The Stanford Daily Magazine Vol. III Issue 5 (05.14.19)

MAGAZINE T H E H E A LT H E D I T I O N VOLUME III

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ISSUE V

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MAY 17, 2019

OAE p.

MENTAL HEALTH p. 8

ALLERGIES p. 10

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The Stanford Daily MAGAZINE

THE HEA LT H E D I T I O N EDITOR-IN-CHIEF Claire Wang EXECUTIVE EDITOR Anna-Sofia Lesiv MAGAZINE EDITORS Katie Keller, Elizabeth Lindqwister MANAGING EDITORS Amir Abou-Jaoude, Chloe Barreau, Ellie Bowen, Michael Espinosa, Claire Francis, Dylan Grosz, Julia Ingram, Jacob Kuppermann, Karen Kurosawa, Miranda Li, Elizabeth Lindqwister, Jackie O’Neil, Evan Peng, Bobby Pragada, Ashwin Ramaswami, Leily Rezvani, Alejandro Salinas, Erin Woo LAYOUT Shirley Cai, Harry Cole, Maya Harris, Yifei He, Sarah Kim, Miranda Li, Anna Manafova, Annie Ng, Cathy Yang BUSINESS MANAGER Regan Pecjak AD SALES MANAGER Evan Gonzales DIRECTOR OF ALUMNI DEVELOPMENT Arianna Lombard

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news 10

ALLERGIES Dr. Kari Nadeau is breaking new ground in curing lifethreatening food allergies, Charlie Curnin reports.

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OAE Hannah Knowles and Courtney Douglas investigate the difficulties many students with disabilities face in receiving OAE accomodations.

opinions 8 MILLENNIAL MYSTIQUE Terence Zhao contextualizes the mental health epidemic within the broader socioeconomic difficulties that millennials face.

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GRAD MENTAL HEALTH Francis Aguisanda demands grassroots and institutional change towards solving the graduate student mental health crisis at Stanford.

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DISORDERED EATING Claire Dinshaw and Emily Elott discuss the manifestations and causes of disordered eating, in its many forms.

sports 4 SYNCHRO Gillian Brassil reflects on her bittersweet experience with synchronized swimming and the profound ways it shaped her.

arts & life 13

DISABILITY IN BALLET Amir Abou-Jaoude examines the way famed ballet dancers Nijinsky and Nureyev were portrayed by critics in light of their disabilities.

the grind 30

SEX POSITIVITY

What is it like to be at Stanford and not be ready for sex? Alanna Flores argues this situation is more common than the “hookup culture” would have you believe.

creative 28 LIGHTROOM A collection of campus spaces that embody peace and quiet.

Volume III, Issue V

From the editors: Health has increasingly become a central topic of the current Stanford zeitgeist. Over the last year, students have fought the University in a class-action lawsuit that alleges discrimination against students with mental health disabilities; 30 years of advocacy has culminated in last year’s movement to create a permanent disability community center on campus; students are beginning to think more critically about disability identity and the privilege derived from able-bodiedness. Yet for every story about health that gains public exposure, there are many more that are kept private — health and disability are personal, nuanced and often still stigmatized.

It’s not easy to handle physical and mental health issues while responding to the demands of being a Stanford student, and it can be even harder to do so in silence. We wanted to use the pages of this magazine to amplify these narratives. While this magazine only scratches the surface of our community’s relationship with health, we intend to contribute to an ongoing conversation about these issues. These articles are far from representative of the entire disability community, and we hope that more voices continue to come forward and fill in these gaps. Our aim has been to make a small contribution to the patchwork process of representation and visibility.

With love for the magazine and for the Stanford community, Katie Keller ’19 Liz Lindqwister ’21

EVAN PENG / The Stanford Daily

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CROSSWORD Solve an all-new crossword by none other than the puzzle master himself, Grant Coalmer.

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On Leaving the Sport That Raised Me: An Athlete’s Choice Between Her Sport and Her Health

by Gillian Brassil

I

qualified for my first Olympic trials when I was 14 years old. Getting there was hard, but leaving the sport was harder.

Synchronized swimming (now artistic swimming), as Wikipedia defines it, is a “hybrid form of swimming, dance and gymnastics, consisting of swimmers performing a synchronized routine of elaborate moves in the water, accompanied by music.”

Some people still see synchronized swimming (synchro for short) as underwater dancing performed to 1950s showtunes, but to me, it was therapy. Slipping beneath the surface, creating chlorinated currents with a cupped hand — I felt powerful. A synchro swimmer is strong physically and mentally. We lift our teammates to new heights — figuratively and literally. It is the ultimate team sport.

Synchro was my home. My safe haven. My identity.

But synchro almost killed me.

Athletics are a way of life and every sport has its hurdles. Mental health issues in athletics are hard to treat and Stanford offers some resources for its athletes in need, but what are you supposed to do if you were burnt out before you even got here?

Maybe you’re a synchro swimmer, maybe you’re a varsity athlete, maybe you’re someone with a passion for something that you’ve left behind. No All photos courtesy of Gillian Brassil

matter what that passion is, you’ve likely had a love-hate relationship with it. This is mine.

Therapy

When I was in preschool, I spent a month bedridden with a Kawasakiimitation disease followed by pneumonia. I was small for my age and suffered from severe asthma. The combination of these ailments set me up to focus on academics rather than athletics. Still, my parents wanted me to be recreationally active, so they signed me up for gymnastics and ballet.

But when I was nine, I was diagnosed with hypermobility syndrome (real-world doublejointedness). I spent a year off and on crutches while my overly flexible joints prohibited me from participating on the dance floor. The doctors said, “No land sports.” Luckily, my mother met the daughter of a synchro coach who convinced her that it would be a good sport for me to try.

I started at my local YMCA in Andover, Massachusetts. By the time I turned 11, I had been talent-identified, as the search for synchro swimmers across the nation grew to save the dying sport. From there, I participated in a series of USA National Team camps and trials, which brought me to the Olympic Training Center in Colorado.

Even though I did not make the 11-12 aged National Team, I knew I wanted to swim at Stanford some day.

Stanford was and remains in Issue 5 | 5

the top two synchro schools in the nation.

My parents came from nothing: My mother worked two jobs while pregnant with me to pay her way through law school and my father dropped out of college to become a firefighter. My grades weren’t going to be strong enough on their own, especially if I couldn’t afford tuition.

That’s when synchro swimming became my family’s life.

My mother picked up synchro coaching to aid our tiny team — but at some point, I started losing her as a mother. When I went home at night, we only talked about synchro or about the homework I needed to do. We used to fight over how I spent my time; if I wasn’t studying, I should be stretching. Mostly, we argued over my crippling shyness.

Through swimming, I learned how to express myself. After presenting myself in the pool, it translated elsewhere. In middle school, I made new friends. I flirted back when pre-pubescent boys talked to me. I befriended my teammates.

My presentation in the water carried me a long way — so far that my family realized the small club team where I started couldn’t sustain my drive.

When I was 14, after realizing that my scores at Nationals qualified me to try out for the first phase of the 2012 Olympic trials, my mother started speaking to other coaches at a talent-identification camp.

Although I had been invited to try out for a lot of National Teams, I had never made the final cut. My mother decided it was time to ship me out west to train with one of the best synchronized swimming teams in the country: the Walnut Creek Aquanuts.

My mother told me that I could either stay in Massachusetts and never swim again or move across the country. Above all, she said she hoped it would give us the space we needed to repair our relationship.

Three weeks after that camp, I moved to a one-bedroom apartment in Moraga, California with my father, but I wasn’t the first synchro swimmer to move West. Most of my coaches had done the same thing, and many of them have at least one Olympic title.

I devoted myself entirely to synchro. I did my homework in the library during lunch.

I only ate meals during car rides — always the same: milk for breakfast, peanut butter sandwich for lunch and chicken with broccoli and carrots for dinner. Swimming 30 hours per week, I would have my father take me to the pool to swim on my own when I didn’t have practice.

I landed a spot on my first National Team that year. Instead of competing for them, however, I went on to represent the U.S. at the most highly regarded competition in the world for swimmers under age 15: the Mediterranean Cup. Although I placed well and left a strong impression on the international community, the most important thing I gained in Torrevieja, Spain was friendships with swimmers from all over the world. I was reminded that despite political differences, these swimmers could come together for the love of synchro.

That reminder helped me come out of my shell and further fueled my passion. I visited my mother and found that our relationship had greatly recovered. I started building bonds with other kids at school. I started chatting with my teammates about things unrelated to synchro. I was set up for a happier year in California.

Through swimming, I learned how to express myself.

California

My freshman year of high school, I didn’t make any friends at school; instead, 6 | The Stanford Daily Magazine, Vol. 255

Dark clouds

Synchro had been my therapy, but when I was 15, I was torn from it with multiple injuries. I fractured a rib but continued to swim. I recovered with a mild misshappenness, but the real trouble came when I tried to front-flip into the pool and landed headfirst on the deck instead.

I remember my teammates crying while one of them held my blood-covered swim cap. I was too shocked to cry. Strapping me to a backboard, the lifeguard pulled me out of the water amid the faint sound of blaring sirens. My coach was tear-stricken on the phone with my father. It was winter. I was shivering in my swimsuit and the paramedics kept asking me what day it was and how many fingers they were holding up as they loaded me into the ambulance.

My tears came when they called my mother and she started yelling at me over the phone, “Are you stupid? I told you this would

happen.” That phone call left me numb.

The doctors stapled my head shut, no anesthesia required.

But the worst part of it was that I wasn’t allowed to swim for the next 10 days.

Nationals were in 14. For the first time since the beginning of my freshman year, a sadness clouded my vision. I was disappointed in myself, my relationship with my mother was on edge and I felt like I was letting my team down.

Still, 10 days passed and I not only competed in, but also placed well in, all the events I had intended to at Nationals, going on to earn a spot on the Junior National Team for that summer.

But that safety didn’t follow me to Riverside, California, where I was training with the National Team. Already hindered by asthma in the dry, southern California air, I decided to try something I’d only tried once before: having someone backflip off of my shoulders.

I had jumped off of people’s shoulders before, but I’d never had someone jump off of mine. The National Team coach, whose harsh style of coaching preceded her, was making us do a punishment set. I was too afraid to say that I wasn’t ready to serve as a springboard, so at the end of a long, hard practice, in an attempt to impress my coach, I let my teammate attempt take a leap of faith off of me.

I don’t clearly remember what happened next.

Someone pulled me to the surface. I remember hearing “come to the wall” and I complied. A few days later, I was tested for a concussion. The doctor said not only was I severely concussed, but also I likely had a brain bleed. I’m lucky to be writing this article for you today.

My mother flew out to take care of me — a bonding moment for us — but when she went home, I was left alone in the team cottages with my concussed thoughts. They weren’t happy ones.

