A Good Critique of the Medical Model is Hard to Find

I was optimistic about reading this critique of the medical model of mental illness by professor of clinical psychology Peter Kinderman, in part because it is written by someone with experience in the field and in part because it is published on Scientific American, which I trust.

However, while the article makes a number of good points that I will discuss later, it starts off immediately with such a tired and oft-debunked misconception that I almost quit reading after that:

The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one.

I’ll say it again for the folks in the back: nobody* is trying to medicalize “distressing emotions such as grief and anger.” They are medicalizing mental patterns (which can include cognitions, emotions, and behaviors) that are not only very distressing, but also interfere with the person’s daily functioning. It’s kind of like how some stomachaches are minor annoyances that you wait out (or take a Tums), and some land you in the ER with appendicitis. Therapists and psychologists are not concerned with the mental equivalent of a mild cramp.

In general, people don’t end up in my office because they get pissed off when someone cuts them off in traffic; they end up in my office because they are so angry so often that they can’t stop physically attacking people. They don’t end up seeing the psychiatrist down the hall because they get jittery and uncomfortable before a job interview; they see the psychiatrist because they feel jittery and uncomfortable all the damn time, and they can’t stop, and they can’t sleep, even though they rationally know that they are safe and everything’s okay.

I understand that it’s more difficult to grok differences in degree as opposed to differences in kind, because Where Do You Draw The Line. Yes, it would be easier if mentally ill people had completely different emotions that had completely different names and that’s how we knew that they were Really Mentally Ill, as opposed to having emotions that look like more extreme or less bearable versions of everyone else’s. (Sometimes, from the outside, they even look the same. “But sometimes I don’t want to get out of bed either!” “But sometimes I feel sad for no reason either!” Okay, well, you might be depressed too. Or you might find that those things have no significant impact on your day-to-day life, whereas for a person with depression, they do.)

But it really doesn’t help when you’ve got mental health professionals obfuscating the issue in this manner.

As I said, Kinderman does go on to make some really good arguments, such as the fact that psychiatric diagnoses have poor validity and reliability. This means that they don’t seem to correspond that well with how symptoms actually look “on the ground,” and that different diagnosticians tend to give different diagnoses to the same cases. However, these are criticisms of the DSM, not of the medical model. I’ve felt for a while that we should move away from diagnostic labels and towards identifying specific symptoms and developing treatment plans for those symptoms, not for some amorphous “disorder.”

For instance, suppose I’m seeing a client, Bob. After getting to know each other for a few weeks, Bob and I determine together that there are a few issues he’s particularly struggling with: self-hatred and feelings of worthlessness, guilt, difficulty sleeping, lack of motivation to do anything, loss of interest in things he used to enjoy, and frequent, unbearable sadness. Traditionally, I’d diagnose Bob with major depression (pending a few other considerations/differential diagnosis stuff) and move on with treatment. But without these often-invalid and unreliable diagnostic labels, I just skip that step (although I might let Bob know that “depression” might be a useful word to Google if he’s looking for support and resources). Instead, Bob and I look at his actual symptoms and decide on treatments that might be helpful for those particular symptoms. Cognitive-behavioral therapy might help with Bob’s self-hatred, feelings of worthlessness, and guilt. Behavioral activation might help with his lack of motivation and interest. Certain dialectical behavior therapy modules, such as distress tolerance, might help him cope with sadness in the meantime. Antidepressants might very well help with all of them!

Because mental healthcare doesn’t treat disorders; it treats symptoms. Whether that mental healthcare is medication, therapy, or some combination, the ultimate goal is a reduction in symptoms.

I can see how the medical model makes this seem bad when it isn’t. In traditional healthcare, treating symptoms rather than getting to the root of the problem is downright dangerous. If someone has headaches and you give them painkillers without diagnosing their brain tumor, they’re in serious trouble.

