Towerview november 2017

TOWERVIEW > NOVEMBER 2017 | VOL. 19 | ISSUE 2

We have a new student health center... but is Duke healthy?

2 | WEDNESDAY, NOVEMBER 29, 2017

TOWERVIEW

The Chronicle

Drug use: An issue for Duke or Durham?

By Carly Stern Editorial Page Managing Editor

“Are there black men in prison in the Durham County Jail because Duke students use drugs with relative legal impunity?”

The question lingered, met with silence from students. Adam Hollowell, adjunct professor in the Sanford School of Public Policy, asked it during a class exercise in his annual course “Ethics in an Unjust World.” Hollowell sought to capture the relationship between drug use on college campuses and the broader structural realities of drug arrests and sentencing in America, outlined in books like Michelle Alexander’s “The New Jim Crow.”

Before posing the question, Hollowell asked students to assume they had $100 and the desire to buy an illegal substance. He framed the situation as hypothetical to keep it free of judgment. He asked whether students feasibly could purchase drugs in the Sanford School building within two hours—without leaving the building, with the ability to use their phones. Students circled yes or no on paper, and folded and submitted their responses to keep the survey blind.

Ninety-two percent of students wrote yes.

Hollowell has posed the same question to his class every year, with responses ranging between 70 and 92 percent. Although he said that students seemed unsurprised by the results, they demonstrated greater resistance to conclusions he drew from the survey.

He asked students if these interactions would classify the Sanford building as a drug market, or if this meant that Duke students were drug dealers. In both cases, students hesitated to respond in the affirmative.

“I am genuinely curious about how drugs flow into this campus, what the repercussions are of that drug flow for the broader community and the ways that race and racism play into who faces which consequences for illegal drug use on campus,” Hollowell said.

Blacks and African-Americans comprised 37.2 percent of Durham County’s population in 2016, according to the Durham County website.

In contrast, 7 percent of Duke’s student body is black or African-American.

Hollowell has spent the last seven years teaching at Duke, where he also earned his undergraduate degree in religious studies and philosophy in 2004.

His class exercise portrays a student body that does not often consider those outside our institution who enable our lifestyles—the people who cannot write their own rulebooks.

We are taught to criticize, analyze and deconstruct systems of power in the classroom.

But applying the same logic to evaluate the balance of power between Duke and Durham reveals that our academic ideals might diverge from our lived decisions.

We distance ourselves far from the language of addiction, incarceration and crime. Inside Duke’s walls, we are Duke students: ambitious, invincible, blameless.

A consistent relationship Twenty-seven days, 106 text messages.

Between October 26 and November 22, a Duke student exchanged 106 text messages with one contact. During the same time period, he exchanged just a few more messages with his mother: 120.

This person is not his girlfriend, his best friend or his lab partner.

He is the student’s cocaine dealer.

Requesting anonymity for legal protection, the student estimates that he has probably exchanged thousands of text messages with various dealers throughout his time at Duke.

The student, who is a white male, said he usually smokes marijuana two to three times a week. He uses other drugs approximately every other week—most frequently cocaine. He classifies himself as a regular drug user.

The student does not directly interact with his marijuana dealer, but he knows his cocaine

Graphic by Jeremy Chen

dealer well. He said the man has “strangely become a friend.”

He said he feels more comfortable buying drugs from the dealer who he knows more closely.

This dealer is similar to the student in terms of socioeconomic background, ethnicity and education level. He knows this dealer has other revenue streams to comprise a safety net.

When questioned, the student said he could not separate his drug consumption from the larger issue of mass incarceration. He thinks every customer bears responsibility.

Many of the dealers he has interacted with in Durham are black. The student acknowledged that mandatory minimum sentences disproportionately affect blacks and AfricanAmericans.

He described his nonchalant attitude toward purchasing drugs.

“A cop seeing me driving is most likely never going to pull me over unless I’m doing something egregious, so I’ve never felt like I was ever at a significant risk of getting in trouble,” he said. The student said this is largely a function of his privilege as a white male.

He also said he would feel worse about implicating a black dealer than a white dealer.

Police officers demonstrate a greater likelihood to stop, search and arrest black or Latino drivers than white drivers, according to an analysis carried out by Stanford University researchers. Police abide by a lower threshold of suspicion to search minorities during routine traffic checks.

This national pattern has been observed in Durham. Black drivers in Durham were searched more frequently than white drivers, according to Durham Police Department Stop-and-Search Data published by the Southern Coalition for Social Justice in 2013.

Black and Latino offenders are more likely to be incarcerated than white offenders, according to the ACLU. Black males also get longer sentences than white males arrested for the same crimes with similar criminal backgrounds.

The student said he prefers to obtain drugs for himself rather than relying on friends as intermediaries. He likes to have agency over the situation so others cannot be blamed.

He said that if a dealer were to be caught by the police for a transaction involving him and his friends, his first emotional response would be to feel concern for his friends. However, he believes the dealer would face the greatest risk.

“If I were to reflect honestly on who I am the most concerned about facing legal trouble, or actually like having a life altering-experience

from it, it would probably be the original source [of the drugs],” he said.

The student said that he and his friends have access to resources, if a situation with legal repercussions arose.

“We have parents that—at the end of the day—are going to sit down with us and help us get lawyers...we’ll probably get some sort of community service assigned to us, and it will be wiped off our record. Other people don’t have those resources.”

Previously, he has never given much thought to who bears degrees of risk during these transactions, he said.

‘A part of this system’ A conversation with another student, a white female who also requested anonymity for legal protection, revealed a similar risk assessment.

She considers what is at stake for herself and other people she is with when she uses drugs, but does not initially think about the dealer’s circumstances.

In a message, she wrote that she uses marijuana seven days a week in addition to occasionally using other drugs. She obtains marijuana from a Durham resident who supplies many Duke undergraduates.

They communicate through text messages and typically meet every other week at a specified location on Duke’s campus. The student wrote that she feels comfortable buying drugs on campus, but not elsewhere in Durham.

She asks friends to go into the dealer’s car, so she and the dealer have not met face-to-face.

