The nuts and bolts of getting help
A beginner’s guide to mental health treatment
It seems that at MIT, toughness is valued above almost all else. We take pride in stretching ourselves thin, whether taking an absurd number of classes, pulling multiple all-nighters, or doing well in a class we never actually attend. With our workloads, time is precious. When we’re tired, sick, or in a bad mood — we learn to cope.
Time and time again, I’ve seen my friends and classmates apply this attitude to their discontent, loneliness, or depression. I don’t know if they’re not familiar with the kind of help available, or if they’re just hesitant to seek it. Personally, it’s hard for me to empathize with that mindset, because I’ve been depressed my whole life. I never thought there was something wrong with me until I went on medication, and my life improved dramatically. I feel very lucky that this took place before I tried to drink from MIT’s firehose. I can’t imagine how hard it is to come face to face with depression, anxiety, or anything of the sort for the first time while trying to handle MIT.
The basics of mental health
In light of my experience with mental health treatment, I’d like to offer a student perspective about different options and what to expect. Let’s start with the basics. Most forms of mental health treatment fall into two categories: psychotherapy or psychopharmacology.
Psychotherapy covers many different approaches and can be performed by psychiatrists, psychologists, and various types of counselors and social workers. You might picture a person lying on a little couch talking about his or her feelings as a doctor takes notes, but that setup is to psychotherapy what the Model T is to cars — just the beginning. There are hundreds of different schools of thought under the heading of psychotherapy that I know very little about, from group therapy, to hypnotherapy, to art therapy, and so on. In its most basic form, though, psychotherapy is spoken conversation between the therapist and the client, with the goal of trying to improve the client’s emotional life.
I’ve undergone psychotherapy with a psychiatrist and a psychologist at different points in my life. The first guy even had one of those little couches, although at the age of 11, I took myself too seriously to actually lie on it.
These days, my therapist and I talk for 50 minutes once a week, typically about my past, how I’m feeling about different aspects of my life, and trends in my reactions to various situations. I’ve been in therapy for almost 10 years, and I have no idea how it works. I’m somewhat troubled by this fact, and as MIT students, you guys might be too. Some people spend their time in therapy identifying problems and then developing solutions for them, but I mostly just monologue. It doesn’t make sense that this has the ability to make me feel calmer, more in control, and less depressed. But, at the end of the day, it doesn’t matter if it makes sense. It works.
Next, there’s psychopharmacology, which is the practice of prescribing medication to treat various psychiatric conditions. Psychopharm is necessarily performed by a medical doctor or nurse clinician. From what I can tell, it’s a pretty tricky business, because there’s no way to identify the mechanism that might be causing a particular person’s problem. These days, psychiatric conditions are identified largely by symptom, not etiology. A drug like Prozac might work excellently for me but have no effect for someone with my exact presentation. Sometimes it seems like your doctor is playing pin-the-tail-on-the-psych-disorder, completely blind to the actual biology going on in your head.
I’ve seen three different people for psychopharmacology over the past eight years, and it’s the same drill every time. First appointment: you meet your doctor, tell them the abridged version of your life story, explain what problems have led you into their office on that particular day, and then make a treatment decision. This is approximately a 45-minute process. I’m sure a great deal of subtlety and tact goes into these initial meetings, and that psychiatrists would be shaking their heads at my dumbed down version of their lives’ work. That’s the gist of it from my end, though. After that, you come in for follow-up meetings, which are shorter, since you just have to get them up to speed about how you’ve been feeling since your last visit, and then discuss your plan for treatment. I had one psychiatrist in particular who was exceptionally speedy with these follow-up meetings. My all-time record was seven minutes.
I mention the duration of these meetings because of how it relates to the cost. Both psychotherapy and psychopharm can be insanely expensive. If you are seeing a psychiatrist who is not covered by your insurance, you can drop hundreds of dollars on a 15-minute appointment. It’s a non-starter for the vast majority of the population. In most cases, however, you should be able to get help without paying the sticker price.
Finding a provider
This brings us to your choice of provider. In terms of price, MIT Medical is very appealing. Visits to Mental Health and Counseling are free for registered MIT students. They offer psychopharmacology and a range of types of psychotherapy, all with no co-pay. This is a huge deal. Besides that, they’re right on campus, the providers understand the plight of the MIT student, and they’re familiar with great resources like Student Support Services. I’ve been very satisfied going to Medical for psychopharmacology for a while now.
Some people do choose to see outside providers. It’s nice to get off campus, and there’s something to be said for keeping your mental health separate from your life at school. From what I’ve heard in the past three-and-a-half years here, there’s a fear among the student body that if they go to MIT Medical in distress, there’s a chance they could get forced to go to the hospital, and possibly take a leave of absence from the Institute. This process is surrounded by rumors and misinformation, so I want to clarify a few points about it.
In Massachusetts, physicians, psychologists, police officers, social workers, and certain nurses have the ability to fill out a form that requires someone to be transported to a particular facility to be examined by a psychiatrist. If that psychiatrist deems the person unfit to look after themselves because of mental illness or at risk of harming themselves or others, that person may be hospitalized. This is often referred to as a “Section 12,” because of specific part of Massachusetts legislature that describes it. According to Alan Siegel, Chief of MIT Mental Health Service, 2,316 students have visited Mental Health and Counseling this year for a total of 12,955 visits. Approximately 45 percent of these students were undergraduates. Since July 1, 25 undergraduates and eight graduate students have been hospitalized for reasons relating to mental health. This includes students who voluntarily admitted themselves to the hospital, those who were sent by outside providers, and those who were sent from MIT Medical. Thirteen of the 25 hospitalized undergraduates and five of the eight graduate students have since returned to their studies.
Now, I’m sure that Section 12s have saved lives, and in other cases, they weren’t the best course of action. Some of you who are worried about this possibility may choose to avoid MIT Medical all together. If you’re worried about being misunderstood, my advice would be the opposite — come earlier, come more frequently, and develop a relationship with a provider there.
I have a final word to the wise. If you decide to try psychotherapy or psychopharm for the first time, and you feel like you don’t get along with the provider — find a new one. You’re not going to keep up with anything that involves sitting in a small room with a person you dislike. Getting help involves a high barrier to entry for lots of people, so you’re doing yourself a huge disservice if you give up on it after one try with one person. Please give yourself the best possible chance of getting better.
For more information on costs and insurance outside of MIT Medical, visit: http://medweb.mit.edu/mentalhealth/mh-costs.html.
For more information on hospitalization, visit: http://medweb.mit.edu/mentalhealth/mh-questions.html.
To make an appointment at MIT Mental Health or to get a reference to an outside provider, call 617-253-2916 during business hours.