Searing headaches made it hard for me to be awake for more than three hours at a time.

I had no hobbies, no television that I was able to watch.

That’s when I realized I was not only lost without swimming, I was dependent on it.

An identity

I tried to get in the pool two months later, but the water pressure drove sharp pains through my brain, so I left the National Team behind and visited Andover for the first time in nine months. I pushed myself through National Team trials to make the 2014 Junior

National Team — a team that was expected to build the foundation for the 2016 Olympic team — but my efforts in those tryouts led me to collapse in my classes at school. I went to a brain doctor, who told me I should end my synchro career or risk never recovering.

For a while, I held onto my identity. I pushed myself harder in the pool, training up to 45 hours per week, fueled by my desire to compete at Junior Worlds in Helsinki, Finland. I often ignored the pains in my head, taking the medicine which the doctors prescribed to stimulate brain cell repair.

Ultimately, I turned down my spot on the 2016 Olympic team after I was recruited

by Stanford. It was one of the hardest decisions I’ve ever had to make, but it showed me something that I had previously undervalued: synchro-life balance.

I returned to my high school and the Walnut Creek Aquanuts. I still swam before and after school for at least 35 hours per week, but I contributed more vocally in class and in the pool. My relationship with synchro felt healthier. The promise of swimming at a world-class academic institution like Stanford meant that I would be able to be more than a swimmer again.

Although I came in second when the Aquanuts competed at Nationals, my team won and I enjoyed the journey. We competed in Switzerland that summer; it was the last time I would carry the American flag for my country.

At Stanford

Once I got to Stanford, I realized that not only was collegiate synchro very different from National Teams, college-Gillian was very different from old-Gillian. I had access to something I never had growing up: time to build real relationships outside the pool, and a desire to do so.

Practice was capped at 20 hours per week under NCAA rules, allowing me more time to focus on the side of me which thrives outside of the pool. The atmosphere at practice was more relaxed. But often, practice felt like a chore. I loved my Stanford teammates and coaches, so why didn’t I like what I was doing?

This dissonance stuck with me. I still defined myself as a synchro swimmer, but people started to like me before they realized I swam. I stayed up until 4 a.m. with my friends despite my 5:15 a.m. alarm. I could have dedicated myself to synchro more, but I didn’t want to. I was burned out from doing the only thing I knew how to do as a kid.

But I was afraid to quit. I kept swimming

through my first three years at Stanford.

In the end, it took time away from Stanford for me to realize that your identity is never set and that no one expects you to be the same person you always were.

My junior spring, my uncle overdosed on heroin and died. I got the phone call that he was brain dead around midnight on Thursday. I stayed up all night and got a bus ticket home from New York City so that I could be there after we pulled him off life support.

My family recognized that I was no longer a child, and they turned to me for advice. I helped choose the photos we used on the funeral cards; I edited the obituary for the paper. I carried my uncle’s 31-year-old son with cerebral palsy down the steps of the church. I drove the leading car in the funeral procession.

Ultimately, I realized that although synchro shaped me into the woman I am, I am more than it now.

That tragedy helped me understand that I had the strength to leave the sport that raised me.

The only person standing in my way was me.

I stopped swimming this fall. After two full-fledged concussions, multiple broken bones and lots of heartache, I left the sport that taught me how to speak — taught me that if I worked hard enough, I could achieve anything. It taught me how to build the best relationships I’ve ever had.

Synchro is always with me, just in a different capacity. I can happily reflect on both the good and bad times, even if they were just ... times. I’m forever grateful for the people and training that molded me into the person I am today.

Although it’s been a while since I’ve competed, the lessons that synchronized swimming taught me have translated into everything I do. That’s something I’ll never lose.

All photos courtesy of Gillian Brassil

Contact Gillian Brassil at gbrassil@stanford.edu

Issue 5 | 7

The Millennial Mystique A socioeconomic contextualization of the mental health epidemic

I

’ve had enough experience with speaker events about mental health to know that they proceed in predictable ways — the speaker’s story will strike a chord with the audience, who will then crowd the speaker to tell them about how much they related to their story. I was one of these speakers once, at the 2018 New Student Orientation. After my talk, I was bombarded with compliments from well-meaning people ranging from audience members to a Vice Provost: things like how much my mental health struggles resonated with people, how powerful the narrative was and how important it was that narratives of mental health are being elevated, especially at a time when so many people are facing similar struggles in their own lives.

On the one hand, I of course appreciated the kind words and take them for the compliments that they were clearly meant to be. But, on the 8 | The Stanford Daily Magazine, Vol. 255

other, I couldn’t help but feel how strange it was that something like this would be considered a compliment. Replace “mental health issues” with any other illness, and you’ll see what I mean. Imagine someone saying something like: “It must be so rewarding to see and know that there are so many people in that audience who also struggle with pneumonia, and who deeply resonate with your story and love that these pneumonic narratives are brought to the forefront…”

We can and should be grateful that increased mental health awareness has resulted in decreased stigma and taboo. But to declare victory on this alone would be ludicrous. Just because there has been a reduction in the taboo around mental health doesn’t mean there isn’t still plenty of stigma for talking about it or seeking treatment — even in places like Stanford where mental health issues are comparatively less stigmatized.

For one thing, cultural change must be accompanied by robust improvements to an institutional and medical infrastructure that is, at present, sorely lacking. Both access to and quality of care continue to be dangerously inadequate, and one doesn’t need to look far to see these conditions. On Stanford’s campus, Counseling and Psychological Services (CAPS) continues to struggle with long wait times and an inability to provide adequate long-term care.

As much as we can talk about the need for the University to increase funding for CAPS, the situation remains that even at a place of such concentrated wealth and resources, mental health services are just not keeping up.

Though the necessity of better infrastructure for treatment and services is real, we must confront the underlying crisis and ask: What exactly has turned the mental health issue into an epidemic?

EVAN PENG / The Stanford Daily

by Terence Zhao When Betty Friedan’s “The Feminine Mystique” was first published in 1963, it sent shockwaves through society by being the first to point out the “problem that has no name” — namely, the widespread unhappiness of middle-class housewives in American society, which Friedan attributed to their societallyenforced exclusion from the workplace.

Friedan argued that middle-class women should be allowed to head to the workplace rather than be confined to domestic roles.

That suggestion was revolutionary for the time. It showed that the way society was organized — that is, the status quo, the accepted way of doing things — was actually causing deep hurt to women and their psychological well-being on a horrific scale.

And, indeed, it is high time to question once again whether the way our society works in our “business as usual” manner is making us sick. Research has already demonstrated

that economic anxiety tends to translate to worsening of mental health in myriad ways: For example, that unemployment worsens one’s mental health, that poverty and mental health issues often go hand in hand, or that, as one group of researchers from Columbia put it, if you’re “anxious” or “depressed”, “you might be suffering from capitalism.” We also know that the economic anxiety of this kind is very real at Stanford (as obscured by our obscene outward wealth as it can often be), where students are at times reduced to literally foraging fruits just so they could feed themselves.

When talking about mental health, then, we can’t forget about the overall economic state of our society, which is progressively worsening — especially for young people. The costs of basic life have skyrocketed. The cost of a home has risen to $119,000 in 2000, up more than threefold from what it was in 1940 even after accounting for inflation. It is no surprise, then, that the age profile of homebuyers in the US have changed significantly — in 1981, they were 25-34; now, they are 44. Cost of education has also skyrocketed to around 17 times what it had been in 1971. In fact, the cost of a college education is currently growing eight times as fast as wages. It is also no surprise, then, that the typical U.S. college student is now carrying $30,100 in student loans at the time of graduation.

Yet, at the same time, the job market has not kept up. Millennials, for example, currently face a 45 percent underemployment rate, which makes actually landing a decent-paying job that could enable paying for these increased costs — especially a job in a specific field of study — far from a certainty. Moreover, entry-level wages have noticeably sagged. The average young worker in 2012 was paid about 58 percent of the average wage in the country, compared to young workers in 1980, who were paid about 82 percent of it. All of this has millennials as the first generation in American

history to earn less than their parents. For the average millennial born in the 1980’s, the chance that they will outearn their parents is less than half, which means that only a minority of millennials could be winners of this economic game by out-competing the majority of their peers either through circumstance or hard work.

In light of all this, it is plain to see that this mental health epidemic, while it may have caught many by surprise, did not come from nowhere: It came from a society that is becoming increasingly stratified and hypercompetitive, leaving everyone feeling more precarious, more under pressure and more stressed to push themselves to their limits to emerge as the winners of an increasingly winner-take-all system. We are rushing to optimize everything else in our lives at the expense of the most basic aspect of our existence — the health of our minds and bodies, and it is leaving us all more miserable because of it.

In the short term, I would love for everyone to be able to sit down with a professional and talk about their mental health, and I would love for everyone to be able to get the mental health treatments they need and deserve.

This would not come cheap, but it would certainly be cheaper than the $16 trillion that the mental health crisis is on track to cost the global economy within the next decade.

However, just as importantly, I also am certain that merely offering treatment for the symptoms would not be enough.

We need to confront the root cause of the problem and examine the frightening ways in which, somehow, a mental health epidemic has become just another negative externality of the culture and society we live in. As one panelist at a February mental health event here at Stanford put it: “We can’t stay on the merry go round, we have to fix the merry-go-round.”

For one thing, cultural change must be accompanied by robust improvements to an institutional and medical infrastructure that is, at present, sorely lacking.

Contact Terence Zhao at zhaoy@stanford.edu.

Issue 5 | 9

Experimental procedure offers relief from even the most severe food allergies.

“T

here were times that Dr. Nadeau and other people were like, ‘It’s okay if you stop,’” said Nicole Orsak ’21. “But I was like, ‘No, I didn’t come all this way for nothing.’”

Orsak, now a sophomore studying management science and engineering, was 10 years old when she enrolled in a clinical trial run by Kari Nadeau to conquer her severe food allergies. While the process was arduous, Orsak says, the results have been life-changing.

At one year of age, Orsak was diagnosed with allergies to peanuts, tree nuts, soy, dairy and egg — with a few others sprinkled in for good measure, like strawberry and mushroom. Her reactions were so severe they repeatedly resulted in anaphylaxis that brought her to the emergency room.

And so her parents sought the counsel of Nadeau, already an established expert on allergies and asthma. Nadeau’s renown has grown still since then, with authorship or co-authorship on more than 160 scientific publications, a laundry list of awards, and a $24 million gift from tech titan Sean Parker that established her as the director of Stanford’s Sean N. Parker Center for Allergy and Asthma Research. A 2013 New York Times profile christened Nadeau “The Allergy Buster” for her work in treating patients’ food allergies through a technique known as allergen immunotherapy.