She has little background information about him and would not want to know more, she wrote. She does not want their relationship to be a close one.

“It always made me a little uncomfortable to be in such close quarters with someone doing something so blatantly illegal,” the student wrote.

“Which is ironic, because me buying drugs from him was just as illegal.”

She also reflected on whether she believes her consumption of marijuana is related to increasing rates of incarceration.

“During the act of smoking or interacting with my dealer, I have never thought about the risk that he is putting himself at and the role that I am playing in that risk,” she wrote.

“Maybe that’s because I am selfishly thinking about the risk I am at personally. That being said, the people who the dealer is supplying to are inherently necessary in the drug deals they are incarcerated for.”

“I am absolutely a part of this system,” she

wrote.

The student noted that a security guard once caught her smoking marijuana on campus and called DUPD. After the student admitted to her actions and repeatedly apologized, authorities did not note the incident on her record. This incident has not affected her current habits, she wrote.

On Duke’s campus, degrees of separation exist between actions and implications. It is easy for students to pay no heed to consequences when they affect people who we do not see.

Navigating structures of power The first student is involved with numerous extracurricular activities at Duke and hopes to pursue a career in politics after he graduates in May. The second student has a near-perfect grade point average and has advocated for various social causes throughout her college years.

Both are ambitious and involved in campus culture, successful by Duke’s metrics.

When it comes to legal trouble versus disciplinary trouble at Duke, the first student said he would be more worried about his academic standing. He would not want to jeopardize his reputation as a student.

The student said he is under the impression that Duke’s administration is fairly willing to work with students who are prepared to confront their issues and follow through with corresponding steps, like going to Counseling and Psychological Services or other mandated programs.

Because college students are undergoing formative years in terms of character and habit development, he believes Duke’s approach to drug use makes sense.

“I do think obviously, that when problems get serious, Duke can be very serious,” he said.

John Dailey, DUPD chief of police, wrote in an email that the underage possession of alcohol and the possession of a small amount of marijuana have been a low enforcement priority of the department. DUPD prefers to use the student or employee conduct process for scenarios without aggravating factors, he explained.

“We do not believe this to be a great use of the court system,” Dailey wrote. “We have systems on campus for student and employees that can impose an appropriate corrective action.

The same violation off campus may result in a different process, as there is not an alternative to See DRUG USE on Page 3

The Chronicle

TOWERVIEW

DRUG USE FROM PAGE 2 the court system.”

Dailey wrote that the police document the incident, but do not determine whether sanctions will be issued.

According to the Student Conduct website, disciplinary hearings differ from trials and are not subject to the same rules of procedure, evidence or standards as the court system.

Dailey noted that the assistance of an attorney who understands legal processes can make the court system easier to navigate. He wrote that it appears as though the Durham Police also regard the enforcement of minor quantities of marijuana to be a low priority.

Institutional accountability Data published by the University reveals a disparity between the number of drug referrals at Duke and resulting arrests. Students are not punished for every incident report documented by a resident assistant, security guard or police officer—just as defendants are not always convicted in criminal court.

According to the federally mandated Clery Act Annual Security Report, Duke referred 53 drug violations in 2013. Eighteen cases led to arrests.

The University referred 75 drug violation cases and made 13 drug arrests in 2014, and referred 100 cases with 10 arrests in 2015. In 2016, there were 85 referred violations, which resulted in 15 arrests.

The percentage of violations leading to arrests ranged from 10 percent to approximately 34 percent.

The Clery Act is released each October and includes data from the previous year. The University also releases yearly Undergraduate Disciplinary System Statistics Snapshots, which provide data about student conduct processes.

According to Stephen Bryan, associate dean of students and director of Duke’s Office of Student Conduct, the typical sanction for

possession or use of a small amount of marijuana is disciplinary probation for a specific duration of time. This sanction is accompanied by referral for substance use assessment and education, he wrote in an email.

However, evidence of distribution or sales could lead to suspension, Bryan wrote.

Expulsion generally would be considered in repeat instances or other aggravating factors.

According to the yearly snapshot, OSC recorded 94 incidences of “Drugs and Drug Paraphernalia” during the 2013-14 academic year. OSC found 39 students responsible at a rate of 41.5 percent.

OSC recorded 133 incidences in 2014-15, finding 59 students responsible at a rate of 44 percent.

In 2015-16, OSC reported a rate of 121 incidences, finding 45 students responsible at a rate of 37.2 percent.

OSC processed 121 incidences in 2015-16, with 45 students found responsible at a rate mirroring that of the previous academic year.

Dailey wrote that the disparity between referrals and arrests on campus likely exists because the number of referrals in the Annual Security Report includes reports from residence assistants and other campus security authorities beyond the campus police. Most of the reports result from resident assistant documentation and did not involve DUPD, he wrote.

Residence assistants are instructed to act based on whether they suspect or are certain that a resident possess drugs or is dealing them, resident assistant and senior Olivia Deitcher wrote in a message.

Residence assistants must follow a standardized flow chart that includes knocking on the door, asking specific questions and documenting the situation through incident reports. They report the facts but do not determine whether the student engages with the residence coordinator or student conduct.

Residence assistants immediately call DUPD and the residence coordinator to handle the

WEDNESDAY, NOVEMBER 29, 2017 | 3

situation if a student has previously been documented for drug use.

Deitcher explained that supervisors do not instruct residence assistants to proactively seek out policy violations. However, if they smell marijuana use, see drug usage or view drug paraphernalia, they are obligated to document the incident.

Overall, Deitcher believes Housing and Residence Life’s policy is reasonable. From her standpoint, the dialogue that students have with the RC or Student Conduct appears to be community-centered rather than focused on shaming habits.

“HRL has never told RAs to go on a witch hunt,” she wrote.

If caught, the dealer who delivered those drugs likely will face a court system that is less forgiving.

Any distribution of marijuana exceeding five grams is treated as a felony in North Carolina, according to the website of Raleigh-based law firm Hatch, Little & Bunn, L.L.P. The motives behind administrative and DUPD policies cannot be presumed. However, at least one conclusion can be drawn: when caught with drugs, sometimes students are afforded second chances.

