- A persistent sad, down or "empty" mood
- Crying or getting angry easily
- Sleeping too little, early morning awakening, or sleeping too much
- Reduced appetite and weight loss, or increased appetite and weight gain
- Loss of interest or pleasure in activities once enjoyed
- Restlessness or irritability
- Difficulty concentrating, remembering, or making decisions
- Fatigue or loss of energy
- Aches and pains that do not go away
- Social isolation and withdrawal
- Loss of direction, meaning, or purpose
- Thoughts of death or suicide
- Feelings of worthlessness or guilt
- Low self-esteem
For Students in Distress
In the face of these national patterns and day-to-day experiences with troubled students, many faculty and staff members have expressed concern and requested information to assist them in identifying problems and helping students locate professional support. At Bowdoin, by virtue of our small size and academic values, we have committed ourselves to support students in their growth as total human beings. This document is designed to assist faculty and staff to recognize typical signs exhibited by students in distress, to communicate effectively with such students, and to refer them to appropriate campus resources.
Dealing with Depression
It has been estimated that 17 million Americans suffer from a depressive illness. It affects approximately 3-5% of the population at any one time. There is a 20% chance of women having an episode of clinical depression at some point in their lives; a 10% chance among men.
People don't have to feel sad or blue to be depressed. It can be masked or disguised in symptoms such as a stomach ache, back pain or fatigue. Many people suffering from depression can end up going to their Health Care Professional's office feeling sick and being told there is nothing wrong physically.
The various facotrs that play a role in the development of depression include:
- Biological predisposition (family genetics)
- Medical illness or chronic pain
- Previous episodes of depression
- Periods of heightened stress and demands
- Social isolation and withdrawal
- The loss of a loved one or the separation from loved ones
- Traumatic events or natural disasters
- Challenging transitions or major life changes (financial, relationship, family, work, etc.)
- Lowered self-esteem or insecurity
- Rigidly negative views regarding oneself, others, and/or the world
Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime.
A less severe type of depression, Dysthymia, involves long-term, chronic symptoms that do not disable, but keep a person from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience major depressive episodes.
Bipolar Disorder (previously known as Manic Depression) is a diagnosis that includes periods of depression as well as mania, leading to extreme shifts in a person’s mood, energy, and ability to function. These symptoms can lead to damaged relationships, problems in working or performing in school, and sometimes suicide. Mania is characterized by:
- Inflated self-esteem (“feeling on top of the world”)
- Sudden irritability or rage
- Decreased sleep
- Rapid speech
- Racing thoughts and distractibility
- Increase in goal-directed activity (“hyperactivity”)
- Impulsive or dangerous behaviors (reckless driving, shopping sprees, risky financial investments, or impulsive sexual behaviors) ·
If untreated, episodes can lead to psychotic states, consisting of hallucinations and delusions. Often with Bipolar Disorder there is a strong genetic link and an early age of onset, usually adolescence or early adulthood. Other factors that contribute to Bipolar Disorder are extreme stress, sleep disruption, and drug and alcohol use.
Many will begin to return to normal functioning within 6-to-8 weeks. Early intervention greatly increases the likelihood of positive therapeutic outcomes. Short-term therapies (10-to-20 sessions over a period of several months) have proven to be very successful in treating the areas of concern that either trigger or maintain depressive disorders. Symptom specific medications and current psychological therapies are more advanced and effective ever before. Unfortunately, less than half of people suffering from depression seek treatment and remain unaware that they have a treatable disorder.
- Do you feel sad more often than you feel happy?
- Have you lost interest in activities that you usually enjoy?
- Are you experiencing frequent feelings of worthlessness or hopelessness?
- Have you noticed a recent unusual weight loss or gain?
- Do you feel fatigued or sluggish or restless much of the time?
- Are you usually having difficulty concentrating or making decisions?
- Have your eating or sleeping patterns changed?
- Are you having difficulty remembering when you last felt happy?
- Have you had thoughts of death or suicide?
If you answer "yes" to five or more of the preceding questions, you may be suffering from some form of depression.
