Female University Student Reading a Book in a Library

5 Signs It Might Be Time to Take a Mental Health Leave From College

This post was written by Jason Bowman, the creator and Director of Fountain House’s College Re-Entry Program, which helps academically-engaged 18 to 30-year-old college students, who withdraw from their studies due to mental health challenges, return to college and successfully reach their educational goals. 

College can be exhilarating, but it can also be a vulnerable time for students with mental health challenges. Most college students I work with who are diagnosed with major depression, anxiety disorder, bipolar or schizophrenia, first experienced symptoms in their late teens or early 20s, while they were in college. Since this often coincides with the first time many college students are living on their own without a proper support system, it is all too easy for these students to quickly lose their ability to maintain “normal” or appropriate psychological defenses.  

While it can be difficult to assess a negative situation for oneself, in my experience, there are some notable signs that it might be better to take a medical leave and get support than it would be to struggle through another academic semester. What are those signs? How can you tell it is a good idea to take a leave?

Here are some things to look for:

1. Growing isolation.

You have stopped communicating with your friends, professors, counseling center staff. People are often unable to reach you. Your friends are seriously concerned about you. Everyone you meet asks how you are in a worried tone.

2. Noticeable symptoms.

You are experiencing overwhelming anxiety or depression. You cannot get out of bed because of anxiety or sadness. Simple acts of your daily life like showering or eating might feel too difficult.

3. Excessive substance use.

You are drinking more alcohol or using drugs to make yourself feel better when you are stressed. The amount you use is getting in the way of your ability to take care of your work and maybe even yourself. Often, overusing alcohol or drugs covers up some of the symptoms that come with mental health issues (psychosis, depression, mania).

4. Increasing number of incompletes.

You are behind on assignments with no plan to catch up. You are dropping multiple classes each semester or have frequent incompletes. While many students have occasional incompletes or drop a course every once in a while, frequent incompletes or dropped classes may be a sign of a bigger issue.

5. Available support services on or around your campus are not meeting your needs.

While the decision to take a medical leave is a serious one, it is important to recognize it is totally acceptable and fine to do so. Most colleges have policies and procedures in place that allow students the time they need to recover from a health condition. Giving your brain and body the clinical treatment and self-care regimen it needs to recover is a smart decision.

I often remind students that many undergraduates take more than four years to earn a degree. In fact, at most public universities, only 19 percent of full-time students earn a bachelor’s degree in four years. In addition, taking a medical leave can be better than struggling through with lower grades than you’d hoped and then figuring out how to get your GPA back up so you can graduate.

So, if you are struggling in school and don’t know what to do, reach out to your counseling center, family, and/or friends and let them help you. If you identify with one or more of the five signs outlined above, consider taking a medical leave so you can heal and return to college successfully.   

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Thinkstock photo via Digital Vision. 


Woman standing outside wearing a coat

To My Parents Who Worry About My Mental Illness

Hi Mum and Dad,

I can still see your faces when my depression diagnosis was explained to you. I had never seen that amount of hurt on your faces before. I had never seen you seem so lost and confused. That was a few years ago now and with an added burden of anxiety, I know how concerned you are about my mental health. I know, when I visited in 2013, you saw the worst I had ever been. Depression caused me to either be endlessly sleeping or sobbing, and it broke your hearts. I felt mine breaking too as I saw how much my state was affecting you.

I found out later why my behaviors were extra scary to you – mental illness has appeared in our family in the guise of our closest family members. A relative who couldn’t cope after knee surgery so she started hoarding. A family member who took to drugs when he couldn’t find employment. Another who took to drinking after her marriage collapsed.

And I guess this is what my depression and anxiety are to you two. You see your daughter, who by all rights should be considered successful — always in the top percentile at school and university, surrounded by friends while performing in choirs and bands, working in a profitable career for many years now. An overachiever by far. Happily married and living my own life states away from my hometown.