But once students grow accustomed to leeway, will circumstances ever force us to shed these expectations during life after Duke?

The first student discussed how he is passionate about progressive causes, but he thinks others have difficulty reconciling his convictions with his behavior. He looks forward to being forced to live out his beliefs when he enters the workforce and encounters new communities.

The student believes that being constantly surrounded by 18 to 22-year-olds insulates students’ attitudes. He said he might change his drug habits if he had a neighbor with young children, who had witnessed him using drugs.

“If I felt like I was adversely affecting the

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Outside of the bubble “What was your bottom?”

Elisha McLawhorn, TROSA graduate and staff member, said this question is frequently asked at TROSA. TROSA is a multi-year residential program in Durham that allows substance abusers to rebuild their lives through comprehensive treatment, vocational training and continuing care.

Effectively, the question translates to, “What brought you to TROSA? What caused you to make these shifts in your life?”

McLawhorn said that the socioeconomic backgrounds of TROSA residents vary significantly. The program includes residents who grew up in wealthy families, pursued law degrees or business degrees and had successful careers before coming to TROSA. “Addiction doesn’t discriminate,” she said. “It doesn’t care if you come from a nice family; it doesn’t care if you come from a poor family.”

She spoke about how facing accountability early in life can shape people’s behaviors, decisions and expectations with regard to drug use down the line.

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people who live next door to me…that would probably curb [my drug use],” he said.

The student also thinks that knowing the specifics of who would be implicated or arrested for students’ drug use would influence students’ habits. He believes Duke students generally are empathetic, but that they feel shielded from actions that extend beyond campus.

“I think that a lot of us feel that because we’re in the Duke bubble, within Durham, we aren’t responsible for what happens outside of the Duke bubble,” he noted.

He believes attitude drives students toward more open drug use.

“Especially in Durham, Duke students are sort of masters of the universe,” he said.

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The Chronicle

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‘Duke would rather sweep the issues under the rug’ Students voice concerns about mental health resources on campus

Chronicle File Photo The Student Health and Wellness Center opened in January after nearly two years of construction. All students are able to use the center, regardless of their insurance plans.

By Claire Ballentine Towerview Editor

Life in the ‘Gothic Wonderland’ has never been easy for Duke students—between challenging academic courses, pressure to have a thriving social life and the overarching goal of effortless perfection, it’s no surprise that many undergraduates face problems with their mental health.

Complicating the issue? The fact that Duke’s resources for assisting students—including Counseling and Psychological Services and DukeReach—are often lacking, according to students interviewed by The Chronicle.

Some say that the Duke administration is not making students’ psychological health a priority.

“The administration and Duke as a whole can do a better job of understanding students’ mental health needs,” said senior Thomas Klug, president of Peer for You, a group that allows students to anonymously receive advice on their mental health concerns. “I think Duke often treats mental illnesses as more of a liability than as something it needs to address.

It would rather sweep the issues under the rug than try to deal with them.”

CAPS’ limited resources Many students’ complaints regarding mental health care on campus involved the office of Counseling and Psychological Services, which they said does not have the resources to adequately serve students.

Pooja Mehta, Trinity ‘17, said that CAPS doesn’t have enough counselors to provide sufficient care for students.

“Everyone in CAPS is booked to the nines seeing patients,” she said. “It’s not a reflection on CAPS as much as the way the University prioritizes the mental health of students.”

Before coming to Duke, Mehta had been seeing a therapist for her mental health needs and began to recover, so she stopped treatment.

While at Duke, she realized she needed to visit a service provider and turned to CAPS. She started having sessions with a therapist once every two weeks, but soon learned a truth many students have come to know—CAPS isn’t designed to provide long-term care.

She said that because they couldn’t keep seeing her on a regular basis due to limitations in staff numbers, they referred her to an offcampus provider.

“CAPS is to help patients through shortterm things like day-to-day stressors or just general on-campus things,” she said. “Bigger, long-term mental health problems require relatively intensive care.”

Sophomore Alex Chan had a similar experience with CAPS. Chan initially visited CAPS because she was feeling sadness and

loneliness, which she recognized as symptoms of depression. She just wanted someone to talk with, she said.

Although Chan noted that CAPS tries to accommodate everyone, she was only able to get an appointment once every two weeks— which she says wasn’t adequate for what she was going through.

“That’s not really enough for anyone,” she said. “So much changes in two weeks, especially in a college environment.”

Then her therapist told her that there’s a max number of visits CAPS can provide students with, Chan said.

It felt like being shut out and left without a safety net.

She has continued to go to walk-in hours for therapy services, but was told by her therapist that after this semester she can’t go to CAPS anymore and must find an outside provider.

Now she’s forced to use her remaining CAPS visits wisely.

“It’s like some weird game where I have to play my cards right,” Chan said. “Do I really need CAPS or should I save it for another time?”

Danielle Oakley, director of CAPS, told the Chronicle that CAPS does not have a session limit, but they’ve found that most students “self-select” to attend sessions between four and six times.

However, CAPS providers attempt to determine whether students’ issues can be resolved in the short term or if they will require long-term care.

“What we do try to figure out is if a student can be seen around that session time,” Oakley said.

For Chan, it seemed contradictory that Duke could build a new student health center if CAPS doesn’t have enough resources to meet students’ ongoing needs.

“Duke is pouring their money into the external look and making it appear very peaceful, but there’s not the resources,” she said. “It’s definitely something Duke can improve on. I wish they hired more counselors instead of spending millions on a new wellness center.”

Oakley noted that although Duke is wellresourced compared to many of its peers, no schools have sufficient resources to deal with the multitude of mental health problems afflicting college students.

Currently, CAPS has 26 permanent staff members, with five serving in administrative roles and five as psychiatry staff, she said. Not all of them work full-time.

providers in the community.

Many of these therapists accept students’ insurance if they are on the student health plan. However, problems can arise when students are on their own health care plan, which may have high deductibles. In those cases, CAPS has a fund that can help students’ with co-pays, and students can also work with financial aid to get loans.

