Student depression

University terms are starting all over the country. When I was an undergraduate, the Cambridge term started late, in early October, and our terms were only eight weeks long. That first one was seven weeks six days too long for me.

I have had several responses from students to my blog on dysthymia – low-level persistent depression, or what is now called persistent depressive disorder. The people who contacted me are just the tip of the iceberg. In your class of a hundred fellow students it could be that as many as nearly twenty of them are mentally ill, to some degree, right now. That’s a lot of sick people; imagine a class where twenty people were sneezing and coughing non-stop. Who are these people? Can you tell? Are you perhaps one of them? And a couple of lecturers are probably depressed right now, too.

What’s the leading cause of death for young people aged 20-35 in the UK? Those risky boys speeding round blind bends in their sporty cars? Drugs? Falling under a bus blind drunk? Being mugged and murdered? No, by some way, it’s suicide. Suicide is also the leading cause of death for men under 50. And most people kill themselves because they can’t take the hopelessness and pain of depression any longer. And if suicide doesn’t kill you, depression is associated with a host of disorders, such as heart disease, cancer,  and dementia, which might get you later.

Depression and anxiety are closely related, and usually go together. Epidemiological studies show that anxiety and mood disorders are remarkably common: it’s estimated that one in three people will suffer in their lifetime, and between one in six and one in ten are ill now. The reporting of mental illness has increased, but whether that’s because of better understanding of the disease, better diagnosis, reduced stigmatisation of the ill, increased pressure of contemporary life, or, most likely, all of these, is unclear.

When I was young (under twenty, say), I didn’t know what depression, anxiety, and obsessive-compulsive disorder were, although in retrospect I suffered from all of them. I was aware of something my relatives talked about in rather hushed tones called “a nervous breakdown”. I’m still not entirely sure what one of these was, but I think it was a sudden mental illness requiring some kind of treatment, and even incarceration in an “asylum”. Treatments were very limited back in the 70s; remember that chlorpromazine wasn’t released to the market until 1953, the first benzodiazepine, Librium, in 1960; and the first antidepressants in 1957 (iproniazid, a MAO inhibitor) and 1958 (imipramine, a tricyclic), although these drugs have many serious side-effects. The relatively more benign Prozac (fluoxetine) wasn’t available until 1987. I don’t think I knew about these drugs until I switched as a student from Natural Sciences Physical to Psychology. Indeed when I was a teenager, I thought of treatment as shock treatment; that’s about all there was.

Attitudes started to change when Prozac became widely available; perhaps that’s generally true – diseases only begin to lose their stigma when there is some hope. When I was young “cancer” was another dirty word, sometimes just called the “c word”. Don’t ask my younger self about swearing though; when I was ten, I thought the filthiest word in English was “pub” (where my father went Sunday lunchtime).

I was the first person in my family to go to university, and I had no idea what was involved, no idea really what a degree was (although I knew students “read” for it on University Challenge), no idea how to manage money (fortunately credit cards weren’t available then), no idea how to manage my time, no idea how to study independently, no idea how to live, no idea how to make use of what was available, no idea what a girl was, and no idea of how to cope when I was a raving loony without realising it. I was extraordinarily shy, which didn’t help. I wasn’t lazy; I tried my best, but I had no idea how to organise my time. I expected university to be like school, which of course it isn’t.

I stuck out the first year, mostly because I drift through things and staying was the easiest thing to do, and I was just clever enough to get by in spite of my deficits. The turning point was joining a society where I met other people. I still can’t say that I felt at home, and at the end of the first year I got a summer job where I did. I was earning good money, I had friends of sorts, I seemed to have some purpose, I felt like I was part of a community, and I wondered why go back to Cambridge. At that point I nearly gave up.

I don’t really know why I didn’t; it was easier to stay than not. And when I went back to Cambridge I discovered psychology, and things started to look up.

If I knew then what I know now I would have got professional help. I would have started with meta learning rather than learning. I would have been bolder about asking questions. Mostly I would have realised that I was ill, I wasn’t alone, and that I should talk to people.

Loneliness

Lonely people tend to die younger. They have more health problems when they’re still alive, and tend to be more anxious than average. They tend to suffer more from high blood pressure. They have weaker imune systems. And I’m lonely.

Lonely people tend to die younger. They have more health problems when they’re still alive, and tend to be more anxious than average. They tend to suffer more from high blood pressure. They have weaker imune systems. Bummer.

Of course as with all findings about mental health, you must be careful talking about causes when all you have are correlations (feeling unwell might prevent you going to social events, for example), but it does seem likely that being lonely is bad news. The findings on the positive effect of social support – people with plenty of good friends and a strong social network tend to be happier and healthier – are after all just the other side of the coin.

We can distinguish acute loneliness (loneliness that persists for a relatively short period of time and that arises as a result of loss or transition, such as the death of a partner, change of job, or a geographical move) from chronic loneliness (loneliness that goes on and on and is part of a person’s life over some years). I’m currently reading Emily White’s book Lonely, about her chronic loneliness, and enjoying (or identifying with it perhaps) very much.

I think there is now more of a stigma attached to being lonely than there is to being mentally ill. Most people now accept that mental illness is a result of many factors, and that the ill person is not to blame. However, many people appear to believe that if you’re lonely, it’s your fault. You should just try a bit harder: join a club, do volunteering work, or take a dancing lesson. Or perhaps, they think, you’ve got no friends because you’re not a very nice person.

I admit it: I am chronically lonely – and I’m a very nice person.

Being chronically lonely (just lonely from now on) is related to many other things. White clearly thinks that being lonely and being depressed are very different; the main evidence for this claim is that many people report average levels of depression. I’m a bit sceptical that people have good insight into their mental states (we know from cognitive psychology that our insight is limited), but loneliness does seem to be related to social anxiety and personality factors independently of depression. I can feel lonely at a crazy party. In fact I sometime feel loneliest at a crazy party, where everyone else is obviously enjoying themselves, playing party games and singing songs. I have been in a packed football stadium where everyone else is singing and chanting and cheering and I just can’t join in; it feels false, wrong. I’m not looking down on the people who join in – although it must often look that way to other people – I just can’t make myself feel like other people. I’m an outsider (or as my mother used to say, “weird”, the irony being that she also is a lonely outsider).

I do wonder if people who think of themselves as very lonely mean “lonely” in the same way as others do. I think most people have acute loneliness in mind, whereas I think people like White and me are struggling for a word to capture a sense of alienation and otherness that pervades our lives even when others are present. A lot of what White talks about in Lonely makes me wonder if she just means “single”: a lack of intimacy, having somewhere there, the sound of voices and feet padding on the carpet at home, havint someone to touch, having someone with whom to share everything. But then I have felt lonely when with other people, including partners. Perhaps some of us are just destined to feel different. And for me it is entwined with depression.

But these are simple labels for complex experiences. I have no advice for others in the same party. I don’t want to go to a party or start dancing. Perhaps that’s why I enjoy the gym so much: I can be with other people, who vaguely share the same aim, but who don’t expect anything of me.