Liberal Arts, Diagnostic Inflation, and the Pathologizing of Everyday Life

The ideas and viewpoints expressed in the posts on the Ideas and Creations blog are solely the view of the author(s). Luther College's mission statement calls us to "embrace diversity and challenge one another to learn in community," and to be "enlivened and transformed by encounters with one another, by the exchange of ideas, and by the life of faith and learning." Alumni, faculty, staff, students and friends of the college are encouraged to express their views, model "good disagreement" and engage in respectful dialogue.

Recently, a student asked me for an extension on a paper, informing me that her anxiety and depression had been acting up making it difficult to concentrate on her work. I try to be sympathetic to the mental wellbeing of my students, so I granted the extension. But the way she talked about her anxiety and depression I found troubling.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), one does not merit the diagnosis "depression" unless one has been experiencing the symptoms of depression most every day for at least two consecutive weeks. We call this condition "chronic depression" for a reason. It is not episodic. People with depression generally struggle with depressive symptoms chronically for an extended period of time.

My student, however, right up until the time she asked for the extension, showed few signs of depression. She was attending class regularly, engaging in the class discussions, engaging with her peers, and smiling and laughing just like everyone else. Of course, people can hide their pain, but truly depressed people normally exhibit significant behavioral changes too. In addition, the language she used—"my anxiety and depression have been acting up recently"—seems not to fit with the DSM criteria. Depression is not something that "acts up" from time to time like arthritis. It is chronic.

I think my student is the victim of diagnostic inflation. Diagnostic inflation refers to the tendency of the medical establishment to expand diagnostic criteria for certain diseases, allowing more people to be labeled with a particular diagnosis. This then has profound effects on the kind of medical treatment they receive. If the criteria for "normal" blood pressure are lowered, for example, more people will be diagnosed with hypertension and prescribed a blood pressure medication.

Diagnostic inflation has been especially pernicious in the mental health field because there are no medical tests diagnostic of any mental illness. Mental illnesses are diagnosed purely on the subjective reporting of the patient’s feelings and changes in their behavior observed by those around them. The very subjective nature of mental health diagnosis allows then for the expansion of diagnostic criteria unchecked by the results of actual medical tests. And the mental health industry along with the pharmaceutical industry has employed this power with abandon.

The first edition of the DSM published in 1952 described 128 discreet mental illness categories and was 132 pages long. The current fifth edition, published in 2013, describes more than 500 categories and is 947 pages long! Are we really to believe that psychiatrists have "discovered" hundreds of new mental illnesses in the last sixty years? Of course not. Diagnostic inflation has instead systematically pathologized ever larger aspects of normal human emotional experience.

For example, every version of the DSM up through the fourth edition carried a grief exclusion in its description of major depression. That is, if a person exhibited the symptoms of depression, but it could be determined that those symptoms occurred in response to a major emotional loss, like the death of a loved one, then the person should not be diagnosed with depression. They are instead experiencing the normal human reaction of grief. But in DSM-5, the grief exclusion was eliminated! Now the normal human experience of grief can be pathologized into the mental illness of depression—and treated accordingly, much to the benefit of the pharmaceutical industry. But what effect does this have on society?

As diagnostic inflation has ensnared more and more aspects of normal human emotional experience in the web of mental illness, many people are coming to think that any negative emotional experience is abnormal and a sign of illness. Anxiety and depression (which can both manifest in very serious forms) become labels to name any negative emotional experience. If someone feels a little sad today because they had a fight with a friend, they are depressed. If someone is feeling stressed about a number of upcoming deadlines, they have anxiety. The normal ups and downs of life become pathologized, leading to a sense of helplessness and a lack of emotional resilience among our young people.

Unknowingly embedded in this pathologization of everyday life, our young people toss around the labels anxiety and depression far too cavalierly and come to believe that every moment they are not happy, relaxed, and content is reason to believe they are ill. And their ability to rise above life's discontents is therefore seriously compromised.

Perhaps this is where a liberal arts education can be helpful, by foregrounding the emotional turmoil that has attended some of the great figures in history. Would Martin Luther have authored the ninety-five theses had he not suffered a major emotional breakdown? What role did Abraham Lincoln's well-documented depression play in making him America’s greatest president? How has emotional suffering played a role in many of the great literary, artistic, musical, and intellectual landmarks of history? Negative emotions are an inherent part of being human and may even inspire some of our greatest cultural achievements. They may be unpleasant, but they are not necessarily abnormal or signs of illness.