Mehta said that CAPS needs to do more to make sure students can properly connect with outside providers. Some have issues finding transportation to these off-campus professionals, she noted.

“If you don’t have resources to provide longterm care, make sure students have resources to have long-term care,” Mehta said.

She suggested that CAPS should try to set up a transportation system to ease the travel burden on students, but recognized that CAPS doesn’t have the funding. Change is needed from a higher administrative level, she said.

Senior Katie Anderson—who requested that her name be changed because she didn’t want to reveal her mental health issues— went to CAPS for help with her depression but became dissatisfied with the counselors she saw and requested a referral off-campus, where she thought the standard of care would be better. Her health insurance was able to cover the costs, but she noted that this is not the case for all students.

Having to find the time in her schedule to make the trek off-campus was difficult for her and often discouraged her from even attending the sessions.

“It was hard at first and took a lot for me to go,” she said. “It was a 20-minute walk in between classes.”

New walk-in hours For those students trying to utilize CAPS’ services, a main complaint in past years has been the long wait times that often discourage students from seeking treatment.

However, Oakley explained that since June, students can walk into CAPS anytime between 9 a.m. and 4 p.m. and ask to see a counselor. A staff member will have them fill out forms on an iPad and then meet with them for 15 to 20 minutes to gather information about what’s going on and assess any risks or safety concerns.

“We wanted to make sure we were reducing barriers so students didn’t have to set the appointment to come in, but also so that we’re capitalizing on seeing students at the time they want to start treatment,” Oakley said.

Previously, students would have to call and make an appointment, which might mean waiting two or three weeks to see a provider.

Now, students can immediately be assessed to determine which kind of therapy will be best for them. This could be individual counseling— typically 45 to 50 minutes with a therapist—or group sessions.

“Not everyone who comes needs therapy, they may just need skill-building,” Oakley said.

She noted that the feedback she’s received from faculty and staff has been very positive.

Faculty know they can simply tell a student to head over to CAPS instead of instructing them to call and make an appointment.

But this doesn’t mean wait times at CAPS have been eliminated. The wait to see a counselor after that initial consultation, is about two weeks, Oakley explained. When the wait time is longer than that, no-show rates start to rise, she said.

“We work really hard to keep it under two weeks, but sometimes during the semester it goes over that because of resources,” she said.

“It’s like every campus in the U.S.—no one has enough resources, and we’re trying to figure Referrals off-campus Oakley explained that for students who out creatively what to do with resources that need long-term or weekly care for a significant we do have.”

Klug said the new walk-in hours are an period of time, CAPS has a referral coordinator who helps students make connections with improvement, since before students would have

to wait long periods unless they admitted to the CAPS staff that the need was crucial or that they might hurt themselves.

Mehta also voiced frustrations with the previous wait times. She would sometimes spend weeks encouraging friends who were in need to seek out CAPS. When they finally did, they were often slammed with a monthlong wait.

“Now you can walk into CAPS at any time during the day,” Klug said. “Just having access to that care is a great resource.”

Staff member diversity The inadequate number of staff members at CAPS is a problem, but so is the lack of diversity in the ones they do hire, students said.

The demographics of the staff do not reflect that of Duke as a whole.

At a community forum in November 2015, students called into question CAPS’ diversity— particularly the fact that the department had only one Asian-American counselor at the time.

Klug explained that in his experience with CAPS, many of the therapists are white professionals, cisgender and straight. Although there have been some improvements in recent years, the staff is still not representative of the Duke community, he said.

“My therapist did not understand at all what I was going through just because of that identity variable,” he said. “You can be as trained as you want, but at the end of the day it’s really hard to empathize and understand what someone may be going through if you haven’t dealt with that issue.”

Junior Tatyana Bidopia, president of Duke’s chapter of the National Alliance on Mental Illness, said that she thinks hiring more diverse staff needs to be a priority for CAPS. “It’s something that should be on their radar,” she said. “It’s important for students to be able to identify with their counselor.”

Despite the student complaints, Oakley said she thinks CAPS has made significant progress in this area recently. They’ve made five hires in the last three months, and all of those are people of color. She noted that they now have two Chinese therapists, two providers from southeast Asia and several who identify as black, along with therapists with various sexual orientations.

CAPS also has a race equity strategic plan that takes diversity concerns into consideration, she said.

Graduate students as providers Several students raised concerns about CAPS’ practice of having graduate students see patients, questioning their experience level and See MENTAL HEALTH on Page 7

Courtesy of Duke Photography Danielle Oakley, director of CAPS, said that the department instituted new walk-in hours in June to decrease student wait times.

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WEDNESDAY, NOVEMBER 29, 2017 | 5

‘The pressure to be thin’

Examining eating disorders and the Duke culture that contributes to them

By Katherine Berko Senior News Reporter

It was Spring 2015 and then-sophomore Mera Liccione was leaving for the gym when she fainted in her Central Campus apartment.

Friends thought she was having a seizure, but they were wrong—Liccione’s anorexia nervosa was the culprit. Her thin body had developed an electrolyte imbalance, which was negatively impacting her heart.

“It was the scariest thing I had ever been through,” Liccione, now a senior, said.

For many people suffering from eating disorders, it takes a dramatic breaking point— such as Liccione’s trip to the emergency room— to open their eyes to the severity of their illness.

Eating disorders at Duke Female students with AN, like Liccione, are not alone on Duke’s campus.

A recent national survey from the American College Health Association found that Duke undergraduate women were twice as likely than students at other colleges to report being “diagnosed or treated by a professional” for anorexia. The number at Duke was more than four percent of women surveyed, compared to less than two percent nationwide.

According to the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, people with AN restrict their energy intake to the point where their body weight is extremely low and they are either very afraid of gaining weight or do not allow themselves to experience weight gain.

Nancy Zucker, the founder and director of the Duke Center for Eating Disorders, said that it is not surprising for schools like Duke to have higher-than-average rates of eating disorders.

