Chronic in College

Person 1: Hello!
Person 2: How are you?
Person 1: I am healthy. How are you?
Person 2: I am not healthy.
Person 1: Oh that is too bad.

Most conversations do not play out like the one above. Perhaps this scene would make more sense if the characters used the used the word, ‘well’. Yes this may have been drawn out as a hyperbole, but this scene displays a critical idea. We often associate the terms, ‘health’ and ‘wellness’, but these words can convey very different meanings. These terms are not as interchangeable as we think!

This week’s entry is all about defining health, and differentiating it from wellness. I want to make a point to do this because of an idea I mentioned in my first blog entry. In the recent year, Penn State University was ranked in the Top 25 Healthiest Campuses in America. Does PSU live up to this title? Well… does the title fit the criteria? That is a better question! I have been analyzing this issue for weeks, and I believe the word, ‘healthiest’, is misleading. Let’s break this down with some definitions.

According to the the Merriam-Webster dictionary, health is “the condition of being sound in body, mind, or spirit”. Wellness, however, is “the quality or state of being in good health especially as an actively sought goal”. I think the last part of the wellness definition—”an actively sought goal”— says it all! Health and wellness are different in your ability to control them. Health can be impacted by behaviors, but many things in health are inevitable. Chronic illness compromises health simply because no cure exists. It is only costly interventions that can make a difference for these patients. On the other hand, wellness is a status that results from daily choices; we can chose to improve the quality of human life by exercising, dieting, and refraining from risky behaviors.

To sum it up, health and wellness are not synonymous. Based on the definitions, I think PSU aligns itself better with the term “wellness”. With three gyms, healthy dining hall options, and a large campus for walking; it is evident that students can keep achieve a high standard of well-being. But flexing the IM Building (Figure 1) doesn’t do much for the migraine patient.  We have to realize that wellness has been satisfied, but we are still working towards health.

And if we do not acknowledge this issue, then we cannot create change. In fact, I feel that interchanging these words has held Penn State back from doing more for patients. This is certainly not enough… it’s time to work at it!

For this week’s entry, I wanted to shift my focus slightly. Much of what my blog has covered were the major services and resources to student. But this week, I wanted to understand if support can come at the individual level. In order to achieve this, I looked to residence life. The main figures in residence life are the resident assistants (RAs). RAs are upperclassmen available to a floor, and play the role of “peer mentor”.

In my investigations, I thought it would be interesting to get an RA perspective about the issue. This led me to interviewing my own RA (who will remain anonymous) to understand how the residence life team handles chronic illness. My interview consisted of five questions that would help me determine if Penn State is doing “enough” at this individual level. Here is a transcript of the interview:

Q1: What are your responsibilities as an RA?

A1:

 

Q2: What kinds of training do you receive before becoming an RA?

A2:

 

Q3: Did you receive any training that was specific to chronic illness, mental health, and/or disabilities?

A3:

 

Q4: What would you do if someone on your floor was feeling debilitated/overwhelmed by their chronic illness?

A4:

 

Q5: Do you think the RAs do enough for chronic disease patients? Explain.

A5:

 

Based on this interview, it seems like RAs do not receive enough training on chronic illness. As a result, students need to rely on the other campus resources (which if are not the most reliable based on my previous research). Therefore, I have to conclude this blog, and say that “enough” has not been acheived.

 

The title reads, “My Story (Part 2)” because my story isn’t over; my story is in the making! If you recall from last week, I was writing my passion blog in the midst of migraine. Well even after closed my MacBook at the completion of my blog, the pain continued to effect me. From Wednesday and through the weekend, I felt as though my migraine was controlling me. The pain dictated the way I was spending my days, and I knew that I needed help.

Desperate for relief, I referenced back to the student affairs page on migraine (which I mentioned in last week’s blog). What service could help me in this moment? And then I saw it! I read the words ‘Advice Nurse’, and I knew my solution was only a call away. In 2003, Health Services began the 24-7 Advice Nurse program for Penn State students. By calling this help line, a student  could receive advice about a health concern. These nurses primarily helped students decide if they needed to seek immediate medical care. I sat in my room on Saturday night, and I decided that it was time to call. If anyone could help me in this moment, it would be an advice nurse. If only a nurse picked up!

