

Pressure of perfection: The stigma of suicide and mental health at Penn

Claudia Stedman is careful not to compare herself too closely with Madison Holleran.

Holleran, who took her own life as a freshman at Penn two years ago, is probably the most high-profile student suicide at Penn in recent years.

“I didn’t have the same stress that she did. I’m not a D1 athlete,” Stedman says. (Holleran ran track.) Still, when she heard of Holleran’s death, where they overlapped bothered her: She too was a freshman that year, and she could safely guess that they had been struggling with depression around the same time.

There have been 10 suicides at Penn in the last three years at a rate that’s double the national average. The most recent, Ao “Olivia” Kong, a Wharton junior, died on April 11. “We were approaching 40th Street, and the train suddenly stopped,” a passenger on the Market-Frankford Line train that hit her told 6ABC. “They pulled the power off…. People with flashlights said there was someone under the train.”

Biology Department Associate Chair Arthur Dunham made controversial remarks in a lecture after Kong’s death; his commentary was recorded and published by The Daily Pennsylvanian. “Some people are delirious if they’re getting a B or a B+. Some people want to go out and jump off a bridge if they’re getting a B or a B+, I can’t judge that,” said Dunham. “So you’ve got to decide what you can settle for and all of that. I take no personal responsibility for any suicides that happen as a result of my grading.”

Dunham later apologized and said he wasn’t referring to Kong, but other students. His words echoed a rationale commonly given when describing the “culture of perfection,” that anything less than straight As and spotless success can make some pupils crumble. On campus, students use the term Penn Face to describe when someone is carrying on like all is well, not sharing what they’re really feeling.  Meeta Kumar, a veteran therapist at CAPS told the New York Times last year that a B is enough to bring about some kids’ unraveling. “What you and I would call disappointments in life,” Kumar said, “to them feel like big failures.”

Waiting for help

Stedman’s first two semesters were rough.

Sure, high school was hard. But her classes at Penn were “way harder than I thought they were going to be.” When could she drop a class without it staining her transcript? What were the best study management tactics to cover the heavy workload? The year proved overwhelming, “going through all of these experiences having no knowledge of what I was doing.”  She knew things weren’t copacetic, but she sensed that something was seriously wrong when she was reading a page at her desk and couldn’t understand the words in front of her.

“I literally read it five times and I have no idea what I was reading,” says Stedman. “I called my dad that day Iike, ‘Dad, I don’t know what’s going on. I can’t read.’ He was like, ‘What are you talking about?’” She read the page aloud to him. He was still puzzled, “You know what this is saying,” she remembers him telling her. “No, I don’t,” she told him. He asked if she had been getting her sleep. “No, not really. I don’t have time,” she replied.

Stedman had heard that it could take weeks to get an appointment; she didn’t think she could wait that long.Penn’s Counseling and Psychological Services (CAPS), located near 36th and Market Streets, has a triage process: The center makes a determination of the severity of the patient’s case (often through a telephone call) and schedules by urgency. To ask a person seeking mental health treatment to wait a significant amount time before receiving care is a point for which CAPS is commonly criticized. An emotional disorder might not feel unbearable one day, but tomorrow could be different.

Perfection, or chronic stress?

Campus suicides and high incidence of mental illness among college students regularly provoke discussion of the culture of perfection; Kong’s was no exception. According to the Center of Collegiate Mental Health’s 2015 annual report, almost half of American college students have sought counseling. A third are on medication; a third have seriously considered killing themselves. Vox published a feature on millennial stress last autumn that deemed the occurrence of depression and anxiety in young people “unprecedented.”  We don’t know what motivated Kong to take her own life. But for large swaths of undergraduates, research reveals a more detailed picture than the fragile perfectionist stereotype.

At the campus vigil in memory of Ao "Olivia" Kong.

At the campus vigil in memory of Ao "Olivia" Kong.

Daily Pennsylvanian/YouTube

“What we see… is really an overload in school and out of school,” says Denise Clark Pope, a Stanford professor who specializes in high-achieving students who’s the founder of Challenge Success, a healthy schools strategy firm. “They really think with the help of caffeine and stimulants and Adderall that they can do it, they can squeeze it all (in),” Clark Pope says. “They literally don’t have healthy coping strategies for stress.”

It’s exceedingly common to find students at competitive colleges stressed and short on sleep, and chances are, they’ve been that way since high school, if not younger.

“They’ve had to look like they’re all together since they were 10 years old,” says Clark Pope. “Their mindset is ‘Don’t have the appearance of being vulnerable because that’s not going to allow you to get to the next stage of your life.’” Chronic stress and sleep deprivation both have serious effects on brain function. Lack of sleep has deep ties to depression.