However, we haven’t yet developed great ways of figuring out what “the root of the problem” is when it comes to mental symptoms, especially since there often isn’t one. It’s almost always some complicated tangle of genetics, early childhood stressors, interpersonal patterns learned from family, sociocultural factors, and so on. All of this affects the brain in fundamental biological ways, which further drives the symptoms.

Thankfully, that’s not as much of a problem as it would be with a physical health condition. If you only focus on symptoms and don’t treat the underlying cancer or diabetes or whatever, it will slowly kill you. But if you successfully treat the symptoms of mental illness, you will make the person’s life much better no matter what originally caused the symptoms. There won’t be anything silently killing them in the background, and good therapy teaches people the skills to avoid future relapses of their symptoms.

Sometimes the root cause of mental illness is, as Kinderman points out, a social problem. Poverty, social inequality, and other issues contribute heavily to mental illness. But since you can’t solve those issues from the inside of a counseling office, all you can do is help your client as much as possible. I do this every day, and believe me, it feels weird and gross at times. But what else can I do? Until our fucked-up society decides to come in and take a seat in my office, I can only work with my clients as individuals. (Otherwise I would have a very different job and it would not be therapy.)

Kinderman argues that treating mental illnesses as diseases is wrong because of these social factors that contribute to them. I understand his concern, because he (and many other people) treat “disease” as synonymous with “thing that is entirely biologically based.” So, the medical model feels like an erasure of the complex and valid social dynamics that contribute to what we call mental illness.

But I don’t think of disease that way at all, and I’m betting most doctors don’t either. Social factors contribute heavily to physical illnesses, too. People who are living in poverty or who are marginalized by the healthcare system in other ways are much more likely to have all sorts of physical health problems, and the results tend to be more severe for them. Stress, which includes the stress of poverty, racism, and other social problems, makes everyone more vulnerable to illness. Eating well and exercising enough, two very important factors when it comes to physical (and mental) health, are not equally accessible to everyone. Heart disease and diabetes may have biological origins, but they do not happen in isolation from societal factors, either. Just like mental illness.

You might argue that physical illnesses and mental illnesses differ in that physical illnesses are more heavily caused by biological factors and mental illnesses are more heavily caused by social factors, and I might agree. But again, that’s a difference in degree, not kind. Both types of illnesses affect us physically and mentally.

Another good argument that Kinderman presents is that the medical model may not help reduce stigma, and there’s research to back this up. Kinderman writes:

Traditionally, the idea that mental health problems are illnesses like any other and that therefore people should not be blamed or held responsible for their difficulties has been seen as a powerful tool to reduce stigma and discrimination.

Unfortunately, the emphasis on biological explanations for mental health problems may not help matters because it presents problems as a fundamental, heritable and immutable part of the individual. In contrast, a more genuinely empathic approach would be to understand how we all respond emotionally to life’s challenges.

So, that’s important and deserves highlighting.

However, I think the issue of how best to reduce stigma against mental illness is slightly separate from the issue of how best to help people with mental illnesses feel better. (There’s a school of thought in the disability community that disabilities [including mental illnesses)] “hurt” only because of the stigma and prejudice against people who have them, and I’m not particularly equipped to engage with that here except to say that it makes me angry in a way I can’t possibly explain. It completely invalidates how awful and wretched I felt because my symptoms hurt unbearably and not because of anything anyone else said or did to me as a result.)

When it comes to what people with mental illnesses actually find helpful, for some it’s the medical model and for some it isn’t. In her piece on mental “sick days,” Katie Klabusich writes about how freeing it actually was to see herself as “sick” when she needed to take a day off due to her mental illness:

I’d realized that not only is it alright for me to think of the dysthymia as the illness that it is, it’s necessary. If it were a south-of-the-neck illness, I wouldn’t have had the conflict about it. Yes, I’ve worked when I had a virus and shouldn’t have. (See the stats on service industry staff who work when they’re sick; we’ve all done it.) But my thought process would have been totally different. I certainly wouldn’t have needed the Ah ha! moment to know I had the flu. So why didn’t I realize I was sick?