Twenty minutes. This was the amount of time I waited until I hung up on the Advice Nurse help line. I was hopeful. I was seeking help. I was under the impression that UHS would come through for me, but I reached minute twenty I found and my heart broke.    The seconds after I hung up felt like a moment of defeat. I began to sob. Now I was experiencing everything that my blog had been preaching.

Imagine all the unresolved injuries, anxiety attacks, and flares of pain that were not heard out. And why? Because no one picked up that phone! Now I am among the unanswered calls, and this brought on a new type of pain. To feel like no one is listening is a horrible pain that I wish upon no one. I may have had an answer if I just continued to wait, but I would have been dissatisfied regardless. There was no urgency, and my needs deserved immediate action.

The standards need to improve. Actions and programs have been implemented, but UHS cannot settle. The collection of services need to be improved because the quality at which they exist in not enough. Every week I find myself saying “enough has not been satisfied”, but this week I want to leave you with a different thought. I have had enough of THIS not being enough!

 

I was saving this entry for another week, but then my chronic pain flared up this morning. As I type up this blog, I am experiencing what feels like an attack on my body. I have pain shooting from my head, down my back, and through my legs. It may be hard to comprehend why I would want to write a blog about chronic pain while feeling these sensations. But I can tell you that this goes above what I want to do; it is what I have to do. This is my passion blog, and if I want to convey the raw emotions I associate with my illness, then I need to seize this kairotic moment.

The pain has a name, and it is called chronic migraine. This debilitating condition impacts over 140 million people across the globe, and I am among this population. Migraine is mostly known to cause intense head pain, but can be a full-body attack. When my migraines develop, I can expect to feel pain in my head, face, neck, back, and legs. Many people underestimate migraine, and I want to stress that my condition is more than “just a bad headache”.

Symptoms are one component of the illness, and reoccurrence is the other. As a chronic migraine patient, I experience frequent episodes of this discomfort. Without medications, I was in pain more often than not. Today I am fortunate enough to receive treatment for my condition, but I still find myself with a migraine once a week. This can pose many challenges in the context of my life. It is not ideal to sit through lectures while in pain. It is not ideal to be in Beaver Stadium when all you want is a quiet room. Migraine is not the ideal of a college student, but I persevere because Penn State is worth fighting for.

So here comes the essential question: Is Penn State doing enough? I answer this question for every entry, but this time I am more qualified than ever to provide a response. Is Penn State doing enough? To answer this question, I ask a question: has Penn State even started? I am a patient, and I do not know my resources. I had to do extended research, and it was alarming to see how little information there was on neurological health services.

After searching for forty minutes, I found a single page on the Penn State – Student Affairs website (to see this page visit: https://studentaffairs.psu.edu/health-wellness/medical-services/health-information-resources/headaches). The bulk of the page was for educational purposes, and informed readers about what migraine is. The resources available to patients were only explained in the last three paragraphs. Among the (very few) resources was the emergency room at Mount Nittany Medical Center. This is not even a resource offered by the campus, and can imply that the university does not want to take ownership over migraine patients. I do not know what the future holds, but I hope that more resources become available to patients with chronic pain. “Enough” has not been satisfied!

On my first Penn State tour, I distinctly remember reaching the Patee-Paterno Library.  I remember climbing stairs, and when reaching the top, my guide directed our attention the campus behind us. And when I turned around, I was introduced to the charm of the Penn State campus. I distinctly remember the image of Southern Campus, and it would be hard to differentiate my view from the National Mall in Washington DC. I was grateful for this moment, but today I am even more grateful. Why? Because I made it up those stairs. Because that view was something I had easy access too. Because if I was a student with a physical disability, I would have to spend an excess amount time looking for an alternative route. Today, I am plan to discuss the topic of disability.

