Constructively Occupied: Why university health centers might not be enough to help manage the stress of your semesters.

Why university health centers might not be enough to help manage the stress of your semesters. 

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Student? Stressed? Yeah, we get it. And we can help.

by Emma Platoff for The Yale Daily News

For Michaela Macdonald ’18, it started in elementary school.

In and out of treatment for a depressive disorder she discovered early on, she was pleased when, after her senior year of high school, she was feeling better. She stopped treatment before starting at Yale, but soon into freshman fall, she picked it back up again. After an unsuccessful stint with a counselor at Yale Mental Health and Counseling, she turned to a therapist outside the University.

“I love Yale, I really do. But it kind of feels like it turned on me when I needed something it couldn’t give me.”

—Michaela Macdonald ’18

It worked for a time, but once sophomore year started, Macdonald found herself discussing her mental health with her dean in near weekly meetings. Still, she was surprised when he first suggested time off from Yale. And initially she refused.

“I was like, ‘absolutely not’ — I’d never gone off the beaten path before,” she says, sipping from an organic-looking tea that turns her tongue yellow-green. Home now, Macdonald has agreed to meet me in one of her many workplaces: Steam Coffee Bar, famous for its “locally acquired, chef inspired” drinks and treats. She puts down her tea and continues. “But things didn’t really get better.”

During Thanksgiving break, realizing how daunting the thought of returning to Yale was, she broached the subject of withdrawing with her parents. Her mom was more supportive than her dad, initially, but both came around — until they discovered the financial implications. Both Macdonald and her brother receive financial aid from their respective colleges, and her taking a semester off would have meant a nearly $20,000 hit for their family. After consulting Yale financial aid’s office, Macdonald and her parents realized withdrawing was simply not a financial possibility.

And so, she went back.

But the spring semester was “just miserable,” and by February, Macdonald knew she couldn’t stay at Yale. She was skipping class, dropping extracurricular activities and, in the process, becoming more and more socially isolated. Just weeks into the semester, after consulting with her dean, her parents agreed to shoulder the financial burden. Macdonald left in February. Since getting home her health has improved, but she remains conflicted on her feelings about the University.

“I love Yale, I really do,” Macdonald told me. “But it kind of feels like it turned on me when I needed something it couldn’t give me.”

Since withdrawing from Yale, Michaela Macdonald ‘18 has started working at Steam Coffee Bar. (Emma Platoff)

Macdonald hasn’t been back to visit and is in touch with friends from school only infrequently. There are no bad feelings, she says. It’s just that everyone is so busy.

Social life at home isn’t much better. Two of her high school friends are also home taking time off from school, but she rarely sees them, also due to busy schedules. Her parents, especially given the added financial stress of her withdrawal, are “not the most fun to live with.” She spends a lot of time with coworkers from her restaurant job — many of whom are decades older than she is — but they are hard to relate to. It’s been a strange transition, returning to the restrictions of living in her parents’ house after the freedom of college.

Still, she feels good. The first few weeks home were difficult, but since she found ways to fill her time, it’s been only positive. Face flushed from a long gym session, she smiles throughout nearly our whole conversation. On top of spending most of each weekend as a restaurant hostess, Macdonald has recently started teaching English as a second language to immigrant women in a nearby city. She’s volunteering at the Humane Society. She’s helping Steam Coffee Bar’s owner handle the business and will soon manage the shop’s second location.

“I’m doing a lot better and more productive things with my time right now than when I was at school,” she said. “Everyone’s like, ‘I’m so sorry.’ But I feel great right now. I’m really taking control of my health.”

***

Some students, like Macdonald, find peace away from Yale; others continue to struggle. Even so, policy treats everyone the same. Yale does not differentiate, for example, between students who withdraw in the fall and those who withdraw in the spring, and the four months of the summer mean students who leave around the same time can be required to spend drastically different amounts of time away. Medical withdrawals require a student to take off one semester in addition to the one from which she withdraws, meaning a student who withdrew on medical leave in December 2014 would first be eligible for readmission in fall of 2015. But a student who withdrew in late January 2015 would have to wait nearly a full calendar year, until the beginning of the spring semester in mid-January 2016.

“I was like, ‘absolutely not’ — I’d never gone off the beaten path before. But things didn’t really get better.”