Ivies have received a lot of criticism of late for their mental health standards. Challenging leave of absence policies and demanding better services have become a norm on these campuses.

When asked if college counseling offices were equipped to handle student patients considering sleep deprivation, intense stress and extenuating circumstances, Joshua Watson, editor of the Journal of College Counseling, had a quick answer: No.

“I think one of the big challenges that college counseling centers face, that other departments in university departments face, is a lack of funding and resources to appropriately put in place all the safeguards and support services that would be needed,” says Watson.

“While I agree that a lot more can be done in terms of proactive work, building protective factors and focusing on coping strategies, I just think the resources aren’t there right now… Unfortunately, we’re dealing with issues— students’ lives— that really take precedent over any of the financial aspects of the university. It would take some work with the administration to put more of a value and interest in these types of services.”

13001218_1008590209206163_715207114343643061_n

Kong, who committed suicide earlier this month, was a Philadelphia native.

Facebook

Penn’s endowment is $10 billion, undergraduate tuition is more than $50,000, not counting housing or dining, and its donor network is legendarily well-heeled. The university has upped its CAPS budget by nearly $900,000 in the last two fiscal years, per The DP. It’s hard to call Penn under-resourced, but the question lingers. One metric to judge proper staffing levels is wait times. According to student complaints, Penn CAPS still has a problem with this.

Watson explains that college students who suffer from suicidal thoughts often fall into two camps: those who had pre-existing conditions before college and those who have trouble adjusting as they transition from high school seniors to undergrads.

And what makes student counseling all the more complicated, Watson notes, is that mental disorders often come to a head from high school through college age. “Half of all lifetime cases begin by age 14; three quarters have begun by age 24. Thus, mental disorders are really the chronic diseases of the young,” according to a 2005 National Institute of Mental Health report.

“When you add all that together you realize that it’s creating a perfect storm, where there’s absolutely no time for things kids absolutely need,” says Clark Pope.

Where Penn students go for care

Officials at the university convened a task force from 2014 to 2015 after six suicides occurred in a 15-month span. The end result was a report bearing a list recommendations to improve mental health awareness on campus and make CAPS more robust. As reported in The Daily Pennsylvanian, the report detailed that wait times in the campus mental health system had been slashed to 8.5 days on average, a 61 percent drop. Students continue to complain of longer waits, however. Last spring, a student told The DP she had a three-week wait: “When I got to Penn, I thought it would be the first time I’d be able go out and get real help,” she said. “My whole life felt like everyone had been putting my mental health on the backburner, so I was extremely disappointed when I felt like my mental health also wasn’t a priority here and that the school didn’t care.”

Wait times aren’t the only issue. According to the DP, all CAPS options are short-term arrangements. Carly O’Donnell wrote a Facebook post after Kong’s death that has been shared nearly 800 times so far, asked a spate of questions, many on the difficulty of establishing consistent care.

“I have become quite aware of “Penn-Face”—a term that now labels the deceptive façade that students put on daily to conceal all perceived imperfections… Showing weakness or inadequacy is shunned, even if only internally. Talking about this—acknowledging it for the problem that it is—is a step in the right direction.

But we are not entirely to blame for this culture. I am profoundly disappointed in the actions of the administration here at Penn.”

Her post raised questions surrounding the university’s handling of the news of Kong’s death. A few days later, Penn President Amy Gutmann and Provost Vincent Price announced that its Task Force on Student Psychological Health and Welfare would be re-deployed.

The task force’s 2015 report largely spoke to creating a “caring culture” on campus. Some found this to be an inadequate response.  “I was expecting there to be data and numbers and a definitive way forward, and it isn’t there, and I actually think that they have truly skirted the real issue,” one student told Billy Penn last year. “It’s insulting to Penn students to say, ‘just stop being such perfectionists.’ Well, that’s what’s rewarded here.”

Gutmann’s and Price’s announcement detailed that the task force will assess how well their recommendations have fared and what “additional steps can be taken to help ensure the health and well-being of our students.”

O’Donnell believes more numbers would be helpful. She points out that the 10 suicides were the “successful suicides. I’ve personally known at least three people who have tried to kill themselves. I think it would be interesting to gather that data. How many people have attempted or had suicidal ideation? Just showing how much this is affecting our student body,” she says.

‘I decided it just wasn’t worth it’

O’Donnell tells Billy Penn she’s been flooded with messages from students and alumni sending notes of thanks and support. She prefers to keep private exactly what caused her to seek help at CAPS. She shares that she was disappointed when she did.

