Health

College Students (And Their Parents) Face A Campus Mental Health ‘Epidemic’

As colleges and universities across the country report an explosion of mental health problems, a new book argues that college life may be more stressful than ever. Dr. Anthony Rostain, co-author of The Stressed Years of Their Lives, notes that today’s college students are experiencing an “inordinate amount of anxiety” — much of it centered on “surviving college and doing well.”

“What we’re seeing now are growing numbers of students coming [onto] campus who are already being treated for mental illness, or who are on various medications and who really have learned to manage their illnesses at home,” he says, “but suddenly they’re on their own and sometimes they’re not following through [with] their own recommended treatments.”

Rostain is a professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and the former chair of the school’s Task Force on Student Psychological Health and Welfare. His co-author, B. Janet Hibbs, is a family and couples psychotherapist whose son took a medical leave of absence during his first college spring break to deal with anxiety and depression. Hibbs faced a difficult set of choices: she wanted to best parent her son as he struggled, but she also wanted his life to stay on track.

“One of the reasons we wrote this book is not to scare parents, but to help them know what they can do to help,” she says. “When a child, for whatever reason, is hopeless or verging on that, families are incredibly, vitally important in maintaining hope. … Having the emotional expression of the family convey warmth, support, unconditional support, not judgment, that … is one of the best medicines.”


Interview highlights

On why current college students are more stressed than previous generations

Rostain: We think that the culture has changed in the last 30, 40 years, and that these students are growing up in the post-9/11 era, that they’ve been exposed to a lot of trauma, both in the media and also in their lives. … School shootings, the rise in the uncertainty from globalization and the economic uncertainties, and of course the economic recession of 2008. Our students today were young then, and the anxiety, we think, really had an impact on their families, as well as on what they could glean from the news. And, of course, being in this 24/7 news cycle as well as the Internet itself, has really created a different childhood.

Hibbs: Parents are scared that there’s only one path, a linear path, to the good life, and so for some parents who are affluent enough, that means the brand-name college, or the top prep that you can get. For other parents, it’s just a lot of pressure on the kids, “You have to do well. You can’t make a mistake or your chances will be ruined.” So we see especially very smart kids, which some researchers call brainiacs, they have what we call “destructive perfectionism”; they cannot tolerate not excelling at everything. And no one typically excels at everything. We all have, you know, times when we both make mistakes or fail. And kids don’t have as much practice at that today, because they’re protected from having those experiences, and also it freaks their parents out, which makes then the kids feel more responsible.

On how high tuition is contributing to stress

Rostain: Students come to school nowadays very conscious of that … and that adds to their burden of worry about doing well and especially about anything going wrong. I mean, we can also talk, I think, about the preparation for school — that many of them have been over-parented and also over-prepared, in terms of taking tons of AP classes and really packing their CVs with all kinds of activities. And we worry that there is not enough downtime … [to do things that are] not going to necessarily always result in a grade or in someone noticing them.

On why some students have trouble adjusting to college

Hibbs: I think most kids are still really happy to leave home. They want to be in the life of the pseudo-adult. But what they’re unprepared for are what I would call … the “expectable challenges” that college poses — in terms of the requirement for more independence, more ownership of your hours, whether it’s sleep, saying no to partying, managing yourself, basically.

Rostain: There’s a certain amount of inevitable anxiety about the transition. … But it’s the response that they’re having to that uncertainty that we’ve noticed students have a lot less resilience or preparation [for]. So that’s part of what we’re trying to do in this book is really talk about readiness — social-emotional readiness.

There’s no question people are academically prepared. They’re learning an incredible amount nowadays in school. They’re learning amazing kinds of things, and the Internet has opened up knowledge that was never as available. But it’s also created distractions and a lot of pressure socially and, more importantly, I think, when people get to college, maybe not enough time has been spent in high school — both in the curricular side and with the family — in what we call social-emotional readiness, or maturity.

On the cost of pushing kids too hard

Rostain: We’re giving our kids everything we have and we care about them, but at the same time, what’s the message? It’s, “Oh you need to succeed or else we’re going to really get upset,” as opposed to, “Life is curvy, and there are moments of ups and downs.” I think if the message from a parent to a kid is, “You may not know, but we expect that you’ll be able to figure it out. Let’s see what happens,” [that] is different than saying, “You better do this. You better know that. You better not mess up.” … We want parents to deal with their own anxiety and then [be] able to let go in a way [that] more feels more natural. It’s OK to not know.

On why most students don’t use counseling services

Rostain: There are some startling surveys that show that among students who endorse suicidal ideation, suicidal thoughts on a regular basis, only about one in four go for help. The other three out of four say things like, “Well, I can handle this myself,” or “It’s not probably not that bad,” or, “I don’t have time.” And wishing that eventually it’ll just go away on its own like a bad cold.