I have no doubt that my student was legitimately experiencing a stressful period in her life that did indeed make it difficult for her to concentrate. And she did need extra time for the assignment. But was she suffering from a mental illness or simply experiencing the stresses of normal life? She turned in her paper on the new due date and it was among the best in the class. She was clearly able to function at a high level despite her emotional difficulties. But will she be able to consistently call on this well of emotional resilience when she is socialized to believe that her stresses are a sign of a chronic mental illness that is "acting up"?

We must resist diagnostic inflation and begin to re-engage with the full panoply of our normal emotional reactions to the experiences of life, reactions that ultimately define what it means to be authentically human. After all, there is often greater insight and wisdom in misery than there is in contentment.

Robert Shedinger

Robert Shedinger

Robert Shedinger is a professor of religion at Luther College. He is the author of several books, including the 2015 "Jesus and Jihad," "Was Jesus a Muslim?: Questioning Categories in the Study of Religion" and "Radically Open: Transcending Religious Identity in an Age of Anxiety."

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Comments

  • April 30 2018 at 12:01 pm
    Faruk Emre Büyükkaba

    Thank For The Post

  • April 30 2018 at 2:38 pm
    Robert Shedinger

    You are welcome, Faruk.

  • April 30 2018 at 6:59 pm
    Tabita Green

    Thanks Bob. Wise and important words. The pathologizing of any human experience, including what we call psychosis, is troubling to me. Especially since these experiences in other cultures are honored—and sometimes considered a gift. And we know people with such experiences in other cultures fare much better than they do here (often ending up homeless, heavily drugged, or locked up in a psych ward). I hope that Luther College and other colleges around the country will start talking to students about this and finding ways to communicate that there is nothing *wrong* with them. As you say, students are having a normal response to their environment and experiences. And can we go a step further and consider changes in the college environment that would actually optimize the emotional wellbeing of faculty, staff, AND students? I hope so!