Vulnerability factors for these disorders—such as competitiveness—are common among the type of people admitted into upper-tier universities.

The ACHA survey also found that female undergraduates at Duke exercise more than their counterparts, doing increased moderate intensity and vigorous cardio or aerobic exercise.

However, this raises the concern of whether the exercise represents good health or an unhealthy obsession with exercise.

The DSM-5 does not currently include “exercise addiction” as an addiction disorder because there is “insufficient peer-reviewed evidence to establish diagnostic criteria.”

Kim McNally, director of undergraduate studies in the Department of Health, Wellness and Physical Education and a former track team member at Duke, said over-exercise should be measured by its effect on health rather than by the intensity of the exercise.

“If an individual is experiencing signs of overtraining such as recurring injuries, mood disturbance and poor exercise recovery, then they are doing too much,” McNally explained.

McNally also noted that when students exercise so much that it interferes with their academic, career or social obligations, they may have unhealthy relationships with exercise.

In Liccione’s case, exercise was definitely hurting other areas of her life.

Deciding to go on medical leave Liccione was already battling her eating disorder when she arrived at Duke. The summer prior to her first year, she was so nervous about “measuring up” to her future peers that she began over-exercising and severely limiting her calories. “[It was] a means of coping with my anxiety,” she said.

Her first year, during a visit to Counseling and Psychological Services, she was diagnosed with disordered eating—a sign of unhealthy dietary habits not yet rising to the level of an eating disorder as defined in the DSM. “I didn’t think at the time that I had a

Graphic by Jeremy Chen

problem,” Liccione explained.

She was not the first person in her family to suffer from this type of issue—her mother is a recovering anorexic.

Soon after her diagnosis, Liccione’s weight dropped enough to meet the clinical criteria for an eating disorder. Still, she refused to acknowledge that she needed help. But early in the second semester of Liccione’s sophomore year, one of her friends reported her to DukeReach.

“My friends and professors were starting to get really concerned about how exhausted I was looking, about how malnourished I was looking and that my emotional state was really bad,” she said.

“As Duke students—and Duke students with eating disorders—we’re a nasty competitive bunch.”

MERA LICCIONE senior

Still, Liccione brushed aside her friends’ worries. She continued to exercise religiously and monitor her meals.

The fainting incident that put her in the emergency room caught her attention. It was then when she realized that she was severely sick and needed help. With some cajoling from her dean, Liccione signed the papers to go on medical leave.

From April 2015 to December 2015, Liccione underwent intensive treatment for her eating disorder, which she described as one of the most difficult experiences of her life. She was sent to an intensive, outpatient treatment center, as opposed to an inpatient treatment center, because her doctors did not want to put her in an environment where she might feel pressured to “be the sickest.”

“As Duke students—and Duke students who have eating disorders—we’re a nasty competitive bunch,” Liccione explained.

She returned to Duke in January 2016 and is listed currently as a member of the Class of 2018, one year behind her original class.

Learning to be open An undergraduate student—who we will call Emily to protect her identity because of her public status as a student athlete—is no stranger

to eating disorders. In high school, her AN was so severe that she nearly died from it.

Emily’s sickness started when her best friend committed suicide. It was after this traumatic incident that she decided the best way for her to deal with her emotions was to control her food. By age 15, she had lost 35 percent of her body weight.

“I was horrendously sick, to the point where I couldn’t go to school,” she said. “I couldn’t do anything.”

Yet, Emily still could not comprehend how ill she was. She can recall days when she ripped down her curtains out of frustration because her mother told her to eat a potato.

But, it was ultimately the distress that Emily’s illness caused her parents that led her to seek treatment. Watching her parents break down in sobs as well as her school threatening to kick her out made Emily want to get better.

“I think the biggest thing about recovery is admitting you have a problem,” Emily explained.

In her recovery period, during which she underwent outpatient treatment, she was weighed by a professional every day. She never saw the actual number on the scale; she was always told if her weight went up or down.

“I went from eating very little to eating an incredible amount a day—desserts followed by weight gain shakes followed by desserts,” Emily said. “Every single time I did it, I felt horrible. It was a really bad feeling, but I reminded myself why I was doing it.”

Throughout this trying time, Emily often had to remind herself that just as a sick person needs medicine, an anorexic must eat food.

“There was a lot of pride in [eating more]— every time I felt full, I was like, ‘I’m one day closer to getting better, to getting my period back, to doing my sport again,’” she said.

In retrospect, Emily said that a major aspect of having an eating disorder is being fixated on numbers, whether it’s one’s weight or caloriecounting. After going through her recovery, Emily has learned the importance of intuitive eating. She now knows that if she’s hungry, she should eat a snack, regardless of whether or not the people around her eat one. She has learned to listen to her body.

Emily also explained that many people with eating disorders suffer in silence, but she has found that the best way to combat her AN is to be completely open about it. When she returned to her high school after her treatment, fellow students would ask her how her day was going.

She would be brutally honest.

“I’d be like, ‘It’s really sh*t, I tried to eat cake and I couldn’t do it,’” she said.

Emily knew that people around her could tell she had an eating disorder, so she decided that she would not try and hide it. “[That’s] the reason I recovered so quickly,” Emily explained.

Emily also credits her supportive high school friends as a major part of her speedy recovery.

Emily considers herself a hyper-social person, but there were some days she refused to go out. During these episodes, her friends tried to convince her to go out with them and when they failed, they simply went to Emily’s house to keep her company.

“Every person has a time in their life when they’re going to feel funny about the way that they look. That’s natural,” Emily shared. “We have to embrace the fact that we can’t feel great every day, but what I’ve had to learn is not to take it out on myself. I have to learn to love myself regardless of what I put in my body.”

Emily has worked to make the lives of people with eating disorders less stigmatized.

Back home, she has promoted mental health education in school curriculums.

An uncomfortable conversation Another undergraduate student on the same team as Emily asked to remain anonymous, so we’ll call her Julie. Julie began suffering from disordered eating when she was a junior in high school. It was the recruitment season for college athletics and suddenly her sport “metamorphosed” into something that it hadn’t been before.