Our culture impresses upon us that we SUCK IT UP and GIT ER DONE when our “issue” is “just mental.” Except . . .


It turns out that what happens in my head has a real—not imagined or exaggerated—physical affect on my other bodily functions. That list of symptoms from a dysthymia flare? They’re worse than the flu. Full-blown body aches and exhaustion alone are enough to make just sitting up nearly impossible. What work Idid do last week was all done from bed. Including writing this.

Others may not find that way of thinking helpful, in which case, they should absolutely abandon it in favor of whatever does help.

I want to end on a cautionary note about this whole idea of the medical model “pathologizing” “normal” emotions, because the alternatives I sometimes see offered to the medical model seem far, far worse about this. While Kinderman seems to argue sensibly for a more “psychosocial” approach to mental healthcare and a reduction in the use of medication (which I disagree with, but at least it’s sensible), others turn entirely away from scientifically validated treatments into “holistic” or “alternative” treatment. In many of these communities, “positive thinking” is seen as the only treatment you need, and anything that strays from the “positive” (like, you know, the negative emotions that are a normal part of almost any mental illness) is actively preventing you from recovering. There’s a very victim-blamey aspect to all of this: if you’re unhappy or sick,” it’s your own fault for not thinking positively enough.

I’ve had clients from these communities in counseling, and it’s very difficult to get any work done with them because they only ever want to share “positive” thoughts and feelings with me. As it turns out, medical model or no, they have completely pathologized any sort of negative emotion–including, in fact, the totally normal negative emotions that all of us experience all the time.

Yet it’s those evil psychiatrists who don’t want anybody to be sad or angry ever. Okay.

Some critiques of the medical model are quite valid and very useful. Others seem to rest less on evidence and more on a general sense of unease about the idea of thinking of mental symptoms as, well, symptoms. Kinderman even implies that it’s unethical. But “makes me uncomfortable” isn’t the same as “unethical,” as we all know. Unless I see evidence that this conceptualization is harmful overall, I see no reason to throw it out.

That said, if you’re a mental health provider and you have clients who are clearly uncomfortable with this model, maybe don’t use it to explain their conditions to them, since it’s unlikely to be helpful. All of these labels and diagnoses and explanations should serve the client, not the other way around.

And if you’re a person who experiences some significant amount of mental distress and you can’t stand thinking of it as an illness, then don’t! You don’t have to think of it in any way you don’t like. I hope you’re getting treatment of some sort that works for you, but at the end of the day, it’s actually none of my business.


*Yes, there are probably some bad psychiatrists out there who think that grieving at the loss of a loved one is literally a mental illness. There are also surgeons who leave crap inside of people’s bodies or amputate the wrong limb. I see these as roughly analogous.


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Against Role Models

Whenever a famous person does something of which the general public disapproves, much is often made of that person’s status as a “role model” and how it influences the public’s judgment of their behavior, and whether or not it is time to revoke that status.

It seems that celebrities cannot escape being seen as “role models” no matter what made them famous. We expect an athlete or a singer or an actor to be good at not just sports or singing or acting, but at upstanding, ethical behavior, too. The assumption is that children should look up to these figures not just because they represent talent and achievement that (supposedly) comes from lots of hard work and sacrifice, but because their behavior in the rest of their lives is something to emulate, too.

This makes sense to an extent. We know that children learn by modeling the behavior of adults, and we want them to have adults whose behavior they can model. While a parent is normally the one expected to serve that function, most parents hope for their children to achieve more than they (the parents) have been able to in their own lives. Choosing and fixating upon a random successful but unknown doctor or lawyer or scientist or writer seems odd, but famous people already serve the role of entertaining the public simply by existing. So, perhaps some parents hope that celebrities can be good role models for their children and inspire them to both professional and personal success.

