Guest Post: Ten things I wish I had known about mental health before going to university

Sharon Hastings

“You don’t have to do a thing.  I’ll tell your clinical tutor for you, and – ”

“No, please!  I’m managing my work.  I’ve passed my written papers.”

“Sharon, you’ve been admitted to hospital.  The university needs to know.”

My psychiatrist sets down his pen and leans towards me.  There is a pause.

“Then I’ll tell them myself.”

My neck feels hot and my hands tremble.  Surely I’ll never be allowed to finish now.

This was January 2007, six months after I was first diagnosed with depression at the beginning of my final year at medical school.  Until I was admitted for inpatient care, I had kept my illness under the radar, terrified that being identified as mentally ill might have terrible consequences for my medical career.  I hadn’t told friends at church either, but now it was crunch time.  A lot seemed to hang in the balance.

Today, I look back with sadness because of the enormous burden I carried for so long as a student barely into my twenties, knowing now that such secrecy was unnecessary.  There was more stigma attached to a diagnosis of mental illness fifteen years ago than there is now, but as it happened, once I finally admitted that I was unwell, I was met largely with compassion.

With very significant accommodations from the medical school in relation to my final semester, I did complete my clinical finals and I did graduate as a doctor.  I did not complete my postgraduate Foundation Training, but that was because I went on to develop psychosis (a separation from reality) and was found to be ‘unfit to practise’.

I had arrived at university able to name a few mental illnesses but with no positive concept of mental health, and certainly no idea of how to maintain it.  The World Health Organisation defines mental health as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”. 

Such an idea had never been talked about in my school, family or church communities; I think that most young people heading to university today are better-informed, thanks to important changes in the educational curriculum and also to media campaigns and high-profile spokespeople.

So what do I wish I had known about mental health before I went to university?  Here are ten things which might have made my days as a medical student so much less painful…

We are all on a mental health spectrum.

I started medical school very aware of, and interested in, physical health.  I understood that we all have physical health or ill health, and that some diseases we have no control over, while others are related to lifestyle choices.  I really didn’t know that we are all on a similar spectrum in relation to mental health, with some enjoying buoyant mental health, some having mental health problems, and some having clinical diagnoses such as depression or bipolar disorder.

Looking back, I was in a state of reasonably good mental health when I started my first year but had had symptoms of undiagnosed mental illness in my teens which would later re-emerge.  Had I been more aware of mental health and my own history, I would have been better placed to manage my wellbeing and to notice when I was becoming fragile and ultimately unwell. 

Mental illness commonly emerges in the student age group.

When I set off for uni, I had no idea that most adults with mental illness have their first episode before they are twenty-five, so I was already in an at-risk group.  The charity Student Minds cites this factor, along with increased stress, and lack of support as being key to the increasing prevalence of mental illness in university populations.¹

I do think young people today are more aware of the risks of becoming depressed or anxious when they go to uni, but I’m not sure they are any more aware than I was of the risk of developing a so-called ‘severe and enduring’ mental illness – schizophrenia, bipolar disorder or schizoaffective disorder – where psychosis is a major factor.

Had I known that 18-25-year-olds are at risk for emerging mental illness, I might have been better prepared for what happened to me.  I have schizoaffective disorder, which could not have been averted completely, but I think my pathway to diagnosis might have been smoother if I had been more alert to signs and symptoms.

Starting university brings many stressors that can contribute to mental health breaking down.

When I was preparing to go to uni, the picture painted for me of student life was overwhelmingly positive.  I looked forward to an interesting course, exciting opportunities to take part in extracurricular activities, a vibrant CU scene, and increased independence.  No one really told me that meeting so many new people, managing my own workload and deadlines, managing my finances, living with very different personalities, peer pressure of various kinds, juggling a full-time course with a part time job, and so on, could actually be really stressful!

Of course, stress is normal and not a mental illness, but difficulty coping with stress is a mental health problem, and prolonged or severe stress can cause breakdown.  My illness really emerged in the summer before my final year, and I had been under some added stress of various kinds (pressures related to juggling too many extracurricular responsibilities, for example).  I don’t believe stress caused my mental illness, but it is likely to have played a role in the timing of my crisis.

Middle class students in professional courses get mentally ill.

When I was a 4^th year medical student, I was sent to a psychiatric hospital (which would now be known as an acute mental health inpatient unit) for a clinical attachment.  I remember going to the cafeteria where the staff and patients could both get coffee and snacks in the same room, but the staff would sit at one end, and the patients at the other.  I was with the staff, of course, and felt that, in that ‘them and us’ situation, I was glad to be the ‘us’ and not one of ‘them’.  Less than two years later, the tables would be turned.

I had the mistaken belief that it was the lower socioeconomic classes who suffered from mental illness - that it had to do with living on benefits, drug and alcohol misuse, broken homes and dirty, overcrowded environments.  Of course, now I have been in a mental health inpatient unit with people from all backgrounds and walks of life and I can see that mental illness is no respecter of wealth or prestige.  Doctors, solicitors, social workers, successful businesspeople…all can end up with mental illness, and this may, in turn, cause social deprivation.  Students on professional courses become mentally ill too, and that is not a sign that they are not suited to their vocation, just a marker of their humanity.

Christians get mentally ill.

I remember as a child being told that, if I did not smile at church, people would think that I had ‘lost my joy’.  I remember being asked later, when admitting that my mood was low, whether I didn’t have ‘joy in the Lord’.  I know now that joy has little to do with mood and absolutely nothing to do with having a smile on your face.  But in my naivete it really made me think that Christians weren’t really Christians if they got depressed.