First developed in 1911 by two British physicians, allergen immunotherapy involves exposing individuals to the very things they are allergic to — at first in minuscule doses, then steadily larger quantities. Nadeau has made considerable advances to the technique, accelerating the desensitization process and even treating patients for multiple allergies concurrently.

“We ventured into the food allergy field because of the needs of the patients — because patients had been dealing with this epidemic,” Nadeau said.

The technique has been revolutionary in minimizing the dangers that people with allergies face on a daily basis, but it is not a complete cure. The process does not erase a patient’s allergies so much as it trains their body to suppress them, raising the amount

It’s not easy.

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By Charlie Curnin

Transformational results

Christina Stankey, a senior studying biology at Yale, describes growing up with food allergies as a “marshmallow test” — a reference to the famous Stanford experiment on children’s capacity for delayed gratification.

“I would turn down a slice of birthday cake or other potentially dangerous food in favor of a safe food later,” she wrote in an email to The Daily.

But other times the severe dangers posed by her allergies were impossible to avoid.

“After my older brother spilled milk in my car seat, I took one of my many ambulance rides to the hospital in anaphylactic shock,” Stankey wrote. “Food allergies taught me to be resourceful, and I enjoyed the usual childhood trio of school, friends, and sports with EpiPens at my side.”

During her senior year of high school, Stankey entered one of Nadeau’s clinical trials with a treatment plan to be desensitized to seven different allergens — all at the same time. “In mere months,” she said, she began to see improvement. Eventually, Nadeau’s treatment enabled her to explore restaurants, cook new meals with her family and study abroad in Italy.

“I could not have envisioned a life free from the dangers of allergic disease were it not for Dr. Nadeau,” she wrote. “Epinephrine had saved my life; immunotherapy transformed it.”

In her early teens, Orsak was hesitant to join Nadeau’s trial. In addition to potential side effects of the treatment, she was afraid of the IV needles she’d need to endure on the first day. But after two anaphylactic reactions within the span of a few weeks, she decided she had few other options.

“I realized I could be living my life as safe as possible and still have this freak reaction,” she said.

Having outgrown her other allergies, she joined Nadeau’s clinical trial to alleviate her severe reactions to peanuts. (Nadeau, she says, also figured out a way to remove the IV requirement.) Every day for three years, until her “graduation” from immunotherapy, she ate small amounts of peanut flour designed to train her immune system.

Orsak, who says she was one of Nadeau’s first oral immunotherapy patients, thinks her therapy may have been particularly grueling because of the severity of her allergies.

“I had a very difficult time tolerating the dosage,” Orsak said. “I would do my dose — which you have to do every day — and I would have severe reactions to it. At one point I even had an anaphylactic reaction to my dose.”

Some days, she said, her daily dose of peanut flour would cause “excruciating” pain, sending her to the couch screaming.

But even as Nadeau offered her outs — and she watched other patients quit the trial — she remained intent on finishing her treatment.

“I stayed in the trial knowing I could not continue to live my life as I had before,” Orsak said.

“Epinephrine had saved my life; immunotherapy transformed it.”

—Christina Stankey To this day, Orsak maintains her results by ingesting small portions of peanuts every other day. She finally feels free from the persistent anxiety of accidental contact with an allergen.

“I probably would not be here right now and living my life as I am if it hadn’t been for Dr. Nadeau,” she said.

Courtesy of Bren Barna

of allergens their immune system can safely handle. Even after finishing a clinical trial, most patients must consistently take a “maintenance dose” through which they sustain their desensitization.

The treatment involves significant obstacles. The oral immunotherapy itself can trigger a dangerous physical reaction in some cases. Psychologically, patients say eating a sample of food which they know they are allergic to — and being on guard for a reaction, whether it comes or not — can be distressing.

“You have to do it daily, so that’s rough on people,” Nadeau said. “It’s tough to get into the habit of doing that. And these are kids that were previously told that this could harm them.”

Still, many describe the treatment as nothing short of a miracle.

Nicole Orsak ‘21

A powerhouse

Patient descriptions of Nadeau read like the thesaurus entry for exceptional: “kind,” “smart,” “compassionate,” “exceptional,” “amazing,” “incredible.”

“That woman is a powerhouse,” Orsak said.

It is not surprising, then, that when some patients had difficulty with tolerating oral immunotherapy, Nadeau took note. She said her team has learned from the experience of early clinical trial participants and “pioneers,” and worked to find allergen immunotherapy doses that are effective while offering minimal side effects.

While the Parker Center continues to work on improving oral immunotherapy, Nadeau is also overseeing the development of techniques that don’t require patients to consume crushed morsels of their allergens.

One surprising partner is Sean Parker, former Facebook president and endower of Nadeau’s current research institution. Parker, who suffers from multiple severe allergies of his own, was reluctant to engage in treatments that involve oral ingestion or physical contact with an allergen — and pushed Nadeau to think about developing a vaccine, she said.

The vaccine is currently under development.

“It goes underneath the skin, and you only need four doses,” Nadeau said. “You never need to eat the food allergen. You never need to put it on your skin.”

Alongside mechanical engineering professor Sindy Tang, Nadeau is also working on replacing the “food challenge,” a diagnostic procedure in which a clinician investigates a patient’s allergies by introducing various allergens to them and observing their reactions.

“A lot of patients don’t like food challenges,” Nadeau said. “So when you see and hear the pain of the people in any diagnostic you are compelled to do something different.”

Issue 5 | 11

Kari Nadeau, MD, PhD Tang and Nadeau’s replacement procedure, Nadeau said, can provide similar diagnostic information from two drops of blood taken from an individual, meaning patients never have to come into physical contact with allergens.

In another Stanford collaboration, Nadeau and psychology professor Alia Crum, who leads the Mind & Body Lab, investigated the role of patients’ “mindsets” in allergy treatments.

Patients who were told to view symptoms of the treatment as signals of their bodies’ growing strength — instead of unfortunate side effects — saw improved outcomes from oral immunotherapy. Not only were they less anxious, but their bodies’ physiological responses were more robust.

“Our study was — pun-intended, I guess to some degree — mind-blowing because no one thought that by just changing the mindset alone that we would actually see the blood markers change,” Nadeau said. “And we actually did see them change.”

The research frontier

With the prevalence of food allergies rapidly rising, Nadeau describes an urgent need to develop better diagnostic, therapeutic and even preventative treatments for allergies. She has built a team of doctors, nurses and researchers who are unified in their commitment to this goal.

Nadeau has also brought into her labs a cohort of undergraduates, some of whom have experienced firsthand the benefits of her treatment.

In 2017, after finishing her oral immunotherapy treatment, Christina Stankey 12 | The Stanford Daily Magazine, Vol. 255

returned to Stanford’s Parker Center as a researcher. She studied the interactions of IgE and IgG4, antibodies associated with allergies, in patients undergoing oral immunotherapy for cashews.

“My time in the Nadeau Lab taught me that patient care and research are inextricably intertwined,” Stankey wrote. “The dramatic changes in antibody binding that I observed showed more than decreased biological reactivity; in these results I saw a child able to enjoy a store-bought birthday cake for the first

“There is hope.

The fact that I can walk around the next day and feel completely cured gives me hope that we can find that for everyone...”

—Eric Smith

Courtesy of Sean N. Parker Center for Allergy and Asthma Research

time and a mother able to drop her child off at school without worry.”

Eric Smith ’20 is a biology major studying microbes and immunity. He first encountered Nadeau’s work long before coming to Stanford, when an allergist put him a course of oral allergy drops for his environmental allergies.

The treatment involves consuming small amounts of allergens in liquid.

“Ever since starting oral drop therapy, it’s like I don’t even have seasonal allergies anymore,” Smith said.

“When I actually got into Stanford,” he added, “I thought, ‘hey, I really should find out who came up with this idea.’”

And so, as a freshman, he enrolled in MED 50N: “Translational Research: Turning Science into Medicine,” a former introductory seminar taught by Nadeau and Parker Center Senior Research Scientist and Stanford Center on the Legal Profession Research Fellow Deborah Freeland Ph.D. ’98 J.D. ’03. When the course ended, Smith asked Nadeau if he could work in her lab. She said yes, and he’s been there for the last three years.

Smith currently does research under Swati Acharya — “an incredible mentor” — on a project that investigates the protein biomarkers that appear during allergic reactions.

“It’s just good to know that I can help people with similar conditions,” Smith said. “There is hope. The fact that I can walk around the next day and feel completely cured gives me hope that we can find that for everyone, especially in this field.”

Contact Charlie Curnin at ccurnin@stanford. edu.

hidd n

struggl :

flaws in ballet’s disability narrative

by Amir Abou-Jaoude

Issue 5 | 13

T

he critic Susan Sontag once observed continue to affect how modern commenthat dancers differ from other artists. tators describe disability. While most writers They are “driven by notions of are able to describe an elegant arabesque perfection — perfect expressiveness, perfect or an impeccable pas-de-deux, they often technique.” As Sontag noted, “the daily life cannot come to terms with the physical or of every dancer is a fulltime struggle against mental handicaps that the dancers might be fatigue, strain, natural physical limitations experiencing. The stories of Nijinsky and and … injuries.” Because they are in pursuit Nureyev not only illuminate typical attitudes of perfection, “news of dancers’ injuries … toward disability in ballet, but also raise tends to be suppressed.” As they perform questions about how a critic should portray multiple times each week, dancers are disability in their writing. susceptible to a variety of common ailments, Granted, it is difficult to discuss disability from Achilles tendonitis to broken toes. in dance. There are no “cripples” in classical Still, in the last years of their lives, two ballet—especially not in the ballets themof the 20th century’s most legendary ballet selves. Take “Giselle” and “Marguerite and performers were beset with health issues far Armand,” two of the most beloved ballets more severe than a sprained ankle. Though in the repertoire. In “Giselle,” librettists they presented an image of perfection on Théophile Gautier and Jules-Henri Vernoy stage, Vaslav Nijinsky and Rudolf Nureyev de Saint-Georges convey the tragic tale of the were unique — both in their artistic promi- titular protagonist, who falls madly in love nence on the stage, and the severity of their with the dashing Albrecht. Upon realizstruggles out of the spotlight. ing that he is already Nijinsky’s dancing brought engaged, Giselle loses ballet into the modern age, ...critics used all reason. She dies in a and his sensuous style of mad frenzy, and the first movement inspired lumi- [Nijinsky and act ends. As every aficionaries from the sculptor Aunado knows, however, Nureyev’s] guste Rodin to the poet W.H. Giselle is resurrected Auden. His revolutionary disabilities in act two to perform ballets, including the “Aftera sublime pas-de-deux noon of a Faun” and the sen- as a pretext with Albrecht. While sational “The Rite of Spring,” for conveying the heroine of Frederick rejected classical convenAshton’s “Marguerite tions. Nijinsky eschewed larger and Armand” is beset by virile heroes and vivacious narratives. tuberculosis, not mental heroines to explore thorny illness, but her trials are issues of sexuality and vioalso glossed over with lence. His choreography was awe-inspiring artistry. not always graceful, but ofOn her deathbed, ten seemed harsh and unpolMarguerite reminisces ished. Although his works stunned audiences, about a handsome cavalier named Armand.