In fact, there is absolutely no reason why someone’s success at sports or music should be taken to mean that that person’s treatment of others is just as admirable. There’s no reason why being a great actor means you keep your promises to your partners and respect the law. There’s no reason why being in a famous band means you are very careful about your health and avoid dangerous drugs. Expecting celebrities to be able to model these types of “good behavior” makes no sense.

And even when we try to see someone as a role model in a specific domain only, it never seems to quite work. We fall victim to black-and-white thinking–people are either “good” or “bad,” and if a talented, successful athlete cheats on his wife, he goes from “good” to “bad” very quickly. Even though many people cheat, and even though occasional bad behavior doesn’t necessarily mean someone is a “bad person.”

The expectation of being a role model places undue pressures on celebrities, especially women. Tracy Moore writes:

Critiquing famous (or any) women’s behavior in terms of whether what they do is good for the girls or not is a sticky trap. It prevents them from being complicated, actual people working themselves out — you know, individuals? The thing we want women to be seen as? It keeps us in an endless loop of chasing after this One Correct Way for Women to Conduct Themselves. It’s exhausting, and I refuse to buy into it, and I don’t want to help christen it.

I also think it insults girls, who are more individual, and already far more developed as people than we give them credit for by treating them like blank slates who will copy and absorb every thing they ever see on command. That may be true for fashion, and I’m not disputing that teens copy famous people’s behavior too (and yes I’m staring down a princess phase with a toddler), but that doesn’t mean they instantly absorb the values and ideology of everyone they admire.

What I want is for women to be seen as human, which means, flawed, misguided, shitty, awesome, talented, cool, all of the above. In order to be treated like equal people, we have to have the latitude to have the same range of profound greatness and disturbing awfulness as men. We have to be ordinary, boring, fascinating, idiotic and brilliant.

Moore notes that female celebrities seem to bear a greater burden for Making Sure Our Children Turn Out Okay than male ones do, and male celebrities do seem to have an easier time recovering from Scandals with their popularity mostly intact (see: Bill Clinton, Charlie Sheen, Chris Brown, R. Kelly).

And what about non-celebrities? What happens when they’re expected to be role models?

I don’t know how this plays out in other professions or contexts, but within social work and mental healthcare, there is an immense amount of pressure put on professionals to be role models. We’ve talked about this in my social work classes.

People look to social workers and mental health professionals for more than just “help me fix my brain bugs.” They also look to them as examples of how to live well, and they often expect them to be wearing the same professional “face” even if they encounter them randomly outside of the office.

Our professors ask us what we would do if we encountered a client, say, at a bar or on public transit or even at a party. How would we manage their expectations of us with our desire to behave as we usually would at a bar or on the subway or at a party? Would it harm our relationships with our clients if they saw us acting like, well, normal people?

It’s true that if our clients think that we’re always the way we are in a session–calm, empathic, curious, mature, “wise”–it might disturb them to see us drinking at a bar or kissing a significant other in public or dancing at a party. They might wonder if we’re “faking” when we’re in a session with them. They might wonder who we “really” are.

For some professionals, this seems to be enough of a reason to significantly alter their behavior if they see a client out in public, or leave a bar or party where a client happens to be. They might even consider whether or not doing things like going to bars and parties after hours is even compatible with who they are as professionals.

When we discussed this in class, I was glad that most of my classmates reacted with minor indignation. Why should we be expected to be professional 24/7? Why does everyone else get to take off their work persona when they leave the office, but we don’t? Why is it our fault if our clients judge us as immature or irresponsible just because we go to bars on the weekends?

I think there are two reasons why expecting therapists to act like therapists 24/7 is harmful. One is that, on the individual level, it’s stressful and takes a toll on one’s mental health and freedom to live life the way they want to. Deciding to be a therapist should not be a life sentence to never behave like a normal person outside of work again. That’s too much of a burden for someone whose work is already very stressful and difficult.