  • April 30 2018 at 7:03 pm
    Anonymous
    While Dr. Shedinger's opinion that not all stress, anxiety, or periods of feeling down represent a true pathologic diagnosis according to the DSM, I do not believe he is in such a position of authority to make the determination that "diagnostic inflation" is responsible for this. Based on the article, he has a poor understanding of the DSM and its applications, primary mood disorders (is he aware that depression is actually the symptom of a spectrum of primary mood disorders independent of major depressive disorder that have a variety of presentations?), and medical diagnosis in general (is he aware that there are many medical disorders outside of mental illness that are also diagnosed on the basis of "subjective" symptoms alone without the aid of diagnostic tests?). Further, the segment on grief and what represents pathologic grieving is completely inaccurate, as there remains a clause in the criteria for adjustment disorder that excludes normal bereavement from the diagnosis. The DSM has expanded as a more nuanced understanding of psychiatric pathology has developed, and better delineation of psychiatric illness has resulted in greatly improved care for millions of individuals worldwide. Better delineation between these disorders has resulted in MUCH greater identification of which patients require medical treatment, which can be managed with cognitive behavioral therapy (aka counseling), and who does not benefit from any sort of treatment at all. It may surprise you that the purpose of many of these "new diagnoses" is actually to identify people who don't need any treatment AT ALL, and differentiate them from people who actually do need treatment. Such is to say, Dr. Shedinger's understanding of psychiatric diagnosis is limited, and thus his interpretation of "diagnostic inflation" as simply a means to expand indications for medical treatment and thus $$$$$$ big pharma, is simply inaccurate and unfounded. I agree that normal everyday stress and feeling down should not be dramatized and should be distinguished from a real psychiatric disorder. Dr. Shedinger may be right that the terms anxiety and to a lesser extent depression are over-utilized among young people these days. We all need to learn how to deal with our problems and manage the stresses of every day life, that is absolutely true. However, to write such an opinion piece, while lacking medical training and having little understanding of the spectrum of psychiatric illness, is frankly dangerous. Such an opinion, coming from an individual in a position of power, may marginalize students with these feelings and discourage them from seeking medical care when they actually need it. I implore anyone who reads this article to take home the main message that a little stress and anxiety are a part of every day life, and that we can all expect to experience at some point or another. However, I also implore you to realize that this piece is coming from an author with no background or formal training on the subject, and it should not be taken authoritatively. If you are experiencing mood symptoms you feel are significantly interfering with your every day functioning, you should see you healthcare provider.
  • April 30 2018 at 9:08 pm
    Jack Evert
    I am unclear about a couple of points you are making. Was the student who reported her anxiety and depression as acting up in fact under a doctor's care? If so wouldn't it have been appropriate to ask that she schedule a visit with her doctor and report these symptoms? I worked for years as a Psych Chaplain and therapist, so I understand the process is more specific and present in every part of a person's life, than you imply. The reason for hospitalization (psych) is to monitor medication, so it seems her "condition" raises the question of an adjustment in her medication. I assume, as is generally recommended, both therapy and therapy is recommended. Was she seeing a therapist? Because brain chemistry can be impacted by prolonged grief and/or significant transitions, that too might be in play. My concern is that the bias against seeing a Psychiatrist and maintenance of medication needs to an educational goal for public health. It seems your concern could better be discussed with those who prescribe medication. What is their experience and perspective. I think you have hit on an important dynamic but not addressing the problem of the misuses of psychiatric terms by laity. For example, the diagnosis serve the purpose of understanding about to treat a person, it is not a personality trait but rather hides a person's character. Thank you for your observations. I encourage you to "educate" you students in advance of their next request for their next extension. Not to make them self conscious, but simply ask "Have you or will you now, since you asked for an extension take the following steps ..." It is an important educational and mental health opportunity.
  • April 30 2018 at 10:06 pm
    Luther alum
    This analysis is misinformed and quite tone deaf to the reality of what living and surviving with mental illness is like. The description of this student leaves readers with a tiny slice of one interaction, and that example is inadequate in its use as a tool for extrapolation. I’m a successful working adult who meets the criteria for major depressive disorder. I manage showing up to work reliably, sincerely smiling with others, and getting my work done when most around me would have no clue of my clinical, medical diagnosis. I’ve learned to manage living everyday life with a chronic condition as many do, and this is indeed an example of the very resilience of which you speak. Due to my own desire for privacy, and the unavoidable shame that accompanies mental illness in our culture, I’ve used very similar symptom minimizing phrases - “acting up”, “worse today” - when asking for time off or assistance with my work. And, I work in the mental health field, and am still self conscious about bringing this forward. Your reaction to this student only serves to further stigmatize, shame, and silence others who may be struggling with mental illness. It is dangerous and inappropriate to reduce her experience and words to merely stress, especially when you have no clue what her history with this condition has been. She seems to be more of a victim of professor doubt and distrust than inappropriate diagnoses.
  • April 30 2018 at 11:43 pm
    Anonymous
    Could it be that the DSM has expanded over the years because psychologists are continuing to understand mental illnesses better? Maybe it's not so much that they are discovering hundreds of new illnesses, but categorizing and refining what was there in the 1952 edition. Even if the diagnostic inflation assertion is correct, I think slipping that "big pharma" conspiracy comment was a sour move which lowers the credibility of an otherwise insightful article.
  • May 1 2018 at 1:38 pm
    Robert Shedinger

    I appreciate all the responses but unfortunately cannot respond in detail to each one. I realize this is a controversial subject for many people. But some of the critical comments above accusing me of not understanding what I am talking about seem themselves to be quite misinformed about the history of the development of modern psychiatric practice and the role of pharmaceutical profit-seeking in that history. This is not some conspiracy theory of my own making but a well-documented but inconvenient truth. Even the National Institute of Mental Health has recognized these problems and the New England Journal of Medicine has reported research showing that clinical trials for antidepressants have been published in misleading ways to make the drugs appear more helpful than the clinical trials literature actually shows, where in many cases these drugs do not outperform placebos in controlled studies. new criticisms of modern mental health practice are appearing nearly every day, many coming from psychiatrists and psychologists themselves. I may not have a clinical background, but I do have first-hand experience with major anxiety and depression and with the mental health system. I wrote about it in my book "Radically Open: Transcending Religious Identity in an Age of Anxiety" for anyone who is interested.

