How students fail to address mental health

For any advocate on any subject, one of the most important things to keep in

For any advocate on any subject, one of the most important things to keep in mind is your status. Those who have the privilege of helping are not simply more equipped or more able. They are interested parties whose motives may ultimately limit what they are willing to do for those less fortunate. They often seem to do a lot and feel that they are. But the nature of their action can be mismatched to the problem.

Here’s an example: the mental health crisis. It’s clear that mental health is a cornerstone of student advocacy around the country, and it has been since the start of the millennium. Yet throughout this period, things have only gotten worse. In 2019, people had never been more suicidal since World War II. Among our cohort (18-22), 7% would contemplate suicide in any given year.

We’ve been trying to fix things. Academic institutions have been some of the most active problem-solvers all along. A sign of the mental health crisis was the explosion of self-help groups, which are a reaction to the insufficiency of available therapeutics. Modern self-help is in part derived from the work of Stanford psychologists whose legacy is evident in our sheer number of wellness labs. Their research is taught in public health and psych classes. Students then use that as their knowledge base for advocacy. 

A solid example of this is found in HUMBIO 128: “Community Health Psychology.” One-third of the course deals with stress and coping, but lectures tend to conclude — as they should — that we cannot reliably get people to be less stressed or reconnect with those around them. Then there are lectures from the Mind-Body Lab and Contemplation by Design about meditation and mindset. Something similar is true of HUMBIO 126: “Promoting Health Over the Life Course.” The lecturers are consistently and explicitly pessimistic about the prospect of getting people to be healthier. But they also dedicate several classes and readings to meditation and self-compassion.

The issue with this is that there is little evidence for any sort of positive psychological intervention as a public health tool. Crises are about the public. As an analogy, exercise is good for you as shown in empirical studies, but it won’t solve the obesity crisis. We only promote it because generalization to populations — bordering on logically worthless — seems better than nothing.

The unmitigated problem leads many students to think more research is needed. But here’s the truth: common mental illnesses have been exhaustively studied. We already know their causes. Single and quite simple distinctions — a degree, bullying, apathetic parents, a history of unemployment, etc. — have lifelong consequences for well-being. I have written at length about how their continued effect depends on the inertia of social disadvantage. 

I continue to harp on this because it is a jumping-off point for action in a time when nothing works. If the issue is social, we need little to at least make an effort: troubleshooting current services such as peer counseling by interviewing students in distress, devising a reliable way to identify those who are shut-off within dorm communities, working to put together mutual support groups so that people keep each other accountable (beyond just HapCo), etc. College is a good time to start trying these things since the disadvantages of youth bloom in young adulthood. We could work within our community to rehabilitate and reintegrate those who are struggling, and use what we learn to make broader change. But instead, we push the detached interventions of an inefficacious wellness cult. Why?

The answer has to do with how we approach advocacy. The academic movement of which we are a part is a self-interested one. And alongside our desire to help, we have a desire to feel progressive: to be excited by the novelty, passion and reward of our contribution to humanity. The career which draws us is both virtuous and luxurious since those who do good, as goes the Stanford catchphrase, ought also to do well. 

Here then is the problem: The very ordinary causes and nature of mental distress detract from this self-image and aspiration. The ways in which troubled people become dysfunctional are no academic mystery. And their restoration is neither exciting nor opportune. To aid them would require repetitive work: volunteering, mentoring, community-building, etc. We would rather innovate and discover than implement what is already obvious, perhaps since there is no excitement or glory in the latter.

We focus on niche aspects of distress that are more rewarding. The voluntary pathway of our study transforms mental illness into a technical problem, sometimes by hyper-focusing on biological causes, which cannot possibly explain the sudden increase in depression and suicide, but often without question. We come to view mental health as if it were an unexplored frontier, filling seats at neuroscience and general psychology courses because we find human behavior fascinating. Eventually, we forget the narrowness of our study, and thus the huge number of people who could be helped by simple outreach.

I’ll offer an example of the toll of our forgetting. Last year, I ran a grant-funded project on loneliness on campus. The project received constant excited input from all manner of people, most of whom drew an explicit link between loneliness and the mental health crisis. However, many had an overcomplicated understanding of the issue. 

Loneliness is simple. Sociological literature — contra fabricated data and poor science — says that the cause is a lack of social skills or energy to sustain relationships or the othering which follows from simply existing in public space alone. Lonely people are generally so because they have few and/or uninvested friends. There is no need to make things more complicated than this if we have not addressed that fact. 

But we can’t help ourselves. Nearly every student who contacted me focused exclusively on cognitive distortion and modernization. I assume they all watched the same YouTube video because I lost count of how many times someone came to me with a near-scripted speech on how loneliness is a mental trap fostered by technology and busyness. It was no different from any other indulgent cultural fascination: like how we can go on for hours about social media or capitalism without saying anything at all.

It was surreal how not a single person I talked to had anything to say about either friendlessness or inadequate support. That’s not because people were wrong, since emotional loneliness is real. It’s that their niche focus demonstrated a total lack of proportion. It is common sense that all kinds of loneliness are very heavily correlated with one’s number of friends. This correlation applies to emotional loneliness since distressed people have poor relationships. 

The other thing that struck me was how unrigorous students’ claims were. While many described isolation as some modernist plague, most material factors people use to explain loneliness have no demonstrable correlation. The best example is living alone, which has been surveyed both in the U.S. and U.K., and shown not to correlate. If something so tangible has no impact on symptoms of loneliness, what would? 

This is a question long answered. When a problem seems immaterial, the handy explanation is that it is social in nature: born out of organizing processes and implicit norms. It is a natural explanation for loneliness whose nature is inherently social. But Stanford students seem unable to reach, let alone follow-through with so bland a conclusion. They cannot be bothered to care about those whose problem is the simple inability to fit in.

They certainly don’t try. When submitting my grant proposal, I had to find out what had previously been done about loneliness. I searched a large number of mailing lists several years back and found only a handful of emails that even mentioned the word loneliness. Few if any were centrally about it. As it turns out, this is because there has not been a comparable project carried out on behalf of any student organization in decades. I cannot overstate how much this reveals our disregard for mental health since loneliness is one of the primary causes of human distress.

We can generalize this critique to the mental health crisis. It is not a biological or behavioral phenomenon to be understood in a lab. The speed with which it occurred — the ease with which our communities were made to produce abandonment and despair — can only be explained by societal shifts exploiting and then shaping our values and ways of relating. But instead of working on these things, we continue to push technical interventions. 

If we see distress as divorced from social context, we will never help people out of it. This is a simple truth, made all too clear by the fact that we don’t even know how our fellow students are fairing mentally. We talk in circles about stress but either don’t collect or don’t have access to data on student mental health. Let me know if you find it. Otherwise, our discussions on the subject are hollow virtue-signaling since you cannot systematically improve mental health without knowing who is suffering, how badly and why.

Contact Noah Louis-Ferdinand at nlouisfe ‘at’ stanford.edu. 

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