Second, part of our role as mental health professionals is encouraging clients to think rationally, accurately, and adaptively about other people and their relationships with them. “This person is drinking at a bar therefore they are immature and I can’t trust them as my therapist” is not a rational, accurate, or adaptive thought. (Well, it could be accurate, but you’d need more evidence to come to that conclusion.) Neither is, “This person is behaving differently after hours than they are at work, and therefore the way they behave at work is totally fake and they’re just lying to me.”

But speaking as someone who’s been on both sides of that relationship, I have to say that we are really, really patronizing our clients if we think that they are incapable of realizing that we have selves outside of the office. We are treating them like children if we presume that they need to be carefully prevented from seeing any part of our non-therapist persona, including kissing a partner in public or getting tipsy at a bar.

But it’s possible that some clients might be confused or bothered by seeing a therapist acting non-therapisty out in public. I think that the best course of action then is to discuss that in therapy, not laboriously alter one’s public behavior so that such an issue never comes up to begin with.

Because our classes are mostly discussion-based and there’s little in the social work code of ethics about situations like this (dual relationships, though, are a different matter), my professor never gave a definitive answer on whether or not we should endeavor to be role models to our clients no matter where we encounter them. His intent, I think, was mostly to spark discussion and let us know that this is something to consider.

The examples of celebrities and mental health professionals are two very different examples, but my conclusion is largely the same for each: being expected to be a “role model” in every context, at work and outside of it, in one’s chosen domain (be it sports or entertaining or counseling) and in every other domain in which it’s possible to judge a person’s behavior, is too much.

A final reason holding people up as “role models” is harmful: the criteria by which we judge them are largely based on social norms, which can be a very poor barometer for determining how ethical an action is. That’s why, when Miley Cyrus was vilified for her performance at the VMAs and reprimanded by many commentators for not being a good enough “role model,” the focus of most of the criticism was not the racism inherent in her performance, but the fact that she dressed revealingly and shook her ass. And she shook it…at a married man! How dare she. The married man, by the way, made a clear show of enjoying it, and he’s the one who’s married. And the one who sings a song about “blurred lines.”

It’s also why, when Kristen Stewart cheated on Robert Pattinson (to whom she was not married) with Rupert Sanders (who is married), it was Stewart on whom the majority of the public opprobrium fell, and who was finally compelled to publicly apologize. (A hopefully unnecessary disclaimer: I think breaking a promise to a partner is wrong, but I also wish people didn’t make promises they couldn’t keep in the first place, and I don’t think cheating is the worst thing a person could do and I don’t think a person who cheats owes an apology to anyone but the person they cheated on.)

And women of color in particular are held to impossibly high standards as “role models,” as public reactions to Beyonce and Rihanna attest.

Sometimes the intersections between the expectation of role model behavior and various types of prejudice affect people’s livelihoods in really crappy ways. To return to the example of therapists, I’ve been reading this blog by a woman who is studying to be a therapist and also works as a stripper. The faculty of her program are pressuring her to either quit sex work or leave the program, because doing both is necessarily an ethical violation. They also told her that being a stripper “contributes to further injustice in the world,”  and is therefore incompatible with her other role as a therapist.

That’s a slightly different type of role model that she’s being expected to perform, but that demand that therapists be perfect in every aspect of their lives is still there. The role of therapist is supposed to take precedence over everything else she may want to do in her life, including making enough money to get by and finish her education. And in this case, these expectations are intersecting with stigma and prejudice against sex workers.

So, whether you’re a celebrity or just a regular person trying to make the world better, it’s rarely a neutral expectation that one be a “role model.” Like all social expectations do, it comes along with lots of baggage. And it’s incredible how often, for women, being a “role model” means having no sexuality.

Children may need adults to look up to and clients may need therapists to learn from, but that’s not a good enough reason, in my opinion, to expect or demand perfection from people.

I think a more realistic view is that almost everyone can teach us something, and almost everyone has done things we probably shouldn’t emulate*.


*And to be clear, wearing revealing clothing and/or being a sex worker are not the sorts of things I’m particularly desperate to discourage.