Defining Disability

According the Australian Disability Services Act (1993), disability can be defined as a condition that restricts everyday activities. I decided to discuss disability for this week’s blog because disability, like most chronic illnesses, exhbits continuity and hardships on patients. Impairment comes in many forms: there are physical disabilities, sensation-based disabilities, psychological disabilities, learning disabilities,  and “invisible” disabilities (like Epilepsy). With increasing knowledge on all categories, it is the job of universities— like Penn State— to accommodate all of these cases.

What has Penn State done right?

The opening of this blog entry was example of where Penn State is lacking— and believe me, Penn State has a long way to go— but there are some “rights among the wrongs”. One of the “rights” are the accommodations the University offers.  On the Education Equity page of the Penn State website, you can find a list of different ways the University can support students with disabilities. These efforts range from reasonable adjustments (such as extended time on an exam) to services (like a sign language interpreter). The view the many means of support, visit: http://equity.psu.edu/student-disability-resources/applying-for-services/reasonable-accommodations .

I can also applaud the university for implementing some diasabiilty-friendly resources in the buildings, as well as on the streets. I used naturalistic observation in order to find these aids. One of the resources I encountered were elevators. Almost every building in the school has one or more elevator; this provides a clear alternative to the stairs. Walking along the sidewalk, I also noticed a resource called braille brick (also referred to as “street braille”). If you ever walking down campus, you make have observed what looks like lego blocks in the side walk. This is braille brick (see Figure 1), and it allows the visually impaired to detect when they are about to enter the street. This is a great resource that can ensure safety for visually impaired students.

Where is Penn State lacking?

From the beginning of this blog, it has been forecasted that Penn State is simply not doing enough. It was mentioned before that Penn State snuggles with accessibility. This is because the campus was founded in 1855, but the American Disability Act (ADA) (which improved that standards for disability in the U.S.) was only implemented during the 1990s. Therefore, much of the architecture is not made with patients in mind. That is why many buildings have strange entrances that are hard to navigate, and lack of rails opposed to stairs.

Another issue is that students are lacking access to the psychological resources. Data collected by the university indicates that anxiety and suicide rates are notably higher among students with disability. While the campus does offer a center Counseling and Psychological Services (CAPS), it is evident from the last blog (see “Behavioral Health in Happy Valley”), that that this resource is not the most reliable, and has not accomodated the demand of the student body.

Is it enough?

Based on the information I have gathered, I come to a conclusion that echos last week. Penn State is making great efforts and strides in the area of disability accommodation, but I do not believe ‘enough’ has been acheived. To end this blog, I want to report some data from CollegeChoice. This website recently ranked 50 universities for their efforts in disability. Penn State programs are known to receive high rankings and great recognition, however, our acts for disability did not make the cut. It brings me great sadness, but I have to agree with this website. Penn State must do more for these patients!

What does mental illness look like? Maybe it looks like the scars of self-harm, or the prominent ribs of an anorexia victim. 
What does mental illness feel like? Maybe it feels like paralysis by depression, or like losing control to addiction. 
What does mental illness sound like? Maybe it sounds like daunting voices of the the schizophrenic mind, or heavy hyperventilation by a victim facing anxiety. 
Where does mental illness reside? There is no maybe. Mental illness lurks into the lives of many, and Penn State students are among the many.

Introduction

For my second blog entry, I am addressing one of the most prevalent kinds of chronic illness at University Park: mental illness. According to the National Alliance on Mental Illness (NAMI), a mental illness is a condition that affects a person’s thinking, feeling or mood. These deficits, like any pain or disability, can and do effect a person in their daily life. Mental illness is chronic, debilitating, and on the rise in college students. This “epidemic” has been displayed at Penn State, and in recent years has driven action by university officials. The intervention I plan to discuss the Counseling and Psychological Services (CAPS) program. This blog evaluate the impact of CAPS on Penn State students, and revive the essential question of Chronic in College: is Penn State doing enough?

What is CAPS?

CAPS (short for Counseling and Psychological Services) is a program implemented by Penn State to support students in the pursuit of holistic health (Figure 1). To achieve this goal, CAPS offers a variety of expert-led services that combat mental health issues. The services include counseling, crisis intervention, and psychiatric evaluations. Additionally, CAPS has focused on making this care accessible to all students; therefore the services are FREE. The hope is that any student  can lead a mentally healthy lifestyle.

