December 8, 2006
Troubled Children
Off to College Alone, Shadowed by Mental Illness

By LYNETTE CLEMETSON
Her mother called it a negotiable proposition. But to
Jean Lynch-Thomason, a 17-year-old with bipolar
disorder who started college this fall, her mom’s
notion to fly from their home in Nashville to her
campus in Olympia, Wash., every few weeks to monitor
Jean’s illness felt needlessly intrusive.

“I am so totally aware of the control you have over me
right now,” Jean said, sitting in her parents’ living
room one evening last June, before coolly reminding
her mother of her upcoming 18th birthday. “In a few
months the power dynamic is going to be different.”

For Chris Ference, 19, who is also bipolar, the
fast-approaching autonomy of his freshman year held
somewhat less appeal. His parents had always directed
every aspect of his mental health care. Last summer,
over Friday night pizza at his home in Cranberry
Township, Pa., he told them that assuming control felt
more daunting than liberating.

“If it was up to me, I would just have it so you could
make those decisions for me up until I was like, 22,”
he said. “I mean, you’ve raised me well up to now. You
know me better than anyone.”

The transition from high school to college, from
adolescence to legal adulthood, can be tricky for any
teenager, but for the increasing number of young
people who arrive on campus with diagnoses of serious
mental disorders — and for their parents — the passage
can be particularly fraught.

Standard struggles with class schedules, roommates,
and sexual and social freedom are complicated by
decisions about if or when to use campus counseling
services, whether or not to take medication and
whether to disclose an illness to friends or
professors.

Keeping a psychiatric disorder under control in an
environment often fueled by all-night cram sessions,
junk food and heavy drinking is a challenge for even
the most motivated students. In addition, the normal
separation that goes along with college requires new
roles and boundaries with parents, the people who best
know the history and contours of their illness.

Like Jean and Chris, young adults approach the move to
a new life differently, some with defiant
independence, some with avoidance. Each approach, say
psychiatrists, counselors, dormitory assistants and
other campus leaders, comes with its own risk. The
students who are most dependent on their parents may
be dangerously unprepared for the inevitable stresses
of college life. On the other hand, students who are
adamant about doing everything on their own may be
afraid to reach out for help when they stumble.

For parents, the anxious pride at seeing children go
off to college is often tinged with fear that their
child might fall apart, spiraling into depression or
becoming suicidal. Are they going to therapy as they
promised? Are they taking the right dose of medication
at the right time? Should they as parents inform the
school that their child has an illness? Is a fight
with a roommate part of a normal transition to college
life or a sign of impending trouble? Does an emotional
e-mail message written at 3 a.m. represent a
transitory moment of turmoil or a reason to get on an
airplane?

Once teenagers legally become adults, which in most
states happens at age 18, they, not their parents,
assume control over decisions about therapy and
medication. If trouble arises, parents may or may not
hear about it because college counselors are bound by
confidentiality when dealing with adult students.

The Trauma of Separation

For Jean, as for many teenagers coping with mental
disorders, just getting through high school was an
ordeal. After experimenting with home schooling, a
high pressure prep school and an outdoor learning
academy geared to nature activities, Jean, a bright
student with inconsistent grades but high SAT scores,
decided to forgo her senior year and find a college
that would take her without a high school diploma.

She was accepted at Evergreen State College in
Olympia, Wash., a nontraditional college of roughly
4,400 students that issues written evaluations in
place of letter grades.

Evergreen’s environmental focus — the campus has its
own organic farm, composting program and a contest for
commuters who bike, walk or carpool to campus — felt
like a good fit for Jean, who is passionately
committed to the environment and social justice.

A consciously quirky teenager who sews her own clothes
(to avoid crass consumerism, she says) and who prefers
bus trips to flying (to avoid contributing to the
pollution caused by air travel), Jean is disarmingly
straightforward and self-aware.

She said she stopped taking medications when she was
14 because the side effects left her feeling “out of
whack and emotionally inauthentic.”

She is determined to stay off medications during
college, and she devoted considerable advance thought
to possible triggers for her illness, like the long
rainy winters of the Pacific Northwest.

“I don’t feel vulnerable about this transition because
this is very much my decision,” she said. “This is a
very autonomous move, very much me structuring my own
life. I feel like I am putting myself in a situation
with really clear intentions.”