On “Sincerely Held Religious Beliefs” and Being a Counselor

Via JT, here’s a new bill that recently passed in the Tennessee State Senate Education Committee by a 7-2 vote:

Republican state Sen. Joey Hensley encouraged fellow senators to pass SB 514 to “prevent an institution of high education from discriminating against a student in the counseling, social worker, psychology programs because of their religious beliefs.”

Hensley’s bill would protect any student who “refuses to counsel or serve a client as to goals, outcomes, or behaviors that conflict with a sincerely held religious belief.”

Here’s another relevant quote:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…

I don’t have to cite this one, right?

Forcing public universities to allow their graduate students to use their religion to avoid doing what they’re supposed to do is absolutely “respecting an establishment of religion.” And, contrary to the apparent opinions of the seven senators who voted yes, allowing public universities to require their graduate students to do what they’re supposed to do does not constitute “prohibiting the free exercise” of religion unless you view your counseling work as a form of religious worship. Hopefully, nobody does.

All of this relates to the larger problem of people believing that the First Amendment gives them the right to do a crappy job at work without being fired. When you’re choosing a career path, you should consider, among other things, whether or not you are willing to do the things that your chosen job requires. For instance, I started out college planning to be a journalist, but I realized that pestering people (especially survivors of traumatic newsworthy events) for interviews went against my personal ethical code. Rather than expecting the profession of journalism to adjust itself to my ethical code, I found a different field.

If you are unwilling to help people simply because of who they love, don’t become a counselor.

If you are unwilling to drive a bus simply because it has an ad about atheism, don’t become a bus driver.

If you are unwilling to give someone their prescribed medication simply because it will prevent them from getting pregnant, don’t become a pharmacist.

If you are unwilling to perform an elective surgery on someone simply because it will change their assigned sex, don’t become a plastic surgeon.

If you are unwilling to teach actual science simply because it includes evolution, don’t become a science teacher.

When I was applying to my social work program, I read through the list of requirements for acceptance. I needed a B.A. from an accredited college/university, at least 60 credits in the liberal arts, a decent GPA, and so on. There was also a list of attributes that social work students should have: empathy, interpersonal skills, and a bunch of others. On the list was also this:

The social work student must appreciate the value of human diversity. He/she must serve in an appropriate manner all persons in need of assistance, regardless of the person’s age, class, race, ethnicity, religious affiliation (or lack thereof), gender, ability, sexual orientation and value system.

There you have it. It’s a requirement. If I’m unwilling to do it, I shouldn’t go into the field.

Of course, with counseling things can get a bit tricky. If a counselor realizes that their personal bias may prevent them from working appropriately with a given client, it is their responsibility to refer the client to another counselor. Not to just say, “Sorry, can’t help you,” but to try to ensure that they get the help they need somewhere else.

Furthermore, counselors should not attempt to practice outside of their expertise, so if a client shows up with problems that you have no idea how to work with, you should also refer them to someone else. That doesn’t necessarily mean that you should refer out every LGBT client who comes your way, of course, but if they’re struggling with issues like coming out, dealing with homophobia, or trying to have children, and you have no experience counseling LGBT individuals facing such issues, this is probably not the client for you and you are probably not the counselor for this client.

But there’s a fine line between being unable and being unwilling to do something. There’s a difference between lacking the training or experience you’d need to work with someone and simply not wanting to work with them because you disapprove of their “lifestyle.” There are plenty of “lifestyles” of which I suppose I “disapprove,” but all that really means is that I wouldn’t want to do the same thing and don’t necessarily understand why someone would. That doesn’t mean I can’t still affirm that person as a human being worthy of sympathy and help.

I don’t know how it is everywhere else, but in the programs I’ve looked at, graduate psychology students who are interning tend to work with clients on a sliding scale, which means that these interns are often the only type of counselor that some people can afford. The silver lining of a bill like this is that these clients, who may already be disadvantaged, will be spared from homophobic counselors.

