Can we stem the rising tide of serious psychiatric illness in college?

Last week I "launched" my oldest off to college. As anticipated, it was an intense emotional experience full of joy, sadness, and many things in between. (I have to tip my hat to fellow Globe writer Beverly Beckham for her piece I was the sun, the kids were my planets that was very helpful. However, I might have written that my child was the sun, a burst of light in our household, and the experience of leaving her is like being temporarily knocked out of orbit as our family re-orients to life without her.)

The same week I received in the mail, in exchange for filling out a questionnaire about a study on diversion -use of ADHD medications by individuals for whom it was not prescribed- this pretty laminated poster of all the drugs currently available for treatment of ADHD.

Statistics indicate that serious mental health problems in the college community are growing at rapid rates. Some optimistically speculate that this is because of decreased stigma for getting care. But I wonder at the paradox of the parallel increase in availability of new psychiatric drugs- I counted 22 different formulations for ADHD medications on that poster- and the rise of serious mental health problems. Could it be that the drugs themselves are responsible for this increase? If the drugs were effective in childhood, shouldn't we see a significant decline in serious mental illness in college?

How would this work? Starting at a young age, rather than learning to manage stress in the context of supportive relationships, the symptoms are medicated away. The brain is actually wired in relationships, and in the absence of this kind of co-regulation of emotion, the areas of the brain responsible for emotional regulation do not develop properly. All forms of mental illness, including depression, anxiety and attention problems are essentially problems of emotional regulation. Then as the challenges of life increase in complexity, the medications often increase in strength and complexity. Children learn to be defined by their medication and are further estranged from a core sense of self. Add to that unknown side effects on the developing brain, and it is no wonder that there is a significant increase in serious mental illness by the time a child gets to college.

But what about that issue of decreased stigma? That also is likely true. At a superb talk given by a psychology professor at our child's orientation, we learned about the school's  "invisible safety net." It is made up of an elaborate interconnected system of students, faculty and mental health professionals to monitor the emotional well-being of the students. It is all about relationships and connection.

The very existence of this net reduces the stigma of emotional struggles. The fact that the school goes to the trouble to train such an elaborate system of care (sophomore advisors- or "SA's" the front line of this system, must apply in January of their freshman year, and they get several weeks of training prior to the start of the school year), conveys to both students and parents that it is normal and expected that people will struggle and need help.

I believe there is something to be learned from this "invisible safety net" model. If we as a country were to implement a model of preventive mental health care, we would have in place a net made up of primary care clinicians, early childhood educators, childcare workers, mental health care professionals, as well as others who come in contact with young children and families. There would be open and expected lines of communication. (At this college, if a parent calls with a concern about their child, within the hour there is a person making face-to-face contact with that student, even if it is just inviting them out for a slice of pizza- and that person is trained to recognize when it is necessary to call in a higher level of intervention.)

If such a net were there from infancy-including a system for identification and treatment of perinatal mental health problems- through adolescence, then maybe kids wouldn't need all those pretty little pills to take to college.

A perfect community moment: holding a mother so she can hold her baby

I am a devoted fan of Zumba, specifically as it is taught by my wonderful teacher, who has a dedicated following. She has been out for the past month, home with a newborn and two year old. Last week, she came with her baby to try to take the class, now being taught by a substitute, also a regular member of her class.

"I need this for my mental heath, " she confided as we walked together in the parking lot. A mother of a teenager who was also taking the class greeted us at the door.  Without hesitation, she offered to take the baby to a nearby park with her other two kids. "I'll bring him back when he needs the breast, " she said, and was off.

About 20 minutes in to the class, we heard the insistent cry of newborn hunger. His mom stopped her dancing and sat on the side nursing the baby, cheering the rest of us on through the new routines. A few minutes later, she was back in action, the other mom taking the baby again. My teacher was able to get a couple more numbers in before her baby demanded the second breast. Again she stopped, and settled in with him on the floor of the dance studio, where the two of them remained through the end of the class. We all wished them well as we filed out of the class.

It was a beautiful example of both  "the holding environment," and "primary maternal preoccupation," two ideas central to the work of D. W.Winnicott, pediatrician turned psychoanalyst.

Being home full time with a toddler and newborn is among the most difficult jobs there is. Taking care of your mental health is essential. This little scene included two important elements: physical activity that is calming, Zumba being a great example, and a community of supportive caring people.  In an ideal world, every mother would have access to such a "holding environment." When  a mother is struggling with perinatal emotional complications, such as depression or anxiety, this is particularly important. In such an environment, a mother is free to provide the "maternal preoccupation," that my teacher demonstrated with her unhesitating attention to her baby's needs.

Human infants, unlike some other species,  are completely helpless and dependent for the first 8 to 12  weeks of life.   Beyond these early weeks, babies begin to have the ability to comfort themselves, for example bring a thumb to their mouth. The need for this kind of preoccupation lessens. In fact, as they grow and develop, learning self regulation by not having their every need met becomes increasingly important. But in these first few months, being highly attuned and  attentive to a baby's needs, or "preoccupied," while it can be exhausting,  is essential for healthy development. It lays the groundwork for self-regulation and a healthy sense of self.

Thinking about this scene led me to reflect on a post written by Kara Baskin, one of my fellow Boston Globe bloggers, about Yahoo CEO Marissa Mayer's plans to take only a few weeks maternity leave. She writes:

I’m sure Mayer will make the situation work for her however she can, whether that means hiring an army of nannies or installing some kind of high-tech baby-cam from which she can run meetings while playing virtual peek-a-boo or, you know, trying to work flexible hours.

Baskin wonders how realistic this is considering how emotionally drained and physically exhausted a new mom can feel.  This is an important point. But at the risk of accusations of anti-feminism, I think Mayer's idea is selfish. Recently I spoke with a very experienced maternity nurse. She observed that, more than in previous generations, for today's new Mom the pregnancy is "all about them."

Well, the hard reality, and also the great joy, is that it is not all about them.  At the end of the nine months, this baby needs someone to offer the kind of primary preoccupation that I described above. It doesn't necessarily need to be the mother. It could be a father, grandparent or other relative. If it is a nanny, which in my opinion is not ideal, then it must be recognized that when that nanny leaves, it will be a significant loss for the child that will need to be processed and grieved.

Our society needs to recognize the value of those first two to three months. We need to provide a holding environment for new Moms. We need to let them know that taking time to devote to preoccupation with their newborn is among the most important things they can do. It's not that much time. But in terms of the health of future generations, it will go a long way.

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Sexually Transmitted Diseases Can Hurt Your Baby

Sexually transmitted diseases (STDs) are diseases passed from one partner to another during sex. When you get prenatal care, you will be tested for STDs (another important reason to get prenatal care). If you have any infections, you and your partner will be treated. If these diseases are left untreated, they can seriously harm your infant. Go to the getting healthy before you get pregnant page to read more information on STDs and their impact on your pregnancy and baby.