Lost in transition

I cannot remember when I had my first anxiety attack in the Medill on the Hill newsroom, but I do remember exactly how it felt. Two hours into a morning of making phone calls and sending emails, my vision blurred, my chest throbbed and my limbs went numb.

I made a beeline for the restroom, avoiding eye contact with everyone else in the office. Behind the safety of a stall door, I curled up into a ball and began to sob.

Ten minutes later, I regained control of my breathing. I dried my eyes, washed my face and took a few deep breaths. I walked back into the newsroom, and nobody was the wiser.

In the weeks before I went to Washington, D.C. for Medill on the Hill, a quarter-long politics reporting program, I worried about things like stocking up on knee-length skirts to wear around Capitol Hill, finalizing rent payments and catching up on the news. I had not thought much about my mental health.

When students spend time away from the Evanston campus, Northwestern can connect them with mental health resources off-site. For international programs, administrative procedures such as health forms and pre-departure orientations facilitate these conversations. For domestic experiences such as internships or teaching residency programs, students can reach out to advisers or Counseling and Psychological Services if they have concerns.

These systems, then, are largely predicated on students anticipating and pre-disclosing problems they might have. For some, however, mental health concerns do not necessarily fall under the neat umbrella of “pre-existing condition.” Rather, the stresses of new environments – culture shock, professional expectations, loss of a campus support system – can pose unanticipated challenges that affect students’ day-to-day faculties to function. Depending on the program, communication about these challenges and how to deal with them can be limited at best and non-existent at worst.

Tight protocols & procedures

A huge whiteboard hangs on the wall in the office of Julie Friend, the director of global health and safety at Northwestern. Covering it are the initials of the programs she is currently monitoring, from South Africa to Israel, representing the 76 students abroad this spring. Friend is responsible for hundreds more students in the fall, when about 400 leave campus. Worrying about Northwestern students abroad is her full-time job. She works closely with Northwestern’s Study Abroad Office and Office of International Program Development to identify and work with students who might need help.

When applying to study abroad programs, students must fill out a form to disclose pre-existing health conditions, including mental health. Students can then meet with a CAPS counselor to talk about strategies and coordinate with the HTH Worldwide Student Health Insurance, a U.S.-based insurance company that provides coverage for students abroad, to find a therapist in their destination. For Northwestern-designed programs run through IPD, all students must attend pre- and post-departure orientations that, in part, talk about how to seek treatment while away.

Emily* sat through IPD-mandated orientation and did not check the box disclosing any health problems before she left to study abroad in Paris in fall 2015. She had never seen a therapist and did not think she would need to. Instead, she was preoccupied with thoughts of how thrilled she was to leave the country for the first time. But once the novelty wore off and loneliness replaced her initial excitement, she says she felt “pretty depressed” and isolated, especially when alone in her room at her host family’s house.

“That was really disconcerting because I was like, I should be having the time of my life and I’m really not,” she says.

As part of her program, however, she had been given an emergency contact list that included the names of two local English-speaking therapists. She went to one of them for a handful of sessions before deciding to stop. The two of them did not really click, she says, but she had other friends and IPD staff members there that were supportive enough to help her through her time abroad.

“I think that in this particular situation, it wasn’t the fault of Northwestern staff or faculty,” she says. “That’s what having a mental health problem feels like. It’s a shitty feeling, and you feel like no one understands, even if they would or they would try.”

The limits of being proactive

For students looking for resources before they leave campus, Mona Dugo, senior associate dean of students in Student Assistance and Support Services, can also help. Typically her office reaches out to students she has worked with in the past who have pre-disclosed mental health issues to ensure their plan of action in regards to treatment abroad, in order to make the transition as seamless as possible.

“A transition like that is really stressful on a good day, for somebody who’s feeling really well,” says Dugo. “And if there’s a history of depression and anxiety, of course I’m going to be worried.”