“The waiting room in CAPS right now… it’s a huge, empty space. You can see everybody. You can see your friends, your acquaintances, people you don’t know. You have to actively avoid making eye contact,” she says. “They shouldn’t be, because there’s nothing to be ashamed of,  but a lot of people are ashamed. That’s just making it harder for people to feel motivated to go down there.”

We asked the university for a response to student complaints over wait times and staff retention, and received no response. The university declined multiple requests for comment, as did several administrators, including the Vice Provost Valarie Swain-Cade McCollum, CAPS Director William Alexander and task force co-chairs Anthony Rostain and Rebecca Bushnell.

O’Donnell says that after getting assigned a new therapist at CAPS, the new shrink stopped following up with her. “I decided it just wasn’t worth it,” she says. “This semester I’m in a much better place, but I would not credit CAPS for that.”

Kong made this flier her Facebook cover photo as a freshman. She captioned it, "Do it!!!"

Kong made this flier her Facebook cover photo as a freshman. She captioned it, "Do it!!!"

Facebook

Stedman found a psychiatrist in Center City with her parents’ help. She was nervous because she didn’t want to go on meds. Her psychiatrists didn’t write her a script, but rather put her on a sleep schedule. She recovered with more shut-eye. She says she hears “brag[ging] about pulling all-nighters” sometimes, but that’s them.

She believes Penn Face isn’t about only students smiling through the stress, but also solely talking about the good things they’ve got going. It doesn’t stop people from talking about a new internship they landed and how busy they are.

This curated self-projection mirrors what happens on Facebook or Instagram. “We now have social media propagating this sense of Penn Face all the time,” says Clark Pope, who notes that this attitude is common in colleges across the country.

David Thai, a sophomore, considers the culture at Penn toxic. There’s endless pressures not only to meet high academic standards, but white blue-blooded ones socially.

“In light of Olivia’s passing, many students were quick to point fingers at CAPS, point fingers at Penn. I say there’s some truth in [that,] but we often forget that we are Penn students and perpetuate the social, the stressful, the cutthroat atmosphere that is Penn,” he says.

Thai has had difficulty managing stress and test anxiety. He says that growing up, seeking mental health care was seen as unnecessary. If he hard a hard time, he was supposed to shake it off. In college, he has a more liberal view, but he hasn’t gotten therapy yet.

“It’s still at the bottom of my priorities because I still have this mindset that mental health is a stigma. I tell people that mental health is a serious, real issue, and by us brushing it under the rug, we’re perpetuating that stigma. Unfortunately, I would say I’m a hypocrite in that sense.

I don’t reach out to CAPS. And here I am telling people, ‘Oh, you’re feeling really stressed out? I encourage you to seek professional help.’”

Thai says recommending CAPS, for many students, is a “surface-level” answer that’s tossed around without knowledge of how getting treatment works. “A lot of people don’t know where CAPS is located,” he says.

 

Not just the stress of the workload

Sandra Loza-Avalos is a junior from Texas. Since she enrolled, staying competitive in notoriously tough pre-med track classes has felt like swimming upstream. Many of her classes are graded on a curve, which, at Penn, boosts grades (failing even) but caps the percentage of students that can get As, Bs and so on.

She’s first generation Mexican-American. Her high school was public. It’s difficult to compete with peers who went to private academies, the Andovers and the Exeters. She found out what those schools were when she came here.

Thai, another first-gen student, feels similarly. (Studies have shown that undergrads of color are more likely to feel underprepared emotionally and academically, but are also less likely to pursue treatment.) He says he exhausts every tutoring hour available to him. He also makes time in his schedule to visit and care for his ill mother in South Philadelphia. “The university has not done its part to level the playing field,” says Thai.

Loza-Avalos compares it to a point raised in the pro-choice debate: If pro-lifers insist that a fetus should be born, what are their plans for care when the child arrives? “Maybe that’s what Penn’s done with me. They’ve taken all these minority students, and they just stamp down their stats [and tell] US News or Business Insider ‘look how diverse we are.’ After that they kind of just let us flop around and fail.”

With the rising tides of stress, a student still may have to contend with family illness, or struggle to come to terms with their sexual orientation, or find it tough to build new friend networks, or struggle with intense feelings of alienation because of their background, or experience sudden trauma. The list really goes on, as the challenges of everyday life and society do. Personal issues don’t disappear on test day.

O’Donnell says that even when she does well on a test graded on a curve, she feels guilty for enjoying her good grade. Mathematically, her success limits who else could’ve done well. She doesn’t like that feeling.