—Michaela Macdonald ’18

“It makes me angry that I had to take the entire year off,” Macdonald said. “Who’s to say I won’t be well enough to go back in the fall?”

Macdonald said Yale would do well to examine each readmission candidate on an individualized basis. Mental health is incredibly personal; the policies should be personalized as well.

In fact, this lack of individualization is one of the loudest criticisms of Yale’s withdrawal and readmission rules.  Among many other reforms suggested in spring 2013, the Yale College Council proposed that the University consider withdrawn students on a case by case basis, taking into account their financial needs and the quirks of their home lives. A committee charged with reexamining the University’s withdrawal and readmission policies has promised to consider the YCC’s list of recommendations along with other student feedback. But so far there has been no response to the YCC’s call to personalize policy.

Among many ambiguities in Yale’s withdrawal policies, perhaps the most confusing is the phrase “constructively occupied,” the state Yale requires its withdrawn students to maintain while away from school. The University explicitly requires withdrawn students to take two courses before reapplying, but beyond that, students must define “constructive” for themselves. Some residential college deans give more advice than others, and many students are confused about how they are meant to fill the time they spend away. Is a minimum wage job constructive, they wonder? What about an internship? And what if the most “constructive” thing to do would be to simply focus on therapy?

Even while fulfilling Yale’s most unambiguous requirement — the two courses — students often feel like they’re wasting their time. This semester,Peter** is taking “Issues in Sustainability” and “Introduction to Psychology” at a nearby community college, but he feels like he would be more constructive outside the classroom. Peter appreciates that readmission committee chair Pamela George made an exception to the course rule by allowing him to enroll at a community college instead of a four-year institution in order to save money. But the requirement still kept him from accepting a tempting job offer that would have involved fully funded travel across Asia, and it’s frustrating to sit through classes unrelated to his major just to show Yale he’s ready to come back.

“A more individualized approach would make a big difference,” he said. “A person can show that they’re ready to come back without following an exact procedure.”

Despite a busy schedule, Eugenia Zhukovsky '18 usually has mornings to herself. (Emma Platoff)

Eugenia Zhukovsky ’18 has been hearing questionable things from physicians all her life. Following a growth plate injury when she was eight, a doctor told her one leg would never grow again (currently, she stands at a petite but balanced 5’3”). After a year of drastic decline in the quality of her eyesight, a physician told her she’d be legally blind by age 16 (now 19, she wears contact lenses, but still sees and drives). Most recently, a few questionable prescriptions from psychiatrists at MH&C have left her doubting the quality of Yale’s medical resources.

At home, Zhukovsky works with doctors she trusts. After starting psychiatric medication the summer before her sophomore year at Yale, Zhukovsky spent much of her first semester struggling to settle on the right dosages. Back on campus, she tried to find the treatment with unsatisfying results.

“It wasn’t as consistent, it wasn’t really that accurate — it just wasn’t very good,” she said.

Instead, she tried commuting home each month to Long Island to see doctors there. But this method was both unsatisfying and unfeasible. Following a particularly bad panic attack in late November, Zhukovsky decided to speak with her residential college dean.

“I was so nervous about what was going on — it just all caught up with me,” Zhukovsky said. “[My dean] suggested maybe taking medical leave, and to take Thanksgiving as time to decide. I came back after Thanksgiving break already considering myself out of school for that semester.”

Zhukovsky now keeps track of her life in a small green notebook containing to-do lists in no particular order — her memory, she says, is a little fuzzy because of some of her medications. She jokes that she takes twice as long as most people to do things — get out of the car, gather her belongings or her thoughts. But she is not the kind of person who could sit still all day.

A month after leaving Yale, she spent 10 days in Israel on a Birthright trip – a good experience, she said, although her medication sometimes left her feeling unlike herself, as she was still struggling to find the right dosages.  Now back home in Stony Brook, Long Island, Zhukovsky has worked a total of four jobs, with a maximum of three at any one time. On weekday afternoons, she dons a red polo and heads to a job supervising an after-school activities program at a nearby junior high. Recently, the kids in the performing arts contingent — an especially rambunctious group that the rest of the staffers studiously avoid — have discovered Zhukovsky’s background in gymnastics, and recruited her to spot cartwheels and coach other acrobatics. The day I’m there is especially hectic, she tells me. The kids argue about whether the window should be left open, and someone has been left out of a dance number for the talent show. Zhukovsky tries to retain control without becoming a tyrant, but isn’t always successful.