However, unforeseeable events during the study abroad experience itself can leave students feeling lost and isolated. They can reach out to the Dean of Students Office to find support, but this doesn’t necessarily play out in reality.

For most of Angela’s* fall 2015 semester in Europe, she felt fine. But things took a turn for the worse during the final weeks of the program.

Angela had been romantically involved with a non-Northwestern college student living in her building, whom she had been close to since the beginning of the program and sleeping with since the third or fourth week. Everything was consensual at first, but then things changed with two weeks left.

“I had lots of instances when I’d wake up in the middle of the night and he’s getting in my bed and essentially not asking for consent and doing things to me while I was trying to get him to stop physically and verbally,” she says in an online message.

Angela did not label the encounters as “crazy unhealthy,” emotionally or physically, until the end of the semester, when she started avoiding him – which was difficult, given that they lived in the same building and belonged to the same friend group.

“There were lots of days that I was just like, ‘Okay, if I make it through, it’s another day crossed off the calendar and another day closer to being home,’” she says.

Angela remembers a pre-departure presentation on bystander intervention situations that she says would not have applied in her case; she does not know whom she would have been able to talk to in order to get help. Apart from friends back home, she never told anybody else on the trip about was going on because she did not think they could help.

Even when she came back to campus, Angela did not report the case to the University. She did not believe the accompanying emotional distress would be worth filing the paperwork. She did not want to dredge up the memories.

“Ultimately, I decided to just deal with it,” she says.

Lack of conversations for domestic programs

While unplanned events can affect the mental health of students such as Emily and Angela while abroad, Northwestern tries its best to provide resources for students who ask for them. The issue, then, lies in finding adequate enough support or knowing where to turn.

For students who complete domestic programs, such as Medill’s quarter-long Journalism Residency (JR) internship requirement or SESP’s practicum, leaving campus entails entering high-stress professional environments for the first time while simultaneously adjusting to new cities.

Unlike with international programs, there are no pre-departure discussions about mental health. Students leaving campus must take the initiative to disclose concerns to their program coordinators or individual advisers before leaving.

When the time came for Medill senior Jillian Sellers to leave campus for her JR during Winter Quarter 2015, she could hardly wait. Sellers says she had always considered school a trigger for her depression and eating disorder, while she has thrived in all of her “real-world” multimedia journalism internships.

Everyone else – her JR and academic adviser, friends, family and therapists – was less sure. They initially encouraged her to stay in Chicago, where she would still be able to go to her usual rehabilitation, psychiatrist and clinical nutritionist appointments. After a lot of conversations about insurance, therapists and contingency plans, though, she received the green light to go to New York.

Sellers says she was grateful for the trial-run of handling her mental health independently while on JR.

“From my perspective going to New York, that was my decision, and it’s so reflective of what the real world is like,” she says.

But for students without a complete grasp of their mental health and a support system like Sellers, conversations about wellness do not always happen. Issues with international insurance do not arise, and the Office of Global Health and Safety does not get involved. CAPS is the authority on handling mental health concerns, according to Journalism Residency Director Karen Springen.

CAPS, however, is only a piece of the overall community responsible for students’ wellness, says Executive Director John Dunkle, especially since the department has been stretching its resources to accommodate the growing number of students walking through its doors every year. Currently, CAPS has only one staff member available for every 1,032 students on the Evanston campus, a significantly lower staff-to-student ratio than other comparable universities, according to the faculty task force report on the undergraduate academic experience published in December 2015.

“We only have a finite number of people here to do what we need to be able to do,” Dunkle says. “We need to think carefully about how to do it.”

CAPS has a liaison that works with each Northwestern school if their programs request consultations about mental health, according to Dunkle. However, he says he has never personally worked with Medill’s JR program, and they’ve never done a pre-departure workshop. Instead, CAPS has helped individual students map out treatment plans for when they leave, on a case-by-case basis.

“While CAPS really does its best to make sure that we’re providing the essential services, especially here on campus, we obviously can’t be everywhere,” he says.