Nijinsky’s career was soon stunted by a dete- Suddenly, he appears, and they dance a rioration of his mental health. Soon after the triumphant duet. In both ballets, disability raucous premiere of “The Rite of Spring,” he is nothing more than a pretext for a pas-destarted to suffer from schizophrenia. He spent deux. the last three decades of his life in psychiatric Nijinsky’s performance in “Giselle” in hospitals and died destitute in 1950.

1911 was widely praised, and Ashton created When Nureyev defected from the Soviet “Marguerite and Armand” for Nureyev and Union in 1961 and began dancing in the his preferred dance partner, Margot Fonetyn.

West, balletomanes called him the greatest Their performances were widely praised. male dancer since Nijinsky. Nureyev quickly Nijinsky’s dazzling display of technique in became an international star, performing “Giselle” made audiences interested in his with a multitude of companies throughout experimental work with the Ballets Russes, the world. Even his critics admitted that he and Nureyev’s exquisite skill in “Marguerite brought ballet to the masses. Then, in the and Armand” demonstrated to Western 1980s, Nureyev contracted AIDS. He continaudiences that he was a major talent. Critics ued dancing until his death in 1993, chooswere so struck by these dancers’ abilities that ing to keep his diagnosis secret while his they overlooked problematic portrayals of abilities declined sharply. Only after his death disability. Perhaps it is not surprising that did the public discover how sick he was. when Nijinsky and Nureyev both became These dancers’ decisions to obscure their handicapped, critics treated their disabilities afflictions were personal choices, but they much like the librettists in the ballets. Instead 14 | The Stanford Daily Magazine, Vol. 255

of honestly addressing the obstacles Nijinsky and Nureyev faced, critics used their disabilities as a pretext for conveying larger narratives.

New York University English professor Ato Quayson organizes these narratives into overarching categories of “epiphanies” and “moral tests.” As an “epiphany,” an individual’s disability serves to awaken others to pervasive problems plaguing society. As a “moral test,” disability provides an opportunity for an individual to showcase their spiritual strength. Both of these tropes are common in writing about Nijinsky and Nureyev. Nijinsky’s schizophrenia serves as an “epiphany” to make audiences aware of social ills, while Nureyev’s struggle with AIDS demonstrates his dedication to ballet.

Lincoln Kirstein, the co-founder of the New York City Ballet, was one of the first intellectuals to analyze dance. Still, even this most erudite of scholars did not know how to effectively deal with Nijinsky’s disability. In his 1975 book “Nijinsky Dancing,” Kirstein chooses to relate an apocryphal story that draws a connection between Nijinsky’s schizophrenia and World War I. In 1918, just before Nijinsky was admitted to an asylum, he gave a final performance at the Swiss resort of Sils-Maria. He appeared “disturbed” and he seemed increasingly obsessed “with battle, horror, catastrophe, apocalypse.”

Before beginning the final performance, Nijinsky chillingly declared that he would enact for the audience “‘the war, which you did not prevent and for which you are responsible.’”

Kirstein describes Nijinsky’s disability as his “personal crucifixion,” but he also suggests that it has broader societal implications. After all, only “disturbed” decision makers would force an entire continent into a cataclysmic conflict due to their own obsession with battle, horror, catastrophe and apocalypse. Nijinsky may have schizophrenia, but to Kirstein, his schizophrenia elicited an epiphany from the audience: Europe’s leaders were mad because they chose not to prevent war. Nijinsky’s disability helps others recognize their own insanity. Just as Giselle’s madness seems frivolous, Nijinsky’s schizophrenia is simply a pretense.

This portrayal of his schizophrenia persists into more recent scholarship. In her 2013 book — the newest biography of Nijinsky — historian Lucy Moore asserts that Nijinsky’s schizophrenia was a result of “the social disjunct between his deprived childhood and the sophisticated world in which he moved as an adult.” Nijinsky’s disability supplies another epiphany to his audiences: Europe’s class system is inequitable. Therefore, as viewers stare at the “tragic image” of “the

stodgy, blank face of the mental patient,” they should be motivated to heal societal divides.

Overwhelmed with this litany of epiphanies, they need not pay attention to Nijinsky’s plight.

While Nureyev’s handicaps were different from Nijinsky’s, Nureyev’s disability was also treated as a metaphor when critics became aware of it. Even as he became gravely ill and his strength faltered, Nureyev continued to dance. Unaware of his battle with AIDS, critics reviewing his performances at the time simply saw subpar performances. In The New York Times in June 1986, dancer Georgina Parkinson expressed the contemporary consensus on Nureyev’s later work, writing that “Rudolf Nureyev … has almost destroyed his own legend.”

After Nureyev died in January 1993 and his diagnosis became public, critics began to reevaluate his final performances. In this new light, his command of technique became less important than the inner fortitude he showed in continuing to contribute to the ballet. As he was weakening, Nureyev choreographed the ballet “La Bayadère” for the Paris Opera.

In his biography of Nureyev, the journalist Peter Watson provides a vivid description of the premiere. Before arriving at the theater, Nureyev had “one of [his] bad days.” He was so weak that “a bed or chaise-longue had been prepared for him, banked with cushions” so he wouldn’t have to sit up in his box.

Although friends came to congratulate him on the occasion, “he couldn’t speak, partly because he was exhausted, partly because his mouth was filled with candidiasis, oral thrush.” In spite of all his physical limitations, however, Nureyev still went on stage at the end of the ballet to accept the audience’s applause. He “was too weak even to bow,” but he would not abandon the public. Watson’s detailed analysis of the moment renders Nureyev’s disability as a “moral test.” For Watson, AIDS reveals Nureyev’s boundless passion for ballet. By going out on to the stage, Nureyev proves that he loved his art form more than he cared for his own health.

By describing the dancers’ disabilities as “epiphanies” or “moral tests,” these authors elide complicated questions. Nijinsky kept a diary in the early stages of his schizophrenia, and it provides a powerful corrective to all

romanticized accounts of his illness. Alone in the asylum, Nijinsky felt lost and abandoned.

He feared his wife was having an affair with his doctor. As the diary continues, Nijinsky loses his grip on reality. Although some of these remarks have a prophetic gravitas about them, his statements become increasingly confused and nonsensical. Nijinsky claims “that the Earth is suffocating, and therefore I ask everyone to abandon factories and obey me … I know how to light a stove and will therefore be able to light up the earth.” In the context of the diary, it is impossible to interpret this comment as a protest against industrialization and a glorification of art. Every reader must accept the fact that the world’s greatest dancer became disabled.

While the narrative about Nureyev’s disability exalts his contributions to ballet, it transforms an extraordinarily complex human being into a trite inspirational figure.

Nureyev may have bravely continued to act in the best interests of the ballet until his death, but he neglected the concerns of others with AIDS. The writer Paul Monette castigated Nureyev upon his death. “Nureyev was a great artist,” Monette wrote, “… but great artists also owe a great deal, and their notoriety also includes the harder stuff, like a responsibility to the world around them.”

By refusing to admit that he had AIDS, Nureyev shirked that responsibility. Had he revealed the truth, he might have encouraged researchers and the public to pay more attention to the AIDS epidemic.

We must be vigilant about the clichés surrounding disability narratives. Sontag may be correct in asserting that Nijinsky and Nureyev were both “driven by perfection,” but it’s time to admit that stories of disability are not always perfect. We should resist the temptation to make them as clean and as rehearsed as a precise pas-de-deux or an unimpeachable pirouette, and instead commit ourselves to telling them as honestly as possible.

Contact Amir Abou-Jaoude at amir2 ‘at’ stanford.edu.

Issue 5 | 15

by Courtney Douglas and Hannah Knowles

“No laptops.”

16 | The Stanford Daily Magazine, Vol. 255 EVAN PENG / The Stanford Daily

For most students, it’s an easy ask — a common refrain among professors sick of pupils checking Facebook during discussion.

For Bryce Tuttle ‘20, it’s a problem.

Tuttle’s dyslexia means he writes slowly and nearly illegibly.

Typing helps him keep up. Last winter, as usual, he emailed an instructor his letter from Stanford’s Office of Accessible Education (OAE) outlining the disability accommodations the office had recommended for him, which included laptop use in class.

A few days later, Tuttle said, he received a phone call from his OAE advisor, who told him the instructor had a strict no-laptop policy and did not want to honor Tuttle’s accommodations.

“I could have made this a crusade or I could have just dealt with it and not used my accommodation, and I chose to do the latter,” Tuttle told The Daily. “I think lots and lots of students with disabilities choose to just do the latter when confronted with this kind of thing … I can either take this burden upon myself, or I can just ditch it.”

Stories like Tuttle’s have gotten more public attention since December, when another student opened up on her blog about her frustrations with Stanford’s disability accommodations.

Brooke Vittimberga’s blog post — half narrative, half how-to guide for other students with disabilities — circulated on social media, among administrators and, in February, the entire student body, thanks to an email blast from student government leaders. Vittimberga’s highly personal post detailed, in part, the challenges she said she’s come up against at Stanford as a cancer survivor seeking academic aids like excused absences and extensions.

“I want all students to know that your professors do not know what they are talking about!” Vittimberga wrote. “They do not know your rights. They will often tell you that an accommodation is not possible or reasonable when you have an absolute right to it.”

As student leaders make disability advocacy a top priority and push for a disability community center, some with disabilities say they struggle to get all their needs met in the classroom — and worry that others less willing to advocate for themselves lack aid to which they’re entitled.

Stanford’s OAE may provide guidance, but in the end, it is the faculty’s responsibility to weigh accommodations requests with course requirements and decide what’s reasonable.

Navigating this gray area of “reasonability” in accommodations decisions can be challenging for students and faculty alike.

Tuttle described a difficult power dynamic when students request their prescribed OAE accommodations from unwilling professors. He compared it to a concept from political science, the “second face of power.”

It’s “a power dynamic that’s enforced to a degree where you don’t see any visible conflict,” he explained, “because it’s so clear who’s going to win that no one ever fights against it.”

“I think that’s a lot of the accommodations process,” he added. “When students with disabilities see these kinds of policies they see these professors who seem immovable. So they just don’t even try.”

Recommendations, not requirements

Tuttle came to Stanford in part because of the strength that he saw in the OAE accommodations process. He needed to know he was going to a college that would be accessible to him.

“I toured other colleges, and when I said, ‘I have learning disability, how are you going to help me with that?’ the admissions officers were like, ‘Oh, you know, I’m sure we [can] figure that out somehow,’” Tuttle recounted. “Stanford had a very clear answer. I met with people from

the OAE, and I knew that there was a robust accommodation, she said, but she can draw on infrastructure. I knew I’d be able to get my 30 years of case law for precedents. readings done.”

