Harvard's Busy Mental Health Bureaucracy

There has been a subtle but visible increase in the number of Harvard-Radcliffe undergraduates seeking therapy and counseling over the past five years. The number of student visits to the Psychology Service of the University Health Services has more than tripled since 1969, with a 20 per cent increase within the past year. In the Psychiatric Service, the average number of sessions per patient has noticeably risen within the past three years. And at the Bureau of Study Counsel, the number of undergraduates counseled jumped 73 per cent in two years.

The reasons that Harvard professionals give for this change have nothing to do with the students themselves. Instead, we are meant to understand the increase as a result of changes in service.

The Counseling Service of the Bureau of Study Counsel, which basically deals with the same student concerns as the UHS Psychology Service, attributes its increase in number of undergraduates to its staff, its relation to freshmen advisers, and a small brochure that briefly explains the bureau's function and is distributed among students and faculty.

Officials at the psychology service cite a number of factors to explain the larger number of student visits: its training program for graduate students, an expanded group and couples therapy program, and a greater degree of staff involvement in the Harvard community, where members of the service are associated with Harvard Houses and can thereby make more contacts for referrals.

In the 1972-73 annual report of the University Health Services, Warren E.C. Wacker, director of the UHS, explains that increases or decreases in utilization of the psychiatric service can never be fully understood: "Probably no change, whether it be up or down, is of special significance unless it takes form as a definite pattern for at least an academic generation. When this will occur is a matter of speculation, but when it does, it will have happened without apparent cause...'"

It is easy enough to understand that there can be no absolute reason for the increase in utilization of the UHS and Bureau of Study Council, particularly in psychiatry and psychology. The pains, concerns and problems of Harvard-Radcliffe students are infinite and cannot be quantified for the sake of reason, as much as one would like to try. Still, as William Perry, director of the Bureau of Study Counsel, points out in the 1973-74 annual report of the Bureau, "The pain of the most distressed students, being atypical in intensity and varied in origin, may not be very informative about the general--except that there seemed to be more of it."

But it is apparent that external goings-on at Harvard have changed drastically. Five years ago, student activism was still alive and supposedly represented a release in which students could externalize their anxieties. Today, student activism lies dormant as the number of clubbies grows, along with the resurrection of Harvard's only fraternity house, which died in 1969. In a sense, the undergraduate psyche has been driven back to where it was in the early '60s--pent up and anxious. As the 1972-73 UHS annual report observed:

Depression and anxiety again appeared to be the most usual symptom formations patients brought to us. Thus, we noted a return to these commonplace and endemic problems at rates of incidence that were much like those regularly seen in the past except during the years when acting-out instead of internalizing conflict was so much in vogue.

But there have been changes in the mental health situation at Harvard. Many undergraduates are now both overly concerned about the confidentiality of their visits (thanks to the "Plumbers" case) and are realistically concerned about making a success of their own individual lives--something which "hasn't been an issue for Harvard before," says Elizabeth Reid, associate psychiatrist to the UHS. "There were very few Harvard graduates driving cabs ten years ago," she says. "In the spring last year, I saw an awful lot of seniors who were feeling terribly upset because they couldn't find anybody who wanted to hire them. That's a general anxiety throughout everybody, and that all of the undergraduates are aware of. Their chances of getting into medical school or law school or graduate school or getting a job that will interest them--that's very anxiety provoking and not at all neurotic."

What becomes clear, then, in a world of unstable economy, is a new concern about the future among Harvard-Radliffe students. And the future-oriented concerns seem to occur earlier and earlier in undergraduate life. During the 1973-74 academic year, sophomores had a higher percentage of student visits at the psychiatric servies than did any other class. And coincidentally or not, the same class had a higher proportion of premeds than any other class at Harvard.

Besides the undergraduates who have difficulties dealing with anxieties, whether they be future-oriented or not, there are those who simply cannot cope at Harvard and need to be hospitalized. The number of Harvard-Radcliffe students who have been hospitalized for psychiatric reasons has varied very little over the past ten years. There are typically about 30 such hospitalizations per year. The only significant increase of admissions to outside hospitals occured during the 1965-66 academic year when 54 such hospitalizations were made. This increase among undergraduates was due to a virtual elimination of leaves of absence for men who would have lost their student deferment if they took time off from school.

Unlike the relatively steady rate of hospitalization, the suicide rate at Harvard has decreased somewhat in recent years. In his study of suicide at Harvard, William Temby, former assistant psychiatirst to the UHS, found in 1961 that the suicide rate at Harvard was approximately 1.5 each year for every 10,000 students. That was about 50 per cent higher than that of the American population at large. Since that time, the suicide rate has dropped off slightly. Last year, two students and on Faculty member committeed suicide.

Perhaps the most striking fact that arises in evaluating the current mental health situation at Harvard-Radcliffe is this: there were proportionally twice as many women as men using the psychiatric services at the UHS during the 1973-74 academic year. 16.4 per cent of the total Radcliffe population sought psychiatric help as opposed to 7.7 per cent of the Harvard population. And at the Bureau of Study Counsel, the most marked increase in the number of undergraduates counseled in the past two years is among women--from 104 to 247, or 137 per cent. The numbers for men rose from 277 to 413, or 46 per cent.

The numbers read loud, but not so clear. Certainly, the situation is not specific to Radcliffe women. Within the American population at large, there are more women than men in therapy. But why the over-whelming 2:1 proportion in psychiatry at the UHS, and why the dramatic increase in women at the Bureau? The answer seems to be anyone's guess.

