Editor's note: This is the second installment in a three-part series discussing mental health at Notre Dame and Saint Mary's in recognition of national Mental Illness Awareness Week.
Saint Mary's junior Molly Smith said she first experienced depressive episodes during her sophomore year of high school.
Since then, she has been fighting to get better.
"I think this summer was a big point where I realized if I wanted to feel like I was living and not just existing, I had to really work on the issues that were keeping me sick," Smith said.
Smith's struggle with mental health started with depression and anxiety but grew to include an eating disorder in which she restricted food intake, she said.
"Looking back, [the eating disorder] was kind of a coping mechanism to the depression," Smith said. "I think in hindsight, I didn't really see how much the depression and all of that were controlling my life."
Smith said she underwent in-patient treatment during winter break of her freshman year at Saint Mary's. Her subsequent fight to stay well had its ups and downs, she said. Her eating disorder resurfaced during October of her sophomore year, and her health spun downhill again.
"It was a lot harder than the first time," Smith said. "I think [it was] kind of the rock-bottom point of me figuring out that I really needed to address this head-on."
'A common struggle'
Smith's battle with mental health issues is far from uncommon. Between 6 and 12 percent of college students nationwide seek counseling services, according to the 2012 Executive Summary Report of the Association of University and College Counseling Center Directors.
Dr. Susan Steibe-Pasalich, director of the University Counseling Center (UCC), said the top five reasons students sought services at the UCC during the 2012-13 school year were anxiety, depression, family concerns, romantic relationships and attention deficit hyperactivity disorder.
Two factors contribute to the development of a mental health issue, Steibe-Pasalich said.
"There's a predisposition toward mental illness - a genetic, biological disposition - and then there are environmental factors," she said. "Both things need to be present for you to develop a mental disorder."
Notre Dame psychology professor Gerald Haeffel published research about a risk factor for depression, called "cognitive vulnerability," in the journal Clinical Psychological Science last spring. He told The Observer in May that cognitive vulnerability is a style of thinking about events that can be passed from one person to another. A person's cognitive vulnerability can predict future depressive episodes.
Haeffel said last week it is difficult for most people to identify their levels of cognitive vulnerability, but they can notice when their moods are abnormally negative.
"You may not be able to completely pick up on what dial of thinking you have, but you can pick up on when you're feeling a little down," he said.
'Engage in self-care'
Notre Dame senior Zoe Jimenez said she struggles with anxiety. When she realized her stress level was constantly high, she sought counseling at the UCC.
"Especially on this campus, it's hard to figure out when your high levels of stress are not just regular ... because all of us are very, very stressed out all the time," Jimenez said. "[I realized my stress levels were extreme] when the anxiety started to seep into other aspects of my life, rather than just academics, [and] when I couldn't stop thinking about work and the things I had to do while hanging out with friends on weekends."
Students can take steps to decrease their stress levels, Jimenez said.
"Whether or not you think your level of anxiety or stress is normal, if it's not desired, ... you can do things to help yourself out - like running, exercise, yoga, meditation, praying, going to daily Mass," she said. "These are all little breaks from life that we all need."
Steibe-Pasalich said students should also take other measures to preserve their mental health.
"Engage in self-care," she said. "Allow yourself to have good social support systems, good friends, people that love you and you love back. ... [Also helpful are] letting yourself be vulnerable to others, giving up perfectionistic ways of thinking and ideas."
'A community that cares for each other'
Students should work to be active bystanders with regard to their friends' mental health, Steibe-Pasalich said.
"The whole idea is that you would not just stand by and let a crisis happen, but that you would intervene in an active way to help somebody to get involved in preventing an emergency situation," she said. "It's sort of [the] 'I am my brother's and sister's keeper' idea, that we are a community that cares for each other."
Steibe-Pasalich said if a friend's behavior seems radically different than usual, the student might be facing a mental health issue.
"Your friend who suddenly isolates or stays in their room and stops going to class and doesn't go to the dining hall anymore, that could be some manifestations of depression," she said. "Or somebody who has extremely excessive energy and hadn't been that way, but suddenly they're up all night painting their room or running around the lakes, and they just go ... without sleep for more than 24 hours, that could be a bipolar disorder manifestation.
"So any real change or very unusual or bizarre behavior, you might suspect that there's a problem."
Helping a friend who has a mental health issue is tricky but important to his or her well-being, Smith said.
"I think the best thing you can do is just be patient with them and ... express to that friend that you're there if they need anything," Smith said. "Obviously, if it gets to a situation where you feel like something bad may happen, ... you do need to try to talk to them. And if they're not willing to do it, maybe talk to an RA [resident assistant] or something, because it's important that they get help."
Jimenez said friends should help each other to stay healthy by participating in relaxing activities together.
"If you have a couple hours, leave campus, because a huge part of this is the environment and how stressful it is," she said. "A lot of times, people need to exit a situation to stop feeling stressed out about whatever is happening in that situation."
Steibe-Pasalich said if the situation seems serious, however, it is appropriate to ask the friend if he or she feels suicidal. She said it is myth that using the word 'suicide' will put the idea in someone's head.
If a friend does feel suicidal, Steibe-Pasalich said to bring him or her to a rector, an RA or the UCC.
"I think direct and straightforward is the most courageous way to [approach a friend]," she said. "[You can say] 'I really care about you, and I'm concerned about how you've changed, and I think you need to talk to somebody - more than just us, more than just your friends.'
"Or, 'Let's call and make an appointment for you right now,' so you're doing it right with them. It's also good if you can use very specific examples about behavior you're concerned about with your friend."
'Fighting to get better'
Ryan Murphy, a Notre Dame senior, said he struggled with obsessive-compulsive disorder during his senior year of high school. He became extremely anxious all the time, was hyper-observant about his actions and refused to eat certain foods because he believed they were unclean.
Murphy said receiving counseling for his illness taught him to challenge the stigma against therapy.
"I think one of the biggest problems on campus ... is that people tend to think that mental health issues are 'These are broken people, and these are normal people,'" he said. "And that's not the case at all. ... Everyone is susceptible to anxiety, compulsions, depression, ... just like everyone's susceptible to the common cold.
"You're not broken, that's the thing. You're feeling something that is part of a normal human condition that can be helped and can be controlled."
A student who is worried about how he or she feels can call the UCC to share concerns, Steibe-Pasalich said. Students can also attend one of the Center's "Let's Talk" sessions, which are 15-minute, walk-in consultations the UCC hosts three times a week in locations around campus.
Smith said people at Notre Dame and Saint Mary's are willing to help students in need of support, as long as students make them aware of their needs.
"If you need a friend to help you do that, find one of your close friends who can help you," she said. "RAs are great for that, too.
"The easiest thing to do is to not say anything and to just try and pretend like it's not a problem, but that's, at the same time, the worst thing you can do for yourself. Everybody deserves to feel good about themselves and to be able to enjoy and take what they can from their college experience, and you can't do that when you're sick."
Students should not quit trying to get better when the going gets tough, Murphy said.
"There is someone out there to help you," he said. "There is always a way to get better, always a way to improve your life."
Smith said it is important that a student struggling with mental health issues believes he or she deserves to feel better.
"If you don't feel good about yourself, you don't see a need to address these kinds of things," Smith said. "You don't really think you deserve it.
"People should know that no matter who you are, what you've done, where you've been, you deserve the help. And you deserve to feel good."
Contact Marisa Iati at miati@nd.edu