- Do not set difficult goals or take on a great deal of responsibility
- Break large tasks into smaller ones, set priorities and do what can be done
- Do not expect too much from oneself too soon, as this will only increase feelings of failure when personal goals are not reached
- Try to be with people; Being with others tends to be better than being alone
- Do not be overly self-critical if one's mood does not improve right away; Feeling better takes time and effort
- Do not make major life decisions without consulting others who know you well and who have a more objective view of your situation; In any case, it is advisable to postpone important decisions until the depression has lifted
- Build structure into your day; Set daily goals and stick to them as much as possible
- Treat yourself to something that you will enjoy and that will require you to expend some energy
- Get plenty of rest and sleep, but do not overdo it; About 6-to-8 hours is sufficient
- Eat balanced nutritious meals; Cut down on junk foods
- Allow yourself to experience your feelings; If you need to cry, do so. If you are angry, find a safe way to express your feelings
- Keep a journal; Write out how you are feeling and what you are thinking; It's a positive way to experience your feelings, rather than keeping them inside
- Stick with what you know is true, real, and observable; Do not jump to conclusions or to make assumptions; Stay away from the negatives, as much as possible
- Give yourself positive affirmations; Develop a support system of positive people who will be supportive, encouraging and uplifting
- Be aware of possible causes of your depression and try to be optimistic about your future
- Try to challenge your negative thoughts with more positive ones
- Focus on your positive experiences and previous successes
- Make a weekly list of your positive accomplishments and achievements
- Regain your level of social activity
- Find, or reactivate, hobbies that bring you a sense of satisfaction and pleasure
- Exercise daily
- Use self-relaxation techniques whenever you feel tense or down; For example, slow breathing for several minutes can make your entire body feel more relaxed
- Do volunteer work to keep active, if other activities seem harder to accomplish
- Learn to accept, and appreciate, that everyone has different abilities and interests; Focus on your unique characteristics and skills
- Try to know, appreciate and develop your individual strengths
National Institute of Mental Health, Information Resources
Bethesda, MD 20892-9663
Depression Brochures: 800.421.4211
National Depressive and Manic Depressive Association
Chicago, IL 60601
National Mental Health Association
Alexandria, VA 22314-2971
National Foundation for Depressive Illness
New York, NY 10016
Online Mental Health Resource for College Students
(In large measure, this website is the compilation of documents developed and produced by other mental health agencies and organizations. They include the National Institute of Mental Health, and the National Depressive and Manic Depressive Association, as well as the Counseling Centers at the University of Texas, University of Illinois at Urbana-Champaign, University of Florida, University of Buffalo, and Dartmouth College).
The Warning Signs of Anxiety & Stress
Anxiety is part of the body's hard-wired fight-or-flight response, which prepares us to act quickly in the face of danger. It is a normal reaction to unfamiliar or challenging circumstances. However, when anxiety is persistent or out of proportion with life events it can impede everyday activities and undermine wellbeing. All of us experience stress and can benefit from developing healthy stress-response skills. However, if stress or anxiety become overwhelming and begin to have a negative impact your life, it may help to speak to a counselor or other professional resource.
Different forms of anxiety can include the following:
- Restlessness or uneasiness
- Difficulty controlling worry or anxiety
- Muscle tension
- Poor concentration
- Repetitive or obsessive thoughts and difficulty “letting things go”
- Difficulty relaxing and sleeping
- Avoidance of particular situations, places or things that cause anxiety
- Tension, or migraine headaches
- Upset stomach, problems retaining food
- Change in appetite
- Tightness in chest, back, shoulders
- Aching jaw, tight forehead
- Shortness of breath, dizziness
- Excessive sweating
- Sweaty palms
- Tingling sensation in fingers, toes
- Nervous tension all over; heart palpitations
- Diarrhea or constipation
- Constant low grade fever
- Cold, or sore throat
- Rashes, hives, skin irritation
- Increased blood pressure
- Always tired
- Menstrual problems, missed menstrual periods
- Change in eating habits
- Eating more or less
- Sleep problems
- Too much, too little
- Difficulty talking to, holding, loved ones
- Isolating self from others
- Staying at home or staying at work
- Complaining more
- Increased use of alcohol, drugs, coffee, tobacco
- Change in general activity level
- Change in sexual activity, either more or less
- Increased nervous habit, such as nail biting or hair twisting
- Loss of temper: yelling, throwing, and kicking
- Increased recklessness, risk-taking
- Bossiness or inflexibility with others
- Grinding teeth
- Sudden outbursts of crying, laughing, or anger
- Less interest in hobbies, familiar fun activities
- Upset by the unexpected
- Sudden shifts in mood
- Frequent and/or recurring nightmares
- Vague feelings or uneasiness, restlessness
- Feelings of being swamped, overwhelmed
- Feelings of anger, resentment
- Intolerance, irritability with others
- More easily frustrated
- Increased fear of failure
- Feelings of inadequacy, powerlessness, hopelessness
- Changed interest in sex, either more or less
- Apathy, general dissatisfaction
- Desire to cry
- Reduced confidence
- Fear that everyone except you is doing fine
- Worry that you are asking for too much help or too much time from others
- Having difficulty remembering recent information or details of recent situations
- Less able to make decisions
- Difficulty concentrating
- Attention span shortens
- Feeling confused, especially with familiar tasks
- Repetitive thoughts
- Continually thinking particular thoughts
- Misunderstanding what others tell you
- Increasingly poor judgment
- Thoughts of escaping, running away
- Racing thoughts
- Unable to slow down thought process
- Loss of objectivity
The following exercises are great ways to achieve quick relaxation. Try a number of them to see which ones work best for you.
- Count your breaths. With eyes closed breathe normally, counting at each exhalation up to a specific number. Concentrate on the air moving in and out. Go back to "one" if you lose count.
- Listen to your heartbeat. Choose a word and repeat it to yourself with your eyes closed. Repeat the word for at least five minutes.