Two or three days a week, she follows her first job with a shift at a local tutoring center. It’s chaotic in a whole different way: persuading kids to master the protractor when they might prefer to braid each other’s hair or throw Styrofoam dice at their sisters. But both jobs are hard, and both jobs remind her of how much she wants to get back to Yale.

Compared to her hectic afternoons, mornings are relaxed — a stop at the neighborhood bagel shop, smoking cigarettes by one of the many local beaches with friends from home, a few errands. She sees both a psychiatrist and a therapist regularly, a routine she will likely continue when she returns to campus, though she said she will not seek psychiatric treatment from Yale again. On the weekends, she has recently started attending a stand-up comedy class in Manhattan; while we talk, we brainstorm ideas for the three- minute monologue she has due in the next Sunday.

A few friends from high school still live nearby, at Stony Brook University or Suffolk County Community College, but Zhukovsky mainly uses the time off for herself, doing things she wouldn’t have time for at Yale: pleasure reading, writing, taking the comedy class. It’s sometimes difficult to spend time with friends who are on such different pages in their lives, she said. If she doesn’t see friends after work, she’ll go home, listen to her extensive record collection and sleep. The cycle begins again when she wakes up the next morning, usually around six — a new internal alarm clock that is likely a side effect of her medication.

Zhukovsky is not shy about her mental health — one of the problems with the stigma surrounding mental illness, she says, is that people are afraid to talk about it. When I ask about medications, I’m worried it will bother her, but she ticks dosages off on her fingers without any hesitation. She tells me about her sometimes contradictory, always confusing side effects — drowsiness, hyperactivity, anxiety — and explains that it’s hard to gauge which pills cause which. Still, since coming home, she is feeling far better.

“I wouldn’t say it’s 100% perfect, because none of these things are 100% perfect ever,” Zhukovsky said. “But it’s definitely better — it’s in a place where I feel like, ‘I can live in this place.’”

For Zhukovsky, being home on medical withdrawal feels a lot like being back in high school — old friends, parent-imposed curfews, familiar landmarks. She does not regret taking the time off — being away was necessary for her to get medications and side effects in order, and she’s enjoyed having some time to herself.

But what she really wants is to go back as soon as possible, so she can put the experience behind her. And being busy makes the time go by faster

“I’m happy I took the time off,” she said. “But if I could have done treatment at Yale, I would not have wanted to leave.”

***

Being home, Zhukovsky says, is a constant reminder that once you were a Yale student, and now you’re not. Part of that is the physical landmarks — 7-Elevens that inspire nostalgia, that quintessential suburban bagel shop we visit two times in as many days, the countless beaches looking out over the Sound — but it’s also the people. During the workday I spend with her, both students and employers often forget why she’s away from school for a whole semester. Several ask if that’s “even allowed.” Each time she’s met with the question, she responds the same way.

“That’s a longer story, but we can have that conversation if you want,” Zhukovsky replies. Most kids don’t inquire further.

Withdrawing has given Zhukovsky time to read, write and enjoy her extensive record collection. (Emma Platoff)

But their confusion resonates with many others, including withdrawn students themselves, who wonder: are you still a Yale student when you’re away from Yale?

At an open mental health forum in February, administrators acknowledged the role words like “withdrawal” and “readmission” play in this perception.

“A lot of us have discussed the term readmission,” English professor John Rogers, the chair of the committee reviewing withdrawal and readmission policies, said. “It suggests you are not a Yale student, and it isn’t true.”

But rhetoric is one thing, and realities another: students overwhelmingly disagree with Rogers’s statement. While withdrawn, students lose access to Yale resources like career services and libraries. They lose their netIDs and Yale emails, a puzzling policy that makes communicating — already difficult — even more of a challenge. Students aren’t allowed to be active in Yale extracurricular activities (barring special permission from Dean of Student Affairs Marichal Gentry), don’t retain swipe access to Yale buildings, and can’t participate in the housing draw for the semester they return.

