We live and die for the weekend. Nowhere is this more true than on college campuses, where students are in hot pursuit of the pleasure principle. Chasing excess is a sport as well as a rite of passage. But the 72 hours from Friday night to Monday morning can also be among the most perilous, a portal to despair with no exit. A college crisis clinician for eight years, I encountered many students who suffered the weekend as exiles.
Over time I listened to dozens of anguished stories, so many that I could almost predict their twists and turns. Some were as lurid as a tabloid headline. Others landed faintly on the ear, a circuitous tale with multiple digressions before arriving at the dreaded destination — pain. Their narratives fell under many rubrics — crushed idealism, first love gone awry, dreams vanquished by failure. Betrayal.
To the casual observer, such confidences might seem transient and overblown, hysterical laments tied to youthful indiscretions. But to those overcome by despair, isolation can often feel permanent and unending, a life sentence without reprieve.
Their calls often come in the middle of the night. By force of habit, I sleep restively, my ear cocked in anticipation of the mobile pager's trill. Each time it summons me, I try to suppress a vague sense of dread and the panicked feeling that I don’t really know what to do despite my years of experience. A rush of adrenaline gives me a heightened sense of alertness and danger but also of being put on the spot.
Like so many other nights, I rouse myself from half-sleep and strain to collect myself in the dark. The phone lies on the bedside table, but my fingers, as reluctant as an arthritic's, resist reaching for it. After speaking with the campus police, I dial a number.
“Hello. You called the crisis line?” I ask. “How can I help you?”
“It’s my roommate, Kevin. I’m not sure, but I think he’s suicidal,” a trembling voice says. “What should I do?”
“Can you bring him to the phone?”
“Hello,” a timid voice says in a tone that is anxious yet oddly detached.
I introduce myself as the crisis counselor and then proceed: “Could you tell me a little bit about what’s going on, about how you’re doing? Your roommate’s worried about you.”
“Doing OK,” he states flatly as if he were completing an online survey. “Fine.”
“Do you have any idea why he would call the crisis line? Are you sure nothing’s wrong?” I continue.
“Hmm ... things are fine. Weird.”
“He thinks you want to die. Why would he think that?”
“I don’t know. I guess he overreacted,” he says dismissively.
“To what?” I ask. “For some reason, he’s convinced that you’re not safe. Why do you think he’s so worried about you? Did you say or do something?”
Circling The Rooftop
Silence. Is my directness too intrusive, shutting Kevin down before we have even had the chance to establish a rapport? “It’s OK, you can tell me, Kevin. I want to know how I can help you.” I try to sound less accusatory.
Again, nothing. I experience a slight sense of dizziness, as if falling through the air, unbounded. I notice I am clutching the phone. “Kevin?” I inquire, wondering if he is still on the line.
He speaks, again his voice sounding weak. “Sometimes I think about jumping from the roof of my building. I know that would kill me. I walk in circles on the rooftop and look down at the alley. Who cares if I die? Nobody."
In a halting monotone, he describes weeks of sleeplessness. Days and nights of worry and dread. This weekend he was unable to leave his room, his bed. It is impossible to think clearly anymore. He mentions that he hasn’t eaten in two days. "Everything is fuzzy," he says. "Everything is too fuzzy now."
As I listen, I am awed by the depth of Kevin’s loneliness and detect the sound of hopelessness stuck in his throat. I feel tremendous pressure to bring him through this intact.
“Where are you right now?” I ask, my own voice tight with worry.
“In my room,” he answers. “I can’t sleep.”
“Stay put,” I say and call the police to bring him in for an evaluation.
I reach for the light switch, trying to focus my disordered self. My feet touch the floor, and I make my way through the night, relying on the security of the sensate world, a brief but comforting stay against worry and confusion.
I quickly drive the few miles to campus, stopping at a Dunkin' Donuts for a cup of hot chocolate. Entering the campus police station, I notice dark stains on my shirt, two blots of chocolate betraying my own muddle. A police officer glares at me and scowls as if to say, "What kind of doctor are you?"
Finally, Kevin and I meet.