Now, it may be true that for some students, they’re able to plow through and avoid disaster. But what … I have seen too often is [students] waiting too long to acknowledge and in a way staying in that state of denial. Not because you’re deliberately doing so, but because you really don’t want to have to face maybe having to take care of this. Or even worse, maybe having to leave school because you just can’t function. You’re so much a part of a community when you’re in college. … The thought that, “Gee, I can’t function anymore and I may need to take a break” — that’s a hard pill to swallow, so to speak.

On how parents can help their college-age children deal with anxiety

Rostain: I think growing up is a complicated process, and we all have to recognize that we’re all still going through changes. So parents have to adapt to the idea of their child growing up and of letting go. And if they’re anxious about it, [parents should] try to figure out why and to be more mindful about their reactions, and to try to be less reactive and more responsive when things are not going as hoped for.

Don’t be afraid of getting help from mental health professionals. We’re here to work with you and with your kids and we’re not here to blame you or to condemn you. – Anthony Rostain

It’s fine [if] your kid goes off to school and they’re successful. Everybody feels good. But what if there’s a setback? What if things don’t go as planned? How do you prepare yourself for that? By simply reminding yourself that there is no straight line through life. … Time off may help. Sometimes it’s better to just take a step back. Get your game back to where you want it to be. … Don’t be afraid of getting help from mental health professionals. We’re here to work with you and with your kids and we’re not here to blame you or to condemn you. So many parents face this fear of the shame or the embarrassment or the stigma, and what we think is the most deadly thing of all is not the mental illness, but the stigma around it that leads people to avoid getting the help in time.

Sam Briger and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Clare Lombardo adapted it for the Web.

Copyright 2019 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

This is FRESH AIR. Colleges and universities across the country are reporting an explosion of mental health problems verging on an epidemic, according to my guests, Dr. B. Janet Hibbs and Dr. Anthony Rostain. Their new book, “The Stressed Years Of Their Lives,” is about why college students are more stressed and how parents can help their kids cope with stress and anxiety and prepare them to become independent.

Dr. Hibbs is a family and couples psychotherapist. Her son took a medical leave of absence during his first college spring break to deal with anxiety and depression. When he returned home, he was treated by Dr. Rostain, who chaired the University of Pennsylvania’s task force on student psychological health and well-being. Dr. Rostain is a professor of psychiatry and pediatrics at the University’s Perelman School of Medicine and practices at the Children’s Hospital of Philadelphia.

Dr. Rostain, Dr. Hibbs, welcome to FRESH AIR. Dr. Rostain, I want to start with you. You say that you’ve seen a dramatic rise in campus mental illness rates. Describe what you’re seeing on campus.

ANTHONY ROSTAIN: Well, we’ve always had students come in with anxiety and depression or adjustment disorders and having to see a counselor, or a therapist or a psychiatrist to help them through a crisis. What we’re seeing now are growing numbers of students coming into campus who already are already being treated for mental illness, who are on various medications and who really have, you know, learned to manage their illnesses at home. But suddenly, they’re on their own, and sometimes they’re not following through their own recommended treatments. We’re also seeing students coming on with an inordinate amount of anxiety about surviving college and doing well.

And we think the anxiety levels are rising and creating in students a great amount of both distress when anything goes wrong, like, more of a brittle response to challenges, a greater avoidance of risk – so people are really not wanting to move out of their comfort zone – and a real overreliance on things like alcohol and other substances to help manage things like social anxiety. The good news, though, is that they’re more aware of that. So we think more of them are coming forward to talk about it with us.

GROSS: So if you’re seeing more stress and anxiety in students today, what do you think are some of the causes behind those new levels of stress?

ROSTAIN: Well, we think that the culture has changed in the last 30, 40 years, and that these students are growing up in the post-9/11 era, that they’ve been exposed to a lot of trauma both in the media and also in their lives, many of them. School shootings, the rise in the uncertainty from globalization and, of course, the economic recession of 2008. You know, our students today were young then and the anxiety, we think, really had an impact on their families, as well as on what they could glean from the news. And of course, being in this 24/7 news cycle as well as the Internet itself has really created a sort of a different childhood.

GROSS: You were at the University of Pennsylvania, which I should say is a pretty expensive…

ROSTAIN: Yeah.

GROSS: …School. Does that add to the stress

ROSTAIN: Absolutely.

GROSS: …The sense of the huge investment that you or your family are making in this college education?