In ambiguous situations where, say, a student Seventeen percent of the student body was wants to make up a problem set, Gonzalez registered with OAE for academic or housing typically talks with the professor about their accommodations at the end of the 2017-18 options; she said she’s never encountered a school year, though not everyone chooses to situation where stronger intervention seemed use their accommodations. That’s more than necessary. Could the professor use another double the percentage of students registered in faculty member’s p-set? Could they have the 2009-10. student attest under Stanford’s Honor Code Tuttle said OAE has been quite helpful, that they have not used others’ answers? especially in setting him up with technology “I could see their being uncomfortable with to turn long PDF documents into speech. doing that for more than one time,” she said.

But he’s found that the office cannot override “But I would hope that that faculty member professors who balk at accommodations they might sort of want to think out of the box to find disruptive. think, ‘How else can I assess what I’m trying to All OAE letters reviewed by The Daily teach here.’” contained the sentence, “Based upon review of [the student’s] functional limitations, I Not worth it am recommending the following academic OAE says it hears often from faculty who accommodations.” The letters’ language of feel that a student’s OAE requests infringe requests, rather than directives, underscores too much on their class — faculty like Tuttle’s OAE’s role as a mediator between students and Program in Writing and Rhetoric (PWR) professors rather than an advocate for students instructor, who didn’t want to make an alone. exception to his no-laptop policy.

Letters emphasize that “academic Tuttle said that after multiple conversations modifications should in no way compromise with his OAE advisor, who acted as an the essential elements” intermediary between of a professor’s course.

Tuttle and the teacher, This is in line with the he decided to drop the Stanford’s OAE may 1990 Americans with issue. The advisor offered provide guidance, but in Disabilities Act (ADA), a to tell the instructor the end, it is the faculty’s landmark civil rights law that Tuttle needed the that says schools must responsibility to weigh accommodations. But provide accommodations Tuttle, who had already accommodations for students with been trying to convey requests with course disabilities, unless the how important the requirements accommodations would laptop was, realized he cause an “undue burden” and decide what’s didn’t want to force the or change the fundamental instructor’s hand. reasonable. nature of a program.

“It’s a small seminar Though faculty at course where he would be Stanford are “strongly grading everything I was encouraged” to reconsider attendance rules doing personally, and I didn’t want to deal with for students who may have to miss class due that dynamic for the rest of the quarter,” Tuttle to disability, OAE affirms that professors “are said. under no obligation” to revise their attendance Feeling uncomfortable with the situation, policies for these students.

Tuttle asked OAE if it could help him switch Even the grievance process intended PWR classes. According to Tuttle, OAE said to resolve disputes over a student’s he should take up his request directly with the accommodations does not give faculty PWR department. The first week of the quarter mandates. Instead, the process involves was over, and Tuttle was concerned that by the conversations with faculty to find a solution, time he switched classes he would be too far explained Rosa Gonzalez, who oversees the behind in his new class to catch up. He decided grievance system in Stanford’s Diversity and that fighting for his accommodation just wasn’t Access office. worth it.

When a student’s dispute proceeds to a “I have the liberty [and the] the luck formal grievance process — which Gonzalez to be like, ‘Okay well I can not take my estimated happens in only five or so cases accommodation and I’ll still probably pass,’” each year — Gonzalez gathers facts about the Tuttle said. “Other people don’t have that situation and writes a report. Disability law option.” is vague about what constitutes a reasonable Issue 5 | 17

OAE said it is unable to speak to specific students’ situations. However, the office’s online guidance for faculty states that it’s “reasonable” to make an exception to laptop policies for a student with an accommodation.

OAE told The Daily it does not know how many students decide not to use their accommodations or set them aside after encountering resistance. Asked how frequently students drop requests due to worries about how an instructor will perceive them, OAE added in a statement that from its “experience with thousands of students, it is not an issue that students mention often.”

OAE said it typically refers students to academic advising or Undergraduate Advising

and Research (UAR) when they need to switch class sections. It will communicate directly with a department when a need is “program or course-specific, and directly related to an access issue.”

“We make every effort to be responsive, act quickly, and resolve issues as they arise,” OAE wrote.

PWR Faculty Director Adam Banks, like OAE, said he could not comment on students’ situations for privacy reasons. But the program’s policy, he wrote in an email to The Daily, is that “accommodations recommended by the OAE should be provided when students share an accommodation letter with their instructor.” PWR encourages instructors to

come to program leaders with questions on how to provide these aids, Banks added.

Tuttle recalled thinking that he, of all people, should be able to advocate for himself.

He’s played a leading role in the push for a disability community center at Stanford.

This school year, he’s serving in student government as director of disability advocacy.

Tuttle emailed his PWR instructor looking to talk his concerns over, and they turned to the issue one morning after a meeting to discuss Tuttle’s research topic. Tuttle recalled the instructor saying he could have used his laptop in class if he really wanted to, though the teacher preferred no computers. Tuttle, on the other hand, said it would be difficult to go against the teacher’s wishes given the inherent power imbalance in their relationship.

“When a professor asks the student not to use their accommodation, they’re not going to use it because they’re going to feel uncomfortable for the rest of the quarter,” Tuttle remembers saying.

“He just kind of refused to understand why what he did made me really uncomfortable,” he added.

Behind the blog post

EVAN PENG / The Stanford Daily

EVAN / TheDaily Stanford Daily Vol. 255 18 | ThePENG Stanford Magazine,

Bryce Tuttle ’20

Brooke Vittimberga ’19

Vittimberga, the student whose blog post sparked conversations around campus, echoed Tuttle’s worries that a professor’s resistance to an accommodation — even if they’re ultimately willing to budge — can effectively prevent a student from getting what they need. Vittimberga is the daughter of a college professor; she suspects she knows better than most how to navigate University processes and stick up for herself.

When decisions about disability accommodations are applied unevenly, she said, at the will of professors, that adds “additional layers of discrimination” — “some students come from backgrounds that have better prepared them to advocate for themselves.”

When Vittimberga ended up in the hospital in May 2017, she missed one of her organic chemistry labs. She’d come back to Stanford that winter after spending a year and a half fighting off and recovering from leukemia, a cancer of the blood and bone marrow. She landed in the emergency room for a few days about once a month. Because she was suppressing an immune system that had turned against her, even a fever could turn into a major threat, and she had to go in preemptively each time an illness flared.

Vittimberga, whose OAE letter recommends she get extensions and not be penalized for absences, sought to excuse the missed lab. But Brennan declined, saying Vittimberga would have to take a zero since

she hadn’t requested the accommodation in advance. The lecturer had already waived two of Vittimberga’s problem sets in lieu of giving her extensions — the chemistry department had and continues to have a policy of removing excused assignments from a student’s grade calculations, rather than taking late submissions.

“Since you have already been excused for missed work, even though for legitimate reasons, I am starting to become uncomfortable with being able to say that you actually completed enough of the course if there is much more absences etc.,” Brennan wrote in an email to Vittimberga, which Vittimberga shared with The Daily. “I strongly urge you to talk with your UAR advisor, since even if I excuse the work, I am not entirely sure I am doing you a favor in the long run.”

In some ways, Vittimberga’s experience in organic chemistry shows how OAE can be an effective mediator between students and faculty, stepping in when they disagree. Emails Vittimberga provided show that the lab grade dispute was resolved more quickly and with more help from OAE than her blog post conveys: Brennan agreed to waive the lab four days later, after an OAE advisor intervened on Vittimberga’s behalf.

“Based on Brooke’s disability, I support her being able to make up lab work as possible,” wrote Vittimberga’s OAE advisor, Carleigh Kude, in an email to Brennan. “I am wondering if we can discuss the policy against lab makeups and determine if making an exception in Brooke’s case qualifies as a reasonable accommodation.”

In a follow-up email to Vittimberga later that day, Kude relayed that Brennan would not, in fact, penalize Vittimberga for the missed lab, though resource constraints meant she would not be able to make it up.

However, the waived lab did not alleviate Vittimberga’s discomfort with having to argue for an accommodation, nor did it address the more systemic problems she saw with faculty attitudes toward disability. Vittimberga emphasized both of these issues when asked why she left OAE’s intervention and Brennan’s reversal on the lab score out of her post.

“There’s a difference when you walk into a room and someone says, you know, I’m here to support you … and if you have an absence let’s work it out and come to office hours,” Vittimberga said. “We’re not asking for people to make leaps and bounds, we’re just asking them to follow the law.”

Other students’ responses to Vittimberga’s blog post have indicated to her that she is not alone in receiving pushback on accommodation requests, especially in the chemistry department.

“I don’t know if I’m going to continue across majors. premed, chem, or just work on other things According to Vittimberga, Stack in more supportive departments,” one student emphasized the difficulty of providing wrote to her last month (he did not respond to certain academic accommodations, saying outreach from The Daily). at one point that the chemistry department Typically it’s fine if a student misses a lab for was already stretched thin accommodating illness, Brennan wrote in an email to The Daily, student-athletes’ schedules. At the end, as the lab would simply be excused. Absences Vittimberga said, she asked Stack what become harder to excuse as they accumulate, he would have her do as a student taking she added, because chemistry, given her students need certain disability. training in lab techniques “I guess you have to “We make every to move on safely to other take it elsewhere,” she chemistry courses. says he told her. effort to be “These situations “My jaw dropped,” responsive, act are usually handled Vittimberga recounts on a case by case basis in her blog post. quickly, and resolve and we do our best to “Since that day, I have issues as they arise,” be accommodating to heard those words students given their thousands of times OAE wrote. circumstances all the in my mind.” She while being fair to the argues the chemistry other students in our department’s approach class,” Brennan wrote. to accommodations OAE wrote in a violates the ADA. statement that the office Stack told The follows an “interactive process” when talking Daily he does not recall the details of the to faculty about whether an accommodation conversation from a year and half ago and, is reasonable. OAE staff do not disclose regardless, did not want to speak to particulars details of a student’s disability, but they do of Vittimberga’s case. But he reiterated his view “identify the accommodation as appropriate that some accommodations are too challenging for [it],” try to understand whether an to provide. accommodation will undermine the class at a “I think she was asking for something that fundamental level, and mull over alternative we just couldn’t deliver,” he said. ways to accommodate a student, OAE Asked about Vittimberga’s takeaway from said. Sometimes, staff will talk with other their talk — that students with certain needs administrators and department chairs. should not take chemistry at Stanford — Stack “Rarely do we discuss legal precedent, said he does not think he would have said that. unless it is a very commonly upheld The department accommodates “to the best of accommodation, because every student and our ability given the resources that we have,” he every class context, is unique and must be added. He said he may have been explaining his examined on a case-by-case basis,” OAE personal philosophy on balancing academics wrote. with other priorities, one he’s given many Vittimberga’s conversations with chemistry students through 25 years of advising, but that department didn’t end after her lab was he says has no bearing on chemistry’s approach excused. She had lingering questions about to OAE requests. her final grade tallying separate from the lab “Life events can really knock you off issue, which she said she felt more reluctant your game, and I think that trying to pursue to press after her other email exchanges. She chemistry, trying to pursue research, when you also wanted to push for a broader change in have a life event, is really difficult. Exceptionally how the department handled OAE needs. difficult,” he said. “It takes a long time to She didn’t want to get in more disputes, and get over such life events, and one does not many students, she thought, would have taken necessarily drill down very deep, you know.” a professor’s “no” to excusing an assignment For Vittimberga, whose disability isn’t or giving a makeup opportunity as the final going away soon, Stack’s view is deeply word. discouraging.

