Jane* was sitting in her apartment the night her roommate tried to kill herself. From her room, she could hear her friend struggling with a bottle of pills in their bathroom. At first, she wasn’t alarmed. ‘Okay,’ she thought, ‘she’s probably taking her meds.’ She heard some more rustling and the toilet flush. Then she heard the door to the back porch open and her roommate walk outside. Still in her room, she overheard her friend call her doctor to tell him she’d almost swallowed a handful of pills but spit them out at the last minute.

Practically in front of her, Jane’s roommate Mia* had tried to end her life. And Jane had no idea it was coming.

“I was trying to pay attention to those things that were off,” Jane says. “And for me personally, I’m trying not to be guilty and feel like a failure because suicide is never your fault as a friend. But I should know better.”

Jane and Mia met freshman year through their sorority. They were never close, but Jane was one of the people who made the sorority feel like a safe place for Mia. In 2015, they decided to live together during their senior year. Jane seemed to be able to calm Mia down, ground her and make her a little less depressed; it seemed like becoming roommates could only be a good thing. But Jane didn’t realize the toll it would take on her own health until her roommate landed in the hospital the first week of November 2016, after she spit out the pills.

Even though Mia assured Jane that she didn’t need or want anything aside from space, Jane found herself struggling not to feel culpable for her friend’s health after Mia returned from a brief hospital stay.

“It’s this feeling of personal guilt and responsibility,” Jane says. “Which is completely irrational, but at the same time, you have to live with her.”

Mental illness doesn’t always manifest through a suicide attempt or a hospital stay. The National Institute of Mental Health reports 17.9 percent of Americans over the age of 18 experience mental illness each year. Inevitably, it will touch the lives of each student at Northwestern. The Counseling and Psychological Services (CAPS) 2015-2016 Annual Report reported that 18 percent of their self-report Northwestern survey respondents said that they had seriously considered suicide in the past five years, and 4.1 percent said they had made an attempt. Compare that to the American College Health Association (ACHA)'s 2016 report that found 10.5 percent of college undergraduates nationwide have considered attempting suicide. When someone experiences a mental illness, its impact spreads beyond them; each student who struggles comes with a network of friends, family and peers who are also affected. Jane’s senior year has been shaped by respecting and empathizing with her roommate while simultaneously trying to make sure she’s taking care of herself.

SESP senior Sunny Han, one of NU Active Minds’ co-presidents, says while people acknowledge how difficult living with a mental illness is, the impact it can have on friends is often overlooked.

“Being a friend of somebody with a mental illness is pretty challenging,” Han says, especially during peak periods of mood instability. “The really unfortunate thing about mental illness is that those are the times you need people around you the most – and it’s also when you push them away the most.”

Finding statistics about the way a romantic partnership is affected by mental health is easy. Statistics can show, for example, how many people turn to couples’ therapy and how many others divorce. But there’s relatively little talk about how it plays into friendships, and in college, when students develop many important and often lifelong ones, this information is necessary. Medill sophomore Allyna Mota Melville is one such friend. She considers herself a caretaker and says she has often put the needs of friends before her own. She didn’t realize the strain she was putting on her own mental health until last summer, when she was diagnosed with depression and anxiety after having a particularly intense panic attack at her internship. She’d spent so long taking care of her friends that it was difficult for her to feel like she could take care of herself, she says.

“I’ve always been the person who is like, ‘oh, my problems aren’t that bad, their problems are worse, I need to make sure they’re ok first,’” Mota Melville says. “It doesn’t feel like a burden on you when you’re doing it because, like, you want to take care of your friend, but at the end of the day, it’s about your mental health.”

But the truth is, it can be a burden. There’s a term for this. It’s called compassion fatigue, and occurs when a person becomes overwhelmed or burnt out after hearing the same things their friend is struggling with over and over again.

Steven Andrews, Ph.D., the coordinator of peer initiatives and a clinical psychologist at CAPS, says a lot of this comes from trying to fix a problem and failing – because, of course, no one can really “fix” another person.

“Not surprisingly, when we figure out that we can’t fix things, helplessness can come up,” Andrews says. “And I think it’s important to realize it’s not your job to fix someone if you’re their friend.”