Withdrawn students also lose their Yale Health coverage, which makes it especially difficult for students like Ray Mejico ’17, who received full financial aid at Yale and relied on University insurance, to find treatment at home. Since withdrawing in early February, Mejico has had to apply for Medicaid in his home state of Nevada. But he isn’t sure how much mental health care the insurance covers, nor is he sure of how much treatment he — or Yale — will require before he can return. Medicaid covers 15 sessions, but prior to Mejico’s withdrawal, he heard from a Yale MH&C counselor that he would need to complete six months of therapy. Lorraine Siggins, chief psychiatrist at Yale Health, did not return request for comment on whether readmission requires a certain number of therapy sessions.

Other than one response email from his college dean and Yale’s official withdrawal letter, sent to all students when they leave, Mejico said he has not received any formal communication from the University, from George or from other administrators. He remains close with many of his school friends, but describes the University’s attitude as “pretty exclusionary.”

“We’re taught to buy into the idea that Yale is our home for the next four years. If I choose to leave my home, I like to feel that I’m still part of a family there,” Mejico said. “I withdrew and they washed their hands of me.”

***

Mejico had been struggling with depression since high school and considering taking time off from Yale since his freshman year. Once he came to his decision, though, the process began to move much more quickly.

Mejico and his residential college dean, Camille Lizarribar of Ezra Stiles, were close for most of his time at Yale — they would often meet in her house for casual conversations over an episode of The Walking Dead. But their talk one Sunday evening in early February was far shorter than a 42-minute episode. He told her he had decided to leave, and she presented him with two options:  Mejico could take a medical leave or a personal leave, the latter of which requires the student to be gone one semester longer. Mejico chose a medical withdrawal so that he could return to campus more quickly, and Lizarribar set up an appointment at Yale Health for the next day: before he could leave, Mejico’s medical withdrawal had to be authorized by a doctor from Yale MH&C.

Mejico met with a Yale Health counselor the next afternoon for just twenty minutes. After this meeting, his first with a Yale counselor — Mejico, like many students, said he was afraid to speak openly or at all with MH&C staff, for fear of being forcibly sent home — the counselor gave him an informal diagnosis of depression and authorized him to leave.

At his dean’s prodding, Mejico submitted his official request for withdrawal that Tuesday night. By Wednesday, he was gone.

Mejico said the process felt routine, but not necessarily in a bad way. Neither his dean nor the counselor was aloof, but Mejico still felt like he was being nudged through an impersonal process.

“[The counselor’s] general indifference was beneficial to the situation. I really wasn’t looking to talk to anyone anyway,” Mejico said. “He wasn’t cold or distant or anything — but it did seem like he was just following protocol, passing me on to the next person to check a box.”

Like many students, Zhukovsky is spending her withdrawal at home. (Emma Platoff)

At home now for nearly two months, Mejico has only recently found a therapist and a job working part-time at a local movie theater. Still, he’s unsure how his financial aid situation will look upon his return. He recently received a letter informing him that because he is no longer a student, he must repay his federal financial aid loans, which most students don’t have to worry about until after graduation. He’ll also have to find a way to pay for two courses at the University of Las Vegas, as Yale financial aid does not extend to classes taken outside the University. But many other institutions, UNLV included, do not offer financial aid to students who are merely visiting.

“We’re taught to buy into the idea that Yale is our home for the next four years. If I choose to leave my home, I like to feel that I’m still part of a family there. I withdrew and they washed their hands of me.”

—Ray Mejico ’17

Many students, Mejico among them, said the process of withdrawal is explained as a simple one before they leave, but once they are home, complexities and challenges reveal themselves. In retrospect, Mejico wishes he had waited until the fall and instead taken a leave of absence, which requires students to leave within the first 10 days of a semester, but allows them to return without reapplying. A leave of absence would have left Mejico eligible to keep his Yale Health coverage and would not have required him to pay for any courses outside Yale. Because students are generally not required to begin repaying loans until six months after the last day of formal enrollment at Yale, a semester-long leave of absence would likely have eliminated his financial aid issues as well.

“If I had known how much of a hassle the financial burden would be, I probably wouldn’t have [withdrawn],” he said. “I’m withdrawing to work on myself, but because the whole readmissions process is so unnecessarily stressful, I’m not really given any time to work on myself.”

Much of the stress of withdrawal comes from uncertainty. Zhukovsky, like others, said that the main issue is not the policies themselves, but the lack of clarity surrounding them. Without any University-initiated communication after the withdrawal letter, students feel not just confused but alienated.