- Muscle tightening/relaxing: Concentrate on a particular muscle group in your body. Tighten the muscle for a count of ten and then relax it slowly, noticing the contrast between the tightness and the relaxation. Repeat a number of times. Try the same procedure with other muscle groups.
- Mini-vacation: With eyes closed, visit a favorite peaceful spot in your imagination. Notice the enjoyable sights, sounds, and sensations.
- Feel yourself relax. Pay attention to the interesting details of this location.
- For going to sleep I - Try to keep your eyes open as you watch a clock for five minutes. If your eyes close, force yourself to open them.
- For going to sleep II – Close your eyes and think only about your breathing. Invariably, other thoughts will try to invade your mind, but push them aside and pay attention to your breathing.
- Pick an interesting sentence and write it out in longhand very slowly, making sure that every letter looks just the way you want it to look.
- Imagine yourself floating above the place you are in and pay attention to the way everything looks from up there.
- Rub your palms together vigorously and place them flat on a surface in front of you. Let them rise slowly, very slowly, up about six inches and then fall very slowly, as if they were pushing the air down, to touch the surface. Repeat.
- Sit in a balanced position.
- Settle into your chair so you feel as little strain as possible on your lower back or abdominal muscles.
- Imagine a cord attached to the top of your head, pulling your spine perfectly straight and aligned from the top of your head to the bottom of your feet.
- Place your feet comfortably on the floor and allow your hands to rest easily on your thighs. Now visualize the cord being cut and allow your head to move very slowly to a comfortable position.
- Close your eyes slowly and gently.
- Allow yourself to take a deep breath of air and gently and easily exhale.
- As you inhale, repeat to yourself: "I am . . ."
- As you exhale say ". . .relaxed."
- Continue with this pattern for 5, 10, or 20 minutes, allowing your body to slip into a calm state of deep relaxation.
- When you are ready, discontinue the phrases and slowly stretch your arms and legs, your hands and feet, your whole body.
- Open your eyes slowly.
- Continue with this practice and soon you will become relaxed simply by watching your breathing process.
Coping with Crisis and Loss
When a loved one/classmate is dying or dies, there is a grieving process. Recovery is a slow and emotionally painful one. The grieving process can be less painful if you try to understand that loss and grief is a natural part of life. Learn to accept your loss and believe in yourself. Believe that you can cope with tragic happenings. Let your experience be a psychological growth process that will help you to deal with future stressful events.
The grieving process usually consists of the following stages (note that not everyone goes through all these stages):
Denial and Shock
At first, it may be difficult for you to accept the death of a loved one/classmate. As a result you will deny the reality of death. However, this denial will gradually diminish as you begin to express and share your feelings about death and dying with other students or friends.
During this stage the most common question asked is "why me?". You are angry at what you perceive to be the unfairness of death and you may project and displace your anger onto others. When given some social support and respect, you will eventually become less angry and able to move into the next stage of grieving.
Many students try to bargain with some sort of deity. They probably try to bargain and offer to give up an enjoyable part of their lives in exchange for the return of health or the lost person.
You may find yourself feeling guilty for things you did or didn't do prior to the loss. Forgive yourself. Accept your humanness.
You may at first experience a sense of great loss. Mood fluctuations and feelings of isolation and withdrawal may follow. It takes time for you, the grieving student, to gradually return to your old self and become socially involved in what's going on around you. Please note that encouragement and reassurance to the bereaved student will not be helpful in this stage.
As you go through changes in your social life because of the loss, you may feel lonely and afraid. The more you are able to reach out to others and make new friends, the more this feeling lessens.
Acceptance does not mean happiness. Instead you accept and deal with the reality of the situation.
Eventually you will reach a point where remembering will be less painful and you can begin to look ahead to the future and more good times.
These are some of the common symptoms you can experience:
- Exhaustion, fatigue
- Changes in eating and sleeping habits
- Mood changes
- Missed classes/decrease in performance
- Suicidal thoughts, fears of death or sickness
- Withdrawal/disruption in relationships
- Anxiety, anger, depression
- Difficulty concentrating
- Discuss feelings such as loneliness, anger, and sadness openly and honestly with other students, instructors and family members.
- Maintain hope.
- If your religious convictions are important to you, talk to a member of the clergy about your beliefs and feelings.
- Join a support group.
- Take good care of yourself.
- Eat well-balanced meals.
- Get plenty of rest.
- Be patient with yourself. It takes time to heal. Some days will be better than others.
- Be supportive but do not attempt to give encouragement and reassurance when a student is in the depressed stage of grieving. It will not be helpful.
- Talk openly and honestly about the situation unless the student does not want to.
- Use an appropriate, caring conversational tone of voice.
- Show that you care.
- Listen attentively and show interest in what the grieving student has to say about his/her feelings and beliefs.
- Share your feelings and talk about any similar experience you may have had.
- Avoid using the phrase "I know just how you feel."
- If symptoms of depression are very severe or persistent and the grieving student is not coping with day to day activities encourage that student to get professional help