ROSTAIN: Right. Students come to school nowadays very conscious of that, of the economic expense, and of the sacrifice that parents are making. And that adds to their burden of worry about doing well and about – especially about anything going wrong. I mean, we can also talk, I think, about the preparation for school, that many of them have been overprepared in terms of taking tons of AP classes and really packing their CVs with all kinds of activities. And we worry that there’s not enough downtime and things that they can do that are not going to necessarily always result in a grade or in someone noticing them, you know?

GROSS: Dr. Hibbs, you do a lot of family therapy so you see a lot of families before the child is going to college.

B JANET HIBBS: Right.

GROSS: So what are some of the stressors that you’re seeing in preparation for college and preparing kids to be on their own?

HIBBS: The overwhelming majority of high school students today, it’s somewhere around 90 percent, report college as their top stressor. And to build on what Tony’s saying, it’s not only kids, but their parents, who are anxious. So we’re living in a culture of fear. And many times, parents come to me and go, what’s wrong with kids today? I didn’t have these kinds of stressors, and this isn’t what my college experience was like.

And it’s important for parents to know we’re in what I would call a moment of historic swerve where basically this has been building for about 40 years, and then the thread is just spinning out, rolling out, really fast now with all of the very rapid changes. And so parents have gone into a control mode. They used to promote autonomy. That’s how I grew up. Like, the free-range kid. But now they’re – basically, they’re exerting more and more control, which makes their kids more anxious and also less prepared for the unpredictable.

GROSS: When you say more control, what forms of control?

HIBBS: Parents are scared that there’s only one path, a linear path, to the good life. And so for some parents who are affluent enough – that means a brand-name college or top, you know, prep that you can get. For other parents, it’s just a lot of pressure on the kids – you have to do well. You can’t make a mistake. Your chances will be ruined. So we see – especially very smart kids, which some researchers call brainiacs, they have what we call destructive perfectionism, which they cannot tolerate not excelling at everything.

And no one, I mean, typically excels at everything. We all have, you know, times when we both make mistakes or fail. And kids don’t have as much practice at that today because they’re protected from having those experiences. And also, it freaks their parents out, which makes then the kids feel more responsible.

GROSS: I want to get to something that you mentioned, which is, a lot of parents feel like, I don’t know, when I went to college, I was so happy to get away from my parents and to be independent so why is my child so reluctant to leave home? Why are they having such a hard time adjusting to being away from home? And I’d like you each to reflect on that a little bit ’cause I think it is baffling to a lot of parents.

HIBBS: I think most kids are still really happy to leave home (laughter).

ROSTAIN: For sure.

HIBBS: They want to be in the life of the pseudo adult. But what they’re unprepared for are what I would call both the expectable challenges that college poses, in terms of the requirement for more independence, more ownership of your hours – whether it’s sleep, saying no to partying – managing yourself, basically. And it also is a fact that parents’ remembrance is that it was less pressure. That’s absolutely true. It’s a much harsher environment now. It’s the same number of slots at these top competitive schools – a lot more applicants.

And part of what’s also going on is that as the College for All movement rolled out 45 years ago, it dismantled vocational funding at the federal and community college levels, and even at the public university levels. The underlying message is there is only one path to a good life. And so the pressure on kids who’ve really, you know, drunk the Kool-Aid, that’s the message they believe, is that they’ll have, as one of the kids I’ve treated says, a second-tier life unless they just keep going to the top, top, top, top schools of everything. And even then they feel they cannot make mistakes.

ROSTAIN: It’s all about expectations. Now, there’s a certain amount of inevitable anxiety about transition. I mean, we call this age the transitional age period of transitional age youth, so that we think is natural – the feeling that, ooh, I don’t know quite what I’m doing here – but it’s the response that they’re having to that uncertainty that we’ve noticed students have a lot less resilience or preparation. So that’s part of what we’re trying to do in this book – is really talk about readiness, social-emotional readiness.

There’s no question people are academically prepared. I mean, they’re learning incredible amount nowadays in school. They’re learning amazing kinds of things. And the Internet has opened up knowledge that was never as available, you know. But it’s also created distractions and a lot of pressure, socially. And more importantly, I think when people get to college, maybe not enough time has been spent in high school both in the curricular side and with the family in what we call social-emotional readiness or maturity.

GROSS: How do you teach that? I mean, what do you mean by preparation? How do you…

ROSTAIN: Well – yeah…

GROSS: …Prepare somebody for emotional maturity?

ROSTAIN: And again, going back to the comparisons – you know, in the past, we’d go off to college, sometimes never – our parents would drop us off, but that’s it. Say goodbye, and you’re there.

GROSS: Once-a-week phone call.

