“I went to see 5 different doctors in the general hospital. All of them prescribing me sleeping pills, which is a huge no-no. It doesn’t help you at all in the long term, and it has major side effects. I remember taking it and I was extremely high, so high that I could talk to walls.”
Cindy* remembers the time she cried every day without knowing why. She was reading law in her final year at Reading University, after completing the first two years in Malaysia. Despite some boy troubles, she was surrounded by a sea of people. Many of them were supportive friends. Her Instagram feed showed a good-looking 21-year-old girl happily celebrating birthdays and traveling the UK.
“When I was undergoing depression, I honestly didn’t know why I was depressed. Every day I woke up feeling shitty, I couldn’t sleep, I became anxious, I cried every single day not knowing why. Honestly, I thought there was something wrong with me physically.”
Cindy was battling depression then. As described by the World Health Organisation (WHO), it includes “sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.” Alongside anxiety, it is an increasingly serious problem at university campuses.
Just over a month ago, three first-year students from the University of Bristol were found dead within weeks of the start of term. The coroner’s results are yet to be completed, but online tribute pages for two of the three students are saying the deaths were possibly due to suicide, driven by untreated mental illness.
Bristol University students’ union’s student living officer, Stephen LeFanu, stated that the new students could have felt it was “extremely difficult” starting university. “Many people will also experience complex mental health difficulties, regardless of their environment,” he told The Guardian.
Their deaths came less than a year after the National Union of Students found that eight out of 10 students (78 percent) experienced mental health issues during their studies. Students may have a lower suicide rate, but they have nearly doubled since 2007. 33 percent of the students surveyed had had suicidal thoughts. The Guardian is calling this a “campus crisis in mental health”.
Not exactly “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” i.e. WHO’s definition of mental health well-being.
A feature of this unfortunate state of affairs is its rather democratic nature. It cuts across the usual race, gender, ethnicity, financial et al. barriers. This means that local students’ mental health aren’t the only ones affected. International students are struggling too, and even more so without the usual support structures of family, friends and home.
People usually experience their first episode of psychosis – a psychological term to describe a “loss of contact with reality”, e.g. anxiety and depression – when they are 17 years old. Around this time, teenagers are also asked to make one of the biggest decisions thus far in their life – university. Your entire future rests on this decision.
And for many varied reasons, some teenagers are asked to uproot their lives and move to a foreign country to earn that degree.
A stressful life event alone isn’t usually the cause of depression or other mental illnesses. Mental disorders are usually caused by a combination of biological, genetic, psychological, and environmental factors. But an adverse life event, like the transition into university, can trigger a depressive episode in those with pre-existing conditions.
The transition from high school to college is a big move. The student loses their home, school, and friends for the past 17 years, which are basically their entire world.
For international students, the loss is bigger. According to Young Minds‘ Stressed Out and Struggling (SOS) Project report on international students’ mental health, “They may experience a sense of loss, in the wider sense – of native language, customs, security, of the sense of self even – due to being in a foreign culture.”
This initial sense of loss, if not overcome or left untreated, can build into pressure that persists. An investigation into the mental well-being of Malaysian and Chinese students at the University of Nottingham found that among those experiencing depression and anxiety, the causes were mainly due to the “cultural transition, pressure from academic work, high expectations of family or parents were identified as main causes of students‘ mental health problems.”
Too many expectations, too little connection
Along with this loss, comes a unique set of expectations in today’s set of international students who grew up in a significantly globalised world and the omnipresent Internet. On a more personal level, they are born to helicopter parents and grow up sheltered, being told they are special. They are then shipped off to universities, carrying along their unrealistic expectations.
Three months ago, Pranav Padmanabhan moved from India to Maynooth University (NUIM) in Ireland to pursue his Master’s in IT Management. Managing expectations was one of his biggest challenges.
“To start with expectations, I’d say it is of two types – one would be personal expectations, and the other would be societal expectations.
“Personal expectations are something we expect from ourselves, what we can do and our own perception of our abilities and capabilities. Students who travel abroad generally have high motivation to achieve something, which acts as their drive to go ahead with it, irrespective of the uncertainties that might hover around that decision.”