Her desire to resolve both her grading She maintains that more flexibility in questions and her overarching issues with the the chemistry department’s blanket policy department led her to speak in October 2017 of waiving assignments rather than giving with chemistry professor Dan Stack, who extensions would have helped her reassure her oversees lectures for chemistry “service courses,” instructor that she was learning enough of the the large introductory classes meant for students course. Maybe, she said, she could have Issue 5 | 19

finished the course the first time she took it, rather than taking an incomplete that she finished the next quarter. She understands the work involved in creating makeup assignments, but suggested she could have done old problem sets, bound by the Honor Code from looking at others’ answers.

Accommodations help “level the playing field,” she said.

“And you can never level the playing field,” she continued. “I went to school here for two years without any medical issues, and it was a million times easier.”

take exams a day late, it does not give exams after answers are released, due to cheating concerns.

Spurred by conversations with students like Vittimberga, and with help from OAE, Stack said, the chemistry department has worked to standardize its approach to accommodations requests. With safety concerns in mind, the department has new policies on how many labs a student can miss (attend fewer than six labs in CHEM 33, and you can’t pass the course). And since last school year, all disability requests for special exam conditions like extended time or distraction-free environments go to a central coordinator, a Faculty perspectives graduate student paid by OAE who handles History professor James Campbell said he what Stack says is a growing number of hasn’t run into difficulties accommodating requests each year. students, something he attributes in part to A decade ago, he recalls, a large chemistry his teaching philosophy. He sees assignments lecture of 300 people might have one or mostly as chances for students to learn, two students with OAE letters. Now, 15 rather than chances for them to be evaluated. is standard. Stack said the department So while he’s “not completely indifferent to has struggled to handle this jump and the concerns about fairness,” when a student asks corresponding work. for, say, an extension that he thinks will help “I truly love teaching, you know, intro them actually learn from the assignment, he’s organic [chemistry] … I think it’s just a likely to grant it — with or without an OAE beautiful subject,” he said. letter.

But, Stack continued, “If He views the Americans the courses become just an with Disabilities Act as Accommodations administrative nightmare, I “one of the crowning don’t want to be there.” achievements” of an help “level the A good chunk of that important civil rights era. playing field... and administrative work now “It is the law,” Campbell goes to sixth-year Ph.D. you can never level said. “And I revere it. And student Ariel Jacobs, the I am therefore committed the playing field,” department’s OAE exam to doing everything I [Vittimberga] said. coordinator. Finding space possibly can to ensure that for students who need all the students who come private exam rooms is through my classroom, tough, he said, though he however differently abled believes the department they might be, have an has developed a good opportunity to learn, to system — pressed for rooms, he worked succeed, to flourish.” with OAE recently to host some tests outside But Campbell understands why other chemistry’s home in the Sapp Center. Even professors would face more hurdles than trickier is timing for students who need he does in providing accommodations — professors of classes with hundreds of students double time on a final. Because students can’t take exams early, someone with a disability where creating new batches of problems could end up working on their test until 1 a.m. for makeup assessments is onerous. And — then head to another exam at 8 a.m. departments that have grappled with more These students aren’t happy, Jacobs said.

Honor Code violations might have extra “It’s a jigsaw puzzle,” he added. “It’s crazy.” reservations about, say, spreading out exam Some students said they understand times, he added. when teachers deem accommodations too These were some of the issues chemistry burdensome to implement. An undergraduate faculty cited. whose OAE accommodations also account for Makeup tests, labs and problem sets are class absences withdrew from a math course “not possible given the current resources that in fall 2018 after she missed a quiz — the have been allotted to these courses,” Stack weight of which would just be added to the said, and posting answers quickly so that weight of her final — and grew overwhelmed students can check answers is “important at the prospect of taking an exam without in these large, fast paced courses.” While smaller learning milestones. The student the department sometimes lets students 20 | The Stanford Daily Magazine, Vol. 255

asked her professor if she could take an incomplete; the professor said no.

But after dropping the course, the student — who said her teachers have been largely accommodating — was sympathetic to the professor’s policy against makeup tests.

“I do understand that the quarter system is really fast,” she said. “I imagine … the professor has to have a policy that they just won’t make up quizzes, because it just becomes too complicated. There’s a lot going on.”

Most professors The Daily spoke with, however, reported few problems providing disability accommodations. Some said they comply unequivocally with what the OAE recommends.

“From my standpoint the whole situation is very straightforward. If a student presents an OAE letter then I honor the accommodations provided in the letter,” wrote economics lecturer Scott McKeon in an email to The Daily.

“Period.”

The economics classes he’s aware of do not explicitly take attendance, so students do not request excused absences. He has only received accommodations requests related to exam times and extensions. “And, the rules laid out within the OAE letters have always been clearcut on those issues,” he said.

Fellow economics professor Chris Makler explained that official OAE decisions go through the the department’s registrar office, which he said has “really good processes” for dealing with requests smoothly.

“Ninety-nine percent of the time, things go off without a hitch,” Makler said.

Makler has a son with type 1 diabetes. Given that personal connection to disability, he even encourages some students to ask for OAE accommodations. “Get the letter so that you have extra time if you need to take the time to bring your glucose back in range,” he recalled telling diabetic students in his classes.

Similarly, English department chair Blakey Vermeule said she could not think of “a single case” in which a student came to an English professor with an accommodation request that they could not grant.

“I would always err on the side of trying to help the student to the fullest extent of my capacities,” she said. “And I think all the faculty in the English department feel the same way.”

Invisible needs

Two students with visible physical disabilities said they’ve never had an issue getting the accommodations they seek from faculty.

“The things that I need are pretty straightforward,” said Tilly Griffiths ’22, a freshman who uses a wheelchair. “People can see why I need them.”

EVAN PENG / The Stanford Daily

Issue 5 | 21

But others with so-called “invisible” disabilities said faculty might not notice when they’re struggling, or might question their use of accommodations. Tuttle spoke of unintended singling out of students whose disabilities may not be apparent — by professors who inadvertently make a student reveal their disability to peers, or who don’t realize that giving quizzes in the middle of a class poses challenges for a student with extra time accommodations.

An undergraduate who wished to remain anonymous to maintain privacy around her disability shared an email exchange with a faculty member from last spring in which she explained debilitating nerve pain from a knee surgery. The teacher agreed to set the student’s final presentation so that there would be room to reschedule if she was in too much pain.

When the student followed up to say she did “not feel prepared to present,” the instructor probed the student’s motives. The student was taken aback.

“If this were just a case in which you didn’t feel prepared, or in which you could have done the work to prepare but had freely chosen not to do it, you would still need to present tomorrow with everyone else,” the instructor wrote.

“I am very glad to support any accommodations that you need in order for this class to be accessible and inclusive for you,” she continued, “but not feeling prepared or choosing not to prepare are in a different category from OAE accommodations.”

The student’s knee pain came on top of another, more persistent autoimmune condition that she says sometimes makes her unable to focus and can leave her so tired she can barely lift a fork to eat. The symptoms are serious enough that she’s had to take a reduced course load for most of her time at Stanford. They make it difficult to predict how long she’ll need to complete an assignment; what’s typically a 20-minute task can easily balloon to two hours, she said. This can be even harder to explain to teachers.

“This fatigue thing – you can’t tell your teacher, I couldn’t do it because I was tired,” the student said. “That’s what they hear when you try to explain it.”

OAE letters don’t include the details of a student’s disability. Gonzalez from the Diversity and Access Office emphasized that students should not feel obligated to reveal this information to professors — in fact, she cautions students against doing so.

“People have their own biases or then their imagination goes sort of to the next degree,” she said. “Oh they’re not going to be able to do this, they’re not going to be able to do that.

And then I see it sometimes pop up in letters, 22 | The Stanford Daily Magazine, Vol. 255

like letters of recommendation – in spite of Rosa’s blindness, she did really well in my class.”

But multiple students told The Daily that the reason for an accommodation is likely to come up in conversations with faculty, especially when a student asks for extensions on assignments.

Julia — a senior who has been granted extensions and other OAE accommodations because of her struggles with sexual violence and post-traumatic stress disorder — recalled feeling uncomfortable approaching professors about her needs.

“It does, I think, take some grit and courage to send in your letter to your professor,” said Julia, whose last name The Daily has withheld due to the personal nature of her accommodations. “They are just meeting you.

I feel like the immediate thought is, ‘Oh my God, what’s wrong?’”

She said she has started off quarters hoping to get through classes without needing her accommodations, only to initiate more difficult discussions later. Per OAE policies, professors must accommodate students who send in their letters late in the quarter, though those accommodations do not apply retroactively — a student cannot get an extension on a deadline they have already missed.

Julia said she’s become a better advocate for herself.

“When it’s really come down to an extension or accommodation, that will make a huge difference to me,” she said. “I think I’m good at expressing how much I need it.”

Seeking change

Faced with students’ concerns, administrators said they’re open to feedback.

Lauren Schoenthaler, Stanford’s Senior Associate Vice Provost for Institutional Equity and Access, said the University’s training for new department chairs and deans this year spent more time discussing resources for faculty to help students with accommodations.

However, some students argued that this 15-minute segment is still short and said the University should provide better training for all faculty on academic accommodations.

Faculty know to include a standard “Student with Documented Disabilities” paragraph in their syllabi, outlining how students can request help through OAE. In Tuttle’s experience, though, professors’ knowledge doesn’t extend far beyond that.

“I think what really needs to be fixed is ... on the University level,” he said.

Professors mentioned periodic email reminders from the University about OAE

policies, and Schoenthaler said that this April’s two-hour sexual harassment training for all faculty and supervisors — held once every two years — would “briefly cover” accommodations, OAE and the Diversity and Access Office.

OAE is also working with other departments to “consider whether there are ways to harness resources and systems to support accommodations such as making up labs, and taking tests with extended time,” Schoenthaler wrote in an email. “If students have suggestions for streamlining accommodations, we would appreciate hearing them.”

