Overmedicalization and the Mental Health Crisis Among College and University Students
Christopher Tollefsen, University of South Carolina
Talk of a mental health “crisis” among college students is now common. The National Education Association, the National Alliance on Mental Illness, and the American Psychological Association, among others, have all asserted the existence of such a crisis in recent years, with the NAMI reporting that “73% of students encounter a mental health crisis during their college years.” The number of students entering college with a documented mental health diagnosis has risen; and with that rise has come a variety of different calls for testing accommodations, flexible attendance policies, and more inclusive teaching practices.
This phenomenon seems primarily addressed as a medical problem, both as it relates to diagnosis and to treatment. But it should be asked whether the issue of student mental health is overmedicalized in certain respects. This paper investigates that question in three dimensions.
The first concerns the question of overdiagnosis. Lucy Foulkes has argued that there is a “prevalence inflation” that in part is the result of an oversaturation of mental health awareness. Young persons are encouraged to practice “mindfulness” about their mental health, and this can in turn lead to them over-pathologizing what should in fact be understood as the slings and arrows of ordinary life.
What are the dangers if Foulkes’ analysis is accurate? A self-understanding of oneself as suffering from a mental health condition could diminish one’s sense of agency and enhance the “us versus them” untruth identified by Haidt and Lukianoff, as one comes to see one’s primary obstacle as that of getting help from a social world that discriminates or even conspires against one.
Reference to Haidt and Lukianofff should lead us to ask, in addition to questions of diagnosis, questions about overmedicalization of treatment. Haidt believes that there really is a crisis of mental health among young people, including especially students at colleges and universities. But he questions whether the best treatment for many of these students is medical treatment. This is in large part because he sees the source of much of the crisis as emerging not from some underlying pathology but from patterns of parenting in which children are shielded from experiences that make them resilient, from educational practices that encourage fragility, and from screens and social media.
Thus Haidt’s recommendations include such non-medical activities as increased play, risk-taking, engagement in the “real world” with other persons, and radically diminished screen time and social media. There is some tension, of course, between Haidt’s claims and Foukes, and indeed, Foulkes is a prominent critic of Haidt’s account.
Both accounts, however, suggest that mental health resources which are genuinely needed by students with the gravest needs will not be addressed because of the flood of students seeking medical treatment whose needs can be addressed by other means.
In addition to questions of overdiagnosis and overly-medicalized treatment, this paper takes a step back to situate the student mental health crisis in relation to the disposition, or virtue, of hope. Hope can play an important role in student resilience, and in the overcoming of mental health challenges. But hope sits uncomfortably at the border between a mere emotion or fortunate disposition, and a virtue. I situate the virtue of hope in relation ultimately to the Kingdom of Heaven: hope is hope in the Lord, and in the coming of his kingdom. Hope is manifest, realized, and expressed in one’s intending the Kingdom in everything, and the opererationalization of that intention is to be found in a person’s embrace of her vocation as involving (a) a life plan; (b) to which she feels called; (c) that includes service to others.
Thus, hope requires commitment to a form of life that includes service to and care of others. This form of hope can be threatened by overly mindful concern for self and self-care and by the insularity of a world of screens. But it can be fostered by encouraging students to think more holistically about both the shape of their life and the scope of their personal concerns.
Hope thus provides a counter to the self involvement of mental illness and of social media and smartphones. Such self involvement is problematic because it closes us away from three forms of transcendence. One is the transcendence of the self in concern for others; a second is transcendence of the current moment in concern for the narrative of one’s life as a whole; and the third is the transcendence of the immanent in concern for one’s relationship to the divine.
This phenomenon seems primarily addressed as a medical problem, both as it relates to diagnosis and to treatment. But it should be asked whether the issue of student mental health is overmedicalized in certain respects. This paper investigates that question in three dimensions.
The first concerns the question of overdiagnosis. Lucy Foulkes has argued that there is a “prevalence inflation” that in part is the result of an oversaturation of mental health awareness. Young persons are encouraged to practice “mindfulness” about their mental health, and this can in turn lead to them over-pathologizing what should in fact be understood as the slings and arrows of ordinary life.
What are the dangers if Foulkes’ analysis is accurate? A self-understanding of oneself as suffering from a mental health condition could diminish one’s sense of agency and enhance the “us versus them” untruth identified by Haidt and Lukianoff, as one comes to see one’s primary obstacle as that of getting help from a social world that discriminates or even conspires against one.
Reference to Haidt and Lukianofff should lead us to ask, in addition to questions of diagnosis, questions about overmedicalization of treatment. Haidt believes that there really is a crisis of mental health among young people, including especially students at colleges and universities. But he questions whether the best treatment for many of these students is medical treatment. This is in large part because he sees the source of much of the crisis as emerging not from some underlying pathology but from patterns of parenting in which children are shielded from experiences that make them resilient, from educational practices that encourage fragility, and from screens and social media.
Thus Haidt’s recommendations include such non-medical activities as increased play, risk-taking, engagement in the “real world” with other persons, and radically diminished screen time and social media. There is some tension, of course, between Haidt’s claims and Foukes, and indeed, Foulkes is a prominent critic of Haidt’s account.
Both accounts, however, suggest that mental health resources which are genuinely needed by students with the gravest needs will not be addressed because of the flood of students seeking medical treatment whose needs can be addressed by other means.
In addition to questions of overdiagnosis and overly-medicalized treatment, this paper takes a step back to situate the student mental health crisis in relation to the disposition, or virtue, of hope. Hope can play an important role in student resilience, and in the overcoming of mental health challenges. But hope sits uncomfortably at the border between a mere emotion or fortunate disposition, and a virtue. I situate the virtue of hope in relation ultimately to the Kingdom of Heaven: hope is hope in the Lord, and in the coming of his kingdom. Hope is manifest, realized, and expressed in one’s intending the Kingdom in everything, and the opererationalization of that intention is to be found in a person’s embrace of her vocation as involving (a) a life plan; (b) to which she feels called; (c) that includes service to others.
Thus, hope requires commitment to a form of life that includes service to and care of others. This form of hope can be threatened by overly mindful concern for self and self-care and by the insularity of a world of screens. But it can be fostered by encouraging students to think more holistically about both the shape of their life and the scope of their personal concerns.
Hope thus provides a counter to the self involvement of mental illness and of social media and smartphones. Such self involvement is problematic because it closes us away from three forms of transcendence. One is the transcendence of the self in concern for others; a second is transcendence of the current moment in concern for the narrative of one’s life as a whole; and the third is the transcendence of the immanent in concern for one’s relationship to the divine.