When sophomore Violet Rhodes* got into Dartmouth, she heaved a big sigh of relief. She worked hard during high school, and now she was due for a break from the intensity. Dartmouth was her dream school: her father attended as an undergrad, and both parents graduated from Tuck. "I'm proud of my parents," she says. "They went to top schools and have degrees, and I wanted to do that, too."

But her family had another legacy, as well. "I knew my grandfather was always kind of kooky. My father had been on some kind of daily medication. My mother had had a [troubled] period too, and my brother also had struggles," she explains. Her twin sister's senior-year leave of absence seemed to be of little concern: "I was always the high-achieving daughter." At least until her sophomore fall, when she took a medical leave to deal with her depression.

Violet is hardly the only college student struggling with psychological problems. According to the 2007 National Survey of Counseling Center Directors , 8.5 percent of students sought counseling during the past academic year, and 91.5 percent of the directors surveyed reported that they found a greater number of students with severe psychological problems on their campuses. Reputable publications like the New York Times, Slate.com and Time magazine frequently mention the fact that better health resources and medication are allowing more psychologically troubled students to make it to college. Dartmouth first-year Dean Gail Zimmerman states that more students are coming into Dartmouth disclosing pre-existing disorders, but she believes that this change is due to "some indication of the lessening of stigma" surrounding psychological health issues rather than an increase in students with such problems.

Whatever the cause, the media has thrown these students into the limelight lately. The past few years have seen controversial cases like that of MIT student Elizabeth Shin who died after setting herself on fire, but whose parents had never been notified about her college record of mental health struggle; Jordan Nott, who was barred from George Washington University campus after admitting himself to the hospital, due to feelings of depression and fleeting suicidal thoughts; and Cho Seung-Hui, whose history of psychological problems was largely ignored by Virginia Tech, leading to the historic and tragic school shooting. According to Mark Reed, director of Dartmouth College's counseling and health resources department, "[for a while] the Boston Globe made MIT out to be the suicide capital of the world. Out of its student population of 10000 there was a suicide each year for 11 years. But in fact their numbers are close to the national average."

At Dartmouth, the reality is that students experience psychological problems that span the entire spectrum - from severe mood, learning or eating disorders to relatively 'normal' problems involving stress and sleep. But Dartmouth students have an uncanny talent of appearing happy and well-adjusted, regardless of the inner turmoil they may be experiencing. Jennifer Hughes*, a sophomore who is combating depression and a recently developed eating disorder, says that "I have an astounding ability to act like I'm okay even if I'm not, because I've dealt with this for so long that you couldn't tell." Even though it doesn't show, she has been struggling with depression since about the age of two. "When I couldn't bounce a ball I'd start crying, even though nobody else could either," she says. At high school, she was unhappy but protected by the secure 'bubble' that her family and long-time friends provided. Once she arrived at Dartmouth, she was taken thousands of miles away from that support, and by her freshman winter her depression had started to get worse, and then snowballed out of control. .While being isolated from her friends and family in an unfamiliar environment certainly didn't help, Jennifer adds that, at home, "the stakes weren't as high" and she didn't feel the same overwhelming pressure to succeed. Nevertheless, she pushed valiantly on, keeping busy with sports and studies, until sophomore fall, when she had a complete mental breakdown and ended up at the Dartmouth Hitchcock Medical Center.

The first year of college challenges almost every aspect of a student's life. "[There are] changes in eating, sleeping and stress levels," says Zimmerman. "And the average age of onset for psychological disorders is eighteen to twenty five. It's a ripe recipe for something bad to happen." Violet says that insecurity over her suddenly-less-than-perfect grades, gaining the 'freshman fifteen', and experiencing 'boy drama' contributed to her breakdown. Besides being a new and strange environment, Dartmouth College's academic atmosphere is more rigorous than even the most intense of prep schools..) Students may dismiss this fact, and continue to feel the need to be academically 'perfect', which can lead to feelings of inadequacy. Jon Finnegan*, a sophomore diagnosed with attention deficiency and hyperactivity disorder (ADHD), depression and hypomania, explains, "Dartmouth is intense, and just being clever isn't enough anymore."

The psychological problems themselves can also make everything from academics to socializing much more complicated. Jake Watts*, a junior who suffers from bipolar disorder and borderline personality disorder, had to change his major from Economics to History in order to better accommodate his condition. He says that Economics classes assign constant, small assignments, but History classes are all papers and exams, which he can better work around his "screwed up" moods. Nevertheless, in spite of this change, "academics have been the biggest frustration for me, because some days it's just not going to happen and there isn't really much you can do about it. Your mind just works a certain way and it's very hard to control." He adds that being in a depressed or manic phase in a small school like Dartmouth can create strong social tensions. "When I'm manic I go out more, but I'm also outside of myself, and I alienate people." He has often felt disappointed with the constrained, fraternity-dominated social scene at Dartmouth. "I like to go out to parties and play pong, but that introduces new chemicals into my brain which just makes things worse. And I feel that I can only fit into this little place [the frats], and once that option isn't available I don't have anything."

Most psychologically troubled students usually end up utilizing the resources in Dick's House, whether upon their own decision, or at the prompting of a professor, dean, or other member of the College. Reed states that "we see roughly 20 percent of the students each year for counseling issues." The counseling and health resources department at Dick's House is staffed by five psychologists and one part-time psychologist, two psychiatrists, and two social workers. Often, this isn't enough to meet students' needs.

"The average counselor sees roughly 150-170 different students per year," says Reed. "We do primarily short term therapy due to the number of students we see, but we see some students with the [Dartmouth] health plan, who also have more serious or long term mental health issues, on a long term basis. Even if all the appointments are booked in a given day, we will make time to see anyone with an urgent issue immediately if the situation is very serious." Dick's House also helps students find counselors in the area, and has a ten-bed infirmary which is used for a variety of purposes.