I don’t see myself that way. Well, my depression and anxiety don’t let me picture myself that way. I think of myself as a big failure. I work so hard because nothing is ever good enough. There was always too much paperwork or planning when I was working. High expectations and stress of meeting them left me with many sleepless nights and many missed meals. Managers who told me I was a waste of space, when I was only a graduate and new in my profession. I was so ashamed I just looked for different ways to hide my insecurities; more hours at work than was healthy, performing in local choirs, volunteer hours at local charities, take the husband or friends out to the movies so they couldn’t see me cry in the dark theater. I was keeping up a charade of what I expected a “happy me” to look like.

I know now that, by trying to meet everyone’s expectations, that I was making myself ill. I thought if I could convince them I wasn’t useless, that I was living happily, then maybe I would start believing it too. But that isn’t how my depression and anxiety let me live now. I have to take things a lot slower. I have to change careers to something less stressful. I have to change my lifestyle so I create healthier habits. I’m trying to find what makes life worthwhile again.

I am still so scared sometimes of letting you down. I have terrible nightmares about people finding out about the terrible fraud I am. I am nervous my husband will get fed up as this wasn’t we planned for our marriage. I have pushed so many of my friends away as I didn’t want to be ashamed of having to endlessly cancel catch ups or dinners because of another panic attack or depressed day. I sometimes don’t call for days as I can’t face the fact that I haven’t done anything “worthwhile” in days.

Something my illness has taught me is just how much you two support me. I know how much love I have around me now. I know who my true friends are and how they are helping me fight my battles. I know you are with me, supporting me as well. You show that to me by encouraging me to see a therapist. You shared with me about the times when you were struggling with your own mental health. You reassure me to try again and again when I have had a bad day and can’t leave my apartment. You ring my husband when I can’t answer the phone to check how I am. You send me care packages full of ways to treat myself, or emails listing how to pamper myself at home.

I really want to thank you for all your care. I know the best way to show you my gratitude is to keep caring about my well-being and really make it a priority. It is still a struggle at times, but this is a hard lesson for me to learn. I am breaking bad habits and teaching my mind ways to distance myself from negative influences. I am starting to recognize what creates stress or anxiety triggers and how to avoid them. I’m starting to let friends see how vulnerable I am, which includes you. I appreciate that you are so worried when I do that… but this is me sharing my journey with you. I can tell you worry and are scared that I’ll fall back into my earlier depressive episodes — I am too — but I have a support network that won’t let me fall too far. With your love, as well as the others around me, I know we can beat this together.

I am so glad I have you in my life. I am working on new ways to make you proud, but I know at the end of the day all you want for me is to be proud of myself. Who knew you two would have to keep parenting when I am an adult, eh?

I love you,

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Thinkstock photo via KristinaJovanovic

Group of young adults playing cards in log cabin, laughing

How a Card Game's Mental Health 'Jokes' Led to My Act of Bravery

Tonight I felt brave.

After a nice dinner with friends, we decided to go back to my boyfriend’s house and play some card games. We played the new game I brought – it involved putting comic strips together and it was absolutely hilarious. Cards were played, comics were created, laughter erupted. I could play that game for hours and never get tired.

Toward the middle of the game, a card was put down. An image of two stick figures stared back at me, one with a speech bubble saying, “I think I’m going to kill myself.”

My friends began searching their decks for the next card they felt would be funny after that one. I just sat and stared. I didn’t want to participate in something that made light of suicide. It is something I have thought about on occasions, and I know other friends have attempted. Suicide and self-harm are serious and emotional to me, not to be joked about.

Yet, I went along with the game and put my next cards down. After the round, I reached over to pull the problematic card out of my deck so I wouldn’t have to feel uncomfortable playing the game in the future. Suddenly everyone was looking at me.

“What are you doing?”

“Why are you taking that card?”

“Put it back! What are you doing with the card?”

I kept saying, “Nothing, nothing!” over and over until finally, I had to say “Fine! I just don’t like this card and don’t find it funny and wanted to take it out!”


So many thoughts ran through my mind. What are they all thinking now? Do they think I’m suicidal? Do they think I’m being too sensitive? Are they going to talk about this later behind my back?

I felt my face turning pink. I tried to act like I was fine, but I wasn’t. I was scared – what if another triggering card appeared?