Our conversation takes place in a windowless conference room whose ambiance is as unwelcoming as it is functional. "Don't get too comfortable," the chairs seem to say. The room's generic features make it impossible to gauge the time, the day of the week or season of the year. The fluorescent lights cast an accusatory glare, our faces are washed out, greenish. We’re both weary from lack of sleep.
Kevin is thin, boyish, almost frail, with a fringe of brown hair falling above his eyes. Hunched shoulders give him the appearance of someone who has been standing in the cold for too long. He barely meets my eyes as I begin the interview.
We both slip into our prescribed roles. I rely on the false comfort of a well-rehearsed script and the cartoonish certainty of a psychiatric decision tree.
“In your own words, Kevin, tell me what has been going on.”
Without much prompting, he explains that his family has sacrificed everything for him to go to college. His seems more earnest than on the phone. “Since I was little, I wanted to be a doctor. My mom and dad promised me that if I got good grades in high school they would do everything to make it happen. It’s like the only thing I ever wanted to be.” He describes two hard-working parents, ambitious in their dreams for him. His mother works as a bank teller, father runs a cleaning business.
Sleeping Through The Final
“But what’s happened? What’s turned your life upside down?” I gently inquire. “On the phone you told me that you wanted to jump from the roof?”
“I didn’t say that I’d do it. I said that I thought about it sometimes. There’s a difference isn’t there?”
This time I am silent, giving him wide berth to tell his story. Kevin’s voice slows and he stares past me, parsing his words. “Last semester everything was great. I studied all the time. I made all A’s like I knew I would. This term it came time to take Chem 3. Everyone said, ‘not so easy, get a tutor.’ But I wanted to prove myself. I read everything, studied, crammed, went to all my labs. I memorized tables, stayed up all night. I felt so confident. But I bombed the mid-term. I was sure I did all the right things. How could this happen? I thought I was smart and now I felt so stupid. But I wasn’t going to give up. ‘I know I can do this,’ I kept telling myself and I studied even harder after the midterm. ‘I know I can do this.’ But I couldn’t and I didn’t. I slept through the final on Friday. When I woke up I ran to my professor’s office and begged him to give me another chance. All he said was, ‘Sorry.’ ”
“That sounds nasty. No wonder it’s shaken you up. I’m curious, did you call your parents?”
“Huh?” he replies. “Why would I do that? It would kill them if I didn’t become a doctor.”
He looks right through me and narrows his eyes as if I have betrayed him and then decisively turns away. Despite the anguish over his failure, Kevin appears indifferent to the peril that brings him here tonight.
“Kevin, I know it isn’t easy to talk about. But we have to talk more about your wanting to kill yourself. It’s the only way I’ll know how to help you,” I repeat. “When did you start feeling that way?”
“I think I am OK,” Kevin deflects.
“I know you feel that way now, but what happens when you go back to your room?”
“Don’t I look OK? I’ve told you everything.”
“What if your roommate hadn’t called, how do I know you wouldn’t have done it?”
“Do what?” he challenges.
“Jump.” The word hangs in the air between us.
“Why won’t you believe me?” Kevin protests. “It was just a figure of speech. I don’t want to kill myself. Honest.”
His frustration and anger momentarily stall me. If only I were a paramedic, or a priest delivering last rites, I could take direction from the literal world. I would know exactly what to do. Instead, I must rely on elusive cues and the ambiguous compass of my own judgment. I rub my eyes, doubting if you can ever really know what goes on in another’s mind.
“What’s changed? What’s different now?” I pose, hoping that he will reveal his inner thoughts and fears without my having to bear down on him. “How do I know you will be safe if I send you back to your room?”
“You just have to believe me. I’m fine.”
Kevin’s stubbornness pushes me over a line that I would rather sidestep. Against my better judgment, my tone turns legalistic, interrogatory. His recalcitrance compels me to resort to the professions so-called best practices, a clear sign that my patience is thin. I ask him to spell W-O-R-L-D in reverse, to do serial sevens backwards from 100, to interpret the proverb “One swallow does not a summer make.” My approach is formulaic, impersonal, and flies in the face of everything I know about building trust. “Tell me more about your sleep, appetite, concentration, your loss of energy. When was the last time you had a drink?”