Of course, I have come a long way since then.  I realise that you can’t read the Psalms without recognising the depression of David, the man after God’s own heart.  Spurgeon and other spiritual giants of more recent years have known what it is for their faith to co-exist with lifelong depression.  I realise that having anxiety doesn’t mean you are guilty of not ‘casting your cares upon Him’.  But if I could have been aware of all that back in my late teens, I would have experienced much less unwarranted shame and found it easier to open up to Christian friends and leaders.

It’s not wrong to take medications and other treatments for mental illness if you are a Christian.

I remember the first time I brought a prescription for antidepressants to the chemist.  I was very unsure about whether I should be taking them, and very sure that I didn’t want anyone to know about it, so I bypassed the busy pharmacy in the building adjacent to the medical school and walked some way to another one where it was unlikely I would meet anyone I knew.

Today I still take an antidepressant; I also take antipsychotics, a mood stabiliser, and an anti-anxiety drug, and I am so thankful for each of them because I can see the difference that they make to my functioning.  My brain doesn’t work properly because it is sick, and because it is sick, I need to have treatment.  There are effective treatments available for disorders of the brain, so it makes sense to take them.  We wouldn’t think that someone with diabetes who refused insulin because they were relying on God was very sensible, so why would we think differently about someone with anxiety or bipolar disorder.

Similarly, I remember thinking that Christian counselling was probably okay, but working with a secular psychologist would be ‘dangerous’ for a Christian.  In fact, secular mental health professionals are rarely more dangerous than secular gastroenterologists; I have worked with many talking therapists who have genuinely helped me, and only with one whose attitude towards my faith was unsympathetic.

Universities have structures in place to help students with mental health problems.

As you read, I was terrified of the consequences of telling my university that I had a mental illness.  I wish I had known how commonly this happens to students, and how well-prepared universities and colleges are to deal with it – even more so today than in my time. 

I now know that there are many kinds of services for students who find themselves struggling mentally: designated people within each faculty; disability services who are familiar with all kinds of mental illnesses; students’ union officers with responsibility for welfare; even specific support services for mental health at some institutions.  Their roles include providing signposting to appropriate healthcare; facilitating good decisions about taking time out or continuing with a course part time; and securing extra time during exams or flexible deadlines.  There are also national organisations such as Student Minds (www.studentminds.org.uk) which can provide independent support and advice.

There are things you can do to bolster your own mental wellbeing and they work.

When I first began to struggle, I had no idea how to help myself.  I felt completely disempowered and was buffeted by wave after wave of depression, helpless and completely reliant on health professionals and people close to me to ‘fix things’. 

I think more people nowadays are aware of the basic aspects of self-care in relation to mental well-being, such as eating nutritious meals, connecting with others, and getting physical exercise, and they might even have heard of mindfulness, meditation, or peer support.  I wish I had known how much things which I dismissed as woolly at the time really can help. 

Today I practise daily yoga and meditation, and I try to live mindfully. I believe these things play a significant role in keeping me well.  It makes sense to be discerning about such practices; for example, I choose to follow ‘secular mindfulness’ techniques which, while having origins in eastern religion, are, I believe, consistent with having Christian faith.

There are also faith-based meditative techniques such as contemplative prayer, which some people find useful.  At a basic level, praying through the Psalms can be really helpful.  Psalm 13 is personally meaningful to me as someone who, like David, “wrestles with my thoughts” (see v2).

Difficulty with practising your Christian faith because of mental illness does not change your status before God.

There were times after I became unwell that, aside from my fears that I shouldn’t be mentally ill as a Christian, I also worried that because I felt spiritually dry and far from God, he had withdrawn from me.

I wish I had known that, when you have mental ill health, no matter how little you are able to practise the spiritual disciplines or how little you can feel God’s presence, your status before God does not change.  He remains the same and loves you the same, and we know that nothing – not even mental illness and spiritual drought – can take you from his hand (John 10:29).  Salvation is not earned, but given by God’s grace, and he has a compassionate heart towards all of those marginalised in the church, including those with mental health problems.

I wish I had known lots of other things too - that psychosis and psychopathy are two different things; what various mental health professionals actually do; what the interior of an acute mental health unit looks like…  But the most important thing which I couldn’t fathom at the time but now know is this:

Recovery is possible.

Looking back, I realise that, once I had been diagnosed initially with depression, but particularly when I was later diagnosed with schizoaffective disorder, I thought that there was no life after mental illness.  Indeed, ten years ago, recovery, especially where schizophrenia, schizoaffective disorder and bipolar disorder were concerned, was not really considered possible. 

In 2021, I’m glad to say that attitudes are changing.  Recovery is widely recognised as the goal of treatment regardless of diagnosis.  This does not mean ‘cure’ but having optimal quality of life in the context of ongoing symptoms and medication side effects.  Today, I consider that, despite blips when I do suffer depression, I am walking ‘in recovery’.  My life is meaningful and worthwhile.

I wish I had known when I was a floundering student that, twenty years later, I’d be a functional person with a vocation (albeit not in medical practice), a family, a strong faith, a community and a sense of purpose and wellbeing.  I’m just thankful to God that, even though I began uni with only a negative concept of mental illness, and learnt the hard way what it meant to be mentally ill myself, today I have a positive concept of mental health as well, and feel empowered to strive for the best mental health I can enjoy in the context of living with schizoaffective disorder.  Mental illness is a significant part of my history, but my identity is first and foremost as a child of God.

References

1. Mind (Authored by Student Minds). How to cope with student life. https://www.mind.org.uk/information-support/tips-for-everyday-living/student-life/about-student-mental-health/ Accessed August 2021.