“We Just Can’t Have You Here” | Hacker News Reader

“We Just Can’t Have You Here”

yaledailynews.com

268 pointsjejune06168 comments

Yale has incredibly shitty support infrastructure for it students, and only takes action to the extent it buffs the public image of the university.

Most of other Tier 1 universities where I've known students (Columbia, Mit, Princeton, Harvard, Dartmouth, etc), have much much more proactive support infrastructure to prophylactically protect and suport their students (or at least the undergrads). (whenever a student at one of these schools complains about bureaucracy, I smile at how much more their university cares about/protect students).

Perhaps just at importantly, students at these other schools find it more permissible to openly communicate that they're unhappy to their peer group. At Yale (as of 3-6 years ago), being unhappy was considered socially unacceptable, ie "why are you here then" would be a typical response. Being able to talk about problems amongst your social peer group is very important! (and being unable to is toxic and dangerous)

I've some very very good friends who had terrible mental health issues go unmanaged for years because of Yale's shitty lack of proactive support of students. And thats even ignoring some of the sexual harrassment issues some undergrad women I know there suffered (from their research lab advisors!).

tl;dr, yale is one of the more toxic environments in the ivy league, though to an outsider it looks like one of the warmer communities.

The first step to having a healthy community is making it ok for people to talk about problems and matters.

I speak from the experience of having been a student at yale, a graduate student at another ivy, and having spent A LOT of time visiting friends at many universities. Every school has its faults, but trust least the ones that hide those faults.

Non-US resident here. I found the treatment of the OP appalling, but I have to ask: what's the deal with schools doing this stuff? I'm a PhD student at Tel-Aviv University, the medical services we have on campus are limited to a couple of nurses and maybe a doctor or two, for urgent cases or when you just need a band-aid. Last time I went to the medical "facility" (which is really a couple of rooms), I was told to schedule an appointment with a doctor outside the university, and that was it. So no one at the university even knows about any health issues I may have, and certainly not treats them or evaluates their severity.

Sexual harassment is indeed a problem, here as well, but again I wonder why not go to the police? At least here, it's a criminal offense. Not that students go to the police, but why don't they?

I'm Non-US and I'm not a university student, but Universities look after thousands of students at once, so it makes sense that they try to care about the well-being of their students. A lot, even if they don't have entire hospitals, will have some medical facilities on campus and will have some support infrastructure.

And if sexual harassment occurs on-campus, or involving staff or students, surely that is a University matter?

> And if sexual harassment occurs on-campus, or involving staff or students, surely that is a University matter?

------------------

No, I think that's a police matter. The contrary view strikes me as saying that if a member of my company sexually assaults another that's a company matter rather than a police matter.

The flaw being that the company is going to look out for itself, just as the university will. The third party, ideally, shouldn't have that conflict of interest.

Jurisdiction is not mutually exclusive.

Frequently it is. Interfering with a police investigation is illegal, taking action against someone who the courts have found innocent can be grounds for a lawsuit.

Frankly it strikes me that things would be significantly better if jurisdiction was always exclusive.

Interesting point. I've recently read about a case in my university where the student, who was disaffected with the university's response to a sexual harassment complaint, filed a complaint with the police, then was told the police can't do anything while the university hasn't issued a final ruling.

That is opposite to what the law here says, but if the law simply said that criminal offenses are police matters, period, the police's response would likely have been very different.

> > if sexual harassment occurs on-campus, or involving staff or students, surely that is a University matter?

> No, I think that's a police matter.

I think it depends on who the victim reports it to, and which channel they want to impose consequences.

I've heard that going through the legal process can be stressful enough for some victims of sexual violence / harassment that they refuse to go through with it. From the standpoint of police / prosecutors, investigating / prosecuting crimes where the victim isn't cooperative or isn't willing to testify at trial, and there is little other evidence, isn't an effective use of limited government resources.

Whereas the university discipline process to suspend or expel a student for misconduct is essentially a private administrative proceeding which may be a more attractive forum for victims to pursue: There's a lower standard of proof, so the process is more likely to be successful; and the accused does not necessarily have a right to face the accuser in such a setting (it's clear that Constitutional rule in criminal proceedings is supposed to make it harder for a person to ruin someone else's life with a false criminal accusation, but it also creates a big psychological problem for some victims to overcome.)

My understanding is that university and police investigations are independent processes with different standards of proof.

I think it's because Israel has free universal healthcare, so there is no problem getting medical treatment at any hospital. The situation is similar in the UK.

But, in the US the university is probably going to be providing health insurance to the students, and is therefore actually responsible for providing medical services to them.

Probably it is the Anglo-American tradition of placing universities in smaller towns. The students of Columbia or NYU vanish in the metropolis. But towns like State College (Penn State), Boulder (the University of Colorado), etc. are dominated by the universities, which are cities to themselves.

It's a combination of multiple factors.

I go to UT Austin, which has a population size of 75,000 and basically its own city. An on site clinic is a practical measure since it's convenient and handles the simple stuff[1] for the campus body while deferring to specialists or hospitals for more complex procedures.

The clinic is paid through mandatory fees and thus "free". By comparison, visiting another clinic or doctor is less convenient and has a $10-25 copay (more if you don't have insurance).

> Sexual harassment is indeed a problem, here as well, but again I wonder why not go to the police? At least here, it's a criminal offense.

It is a criminal offense, but there is a lot of emotional fallout that the police aren't prepared to handle. Mental health and counseling services are supposed to help victims in these situations, not push them out.

[1]: List of services on page 4 (PDF): http://healthyhorns.utexas.edu/IMAGES/pdf/UHS%20Information%...

Thank you for the response. Your comment and other ones indeed explain the matter - some colleges are basically their own cities, located near a small town.

My own conclusions from this appalling story are:

1. If you're at a U.S. university and are experiencing mental difficulties - just pay the 25$ copay and see someone outside the university. Had the OP done that, Yale would have probably had no clue what was going on. Maybe someone would notice she's missing classes, maybe not even that.

2. Don't get committed. If you need to, see a therapist on your time and on your own dime. They likely won't order you to take off your underwear, spread your legs, then hop up and down to make sure nothing was hidden “up there".

To not get committed, one would have to lie about hurting oneself (which might not have been possible in this case given the visible injury). Not foolproof, but to not get committed, one should keep these thoughts to oneself. Even a trusted doctor is likely to commit one. This decision still lies purely with the doctor. The _only_ surefire way to not get committed is to not see anyone who doesn't have your best interests in mind and that includes all medical and social professions. Sad indeed.

Yes, sounds like a serious dilemma - try to get help, and you risk being committed. I have a feeling that private psychiatrists know they face a repeat game with a patient they shipped to such horrendous treatment at a ward, and thus have their finger resting much easier on the trigger. But as you said, nothing here is foolproof.

I wouldn't doubt that. Psychiatrists play some horrific games with their patients that border on criminal (and likely should be criminal). These days, a patient that is difficult is simply dealt with in the simplest possible way: drugs. If that one size fits all solution should cause problems or not work, I wouldn't put it past any psychiatrist to commit their difficult patients, especially ones with a history of problems. Most of the time, they won't even bother with a diagnosis, even after years of prescribing medicine. In many ways, it's quite scary, and undoubtedly people that need the help are not getting it while people that don't are being drugged and strung on for the psychiatrist's profit.

Depends on the institution. MIT is incredibly committed to trying to get anyone admitted to graduate, and apparently that includes a lot of free psych services. I know students who dropped out for years and subsequently continued by simply registering and paying tuition.

> what's the deal with schools doing this stuff

The school didn't. They sent her to Yale-New Haven, which is a real hospital, with a real psych ward.

That's where she went through the standard "dangerous person" admission procedure that everyone is reacting to.

Hmm... so what's the deal with the, for lack of better terms, ex-parte hearing Yale put her through?

If the hospital is an unrelated medical institution, how did her medical history get released to the school? Is this even legal?

Also, IIUC, the psychiatrist who told her "we can't have you here" was employed at the hospital, not the university?

In short, there seems to be some type of relationship between the hospital and the university.

That is what I didn't understand either. So Yale has a real hospital, I can see that. But since they admitted an Yale student does it mean all their medical history is now shared. Or does it mean the psych ward head can advise with the "send home" vs "let them stay" binary decision up the chain, to the Dean for example, and the dean just accepts that and goes with it.

That is what I mean lie and don't trust institutions. Always think what and how they can use what you give them against you. Because sometimes they will.

Yep, wanted to make sure it's not just me missing something here. Left the OP a message in the comments that she might want to look into this, maybe she'll see it.

Well, in the case of certain elite universities, one might argue that they bear responsibility for the mental distress they inflict on their students.

For example, here at the Technion...

I read your comment as a joke, but it hints at a serious matter. I'm a TA at TAU EE, and my students really don't have enough time to sleep. Every deadline is a mix of mails begging for an extra day, and submissions at 5 AM. Talking with my students, it appears this is a faculty-wide problem - the coursework is simply too much (and this isn't simply students whining - in 4 years in CS/math I didn't hear of a single person cramming through the night for a deadline, something here is very different). I hear Technion is the same, for CS too.

Now, you take young people, pressurize them to excel or it will have lasting effects on their career, and deprive them of sleep. No wonder people have mental difficulties - it's actually a wonder this doesn't appear to happen here. Maybe it's a bit more maturity coming from the army service.

>I read your comment as a joke, but it hints at a serious matter.

I meant that comment as "ha ha, only serious".

>I'm a TA at TAU EE, and my students really don't have enough time to sleep. Every deadline is a mix of mails begging for an extra day, and submissions at 5 AM. Talking with my students, it appears this is a faculty-wide problem - the coursework is simply too much (and this isn't simply students whining - in 4 years in CS/math I didn't hear of a single person cramming through the night for a deadline, something here is very different). I hear Technion is the same, for CS too.

