The Washington Post recently ran an exposé criticizing Yale’s policy of requiring suicidal students to withdraw from school, get treatment, and then apply for reinstatement. This article treads on familiar ground. Criticism of this policy—particularly (indeed, exclusively) at elite colleges—has been building for years and has been published in many other outlets. Why are universities so heartless as to kick their most troubled students to the curb just when they most need help?

The problem with student suicide for universities, the story goes, is that, if a student commits suicide on campus, his university could potentially be legally liable for negligence. The institution will inevitably suffer reputational damage from the negative publicity. So, read cynically, universities have a clear economic and reputational interest in pushing suicidal students off campus, where, even if they do commit suicide, the institution will escape any association with it. And once they’ve been identified as mental health risks, such students will naturally be given a harder time in their bid to return. For the same reasons that the university wanted them to leave, it prefers that they not come back. But if they were only less cruel and more humane, with all their tremendous resources, institutions like Yale and Stanford could instead allow these troubled students to remain on campus while seeking mental health treatment, or they could even provide such treatment themselves.

The Washington Post story adds another consideration: precisely because students are aware of these policies and dread being forced to withdraw from a school like Yale if their mental health issues come to light, they hide them, avoiding therapy or other measures until it’s too late. In effect, suicidal students at Yale make their decisions about whether to commit suicide based on the university’s policies about withdrawing if they attempt suicide. Being at Yale made them suicidal, but being forced to withdraw from Yale makes them potentially even more so. How could that be?

Based on what the students quoted in this article say, it’s because going to Yale is the most important thing in life, and if you do it, then everyone thinks you’re successful and admires you, envies you, or both. Consequently, if you stop going to Yale, you either let them down or let them win—either way, you fall short of your and their expectations. As one of the students interviewed described it,

She spent her first weeks back in Philadelphia plagued by a sense of defeat. “I felt so broken,” she said. Relatives, high school friends and neighbors, who had all celebrated her acceptance to Yale, kept asking what she was doing back at home. On the heels of the sexual assault, she felt like she was hiding yet another shameful secret. “It’s like I’m lying to everyone. They think I’m this successful student at Yale, but I’m really a failure,” she said …

If this is your baseline worldview, then life may indeed seem worthless if Yale sends you home, even if the thing making you sick enough to be sent home in the first place was being at Yale.

I don’t think there is an easy way out of this dilemma, in part because it is created and exacerbated by Yale’s (and Harvard’s, Stanford’s, etc.) own incredible institutional success. At the regional university where I teach, there is no stigma for withdrawing, transferring, taking a leave of absence, or any such interruption of the standard four-year course to a bachelor’s degree. Although the administration would dearly love to boost its retention and graduation rates, the reality is that students come and go all the time, for all kinds of reasons. At the same time, precisely because my university isn’t fetishized the way Yale is, it can more easily ask students to withdraw for mental health reasons without making them feel betrayed and unpersoned, because hardly anyone thinks of it as a caretaking institution or a validator of their personhood in the first place. It is a credentialing mechanism that dispenses credits in exchange for coursework. If you’re not able to complete coursework at this time, you withdraw and save your tuition dollars until you’re able to continue.

[Related: “The Conspiracist Fantasy of University Bureaucracies”]

Since withdrawal mainly affects one’s self-conception in the elite schools that now face criticism for their mental health policy failures, we might be tempted to say that this entire dilemma is a sort of first-world problem, a monster of Yale’s own creation. But that isn’t quite right either. Two things can be true at once: on the one hand, as Freddie deBoer has written, certain currents in elite culture have transformed perceptions of mental illness from a fate to be avoided at all costs into “a set of attractive and romantic quirks.” This encourages adolescents to embrace mental illness as an identity and adults to sound the alarm about a national “mental health crisis” that is in many respects a self-fulfilling prophecy.

