

“I don’t understand,” Rebecca Scott told her friend. “The interview went so well.”

Rebecca had applied to be a Resident Assistant, but didn’t get the job. This added to the stress of midterms and classwork she was already experiencing in her freshman year at Ball State University.

Her anxiety had compounded those last weeks before spring break, but it didn’t strike her down until the final Thursday. Sitting in her friend’s room, the stress and disappointment rushed over her all at once, and she needed to get out. She gathered her things and left without explanation.

Returning to her dorm, Rebecca threw down her books and began rummaging for a pencil sharpener. All she could think about was how overwhelmed she was. While the distraction of sleep usually eases her stress, that day was different. And she knew this would work.

For the first time in about two and a half years, Rebecca self-harmed.

Fuck fuck fuck fuck fuck, she thought as the blade sank into her thigh. It was the only coherent thought in her mind.

Afterwards, she felt calm. Though she cut in a place where the wounds would be hidden, she was not ashamed.

Apart from this instance, the involvement and community of college has helped to alleviate the depression and anxiety that Rebecca has dealt with since eighth grade.

But for many, this is not the case. About 86 percent of students feel overwhelmed by all they have to do, the American College Health Association found in a 2014 study. The Center for Collegiate Mental Health reported in the same year that anxiety was the most common concern among college students, identified in 55 percent of those who sought help. This was followed by depression among 45 percent of clients.

The report also stated that, like Rebecca, 24 percent of these students had intentionally injured themselves at some point in their lives. There can be several motivations for self-harm, according to the Royal College of Psychiatrists. It may increase feelings of control, ease tension, or relieve guilt.

For Rebecca, it was an escape from her stress.

College students are going through a developmental phase called emerging adulthood, said Ball State psychological science professor Dr. Katie Lawson. This transition encompasses traits such as insecurity and exploration, both of which contribute to stress as students learn to navigate new freedom.

Dr. David Perkins, another professor of psychological science at Ball State, said that the increased performance demand of college is often stressful for new students. While participating, completing homework, and attending class generally ensure success in high school, college requires original thinking, said Dr. Perkins. Students cannot succeed by just going through the motions and giving minimal effort. He said that individuals at this age also begin to think more seriously about their futures. They may experience insecurity about career choices or the ability to afford an education without accumulating significant debt.

Many of the disorders that arise for the first time in young adulthood are stress related. Dr. Perkins said that overwhelming academic stress can trigger problems like depression and anxiety, especially if a student enters college without coping skills or a support system. Biological factors may also contribute to this vulnerability.

Rebecca’s mental illness was partially caused by Hashimoto’s disease, which creates hormone imbalances in the thyroid. Personal interactions became difficult in eighth grade, so she withdrew from her family and classmates. The few interactions she did have were often fights.

Her social anxiety became much worse sophomore year. Two inpatient hospital stays actually intensified the problem because she was weighed down with the pressure to feel better instantly.

Rebecca stayed at a residential facility for about two and a half months during the beginning of her junior year, following a third inpatient stay. She said that the environment was very hostile, and she often felt judged by the counselors and other staff there who did not understand her coping techniques. If she walked away from confrontation to calm down, they yelled at her more. Physical contact was also prohibited, and explicit permission was needed to hug someone who was crying.

This long-term treatment eventually ended when insurance stopped covering her stay. She was not improving as quickly as they wanted her to. Though she disliked the idea of forcing patients to progress and denying care to those who need it most, Rebecca was ecstatic when she got kicked out. She didn’t want to be there anymore.

After that experience, she began to improve her own mental health by designating time for herself. Rather than focusing completely on homework, she welcomed the distraction of YouTube videos. She began eating lunch with a teacher who also had a thyroid condition and struggled with depression when she was younger.

It was a quiet, honest environment, and they didn’t pretend that everything was okay. The teacher had been through many of the same problems that Rebecca was facing, so she was proud that Rebecca was overcoming her obstacles.

By her senior year of high school, Rebecca’s mental health stabilized.

