McCosh worries

Dr. Marvin Geller keeps the shades drawn on many of his office's large windows, allowing soft sunlight to filter through while maintaining a subtle sense of separation from the bustling campus beyond McCosh infirmary.

Many of the people who have visited Geller's office over the years were struggling with the realities of the world outside his windows. And for three decades, Geller — director of McCosh's counseling center — has tried to help guide his patients through some of the most difficult problems of young-adulthood.

But in recent years, Geller has noticed a change in the types of cases he encounters. The volume of cases is larger and their nature is more severe — an alarming trend, the cause of which is essentially unknown.

During the last five years, the number of counseling sessions provided by McCosh has increased substantially — from 4,700 in 1995 to 5,500 last year.

And this fall, more students than ever before came to the McCosh counseling center.

"That is a big leap that has stayed consistent through the whole semester," Geller said. "Why it is happening is very uncertain."

In addition to the increase in student volume, Geller noted that the issues for which students are being counseled are becoming increasingly more serious.

Students who come to McCosh for counseling seek help with a variety of issues, many of which are strikingly personal and sometimes quite dangerous, Geller said. They often suffer from eating disorders, such as bulimia and anorexia. Some have tried to injure themselves physically, and others are contemplating suicide.

Students struggling with depression and anxiety make up the greatest number of cases seen by McCosh counselors, he said.

And while these are issues with which college students have struggled for decades, Geller said their increasing frequency could be indicative of a larger problem.

"A student might come in who is finally facing that she has an eating disorder and wants to begin talking about it," he said. "People will come in knowing their self-esteem suffers or that they're socially awkward and they're wanting some kind of help."

With the steady increase in the number of students seeking counseling, McCosh has hired several additional staff members during the last few months.

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The center's current staff of 13 includes social work interns and a consulting psychiatrist who is available part time. The rest of the staff is made up primarily of clinical psychologists who have their Ph.D.s.

"Increasingly, over the years, we've moved from [counseling] 9 to 10 percent of the population to 14 or 15 percent," Geller said. "Between 35 and 40 percent [seek counseling] over a four-year period."

Geller said he has been in contact with University deans and the Student Health Advisory Board — a group that evaluates student experiences at McCosh several times per year — to try to understand the causes of the increase. "Clearly, there are concerns in the institution," Geller said.

University officials said in interviews this week that it is difficult to explain the rise in student demand for counseling, but some attributed the phenomenon in part to the pressure many students feel even before being accepted at a prestigious school like Princeton.

"Admission offices feel that they have, over the years, inadvertently put so much pressure on students that students come to college burnt out. Their whole high school life is geared to doing all they can do to get a wonderful education," Geller said. "Students are arriving already with an enormous amount of pressure."

And once students arrive on campus, they must trade the pressures of getting in for the challenges of simply being a student, he said.

Another possible reason for the increased demand for counseling could be McCosh officials' efforts this year to make more students aware of the center. To this end, the infirmary has organized several outreach events, including screening days for individuals who believe they may be suffering from depression or eating disorders.

"As more students know of [the counseling center] and more use it, there is less of a stigma attached to it," Geller said.

Vice President for Campus Life Janet Dickerson said she has asked counseling center administrators to offer possible explanations for the increased volume this year.

"But they haven't been able to give me a direct answer," she said. "My recommendation to the people at the counseling center is that they do more surveys or some kind of feedback or focus groups to give us more direct information."

Associate Dean of Undergraduate Students Marianne Waterbury works with the counseling center when students are in what psychologists call "crisis" situations. Such situations involve serious psychological problems or suicide attempts.

Nevertheless, she said she agreed with Geller and Dickerson that it is not clear why there has been an increase in counseling demand.

"It's a chicken-and-egg situation — we don't know if there are more cases because people are more open about it, or because there are more students in need of some kind of therapy or medication," Waterbury said, adding that Princeton's problem is not unique among the nation's other institutions of higher education.

Health officials at Yale, Brown and Duke universities also said they have seen an increasing number of students seeking counseling.

Paul Meilman, director of counseling and psychological services at Cornell University, said he also has witnessed a notable rise in the number of counseling cases in recent years.

Those cases, too, are becoming more serious.

"In the old days, we saw a fair amount of sort of the easy stuff — 'My boyfriend left me, my girlfriend left me, I'm homesick,' " said Meilman, who has been counseling students for 23 years. "Now what we see is someone comes in and says, 'I'm cutting myself, I'm bulimic, I'm suicidal, I'm alcoholic.' And it's all in the same person — multiple problems within the same human being."

Meilman offered another possible explanation for the trend in increased counseling volume. He said he believes the Americans with Disabilities Act and improved psychiatric medicine have enabled more people who regularly receive mental health care to attend college. As a result, college counseling offices are being forced to find ways to support a larger volume of students needing assistance.

"They come to college on medicine, but they come and bring with them pretty significant difficulties," Meilman explained.

Extended care

Students who come to Princeton's counseling center usually return for more than one session, with six or seven being the average number of counseling sessions a student attends per year.

Students are allowed only 10 free visits to the counseling center per academic year because of McCosh's limited funding. Once a student has completed those 10 sessions, the counseling center helps him or her find outside assistance.

Vanessa Wong '02, a member of the student advisory board to McCosh, said SHAB has been discussing student concerns about the 10-session limit.

She said the group is investigating whether students actually continue with outside counseling once they have used their 10 sessions from the University.

Any changes to the counseling program may require that McCosh be given additional funds, something University officials agreed may become necessary as the counseling center is expected to help more people.

Indeed, Geller said his job as a counselor has become substantially more challenging in the 30 years he has worked at McCosh.

The current student body is far more varied than the all-male, primarily white group that attended Princeton in the early 1970s. And new types of people naturally bring new types of problems.

Dickerson admitted that with the challenges college-age people face today, she is not surprised by the higher volume of students seeking counseling.

"It's a time of stress in the world, and students who are here are exceedingly responsible and gifted. They may experience pressures in accomplishing the objectives they set for themselves," she said. "I am very concerned about our general responsiveness to undergraduates and graduate students."