However, according to an article in The Dartmouth, health resources appear to be spread so thinly, that "the average Dartmouth student waits five days to meet with a Dick's House counselor." And Jake and Jennifer have more grievances with Dick's House that stretch beyond counselor availability. "Dick's House is full of people who are very nice, sweet and who mean well," Jake admits, "but they need to completely overhaul their system, or privatize." Since his freshman fall he has been through six different counselors, and found his sessions with them comparable to writing a journal, as opposed to an actual 'medical' approach where his problem was diagnosed, and its symptoms and coping methods were explained to him in a straightforward and transparent manner. Finally, he switched to an off-campus psychiatrist who was more helpful and put him on medication.

Jennifer says her experience with Dick's House "sucked." She did not feel a connection with her counselor, and did not feel that he understood or believed what she was telling him. Because she isn't on the Dartmouth health plan, Dick's House sent her an email recommending a handful of off-campus counselors. "For people who were in my situation, you don't just send them an email with some names three days after their last appointment," she says. "You actually have to teach them how to navigate the insurance system, and how to make an appointment with a therapist. And I was freaking out, because an appointment with an off-campus counselor would show up on my insurance bill, and I didn't want my parents to know [that I was seeking counseling]." However, Reed cautions that while students may feel dissatisfied with certain aspects of their campus counseling services, eighteen to twenty-five year olds in 'the real world' typically have it much harder, as they have reduced access to care and may not be able to afford it.

In addition to counseling services, medical leave is also an option which is open to students. According to Reed, fifty to sixty students per year take medical leave due to psychological reasons - the majority of which are voluntary. "A few times a year, we think about an involuntary leave," he says, "if someone is a significant threat to themselves or others or community." The way the process works is that the student meets with a staff member of Dick's House to undergo a medical assessment, and they send a recommendation to the student's dean. The final decision whether or not to grant the leave rests with the dean - some deans are known to be more accommodating than others. After the leave is granted, the student meets with his dean and counselor and draws up a set of conditions he needs to meet before he returns to campus. Most of the time, these conditions involve beginning psychological treatment and medication, and later sustaining some sort of job, in order to improve his performance in a structured environment similar to college's.

Students temporarily barred from campus usually experience some 'culture shock' upon returning home. After being admitted to the hospital, Jennifer was prompted by the College to withdraw from fall term and to take winter term off as well, and was sent home.. "[Home] was pretty lonely, all my friends were at school and I was stuck at home. I didn't get out much, but I did gain some perspective." When she got home, she immediately started seeing a psychiatrist and a therapist. She was able to return to Dartmouth her sophomore spring.

When Violet applied for a medical leave in the middle of her sophomore fall, she was determined to return that spring. She says that the process of returning to Dartmouth was extremely stressful. "Basically, medical leave is easy to go on but hard to go off. [Officially], you have to apply a term in advance to come back. I started my application in January, even though I didn't know I would be ready, and had to have faith that I would be ready by March. Dick's House and [the Dean's office] both deal with medical leave, but they both have completely different deadlines. But at the end of the process it's doubtful that they'll reject [your request to come back]."

Jon requested a medical leave when he was threatened with suspension at the end of freshman year due to bad academic standing. When suspended, a student is not allowed on campus at all. Jon was devastated by the prospect of being sent home, where he had a sour relationship with his mother, he would be cut off from his friends and work at Dartmouth, and he would have had less access to health resources. Since most of his poor academic work was due to his struggles with inattention and mood swings, he applied for a medical leave by describing his problems in a written statement and in an interview with his dean. His request was granted. He spent his sophomore fall on leave in Hanover, and began seeing a counselor at Dick's House and a psychiatrist in Norwich, Vermont, where he underwent diagnostic testing. By sophomore winter, Jon was taking classes again and making ample progress with coping with his disorders. "It's not so much the medical leave [itself that's important] as it is having time off," he says. Reed states that medical leave has certain benefits over being suspended, besides the obvious factor that a medical leave is not incriminating. Besides having access to campus, students can take courses in other institutions while on leave and receive transfer credit for them. They can also choose to terminate their leave whenever they are ready to do so, while suspensions are a nonnegotiable three-terms long.

Upon their return to campus, life is slowly improving for Jon, Jennifer, and Violet. Violet has continued to see a therapist at Dick's House, who is currently talking to her about possibly taking more leave time, transferring to another college, or dropping out of college altogether. But Violet says she plans to cling to Dartmouth with all her might. Her academics are still rocky, but she says she is having "a lot more fun and fulfillment than before. And I'm a lot more excited [about school] than before. I'm working on feeling happy." Jake, who did not take a medical leave, says that this year, he is a lot more comfortable with his own identity, and realizes that the most important thing is to figure out what works for him, and to stay away from anything that may be 'bad' for him. Jennifer is looking forward to her sophomore summer, and to continuing her studies in neuroscience. Next winter she plans to speak on a student panel aiming to reduce the stigma mental health issues at Dartmouth. She says emphatically that Dartmouth students, while not suffering from psychological disorders, are a lot more problematic than they would care to show. "Look around. The students here are all ready to explode."

Violet realized that she was not the only student who was less-than-perfect when she sent a long email to her friends explaining her plans to take a medical leave. "I got the most amazing responses. So many people said I was brave [for doing this], when I felt cowardly. But a lot of people also said that they wished they could do what I was doing... I got the feeling that nobody is alone and everyone feels the same things." When the interview wound down, and we were getting up to leave, she pointed out to me that people had been periodically looking over at us as we talked. She tells me that she wants them to hear what she has to say. "I want them to feel like they're not alone. They aren't the only ones with problems."

*Name changed at request, to protect privacy