Perfectionism can be Deadly
Summarized by Lois T. Flaherty, M.D.
College students who experience severe shame if they fail to live up to their own and their families’ expectations for academic success, and who see depression as a sign of failure and weakness, are at particular risk for depression and suicide. In a workshop at last spring’s APA meeting, Kristine Girard, a psychiatrist at MIT, termed this syndrome “maladaptive perfectionism”.
Dr. Girard discussed the high profile case of Elizabeth Shin, who died in 2000 after a fire in her dorm room, which occurred after she took an overdose of medication. She had a history of depression with a suicide attempt, and had received mental health services from MIT. Her parents brought suit against MIT and a number of individuals, claiming that MIT had failed to prevent her death. MIT eventually settled the case out of court, which means that this cannot serve as a legal precedent and the details of the findings of investigations are not public. In its aftermath MIT undertook a major self study and implemented changes designed to improve the monitoring of students’ well-being on campus.
Dr. Aradhana Sood was involved in the State of Virginia’s investigation in the aftermath of the Virginia Tech case, in which Seung-Hui Cho massacred 32 students and faculty before killing himself. Cho had a long history of psychiatric illness and was essentially untreated despite progressive deterioration that was obvious to faculty and students. That case highlighted significant gaps in mental health care to college students and the pitfalls of privacy laws.
The cases raised important questions about the limits of confidentiality and the in loco parentis role of educational institutions, which diminished as young adults were deemed progressively more independent. That both cases involved Asian-American students highlighted the pressures facing these students. Mental illness is strongly stigmatized among this group, leading to denial and reluctance to seek help.
The presenters emphasized that combating stigma, advertising mental health services and publicizing warning signs of depression and suicide are key to colleges’ efforts to prevent suicide. Supportive groups such as Asian-American societies and “Active Minds” (www.activeminds.org ) are also positioned to help. According to its website, the latter organization supports student-run mental health awareness, education, and advocacy groups on campuses throughout North America.
Jack Yen, MD. MPH, (Ohio State University) discussed his institution’s attempts at screening to identify students at high risk. Part of the prevention efforts involve educating staff at all levels – the janitor in a dorm, for example, may be the first to be aware that a student is isolating himself in his room. OSU students may take an on-line survey for assistance. Psychotherapy including CBT and medication management are available through student health services. Ohio State, one of the largest universities in the US, has developed a federally-funded Suicide Prevention Resource Center with online resources (http://suicideprevention.osu.edu ). The emphasis is on culturally sensitive approaches, so the Center has developed and distributed brochures for each of the main ethnic groups on campus.
In another session, Doris Iarovici, MD of Duke University listed the major challenges facing universities include the high rates of students currently taking psychotropic medication, Internet addiction, and substance abuse. Students often present asking for stimulants after having taken a friend’s prescribed medication and finding it helps the study and retain information, yet have never required treatment for ADD and may be sufficiently sleep deprived to appear as though they have ADD. She advised college health services to use a harm reduction strategy, as it is unlikely most students will abstain totally from potentially harmful behaviors. The phenomenon of “effortless perfectionism,” in which mainly female students present the appearance of academic success without working, is an emerging and significant source of additional stress on college campuses.
In recent years the APA has increased its focus on college mental health, beginning with Michele Reba’s appointment of a task force on this topic when she was President. This year’s meeting featured several presentations on this topic. “The Deadly Years: Preventing Suicide in Asian American College Students.” was the title of a workshop presented by Aradhana Sood, Kristine A. Girard, and Jack Yen, all members of the Caucus of Asian American Psychiatrists. Dr. Iarovici’s presentation was part of a presentation on generational issues and mental health sponsored by the Association of Women Psychiatrists