Technion is very definitely the same, in both CS and EE. I have never seen such overconsumption of coffee and energy drinks in my life as I have seen here. Worst part is that the professors consider this a normal, positive component of university-level education: they seem to believe that sleep and sanity are for the weak.

When I did my undergrad at UMass Amherst, "all-nighters" (or "white nights" as we say here in Israel) were extremely rare. Only the most difficult courses and the heaviest courseloads actually imposed them on you. Here at Technion, they're a regular affair for anyone taking courses, and occasionally for grad-students and professors too.

>Now, you take young people, pressurize them to excel or it will have lasting effects on their career, and deprive them of sleep. No wonder people have mental difficulties

Bingo.

>it's actually a wonder this doesn't appear to happen here. Maybe it's a bit more maturity coming from the army service.

As far as I can tell, it's not exactly maturity from the army. I would just call it inhumanity from the army. Technion's culture was formed from former soldiers who, given a workload to do, simply sat for six hours and did it, without pausing to stand, walk around, go the bathroom, check the internet, eat, drink, any of it. You can call this "discipline", but to do so makes it sound like a good thing.

My other guess is simply that it does happen here. I was chatting with a couple of other grad-level students in Technion's on-campus pub here last night, and telling them how when I was young I was forbidden to apply to MIT by my parents because of the suicide rate. They told me that Technion is also known for its suicide rate.

If Technion, at least, has a suicide problem, then we can't claim the mental problems deriving from high-pressure overwork are not happening here.

Thank you for the thoughtful response. To be honest, up till now I haven't heard of a suicide problem at MIT, Technion or TAU, but I wasn't exactly at the right circles anyway.

I wonder why doesn't the student body (here or at your place) rebel against this. At times I really want to grab one of the student representatives and suggest they do, but I know this will be the quick death of my academic career (not that chances are good as it is :-)

The reason that universities have come to be prosecutors of sexual crimes is that they aren't burdened with the same burden of proof of the state and certain interest groups want it that way.

Many non-violent, sexual crimes do not yield physical evidence that anything beyond a consensual sexual encounter occurred so it becomes a he-said-she-said (or he-he, she-she, etc) issue in which the criminal justice system cannot, in theory, hold the accused criminally liable. Universities can basically do whatever they want and the US Dept. of Education even suggested that universities apply a "preponderance of evidence" standard for internally prosecuting sexual crimes. This means that the university can suspend/expel/discipline one for just 51% or greater likelihood that you are guilty. Even something as banal as the victim having 3 friends testify and the accused only having two would technically satisfy this all else being equal.

Now, in fairness, crimes do occur without physical evidence and women's groups aren't wrong to demand some form of justice for those crimes. However, these groups tend to be far more influential than anyone defending the accused ("hey, alleged non-violent rapists are people too!" just isn't a catchy soundbite) and have twisted this process into something resembling witch hunts more than modern justice.

just my $0.02

One of my professors did his graduate work at Yale, and echoes your sentiments about it being a toxic environment.

He stated that Yale's prestige allows the university to garner top researchers and their associated egos. As a result there was significant academic politicking and very little collaboration, at least in the CS department.

ZOMG YES.

so little collab, such fiefdoms. Some faculty in math and cs there were pretty cool though.

That said, theres definitely a lot of subfields in computer science that just have toxic research cultures period.

One time in grad school (at another such uni), a professor or two chewed for sharing a research problem I was working on and stumped by! I wanted to collab with folks to come up with a solution sooner, thusly advancing science faster and moving on to new research, but NOOOO, apparently the moment you share problems, in some research communities its kosher to just wander off with this newly learned problem and scoop your potential collaborator?! (Of course the solution is to accept that risk and if they do scoop rather than collab after you disclose the problem, never collab with them again!)

I had a similar experience as a CS researcher at Yale. It was by far the most toxic environment university environment I've ever worked in. I really felt sorry for the poor students who weren't getting paid (or getting paid very little) to deal with the bullshit.

yeah... I kinda consider my undergrad + the year thereafter a "lost half decade of mind fucking unhappiness from social toxicity".

I can say with a straight face that based on the level of work I'm doing now (and was doing in high school), science slowed down some teensy but nonzero fraction for the planet because of how unhappy undergrad was for me.

eg: things i'm up to currently include:

• helping make the engineering techniques / tricks that come up in HPC grade numerical computation easier to learn and use! (I've had a lot of success making the ideas more pedagogically accessible, which is really really cool)

• contributing to at least one open source compiler thats pretty well known

• other interesting things for fun and profit which while wonderful and positive, I won't go into on this thread because mental health is a serious matter worth focusing on discussing properly :)

Schools don't give a shit about you. Whatever they do in these cases is driven by "What can we do to not lose money? What can we do to not get sued? What can we do to avoid a PR disaster?".

Keeping that student is perceived a liability for them. As they honestly put it they don't really think they will be safer at home, and it is obvious they don't care what happens. They just don't want to deal with it. They see this person as a risk not worth taking.

> If I were a liar, I would never have gotten myself into this mess. Fuck me for not being a liar.

You sometimes have to be a liar when dealing with large bureaucratic systems. A large school is certainly one such thing. They do not have your best interests in mind. Healing you is not on their priority list. Be honest with people you trust and love. Don't treat institutions as moral agents.

You'll even find sometimes your doctor's #1 priority might not be to heal you. Their goal could be to perform more surgeries. So all of the sudden you are told to get surgeries. Get second opinions. And so on.

This observation isn't really a complaint about Yale or college in particular.

Yale is not her parents, not her church, not the Connecticut Health Service, not the National Health Service. What does Yale owe her any more than all the rest of us owe her?

Yale is her community while she's there. That's why it matters.

Schools used to be thought of as parent-substitutes of sorts in the past. In loco parentis was used to refer to this idea. Women would be subject to curfews for example and so on.

The idea is really about what she expected her school to be -- a welcoming community that will help her grow or something of that sort (she took the marketing flyers literally). Was she naive to believe that? A lot of young people make that mistake. Some from affluent small town communities have not had to deal with large bureaucracies before. This is their first go at it.

In fact, may colleges make this a core tenant of their sales pitch... "We're a community here, you're not a number! Small class sizes! Professors get to know their students! The Dean gets breakfast in the dining hall with the freshman!" etc. etc.

This here is the crux of the issue. Young, impressionable people believing what the school is selling. And you can argue till the end of the Earth about who's fault it is, but the reality is that the world is full of people who are in turns impressionable and opportunistic.

I loved my alma mater, but I also never for one second believed that anyone outside of the few professors I was close to and still keep in touch with, actually cared about me as a person.

The author's experience with mental health issues was a perfect shit storm of being cut down after taking their warm-fuzzy message hook-line-and-sinker, AND a broken health care system in general.

I would also argue there are no easy answers. It's not my place to suggest reforms, but if you're admitting someone to a psych ward and you know that at least one time they slashed their thigh open with a pocket knife, how can you possibly take their word for it that they aren't going to use the drawstring on their pants, or the plastic cover of a notebook to try self harm again? It's a no-win situation, and those are the worst.

The best case would probably be to abolish psych wards and give everyone one-on-one access to a counselor 24-7 so they can hang out and be 100% sure they're not in danger. But I'd also note the world has moved "forward" a lot in terms of stigmas and treatment of the mentally ill. Is their room to improve, hell yes. But to ignore the almost death-camp like environments of the homes for the feeble minded just a century ago, we're doing okay.

Removing ligatures is fine. Removing actual sharps is fine. I don't know the plastic binder, so maybe removing that is fine too.

Making someone strip naked for a search is not fine. Giving an intimate search is also not fine. Threatening to restrain them to a bed is not fine. Keeping them in their room is not fine. Keeping them on a locked ward is not fine. Etc etc.

If her account is accurate I am shocked by how bad her treatment was. I've attended many a&e units with someone with severe deliberate self harm (much worse than described in the article) and that person got much better treatment. Not just medical clinical treatment, but the humane stuff too.

I can't tell if this is a joke or not. You do realize that going to a school like Yale costs almost $60,000 a year, right?

The $60k is for rendering an education, not providing psychiatric counseling and a safe environment for recovery.

You probably charge your employer $60k (+/- whatever) for rendering services; are you now obligated to help your boss (or CEO/whoever) through an episode of bipolar? Schizophrenia? I mean, they gave you $60k, right?

Most schools provide psychiatric counseling (and primary care, and immunizations, etc) as part of the medical services paid for by the student life fee.

My colleagues were very supportive during a bout of anxiety and depression I had in 2012. I couldn't sleep properly for 2 full weeks and was a complete mess. They let me take an unscheduled absence (paid) for a few days because in the long run I'm more useful and productive to the team if I have a chance to heal when I'm unwell. A psychological illness is as real as a physical one and just as damaging. I'd rather be in a society that cares as standard, rather than counts the dollar value.

The $60k is for rendering an education, not providing psychiatric counseling and a safe environment for recovery.

Have you looked at a catalog for Yale or any similar private school? They're not primarily selling education.

Besides, the "education" is no different from what you'd get at a much less expensive, much less well-known school. You're paying for the "community" and the experience and the brand.

Source: I paid for my own Yale degree.

> You're paying for the "community" and the experience and the brand.

Totally agreed.

But my point still stands; slightly refined:

providing a snobbish "education" != providing a safe place for people with psychiatric disorders.

I would not have used the term "snobbish", but, well, you went out of your way to mention your Ivy League degree, when it didn't fundamentally address my point that anyone paying for any college, regardless of cost/status, should be expecting to get psychiatric services along the way.