Jean’s parents, Amy Lynch, 52, and Phil Thomason, 53,
were hesitant when Jean, the younger of their two
daughters, refused to take medications after eighth
grade. Her childhood and early adolescence had been a
whirlwind of depression, rage and experiments with
different medications and treatments.

But when Jean was about 14, Ms. Lynch and Mr. Thomason
said, she began to seem more stable. Her developing
coping skills, combined with reports about negative
side effects of psychotropic drugs in children,
persuaded them to acquiesce to her demands to ride out
the swings of her illness drug free.

They said they believed Evergreen would be a good
college for Jean. Still, the move — to someplace so
far from home — made them anxious. In the months
before Jean left, Ms. Lynch said she wanted her to go
back on medication to smooth the adjustment to college
life, a suggestion that Jean adamantly rejected.

Ms. Lynch worried that Jean took for granted the tacit
stability of being at home.

When Jean’s depression sets in, she tends to close
herself off from people. At home, Ms. Lynch said, “I
can look at Jean and know in five minutes what’s going
on with her and how to respond to it.”

At such a distance it will be difficult to catch the
signs.

“I feel like we’re doing a high-wire act,” she said,
“and I am not sure we have a strong enough net.”

Rummaging through the accumulated possessions of
adolescence in her bedroom over the summer, Jean
singled out the items that she could not leave
without: her sewing machine, her coffee maker, the
social justice posters that covered her wall.

With her mother out of earshot, she acknowledged that
she understood her parents’ angst. “I get that this is
intense for everyone,” she said. “I do.”

Hesitant to Leave the Nest

The uncertain months between high school and college
were also anxious ones for Chris Ference and his
parents.

Still groggy from an early morning drive to campus,
his husky 6-foot-2 frame jammed into an auditorium
chair in the student union, Chris shifted
uncomfortably as a freshman orientation coordinator
welcomed new students and their parents to the Behrend
College, a Pennsylvania State University satellite
campus in Erie, Pa.

“Today really is the first day of your freshman year
of college,” the cheery administrator told the group
on a June morning more than two months before the
start of fall term.

Chris had initially been reluctant to go away to
college. Though eager to leave the rigid structure and
peer pressure of high school, where he told few
friends about his illness, he preferred the idea of
living at home during college and commuting to an
engineering program in nearby Pittsburgh.

It was his mother, Debbie Ference, a service director
with the southwestern Pennsylvania division of the
National Alliance on Mental Illness, an advocacy
group, who nudged him to move away.

He chose Behrend for its strong engineering program
and small student body of about 3,700.

A boyish and fidgety teenager who likes heavy metal
music, Xbox games and anything having to do with
electronics, Chris said he had given little advance
thought to his new responsibilities in college.

Just days before his orientation, he listened
passively as his father, Michael Ference, and Ms.
Ference talked about his care at school. They wondered
aloud about whether he would be able to continue
seeing his longtime therapist in Pittsburgh, more than
two hours away. They raised the possibility of putting
an advance mental health directive in place, so that
they could be contacted if Chris was ever in crisis
and unable to consent to parental notification.

They discussed how they worried about the possibility
of Chris mixing alcohol with his medications. Chris
huffed in annoyance and told them he was “smart and
moral enough” not to fall into that trap.

The fact that Chris was willing to engage in the
discussion at all was a sign, they said, of progress.

Chris was first hospitalized and received a diagnosis
of bipolar disorder at age 10 after a severe episode
of depression, mania and suicidal thoughts. He was
hospitalized again briefly in sixth grade, after the
lithium that had stabilized him for two years became
ineffective.

But successful therapy and medication since then have
kept the illness at a manageable level. He graduated
from high school with honors, and in his senior year
saw his therapist only every six weeks. A recent
medication adjustment has left him able to feel and
express more than he has in years.

“This whole move is like a coming-out process,” said
Mr. Ference, 50, a service coordinator for families
with autistic children. “Up to now it’s been all
parental motivation. But I think this is a healing
process for him after so many hard years.”

In a 2005 national survey of the directors of college
counseling centers, 95 percent of counseling directors
reported an increase in students who were already on
psychiatric medications when they came in for help.
While universities grapple with how to serve the
growing number of students with mental disorders,
students are taking the initiative by helping one
another.

Active Minds, a student-led mental health advocacy
organization founded in 2001 at the University of
Pennsylvania, now has 56 chapters at schools including
Georgetown University, Columbia University, the
University of South Florida and the University of
Maryland.