Her first semester of college last fall also went well, but February of 2016 hit her hard. She regrets self-harming, but she is not beating herself up over it, because she knows that recovery includes mistakes.

Before self-harming this year, she had a running count on her phone of 845 days since the last time. She restarted the count on March 4, and every day she works hard to keep that number rising.

For Rebecca, depression is a sense of apathy. It began to slowly creep back into her life this semester, when she would wake up and not care about going to class.

She hates not caring.

Nearly a third of all college students have experienced difficulty functioning because of depression, according to Active Minds, an organization that strives to erase the stigmas surrounding mental health. This often hinders academic performance. The effect on Rebecca’s academics isn’t as noticeable in college as it was in high school, but it has caused her to fall behind in assigned readings this semester. Anxiety sometimes makes her think, If I do this, and I do it wrong, then what’s the point?

Rebecca is the president of Active Minds at Ball State. When she was dealing with severe mental health problems a few years ago, it was frightening to talk about. Now she is honest about what she goes through because she wants to educate others and help eliminate stereotypes.

One she often hears is: “You’re not depressed, you’re just lazy.” Sometimes, people can’t understand the anxiety she faces about voicing her opinion.

After meeting with a tattoo artist at the beginning of the year, Rebecca stood at the bus stop with her friend who is a nursing major. Her social anxiety had made it difficult to ask the artist necessary questions about a tattoo she was planning to get later that week.

“You just need to get over it,” her friend told her. “Just jump in and start talking to people.”

“That’s not how mental illness works,” Rebecca replied. “And you’re going to be a bad nursing major if you keep that attitude.”

Her mental health has slowly improved since February. Being involved and busy on campus added to the larger community of friends and sense of independence that college brings. It makes her feel better, both physically and mentally.

But this is not the case for another Ball State freshman who has been diagnosed with a mental illness.

For Marah, the heightened academic demand of college has aggravated the disorder she has faced for many years.

As the final bell rang, Marah latched her trombone case and followed the rest of the seventh grade band class into the hallway. Most of them would be leaving for the day, but instead she stood there and scanned the report card clenched in her hand.

Her eyes scoured the list of letters, halting at one that changed everything. Despite the sharp contrast of the “D” among the other grades, it suddenly appeared blurred as her eyes welled up with tears. It was the first grade below a “B” she had ever received, and that was the end of the world for her.

I need to get out of here, she thought.

Marah ran to the bathroom, locked the stall door behind her, and broke down. She was shaking and crying so violently that she could hardly breathe. That was the moment she knew something was wrong – but she kept that a secret. Marah began having regular panic attacks, which she said are the worst experience she can imagine.

“The only thing I can really compare it to is when you’re on a rollercoaster and you get to the very top,” she said. “You look down, and you’re like, ‘Oh crap, this is gonna happen.’ That feeling in your stomach when you drop, when for a moment you can’t breathe – but instead of exhilaration, it’s feeling like you’re dying. It’s like there’s no end to the track.”

The severity and frequency of these attacks increased throughout high school, once a week in eighth grade and four times each day by senior year.

All that time, she didn’t tell anyone what she was going through.

But her parents found out in December of her senior year, when she had a severe panic attack at school. Someone found her in the bathroom crying and hyperventilating and took her to the counselor. Her mom was called in.

That was traumatic for Marah. She had spent so much time hiding the problem from her parents that having it discovered was horrifying.

The counselor explained to her mom everything Marah had said about the suicidal thoughts and panic attacks.

On the way out to the car, her mom was in disbelief. How could you lie to me like that? How could you keep this part of your life that you’ve been suffering so much away from your own mother?

That was the hardest part for Marah. She could only respond with more crying.

But that’s how panic attacks often go for her. She is so mentally and physically drained afterwards that there is nothing she can do but cry and sleep.

Marah started seeking help. In that same month, she began seeing a psychiatrist and a therapist, and was prescribed medication.

Her counseling helped her the most during the time when she was trying to decide where to go to college and had been arguing with her mom about it. Her mom wanted her to stay close so she could watch over her daughter, but Marah wanted to attend a university away from home.