Everything she consumed had to be perfectly healthy. She refused to let her mother cook for her because it stressed her out too much.

Instead, she prepared all of her meals and snacks.

She developed night sweats and began putting herself to bed as early as possible, for fear that if she stayed up, she would grow hungrier.

“In my head, I thought I was being perfectly healthy, I thought I was eating enough. This was going to be my path to [my sport] and college success,” Julie explained.

Soon, Julie stopped getting her period. In just two months, she dropped 15 pounds.

As the summer before senior year rolled around, Julie received an offer to join a Duke athletics team and suddenly all of the extreme See EATING DISORDERS on Page 6

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TOWERVIEW

6 | WEDNESDAY, NOVEMBER 29, 2017

EATING DISORDERS

When Julie eventually got to Duke, her disordered eating faded into the background.

FROM PAGE 5 But after her first year, Julie’s old eating habits efforts felt worth it. Yet despite her achievement, remerged in her sophomore year at Duke.

Julie grew even thinner and suddenly faced Then one day, after throwing up during anemia—a decrease in the blood’s ability to practice and having what she describes as a carry oxygen. mental breakdown, Julie realized she needed to Still, she did not seek help. take a couple weeks off.

The first time it occurred to Julie that she “I felt like my mind was in a complete fog, should change her lifestyle was when she was and I just realized I needed to walk away,” Julie driving to dinner with her mother one night. said. “If you really love something, I truly believe Her mom told her frankly that it was great she you have to let it go in order for it to come back was succeeding at her sport but if she didn’t have to you because if not, it’s an addiction.” a way to celebrate her successes—such as with Julie said it felt like a sign when her anemia friends or at a celebratory meal—her successes returned. would mean nothing.

“It was kind of something I had to figure out A part of Julie woke up with her mother’s more on my own. It was just kind of coming warning. to realize how much more important our “I was so pissed. I wanted to slap her in the relationships are and life outside of numbers is, face because it stung really badly,” Julie said. “I which is really hard to navigate when [my sport] think I realized though that it was sort of true.” is so results-driven,” Julie explained.

Julie said the hardest part of her break was figuring out the source of her pain, which she realized came from some of her relationships, and that adopting poor eating habits was not going to fix these problems.

She has returned to her sport since then, and she believes that her break gave her the necessary time to reflect on her happiness and on her eating habits and reinvigorated her passion for athletics. She also made it a point to reach out to people, telling them how she was feeling and asking for advice.

“I recently had this overwhelming sense that I’m so lucky to be able to find myself at Duke because my personality was so lost for so long in my disordered eating and my habits and outcomes rather than just the process along the way,” Julie said.

Eating disorders in Duke athletics Both Emily and Julie said that their sports team trains several hours per day and multiple days a week.

“Athletes are going to walk that fine line between healthy training and overtraining to maximize performance,” said McNally, who is currently teaching an “Exercise and Mental Health” course.

Emily mentioned that it is difficult not to count calories when one is on the team, because many of the girls obsessively do so and, as she perceives it, also have poor eating habits. She noted that there is a consistent focus on body image within the team.

“If somebody tells me my abs look great, I’m going to feel good about it, which is a sad thing to say,” Emily shared. “Like with Instagram, I am somebody who is quite obsessed with their body.

My [account] used to be a video documentation of my body all the time.”

She said that people often treat athletes like their bodies are completely separate from Courtesy of Wikimedia Commons their brains. Julie worries that this mentality is People with anorexia restrict their calorie intake to the point where their body weight is extermely low diminishing her enjoyment of the sport. and are either afraid of gaining weight or do not allow themselves to experience weight gain.

“Can I find that love for my sport again, [yet] stripped of this comparison to others, the need to be super thin, to look the way other girls do, to count my calories, to train a certain amount, eat a certain amount?” Julie asked. “I want to love it for what it is.”

The Duke environment “Many of my patients have told me that their impression is that disordered eating is so prevalent at Duke that it normalizes their own aberrant eating and decreases their motivation to get help,” said Zucker, the founder of the Duke Center for Eating Disorders. “Whether that is the true state of things or just their perceptions, [I don’t know, but] it’s probably a little bit of both.”

Liccione agreed, saying “[Duke] is like the most toxic aspect of United States exercise and diet culture concentrated.”

It’s not clear whether or not the Duke environment worsens eating disorders, but Liccione and Zucker suggested students on campus might feel pressured to exercise and eat healthy in order to fit in with their classmates.

Liccione said she often observes which classes tend to fill up the most at the Wilson and Brodie Recreation Centers. From what she’s noticed, the rapid calorie-burning classes such as highintensity interval training and indoor-cycling get the most packed, but the slower-paced Hatha yoga classes have more empty space.

Liccione frequently took HIIT classes, but she now prefers hatha yoga.

Zucker said students may also feel a sense of competition when they exercise together. If two people are next to each other on treadmills, there’s a possibility they want to outrun each other. Zucker also mentioned that she was alarmed by the number of students who do not allow themselves to take a break from studying during their exercise routines. She often walks through Wilson and notices students with See EATING DISORDERS on Page 8

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MENTAL HEALTH FROM PAGE 4 qualifications.

Oakley explained that they have three providers who are psychology interns. These individuals have completed their programs and are in their last year of training.All are supervised by licensed professionals.

For Anderson, having a graduate student as her therapist contributed to her decision to seek an off-campus provider.

She said that although she knows the student was qualified in some way, it was not the help she was looking for.

“I was like, this is a serious issue that I’m having and I’m not getting real help,” Anderson said. “It felt like I was being used as a test.”

Chan noted that her therapist was a Ph.D. student close to her in age. This meant the provider could relate to her struggles but she said the whole experience was slightly weird.

“It felt like talking to friend rather than someone who could give me real advice,” she said.

Complaints from students about receiving care from grad students are very rare, Oakley said.

“We bring very, very skilled people,” Oakley said. “If we had any concerns about our interns’ ability to do this work, we would not have them see students.”