  • May 3 2018 at 8:02 am
    Julie Shockey Trytten, blog administrator

    We appreciate the discussion happening and wanted to remind you that we do have a Blog Commenting Policy that asks folks to share first and last names when signing on to comment (so people can't hide behind the mask of anonymity). I haven't deleted any of the above posts yet, because the author agreed to respond to them even though they're anonymous. For future posts please use your first and last name when commenting. This is a sensitive and important subject folks, let's keep the discussion going.

  • May 4 2018 at 10:53 pm
    Marcia Anderson
    Mr. Shedinger, you are talking about your experience and knowledge of psychiatry. However, you have not answered the people asking how you got such a long blog out of a short experience with a student. Have you accessed her physician's files? I'm sure you have not, as you are a professional with ethics. Have you talked with the individual's psychologist to see how her symptoms present themselves? Again, you have ethics so you have not. Are you sure that this student is telling you her entire life story of mental illness, instead of a few snippets after she has spent a long time agonizing and gaining the courage to contact you? Only you can answer that. And, are you sure that you are not accidentally judging this student harshly because she has high function? This is very common with educators with females, especially those who have ADHD. Teachers do not understand that intelligent young women can be disorganized, have difficulties with executive function, lose attention, be unable to concentrate, etc. They see the intelligence, and don't understand the barriers that the person has to allow the intelligence to shine. The same misunderstandings happen with bright women and men who have depression and anxiety. Also, I am sorry to hear that you have dealt with major depression and anxiety. However, did you explain every detail of it to employers and teachers? I hope they did not assume you should have acted depressed 24/7 and never been able to smile. I have had major depression, and most people believe I am the most positive, happy person they know. Then I go home and lick my wounds and hope for the strength for another day. Sometimes I have it. Sometimes things do not get done. I hope that the people with whom I share small parts of my own story are not writing blogs about how misguided I am, or thinking I am self-diagnosing and making excuses. I also have students who have depression and anxiety, though not at the college level. They do not like admitting it. They feel shame. Often they downplay symptoms, or sort of laugh them off as if they are less severe. They miss weeks of class without my knowing why, and I am fortunate if their parents will share the reason with me. Public schools protect these children. I doubt their symptoms sudden get better at college. If you had depression and anxiety as an adult, yours did not. Please consider all of this.
  • May 4 2018 at 11:25 pm
    Marcia Anderson
    I just realized that in trying to share a little of my story, I actually downplayed it, too. It is difficult to share these things. The stigma is great. I have seen a psychologist. I was referred by a doctor when I went to get relief from extreme insomnia, was evaluated, and diagnosed with depression. I'm a grown woman, and I cried right there in the doctor's office, out of shame, but also relief. The insomnia would not have gone away without my depression being treated, and it took a medication to jumpstart that. I saw a previous post of yours that seemed to suggest that people should think of depression as a natural reaction to life's experiences, and not always get medication. Perhaps I misread it, and of course we shouldn't ALWAYS get medications, but they are there for those who need them, and some people cannot function without them. Not getting proper medications and treatments can be dangerous. I say that as someone whose sibling killed herself, in her 50's. She couldn't control symptoms of mental illness, paranoia lost her her job, she no longer had health insurance and she was suspicious of any medical help after all her meds had worn off. She hid everything from us as she lived several states away, until we found out about her death.