Andrews thinks the best thing a friend can do is provide a nonjudgmental source of support, but also recognize that support can become challenging. He says, “You don’t have to be alone in that.” Without the proper support system, he says, caring for another person in distress can be painful or traumatic for the caretaker, too.

Mia’s best friend Rose*, who has struggled with anxieties of her own since high school, knows how valuable it is for Mia to have a friend who understands. She says she can be the person to remind Mia that she is stronger than she thinks and has people who love her unconditionally.

"It's this feeling of personal guilt and responsibility, which is completely irrational, but at the same time, you have to live with her." - Jane*

“I get it, and not everybody gets it, and because not everybody gets it, somebody has to get it,” Rose says. “I know she needs someone in her life that’s gonna tell her that it’s normal.” Still, she acknowledges that being friends with Mia can be challenging.

Striking a balance between helping a friend and helping yourself is something that NU Listens, Northwestern’s anonymous peer-listening service, sees as very important. Brooke Feinstein, a Weinberg senior and NU Listens’ training chair, says the group puts self-care on the agenda to train listeners how to take care of both callers and themselves. “You have to put self-care first, not just for your own wellbeing, but just to be an effective listener,” Feinstein says. “You might tell yourself, ‘Oh, I just gotta push through it to help my friend,’ but then you’re going to possibly get burnt out or lose your ability to help.”

NU Listens’ director Elena Dansky, a Weinberg senior, compares it to being on a plane and being told that you need to put your own mask on before you can help anyone else. “It’s better to be at your best for helping other people so it ultimately helps both people,” she says. Often, people with mental illnesses are painfully aware of just how distressing their illness can be to friends. Nathan Moxon (WCAS ‘17), a former listener with NU Listens, says that feeling guilt and anxiety about encumbering a friend was a common cause for a call. “I think the best thing you can do as a listener is empower the person and say there’s no reason that you should feel bad for circumstances you don’t have control over,” he says.

The problem is that sometimes, feeling responsible for another’s health is a burden – even if it isn’t the other person’s fault. Many people say they have lost friends because of their mental illnesses. While Jane has been supportive through Mia’s process, Mia says that throughout her life, other friendships have failed. She’s lost count of both the attempts she’s made on her life and the number of friends she has lost.

“I have severe mental illness issues, and I know that it hurts a lot of the people I’m around,” Mia says. “I think it makes it very difficult to be my friend oftentimes, just because sometimes it gets so severe.”

While it sometimes is stressful to not know how Mia is doing or even where she is, Rose says she is able to get beyond feeling hurt by her because she has a deeper understanding of mental illness than many of Mia’s peers. “When you’re friends with someone who has a mental illness, you have to love both parts. You love them and their demons,” she says.

It’s not always as simple as committing to loving all parts of a depressed, bipolar or schizophrenic person. Mota Melville has seen situations where friends have felt hurt by others who withdrew or were absent when they were needed. Communication, she says, is really the only way to handle that situation. “Be honest and let your friends know what you’re going through,” Mota Melville says. “It can feel really alienating, because mental health can make you lash out or be really reclusive to people, so other friends can feel really hurt by that.”

Mia says that she acknowledges and takes responsibility for the pain she causes, but sometimes she feels like her mental state makes her into a different person. “I try to use techniques to prevent that person from coming forward,” she says. “But it's a really long battle, because the part of me that just wants to destroy everything in my path – including myself – in order to prevent it from hurting me is a defense mechanism. To get past it, I have to be vulnerable, and that's what I have the most trouble with.”

The situation gets even more complex when both friends are going through low points in their mental health, especially in a competitive academic environment like Northwestern’s. Aside from putting a level of emotional stress on each other through asking for help, each person in a relationship has different needs. While one person may need to talk something out when stressed, the other may push friends away.

Robert Noone, an Evanston marriage and family therapist, calls this the “dance” of the distancer and pursuer. “Some people, when they get anxious, they start distancing,” Noone says. “And then, if they’re in a relationship and the other person picks up on their anxiety, they start to pursue them. And when they pursue them, the person gets distant, and when the person gets distant the person pursues them.”

Noone says one way to manage this problem is to recognize the “dance” is occurring. If you realize your distance causes another’s pursuit, working to be less distant can help the friend ease up.