However, the bill’s language does not suggest that it was written to protect LGBT clients, but rather homophobic counselors. And crucially, the bill contradicted advice from psychologists, social workers, and those who oversee graduate psychology programs. They noted that programs could lose accreditation, that part of the job of a counselor is to put their “sincerely held religious beliefs” aside when they do their work. But no, the Religious Right won out again.

Quotes from some Tennessee senators are very telling:

Sen. Stacey Campfield, R-Knoxville, couldn’t understand why psychology departments aren’t teaching their students how to pray away the gay with homosexual clients.

“So if someone were to, say, come in and—I’m just going to throw an example out there—say they were a homosexual and a person did not believe that was a natural act and they suggested, say, change therapy?” Campfield asked. “Would that be something you could allow a student to do?”

Sen. Rusty Crowe, R-Johnson City, said, “I would think that you should be up front and truthful and tell them if they are doing wrong and try to counsel them to do what’s right. That really disturbs me.”

I have sympathy for people whose sincerely held beliefs, religious or otherwise, make it difficult for them to do what they need to do. As I said, I’ve been in that boat. And a certain amount of accommodations for religious people at work and school is, I believe, reasonable. It’s not a huge deal for professors and employers to allow people to occasionally miss a day for a religious holiday or to wear religious garments. It is a big deal for them to exempt students and employees from a crucial part of their training or job.

Allowing people to freely observe their religion does not necessitate bending over backwards to allow them to keep doing jobs with which their religion clashes. Sometimes you just gotta get another job.

Besides, such counselors are free to go practice at any of the many religiously-affiliated counseling centers that exist in this country, which is a topic for another post.

Dear Northwestern Administration: Wake Up

I have a letter to the editor of the Daily Northwestern today. If I seem kind of angry, that’s because I am. 

Dear Editor,

Today I learned that Alyssa Weaver, the Weinberg junior who passed away last week, took her own life.

I didn’t know Alyssa. I could’ve, though, because she was going to move into my apartment when she returned from studying abroad. We’d chatted on Facebook a few times. I had no idea how much we had in common.

Because, here’s the thing. Her tragic story was very close to being mine, as well.

I’ve had clinical depression since I was 12 years old. I didn’t know it until the end of my freshman year at Northwestern, by which point it had become so serious that I became reclusive, miserable, exhausted, and preoccupied with the thought of taking my own life.

I went to CAPS. I got my twelve free sessions. My therapist was kind and supportive but never screened me for depression or any other mental illness. After the sessions were over, I was no better, had no idea what to do next, and deteriorated even more.

The only reason I’m here now is because, thankfully, the school year ended right then. I went home to my family, and I am privileged enough to have a loving, supportive family with good insurance that covers mental health. I saw a psychiatrist and started taking antidepressants. I recovered, for the most part, although even now I live in the shadow of the knowledge that depression as chronic as mine usually comes back.

I’ll be blunt. The state of mental health services on this campus is absolutely unacceptable. We have too few staff members at CAPS. We have no orientation program on mental health. There are still faculty members at this school–I will not name names–who refuse to accept mental health-related accommodations provided by Services for Students with Disabilities. Unlike virtually every other top-tier school and even many high schools, we have no peer counseling service, although I have been trying to start one for a year and a half. There just aren’t enough resources.

The only reason we have campus events about mental health at all is because of NU Active Minds, an amazing student group that’s still fairly new. But they should not be doing this work on their own, and there’s only so much they can do.

Dear Northwestern administration: Wake up. Stop building $220 million athletic complexes. Start spending just a bit more of that money on the mental health services your students desperately need.

I have fought tooth and nail to beat my depression and to find a supportive community here at NU. It breaks my heart that some of my fellow students have been unable to win that battle.

How many more Wildcats will we have to lose before the administration starts taking mental health more seriously?

Miriam Mogilevsky
Weinberg senior
Director of NU Listens