After another few rounds, it was my turn to judge. I flipped over a card and read it: “I’m off my medication.”

I tried to take a breath and move on with the game, but I couldn’t. I take medicine daily for anxiety and obsessive-compulsive disorder (OCD), and I take another at night when I am up late unable to sleep because of my anxious thoughts clouding my mind. When I miss a dose, I feel horrible. What was this game trying to imply? That when people are not taking their regular medications something ridiculous happens as a result? Or maybe that feeling horrible and anxious all day from being off your meds is something to laugh at? No, I thought. This is not funny, I am not OK with this, and I am not going to play this card.

“Actually,” I said, with more confidence this time, “I don’t find that funny either.” I pulled the card out, put it on top of the other card I pulled, and flipped over a new card that did not make me uncomfortable. The game went on, and no one asked about it.

I plan on throwing those two cards out and looking through the deck to make sure I am comfortable with the other cards in the game. I will make sure my friends know in the future they are allowed to skip cards that are triggering or make them uncomfortable. When I play card games, I want to have fun, to laugh, to bond with friends. I do not want to feel shamed for something out of my control. I do not want to feel uncomfortable or feel unable to say “Hey, that’s not funny to me.”

Mental health is not something to laugh at.

Sending this message to my friends tonight may not seem like an act of bravery to some, but to me, it was pretty courageous.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

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Thinkstock photo by Ryan McVay

Woman and birds in the wind.

Why I'm Learning to Love My Mental Illness Diagnoses

I love my diagnoses.

The bipolar disorder.

The anxiety disorder.

The depression with psychosis.

The post-traumatic stress disorder (PTSD).

I love them all.

I never thought I would utter these words or even come to this place of saying my diagnoses out loud. That changed after I tried to kill myself.

I had been off my medication for months. I had convinced myself I could achieve a happy and normal life without my medication or therapy. I convinced myself people had it worse and I just needed to buck up and be a “normal functioning” adult. This was the worst mistake ever.

It didn’t take long before I went manic and made risky choices. It didn’t take long till I isolated myself and spent my days off in bed. It didn’t take long till I was finding any way I could not go to work. It didn’t take long till I started hearing and seeing things I knew were not real. I was hanging on by a thread.

The thread held till I lost my job. Then the thread snapped, and the fall felt unbearable. The voices were stronger than ever. That’s when I tried to kill myself. The voices were finally quiet. Thankfully I have my guardian angel, and I survived.

Now I saw two choices. The first was to be miserable about my diagnoses and just go along with the program till I made the same mistake again. The second choice was to love my diagnoses.

By loving my diagnoses, I am accepting my diagnoses, finally, as a part of my life. By loving my diagnoses, I am going to go to therapy and talk about my abuse because it does matter. By loving my diagnoses, I am taking my medication every day, so I can function like a “normal” adult. By loving my diagnoses, I do my best not to isolate myself. By loving my diagnoses, I am loving myself and taking care of myself finally.

I love my diagnoses, and I am proud.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

We want to hear your story. Become a Mighty contributor here.

Thinkstock photo by iYuliya

When Your Picture Tells a Thousand Words, but They Are All Lies

“A picture can tell a thousand words.”

But what people often fail to mention is that it doesn’t necessarily mean the words are telling the truth about that picture. Actually, a picture can do the exact opposite. A picture can tell you a complete lie.

It can make it seem like everything is perfect.

It can make it seem like you have never been better.

It can make it seem like you are having the time of your life.

The key word is “seem.” Because there have been countless times, at least for me, when things are so far from perfect and I have never felt worse. But if you look at my pictures, they will tell you a thousand different lies.

What if I told you my pictures from Halloween I added this past week don’t tell you that a couple of hours before taking them, I was alone in my room crying so much that I couldn’t physically get myself out of bed? What if I told you the picture at the top of this page doesn’t tell you that the night before it was taken, I stayed awake for a long time and wondered if anything would be different if I wasn’t alive? What if I told you my pictures from high school don’t tell you that most days I felt like I was hanging on by a single thread?