Stedman says that the end result of grading tests on curves is that some students don’t like to form study groups. So, a sleep-deprived student who’s feeling isolated from his or her peers may be discouraged from forming social bonds by learning material together — because the grading, too, is competitive.

6328451618_121eaa4eb4_o
InSapphoWeTrust/Flickr

“I think it’s really silly to create this environment where people don’t like studying together. Penn is a very pre-professional school in so many aspects. That to me just seems to fly in the face of their philosophy… When you have a job, you have to work with people,” Stedman says.

Clark Pope says that curved scoring can be an intensely anxiety-inducing. Progressive schools are considering more mastery-based (whether the person actually grasps the material) and standard (not solely one or two assessments accounting for the entire grade) approaches, she explains. “You’re starting to see colleges move in that direction but it’s going to be slow,” she says, “Those kind of grading policies really lower the stress on kids.”

We of course tried to ask Penn officials and administrators on the learning value of curved tests. We received no comment.

 

Students in mourning push for change

There is a list of larger questions, beyond whether curves are a good grading policy. Do universities ask too much of their students? Are the values getting lost?

Before we get there though, there are basic reforms that Penn students would like to see. An online petition, which now has roughly 4,500 signatures, asks for CAPS expansions, but it also calls for policy changes on leaves of absences and class withdrawals.

10553668_1126555737363354_7797788232863917507_o

Penn Benjamins, a peer counseling group, in the middle of a listening meeting.

Facebook

Bryn Baker, a senior, thinks Penn could make changes, but “I also don’t think they could do everything we want them to do. We have to look to each other for that,” she says. “There’s definitely the whole issue of Penn Face, a lot of people don’t want to admit to not being okay, but I’ve also heard the other side of the story. One of my friends the other day said, ‘Now I feel like it’s not okay to be okay.’”

By tapping into this groundswell for mental health activism, Baker sees opportunities to support peer counseling groups. (Baker explains that in her high school, wellness efforts were strong and student-run.) Penn Benjamins, for example, is campus group that allows undergrads to sign up for meetings with a peer listener. “I think it comes down to us,” says Baker. “If we want to make something used or known about, it’s so easy for us to do.”

The university notified students of Kong’s death via email. “She was a bright, well-liked and successful member of our junior class,” reads Gutmann and Provost’s announcement. They didn’t specify who the junior was.

Stedman can respect that the university had to be mindful of the family’s wishes and privacy, and that perhaps suicide contagion was also a concern. Still, she questioned the way the administration decided to notify students.

“It really created a few hours of hysteria around campus. The number of texts and phone calls I got from my friends asking ‘Are you okay?’” said Stedman, a junior. “It was really scary.” Stedman spoke to Billy Penn the day before Gutmann announced plans to reconvene its task force. She was frustrated that a week had passed with no word about changes.

“To me it’s just very telling, they’re saying they’re doing all these things but it doesn’t really feel like they’re doing anything. It just seems superficial,” she said. “I also don’t think that the administration is getting [to the root] of what this cause is. Because to me, expanding hours at CAPS and expanding personnel there are good things, but those secondary to solving the actual problem.”

Students have noted that many classes went on like nothing had happened. “Why are school activities continuing normally as though no tragedy has occurred? As though another suicide is just part of the norm here?” O’Donnell wrote on Facebook. In person, she wonders why classes classes weren’t cancelled that day. Thai mentions that students in his courses who skipped that day are likely behind now.

“The university’s response? During [Kong’s] vigil at nighttime, I didn’t see Amy Gutmann’s ass anywhere,” says Thai. “I expected more faculty. I expected more administration people to be present.”

O’Donnell would like to see more too. “I think it would be wrong in many, many ways to say [Kong died] because Penn is hard. That’s not why these tragedies occur. That’s not the root cause of anybody’s depression, anxiety, or whatever mental health issue we’re talking about,” she says. “But being in an environment that doesn’t value our mental health or just general physical state of wellbeing? That definitely makes it harder. That definitely is not conducive to healing. For any of us, to be an environment where it doesn’t feel like anybody cares?”

As a senior in high school in Texas, Loza-Avalos relied on forums to give her the lowdown on prestigious schools far from home. Cornell, after six suicides in the 2010 school year and dozens in recent decades, installed mesh netting in many of its gorges. She had looked at Cornell, but she thought it could lead her down a different career path, and at the time, it was the suicide ivy. “I didn’t really process that when I was applying,” says Loza-Avalos.

“Because it wasn’t as real to me then as it is now.”

×
×

Follow this story

×

Success! You're now subscribed to “College life in Philly”

You'll get emails from Billy Penn as this story develops. You can unsubscribe in every email.