In trying to attack this problem, Feinstein says it’s also important to recognize how different coping mechanisms work, without judgement. “There’s really no right way to handle certain things,” she says. “The fact that people handle things differently is perfectly okay and should be recognized. A lot about active listening is about the other person. So for example, if I was more withdrawn and my friend wants to talk it out, I might talk it out, because that’s what she needs. To be a friend, I have to understand that this is how she needs to do it.”

While Feinstein recognizes how her friend’s needs may be different than her own, Mota Melville often finds herself trying to be a proxy between her friends. “Sometimes with my friends I’ll be the only one to remind them that this person isn’t trying to be mean,” she says.

Something that Noone says he notices in his practice is that when one person is upset, it tends to upset their counterpart. This is applicable to friendships too.

“Anxiety, which is a part of any emotional disorder, is contagious,” Noone says. “But another good principle is that calmness is contagious too. If someone is very upset emotionally, and someone else can relate to them, and not get so distraught but still be able to engage them, then they calm down.”

Of course, keeping your cool can be difficult. Being able to recognize the distinction between what is your friend’s pain and what is your own is challenging. And when those boundaries aren’t so clear, Mota Melville says taking a step back is important. When she begins internalizing her friends’ pain, she gets hurt. At the same time, Mota Melville says, causing pain doesn’t necessarily put someone at fault. “It’s not your fault if you accidentally hurt someone, because it’s your mental illness,” she says.

"The fact that people handle things differently is perfectly okay and should be recognized." - Brooke Feinstein

Mia doesn’t think mental illness should remove a person’s responsibility to be a good friend, but that’s often easier said than done. “I think it should never be an excuse unless it, like, physically disables you, which has definitely happened to me, but I find myself using it as one,” she says. In order to try to assuage some of this pain, honesty has been crucial for Mia – on all sides. One of her biggest frustrations is feeling that people aren’t emotionally honest with those with mental illnesses. “We’re not so fragile that you almost have to put up walls and barriers,” she says. “That feeds the paranoia, that feeds the feeling of isolation. We are real fucking people.” Even so, Jane is sometimes nervous to push back on Mia and tell her she can’t accept an emotional burden. She knows that Mia will have a relapse at some point – she just doesn’t know when. If that relapse does force Jane to step back, it would likely affect Mia very deeply, as Jane has been one of the few people she connects with.

Weinberg senior Jacob Swiatek comes from a part of campus where emotional disorders often aren’t addressed: the frat quad.

Swiatek noticed just how far-reaching the scope of mental illness is on campus his sophomore year. He noticed a friend was self-harming and approached him after class to ask about it. While Swiatek had encountered mental illness in friends before, this encounter served as a catalyst for him; although he has not struggled with a mental illness, he became committed to getting more involved on campus.

“I basically realized that more and more people around me were going through this kind of stuff that I didn’t initially notice,” Swiatek says. “I kind of developed this sense that mental health isn’t just about depression, anxiety. It’s also your day-to-day dealings of what’s going on in the world around you.”

Swiatek particularly notices how isolating mental illness can feel in fraternities, where you’re supposed to find “brothers” and make friendships that will last forever. But because the culture doesn’t condone talking candidly about these issues, he says, that often doesn’t happen. Mental illness can feel like an individual problem instead of one within campus and fraternity culture. Swiatek describes the common attitude like this: “If you’re in a frat and you’re going through something but you don’t feel comfortable talking to your brothers or you still feel alone, something must be wrong with you.”

This speaks to what Swiatek sees as a problem in campus culture. “Everyone’s so busy that people are hesitant to schedule time out for each other,” he says.

In Weinberg junior Nehaarika Mulukutla’s experience, this comes down to a lack of understanding about how to address individual mental wellbeing. She believes that our generation hasn’t been taught to address and manage emotions well, so when people reach a breaking point, they have trouble coping. “People here, when they hit the stress test, and they start to see themselves sink or fail, their automatic reaction is to push other people who are struggling as well away,” Mulukutla says. “We’re all individually drowning – and we don’t know how to handle our own emotions, so how could we know how to handle someone else’s?”