On the other hand, it is also simply true that beneath these superficial trends, very smart young people who are admitted to elite schools have always suffered disproportionately from severe and decidedly unromantic mental illnesses like bipolar disorder, schizophrenia, and deep, existential depression. College is frequently the time in which these illnesses begin to bloom. Yale’s difficulties in dealing with these students aren’t entirely the product of a distorted culture or misguided psychological theories. It is and likely always will be the case that some truly promising and brilliant students, students who fully deserve admission to elite schools based on their outstanding intellectual merits, will become severely mentally ill while attending them.

So why shouldn’t universities try to help mentally ill students by keeping them enrolled and treating them on campus?

One seemingly compelling reason that the WaPo article offers is that universities are very rich and, consequently, have many more treatment resources than most parents:

Yale’s activists note that students forced to withdraw lose their student health insurance and access to counseling when they need those benefits most.

“My big question was how do I get therapy,” said Alicia Abramson, 22, a current student who withdrew in her sophomore year while struggling with depression and an eating disorder. “Once you’re out, they cut you off from everything. I couldn’t afford therapy on my own. My family didn’t believe I had mental problems at first and didn’t want to pay for it. I had to have a breakdown and almost kill myself before I got the help I needed.”

While it is true that many universities can afford to offer therapy, they don’t have the resources to guarantee that therapy will work. No one does. Many of the most severe mental illnesses students face (like schizophrenia and schizoaffective disorders, bipolar disorder, and major depression) are not presently curable, and even when treated as effectively as possible, they will diminish students’ abilities to participate fully in the academic life of an elite university.

[Related: “Welcome to Bedlam College”]

Some students really can’t come back to college after they withdraw because their illnesses are chronic and severe and will substantially, or even totally, undermine the kind of high-level cognitive functioning required for success at an elite university. If the university promises to care for such students on campus, it will be undertaking an enormous endeavor—it will have to constantly monitor them and enforce their medication regimens, be ready to restrain and hospitalize them, and, in certain instances, act as their guardian when they’re incapable of making medical decisions for themselves. This will be difficult not only because most universities don’t presently have the policies and institutional mechanisms in place to provide such coercive care to students, but also because of the precedents it will necessarily set and the spillover effects such policies of coercive care will have on other students.

Universities are not treatment facilities, but they will have to become like them in order to live up to their promise to treat students’ mental health problems. Unless mentally ill students are to be isolated in a corner of campus with its own rules and regulations, whatever policies are promulgated to accommodate mentally ill students will have to affect everyone. To some degree, this might look like current disability accommodation policy—individual exemptions and provisions—but it won’t only include that. In this case, the disability in question is not a stable characteristic that students arrive on campus with, but a malleable, contagious one that is caused or activated by being on campus. Universities will have to establish preventative measures and a means of testing students who don’t self-report symptoms. If university culture isn’t already sufficiently shot through with ungrounded therapeutic thinking, just wait until the university re-conceives of itself as an actual treatment center for mental illness.

The obvious undercurrent of the WaPo article is that it’s Yale’s moral obligation to support any student it admits through whatever challenges that student will face during his time in college, and possibly beyond. Everything universities are already doing moves in the direction of becoming a therapeutic care and treatment center for young adults, one (but only one!) aspect of which is academic enrichment through coursework. So, my objections here are mostly futile. But one might notice that, as the stakes of Yale’s obligations to its students rise, so, too, will the difficulty of getting into Yale.

Here at my regional university, college is little more than a transaction—tuition for credits. That may seem too reductive, but the more formational obligations the institution takes on vis-à-vis students, the more intensively it has to screen for the right ones. This is on top of the kind of screening it applies when there is competition for seats—you need the good grades and the wholesome personality. And once we include the obligation for holistic health care, you’re going to have to be perfect in every way, including in your ability to constantly demonstrate mental stability. This will, of course, reinforce all your obsessive, crazy-making qualities and put you in even greater need of therapy if you do manage to make the cut. Good luck to you!

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