  • May 4 2018 at 11:59 pm
    Lienne Pak
    As someone with depression that is being treated with medication, it can be very up and down because the medication can be touchy. It is my personal experience that I usually take my medications at a certain time every day but if one day I get unexpectedly delayed by 3 hours and can’t take my medications at the right time, they don’t work as well. I also personally have anxiety and depression like this other student and anxiety does react to my situation and if I’m irrationally anxious about my ability to handle that situation that can lead to negative thoughts about myself and then worsen my depression. My psychiatrist called it “anxiety driven depression”.
  • May 8 2018 at 8:26 pm
    Luther College Active Minds Club
    Professor Shedinger, As a student led organization, we are a part of the Active Minds National Chapter as an advocacy group for breaking the stigma about mental health on campus. Luther College Active Minds has a staff advisor with an extensive background and education in mental health, and we work to educate ourselves and others on campus about how mental health manifests in a plethora of ways, what to look for, how to break shame surrounding struggles with mental health, and how to make Luther College a more accepting environment for students of diverse backgrounds. That being said, we found a multitude of problematic aspects in your blog post and we would like to provide feedback about our concerns for the picture these ideas paint about our institution. First, we would like to address our concerns regarding what seems to be a lack of confidentiality in light of your disclosure regarding this student's request for an extension. We view the choice to disclose this very personal situation on an extremely public platform so soon after the interaction as inappropriate and as disregarding the potential that your disclosure has only perpetuated their mental health struggles further; particularly in the skepticism you express in the legitimacy of her experience. Secondly, we would like to address you citation of the DSM as a way to support your concerns in the validity of your students experience. Expressing skepticism in regards to the symptoms of depression and anxiety your student portrayed in class does not give ground to invalidate her understanding of her mental health. The DSM expresses a multitude of various criterion in order to be diagnosed with chronic depression and generalized anxiety, most of which are subjective to the individuals experience rather than observable behaviors by outsiders. Therefore we find it inappropriate that you have sought to invalidate the understanding of her mental health simply because you cannot confirm her experience. In regards to your claims that depression is not episodic, the DSM also iterates that major depressive disorder can be episodic and is not experienced 24/7 by the diagnosed. In conclusion, we do not find your skepticism regarding a current student's struggles with mental health an appropriate means to propel your personal agenda of the discussion of over diagnosis in our country. If you do not feel as though you can validate your students struggles with mental illness as a means for homework extensions without discussing it on a public platform, we encourage you to simply deny the extension and keep your skepticism to yourself. Perpetuating stigmas regarding the validity of mental illness is not beneficial for anyone. To the student whom this blog post is about, Luther College Active Minds wishes to extend our hand to you to provide you a community and a place of support in light of your mental health journey; good, bad, or otherwise. You are accepted here. To all other students of the Luther community, current and otherwise, this is not the majority viewpoint regarding mental illness held by the Luther College community. Sincerely, Luther College Active Minds Maddy Ross Annika Johnson Sarah Eachus Maggie Piper Stephanie Draeger Gillian Allison Emma Deihl Lexa Krug
  • May 9 2018 at 3:24 pm
    Robert Shedinger