Stigma around CAPS Students also noted that the stigma about receiving services from CAPS can prevent undergraduates from seeking help.

Chan explained that when she first went to CAPS, she didn’t tell anyone besides her closest friends and her mom.

“CAPS has this certain stigma around campus and has become a joke rather than a resource people take seriously,” she said.

Receiving therapy is something students make jokes about, and there’s an association between CAPS and a mental institution, she said. This makes it hard for students to initiate that first visit, especially if they think they might run into someone they know in the office.

Mehta noted that mental health is not given as much attention as it deserves because some people don’t believe it’s a real affliction. At Duke and in society, focusing on one’s mental health isn’t a priority, she added.

“If a student is stressed and if a student needs long-term care, it’s easy to shrug it off and say, ‘of course you’re stressed, you’re in college,’” she said.

Duke has a culture of “effortless perfection,” Klug explained, which makes it seem like everyone can accomplish things easily and prevents people from talking about their insecurities.

To combat this, Peer for You offers a service in which students can send messages anonymously to peer responders who will answer their questions within 24 hours. It’s a space to support students in need but also alert them to resources on campus like CAPS or DukeReach, a comprehensive case management service.

Klug noted that Peer for You is more appealing to some students because it allows them to talk with people their own age and doesn’t require them to identify themselves.

“We provide a stepping stone to students who may need those resources,” he said. “They may feel more comfortable talking anonymously, which you can’t do with CAPS or DukeReach.”

Bidopia from NAMI, who is also on a mental health advisory council that works with CAPS, explained that CAPS often has difficulty reaching students because they’re reluctant to seek treatment. Future efforts should target the period

TOWERVIEW

between students realizing they have a mental illness and actually stepping into the CAPS office.

Some students need an extra push, which could take the form of online scheduling or an anonymous way to receive services, she said.

Oakley noted that stigma can prevent some students from seeing therapists. The number one reason students visit CAPS is because of anxiety, followed by depression.

“There’s a lot of pressure that comes from being here,” she said. “Schools that are more academically competitive have higher utilization rates for mental health services.”

About 14 percent of students at Duke utilize mental health resources each year, which is similar to the utilization rate at Northwestern University and Vanderbilt University, Oakley said. Public schools are typically in the six to eight percent range.

Some students are also predisposed to mental health issues because of genetics or have situational issues that are not resolved, she noted. In addition, factors like racism, sexism and xenophobia negatively affect students’ psychological states, leading to low self-esteem and increased depression and anxiety.

Oakley acknowledged that some students do worry about encountering people they know in the CAPS office.

“We encourage them to talk with their counselor about how to handle that,” she said. “If the other person is here, it means they’re struggling as well.”

Stigma can also come from professors, many of whom are not familiar with mental health issues.

Amy Powell, director of DukeReach, explained that some faculty are better than others at handling students with mental health issues, which she said could be related to the subjects they teach.

“If you’re working with faculty in psychology, you’re going to get someone who understands mental illness—but if you’re working with someone in computer science who may have never had that difficulty, they might come at it with a different approach and be uncomfortable approaching that topic,” she said.

Much of this variation comes down to the education Duke professors receive about mental illness. Although DukeReach does faculty training, they can’t mandate that professors attend—and many don’t because of their busy schedules. The DukeReach office also sends out folders to each department with resources so that faculty can look at it on their own time.

“I think certainly CAPS would be open to talking with faculty,” Powell said. “Faculty are so busy oftentimes that it’s hard to get their attention in this area.”

Tom Szigethy, associate dean and director of the Student Wellness Center, said that faculty and staff can play a major role in combating stigma on campus. High-achieving professors can perpetuate the “effortless perfection” idea that is common among undergraduates.

“It’s up to us to be the example in that regard,” he said.

“There needs to be a level of conversation with staff and faculty about the real-life struggles they may have gone through.”

Compared to UNC There are plenty of complaints about CAPS from the Duke community—but once you step outside of the Duke bubble, are the issues plaguing the office unique? Looking at the University of North Carolina at Chapel Hill’s resources yields insights into the state of mental health services on college campuses outside of Duke.

Maureen Windle, associate and clinical director for Counseling and Psychological Services at UNC, is responsible for

Chronicle File Photo The offices for CAPS and DukeReach are in the new Student Health and Wellness Center, located on Towerview Drive.

WEDNESDAY, NOVEMBER 29, 2017 | 7

Special to The Chronicle Duke’s NAMI chapter is working to reduce stigma around mental illness and encourage Duke students to utilize the services offered by CAPS.

the day-to-day operations of the counseling services there.

In 2007, the department began operating a walk-in model— similar to what Duke adopted this year—because they could not keep up with student demand and always had a waitlist. Now, they are open for students to drop in each weekday.

“We have a commitment that every day we will see every student who walks in regardless of the number,” she said.

In the past few years they have seen a jump in walk-ins, with the highest being 48 in one day. Like at Duke, students initially talk with a provider for about 20 minutes—or longer if there’s a crisis—and then evaluate their next step.

This could be one of their group therapy programs, setting up time with an individual therapist or connecting students with a referral coordinator. As to Duke, students who need long-term care are directed to off-campus providers. CAPS at UNC sees students regularly for one semester at most.

“We have a brief psychotherapy model,” Windle explained.

“We’re looking at students and seeing if we can provide a brief therapy inside of a semester.”

Most students are satisfied and interested in ending their experience with UNC’s CAPS in three to five sessions, she said. Others take between eight and 25 sessions to complete their care.

She noted that they are committed to diversity and have a “reasonably diverse” staff with black and Latinx psychologists as well as LGBTQ+ providers.

Although stigma around mental health certainly exists on the UNC campus, Windle noted that it has been significantly reduced in recent years due to the efforts of student groups like Stigma Free Carolina. In addition, UNC’s statistics show that a demographically representative portion of UNC’s student body is utilizing their resources.

They’ve seen a sharp increase in students visiting within the past three years—a sign of reduced stigma—but creates problems for serving the volume of individuals. Like many colleges across the country, they don’t have funding to hire more providers or expand their services, Windle explained.