ROSTAIN: Yeah, once-a-week phone call if you were lucky, right? Now it’s constant, you know, texting and Skyping and talking to one another. So there’s a lot of closeness. And we’re not against closeness, but what happens then, though, is that the student doesn’t feel like, hey, I really know how to manage this on my own, and haven’t had a chance to practice. And the way you teach it is really by going through, you know, a set of conversations with your kid and saying, hey, you know, let’s talk a little bit about, you know, the way you manage your life. Like, can you get up in the morning and manage your day?

I mean, I run an ADHD program at Penn. And I got a phone call from a parent a few years back, saying, hey, you’re the director of the ADHD program. My son is coming to Penn. I said, great, wonderful. Congratulations. She says, do you have a wake-up service?

GROSS: (Laughter).

HIBBS: Excuse me.

ROSTAIN: I said, do I have a wake-up service? Yes, my son can’t get up without me getting him up every morning. And so what I – I said, listen. We don’t have a wake-up service, but I think it’s really important that he learn how to wake himself up before he gets to college.

So that’s really what we’re saying – is learning to manage your life, learning to do things more on your own without constantly checking back and asking for someone’s help and also being able to handle things like the risks that college brings and being able to handle social relationships – all of those are conversations parents and kids really need to have in an open way.

GROSS: So there’s a level of helping your child that’s maybe too much help.

ROSTAIN: Exactly. And it comes at a cost – right? – because, yes, we’re giving our kids everything we have. And we care about them, right? But at the same time, what’s the message? It’s, oh, you need to succeed or else we’re going to really get upset. I think if the message from a parent to a kid is, look; you may not know, but we expect that you’ll be able to figure it out. Let’s see what happens – is different than saying, you better do this. You better know that. You better not mess up. And that – the anxiety itself is part of what we want parents to deal with – their own anxiety – and then being able to let go in a way that’s more – feels more natural. It’s OK to not know.

GROSS: Let me reintroduce you both. If you’re just joining us, I have two guests. Dr. Anthony Rostain is a professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine. And he practices at Children’s Hospital of Philadelphia and at the university. Dr. B. Janet Hibbs is in private practice in family and couples therapy. They co-wrote the new book “The Stressed Years Of Their Lives: Helping Your Kids Survive And Thrive During Their College Years.”

We’ll take a short break, then we’ll be right back. And when we come back, we’re going to talk about Dr. Hibbs and her son. Her son took a medical leave from college after having suicidal thoughts and profound depression, and Dr. Rostain helped treat him. So we’ll talk about that after this short break. This is FRESH AIR.

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GROSS: This is FRESH AIR. And if you’re just joining us, my guests are the two authors of the new book “The Stressed Years Of Their Lives: Helping Your Kids Survive And Thrive During Their College Years.” Dr. Anthony Rostain is a professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine. He practices at the university and at Children’s Hospital of Philadelphia. Dr. B. Janet Hibbs is in private practice in family and couples therapy.

The college years coincide with the years that some mood disorders start to express themselves or express themselves more fully. And so, like, that can be a very negative interaction. I’d like to hear what you have to say about how that’s affecting a lot of students now.

HIBBS: Well, 25% of kids arrive on campus today on prescription psychoactive medication. And part of the difficulty, I think, for parents is knowing which school – which college support systems are going to be adequate to meet an ongoing mental health need. And then other students, you know, really have, perhaps, a series of Lemony Snicket unfortunate events that propel them into a mental health problem, a substance use problem, an eating disorder that may have been subclinical before and then it emerges in college.

I mean, nobody really has eyes on them unless they’re already part of or willing to be part of the support services that colleges offer. So colleges offer more and more and more support services. They have really tried very seriously to rise to the occasion of helping kids in this kind of skyrocketing epidemic of anxiety, depression and then, also, mood disorders.

ROSTAIN: So to add to what you’ve said, B., there’s a – some startling surveys that show that among students who endorse suicidal ideation, suicidal thoughts on a regular basis, only about 1 in 4 go for help. The other 3 out of 4 say things like, well, I can handle this myself, or, it’s not – probably not that bad, or, I don’t have time – you know, wishing that eventually, it’ll just go away on its own like a bad cold.

Now, it may be true that for some students, they’re able to plow through and avoid, you know, disaster. But unfortunately, what B. and I have seen too often is waiting too long to acknowledge and, in a way, staying in that state of denial not because you’re deliberately doing so, but because you really don’t want to have to face maybe having to take care of this or, even worse, maybe having to leave school because you just can’t function. You know, you’re so much a part of a community when you’re in college, and the thought that, gee, I can’t function anymore and I may need to take a break – that’s a hard pill to swallow, so to speak.

GROSS: Dr. Hibbs, I want to talk with you about your experience with your son, who you call Jensen in the book. So we’ll stick with the name Jensen. So – and Dr. Rostain, you treated him…

ROSTAIN: Yeah.