And Gonzalez said she hopes more students will discover the Diversity and Access Office’s grievance process, which some students with disabilities told The Daily they were not aware of until recently. The grievance process is outlined on OAE’s website, and OAE said it refers students to the process when they are unhappy with accommodations or when they have experienced discrimination based on their disability. Before submitting a grievance, Schoenthaler added, students can talk confidentially with the University Ombuds, or non-confidentially with her about their options.

The grievance process asks that students submit complaints fewer than 10 days after the academic quarter in which their dispute arose.

But Gonzalez says she welcomes discussions of all issues and has investigated incidents more than a year past.

“I would say to anybody, come and talk to me,” she said.

Meanwhile, the ASSU has taken its own steps to raise awareness of resources like the grievance process available to those with disabilities. In the same February email to students that broadcasted Vittimberga’s story, ASSU executives Shanta Katipamula ’19 and Graduate School of Education Ph.D. student Rosie Nelson outlined several University processes that help students resolve academic disputes.

Other students, like Tuttle, are hoping for change in the way both students and faculty think about accommodations.

“I had a time where I didn’t feel like I was entitled to them,” Tuttle said. “It’s like, ‘Oh, we’re giving you extra …’ A lot of people, because of the way that feels to them, just don’t go for it when they need it.”

Contact Hannah Knowles at hknowles@ stanford.edu and Courtney Douglas at ccdouglas@stanford.edu.

Katie Keller and Elizabeth Lindqwister contributed to this report.

EVAN PENG / The Stanford Daily

Issue 5 | 23

Addressing the graduate student mental health crisis, at Stanford and across the country

by Francis Aguisanda

EVAN PENG / The Stanford Daily

24 | The Stanford Daily Magazine, Vol. 255

When I read that yet another graduate student passed away in their residence hall, I knew that we were only hearing about the tip of the iceberg. When you combine the academic pressures of Stanford with the food insecurity and the struggle for affordable healthcare that too many grad students face, it’s no wonder that a deadly mental health crisis has emerged among the graduate community.

What is it about Stanford that perpetuates a culture of misery? How it this culture of misery unique for graduate students? The answer to that question will be different for every person who sets foot on this campus.

For me, there was the prestige of Stanford itself. These halls have produced some of the finest minds in the world. To think that I would have the honor to follow in their footsteps was both inspiring and terrifying.

When I arrived here, I immediately felt the pressure to achieve: the pressure to spin off a new startup or “disrupt” a new space, the pressure to please academics who I’ve looked up to my whole life and the pressure of only having four more years to get on Forbes’ 30 Under 30 list. I was surrounded by brilliant students who were shooting for the stars, and I wasn’t sure if I could make it.

Depression and anxiety had reared their heads at other times in my life, but Stanford fed the fire. I had to leave the lab multiple times a day because I always felt that a panic attack was just around the corner. It felt like I was physically standing in water up to my neck, like an invisible force was crushing my chest and making it difficult to breathe. I would hide under the staircase in our building and cry, sometimes for seemingly no reason, only to dust myself off and get back to work. While I can’t speak for everyone’s experience, numerous opportunities to speak with my colleagues suggest that I’m not alone. When I share these painful experiences with fellow grad students, I am both comforted and saddened by how many can empathize.

Of course, it’s not all Stanford’s fault. The academic machine is famous for driving its trainees into the ground. There are many who believe that the survivors who rise from

the ashes do so because they possessed the mental grit to persevere. Those who make it through the trial by fire of an intense graduate program should proudly bare their scorch marks to the world. This harsh status quo, after all, is what laid the foundation and erected the walls of our ivory towers of academia. But, we need to reevaluate that status quo. A tower built on graduate student anguish stands as an endorsement for the methods that constructed it. Perhaps it’s time to tear it down.

What should be done to address graduate student mental health? I view barriers to mental health solutions as fitting into two general categories: a lack of resources, both financial and structural, and a general stigma against seeking help. I think that the best approach to solving this problem is to attack it from multiple angles. Solutions for mental health can start at every level of influence at Stanford, from the university administration to the academic departments to the grassroots of the graduate student community.

First, we need a transparent effort to allocate financial resources toward mental health support and infrastructure. Since I arrived at Stanford in 2016, the response from CAPS regarding long wait times is consistently “a lack of resources.” Last year, Stanford raised $1.13 billion in philanthropic gifts. Stanford also has an endowment that is larger than the gross domestic product of nearly a fourth of the countries in the world.

While I recognize that philanthropic gifts are often earmarked before they enter Stanford’s coffers, it is frustrating to hear Stanford brag about how much money it is pulling in without hearing about how this money will be used to address graduate student mental health.

We need everyone in the Stanford community, alumni network and beyond to raise their voices. If you are donating to Stanford, make it clear that you want your money to be used for mental health support.

How much money would it take to raise CAPS clinicians’ salaries enough to promote retention? What percentage of Stanford’s net worth would it take to hire enough clinicians to reduce patient waiting times or provide longer care? When I walk through campus and look at our perfectly manicured lawns and beautiful fountains, I can’t help but wonder if those dollars could have been spent on something more impactful.

Second, the administrations of every graduate program need to take this issue as seriously as they would take an imminent threat to research funding. A major barrier to graduate mental health at Stanford is that

there is no unifying drive among graduate students in other schools at Stanford might departments to address mental health. While as well be at another campus — we don’t some students in one program may have very have as many natural opportunities to meet sympathetic program directors that are each other. proactive about exploring mental health This is why it’s important for us to identify solutions, there is no guarantee that a student graduate mental health as an experience in another school will have the same common to all programs and use it to unite experience. If you are a graduate program us. For example, spaces where graduate director, I implore you to state openly to your students can come together and talk through colleagues that this is a problem that needs to their struggles are critical. The Graduate be addressed. Hold a roundtable discussion Student Council (GSC) has opened the with students, with faculty, then with both. conversation about graduate student mental Talk about it during your retreats. health by bringing together administrators Brainstorm ideas together on how to make and students for a series of town halls on the graduate mental health within your program matter. Organizations like the Student better. What pain points are students Biosciences Association (SBSA) and experiencing? Are they financial, academic BioAIMS have hosted panels where graduate or something else? students talk about their struggles with Speaking as a graduate student, it would mental health in graduate school. mean the world if the faculty in my program Experiences like this humanize the problem brought up the issue of mental health. and remind ourselves that this is a crisis Graduate programs should be transparent facing Stanford. These are our friends and with their students with colleagues, and we need to what their options are band together and commit to A tower built on regarding mental health solving this problem as a support, including taking graduate community — graduate student a leave of absence. discussing mental health only anguish stands as Explicitly stating that there in the context of national an endorsement are standard operating statistics makes the problem procedures in place for seem distant and nebulous. for the methods struggling students will Our graduate communities that constructed it. make students more are best able to come up with comfortable with seeking solutions that work for us Perhaps it’s time to them out. I am not naïve when we are consistently tear it down. enough to believe that getting together, talking having these procedures in about mental health, and place will be enough to identifying solutions that convince some advisors that taking a leave of are equitable and mindful of intersectionality. absence or seeking routine help is not Mental health care must work for all of us. indicative of a “weak” student, but I want action. I want concrete action. I communicating them effectively will be a first want to see money move. I don’t want efforts step toward reforming Stanford’s graduate to address our mental health crisis to live in student culture. executive summaries and slide decks. I want Lastly, we need to think about how we every struggling graduate student to feel like address graduate student mental health as a they don’t have to live in the shadows, know graduate student community. A pressing that their struggles are valid and believe that barrier to this effort is the difficulty of they deserve to be helped. I want all of this building community among graduate because I love this university. I love all that students. When I was an undergrad, I felt Stanford has taught me and the doors it has connected to my peers opened for me. As I prepare to leave this because we all shared so many common institution, it is my sincere hope that I leave a experiences. It didn’t matter what your major community that is ready to build on the was — everyone took general education momentum started by the students and staff classes, lived in residence halls with each who know that this issue is of critical other, went to homecoming and participated importance. in campus traditions. However, graduate students have a very different experience. Of Contact Francis Aguisanda at faguisan@ course, we are all excited to come to a great stanford.edu. school. But we are often more excited to join our specific programs and labs, and our emphasis on making connections exists in those realms. It often feels like the graduate Issue 5 | 25

HIDDEN EATING DISORDERS

How types of disordered eating slip through the cracks of college physical and psychological health

“I

mposter.” That’s the word Kay* used to describe the way she felt while receiving treatment for an eating disorder at Lucile Packard Children’s Hospital.

“I was convinced the entire time in the hospital that I didn’t have to be there,” Kay said.

“I was convinced I wasn’t sick because I knew people who had it worse.”

This feeling — of not being sick, or not sick enough — haunts many people who struggle with an eating disorder.

The eating disorder epidemic impacts a staggering number of adolescents. Data from one college, collected over a 13-year period, suggests that approximately 32 percent of college females and 25 percent of college males struggle with some form of an eating disorder.

Because eating disorders are among the most deadly mental illnesses, these statistics are particularly disconcerting. Some cases can leadto heart failure, impact brain function and damage fertility. Likelihood of recovery and survival is much higher if an individual receives help soon after developing an eating disorder. 70percent of people with eating disorders, however, never seek out treatment.

This is partially because our society has come to define eating disorders narrowly.

They are often portrayed as exclusive to upper-class adolescent females, whose eating disorders manifest as either anorexia, extreme undereating, or bulimia, over-eating and then purging. This narrow definition ignores 26 | The Stanford Daily Magazine, Vol. 255

by claire dinshaw and emily elott individuals suffering from less recognized (although not necessarily less common) eating disorders, including binge eating disorder and purging disorder. It props up the false stereotype that eating disorders are cases of extreme vanity or narcissism. And it excludes men or those who are gender nonconforming.

Furthermore, our narrow conception of eating disorders entirely neglects the larger spectrum of disordered eating: Eating behaviors that may not resemble a medically defined eating disorder, but lie somewhere on the continuum of problematic eating and exercise-related behaviors. These behaviors can include calorie counting, over-exercising and over-restricting food groups.

This underbelly of less-recognized eating disorders and disordered eating needs to be acknowledged. The varied stories of Stanford students’ struggles with food and exercise demonstrate that disordered eating and eating disorders are not exclusive to a narrow definition.

the role of college

The transition from high school to college imposes certain stressors that can trigger disordered eating among all students. Students with previous problems and students with healthier attitudes toward food can be affected. According to Robyn Tepper, Medical Director at Vaden Health Center, and Cynthia Kapphahn, Medical Director of the Eating Disorders Program at Lucile Packard

Children’s Hospital, a place like Stanford combines the standard academic and social pressures with a competitive environment that rewards both standing out and fitting in. This combination is an intoxicating draught to drink even for the most resilient of students.