What do all my pictures have in common? They have always shown me wearing a mask.

I have used this metaphor of wearing a mask whenever I speak at a school or conference. When you look up the definition of a mask on Google, it comes up with this definition — “a mask is a manner or expression that hides one’s true feelings.”

I have worn a mask since my freshman year of high school. And, if I do say so myself, I am extremely good at it, too good at it. They say practice makes perfect, and I have had a lot of practice.

Back in high school, I would lay in my bed curled up in a tiny ball under all the covers, silently sobbing into my pillow for hours, after reading horrible messages on Facebook from both people I considered good friends and from people I had never even met before. I would hear my cell phone’s ringtone next to my bed and wait for the torturous notification sound to go off after, letting me know I received another voicemail from a *67 anonymous caller, telling me no one liked me, that I was ugly, or that I should kill myself.

After pulling myself together, I would “put on my mask” and walk downstairs into the kitchen, acting completely normal, as if I had just finished my homework. My mom and dad would usually be cooking dinner, and my brothers and sister were talking about what happened to them that day. I joined right into the conversation, ate dinner, went back up to my room, and proceeded to cry myself to sleep every single night. I thought by asking for help, it showed weakness, so I buried it all inside, keeping a fake smile on my face.

I would drift through the school days, sitting next to some classmates who had said terrible things about me the night before or, even worse, sitting next to classmates that knew it was going on and never once said anything or simply asked how I was doing. If one person, just one person, had asked, “How are you?” I would’ve broken down crying, let it all out, taken off my mask, and said I was far from OK. That I desperately needed someone. Anyone. That I was drowning. But, that didn’t happen.

So, I just kept the mask on. I acted like I was completely fine, still wanting to fit in and be accepted by people who I should have wanted nothing to do with, and pretended that everything was OK… that I was OK. Wearing my mask from one location to the next, with nowhere to take it off.

I came to college and wore this mask the second I stepped foot on the campus. Absolutely no one knew that two months before I moved into my tiny dorm room, I was sitting in an even tinier room in the psychiatric unit of a Philadelphia hospital after attempting to take my own life.

Instead, I pretended to be this confident, positive, extremely happy person, not showing any signs of weakness or insecurity. I got chosen to be in a sorority and had the most votes out of every freshman who ran in the SGA election. For anyone else, this would probably make them feel like they fit in quickly, but I felt like I was still hiding behind my mask.

I would go to therapy secretly each week of freshman year. I was so embarrassed to show I had struggles, that everything in my life was far from perfect, that I was far from being happy.

My therapist I saw freshman year asked me this past spring if I was interested in speaking to the campus about my personal experiences with mental health. I would be opening up this personal information to 10,000 fellow classmates. A school-wide email, to both faculty and students, was sent out and flyers were hung all over the campus with a blown up picture of me and a bolded paragraph that stated:

Suicide Survivor Emily Torchiana will speak about her experience dealing with severe cyber bullying throughout her time in high school. She will speak about her struggles with depression, anxiety, and post-traumatic stress disorder and surviving suicide attempts. Emily found support through her time at a treatment facility the summer going into college. She will speak of how she overcame her struggles and has worked to integrate herself positively in the college community. Today, she is an advocate for mental health and speaks at middle and high schools about cyber bullying and suicide prevention.

Well… talk about getting to know someone real fast. Within a few sentences, strangers knew more about me than some of my best friends and family members did. I felt this mask slowly pulling away, and at first, I absolutely hated it. I had been so used to wearing it, allowing me to hide what I was really feeling inside, and now it was starting to come off.

The reason I am writing this is not to discuss my past, as I always do. If you notice, the flyer only uses the past tense: how I overcame my struggles and how I found support.

But if I am being 100% honest with myself and with you, I am so sick of hiding the fact that I still struggle today. My illnesses are very much in the present, and I have been so afraid to share that with anyone. Why? Why should I hide my current struggles? I am just contributing more to the negative stigma that surrounds mental health. That is why people feel so alone. They don’t know anyone else is feeling the same exact way as they are, and so they keep it all inside, behind their masks.