Congrats, you're special, thanks for letting us know. :-)

> Totally agreed.

What constitutes community in your agreement? For many part of community giving support to those who are going through a rough time.

> paying for any college, regardless of cost/status, should be expecting to get psychiatric services along the way.

Universities often require health insurance if enrolled. Often it is required you buy it through the University. Universities roll many services into one package. It is not uncommon for University programs to target bettering both physical and mental health.

Psychiatric services are just one more Health benefit. Is there a reason to exclude it as part of the package? If it normally is excluded, what reasoning lead to this decision?

> Congrats, you're special, thanks for letting us know. :-)

What are you trying to communicate with here?

> Psychiatric services are just one more Health benefit.

Right. AFAIK Yale has those, and is where the gal went. And they made the decision "this is too serious for us" and sent her to Yale-New Haven, which has a real psych ward.

I am sure Yale has counseling/Health Services for non-clinical depression/etc., but I don't think people appreciate the environment you need for patients with active, dangerous psychiatric illnesses (harmful thoughts/etc.) who are actively going through med changes, that may actually worsen their condition before the right balance is found.

No way Yale, or any college, is going to have those facilities. They sent her to specialists, which was the right thing to do.

Keeping her at Yale under the care of people who are not trained/equipped to help her, would have been worse.

E.g. Yale probably has nurses/doctors to apply bandages, prescribe basic meds, etc., but would you get cancer treatment there? They can't provide everything.

> What are you trying to communicate with here?

I was admittedly being sarcastic and trying to point out the guy was, IMO, bragging about his Yale degree, and talking about the "brand" he paid for, when it really didn't change my point that you don't pay any college, Ivy League or otherwise, expecting that they'll also help you through your serious psychiatric illness while you're there.

Yale requires the purchase of specialty care coverage as a condition of enrollment. This includes 60 days of in-patient psychiatric care annually. Students are paying with expectation that the college will help them out, since that's exactly what it says on the tin.

Mental illness is a disability and is protected by the ADA, so if she had been an employee and not a student she would have had stronger legal protections.

I'm not sure how it works in your reversed example of an employee supporting an employer. The decent thing to do is to support the reasonable adjustments, and to not be a dick when they return to work.

And, while they might require some time off, and maybe hospitalisation, they probably shouldn't lose their job amd have to reapply for it.

The rest of us would also be dicks if we cut ties with her after learning she was going through a personal struggle.

Personally, sure. Institutionally, not so much.

I'm sympathetic, I just don't see what place Yale has in this.

> Personally, sure. Institutionally, not so much.

I don't even know what that is supposed to mean. I'm not institutionally a dick? Is that even a meaningful sentence?

An institution does not have emotions, just like a corporation does not have morals. It's not capable of being an asshole or your best friend. That's what they meant.

In order to call Yale a dick, you'd first have to personify it, but that's a literary trick and not reality.

The decisions of "Yale" the emotionless institution are made by people. I don't want to get involved in discussing this particular case, but I am very bothered by the common sentiment that groups of people should not be held to the same ethical, moral, emotional standards as the individuals within the group.

I never said Yale shouldn't be held to such standards as individuals are. I merely pointed out that, as much as we'd like to believe, and our laws try to contain, organizations of people are by their nature amoral. You can wish Yale could be held to that standard, but it's the individuals that steer the org that need to held accountable.

To cite another case, United Fruit enjoyed cheap land and labor in Guatemala. In the late 40's and early 50's, populist movements started springing up in the country until one day a land-reform minded president was democratically elected. Someone at UF called up some friends in the U.S. government who knew some folks, who organized an assassination of the president by the CIA.

United Fruit is not evil. A vast majority of the people who made up the corporation were probably blissfully ignorant of what the group they were members of were doing. And it's unreasonable and irrational to expect corporations of a certain size to have "all the facts." Instead, a small cabal of individuals colluded to implement a policy that devastated a small Central American democracy for the rest of the 20th century.

In the same way, Yale is amoral. It is not capable of making moral decisions the way individuals in leadership positions are. And American corporate law should reflect that. Instead we get bullshit like corporate campaign reform that allows individuals with an agenda to wield the power of the hundreds or thousands because there's a chance that the that individual's position will positively impact the corporate body.

When the leadership of a company is performing evil acts via the company, that is equivalent to saying that the company is evil.

It doesn't matter what the minor ignorant workers are doing. A ruthless dictator's fingers and toes aren't evil, but he is evil.

>United Fruit is not evil.

Of course it is. Just look what they did!

Corporations are people, my friend. That's a legal reality.

Corporations are people, my friend. That's a legal reality.

Corporations can live forever and suffer only mild losses for egregious ethical failures. They demand sacrifice (of time from the proles, and of ethical compromises from the powerful) that in theory benefits "the company" but actually is for the benefit of the highest officers (priests).

That's not a person. That's a (not necessarily benevolent) god.

Yale has blatantly discriminated against someone with a mental health problem. There was no attempt to make reasonable accommodations, to make adjustments if possible to enable her to continue to stay.

Swap mental illness for wheel chair use or deafness and you start to see why your position is so unreasonable.

The "reasonable accommodation" for someone with suicidal/self-harmful thoughts and actions (active cutting) is sending them to a psych ward for treatment. Which they did.

If a person in a wheel chair had their legs bleeding out, would it be discrimination to send them to the hospital for treatment? Or just the right thing to do?

If anything, they were exactly the opposite of discriminatory, as post-treatment, they let her (now with the "mental history" label attached) back in, right?

I don't know enough about this person to say whether it was the right thing or not, but in general suicidal thinking combined with self harm shouldn't be enough to deny someone access to University.

Self harm is for some people a protective measure that prevents suicide. It's possible that a bit of supervision and temporary lighter workloads would have helped.

I have been careful use use weasle words - "if her account is accurate" etc - because it's possible that the only option was for them to remove her temporarily and their weird system needs her to reapply.

And I'm not sure if they get a pass on not discriminatory. Excluding people with current mental illness, but accepting people with a mental health problem in their history isn't really good enough in the 21st centuary. Again, I don't know what their policy is so I should not judge them, but what do they do with people who disclose hearing voices or psychotic episodes or bi-polar mania or eating disorder? (Anorexia is far more dangerous than self harm, even including the suicidal thinking).

"in general suicidal thinking combined with self harm shouldn't be enough to deny someone access to University"

I would agree with you, but I sympathize with the University as well. In our litigious society, Yale could easily be sued by the parents of the suicide victim. Worse, once a school starts "treating" a student for mental health issues they by default assume some responsibility for that person. If the OP did eventually jump from the roof of Vanderbilt hall, people would be asking, "why didn't they send her home?"

The university could have treated her with more compassion and respect, but their ultimate decision to remove her was probably their best course of action.

This is an excellent point.

Fear of litigation has made it difficult for people or organizations to be generous; their first priority has to be CYA unless they want to risk financial ruin.

You are betraying complete ignorance of how humane and effective treatment for acute psychiatric conditions is supposed to work. The account in this article, assuming it is correct, has so many red flags I don't even know where to begin.

Here's what Yale themselves say about disability: (http://yalecollege.yale.edu/content/resource-office-disabili...)

> Often, the physical barrier is the easiest to remove - the attitudinal barriers are much more difficult. To create a university community, which is truly accessible to and inclusive of all persons, including people with disabilities requires the participation of each and every member of the community. Toward this goal, the Office serves as a resource and a catalyst for change by providing technical assistance, information, and disability awareness training to any member of the Yale community.

It's sort of like an implied contract, you can't pretend to care about people and then shaft them.

Well, legally you often can, but it's a pretty shitty thing to do.

And good for them. Well, not good for them, but it's certainly not their place to be surrogate parents.

There is a huge area between being "surrogate parents" and being outright inhumane.

> For more than a day no one had any idea where I was — not even my parents.

The rest is equally horrifying, but this boggles my mind on top of all that. Is it too much to ask to at least inform her parents? What could be a sane justification for not doing so?

I believe it's illegal for the school to share that information with parents, provided the student is an adult and hasn't given consent.

But it's perfectly legal for someone to decide that an adult is still suicidal when they say they are not, having them taken away and locked up without allowing them a phonecall? If that's mental healthcare in the US, I wonder what abduction is like.

Please understand I'm not justifying or defending, only explaining.

I know. Still, there is a difference between them not having consent because they weren't given consent, or because they haven't even asked for it. Maybe not legally, but I morally for sure. (I simply assume that the article isn't leaving out that they asked her, and that she said no.)

As "not surrogate parents" they don't really have a place to say she can't go there either.

Yale does have the right to decide if she attends or not, and here's why:

Every individual has the right of free association. If you're hosting a party, you have the right to tell one or all of your guests to go home, whenever you want, for any reason (and they have the right to never come back if you mistreat them). The same applies to larger groups of people: the right of free association doesn't disappear when they form a group such as Yale university. Whatever rights a group has are ultimately no more or less than the rights of its individual members.

Some people say that rights entail certain responsibilities. On that view, however, rights are indistinguishable from gifts. If rights entail responsibilities, you don't actually have the right to choose your friends; society merely tolerates your choices, so long as you follow parameters set by others. Your own judgement and preferences become a secondary concern, to be overridden by the group. (If this sounds farfetched, recall that eugenicists employed this type of thinking in their calls for forced sterilization: the rights of the "unfit" be damned, they said, for the good of the group hangs in the balance.)

I want to clarify my general point on rights entailing responsibilities just a little further: my view of rights is not a sanction of wanton irresponsibility. No one has the right to push a person off a cliff (excepting situations of self-defense). Nor do they have the right to smash people's windows, steal car stereos, etc. Put another way, no one has the right to violate another's rights.

