Mental illness is scarily common in college-age students.  At the very end of the Spring 2008 semester, two male Fordham seniors committed suicide.  “One was a CBA (College of Business Administration) commuter student who died at home; the other was a Rose Hill student who died in his dorm room,” said Bob Howe, director of communications at Fordham.  Incidents such as these are not unique to Fordham.  In fact, suicide is the second leading cause of death among college students, according to CNN. In light of this, the Observer spoke to a number of experts in order to help students understand the causes of college-age mental illness, recognize the signs that a friend or roommate is suicidal and ascertain an appropriate course of action.

What Triggers Depression and Suicidality in College Students?

“There are always a certain number of people who, in their first semester of college, have a breakdown,” said Deborah Rubin, a New York City-based clinical social worker and psychoanalyst.  “It’s connected to losing the whole support system that they had—friends, family, the place where they grew up.”  Conversely, Rubin said, another stressful life change occurs when students are graduating from college and begin to worry about facing the pressures of living in the “real world” and being truly on their own for the first time.

“College can also be a point where people who have had problems all along are unable to cope anymore,” Rubin said.  “I have had a number of patients who did break down at this age.  Sometimes an underlying biological disorder, like bipolar, will emerge.”

Bipolar disorder, sometimes known as Manic Depression, is classified by the National Institute of Mental Health (NIMH) as “a brain disorder that causes unusual shifts in a person’s mood, energy and ability to function.”  Individuals with bipolar disorder, according to the NIMH, experience extreme mood swings ranging from a high-energy manic state to a low-energy depressive state.

“One of the things that people should be aware of is that individuals who are bipolar are more likely to commit suicide.  If someone is extraordinarily depressed, they don’t have the energy to [commit suicide,]” said Rubin. When a bipolar person is in a manic episode, “they are more likely to kill themselves” than when they are in a depressive episode, Rubin stated.

Additionally, with individuals who may not be bipolar but who are depressed, when someone is “so depressed that they are doing nothing but sleeping,” they are not as likely to commit suicide, said Rubin.  Surprisingly enough, “it’s usually when they start to become a little less depressed that they are more likely to commit suicide, because they have more energy,” Rubin stated.

“The typical onset of psychosis, like schizophrenia, is 19-20 [years old],” said Lisa Miller, a former social worker who currently works in in-patient adult psychiatry at St. Luke’s-Roosevelt Hospital, near Columbia University.

Miller described “psychosis” as a deep level of unrealism within which an individual is unable to function.  She stressed that some people can appear to be normal, “high-functioning” individuals, and that it is not always “crystal clear” that someone is mentally unwell.  Miller stated that, often, individuals become “psychotically depressed: when [they’re] not seeing reality the way others see it.”

“Kids have pressure from school and social pressure…and [in college], they don’t feel like they can go to their family anymore,” Miller said.  On top of these stresses, there are also some surprising triggers for manic episodes, whether or not a student has ever exhibited manic symptoms in the past.

All-nighters—whether due to partying or to studying—have become commonplace on college campuses.  But who would have thought that late nights could trigger a “psychotic episode?”

“Disruptive sleep cycles can trigger a manic episode,” Miller stated.  “It’s a shift in brain chemistry,” said Miller, that can cause a person who “has seemed completely normal their whole life” to go off the deep end.

Other triggers?  Drugs, which can cause “substance-induced psychosis.”  “I see this show up in just regular, smart Columbia students, who are under stress and away from home,” Miller stated.  “They experience multiple triggers, like staying awake all night…then they smoke marijuana… then that triggers a manic episode.”

Miller continued, “This was surprising for me, because many people do fine with marijuana.  We don’t know why, it just causes a shift in brain chemistry…they can smoke marijuana for years and then something gets triggered… even after the [immediate effects] of the drug have worn off, [psychotic behavior] continues, because it triggers a brain imbalance.”  People can become “paranoid or grandiose.”  Or, like one Columbia student Miller saw, they think that all their teachers are sexually attracted to them, or that there is a conspiracy against them among faculty and students.

“It’s not always clear what is coming first—whether people are self-medicating with marijuana because they have an ongoing mental illness or if the marijuana use becomes more frequent and then triggers mania,” Miller said.