“Colleges value drive and perfectionism,” Tepper and Kapphahn wrote in an email to The Daily. “[These] are qualities that can put you at risk for eating disorders.”

Donner Peer Health Educator (PHE) Julia Gillette ’20 emphasized that Stanford students may be particularly hard on themselves.

“People often strive for perfection, not only in their academic and athletic performance, but also in their self-perception regarding physical appearance [and] fitness,” Gillette wrote in an email to The Daily.

According to Kay, who says she had a positive relationship with food in high school, it was toward the end of freshman year when she first started noticing her peers’ eating and exercise habits.

“It kind of rubbed off on me in the way that it so often does,” Kay said. “I remember I didn’t know what a calorie was. And I remember people making fun of you for that. And then I went and found out what a calorie was, which was a bad thing for me to start doing.”

Kay was ultimately diagnosed with anorexia, but for some students the disordered

eating behaviors they adopt may not resemble a categorizable eating disorder.

the role of athletics

Especially in athletics, disordered eating can manifest itself in behaviors that are less frequently recognized as potentially unhealthy.

Kelsey Reed ’20 took ORTHO 97Q: “Sport, Exercise, and Health: Exploring Sports Medicine,” an introductory seminar in which one unit focused on a type of disordered eating particular to female athletes, recently named RED-S or Relative Energy Deficiency in Sport.

Reed, a member of the women’s club soccer team at Stanford, described what a person at risk of RED-S might experience.

“You have weights in the morning and then class all day, and you [don’t] have time to eat. Then, you have practice after class.” At this point, Reed added, “you haven’t eaten anything all day. You eat a massive dinner where all those calories might be the official amount for the day.”

Reed explained that the “energy deficient period” that this behavior creates while exercising can be damaging to the body. “You don’t necessarily have an eating disorder in the typical sense, but you’re not taking in enough calories to offset the amount of exercise you’re doing,” she said.

RED-S is just one example of disordered eating that might not be recognized for what it is. Particularly in a Stanford context, where student-athletes juggle enormous athletic responsibilities with the hectic reality of the quarter system, RED-S can surface, alongside other forms of disordered eating.

Reed also raised concerns about how disordered eating in student-athletes should be addressed. “Do you try to tell your athletes that they can’t play until they improve their eating habits?” she asked rhetorically of coaches and other leaders in Stanford athletics.

The answer is not simple, but it’s clear that the typical construction of eating disorders is too limited to encompass the full range of problems, especially those particular to student-athletes. This insufficiency becomes especially dangerous if these athletes don’t even realize that they may be damaging their bodies. They are just doing what they can to survive the day-to-day.

getting help

Kay’s best friend eventually convinced her to get help during her sophomore year. Kay called Counseling and Psychological Services (CAPS), but she was told she would not be

able to see someone for another four-to-six weeks. CAPS told her to begin seeing a doctor to get her vitals taken once a week in the meantime to treat the health problems the eating disorder was causing.

Tepper and Kapphahn acknowledged the urgency of both mental and physical health services in the treatment of eating disorders.

“Although therapy plays an essential role in any student’s recovery from an eating disorder, the medical and nutritional problems that result from eating disorders, must be treated, not only for safety reasons, but due to the significant impact the medical and nutritional consequences have on an the individual’s ability to recover,” they wrote.

Even after starting counseling, however, Kay did not feel like she was getting better.

Eventually, after her vitals dipped below a certain threshold, Kay spent two weeks in the hospital.

“It was just helping me become more selfaware of what my problem was, but I was like I know what my thought processes are a little bit more … but I had no power to stop,” Kay said.

"...I know what my thought processes are a little bit more... but I had no power to stop."

- Kay* Kay credits the resources she received in both inpatient and outpatient treatment as significantly helping her recovery, but she says that she could have received more resources earlier.

“I wish that they’d done a lot of things sooner rather than later,” Kay said.

For someone whose problem does not lead to visibly extreme weight loss or significantly depressed vitals, it might not be possible to get the inpatient and outpatient care that person needs to recover. In less extreme situations, it can also be difficult for friends and support networks to know when to step in.

“I don’t want to upset them or presume that I know better than they do,” Reed said. “How do you balance trying to figure out when, as a friend, you should say something or not say something?”

Especially when the current definition of eating disorders excludes people

who are counting calories, skipping meals and over-exercising, it’s hard to know when to bring up the issue. But if these problems go unrecognized, and therefore untreated, they can persist and, in some cases, become more severe.

The experience of those who suffer from anorexia and bulimia should not be discredited or diminished. However, our discussion of eating disorders and disordered eating must begin to acknowledge this gray area. No one should feel as if there is a voice in their head telling them they don’t deserve food.

No one should feel as if this voice is normal.

Inherent in most individuals who experience disordered eating or an eating disorder is the sense that they do not deserve food.

Maybe that means skipping all meals except one. Maybe that means counting calories, and then stopping at 500 or 200 or 100.

Maybe that means only eating fruits and vegetables — no protein, no carbs.

In contrast, Reed told us: “Food, as it is, makes me happy.”

Even if that sentiment doesn’t currently describe a student’s relationship with food, working toward it first requires an acknowledgment of difficulty. The gray area between a medically catastrophic eating disorder and a fully healthy relationship with food is legitimate, real and challenging to navigate.

Gillette encouraged anyone who may struggle with these less defined behavioral ticks or negative thoughts to seek out the numerous resources available on Stanford campus.

“Thankfully there are really great athletic nutritionists and psychological resources for athletes alongside CAPS and nutritionists in Vaden that are available for any student,” she said. *Name changed to protect privacy.

Contact Claire Dinshaw at cdinshaw@stanford.edu and Emily Elott at elotte@stanford. edu.

lightroom: peace & quiet 28 | The Stanford Daily Magazine, Vol. 255

EVAN PENG / The Stanford Daily

SHIRLEY CAI / The Stanford Daily

SHIRLEY CAI / The Stanford Daily

MALIA MENDEZ/ The Stanford Daily

Issue 5 | 29

Sexual life at Stanford T

he word “hookup” is still fertile ground for some good oldfashioned parental disapproval.

Casual hookups, however, have changed their perceived status from taboo to commonplace liberating behavior.

Unfortunately, casual sexual interactions alone are often intertwined with the idea of sexpositivity. This promising, yet at times, narrow societal perception can make people feel restricted.

More than simply codifying the hookup culture, Stanford’s atmosphere of sex-positivity, in this light, should aim to be one of increased self-empowerment, choice and inclusivity.

Given college campuses’ common portrayal as a sexual free-for-all, we might expect campus hookups to be at an all-time high in this era of encouragement. Stanford’s casual hookup culture, in contrast, is hardly flourishing. In a survey of Stanford students conducted

by The Daily, about 67.2 percent

Illustrations by Cathy Yang 30 | The Stanford Daily Magazine, Vol. 255

said that when they engage in sexual acts, they are rarely or never casual hookups. Perhaps this reflects a quiet majority of Stanford students who are less than thrilled by the prospect of diving headfirst into the culture here.

While some students would like to be more active in this manner, others do not have the desire to engage. Our private values and reservations, as well as prior sexual education, play a large role in how we interpret these cultural sex-pectations.

It can be hard to separate our individual conceptions from external expectation and confusion. As Ride Peer Health Educator (PHE) Sofia Poe ’19 said, “some people don’t know how to or whether they should be putting themselves out there.”

Sexual Health Peer Resource Center (SHPRC) Co-President Amanda Hayes ’19 recognizes the challenges of bringing together people from diverse backgrounds of sexual desire,

experience and education.

She says prior education is incredibly variable, but rarely cohesive; some people have had an abstinence-only education while others have been privy to a basic conversation of “what birth control is and … what STI’s are [without] a discussion of pleasure.” In this way, college students entering Stanford come with vastly different sexual knowledge and experience, and can feel uncertain about how to engage with certain sexual conventions.

In her time at SHPRC, Hayes asks the question: “How do we make a sex-positive environment for people who aren’t yet comfortable with sex?”

Experimentation, although seen in the light of liberation and excitement, can often include intensely vulnerable emotions and general awkwardness.

This exploration, however, is a necessary part of building holistic sex lives that include honest conversations about our

A conversation about Stanford’s culture and sex positivity

by Alanna Flores

changing desires and emotions.

Hayes explains that we can connect by asking ourselves a few key personal questions: “How do I establish trust? How do I establish intimacy? How do I know what I like?” This form of self-empowerment and introspection can provide better communication between sexual partners.

“Hookup” can act as an umbrella term for a range of sexual behaviors: 62.1 percent of Stanford students in one survey assessed that the term’s meaning depended on the context of the situation. In this light, it can be difficult to verbalize the range of our sexual behaviors. Kimball PHE Kyle Dixon ’21 suggests ridding your sexual life of the outdated baseball reference, instead advocating for Al Vernacchio’s pizza as sex model: Instead of reaching certain bases, you’re sharing a pizza. Dixon adds, “There are no goals. You’re not trying to win. You’re trying to share something together and

you come to a consensus about what you want. If you don’t like anchovies, don’t put anchovies on the pizza.” This approach to sexual behavior removes the idea that there should be any timely milestones to reach.

There is little issue with discussing and even mocking sex on a surface level in a way that can turn our parents 50 shades of red. However, when it comes to the personal details of the intimate ways we want our pizza, we tend to take a verbal vacation.

The SHPRC general manager stresses the need for these conversations within peer networks that can act as support systems. This form of open and honest dialogue with yourself, potential partners and close friends is crucial, especially for those of LGBTQIA+ identities that are often underrepresented in discussions about sexual experience.

“When slowly exploring and talking to other people about it … have the courage to ask

questions,” urges West Lagunita PHE Ribhav Gupta ’19.

In this complex sexual landscape, we must be willing to communicate in a way that is compassionate and honest as well as inclusive of varying backgrounds and desires.

As Poe says, “It takes one person to change the conversation [and say] this is actually how I feel about sex.”

She adds, “Just be honest … and willing to put yourself out there.”

Contact Alanna Flores at alanna13 ‘at’ stanford.edu.

For more information about Sexual Health Resources visit SHPRC on the 2nd floor of the Vaden Health Center, see http:// shprc.stanford.edu/ or https:// vaden.stanford.edu/healthresources/sexual-health.

Issue 5 | 31

Crossword

by Grant Coalmer

Need help?

Solutions online at stanforddaily.com

Across: 5. Coincide with respect to time 7. The Nutcracker or Swan Lake, e.g.

8. When one has it good; cheers!

9. Last ____ Hero, 1993 10. Conventionally generalized image 11. To defeat emotionally

32 | The Stanford Daily Magazine, Vol. 255

Down: 1. Radical change in assumptions 2. ‘Fine’ eating experience 3. To place between two different things 4. Roughly thirty years’ worth of DNA 6. Puts a ball in play