I'm out of time, so I'm going to stop here, even though there is obviously a lot more to cover on this topic.

I'm not arguing against your point that a college's decisions with respect to student retention are made in the interests of the school rather than the student.

However, you're ignoring the enormous pressure on institutions (especially the prestigious ones like Yale) to maintain a high 4-year graduation rate and a very low dropout rate. Most of these colleges will do absolutely anything in their power to keep students from dropping out, so I'd say her chances of being readmitted were very, very high.

I know because I went to one of these schools. Many of my peers were forced to take time off for reasons ranging from mental health to academic probation to disciplinary action. I know one student who was forced to take time off from my college for three separate semesters for three different incidents. The top-tier institutions give students an incredible number of second chances.

Which isn't to say this falls into the same category as someone who, say, did LSD, got naked and had a physical altercation with the town police.

My only point is this: saying a university perceives troubled students as liabilities is an enormous oversimplification of the factors that go into an administrative response to this kind of situation.

But I do agree universities generally act in their own interests.

> What can we do to not get sued?

I don't understand why this is a bad thing.

Lawsuits are society's way of telling organizations, "don't let this happen again".

So, let's assume, yes, this college is worried about a lawsuit from the girl hurting others.

You assert, "those jerks, they're only focused on avoiding a lawsuit and covering their ass."

Well, yes, because society has told them "if you let this girl/other students get hurt because you ignored an obvious threat to their safety, their parents will sue the hell out of you".

So, in reality, the threat of a lawsuit is, by proxy, actually protecting the other students. How is that a bad thing?

(Frankly, I would give Yale the benefit of the doubt, and assume they were directly concerned for the safety of this and other students, instead of only concerned about the lawsuit, but, either way, the results are the same: no one got hurt, she got help she needed, and she's back.)

I'm having a hard time seeing how Yale's decision would protect other students -- on the contrary, the message that would send to other students is, "you better not do something to deviate from the norm in an undesirable way or you won't be wanted here."

Certainly in this case the girl wasn't a direct threat to anyone else, the only threat I see here from the University's perspective is to their image as an institution that admits "cutters".

> the message [...] you won't be wanted here

You're taking a very specific, dangerous situation (an active psychiatric illness) and making a large extrapolation to "any deviation from the norm".

People will active psychiatric illnesses are supposed to go to psych wards for immediate medication, and then are supposed to have months of follow up while they heal, adjust to meds, and learn to cope.

This official had an extremely bad choice of words, but what everyone is missing is that the right thing happened. She's healing. She's back. She's not dead.

Yes, she harbors a lot of resentment about what happened, but a lot of times people in these situations don't realize what really is for their own good. Unfortunately. Hopefully she can come to realize this eventually.

> wasn't a direct threat to anyone else

Have you read the other comments in this thread about suicidal (only self-harm) people, once in the hospital, slashing staff with a razor blade?

I assert people with psychiatric illnesses are not as predictable as you seem to think. Especially when they're going to be going through a med change, which is often a crap shoot about which meds help and which can actually make it worse.

Do you have training/experience to the contrary? I am admittedly not an expert on "cutters". Maybe we need a "IANAP" (I Am Not A Psychiatrist) disclaimer.

What psychiatric illness was she diagnosed with that would make her a threat to others? I couldn't find anything beyond self-harm, and not to make light of it, but a survey seems to suggest that incidents of adolescents and adults self-harming and having suicidal thoughts is actually pretty high [1], and I doubt a high percentage of these people posed a danger to others. This case is probably more serious than the majority in the survey, but then where exactly do you draw the line in assuming she's a threat to others?

Also, the one comment you're referring to referenced an OD patient being physically restrained by medical staff -- are you going to tell me this is sufficient anecdotal evidence to make her a threat to other students?

[1] http://www.nursingtimes.net/survey-finds-worrying-number-of-...

People with mental illness are far more likely to be the. I tim of violence than the perpetrator of violence.

In this very case she didn't harm any other person but was assaulted herself!

So a few high profile lawsuits from rare events have skewed the perception of mental illness, and now someone with zero intent to harm other people is treated as being a risk to other people? To me that feels like a sub optimal but obvious happening.

It feels like stigma is increased, not decreased.

>You sometimes have to be a liar when dealing with large bureaucratic systems. A large school is certainly one such thing. They do not have your best interests in mind. Healing you is not on their priority list. Be honest with people you trust and love. Don't treat institutions as moral agents.

You know, this seems pretty obvious, but that hadn't clicked for me until just now.

thanks.

In general, if you seek help you will only be punished.

My sister sought help for a sleeping disorder, and received nothing but a suspension of her driver's license. She then had to overcome her medical difficulties on her own and pass an unreasonably arduous test to get her license back.

My coworker went to our boss to say she couldn't make ends meet and needed some kind of raise (making $25k with 2 kinds in bay area). He fired her for being a liability.

I went to the police to report a hit and run, and they used it as an opportunity to search my vehicle in an attempt to levy charges against me. They openly acknowledged they have basically 0 ability to actually find the perpetrator of the real crime.

I ask myself almost every day, as I'm innundated with needless financial and societal burdens I cannot shoulder, what obligations does society have back to me? I cannot think of any.

A cynical but rational outlook on life.

It is not really all that rational. "A few bad things happened, so obviously the world is crap" is an emotional response of the sort normally associated with adolescents. I have plenty of contrary anecdotes of my own, but they would also not prove a universal truth about the world.

True enough, but one must tread carefully. A history of mental illness that demonstrates that you were a threat to yourself or to others is going to impact your residency in the US if you are an alien. A history of alcoholism (and depression may lead to alcohol abuse) with evidence of past harmful behaviour is going to work against you.

I am fortunate to be healthy, but if I weren't, would I tell anyone? Probably not. I like the US and want to stay here.

I can't name a single person in my life who has sought help and not been punished for it. I have, fortunately, learned from their mistakes, and will never seek help myself.

I can't see how it isn't rational. I have ample evidence seeking help is bad. I have none whatsoever that it's good. The rational choice is objectively obvious.

There's even a doctor in this very thread defending that punishment as "first-rate care"[1]. What other proof should I have before deciding mental health care has nothing to do with caring, and everything to do with punishing and isolating people who are inconvenient?

[1] https://news.ycombinator.com/item?id=7119969

The power of accurate observation is commonly called cynicism by those who have not got it

No; cynicism is intellectual and moral laziness. It allows you to distill a complex world to a simplified negative caricature that justifies not making an effort yourself (or makes your efforts seem more extraordinary than warranted).

My personal counter anecdote: 2 weeks ago, I lost my camera (with a nice new lens on it) in the subway. Worth more than $700. Everyone I told said almost the same thing: "you'll never see it again, someone would have to be stupid to give it back; I would, but I'm stupid."

Well, 2 days later I picked it up at the lost&found.

Cynicism has never been useful to actually helping anyone.

Some people think that society has no obligation to the people in it and I understand that they are only refraining from killing and eating other people for fear of consequences. Personally I lean towards the idea that society owes all its members a minimum decent lifestyle and in return you try and be decent to other people.

In the UK there are a few situations where a doctor can suggest you return your driving licence. (I don't know if they can force that or not).

But in that situation you can apply for a bus pass to give you free bus travel. (Sub optimal, it has restrictions on times). That pass can also get cheaper coach and train travel.

Make no mistake, this policy directly results in Yale students not seeking out help for fear of the consequences.

I should know; I was one of them.

I really don't understand the comments here. "Lie better"? Wtf?

The gal has obviously sick. Yes, Yale sent her away, but is there any actual psychiatrist here who would recommend keeping a suicidal/self-harming patient in any school/job situation?

If anything, Yale should get some credit for not black balling her; they, including this awful "won't see the students" Dr. Siggins, readmitted her when she was recovered.

Sounds like a horrible, unfortunate situation worked out as well as can be expected.

You have a point, but this is definitely not an example of it working out as well as can be expected...

> There I was taken to the locked ward of the ER — guarded by officers with guns — stripped of all my belongings, including my pants (they had a drawstring), and shunted into a cubicle containing nothing but a bed. I was here for my own good, they told me.

> Upon arrival, I was taken into a small room with two female staff members, forced to take off my underwear, spread my legs, then hop up and down to make sure nothing was hidden “up there.”

Yes, well, unfortunately but realistically, this is just standard admittance practice for psych wards (per the article this all happened at Yale-New Haven, not Yale itself).

I'm sure it's horrible and humiliating, but a) it's not torture (a word another commenter used), and b) you're admitting known-unstable people into very close quarters with doctors and nurses who will care, feed, and bathe them over the next several days/weeks.

So, yes, hospitals have decided this safety check is warranted. "OMG covering their ass!". Yes, exactly. They're probably covering their ass because sometime ago, someone did get something in, and bad things happened.

If I were a doctor/nurse working in a psych ward year around, I would appreciate the safety check.

The author says, sarcastically, "I was here for my own good" (with various dangerous items removed). She was actually right. They take precautions for a reason, not just to be assholes.

> I'm sure it's horrible and humiliating, but a) it's not torture (a word another commenter used), and b) you're admitting known-unstable people into very close quarters with doctors and nurses who will care, feed, and bathe them over the next several days/weeks.

In theory you are right. In reality, you run a huge risk of triggering a bigger problem if the patient have a sexual abuse history.

> In theory you are right. In reality, you run a huge risk of triggering a bigger problem if the patient have a sexual abuse history.

Depending on the intake procedure, that can be part of the 'flowchart' to deal with.