CAPS certainly was not in D.C., where I had to wrangle with my mom’s insurance company to schedule a meeting with a psychologist.

We filled out insurance paperwork for most of our first meeting. I gave him a rundown of my mental health history: I had seen a therapist in high school and my freshman year of college for disordered eating and anxiety but had never been diagnosed with anything clinical or taken medication.

Finally, he asked how I was feeling. I started to answer. But then I stopped; I did not know what to say. What could I say? That I was miserable at a program that I had wanted to attend the moment I found out about it? That I had fought off panic attacks in the newsroom that I had worked so hard to get into? That I had lapsed back into old patterns of obsessing about food and exercise when this was supposed to be the best three months of my life?

I told him the truth: I had never felt so consistently anxious and sad, even during the most stressful parts of the year on campus. In return, he gave me some lackluster advice about maintaining balance and taking time for myself, and our hour was finished.

I left the office angry, but not quite sure at whom. Before I left for Medill on the Hill, our orientation consisted of an overview of tips on how to find housing, the program schedule and basic expenses. Health care was mentioned only in passing and mental health not at all. Why had no one – program coordinators, other students or faculty – prepared me for the fact that I might need support?

Having an early conversation would have helped Erin Donohoe (Weinberg ‘15) when she left campus during her senior year Winter Quarter 2015 for SESP practicum her major required, she says.

For the quarter, she worked at New Trier High School in Winnetka, Illinois, where she helped teach an American studies class and two English classes.

Despite the three-and-a-half mile distance from campus, the environment was a shock to her. She had never planned lessons before and had little experience with classroom management.

Donohoe had expected it to be stressful, but not to the extent that she felt sick at the thought of going to school every morning, or that she would cry on the phone to her mom every night. She had been taking medication for ADD for years, but she had never seen a therapist or asked for any sort of support, even throughout the more difficult parts of high school.

In the final months of her college career, Donohoe was reluctant to share her anxiety and doubts about teaching, worried that it might affect her grade or ability to graduate.

“How do you tell the difference between normal stress of being a young professional who doesn’t know what they’re doing versus having issues with your mental health?” she says. “The only reason I held on so long was because I thought what I was going through was normal and expected.”

In the end, she reached out to her SESP professors for help after realizing she could not get through student teaching without further damaging her mental health. Her adviser helped waive requirements so she could transfer to Weinberg during February of her second-to-last quarter at Northwestern and graduate on time as an English major.

Donohoe felt like her professors and advisers cared about her, but she wishes that during the weekly check-in seminars with other students and professors that they had talked about the specific kinds of stress that teachers face, or how to find a counselor if necessary.

“If you don’t talk about it,” she says, “how are you supposed to know?”

Coming home

Looking back, I know I could have reached out for support. Logically, I could have called CAPS or the Dean of Students Office and asked for help with therapist referrals. I could have emailed my adviser back on campus to let him know what I was experiencing.

But logic does not apply to mental health, and level-headed thinking often falls to the wayside. Like Emily, I felt guilty for not being happy. Like Angela, I had no idea how to go about finding support locally. Like Jillian, I was grateful for the professional experience, but like Erin, I had no idea what I was getting myself into because no one had talked about that. Reaching out for help felt next to impossible.

My experience in D.C. was not as simple as being miserable the whole time, either. There were many moments of joy: museum visits, morning runs to and from the White House, day trips to national monuments, watching documentaries with my roommates. I loved, loathed and was exhausted by D.C. – a kind of nuance that Facebook photo albums cannot capture and small talk cannot convey.

When I came back to campus, I found myself repeating the same cliches I had heard before I left: best quarter ever, great to be away during the winter, strange to be taking classes again. Eleven wild, exhausting weeks condensed into bite-sized chunks for quick conversation.

I’m still not entirely sure how I would have wanted someone to prepare me for the quarter. So when people ask me, “How was D.C.?” I respond: “It was a lot.” And I leave it at that.