GROSS: …After he came home from college. So Dr. Hibbs, your son had to take a medical leave from college, and this was during his first spring break.

HIBBS: Correct.

GROSS: What did he tell you about why he felt he could no longer stay?

HIBBS: He told me that his friend told him that he had to tell us. And I say this to parents because kids usually tell their friends first. He said, I can’t go back. And I asked him, are you scared you’re going to hurt yourself? And he said, yes. I’m having suicidal thoughts that won’t go away, and I’m scared to go back, which then started a conversation in the den about 45 minutes before his flight was scheduled to take off.

GROSS: This was right before he was leaving to go back to college.

HIBBS: Yes. And I called my husband in ’cause I thought, this is not my decision alone to make. Meanwhile, my mind was shredding every bit of, like, data I’d ever processed about suicidal risk and arguing with myself. I’m not particularly proud of all the arguments. Like, we’ll lose money, and, oh, my gosh, can’t he just finish?

But when my husband came in – and what’s characteristic of these kinds of decisions – it’s like parents often are polarized between the mother bear who’s like, I’ve got to protect my kid, and the, you know, father gruff bear – oh, come on. Suck it up. You can just do this for another, like, six weeks. And we were polarized. But I just, as my son says, put my foot down and said, we can’t send him back. Like, we have to trust what he’s telling us. Get me a plane ticket. I’m flying down on the next flight.

GROSS: To help him pack up and move back home.

HIBBS: To help him pack up and leave, yeah.

GROSS: So did this take you by surprise? Like, what was he telling you in the months preceding that about how college was going for him?

HIBBS: In the first semester, it had gone exceedingly well. He had a great group of friends. We met them at one of the parent weekends. His dorm was the regular hangout spot. So it was going great. He’d done really well academically.

And yet, in the beginnings of the second semester, as he says, the cracks were beginning to show. He had a counselor that he had gone to, like, during part of the first semester. And he had accommodations that he decided not to use, partly because he didn’t want to feel different. As he said, everybody knows why you’re going in that building. So this is part of the mental health stigma that sometimes develops for kids who want to feel like, I’m fine. I don’t need this.

But what the other thing is – is even though I felt like we had done a good job of college search, there are many, many lessons I learned. As I joke with my kids, all my major, monumental mistakes are very well-documented in this book. I’ve kind of corralled them as lessons for parents so they don’t have to repeat this. But part of what I learned was, even though we were Skyping, FaceTiming every week, and I could see him and I could hear him and I was concerned, it wasn’t like I was saying, would you please show me an image of your room so I can see the piles of clothes or the Chinese takeout containers?

GROSS: Yeah. Tell us more what you would’ve seen. Like, what did you find when you went back with him?

HIBBS: Well, you know, so part of the question that I was asking myself was the wrong question. Can he finish? And the real question I should have been asking myself is, is he functioning independently anymore? – because when self-management goes, I don’t get up on time. I’m not going to classes. I’m not eating in the dining hall anymore. So dining hall swipes are a huge indicator of, like, is this student socializing, or have they withdrawn?

So I would’ve seen Chinese takeout containers and a lot of dirty clothes on the floor and a lot of soda cans – Mountain Dews – ’cause he was really trying to, like, manage his deteriorating mood by, like, pumping himself up on Mountain Dew and manage, you know, kind of the social effect of things that were – that he felt terrible just to – like, I’m too depressed to be around people even when they invite me out. But as he describes it, the depression came on so gradually, it felt normal. Like, suffering became the norm.

GROSS: My guests are Dr. B. Janet Hibbs and Dr. Anthony Rostain, authors of the new book “The Stressed Years Of Their Lives: Helping Your Kid Survive And Thrive During Their College Years.” We’ll talk more after a break, and Maureen Corrigan will review four new reprints of novels by Asian American authors. I’m Terry Gross, and this is FRESH AIR.

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GROSS: This is FRESH AIR. I’m Terry Gross. Let’s get back to my interview about the explosion of mental health problems on college campuses. My guests are Dr. B. Janet Hibbs and Dr. Anthony Rostain, authors of the new book “The Stressed Years Of Their Lives.” It’s about why college students are more stressed and how parents can help their kids cope with stress and anxiety and prepare to become independent.

Dr. Hibbs is a family and couples psychotherapist. Her son took a medical leave of absence during his first college spring break to deal with anxiety and depression. When he returned home, he was treated by Dr. Rostain, who chaired the University of Pennsylvania’s task force on student psychological health and well-being. Dr. Rostain is a professor of psychiatry and pediatrics at the university’s Perelman School of Medicine and practices at the Children’s Hospital of Philadelphia. When we left off, we were talking about Dr. Hibbs’ son and his slide into deep depression during his freshman year at college.