How does CAPS help Penn State students?

One of the most known— and utilized— services offered by the program is counseling. The CAPS program has invested in this service, and now offers four different types of counseling: individual, couple, group, and veteran-specific. During a session, students can meet with professional and educationally-accredited counselor to focus on specific needs. The service is free to all, however, if CAPS anticipates the need for long-term support (like in the case of chronic mental illnesses), than students are referred to off-campus resources.

CAPS counseling has proven to be very effective. In 2017, the Center for Collegiate Mental Health analyzed the effectiveness of CAPS counseling at Penn State. It was found that stress was notably reduced after just one counseling session (Figure 2). The data allows us to conclude that counseling is very effective method is preserving short-term mental health.

Is it enough?

While I am pro-CAPS, and I believe all Penn State students should use this service, I am not sure that CAPS is enough in the context of chronicity. My reasoning is attributed to two things I encountered in research. I feel that CAPS can provide incredible short-term support, but ‘enough’ is not satisfied for long-term needs. As mentioned before, CAPS will refer a patient to other services that are not, traditionally, on campus. These resources are likely not free, and may not be accessible for all students. My other reasoning came from a discussion with a fellow student of mine. This student— who I will leave anonymous— made the decision to schedule a counseling session with CAPS. Something that research could never bring to my attention is the three-week waiting list for this counseling. While the service can be so helpful to students, there is so little flexibility in this caregiving. How will CAPS be able to meet the needs of urgent cases? Perhaps CAPS will need a large team of counselors. Maybe CAPS can partner up with the academic colleges. There are many approaches that can be taken, however, ‘enough’ has not been achieved for chronic mental illness.

 

 

Invisble suffering; silent pain.
Where are the bruises they all say?

Hidden bleeding; quiet screams.
No one notices along the way.

Confessing symptoms seen as complaints.
But saying nothing means your okay…

…a difficult life to explain away
When your bones aren’t broken, but ache anyway.

–  JoJo Tabares, Silent Pain

The moments when chronic illness lurks into your day.. that is what we call “silent pain”. Breaking the silence in silent pain is basis of this passion blog. “Chronic in College” is my method of documenting the chronic illness experience at Penn State University. The inspiration for this blog came from my personal battle with Chronic Migraine. I have lived with this condition for my entire life, but I knew that being a patient in college would be a unique experience. This is a life that I am only starting to learn about, but I realize that I am not alone. I am not the only migraine patient on my campus. I am not the only person with a chronic illness on my campus. I am not only person with silent pain on my campus. It is with this knowledge that I write this blog. It is time to unsilence the pain!

Advocacy is only one component of this blog. The other objective is analyze the chronic illness experience at University Park. In a recent report, Penn State University was ranked in the Top 25 Healthiest Campuses in America. This, while impressive, was an ambiguous statistic. What does “healthiest” encompass? Is this adressing student fitness? Is this referring to the health services on campus? To me, “healthiest” is a holistic term. In order to be a truly healthy campus, emphasis must go beyond wellness. A campus is invested in improving the quality of life for students of ALL health statuses. So with my interpretation of “healthiest”, I ask one question: does Penn State to live up to this ranking?

Over the next few weeks, I will be collecting information to answer this question. My hope is to explore the services available to patients on the University Park campus. In my investigations, I will be looking for resources that aid students with mental illness, disability, recurrent pain, and other chronic conditions. I will also plan interview students with chronic illnesses, and university officials that are trained to work with chronic illness. Using this information, I will be able to formulate conclusions that go towards answering my essential question.

So what is my expectation for the journey? In particular, I have high expectations for mental illness. I have learned a lot about CAPS (a counseling service), and it appears to be an amazing resource for students. On the contrary, I am not certain that my own illness will be served at that level. While chronic illness is difficult to combat, I think PSU will put their best foot forward. Based on your knowledge of campus services, would you agree?