I've been there when a suicidal person pulled a razor blade out and started trying to slash us as we were trying to take a chest x-ray after an OD with vomit inhalation. I do not believe that any search risks a bigger problem - it is lucky that no one was hurt (patient included). The later search (including x-raying the patient top to toe) found more razor blades, some internal. Edit: missed word.

Wouldn't a metal detector do the job?

Possibly, I have never used one. A razor blade is very small, and the consequences of a miss could be high so that may be a factor.

Metal detector sensitivities can be turned up to where they detect even pins in a bone. The bigger risk with the metal detector approach is sharpened plastics or glass.

I agree with you on Yale's actions and the suitability of those actions. That does not mean the lesson she drew from her experiences is incorrect; In the real world the only person who always has your back isyou. If you're fortunate one of friends or family will actually be there for you if you need them, if lucky both. Institutions are inhuman and they protect themselves Bureaucracies do not give a shit.

> In the real world the only person who always has your back is you.

When suffering from mental illness, this belief can be simultaneously helpful and devastatingly incorrect.

> In the real world the only person who always has your back isyou.

In context of this post, from personal experience, I can tell you only one thing: This is almost never true.

She's talking about more than that, about the inability of Yale students to talk about and get help with their problems, perhaps before they escalate and become more serious.

While that may well be true in some cases, in my own experience I've never felt like I couldn't get help with my problems, minor as they might have been. Long story short, a serious of unfortunate circumstances led to me having a period of anxiety/insomnia that was affecting my studies. I talked to my freshman counselor who referred me to my college dean, who in turn extended deadlines for several of my assignments to decrease my stress. He also referred me to Yale Health, where I had a few counseling sessions and was prescribed a sleeping aid.

The counseling itself was nothing to write home about, but at no point in the experience did I feel I had to filter my problems to avoid repercussions. Granted, the issues I was dealing with were quite mild compared to the author of this article, and her experiences may well be representative of students facing serious mental health problems. I merely wanted to post to say that, in my opinion, most Yale students are able to talk and get help with their problems without fear of repercussions.

> The gal has obviously sick. Yes, Yale sent her away, but is there any actual psychiatrist here who would recommend keeping a suicidal/self-harming patient in any school/job situation?

I would be reasonable surprised if the first round of advise from a psychiatrist to recommend quitting a job or stopping school. In the cases where it would be recommended I would bet it only happens after there is a strong alternative support network in place.

So yes Yale sent her away, but it is not obvious a psychiatrist would have made the same choice.

> If anything, Yale should get some credit for not black balling her;

Do you think they deserve credit for making a reasonable decision? Or that Yale did a better job relative to what is standard for other Universities?

As a physician, and former member of a college staff, I suspect Ms Williams will look back on this bit of writing with a twinge.

She had to "listen to the rattling gasping sound coming from the person two beds down" and to "a schizophrenic person declare, every hour or so, that he had soiled himself". When she is interning for The Congressman, in a policy debate about primary care or mental health, she will value the opportunity to have borne witness to their sufferings.

She was asked to recite the presidents in reverse order? You mean the psychiatrist was adapt enough to develop a intellectually appropriate variation on the mini-mental status exam? That sounds like first rate care to me.

The men with guns have guns because they're representatives of the state. Yes, ultimately, they exercise the state's monopoly on violence. Which is mostly incidental. We can't arrange special neutered cops for the sensibilities of Ms Williams, and frankly, the psych ward of a downtown hospital is one of the more volatile places in the world. Same for the room/cell, etc, etc. The physical confines are a function of what's safe based on the lowest common denominator in the population: the 6'7" 230 lb schizoaffective linebacker (have met those patients ... do not care to meet again).

Her central thesis, that Yale is focused on image, frankly doesn't sound like anything the university is really worried about. No rational administrator would allow image to enter their minds. If anything, that would be antithetical to the image argument. These are people who live their lives by the mantra that they should be prepared for anything they say to be published on the front page of the New York Times. And they're pretty savvy. They know that doing the best for this student, no matter what the blow back, is ultimately the right thing to do. Take care of the patient and the image issue will take care of itself.

It's not surprising that you manages to justify abuse of power, people in power always do.

How is cutting off a depressed person from the positive factors in their life (future, friends, studies, activities) considered taking care of the patient?

Wouldn't you imagine that blowing the floor out from under an elite college student with friends and interests and a future and sending them to a dead-end, alone, in their parents house would make things a great deal worse? If I were considering suicide even with all those positive things in my life, there'd be no consideration necessary when they were taken away.

Instead, the knowledge that this could happen just provides pretty damn compelling reason not to seek therapy or even support from friends.

> How is cutting off a depressed person from the positive factors in their life (future, friends, studies, activities) considered taking care of the patient?

This "positive" environment was an environment where she was suicidal. Objectively, that's not positive.

Yes, the author insinuates Yale was positive for her, but she was also cutting herself at the time, so you need to take her assertions with a grain of salt.

> pretty damn compelling reason not to seek therapy

Are people not reading the article? It has a happy ending. They let her back in. She's healthy now. (Basically; it'll probably be a life-long struggle for her.)

The more realistic ending to "not seeking therapy", "not speaking up so I don't get torn away from my awesome positive experience" is that she ends up not making it. That would be a much worse story for the Yale Daily News to run.

Also, note that her notion of a support network (the person she texted after cutting herself), was her dorm parent. (Yale uses the fancy term "FroCo"/Freshmen Counselor, but this just some senior who volunteered for free housing, and is no way trained to support/treat suicidal/self-harmful students.)

IMO that shows her judgement about a support network is a naive.

With her sort of thoughts/condition, her support network can't be solely "friends & family who love me", it needs to include "professionals who can help my psychiatric disorder".

>“Well the truth is,” he says, “we don’t necessarily think you’ll be safer at home. But we just can’t gave you here.”

That quote was the central piece of the article, and why she had formed the thesis you're talking about. If get mental health issues, you will be kicked out of the school. I disagree with you that this taking care of the patient.

"That sounds like first rate care to me."

And that's exactly why so many people are increasingly apathetic regarding your profession. To a casual observer, the article reads straight out of the 19th century. I'm glad you're not my physician.

PS I think you will look back at this bit of writing with a twinge. I look forward to IBM's Watson turning you into a over glorified rubber stamp.

This is a textbook example of a comment that used to get a user hellbanned on this site. Maybe mine is too, but you said nothing of substance and were a huge asshole to someone trying to contribute insight to a conversation.

I realize it's only been an hour at the time I write this, and admins can't be everywhere at once, but when you start snark-quoting someone back at them, you should realize you've been compromised. For fuck's sake, get ahold of yourself.

I actually partially agree with you - in that my comment was heavy handed and overly snarky. I think I rightfully pointed out how ridiculous the original poster's comments were (at least from my perspective, and I believe the point of this site is to express opinions). I think calling someone out for ridiculous opinions does have value, just as you calling me out has value.

No need to curse, you made your point. It would've been more powerful without the curses in fact.

You've obviously never had any real interaction with someone in the grip of a mental health emergency. She was put on suicide watch and evaluation, not because it's just fun. She cut the shit out of her leg, to where it bleed through, had repeated, documented thoughts of suicide and then tried to just pretend everything was OK. The first night was emergency care, i.e., make sure she didn't die. The next days were mental health evaluation while making sure she didn't die. You cannot be forcibly admitted in the U.S. she admitted herself. She did not have to stay after the first night, but they will make you think you do because they want you alive and to help you get better. It's not some giant conspiracy to do harm to people.

Does mental health services suck pretty much everywhere? Yes. But nothing she went through was inhumane (I've been through similar scenarios in less pleasant medical facilities) and all of it is geared to try and help.

There is plenty to moralize in your post, but I'll refrain; I'd like to factualize instead.

In many parts of the the U.S., it is possible to be forcibly admitted to a mental unit. In California, for instance, this process is called a 5150 (named for the law that allows it), and authorizes a 72-hour hold for psychiatric care. (It is also possible to authorize a 14 day hold, called a 5250.) This is not unique to California. She almost certainly did have to stay after the first night.

I want to address as well your comment as to "thoughts of suicide". The terminology for this that's used in the literature is called a "suicidal ideation", and they run the gamut from thinking about it for a moment all the way up to making plans. A suicidal ideation is (obviously) a risk factor for suicide, but is not at all a guarantee that a patient will make an attempt on their life. (To hammer the point home, there are plenty of other risk factors that we do not hospitalize for; many patients with personality disorders will try to take their own life at some point, but we obviously cannot hospitalize them all at all times, nor should we!)

Neither I, you, nor anyone outside of this person's care network will have access to her files, so it's not reasonable for me to make a judgement call on whether she should have been placed on suicide watch or not. Given only the data provided, though, it is certainly not a slam dunk that she needed to be admitted.

I appreciate the agony you must have witnessed in someone who needed urgent psychiatric care ... but the experience that you witnessed is not universal.

I've had extensive experience caring for someone with severe and enduring mental illness. That person had several stays at MH hospital, some as an informal patient and some as a patient detained under various sections of the mental health act. In about 6 years that person's DSH was severe enough to require surgical treatment and inpatient admission to general hospitals or hospitals with specialist services. (Eg burns and plastics wards). I have personal experience of accessing specialist mental health services. All of this is in the UK.

I can confidantly say that you are wrong when you say I have no experience of people in acute psycjiatric distress.

Locked rooms is very unusual. Locked wards are not normal. A person might need supervision to leave the ward but they are not prisoners and are not treated like prisoners - risk is managed by closer supervision (I know a person who had 2 members of staff within arms reach at all times) not by locking them in a room. There are rare exceptions to this with special soft rooms - all blue with heavy crash mats. In gloucestershire this room is in the low secure forensic unit, which is in the grounds of but seperate from the main adult mental health hospital for the county.