You know, you write in the book, I over-accommodated his anxiety and enabled his avoidance by helping him organize his schoolwork and meet deadlines. Tell us more about what you did with the intent of helping him that you now think was maybe too much?

HIBBS: It was really, just, he was in a very competitive school early on. And that really didn’t change until we made a change in his high school. And after that, I was able to totally back off. But he was in a very competitive environment. He had trouble organizing his time and organizing – when is this due or that due? And so I would step in instead of letting him have what I call, like, the natural consequences of, like, well, you didn’t turn it in on time. Gee, like, what’s going on? Or how do we figure this out?

So it was hard to figure out, like, why he procrastinated. But it’s actually a classic sign of anxiety. So he was treated for anxiety, but it wasn’t effective. And so I felt like, well, I just can’t let him kind of, you know, kind of fall apart here, you know, with his schoolwork. I’ll just, like, organize it more and better for him.

GROSS: At some point, you went to Dr. Rostain…

HIBBS: Yes.

GROSS: …In spite of the fact that your son already had psychiatrists…

HIBBS: Yes.

GROSS: …Therapists he’d been working with. So Janet’s son was eventually diagnosed with bipolar disorder? Was that your diagnosis, Dr. Rostain?

ROSTAIN: Yes. It was.

GROSS: And what made you think it was bipolar as opposed to various, you know, other things that he had been diagnosed with…

ROSTAIN: Well, partly, it was…

GROSS: …Anxiety disorders?

ROSTAIN: Yeah. He had a different type of bipolar disorder. He had never become manic, but he did have what we call bipolar 2 disorder, where he had had periods of time where he was feeling really good before this crash. He was also nonresponsive and actually made worse by antidepressants. So we ended up…

GROSS: Does that happen? Can that…

ROSTAIN: That happens in bipolar disorder, yes. And so he ended up having a bipolar depression that began to get better when we put him on the right medication.

GROSS: So Dr. Hibbs, I want to get your reaction to this. So you find out through this, like, family therapy that Dr. Rostain is organizing for you and your son, you find out through that that your son thinks you sometimes infantilize him. And you’ve been trying so hard to, like, help him. You’re so worried about him. So what was your reaction to hearing that? And I’ll reiterate, you’re a psychologist who deals with, you know, family therapy yourself.

HIBBS: Well, to paraphrase Victor Hugo, no matter the position of the body, my soul was on its knees. And I was open to hearing anything that would be helpful. It was an unpredictably enriching experience in the sense that I became a more patient person. I became less reactive. I became more accepting of what my son wanted for himself, not what I wanted for him. It’s not that I gave up hope or dreams for him, but I became more pleasant. But during the time in which he was in therapy with Dr. Rostain and – it was a very frightening time. It was as harrowing for me as it was humbling. I learned what I didn’t know, and I became more accepting of, OK, you really don’t want to go back to college.

I mean, he’s, you know, finished about three years and kind of went, yeah, I’m done. I want to be a creative writer. I kind of went, yeah. You kind of need a day job. But I don’t know what that’s going be. But all right. You don’t want to go back to college? So here I am with, like, eight years of graduate training, two masters, a Ph.D., going, you don’t want to go back to college? OK. OK.

GROSS: I think that’s something a lot of parents face who have higher education…

HIBBS: Yeah.

GROSS: …And are working professionals…

HIBBS: Right.

GROSS: …And their children don’t want…

HIBBS: Yeah.

GROSS: …That kind of education.

HIBBS: They don’t.

GROSS: They’re not looking for that kind of life.

HIBBS: No.

GROSS: And don’t you think a lot of parents find that very, like, both baffling and disturbing?

HIBBS: I would say to those parents, please trust your child. Your child is the expert on himself or herself. We are 20th-century parents giving advice to 21st-century kids. They’ve inherited a brave new world that we never lived in. And not to spoil the – you know, not to make a spoiler, but he’s doing really well on a path that I would’ve never predicted, that I could have never foreseen because I was a follow-your-nose academic. And that’s not what he wanted to be.

ROSTAIN: Well, with full disclosure, one of my kids decided not to finish college, and it was a really major crisis for his entire family. I mean, we’re divorced and re-blended, remarried. All of us were trying and struggling. But now he’s doing extremely well. He’s chosen a path for himself that didn’t require a college degree. But yeah, it required me and all of us to recalibrate our understanding and also to reduce our insistence. OK? And once that happened, we could have constructive conversations. You know, nobody wants to talk to someone who doesn’t have an open mind about what they’re really wanting to share.

