Q&A: Dr. Laurie Watson Raymond '73 on Parenting Young Adults with Mental Illness

Dr. Laurie Watson Raymond ’73, a psychiatrist and former director of advising resources at Harvard Medical School, spoke about parenting young adults with mental illness in this Q&A with PAW contributor Robin Herman ’73, who wrote about the topic in an essay for the Jan. 7 issue. For additional resources, see the links at the end of the interview.

Why is this happening now? My daughter/son was fine in high school.

This is often a parent’s first question. Major mental illness (schizophrenia, major depression, or bipolar disorder) doesn’t often develop fully until an individual is in late adolescence or their early twenties. It’s not unusual for a person to describe having had periods earlier in high school when functioning seemed difficult due to changes in their thinking and/or mood and then feel more severe episodes come on in young adulthood when a diagnosis is more likely to be made.

Mental illness is more common than we think. In 2012, the American College Health Association reported that “one in four young adults between the ages of 18 and 24 has a diagnosable mental illness” and “more than 25 percent of college students have been diagnosed or treated by a professional for a mental health condition within the past year.”

When it occurs in your own son or daughter, it isn’t unusual as a parent to blame yourself and wonder what you could have done differently. It’s important to understand that there are many risk factors for mental disorders, and there is no one causal factor. Although family history is important, particularly when it’s multi-generational, even genetic variants found to be common to certain mental disorders don’t predict that any particular individual will become mentally ill.

At this point in our knowledge, stress is not thought to be a causal factor of mental illness but may trigger its onset in someone who is already vulnerable to developing it. Some additional striking statistics from a recent update to the American College Health Association report is that nearly 44 percent of college students have “felt more than an average amount of stress within the past 12 months,” and 86 percent of college students “felt overwhelmed by all they had to do” in the past year, while 46 percent at some point “felt things were hopeless.”

There are a number of factors that contribute to such stress. Leaving family and familiar relationships to go to college requires a level of independence and reliance on one’s inner resources for which an individual may not be prepared. At college, academic or athletic competition may be greater and potentially threaten an individual whose self-esteem has relied on previous success in those areas. In the process of seeking friends, some individuals may be vulnerable to the pressures to “fit in” which may then lead them to unwanted sexual experiences and excessive drug and alcohol use. In young adulthood establishing one’s identity often involves some “trial and error” in these respects, but for many, additional support from family, friends, and professionals is needed to help navigate these various challenges.

What if my child refuses to seek help?

Young adults may struggle significantly with asking for help as they try to establish their independence. The National Alliance on Mental Illness (NAMI) in 2012 published a survey on college students that revealed that “overall, 40 percent of students with diagnosable mental health conditions did not seek help,” and “concern of stigma was the number one reason students did not seek help.”

An initial conversation with your young adult before leaving for college about the expected stresses could help increase the chance that he/she will turn to you should the need arise.

If your son or daughter has never encountered any emotional difficulties in high school, you can address the possibility of psychological challenges at college by normalizing them. You might say: “When anyone goes to college there are many stressful aspects of growing up: in your social life, in your courses, in competition with others, in your closest relationships. It can happen that you go through a difficult period where you might be unhappy or worried about how you’re doing. Those are times I’d really like you to know you can call me – they are a normal part of growing and challenging yourself in a number of ways at college.”

Then your son/daughter can later say, “Remember when we talked about this? Well, I’m going through one of those times.” You now have a shared language for dealing with it.

If a young adult has already had difficulties in high school that required hospitalization, medication, and continuous treatment by a therapist, it’s important to arrange ahead of time for similar supports at college. Many young adults in that situation might hope that whatever happened before could never happen again. Actually, given the biology we talked about and the numerous stressors that college presents, it’s more likely that they will encounter some periods of difficulty. 

I hear stories about suicides at college. Will mentioning it somehow make it more likely?

An important question to broach with your young adult is the one that causes the greatest worry for parents: “Do you feel safe now? Do you worry that you aren’t safe or might harm yourself?” Your ability as a parent to talk about potential self-harm and suicide will actually reassure a young person that you can imagine that’s possible for them and are willing to name it. Your son/daughter may be otherwise protecting you and others by not discussing it, and that feeling of being all alone with those thoughts may actually be what contributes to despair and increased risk for self-harm or suicide.

It would be useful when asking these questions to have already identified a couple of resources such as a young adult mental health program that could perform an initial evaluation, or a psychiatrist who works with young adults, perhaps affiliated with a hospital or academic center that could help identify additional resources (e.g., peer group support, work placement) as needed. If it seems your child is at immediate risk, you may need to mobilize professional support right away for hospitalization, which is difficult even if necessary for both of you.

My child’s college won’t give me any information on how he/she is doing. I’m so worried. How can I be reassured?

There have been several cases of student suicide lately in U.S. colleges that have raised the question of the balance between a student’s right to privacy and a family’s wish to know if their child is at risk. It’s become a very hot legal issue with cogent arguments on both sides. In my own experience at the Harvard University Health Services, whenever a student is experiencing acute mental illness that is likely to require a period of hospitalization and subsequent recuperation, efforts are made with the student before and during hospitalization to involve the family, as they may be an important component of the student’s recovery.

Strictly speaking, if a person is at risk for harming himself, others, or is unable to care for himself, confidentiality in those circumstances can be superseded by the need to care for that person, in which case communication may be necessary with the family.

If you are concerned about your son or daughter, you can also contact the dean of students to share those concerns, and the dean can contact the student directly and/or those people likely to be involved with the student (dorm heads, residential advisors, faculty advisors, etc.) to ensure the student is safe. If there is any question, the dean and/or relevant advisors can also mobilize the health services emergency services for further evaluation of the student, as needed. The dean of students and the student can discuss what communication with the parents will be helpful while still respecting the student’s wish for privacy.

My spouse and I are overwhelmed with feelings of anxiety and helplessness. We feel we’ve failed as parents. How do we go forward?

Caring for parents is one of the most neglected areas of treatment when a young adult is in psychological trouble. Just like using the oxygen mask in the airplane, you and your spouse must first be able to get support for your own distress to help your son/daughter in turn. Parents often need help with the predictable guilt, self-blame, and questions about their young adult’s plight — as well as with the anxiety and sadness they feel over witnessing their child in acute psychological pain.

It is important that parents have a safe space, together with a health professional who is experienced in helping young adults with similar problems, so that ways to cope can be actively implemented. Such a professional can help parents strategize their own self-care, define discrete ways to help and support their child while still encouraging his/her independent functioning, and find support with other parents dealing with similar issues. For parents, and for their young adults, it is the aloneness that is one of the most painful parts of their experience. It is also critical that parents work through their own fear for their son’s or daughter’s future, so that their child can be supported in developing patience and consistency with their treatment and hope for optimal coping and success.

Resources:

NAMI (National Alliance on Mental Illness) help line, peer support, referrals, reference materials, how to choose a therapist, hospital http://www.nami.org/

National Institute of Mental Health (NIMH) for educational resources http://www.nimh.nih.gov/index.shtml

Local departments of psychiatry at medical centers or universities often have programs for parents, young adults.

At Princeton: Calvin R. Chin, Director of Counseling and Psychological Services cc23@princeton.edu, (609) 258-3285