The National Alliance on Mental Illness has 30 campus
affiliates, with 18 more in formation, groups that are
set up as student clubs and are financed by school
activity budgets and fund-raisers. Programs like the
Jed Foundation, a suicide prevention program, and
National Depression Screening Day, held each October,
offer additional resources.

While the overall message from the groups and programs
focuses on the potential for success, students who
have been through the transition of leaving home for
college say it is also important to be honest about
the challenges.

Difficult Experiences

Stacy Hollingsworth, an honors student at Rutgers
University who suffers from major depressive disorder,
dropped out of college in the fall semester of her
sophomore year after the routine aspects of college
life left her so incapacitated that she became
suicidal and was hospitalized.

At home in Old Bridge, N.J., she could retreat to the
isolation of her bedroom when she was depressed — an
impossibility in her crowded dormitory. The staggered
class schedule left her lacking a dependable rhythm.
Even getting dressed and walking to the cafeteria
became an insurmountable task.

“I was in excruciating pain. I couldn’t breathe,” she
said.

Though she had been suffering from depression since
her early teens, she hid her struggle from family and
friends. She sought counseling help for the first time
in college, but still could not cope.

After a two-year absence and the loss of $15,000 in
state scholarships, Ms. Hollingsworth, now 22, is back
at Rutgers finishing her degree in exercise physiology
and psychology. She is founder of the Rutgers’
affiliate of the National Alliance on Mental Illness,
one of the organization’s newest student chapters.

At 37, Robert C. Haggard III, who three years ago
founded a chapter of the same organization at Washburn
University in Topeka, Kan., is still working on his
bachelor’s degree in studio art.

During his first attempt at college, right out of high
school, Mr. Haggard said, “I wasn’t honest with myself
that I needed assistance.”

He tried to blunt the increasing severity of his
bipolar disorder with alcohol, a common tactic for
students with psychological disorders, experts say.

He was on academic probation when, in 1992, he
withdrew from school. He struggled though several
jobs, a variety of medications, and a suicide attempt
at age 29 before he started to get his condition under
control.

It has only been within the past four years, he said,
that he has gained stability. “I study during the day,
sleep at night, eat right and maintain a lot of
structure and routine,” he said. “It sounds simple,
but it can be a hard place to get to.”

Dr. Richard Kadison, chief of mental health services
at Harvard, said there were things students with
mental illness could do before starting college to
increase the chances of a manageable transition.

Most important, he said, is establishing local health
support on or near campus. Maintaining a relationship
with a counselor from home can be helpful, but “you
don’t want to end up in an emergency talking to
someone at school that you have never laid eyes on,”
Dr. Kadison said.

Last-Minute Worries

After the opening session of freshman orientation at
Behrend College back in June, Chris Ference
disappeared into a pack of students to begin selecting
his classes.

His mother headed in the opposite direction and
wandered into a session on student support networks
led by Sue Daley, the director of the counseling
office. She listened intently as the counselor talked
about problems students had encountered in recent
years.

She winced when the counselor related the story of a
young woman who had a psychotic episode the previous
year, during which she ripped tiles from her dormitory
room ceiling because she believed the F.B.I. was
monitoring her.

“We sent her home so she could get her emotional self
together,” Ms. Daley told the group.

After the session, Ms. Ference complained that it
sounded as if the goal of the counseling center was to
get the “crazy kids” out of the way.

“I was offended by that,” she said to Ms. Daley. “I
want to be comfortable enough with this school that I
know you will take care of my son.”

In the car on the way home from the campus visit, Ms.
Ference mentioned her discomfort with the counseling
presentation.

“We definitely have to put some outside counseling
support in place, just in case you don’t like it
there,” she said to her son.

Looking through his thick pamphlet of brochures from
the day, Chris responded, “Hey, we get a discount on
computers and iPods!”

Ms. Ference took a hand off the steering wheel to rub
at the stress headache pulsating at her temple.

About the same time in June at Bongo Java, a trendy
coffee shop near her home in the Belmont-Hillsboro
section of Nashville, Jean Lynch-Thomason pulled out a
tattered journal, held together with silver duct tape.
A picture of herself in the third grade, taped to the
cover of the thick diary, stared back at her as she
gathered her thoughts.

As she prepared for college, she had been writing in
the journal several times a day.