“If you can handle being away from them, then go for it,” her therapist told her. Marah said it was nice having someone on her side.

Being away at college has made Marah’s mental illness simultaneously better and worse. Because one of her triggers is arguing with family members or close friends, being away from them actually helps. But if she doesn’t handle the academic stress of college properly, it becomes a monster she struggles to defeat.

Last semester, right before finals week, a sinus infection and a bad stint of depression caused Marah to miss classes and fall behind in schoolwork. Because she cares so much about academics, this triggered the worst mental health she has experienced since coming to college.

“I miss class not because I’m partying, but because I’m too depressed to get out of bed,” she said. “The circles under my eyes aren’t from being hungover, but from lack of sleep or crying.”

When the stress of college becomes overwhelming, it is helpful for Marah to think about what she can do, even if it’s just small tasks like getting up and taking a shower. She said pushing herself to do that is a stepping stone to larger tasks, like writing a paper.

The seclusion of a small location also provides solace for Marah. She will often go to the semi-private bathroom in her residence hall, lock the stall door, sit in the shower, close the curtain, and desensitize. She blocks out all distractions and calms herself down away from other people.

While her medication now prevents most severe panic attacks, she said her need for that medication has increased since coming to college.

And many college students still do not have the medications they require. Approximately one in four American adults live with a diagnosable mental illness, according to Active Minds. But college-age adults are the least likely to seek help.

This may be due to the turbulence of college years in identity development, said Dr. Perkins. “College students are in transition,” he said. “So every decision they make is kind of an immediate reflection on how they are doing. They may think: What does it say about me that I have to go see a counselor?”

Marah has also been diagnosed with major depression, and has struggled with suicidal thoughts her entire life.

Suicide is always in the back of her mind, aching like a hunger. She can maintain a regular routine, but the thought constantly taunts her. Even when her attention is drawn elsewhere, the feeling remains. She is still hungry. Still suicidal. Though she knows it’s not a good idea, there are countless times when it seems like a reasonable decision.

The most severe occurrence of these thoughts was after her parents discovered her mental illness. She felt that, as an only child, that was the deepest pain she could inflict on them. The guilt became unbearable as her world fell apart.

She felt like she should die.

Earlier, during her sophomore year of high school, she had set a date of July 2, the summer between junior and senior year, when she was going to kill herself.

But she was visiting with a friend when the day arrived, so she changed her mind. She didn’t want to put her friend through that. It was a strange experience for her to just pass over the deadline she had established over a year ago.

After that, Marah never set another date. But there are times when she has the knife in her hand, and she wants to do it, but she convinces herself not to.

Marah keeps a suicide hotline in the contacts list on her phone. She has never called it, but said it is always good to have a plan.

Suicide claims 1,100 student lives each year, according to Active Minds, following only accidental injury as the leading cause of death among college students.

Unlike Marah, most of these students were not seeking help at campus counseling centers.

In a national survey sponsored by the American College Counseling Association, 94 percent of counseling center directors reported recent growth in the number of students with severe psychological problems, with only 11 percent of all students seeking counseling.

Though statistical evidence may suggest an increase in the frequency of mental illness among students, said Dr. Perkins, the reality of this is difficult to distinguish. Counseling centers are being spread thinner than ever, but that could result from decreased funding that leads to a decline in faculty and resources, he said. A recent increase in the diversity of college recruitment could also affect statistics, with more students coming to campus from disadvantaged backgrounds who require a greater level of adjustment.

Marah began visiting the campus counseling center at Ball State during her first month of college, and continued to go until late March of this year. For her, seeking counseling in college was more of a way to feel better that she is doing something to help herself. She’s not giving up, but going out and actively trying to fix the problem.

The idea that mental illness could ever hold her back is frustrating and unthinkable for Marah. She does not allow it to dictate her life. Though it may try to, and she sometimes thinks it may succeed one day, she does everything she can to overcome it.

For Marah, the stress of college can be unbearable. Her depression can creep back in at any time, and she must be prepared to handle the situation if it arises. But despite the challenges, for her, college is absolutely worth it.