And what B.’s describing is a process of revelation that we see over and over again in our work with families as, oh, my God, you know, now I finally get it. I finally understand my kid. Rather than trying to get them to be who I want them to be, I kind of understand better who they are and who they’re trying to be. And I think our job as parents is to help them achieve that then rather than to get them to conform to our expectations for our own – you know, our own selfish reasons. Right?

Now, of course, we want the best for them, and we’ve got to – and I still want my son, at some point, if he wants, to go back to school, to do that. But I’ve accepted that, no, he’s found his path. He’s happy with it. And he’s taking, you know, strides in developing his career.

GROSS: So what is he doing now?

ROSTAIN: He’s a cook.

GROSS: OK. And what’s your son do?

HIBBS: He is a – I’m going to try to get this right – biomedical engineer. And he’s working at hospitals, repairing equipment in hospitals, while he’s also finishing his first novel.

GROSS: Sounds good.

HIBBS: Because he wanted to be a creative writer (laughter).

ROSTAIN: Yeah. My son is also, by the way – he’s also raising fowl and – you know, farm-to-table…

GROSS: Oh, wow.

ROSTAIN: …Kind of – and working for…

GROSS: That sounds great.

ROSTAIN: …A very nice restaurant near here and doing – learning a lot about being a chef.

GROSS: That sounds great. Let’s take a short break here, and then we’ll talk some more. If you’re just joining us, I have two guests. They’re the authors of the new book “The Stressed Years Of Their Lives: Helping Your Kids Survive And Thrive During Their College Years.” And my guests are Dr. B. Janet Hibbs, a psychologist who has a private practice in family and couples therapy, and Dr. Anthony Rostain, a professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine. He practices at Children’s Hospital of Philadelphia and at the University of Pennsylvania. We’ll be right back. This is FRESH AIR.

(SOUNDBITE OF MUSIC)

GROSS: This is FRESH AIR. And if you’re just joining us, my guests are the two authors of “The Stressed Years Of Their Lives: Helping Your Children Survive And Thrive During Their College Years.” Dr. Anthony Rostain is a professor of psychiatry and pediatrics at the University of Pennsylvania’s Perelman School of Medicine. He practices at Children’s Hospital of Philadelphia and at the university. Dr. B. Janet Hibbs is a psychologist in private practice in family and couples therapy. Their book is both an advice book with a lot of case studies in it, but it’s also the story of Dr. Hibbs and her son, and how he left college on a medical leave because of severe depression and also suicidal thoughts.

So Dr. Hibbs, getting back to your son, who you call Jensen in the book – after he went home, leaving college on a medical leave, you were trying to encourage him – well, go to community college. You won’t have to leave home. It won’t be as stressful. And so you’re driving him to his first day of community college, and he decides he doesn’t want to get out of the car. He doesn’t want to go. It’s just too stressful. You had a big decision to make on the spot about how to handle it. Tell us what you decided and why you decided to do that.

HIBBS: I decided for the first time in my life to be a tough love mother, and it was counter to anything I’d ever done. I’d always based my parenting on best practices, best research practices, best, like, warmth and support with high expectations, instead of, you must do this. I don’t care how upset you are. Take, you know – take an Ativan to get yourself out of what was in a panic attack.

And I told him, you’re just being retriggered. We went through a back and forth for about five minutes. It was a very rainy, rainy day. We were stuck in a long line of traffic. I’d driven in there ’cause I was scared he might step out in traffic ’cause he was still very depressed. But one of my relaunch goals was, blend empathy with structure. He needs more structure. He can’t just be at home. He needs to be out in the world again.

And so it was with that idea – that he needed a specific plan to get back to be in the world again – that I came up with the courage to just say, you need to try this. You don’t have to take the class if you don’t like it, but you have to try it. You will not know how it is unless you try it. And then at about half his size, I shoved his shoulder to get out of the car, and he did. And I felt this enormous, you know, exhaustion. And then, as sometimes happened on those days, about three hours later, he came home very chipper, going, oh, I really like the philosophy professor, but I’m not going to do architecture. I kind of went, OK, that’s good.

GROSS: You were so afraid of his suicidal thinking, you were afraid he was going to step into traffic.

HIBBS: Yes.

GROSS: That’s your level of fear.

HIBBS: Yes.

GROSS: At the same time, you’re pushing him out of the car when he gets to community college and saying, you’re going.

HIBBS: Yes.

GROSS: You’re taking some medication to calm your panic attack…

HIBBS: Yes.

GROSS: …But you’re going. So were you terrified at that moment that maybe you were doing the wrong thing? This was a change of course for you to say, you must do this.