“I have so many questions still,” she said. “I email people asking questions all the time and no one really responds to me.”

Zhukovsky said the answers she does get are vague and sporadic, and often leave her with a new question: why didn’t anyone tell me this before? Because she no longer receives communications about such concerns, Zhukovsky hadn’t even considered where she would live upon her return to campus until her former roommate asked about her plans.

Zhukovsky is staying busy at home, but wants to return to Yale as soon as possible. (Sophia Zhukovsky)

While George did not return request for comment on the communications that come out of her office, several withdrawn students said that after the official withdrawal letter, they did not receive any further communication from the University.

Peter has already had to reapply for financial aid, even before Yale’s official re-application deadline. But since he’s no longer enrolled, the financial aid office is no longer in touch; he has to initiate all these communications himself to ensure he won’t miss deadlines.

Every withdrawn student interviewed said the University would do well to send routine, if occasional, emails reminding them of important dates.

“I want them to consider us a priority, but they do kind of seem like they don’t care,” Zhukovsky said. “I want some reassurance that they’re still looking out for us, and still want us back at the school. It doesn’t help if you’re an anxious or depressed person, and the school you felt like you really belonged to doesn’t help you. It’s like they want you to be fixed and then come back.”

That lack of communication often extends up until the moment that students are readmitted — or not. Unlike students being admitted the first time, reapplying students don’t know when they’ll hear a decision. They aren’t told when their readmission interviews will be, so they have to be ready to come to Yale at a moment’s notice. Interviews have to be held in person; Peter heard from his dean that there is no flexibility. This restriction has kept withdrawn students from studying abroad, or pursuing other avenues of “constructive” occupation.

And for many, perhaps the most frustrating part is that it seems that these policies can be easily improved.

***

That frustration hardly dissipates when a student returns to campus. After being forced to withdraw November of her freshman year when she revealed suicidal thoughts to a counselor at MH&C, Marie Cain ’16 did — she thought — everything she was supposed to do in order to come back. She enrolled in two courses at the University of Connecticut and received an A in each; her therapist and psychiatrist both recommended her for readmission to Yale; she interned at a law office. But Cain’s initial application for readmission was rejected. Although she has since returned to campus, she still doesn’t know why she wasn’t accepted the first time. Her only guess is the interview: the first time they met, Cain said George was “very critical.”

“Even though I had the full support of my psychiatrist and therapist, and good reviews from the law office, I was denied readmission without being told why,” Cain said. “They never specified. They don’t have to.”

All withdrawn students interviewed expressed some worry about their prospects of readmission. Many worry for reasons particular to them. Mejico, for example, was ex-commed by George last year for an unrelated incident, and is not optimistic about his next encounter with her. And Macdonald worries that the positive spin her residential college dean has put on the whole process will prove unrealistic when readmission rolls around. But for the most part, students worry about whether they’re doing what they’re supposed to be doing, and even if they are, whether it will prove enough.

George told the News in February that most withdrawn students are readmitted. Still, in January she said that Yale’s readmission policies have room for “immediate improvement.”

The same month, Yale College Dean Jonathan Holloway said that withdrawal from Yale, a deeply personal process, will likely never be completely satisfying for anyone who goes through it, no matter what policies Yale puts in place. Legal issues govern withdrawal, and students who have to leave are unlikely to ever be pleased. But readmission, he said, is more under Yale’s control, because Yale can set the terms. Readmission is where Yale has the most freedom to improve.

With the review committee set to release its report anytime, the University could starting implementing new policies as soon as over the summer, Holloway hopes. The committee’s formation and the February forum signal that the University is taking student frustration seriously.

But true commitment needs to be seen before it will be believed, it seems, and students are unlikely to stay quiet if no substantive changes are made. Many students — withdrawn students among them — were unsatisfied by the University’s efforts earlier this year to expand Yale’s MH&C resources, complaining that the changes did not go far enough. And some have seen the committee’s efforts to solicit student feedback as insufficient and even insincere. This has left students far from optimistic about the potential for change.

“I’m kind of mad at Yale all the time. I want to respect their decisions, but I have not seen any reason to, because they haven’t explained any of the reasons behind any of their decisions,” Zhukovsky said. “I love the school and I believe the administration has good intentions. But I need more proof.”