Here are some of the words used by Dr. Vivian Rakoff when he talks about the mental health -- or lack thereof -- of today's college students:
"Bewilderment." "Increasing rate of suicide." "Desperate yearning." "Rejection of society and culture."
And before you dismiss these somewhat less than reassuring observations with a blithe, "Oh, that's what college kids have always been like," consider Dr. Rakoff's summation of the subject:
, "It seems to be getting worse and worse."
Dr. Rakoff, chairman of the department of psychiatry at the University of Toronto, will present some of his conclusions about the psyches of college students this week when he opens the Sixth National Conference on Student Mental Health, to be held Thursday through Saturday at Johns Hopkins University.
The conference -- expected to attract 150 psychiatrists, psychologists, counselors, social workers, clergy and others who deal with college students -- will be the first national meeting of its kind in eight years. Similar conferences were held from 1979 to 1983 at Hopkins, but were discontinued because oflack of funding.
"There is no national organization that deals just with the mental health issues of college students," said Dr. Ghislaine Godenne, founder and director emeritus of Hopkins' counseling and psychiatric services and organizer of the conference. "We are trying to reach all the different disciplines who work with these issues."
A look at the program for this week's conference makes it clear that the problems of college students today can be much more serious than fleeting depression about love gone sour or transitory anxiety about upcoming final exams. Topics to be discussed include sexual abuse, suicide, multiple personalities and eating disorders.
The need for reviving the public discussion about these and other issues is evident to anyone who works with college students, Dr. Godenne added.
"College students today are more disturbed than college students 10 years ago," she said. "And they're certainly more disturbed than they were 20 years ago. It's difficult to say why, but personally, I think the breakup of the family is the strongest reason."
The number of students that she counsels from broken families has been steadily increasing since she began the service 17 years ago, Dr. Godenne said. "And often the parents split when the kid goes away to college. So not only does the kid have no place to go home to, but he or she often feels responsible for the split."
Another force working on students is the economy. "Even if they get a Ph.D, they don't know if they'll end up a waiter," Dr. Godenne said. Other problems particular to students of the '90s are related to sexual identity. "Females are always confronted by the conflict between career and family," she said. "And now that homosexuality is out in the open, more and more students are questioning their sexual identity."
When Dr. Rakoff speaks of the mental health problems that college students have, he puts campus behavior in the '90s in a historical perspective.
"Suddenly we're involved in neo-puritanism, in a desperate yearning for a way to be," he said of today's college students. "In the late '60s, this [college students] was the group of people who thought they would change the world. They were taken over by the me generation, with their excessive self-involvement. That gave way to students of the '80s, who were characterized by intense career interest and frank exploration of the bottom line."
As examples of what he calls neo-puritanism, he mentioned over-emphasis of sexual harassment, in which any mention of women is seen as sexist; obsessive -- and sometimes ill-informed -- concernabout environmental matters; and rejection of society and culture "because it almost always fails to live up to one's ideals."
Other speakers on the program will deal with mental health problems of college students that are perhaps more readily apparent to the general public. Shelly R. Doctors, a clinical psychologist from the Albert Einstein College of Medicine in the Bronx, N.Y., specializes in eating disorders, widely perceived to be a problem for many college students, especially girls.
"Some of the most alarming articles have reported a prevalence of eating disorders as high as 19 percent and even the most conservative studies report a prevalence of 2 percent," she said. "And there is a big surge, a striking number of college students who don't meet the criteria for psychiatric problems, but still have disordered eating, problems with their eating behavior."
There has been a shift from anorexia to bulimia, Dr. Doctors said, explaining that anorexic behavior may have resulted from the large amount of publicity the syndrome has received in recent years, but it is difficult to sustain and often evolves into bulimia. Most experts, she said, blame the prevalence of eating disorders on "the cultural shift toward thinness, combined with the cultural preoccupation with food." And it is a particular problem with college students "because they're away from home, feeding themselves for the first time."
Dr. Judith Rapoport, chief of the child psychiatry branch of the National Institute of Mental Health, will talk about how college health personnel can recognize obsessive-compulsive disorders, which she said are "much more common than generally believed."
"As many as 1 percent of college-age people may have this disorder, which is a lot," she said. Characteristics that counselors should be on the lookout for include repetition, for example, insistence on reading something over and over, and "the kind of perfection that's much beyond high standards" such as checking and re-checking work and excessive concern for neatness and details of presentation.
Another topic that will be discussed at the conference is crisis HTC intervention. James Archer, director of the counseling center at the University of Florida in Gainesville, became an unwilling expert last August when five students from his campus were murdered in their off-campus apartments.
Dr. Archer will share the lessons he learned with the conference, among them: "An institution needs to respond in a caring, decisive way to provide counseling and extra security." He added that requests for counseling at Gainesville have been up 10 percent to 15 percent this year.
"We've seen people with other problems -- depression, anxiety, relationships, abuse -- presenting earlier than they would otherwise," he said. "All of these things were exacerbated by coming into an environment as stressful as this."