So, for the first time, my mask is coming off completely. I want to be honest and tell you there are times I still feel so depressed that I cannot get out of bed and I sleep for 15 hours at a time. There are times I still wake up in a cold sweat and cry from vivid nightmares and flashbacks I cannot control due to my PTSD. There are times I still feel like I need to leave a party because I’m afraid of having panic attacks from my social anxiety disorder.

I still push those who love me away, and I still isolate myself. I tell people I am fine when I am so far from that. This past week, for the first time since senior year, I have not been at all OK, and I am OK with admitting that to you.

Mental illnesses can be lifelong battles. They do not just go away like the common cold or a stomach virus, as much as I try to convince myself or wish they do. They may never go away, but you can learn to cope with them and deal with them in positive ways.

Although I have not overcome everything and still struggle, I know I have overcome a lot and I will work to overcome everything I am faced with in the future. I have learned a lot about myself this past week. I have learned that it is OK to show weakness. It is OK to cry. Sometimes you have to struggle and feel empty to appreciate the days you feel full. You can’t always be strong and put on a happy face for other people.

Most importantly, you cannot and should not be afraid to ask for help. There is nothing weak about needing help. It takes strength to realize you need help.

It is OK not to be OK.

If you are reading this and going through anything that I have felt or am currently feeling — know you are not alone. Don’t you dare give up on this life. Not tonight. Not tomorrow. Not ever. We are in this together, and if I am going to keep fighting, you are too.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “START” to 741-741.

We want to hear your story. Become a Mighty contributor here.

man flying with colorful balloons in beautiful cloudy sky,illustration painting

3 Things I Learned After Getting a New Diagnosis

Getting a diagnosis can make symptoms and the struggles those symptoms bring, more real. A diagnosis can help us by validating our physical or mental experience, but it can also limit how much we can deny the impact of our illness. Diagnoses, while beneficial to receive in many ways, can be tough to come to terms with, especially when the diagnosis is chronic, terminal or life-altering.

Just recently, I’ve been faced with a combination of diagnoses—relating to both physical health and mental health. The toughest was learning I have a serious dissociative disorder. Every “horror story” (true or fictionalized) I had heard about this disorder hit my mind when I was diagnosed. I was flooded with fear, confusion and anxiety.

Then I realized some important things. These are the ideas I want to share with you.

1. A diagnosis means we can take action.

They can be terrifying, sure, but a diagnosis can also be empowering. We can research symptom management techniques, find communities and read about other inspiring people living with the illness we have.

Of course, it’s important to focus on looking up positive information, rather than just falling into the wormholes a search engine can drag us into. Focusing on how our diagnosis can empower us to take charge of our health can make the news easier to bear.

2. A diagnosis may mean a “new normal.”

Our inner (and perhaps outer) world has changed with this new knowledge. It will take us time to accept and acknowledge this. It’s OK for this process to take a while. Sometimes, we expect ourselves to leave our provider’s office with a completely understanding attitude, but it’s usually not this easy to accept.

In truth, a diagnosis means we can let go of how we saw our “old” life and start to embrace a new life. We can think of it like a “new normal.” That’s what it really is, after all. It’s like moving to a new city, getting a pet, starting a job and various other major changes. It’s OK to be nervous, unsure and hesitant. Let’s try not to shame ourselves for these very real feelings. They are valid and it takes time to adjust. We can learn, one step at a time, to adjust to our new normal.

3. A diagnosis does not change your worth.

You are an amazing and incredible individual. Every single one of us living with an illness and choosing to figure out this new lifestyle is incredibly powerful. Society sometimes tries to knock those of us who live with mental or physical illness down, but we are just as worthy and awesome as anyone else. Even if your new diagnosis means you stop working, let go of friends or make serious changes, your worth remains the same. It’s infinite. Living with or without an illness, or several illnesses, does not change how worthy you are.

These things have helped me settle into a process of adjustment, a time of healing and acceptance. My hope is these ideas will help you also find some peace in the chaos of any new diagnoses in your life.

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Thinkstock photo via Grandfailure.

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