"We just don't know the answer," says Elizabeth Reid. "It's just as simple as that. The reasons now are different than they would have been ten years ago. But we don't really know whether it's that these are inside reasons that have nothing to do with the world at large or whether women feel more comfortable coming to seek help than men. It's also conceivable that being a woman nowadays is more complicated than being a man."

For William Perry, the reason why more and more Radcliffe women are in need of counseling is connected to a change in women's roles. "Within our culture, there is the role differentiation that women can, with self-esteem, be more aware of and thoughful of internal life, and men are supposed to be more extroverted. Stereotypes can affect the degree to which a person feels minded to consult about their inner life."

"But as possibilities open for women, it puts them in a place of greater anomie. They have many, many more choices to make, and they have to find who they are. It's less set upon them by the role."

When asked about the abundance of women in therapy at the UHS, Douglas Powell, Chief of Psychology and Psychologist to the University Health Services, says: "I think they're more sensitive, basically, but they're competitive as hell. They're enormously competitive before they get here, but they seem to be less competitive once they get here. They're more helpful of one and other than Harvard students tend to be. I think something happens once they get here, though. The other issue is that there are some things that are sex-linked and sensitivity to one's own emotions is certainly something that women seem to show more of than men."

And according to President Horner, former consultant to the Psychology Service, the reason for women seeking threapy more than men is associated, of course, with their "fear of success."

"The negative consequences of success for women occur from discrimination to social rejection," Horner says. "It's helpful sometimes just to talk out feelings which aren't neurotic, but perfectly realistic, normal reactions."

Whether Radcliffe women continue to seek professional help in increasing numbers for any of the above reasons is a matter of endless debate. But amidst all the speculations, what clearly emerges in conversation with both the staff of Psychology and Psychiatry is women's concerns about relationships with men. Powell says, "It is very rare for me to see a woman who is concerned about academic problems. What we don't see, generally speaking, is women who come in with problems related to work that they feel they can't handle. It's more of what am I going to do in terms of balancing my life between having a reasonable relationship with a man and doing what I want to do?"

"The most common Radcliffe malady is this thing about relationships with men. Radcliffe women tend to mask their abilities in a variety of ways. Sometimes it come out in a kind of militant explosion. But mostly the girls don't talk in class. Mostly, the guys talk. There is still this business about 'I don't dare show these guys either how dumb they are or how smart I am' because of the 'fragile male ego.'

"It's an intriguing paradox. Why don't you have super capable young women, outstanding men, and it's still just like third grade: Smart girls don't talk? This comes down to relationships in which girls will hold their fire and not discuss things that really should be discussed with a guy they're living with or seeing because of that "fragile male ego."

But the male ego at Harvard, fragile or not, seems to be changing as a result of both the women's movement and co-residential living. In a recently published study in the American Journal of Psychiatry, Elizabeth Reid discusses the effects of co-residential living at Harvard. In it, she says, "...both men and women [living in co-educational residences] test out their preconceived ideas of what is womanly or manly, and as a result they tend to abandon stereotyped notions. Because of the changes in the world this generation is trying to develop new styles of being men and women...Co-residential living offers many more contracts with both men and women than does the one-sex dormitory and therefore far more opportunity to consider these issues in the context of real relationships. It offers greater opportunity for emotional growth."

Indeed, Harvard men do appear to be more concerned about emotional growth these days. "Men come in less to complain about difficulties with papers, career plans, grades, etc. It's more about problems with intimacy, more personal problems than in years past," says Paul Walters, assistant director, chief of training and psychiatrist to the UHS.

The same is true for the male students that Powell sees. "It's changed a lot within the last three years," he says. "Guys are coming in with sexual problems who also bring in their girlfriends with them saying, 'We have a problem.' It used to be a guy would come in and say, 'I'm impotent.'"

And interestingly enough, a preliminary study conducted at the UHS on how students feel about cross-sex counseling found that the student who is most satisfied in therapy is the female student who has requested a male therapist or a male student who has requested a female therapist.

Yet the supply of women psychiatrists, psychologists, and counselors is miserably low, especially when you take into consideration the high proportion of women in therapy. The Bureau of Study Counsel has the largest proportion of women counselors--four out of nine. Seven of 19 members on the staff of psychiatry are women, and only three of the 16 psychiatrists listed in A Student Guide to the Health Services are women. Similarly, the psychology staff is composed of 12 professionals, four of whom are women. Of that four, one is a psychologist while the others are interns. And though the number of women therapists and counselors had increased over the past few years, Harvard still needs more of them.

But even more than women therapists, Harvard-Radcliffe needs to systematically research the mental health of its students. Not only does this mean that more concise records should be kept on each student visit to the Health Services and the Bureau of Study Counsel, but that the student population as a whole should be studied time and time again. One such longitudinal study conducted at the Bureau of Study Counsel offered fascinating results. It found that freshmen entering Harvard today are more sophisticated in terms of relativistic thinking than were their counterparts ten and twenty years ago. The implications of this study are far-reaching and are related, if not directly, to the emotional development of students. Still, further research should be pursued along these lines.

Over the past decade, there has been a hiatus of hard, statistical research in the mental health field.

About one out of every five undergraduates will at one time seek professional help during their four-year stay here. It's about time that Harvard, prided for its research in other fields, focus attention on its students and the workings of their minds.