Drug use, Miller stated, is “often a response to people not knowing how to have healthy relationships or how to have a healthy relationship with themselves.”  The bottom line, according to Miller: when students feel as though they can’t succeed in friendships, they use ‘social lubricants,’ such as marijuana or alcohol, both of which are hallmarks of stereotypical college life.  This, in addition to the fact that biologically-based disorders usually appear around college-age, may contribute to the high rate of suicide in college students.

“Almost any recreational drug has the potential to cause a major shift in brain chemistry,” concurred Rubin.  “Sometimes a person who has had a well-balanced brain can be tipped over into a bipolar state, or [drug use] can trigger Schizophrenia that may not have surfaced or may not have surfaced for many years.”

“It’s normal-seeming, smart people…who feel pressure about school and get caught up in social [issues]…and who don’t know how to apply their intelligence to their emotional life,” concluded Miller.

Symptoms?

“If someone seems dejected and [sad], and if somebody is focused on how inadequate they are, that’s a sign [that they may be depressed or suicidal]—they don’t feel good about themselves and are constantly putting themselves down,” said Diana List Cullen, a New York City psychotherapist and licensed clinical social worker.  “Also, if they worry a lot, and they seem pessimistic or isolated from others.”  Cullen also stated that, in conjunction with the other symptoms, being very judgmental of others is an important sign that something is amiss. Sleeping a lot—or not sleeping at all—is also an indication of depression, according to Cullen.

Miller said, “If people say weird things that sound depressed or bizarre…or [not normal],” that is a sign that they are, mentally, out of touch with reality and don’t see things the way that everyone else sees them.

Said Sivanie Shiran, assistant director of counseling and psychological services at FCLC:  “Perhaps you… notice that they’ve been acting very differently lately—more socially reserved…eating [more or] less than usual, performing [poorly] in classes or at work. They may even be taking more drugs and drinking more than usual or acting in other impulsive ways that you know are likely to get them into trouble or hurt them…”

“If you have a sense that someone seems so weird and out of it that you wouldn’t want to talk to them,” said Miller, “that’s a red flag that [there is a problem] and that they should be seen by a professional.”

How Should Students Cope?

“It’s important if you’re concerned about somebody to ask them if they feel suicidal,” said Cullen.  “A straight-forward question never hurts, and avoiding it is not giving the person the opportunity to feel that they can talk about it.” Shiran said, “The best thing you can do is just to listen and be there for them.”  How to bring up this potentially contentious subject?  “It’s very important, when you’re asking them, to act as if you’re interested in how they think or feel,” said Cullen.  “Don’t act as if you’re challenging them.”

That said, all the experts stress that getting the help of a professional is essential: both for the individual in question and for those who are attempting to help him or her.  “When a friend or roommate is depressed…it is not something that [students] should handle by themselves,” said Rubin.  “Go to the counselors, go to the RAs.  It’s not right for an 18- or 19-year-old to be shadowing someone who seems depressed… it is a huge burden.”

No one wants to feel as though they are betraying a friend, so it is often hard for students to make the decision to call a friend’s parents or to alert the counseling center.  “People tend to respect other people’s desires, and this is a situation where you shouldn’t,” said Rubin.

“I almost don’t know anyone who hasn’t… known someone who committed suicide,” Rubin continued, “I think that we do underestimate the seriousness of depression, in particular.  And it’s a hard thing to expect a college student to spot in another college student, but the only thing that can possibly turn that kind of situation around is professional help.”

“When I was in grad school my closest friend spent the entire year in a psychotic state, and she [eventually committed suicide],” said Rubin.  “She was functioning on a very high level—she was a graduate student at Yale, she was teaching students, she was taking classes, she was working on her dissertation… At the same time, she was containing that [psychotic] part of her.

“I’ve never forgotten it.  [A friend committing suicide] really is something that marks you for life.  In retrospect, I realize that although I knew that she was really psychotic, it never occurred to me to do something.”

Miller said, “People lose track of paying attention to the emotions of others at college because everyone seems stressed… It’s not about being paranoid about other people, but about being responsive to who, and what, is right in front of us.”