A person at severe risk of self harm or suicide will be able to do so in a very bare room - smashing their head on the walls or floor, using their clothing as a ligature.

Strip searching patients is inhumane. Intimate searches of patients is just bizarre. Especially when we remember the overlap between people who have a mental health problem and peole who have been sexually abused. Being stripped and intimately searched is distressing for most people, but could be especially so for victims of sexual abuse.

The UK charity Mind recently did a report about restraint for aggressive patients and for patients who needed rapid tranquelisation. This is something that should be used as a last resort in very clear situations. That report talked about the need to protect people from unneccessary restraint. I mention this because even this clearly protective measure (even most service users recognise a need for appropriate restraint) is looked at carefully to see if there are safer kinder alternatives.

We can't tell from her post how severe her wound was. She doesn't mention any drips, so we don't know if they needed to give her fluids or not. We don't know if they used sutures to close the wounds or if they ised steri-strips. They didn't admit her for surgery.

If her story is true it is shocking.

You say that you've experienced similar or worse. I am very sorry you went through that, and I am angry other people who should have been caring for you put you through that.

(I've noticed a couple of people mentioning my tone so I am trying to work on that. Sorry ifthis post sounds aggressive or grumpy, it isn't meant to. That's just my poor use of English).

Thanks for setting the record straight on this. It makes me really sad to read all the comments here that have no clue how treatment of psychiatric emergencies should be done. If this is representative for the United States, I'm sure as hell glad I don't live there. Never been admitted to a psychiatric hospital myself, but I have enough friends who have (serious self-harm, attempted suicide by overdose or firearms). Their stories are like yours. I have never heard of anything resembling the stuff portrayed in this story. Seems to me that the US conflates violent criminals and mental patients, with some very bizarre and ethically horrendous results.

Psychiatric wards in the U.S. are for very short term stays by people who have extreme problems. They take people who are at major risk of causing harm, and patch them up just enough so that they can be thrown out. And even that is being scaled down and sped up.

The inpatient mental health system is like a mental ICU: designed for prevention of death, not for anyone's convenience.

My point is that this approach causes harm. It's like treating heavy bleeding by applying a tourniquet and sending the patient out the door. It's medically unsafe, unsustainable patient care. This is not simply a question of budgets, it is a question of how society views mental health. This kind of treatment indicates an "us and them" mentality where mental patients are viewed as second-class citizens. Your wording, "extreme problems" also hints at such a dichtomy, although I'm sure you didn't do it on purpose. There are other ways to say this: Basket cases, crazy, insane, psycho, major issues, etc. A neutral term would be "very ill" or something like that.

My examples of attempted suicide by overdose or "self-influcted gunshot wounds" definitely qualify as "extreme problems", so it is clear that there is a different way to do this.

I am aware that your comment probably just meant to say that the system is set up in an unfortunate way, and that you probably don't represent the views I describe here. But from my perspective it appears to be much worse than just an underfunded system.

Her treatment was brutal. I am shocked that you think her treatment as described was in anyway acceptable.

A person who self harms and who expresses suicidal ideation, but says that they are not currently suicidal probably wouldn't be detained against their will im the UK. If they were detained they have strong legal protections. Most mental health wards and hospitals are not locked. There are no armed guards. There are no strip searches. There is access to phones and advocacy (a legal right to legal advice) and etc etc.

You absolutely need to be called on your bullshit.

    http://www.bbc.co.uk/news/health-25777429
    http://www.bbc.co.uk/newsbeat/25689065

Both posted this week. Here's the issue: the UK and Europe's mental health programs are so shitty that citizens don't even know that there's a problem.

I remember a viral article that went around a year or so ago: "Why French Kids Don't Have ADHD." The article was full of the usual horse shit and, of course, it triggered the usual stimulant witch hunt.

Interestingly enough, though, a response came out to that article interviewing a French doctor who basically said that French kids do get ADHD, and that it's under-diagnosed in France because it takes way too long to get treatment and because the French distrust medicine.

So unless you think denial is the solution to mental illness, you seriously need to get off your high horse.

Please edit your post to remove the whitespace in front of the URLs. That will turn them into clickable links.

Your first post is a link to an artie saying that English mental health care needs to be better. I agree. There are many problems with English MH care. I have no idea why you think that article is relevant to this person's treatment' so perhaps you could explain that?

The next article suggests that people in society are stigmatising and need more experience to spot signs of mental health problems. It finishes with an anecdote of a student with depression who isn't thrown out of university and locked away, but who is allowed to continue with their education.

I genuinely have no idea why French treatment for ADHD is relevant. I bet ADHD treatment is shitty in a bunch of countries.

EDIT: you say that people in the UK are not aware that poor quality of MH treatment. That's not true. People are well aware that there are longer waits in MH treatment and that bad practice happens. Looking at the Cornwall report and Winterborne view we see some shocking abuses. But that's the point - these were shocking. Some of those involved will never work with vulnerable people again. Others are in prison. Everyone accepts that the treatment was not acceptable.

The closest thing to the treatment in the original article is detention under section 136; this is the power that police have to take someone who is in a public place to a place of safety. That place of safety is usually a police cell for a maximum of 72 hours. But there are strict legal protections there too.

I've been through your crappy system and first rate care is the last thing I would call it.

Do you know what the mental health system taught me? It taught me not to seek help. If you tell the truth, you will be imprisoned and treated like you are not even human anymore.

I distinctly remember thinking "I will do whatever it takes, I will say whatever they want to hear, I will tell whatever lie I need to get out of this situation".

Talking to a doctor about mental health is the same as talking to the police. They are unlikely to help you, but they can certainly harm you.

> Her central thesis, that Yale is focused on image, frankly doesn't sound like anything the university is really worried about.

Perhaps.

Or perhaps some "savvy", New-York-Times-minding administrator somewhere made a bet -- a bet that was, probably, "rational". They made a bet that a person like Ms. Williams would not write so articulately about her experience. They made a bet that a psychiatrist would not be so honest with her. They made a bet that keeping Ms. Williams around would be more of a liability than sending her away. They took a risk and lost, because Ms. Williams is not just some medical subject; she is a person that others respect, a person that others will listen to. They bet, perhaps rationally, that Ms. Williams would have shut up and gone home.

As someone who attended Cambridge University, UK, this looks totally alien to me.

I have seen my fellow students (good friends) suffer bereavement, depression and self-harm, and none were ever told that they were no longer welcome at the college, or the university, nor treated like criminals[1] as described here.

There are pastoral carers, both religious and non-religious, and councilling services based at different levels within the university, and there is (of course) NHS healthcare as well.

If people do take time out (usually a whole year at a time) they return when they feel well enough, not when they are re-approved as sane by some university figure concerned with PR.

Lying about being "OK" at every turn is also not something that happens. Of course, people don't always answer in detail when asked how they are, as social convention dictates, but it was entirely normal to say that you were snowed under with work/extra-curricular stuff, or that there was something bugging you. Either that or I was doing it wrong the whole time.

[1] == treated like mental patients 40 years ago. Also remember that something like 70% of all inmates in British jails have a mental health problem.

Yale is a sort of a finishing school for the highest levels of electioneering. Having people leave to spend more time with their families is part of the game.

My personal experience at Yale differs quite a bit from hers. A lot of my friends and I struggled through our experiences at Yale. Things sucked a lot at times but there's a certain unity that results from collective suffering. Maybe it's because I'm recollecting the entire 4 years while she's still doing her undergraduate studies.

Things weren't always alright but I did get a break when I needed it. I went to the Department of Undergraduate Health after having really bad headaches, like someone was stabbing me in the forehead. They checked some stuff but the doctor basically said I was working myself to death. I was definitely struggling at that point. He told me to take a few days off and wrote a note for me. I took it to my dean and he wrote another note that basically allowed me to turn in all my work late for about a week or so. I rested and things got better. I don't think I was alone in struggling and receiving help. It's a bit hard for me to reconcile the considerably more compassionate response I received from Yale with her experience. Is Yale so extreme that once you cross a threshold they become stone cold?

People struggle in college. It's strange for me to read that everyone around her is acting OK. I would have told her that things are tough if we had been classmates. It's pretty depressing at times watching the sunrise from the windows of the computer lab. Or in my moment of triumph after getting my toy OS to run there is no one around to share that joy with because most people are asleep at 6 AM on Saturday.

I'm not saying her account isn't true for her but Yale is a big and diverse place. It might to good to be around different people. Go hang out with the CS people in the computer lab on Friday night at 11PM. They will tell you things aren't alright and thanks for the company.

> It's pretty depressing at times watching the sunrise from the windows of the computer lab.

At least your lab had windows...

You're an University of Waterloo alum?

> Things weren't always alright but I did get a break when I needed it. I went to the Department of Undergraduate Health after having really bad headaches, like someone was stabbing me in the forehead.

Perhaps the fact that headaches are not generally seen as mental illness (and/or instability) plays a big role in your experience compared to that of others. I think the approach to mental illness is very different, both by those suffering from it and those responding to it.

So if you cut yourself you get treated as a criminal and tortured? What the hell is going on here? How is this even legal?

The American mental health system is what's going on here. And it gets worse.

Just the other day I was listening to an NPR article about how jails deal with mentally ill inmates. Alot of them seem to end up there for committing minor crimes that stem from their health problems (such as, to quote the article, "action out"). They receive some care in jail (but very little) and none when they are out. Here's the link: http://www.npr.org/2014/01/20/263461940/mentally-ill-inmates...