“The second is societal expectations. This includes parents, friends back home, peers and anyone and everyone around us. For example, once I got here, I had peers who were always on top of everything be it assignments, group work, or class discussions.”
High expectations are expected when students and their parents have piled their hopes – and for some, their life savings – into an expensive international education. Throw in the impossible dreams sold as attainable by social media and the increasingly competitive job market, and the stakes become dangerously higher.
In Cindy’s case, she felt she had to give it all. “I was under a lot of pressure to get good grades for my final year and the worst part is that the pressure came from myself. Once it came down to being in a prestigious university and having extremely brilliant people around me, I felt like I should give my all”.
A high benchmark makes the fall harder. Young Minds’ report states: “When a mismatch occurs between expectation and reality, between the dream of success and the pressure of assignments, both individual and institution are at risk of disappointment and failure.”
And these triggers from failures and disappointments will have consequences, such as falling grades, flunking classes, and excessive isolation from peers. Cindy and Pranav are some of the lucky ones. Cindy could afford a psychiatrist back in Malaysia and Pranav got better through effective counselling. “Today, I am fine, I am happy and I am so much stronger than before,” said Cindy. Help was available before things got out of control.
But some, like Aniza Azim, a medical student at Leicester University, were not so lucky.
Aniza had struggled with depression since her second year in A Levels, with all the UCAS applications, extracurricular activities, and other responsibilities. The depression then followed her to university. On her first day back in uni after spring break, she found out there would be an exam. “I decided to stay in as I couldn’t handle the anxiety and panic while my (ex) partner left for uni.”
“It was a very surreal moment and I felt like I was going mad and that it was too much and I couldn’t handle being in my own head anymore. I grabbed my supplies, drank copious amounts of alcohol, cut myself multiple times and tried to overdose on paracetamol. I passed out eventually and was found by my ex a few hours later. And I woke up in the hospital.”
Now officially diagnosed with depression, Aniza is still struggling with it every day. It has caused her to take a year off from university. And this year, she left her studies.
“I’m unsure of what’s next and it still scares me. But I’m trying to take the time to figure it out and to try and just be okay with just being …
“It’s okay to change, to figure out yourself and to realise that you’re not the same person you were a few years ago. You’re you, you’re not a projection of what your family, friends, and society think of you,” she said.
Often, we are surprised to hear of accounts like these. Or statistics like the above. Our surprise imply that we did not expect that our sons, daughters, and friends are part of this worrying statistic. And it goes beyond just numbers. It shows that we too did not know the scale of hidden anguish our loved ones had inside them.
The way forward
This crisis is a collective problem requiring effort from all quarters. The good news is it is preventable if we are armed with more data and less stigma.
A recent study by the University of Bristol showed that exposure to suicide content, including details about suicide methods, had served to validate and glorify suicide. These findings had prompted the House of Commons Health Select Committee to call for such websites to be banned. The select committee is also urging the government to increase support and investment for public mental health and early intervention services.
At campus level, Pranav urged universities to treat the Bristol students tragedy as a wake up call, calling on universities and students to work together right from the start to make the transition easier.
“Proper orientation needs to be provided to freshmen on how to manage social and school life … I would urge every university to spend a week full of orientation activities at the start of the year to help students make the transition successfully. This should be a necessity if we’re talking about international students, as there are a lot of challenges to overcome,” he said.
The stigma surrounding mental illness has hindered efforts in getting more investment into research and public awareness. For ethnic minorities, like international students, stigma is also one of the barriers preventing them from seeking help. Based on their personal experiences, Aniza and Cindy have called for students suffering from mental health issues to ignore such stigma and to seek help from friends, family, and their university.
“Look for help when you need it. See your GP, the university pastoral support, and counselling service. The latter two will help you with university matters and especially with mitigating circumstances if you need help with exams and deadlines,” suggested Aniza.
Cindy also advised future students to be strong.
“I guess my advice, really, is that anyone who is undergoing this, know that you’re not alone, and that don’t be afraid to seek medical or professional help. Do not think you are weak just because you are going through this. Everyone has problems, don’t be afraid to talk to your friends or parents or even a counselor if you need it. Don’t ever feel like you’re worthless.”
*Name changed at interviewee’s request
Images via Shutterstock