He responds grudgingly and I push harder. He describes the most intimate details of his life without much feeling. He tentatively tells me about loneliness but then redoubles and asserts that he has much to be grateful for. He rests his head on the table and complains under his breath, “You just don’t get it, do you? You just don’t understand.”
I react to his hedging, "What don’t I get — that you wanted to kill yourself by jumping off a roof?”
My bluntness is designed to push through any potential dissembling, but even to me it sounds brutal. He still denies any desire or intent to hurt himself, and defiantly says, “Why would I do that? I told you, it would destroy my parents. I wasn’t going to do anything.”
“How do I know I can believe you?”
“I don’t know.”
“If you don’t, Kevin, then who does?”
“You think I’m hiding something. You don’t even know me,” Kevin protests. “Jesus.”
I look directly into his eyes, feeling annoyed yet plaintive. “How can I let you go if you can’t even tell me how you plan to stay safe?”
By now, my efforts only intensify his resistance. I have failed to disarm him, but I keep at it. "You've told me about weeks of constant worry, insomnia,” I reiterate. “That your worst fears came true when you failed the class. But you haven’t told me anything about who you would turn to for help. I am not even sure if you have any friends.”
Angry tears stain his face. “You say you want to help me, but you’re making things worse.” I slowly repeat the essential question, which now sounds banal, drained of its urgency: “Kevin, did you want to kill yourself tonight? Did you go up on the roof?”
“What does it matter? You won’t believe me anyway.”
To The Hospital
He stares at my fingers as I thrum the "Pink Paper,” its pastel color belying its authority and power to force a three-day hospitalization. By now, he sees me as a bully or a mercenary determined to destroy his future. Perhaps it is no coincidence that the risk assessment takes place in a police station. My questions have been prying and intrusive. To him, I must seem determined to know everything about him without actually wanting to know him.
“You’re going to make me go to the hospital, aren’t you?” he challenges.
“I’m leaning that way,” I respond, feeling a sense of mutual defeat.
“Why don’t you just flip a coin for all you care,” he says sarcastically.
I am worn down by the inexactness of my task, but my gut tells me that I cannot trust him with own life. I tell him that I am sending him to the hospital for further evaluation and explain the process -- the transport by ambulance, the medical clearance, the wait in the ER, further assessment by a psychiatrist, followed by more waiting.
With his dignity all but eradicated, he makes one last stand. “Don’t do this to me,” he seethes. “I told you I don’t want to die anymore. What about my GPA? My scholarship? Don’t you see this is going to destroy my life? You can’t do this.”
Phone calls are made, details presented to nursing staff; within minutes, the disposition is wrapped up. A pair of EMTs arrive and strap Kevin to the gurney, then wheel him out to the ambulance. I watch as his head bobs up and down as if on a spring, his hands grasping the stretcher’s metal bars. “You’ll be OK,” I say, knowing how trite my words must sound.
Kevin’s life and mine intersect briefly, yet his image lingers in my mind. Together, we inhabited a gray area, and I pushed for the contours to fall harder and cleaner. The siren and the red lights of the ambulance fade into the night, transporting him to some vaguely dreaded destination.
Experience has shown me that for some students such an encounter restores a sense of safety and coherence as if pushing a reset button. For others, it may be the emotional tipping point that makes hospitalization the clear and only choice. And then there are those who rally briefly, appearing self-contained even to themselves, while still in danger of acting on their most lethal impulses.
I know that it is impossible for you, Kevin, to appreciate the ways I struggled with my decision. Undoubtedly, I will be a name filed away in "moments best forgotten." Yet, I wish I could tell you that although time can seem like a vacuum, a shape does eventually emerge, allowing you to recognize that this dark night has become a faded moment long ago. Despair will remain fixed in a place called the distant past.
If you are lucky, Kevin, you will find yourself standing in the present, relieved that your footsteps are sure and unwavering in their movement forward. And if you concentrate and still your mind, you will detect the pull of the future, a subtle pulse of light on the horizon. Please know that despite evidence to the contrary, I understand how keenly you will have worked to stay alive.
The case is a composite based on two different individuals, but it represents a common scenario.
John Rosario-Perez is a Cambridge-based psychologist, who worked for many years in college counseling.