Welcome to the mental health "industry". I avoided it, thank god, though by rights I probably shouldn't have in some ways. I self medicated with heroin to avoid being locked up in hospital, with little visitation, no computer, no life, for six months, just like people I knew had. Now I've spent the last year and half getting clean, after 7 years of addiction... And what scares me is that I seem to be doing better than those that went through the real system.

> And what scares me is that I seem to be doing better than those that went through the real system.

How so? What happened to them?

https://en.wikipedia.org/wiki/Lobotomy

Modern technique is slightly different, but the outsome / goals essentially the same. And this historical record is elighntening both in the origins and the evolution of the clinical treatent. Today, the preferred method is to drug children in schools.

Evolution surely hasn't increased the error rate in replicating "normal" DNA sets over the past 50 years, but the data indicates something like 1/5 of them are now "defective" enough to be eligible for the happy treatment.[1]

[1] In US, 20% Of Children Have A Mental Disorder >http://www.medicalnewstoday.com/articles/260697.php

Not precisely. You get restrained to ensure that you will cause no self harm or harm to others. Some of it is harsher than perhaps is warrented for the 'lightweight' case, but the procedures have to deal with very difficult individuals who have cut the hawser to the land of rationality.

You can find the laws for each state listed online. Some of the laws for mental health management and confinement are very reasonable. Others, less so. And there is no blessing that means laws are followed all the time.

I am personally surprised at the level of restraint in this particular case, but I do not know (1) the standard procedures in this hospital and (2) the amount of other issues going on at this particular point in time.

I am also surprised that the author was essentially tossed out and not given a medical withdrawal.

However, the author may have left out bits of her story that would explain these aspects and provided the full context.

This account is very disturbing. Her mental health "treatment" is illegal in the UK and should result in compensation payouts.

Don't Americans have anti-discrimination laws? And the decision to exclide people who disclose self harm is baffling, because people who self harm usually avoid seeking treatment. Not just avoid seeking treatment for self harm, but avoid seeking treatment for other stuff because they are worried about the self harm being discovered.

I had very good support for mental health troubles at NYU. I never harmed myself, so it is very possible that I would have had a different experience in this student's shoes, but it did wonders for me to feel cared for. I can only imagine how terrible it would be to have a support system open up from under you.

An all expenses paid (by you) trip on the "cover your ass" express, stopping at every station. The passenger? Heh, no. You're the cargo.

Although the "disappearing" of her sounds bad, it's clear that Yale made the right decision. Students suffering this kind of mental trauma do no belong in a high stress academic environment. It would be irresponsible to allow them to stay.

Playing devil's advocate here: A similar article drifted around for a while about a girl going to RISD. She talked about how she was abused, abandoned by her friends, etc. After talking to a few friends who actually go to the school, apparently nothing could be farther from the truth.

Remember, take what you read with a grain of salt. You have no way of verifying any of the facts in the article.

Sadly, this is how the rest of the world is (not that Yale or any other educational institution should be like this just because the rest of the world is). Mental problems are frowned upon in our society except when they can be used to profit off of people.

There is NO help for people with mental problems, only abandonment and prosecution. Because of legislation preventing discrimination, this is not done overtly and it APPEARS that one can get help from doctors and mental health facilities when in reality these are just the wardens and prisons for those who are labeled as mentally defective. It's obvious that Yale does not care about its students based on Dr. Siggins' behavior, but this is something that one should expect for the rest of one's life. Best thing to do is to keep quiet and recognize the lack of help. Occasionally, there are doctors and therapists that can help, but mostly they will just try to push drugs.

College is when you transition from the (hopefully) "happy place" you were as a kid to "the real world".

It sucks that Yale didn't help this person when she need it. But it certainly doesn't get any better in the real world.

If, one fine afternoon, your boss says "how are you?" and you say "I cut myself earlier today", then expect to be promptly escorted out of the building. Perhaps to a mental health facility, if you're lucky.

If, one fine afternoon, your boss says "how are you?" and you don't say "fine", be prepared to explain yourself in detail. You'd better have a way with words, because your job is definitely on the line. Especially at a startup.

You might say "that sucks". And it does suck. But that's just the way it is for 99% (wild made up number) of the jobs in the USA. Unlike grade school soccer games, your employer isn't going to hand out trophies just for participation.

All IMO of course.

>Especially at a startup.

Disagree†. High turnover is not desirable anywhere, but it is far less tolerable at a startup. People are far less interchangeable and systems are more often bound up in people's minds rather than in some employee handbook.

†Depending what phase of startup you are referring to, a somewhat tangential discussion.

For what it's worth, I had that almost exact conversation, as an engineer at a startup. The only difference from what I wrote and real life was that it wasn't my boss, it was my boss's boss, the VP of Engineering, doing something called "management by wandering around".

That was 30 years ago, but I doubt that today's managers are any different. I did keep my job, but alarm bells were definitely ringing in top management that day.

Successful startups (which ours turned out to be) are often as much about risk management as anything else. Having employees that aren't 100% "fine", for any reason, is a risk. Of course that risk must be weighted against the turnover of replacing that employee.

Having employees that aren't 100% "fine", for any reason, is a risk.

I doubt you have ever worked for a company where most (or any!) of the employees were 100% fine.

The choice is not whether to be fine. The choice is whether to deal with problems as they inevitably arise in all our lives, or to hide them under the rug ... until they erupt.

True, but if it sucks, surely it's a good thing that people recount their experiences in articles like this so that the status quo can be unsucked?

There are places where it's not quite the way you describe. A few years back I had a colleague who had a mental breakdown. He voluntarily took some time off after discussing the situation with his boss and eventually came back. No problem, and no job on the line (both because he's legally protected and because of the company/country culture).

I like that, and I'd fight to make that a reality if it wasn't so.

Upon my release from the hospital (also not a function of my recovery — but as a result of my expulsion from the College

Damn, that's bleak.

None of us are completely okay. But the pressure to conform to being perfectly functional and happy is a burden that we should neither want nor bear.

We are playing Elsa in Frozen. Be the good girl you always have to be. Conceal, don't feel, don't fear, conceal.

College is certainly very different. Well, also, depending on the people you rely on in school.

I want to say that we should recognize depression and mental illness is just part of life and don't be afraid when bad things come to us.

When I was in HS I had a severe depression. Starting in the junior year I had multiple anger issues and I had to drop some AP classes due to stress. In senior year I had several serious incidents within and outside of school. The stress was killing me. I couldn't resist to see my grade going down, losing grasp of the new shiny robotics club I just started and couldn't get the girl I really like at the time.

I was sent to hospital twice for evaluation. The second time, I was called by my counselor. She told me someone wanted to see me and I asked who. Two NYPD officers showed up and they escorted me to the hospital. I was really scared. I cried and I thought I was under arrested. I was only 17 at the time. I have never been arrested. I thought my counselor betrayed me. I thought everyone sold me out. My counselor said someone else from the school would come with me. A school aid came with us. Both evaluations are dull and tiring. My whole family had to stay with me until 2, 3AM in the morning. Some times later my mother said they all cried when they heard how sick I was. When the MD confirmed I was sick, it was like someone just sentenced me to death. I could finally tell people "yes, I am sick", but at the same time I was sick and people would look at me slightly different.

We all have some experience with depression and anxiety. The experience is never pleasant. For me, it involves sleeping late and feel unmotivated. My day and night reversed. I could sleep for 12-14 hours a day. Nothing felt real when I was depressed. Just watch Frozen.

I could go on and on with a novel writing here (well I suck at writing..). But I can see I am a lucky person. I knew a lot of the people in HS. I used to work in the principal office, I was the go-to IT guy so I knew many people. When I was sick they would tell me "go on John." The school didn't ban me from entering the school. They hired psychiatrist to come to school on a weekly basis (apparently I wasn't the only one having issue in my high school). The social worker and the psychiatrist were both Chinese so my parents could actually talk to them. My teachers didn't penalize me much for the tardiness and would encourage me to come to school. PE became my favorite class. I could run 10-20 laps around the track and the sweat made me happier. Yes. Sun light is important. Locking a patient in a concrete building forever is not going to help much. Socializing with other patients won't help much either... If my senior year last 10 months, I lost probably 7 months fighting depression with 3 months somewhat happy, crazy moments with classmates, friends and teachers.

College is different to me. People come and go. I go to a commute type of school. I get to come home. I get to sleep in and stay inside my room for a whole week if I want to. My parents can worry or feel angry but they are my parents. Unlike people who dorm they have to put up with other "strangers". College is like going for a boring interview for a boring job. That's just me. That's just my experience.

We shouldn't treat people with mental illness as third class citizen. We need to make rehabilitation more human. Drugs can damage brain and can change people. If you have watch Fringe you would know how much the drug and the environment affect Dr. Walter. And if you watch Orange is the New Black, prisoners are afraid of going to the psycho solitary.

I am proud to tell people my story because this is part of my life. I feel like a real person. I am not a Disney character. I have desire and my desire pushed me beyond my limit and so I become depressed, stressed and hopeless.

Don't be afraid to tell people when you are not okay. It's fine. Knowing you are not okay is the first step to rescue yourself. It's okay to feel depress and get depress for a while. Just remember, one day, when you wake up, you will feel better and you will force yourself to go out there. When that happens, don't let the freedom run away from you...

For the first time in forever, there will be music there will be light. For the first time in forever, I will be dancing through the night.

But of course, luck does play in a role. Some people are just not so lucky. They don't get the nice people on their side and they die because of that...

As a side note, I was depressed recently again. I feel better now. I set my foot out of the house. I went to realworldcrypto conference and did volunteering for local FLL (FIRST Lego League). I chilled with friends and people I used to work with and then I saw two great movies. I built a snowman and now I feel better.

Thank you for sharing your story - it helps many others.