More pensive than during the previous meeting when she
matched wits with her parents about her desired
independence, Jean confessed that she had been
thinking quite a lot about her move in the fall.

“There is a lot more fear and anxiety about this
transition than I am letting on,” she said. “We can
set up all the protective measures we want and still
there is just no way to tell what is going to happen,
and man, that’s hard.”

She remained determined not to let her mother fly out
to Washington to check on her. And she resolved to
limit her own trips home, to cut down on unnecessary
air travel.

But she said she felt confident that she had done the
most optimal planning possible. She had decided to
have an apartment by herself so that she could prepare
her own vegan meals. Living alone, she said, would
also afford her the privacy to sleep well and have the
solitude she craves when her depression sets in.

That solitude, she added, might be a double-edged
sword in a new environment where she would be more
reluctant to engage with people during dark periods of
depression.

“I am in a good, copacetic place right now,” she said.
“But I also know that there is every possibility that
things could go bad. I just sort of feel like if I get
out there and don’t do well, then I am letting
everyone down.”

Back at home soon after, she breezed past her mother,
confident as ever.

A New Perspective

Three months after arriving on campus, Jean’s anger at
her parents’ concern seems to have receded. Her
mother’s hotly debated first visit came and went in
October. There were no confrontations over medication,
no accusations of heavy-handedness.

Mother and daughter said little at all, in fact, about
the illness that has so defined their lives, and their
relationship, choosing instead to ride bikes, work at
a free store for the needy, and play in a fountain one
night in the center of downtown.

“I’m more settled, I guess,” said Jean, who will turn
18 next week. She was surprised that she so enjoyed
the visit. “I was in a good place. She was in a good
place. My illness just didn’t particularly seem
relevant.”

Some ideas that had made sense in the abstract — like
living alone — felt unwise after she arrived in
September and looked at a few apartments. When a
friend from Tennessee offered her a tiny crawl space
of a room in an overcrowded home he shared with
several other students off campus, Jean said it felt
just right.

“It’s not like I’m going up to people saying, ‘Hi, I’m
Jean, I’m bipolar,’ ” she joked. “But I’m surrounded
by beautiful supportive people, and I know if I need
it, they will call me out.”

She has maintained sessions by telephone with her
therapist back home every two weeks. But she has also
met people at the campus counseling center. She said
she liked that they encouraged holistic as well as
purely medical approaches to treatment, and that she
would not hesitate to seek help there if the need
arose.

Back in Nashville, Ms. Lynch said she may have
underestimated her daughter’s ability to make good
decisions for herself. The lushness and environmental
consciousness of Evergreen and the surrounding area
seemed to have a stabilizing effect on Jean, she said.
There was not a trace of the early signs of mania or
depression that Ms. Lynch could usually spot in her
daughter well before others.

She said she had decided not to raise the issue of
medication again. For now. “I may have a different
answer a few months from now,” she said. “But what I
know today is that she seems to have learned a lot
about coping. And that’s how we get through this, by
what we know any given day.”

Chris Ference has also changed since he packed his
things and left home in late August. Sitting on the
bed in his dorm room, sounding more mature than he had
a few months earlier, he said the transition was
smoother than he had anticipated.

But he was still working out some of the particulars
of dealing with his bipolar disorder. He told his
roommate about his illness in mid-October, only
because a reporter was coming to their room for an
interview.

“It’s cool. He’s cool. It’s fine,” he said, with a
hint of wariness. “It’s probably good for him to know
anyway, so he can understand it, in case I ever need
him to help me out.”

Discreetly taking his medications in a dorm room
typically crammed with engineering students until the
wee hours of the morning is also a challenge. In an
effort not to draw attention to himself, he said, he
takes his two medications late at night, right before
he lays his head down to sleep. If anyone notices,
they have not let on.

He and his mother met with Ms. Daley, head of the
counseling center, before school started. After the
unpleasant encounter at summer orientation, Ms.
Ference wanted some assurances that the school’s
services were adequate. She left satisfied, she said,
and Chris seemed comfortable enough with the
counseling center to go there if he needed to.

Chris said he doubted he would need help from Ms.
Daley or anyone else at the center. He has friends and
is playing guitar in a band, he keeps his partying
“under control,” and he loves his engineering classes.

He is under no illusions about his illness, he said.
He knows it will be something that he has to learn to
manage throughout his adult life.

“But things are just going so good,” he said. “So far.”



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