That’s not to say that we can’t learn to address our emotions better. Noone says that in order to address campus culture, individual wellness is the first step. “Getting better at managing stress helps with relationships,” Noone says. “Our brains operate better if we’re less stressed. The thinking part of the brain shuts down when we’re more stressed, and the emotional brain takes over.”

Finding spaces to learn about methods of self-care and care for friendships on campus can be difficult. While there are resources for mental health offered by Northwestern like group therapy – which Andrews says is all about improving the ways students connect with one another – workshops, trainings for student groups, CAPS counseling and referrals, it doesn’t always trickle down to the friend-to-friend level.

“Where do you find the space for you as an individual, and your relationship with the other individual?” Jane says. “Because all these relationships at Northwestern are predicated upon you being on the top of your game constantly.”

"There's so many ways to get help and it can be treated. If someone is thinking about suicide, that's a symptom of a mental health issue, so I think if we take it out of the context of suicde, that can sometimes hopefully lighten that burden." - Steve Andrews

And when you’re not at the top of your game, that’s where things start to spiral. The ACHA reported in 2008 that the suicide rate among young adults has tripled since 1950. The Daily Beast ranked Northwestern as the fifth most stressful campus in the nation in 2011, and it’s no surprise to Jane that in just seven years, Northwestern has seen six suicides, three of which were in the past two years.

“That’s not fucking okay,” Jane says. “And we just kinda sit there and go, ‘oh, look, another one. And another one, and another one.’”

Han says Northwestern’s culture expects people not to show their stress, so often their friends may not know they are struggling at all – which is incredibly problematic when talking about suicide. Even if they do know, many people shy away from the topic of suicide for fear that if they ask a friend if they are suicidal, they’re more likely to do it. “It’s actually the opposite,” Han says. “You should ask them ‘are you thinking about doing it?’, because that can make all the difference. To actually address that is really important.”

In his years of clinical experience, Andrews has never seen someone respond negatively to the question “are you suicidal?” “The person always has a choice in whether or not they answer,” he says. “But to know someone cares enough? That’s incredibly important. That is something we can do as a university community: to notice that it’s scary and then hold the fear and do it anyways.”

In fact, bringing it up and asking if someone is considering it can lead to connecting a friend with resources that could save their life. Someone might not want your help or ask for might ask for confidentiality, but Andrews says that asking a friend not to divulge that you may be a risk to yourself can put them in a tough position, especially because approaching a professional is often the best gift a friend could give. The internal conflict that comes from trying to support what friends want and keeping them safe can result in tension or even the end of a friendship.

It’s hard to realize that with something as extreme as suicidality, treatment is still possible; these thoughts are not standalone, but instead a relatively common symptom of a wider health issue. “I think most people want help,” Andrews says. “There’s so many ways to get help and it can be treated. If someone is talking about suicide, that’s a symptom of a mental health issue, so I think if we take it out of the context of suicide, that can sometimes hopefully lighten that burden.”

Knowing what to do when a friend struggles with mental health issues, or about suicide in general, is not commonplace on campus. A number of students attributed the lack of resources to the lack of value placed upon friendships.

“I feel like when people talk about relationship problems or how to navigate relationships, they’re usually talking about romantic relationships,” Feinstein says. “I feel like people don’t talk so much about friendships. And I don’t know if that’s because people think that they’re less complicated or not as valuable. At my stage in my life right now, my friendships have all been more valuable than any dating. This is the time for developing friendships.”

But without ways to learn about and develop those healthy friendships, Mulukutla says it’s more difficult to know how to be a caring friend when someone asks for help. “It’s not wrong to say I can’t do that for you right now,” she says. “But I also don’t think enough people stop and say ‘I can.’ So that’s what makes it hard.”

Because Jane trusts in her own ability to cope, she’s felt she could say “I can” to Mia during times the majority of Mia’s peers haven’t. Jane has found a balance by using an outside network of friends as well as her therapist, but it remains a challenge because she knows that Mia’s problems won’t miraculously dissipate.

“It’s ongoing, and it’s a chronic disease that just doesn’t go away,” Jane says. “So what can I do as a person, besides going to a therapist to talk out my own issues and make sure that I’m not putting so much emotional labor on myself and be a good friend?”

*Editor's note: Names have been changed to protect students' identities.