> Don't be afraid to tell people when you are not okay. It's fine. Knowing you are not okay is the first step to rescue yourself.

So true. I've known many people who suffered deeply, and reaching out to friends was an important step to recovery. I've experienced this myself too.

It's kind of odd, really, that we don't do this, and perhaps equally odd that we don't watch out for each other a little better. It's like we collectively pretend that we're perfectly okay, and we don't want to ruin that illusion by admitting that many are not.

If my friends notice that I eat a lot of junk food, or that I smoke too much, they'll point it out to me. But it takes a major depressive episode and/or social isolation for anyone to bring up my mental state (if at all).

Of all my friends who suffer from (pretty serious) mental illnesses, the ones who seem to have a handle on it are very open and communicative about it. That really does seem to be very important.

> But of course, luck does play in a role. Some people are just not so lucky. They don't get the nice people on their side and they die because of that...

For me this is the scariest thing about mental illness. I've become increasingly convinced that a large number of people, much larger than we're inclined to think, are incredibly fragile and not far removed from a serious mental breakdown or prolonged mental illness.

Of those people, many find help, recover, or fend off their illness because they have friends and family looking out for them, a social safety net. Strong connections where they feel safe to admit they have a problem.

I've personally seen people slip into depression and disappear from sight, only to find out later that they were institutionalized or (temporarily) homeless. They rarely fully recovered, if at all. What set them apart from those who bounced back was mostly this social safety net, I suspect. There are other factors, of course, but this one seems crucial.

And that worries me, because when I look around me, it shocks me how weak people's social connections are. I regularly meet people who can't rely on family and have few close friends. I spend a lot of time thinking about how this problem can be solved.

I grew up with very strong family bonds and in close-knit communities. If I were to have serious mental health issues, my parents, and at least some of my other social connections, would go above and beyond to nurse me back to health. I've seen many, many unstable people join a church and improve greatly through the community's care and attention.

I'd like to think we can find a way to create and maintain strong ties even in urban environments, and even in our individualistic post-religious societies, but I haven't found out exactly how yet, or what my part in this can be.

It keeps me up at night.

Thanks for your post, it really resonated with me.

Thank you for sharing.

I have had a few bouts with depression, and they are absolutely dreadful. The faux-happy persona so many people work so hard to project is extremely tiring, and mediums like Facebook only serve to indirectly perpetuate the stigma that mental illness is a rare thing. One thing I became very good at from my episodes is being able to tell who is actually nice, and who just plays nice. There's a huge difference in these types of individuals. If you're susceptible to mental illness, you don't want ANYTHING to do with the latter category. Not being able to do this caused a lot of heartache.

I am me because of mental illness. I would not wish anyone to go through it, but I wouldn't remove it. It's made me much more empathetic, kind, and helped to focus on things far more important than the cheap trinkets of power that most people fall for.

Funny that you interpreted Frozen that way, those were my exact thoughts as well - Disney trying to subtly discuss mental illness through metaphors. Which seemed pretty surprising; Disney has always been about the status quo and society's expectations.

I'm actually dumbfounded that this happened to this student if it as she described. I went to an Ivy years ago and I and many other students took medical leave. There was no need to reapply or jump through hoops, you just had to tell them you were better. Has something changed? Can they kick you out for other illnesses?

When I read stuff like this, I am glad I didn't go to an Ivy League school. I know this is Yale and not the other schools, but I have heard similar issues with anxiety, pressure and suicide at many other top schools.

Americans are addicted to success. People lie to each other about how good everything is.

"I hate my job, but life after 5pm is okay." "I have no time to see my family, but my life is rockin!" "I work 100 hours a week, but I love it!"

Balance is difficult because no one can tell you what it is, you have to find it yourself.

And that's just the beginning. Now that this is on her permanent record, she gets to explain it to potential employers. Dealing with the American mental health system has a guaranteed cost, and uncertain benefits.

Huh? What potential employer gets its candidates health records?

As Jtsummers wrote (before it was zapped), it's an issue if you ever want a clearance. Also, they're free to ask, giving you the opportunity to either tell the truth and risk being passed over -- good luck proving discrimination -- or lie and put yourself in a position to get screwed later.

I removed my post because I didn't like the way I wrote it, and wasn't sure how to rewrite it. I wasn't meaning to contradict tptacek with it, but it came off (to me) that way. And I deleted just after it popped up after my 2 minute post delay.

My point was: Physical health - all I've seen from jobs is a requirement for a physical. They may request the records from the physical and it could be comprehensive. I've never heard of requests for older records, though a doctor may need to fill something out (like a physical limitations form for an applicant or worker who has had a hernia or back surgery).

Mental health - I've only seen this in relation to security clearances. In that situation (IMO) the request is entirely reasonable, and has not (IME and experience of friends) been a showstopper to be honest. But I don't know anyone that was hospitalized either (well, that I know of) who sought a job with a security clearance requirement. Really, the agencies involved knowing about the problems is the main thing. If they know about it, then it's harder for someone to use it as leverage. Similarly, with good bosses, them knowing I have issues with anxiety/depression has meant they've intervened and helped me catch it earlier than I ever would have on my own.

And that is why privacy is needed for many people.

That is a fucked up way to treat psychiatric patients. Are all psychiatric wards in the US like this?

It depends on your insurance, and probably what region of the country you're in too. Personally i've been in three places that were better, one that was worse: sexual abuse, orderlies stealing meds meant for patients, completely ignoring people except to punish them, foul-tasting food, etc.

I wonder why she went back?

Right!? I'm flabbergasted by the pedestal people put schools on. She's going to be a real wreck once she leaves Yale and realizes having a Yale degree doesn't solve any of her problems.

Taken at face value, the OP required help. And Yale just happened to be the place she was when it came to the fore.

I would like to posit that many organizations can react the same, and my personal experience is that it is incredibly helpful to "stay out of the system" if at all possible, again with the caveat that said person is not suffering from a serious health issue like depression/self-mutilation, discrimination to the point of lethal action, etc. that would greatly benefit from being discovered and treated, or at least isolated as the cases may merit.

My difficulty was taking my addictive personality and my "gaming the system" mentality and using it on my escapes of choice, mostly alcohol, at the time. Being on the system's radar (Driving Under the Influence conviction) taught me the lesson of the value of freedom.

I completely abstain at this point, easier for me just to not drink any intoxicant than to try to monitor my intake/arrange for cabs/limos, etc. My freedom is a rejoice-able thing, especially when I see the tendency for bureaucracies to treat people with problems with generalistic patterns/antipatterns. Labels like "alcoholic" or "suffering from depression" are easy targets/goals for the people who are saddled with the responsibility of deciding how to deal with a person with problems in a life where the deciding individuals feel overwhelmed with the amount of cases they are expected to get through.

And I see a reason for concern as the current US government (my location, I do not know if other countries are similar) looks for methods of simplifying the task of dealing with gun control, whistle blowers, and other events/people that may be perceived as threats to the current system. It would be conceivable, based on current legislation attempts/actions, that my government would decide that it is easier to limit the possession of firearms to individuals who have never had "issues" with addictions or mental deviations from what is considered "normal." Or that the potential for disruption of society and markets make self-publication on mediums (Internet blog posts? Self-made videos?) something that should be heavily regulated, for society's own good... And that same governing body is necessarily the arbitrator of what is "normal." Wouldn't bucking the British rule of colonial America be possibly considered "abnormal" by the British government of the time?

One may argue that we do not want mentally-challenged individuals in possession of firearms, I may agree frequently on a case by case basis, but that also then extends to possession of vehicles (more death due to automobile accidents than many other causes), and eventually anything else that can be considered a threat. Box Cutters on planes? Aren't there individuals out there who have the ability to use their own bodies to carry out extensive damage without the aid of any other physical weapon? How would we limit them?

More thought and dialog seems merited, and I appreciate this article for that, as well...

This is not a problem with Yale alone. It's a problem with people. Most people have no sense of social justice and have no problem kicking someone like her when she's down.

It's tempting to think most people are good because few people are obviously evil, and that's wrong. Most people are weak. They're just shuffling through life, not giving a shit, and those who end up in power tend to be the worst (rather than being unambitious, they tend to be the ones with empty ambition).

Here's why this sort of situation, within the U.S. social model, will never get better.

Technology's somewhat different (for now, but the disgusting mainstream business/MBA culture continues to invade because engineers do not fucking fight for themselves) because a high-talent person (even with intermittent health issues) can add a lot of value. However, for most of white-collar America, "work" is just pointless private-sector social climbing. Pure image, no substance, because the work is not demanding and Making Decisions (parable of the bikeshed) is valued in its own right.

The only way to resolve those environments and pick winners among the horde of petitioning narcissists is to set up pointless reliability contests and see who drops first. This idea that it's somehow wrong to discriminate against, or turn one's back on, those with organic physical or mental health issues throws a wrench in that whole game, because transient, context-driven illness (physical and mental) is the core of the selection process. It's what selects people out. The whole point of the old-style corporate-ladder game is to load people up with easy (and often purposeless) work, but in extreme volumes, and presume that those who break last are the best, and those who deserve to lead. (Actually, the opposite is true. Superficial reliability and creativity are negatively correlated, but that's another discussion.) But if you start designating specific illnesses as formal disabilities that must be accommodated (which, from a social justice perspective, one should) that game stops working.

Could you imagine telling an investment bank that people with clinical depression could no longer be expected to work over 60 hours per week? So many people would get themselves diagnosed with depression that people with actual depression would be assumed to just be "faking it" anyway.

What the OP experienced at Yale is wrong, but it's no different from what she'd expect in The Real World.

How do you break out of conventional thinking like this? Awesome.

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