“We need more resources as the demand continues to grow, but we don’t know if we’re going to get those resources,” Windle said. “We’re busting out of the seams in this building.”

This article has been condensed for print. The full version can be found online.

Special to The Chronicle DukeReach allows students to submit reports about their friends who may be suffering from mental health issues.

8 | WEDNESDAY, NOVEMBER 29, 2017

DRUG USE

TOWERVIEW

his friends actually feel.

“I’m very aware of the fact that the one-inten-billion chance that I happened to be born adulthood can be very shocking,” she said. into the family that I was born into affected the However, McLawhorn noted that those with way that my life went,” he said. status may feel protected because their families McLawhorn noted that TROSA participants get the best lawyers and leverage connections in could offer insights to a Duke student. adverse situations. As a result, run-ins with the “No one, no matter what kind of economic law might leave certain users to face only a “slap background they come from, nobody’s on the wrist.” guaranteed anything,” she said.

“I think everyone deserves a second chance, but not everyone gets one,” she said.

Fragile, fallible, human She said that high-achieving, functional drug Hollowell said that University initiatives like users can only juggle competing interests for DuWell help students approach questions of so long. But the collision between reality and recreational drug use in terms of personal health repercussions may come slower to those with and wellness. However, he does not believe unconditional support systems. She would not Duke frames the risks or implications of drug expect drug users who have always been enabled use as an issue involving lives of people in the to expect heavy punishment.

Durham community, or even as a broader social So what ends up shattering that sense of or community issue. invincibility?

He does not necessarily hold students “It just depends on if they run across responsible for that lack of consideration. somebody that’s not going to allow that to “After all, students consider what we as a continue happening,” she said. “At some point in University invite them to consider,” he said. your life, you’re going to come across someone Institutional structures make it so that attaining who will…set boundaries with you.” the benefit of the doubt is never fully out of reach McLawhorn said that drug users from poorer for Duke students. As a result, many operate as families might face more challenging pitfalls than though they live outside the scope of the law. those with access to resources, but all people face Would students act differently if we were the same core susceptibility to drug use. forced to more deeply consider the ripple effects “Whether you go to Duke or whether you caused by this invincible attitude? go to Durham Tech, you’re a human being. All Perhaps yes, perhaps no. But hopefully we human beings are fallible,” she said. would think within a framework larger than McLawhorn believes it is important for that of our distorted world, and at least act with everyone to learn about homelessness and awareness about how our lives are intertwined addiction, regardless of whether people feel with the lives of others. separate from these issues. “There are homeless Should students be capable of undertaking people standing on the corner, and you have no this consideration ourselves, without prompting idea what led them to that point,” she said. from an institution?

The first student said that if he were to Yes—but when instinct fails, power structures pass by a person dealing drugs in downtown can provide insight.

Durham, he and his friends might make Beyond Campus Drive, Duke students are derogatory assumptions about the person’s not masters of the universe. Ultimately, we will character or background. However, he said face life’s storms as anybody else does: fragile, those comments would not reflect how he or fallible, human.

FROM PAGE 3

EATING DISORDERS FROM PAGE 6 textbooks propped up on their machines.

“It’s sad that we’re so stressed out that we can’t even separate our studying from our exercising,” Zucker said.

Liccione also cited Greek life as a potential stressor that intensifies eating disorders at Duke.

Although she is not in a sorority, she said she has noticed this among her friends.

“During formal season, it’s very much about appearing appealing—fitting into your formal dress, making sure you’re appearing in-shape for beach week,” Liccione said. “Look at the number of Greek letter-embalmed tank tops in the HIIT classes. You go to the gym, and everybody’s got their letters on.”

Emily has seen girls struggle to appear perfect in order to fit in with her sorority. She said they’ve started having chats where everyone shares their feelings. But outside of these chats, when she notices a friend looking upset and checks in with her, the friend brushes her away.

This disturbs Emily, since it was the openness about her eating disorder that allowed her to improve so quickly. When she arrived at Duke, she shared the story of her AN with everybody and people would look aghast and ask her why she was telling them about it, to which she would respond “because it made me who I am.”

She believes part of the problem is that as soon as you join a sorority, you are forced to make several dozen new best friends. You are not going to forge deep connections immediately, so you are less inclined to tell your new sorority sister when you are having a bad morning, she said.

“They’re all trying to be as cool as possible,” Emily said.

Liccione said her own eating habits worsened at Duke, not necessarily because of the pressure to exercise or look fit but due to the rhetoric about how busy people are. When

The Chronicle her anorexia began to spiral out of control, her schedule was so packed that on Tuesdays and Thursdays she didn’t have time to eat between 7 a.m. and 5 p.m.

Yet, Liccione thought that was normal, because it seemed that everyone around her had just as little free time.

Zucker said that when she learned about the aforementioned ACHA survey, the statistic about loneliness was particularly bothersome.

Duke undergraduates reported feeling “very lonely” at a significantly higher rate compared to their national peers. About 60 percent of college students surveyed reported feeling very lonely at least once in the past 12 months, but nearly 80 percent of Duke students surveyed had felt that way.

“It’s the perfect storm,” Zucker said, alluding to Liccione’s point about overcrowded schedules.

“It’s very easy for people to get in a rigid routine of studying all the time, exercising very hard, not having a break, falling down the slippery slope of disordered eating pathology.”

Despite its higher rates of exercise and anorexia, Duke has made strides in recent years to combat these problems.

Liccione has noticed a difference in Duke’s approach to mental health, even since she arrived on campus four years ago. “[Back then], there was next to no mention of dealing with mental illness, CAPS was something that was very ‘hush hush,’ and there was no [National Alliance on Mental Illness] chapter,” Liccione said.

Liccione said one of the aspects of Duke’s approach to mental health which helped her the most during her time off was its commitment to seeing its students through until they graduate.

“One of the things [Dean Sabrina Thomas, director of the Office of Student Returns] does is make a point of saying and acting on this, ‘once you get admitted, we’re committed to seeing you through and graduated,’” she said.