HIBBS: I was terrified for over a year. But in moments of lucidity, I had goals that I thought would help him relaunch. And I wasn’t afraid that, at that morning, once he got inside the class, anything bad would happen. And I trusted that – as we told him before, if you’re scared, call me. I’ll come pick you up – which he did a few times. He’d be at a train station late at night – I’m scared. I’m looking at the tracks. We’d come and pick him up. That was when the suicide – he had chronic suicidal ideation, which he hated. He did not want to kill himself. He told us – he told me repeatedly, I don’t want to. I have no plan. I can’t help these thoughts. They were very intrusive thoughts.

GROSS: Dr. Rostain, do you have – does, like, the medical profession have any explanation for this, like, obsessive suicidal thinking when the person who is thinking this way doesn’t really want to end their life?

ROSTAIN: Yeah. So first of all, depression itself robs people of a sense of hopefulness. So in a way, I mean, we owe a lot to my mentor Dr. Aaron Beck, who kind of identified hopelessness, in and of itself, really raises the risk of suicide. So regardless of one feeling sad or loss of interest in things – all of the, you know, kind of classic signs of depression – when you begin to think, this is never going to get better and I have this unending pain ahead of me – then when the hopelessness takes over, that’s when the thought of suicide steps in and offers you a way out.

So in those situations, when we think about what Jensen was describing – is he didn’t want to feel this way, but it was almost like he felt no other hope for me but death. At the same time, there’s also a subgroup of individuals, which he fits into, who are generally ruminative people anyway and who get intrusive thoughts like that. There are some people who get intrusive thoughts to cut themselves or intrusive thoughts to do other risky things. So that’s not quite the same, but the two linked together does pose a dilemma because even though his rational mind says, I’m – you know, I’m here, I’m OK, there’s some other part of him that is insisting on, no, I’m not ever going to be better. That’s the hopelessness. And the image, the vision of the way out becomes almost like a fixation.

So we talk about fixations and we try to get patients to verbalize them and then to begin to come up with scenarios – what do you do when you’re stuck in that mindset? Because there are ways to distract yourself – calling for help, having music, doing things to get you out of that danger zone where you’re really beginning to feel like, oh, I may actually take the next step beyond thinking about this and actually act in that direction.

GROSS: So we’ve done this interview in kind of two parts – part talking more generally about the stresses students – college students and their parents face during the college years. Then we talk specifically, Dr. Hibbs, about your son and your story, trying to help him and sometimes doing the wrong thing in the process…

HIBBS: Right, yeah.

GROSS: …And Dr. Rostain, your work in treating Dr. Hibbs’ son. So Dr. Rostain, as somebody who’s a bit of an outsider here in Dr. Hibbs’ son’s story, what are some of the takeaways that you see for other parents of college-age children, for other college-age students who are listening now? I mean, the example that Dr. Hibbs gives is a little extreme because your son was diagnosed with a form of bipolar and also had, you know, obsessive suicidal thinking. I think that’s the kind of far end of what parents have to deal with, although a lot of parents have to contend with that.

ROSTAIN: Well, to start with, I think growing up is a complicated process. And we all have to recognize that we’re all still going through changes. So parents have to adapt to the idea of their child growing up and of letting go and, if they’re anxious about it, to try to figure out why and to be more mindful about their reactions and to try to be less reactive and more responsive when things are not going as hoped for. OK? It’s fine. Your kid goes off to school, and they’re successful. Everybody feels good.

But what if there’s a setback? What if things don’t go as planned? How do you prepare yourself for that by simply reminding yourself that there is no straight line through life? And, you know, I shared my own story in the book where I had to leave college for a while, and it really saved my life, OK? – because I was all gung-ho about going to college, and I wasn’t prepared for it. And fortunately, I could take the time away.

So the second thing I want to say is time off may help. Sometimes, it’s better to just take a step back, get your your game back to where you want it to be. And then the third is don’t be afraid of getting help from mental health professionals. We’re here to work with you and with your kid, and we’re not here to blame you or to condemn you, you know? And so many parents face this fear of the shame or the embarrassment or the stigma. And what we think is the most deadly thing of all is not the mental illness but the stigma around it that leads people to avoid getting the help in time.

GROSS: I want to thank you both so much. Dr. Hibbs, Dr. Rostain, thank you.

HIBBS: Thank you, Terry. Our pleasure.

ROSTAIN: Thank you. Thank you for having us.

GROSS: Dr. Janet Hibbs and Dr. Anthony Rothstein are the authors of the new book “The Stressed Years Of Their Lives.” After we take a short break, Maureen Corrigan will review four new reprints of mid-20th century novels by Asian American authors. This is FRESH AIR.

(SOUNDBITE OF DANIEL FREEDMAN’S “LOVE TAKES TIME”) Transcript provided by NPR, Copyright NPR.


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