    Thank you to the members of Active Minds for a very thoughtful response to this blog post. I hear your concerns and take them seriously. Perhaps I should not have referred to an interaction with a student to frame my comments and I do hear this criticism loud and clear. But I am a bit puzzled by your comments and those of others on this post that I am somehow skeptical of this student's struggles or tying to minimize them. This is certainly not my intention and I see nothing in the blog post to suggest this. Everyone's experience is real and should be validated as such. But how we label these experiences and talk about them has a profound effect on how we respond to them. Our current societal discourse about mental health is only one such way to talk about and respond to these issues. This discourse has only been with us for about the last 35 years and has a specific history of development that many people are unaware of, which undermines the crucial concept of informed consent in mental health treatment. I am simply trying to raise awareness of this history and consider alternative discourses. We should not uncritically accept the current societal discourse given that rates of mental illness have increased over the last 30 years, not decreased as might be expected if the current paradigm was very effective. These kinds of issues must be open to critical scrutiny in an academic setting.Thank you for helping to continue the conversation.

     

  • May 9 2018 at 5:48 pm
    Athena Hatfield
    Hi all. I've been thinking a lot since reading this post, and I would like to discuss my take on it. I've chosen here to open up about some more personal things, as I think it may help facilitate discussion and learning from this. If you have questions about my experiences, feel free to ask for clarification, as I am pretty open about this subject. I guess I'll start with this: I am the student that inspired this post. And upon reading it, I had many concerns. In fact, I was pretty shook by it. I will not lie. I had an anxiety breakdown Friday night after I found the post, and the stress from figuring out how to respond affected me through the weekend and into the start of the week. Another thing I should mention before I get going - I met with Professor Shedinger today and discussed this post with him, and I do believe the discussion we had was positive and productive, though I won't go into details. I'm going to tell my story (not in its entirety, obviously - there's much more to me than my diagnoses). Though I know I shouldn't have to and do not need to, I think it will help those who maybe wonder about the validity of my diagnosis, and even those who don't question it. In second grade, I was diagnosed with ADHD. From before the diagnosis, and beyond, I struggled quite a bit with executive functioning. I performed well in school, but managed to forget or lose assignment after assignment, causing constant stress. In high school, my performance in class and on tests was no longer enough to make up for the homework I was missing. I had accommodations, but I also encountered a couple teachers who were unsupportive and who made it difficult to communicate my needs. At some point, the stress from trying to adapt in an environment that did not understand my needs and my abilities developed into much more. I was diagnosed with depression and anxiety in tenth grade. From that point on, I started the long process of recovery. Between tenth and eleventh grade, I missed 100 days of school. I started medication, which helped, but was not a full solution. I also started therapy. This combination helped me through a journey that transformed who I am. I graduated high school two months after the rest of my classmates. I started school at Luther. And here I am, thriving. This doesn't mean my anxiety and depression haven't been there. They've affected me in so many ways. I still have panic attacks. I still worry and stress over assignments and papers until I've spent 6 hours straight doing nothing but worrying. I still miss class sometimes. It's still part of my life, but I'm much better at coping and functioning now. So this is where I'm coming from. Now to address Professor Shedinger's post. There is truth to the idea that the way our society addresses mental health is not always in the interests of those who have mental illnesses. Discussing this and addressing it is important, and there is much to be improved in the medical world in terms of making sure the interests of companies are the interests of patients. With these ideas, I am in agreement. However, the students from Active Minds summed up quite well what I made of this post: "In conclusion, we do not find your skepticism regarding a current student's struggles with mental health an appropriate means to propel your personal agenda of the discussion of over diagnosis in our country." I think the discussion that has been provoked is great. I think diagnosis in our country and treatment in our country needs to be looked at from different perspectives. I don't think that using a specific student as an example is the way to go about this. You cannot draw assumptions about someone's story based on their behavior in class. What you see is a piece of the puzzle, and not all of it. I know Professor Shedinger's intention was not to minimize the experiences of those with depression and anxiety. I know that he very much believes in the validity and reality of these experiences. However, deciding that someone does not have an illness they have been diagnosed with, without being a medical professional who knows the person's case well and on a personal basis, does indeed add to the stigma surrounding mental health. Thank you for reading.
  • May 12 2018 at 8:43 am
    Brad White ‘06
    I’m disappointed to read this piece and Mr. Shedinger’s responses to many insightful comments. The hurdles that those with mental illness face are immense and non-judgmental support is essential to their healing and wellness. The questioning of reality or severity is judgmental, under-informed, and short-sighted. The simple word your entire analysis was missing was “and.” Mental illness like anxiety is indeed chronic AND episodic. Just like back pain, anxiety can and does flare up even when managed well through therapy and/or medication. As a principal and manager for nearly 100 educators in Denver, I can’t imagine ever questioning someone with a broken wrist or carpel tunnel who wouldn’t be able to type at all or as much for a period of time. If I chalked their pain or impairment up to diagnostic inflation, I’d not only be wrong, I’d be insensitive and careless with the health of those for whom I’m responsible. Mental illness must be treated with the same level of urgency and care as more visible illness or injury. This post, by questioning the validity of the student’s anxiety peaking for one reason or another, does in fact treat mental illness as inferior to physical health. Anxiety and sadness are certainly different. There are many spot on assessments in this comment thread that deserve to be learned from and implemented. If I’m Mr. Shedinger, I’m now grateful for having shared an incomplete and under-informed idea, received helpful and earnest feedback, and would want to then respond with a humble and revised new post (outside the comment thread). Anything less only furthers the stigma about mental illness, especially due to your position of power, and does not support the real needs of students at Luther College.
  • May 14 2018 at 2:06 pm
    Sonja Langsjoen
    And now, the person everyone's waiting for.... the MOM! Thank you, LCAMC, for your well-thought out post. You said almost everything I was thinking, as I sat on my hands since Friday night, having listened to my Athena grieve. I didn't come out with my fingers a-blazing on the keyboard to say what I thought because they (Athena) asked me not to, and they wanted to talk to the professor personally. Unfortunately, the discovery of the blog post on a Friday night meant that there were huge repercussions, because there was no recourse or relief for 60 hours. That is forever in the case of someone with anxiety and depression. A long weekend where one feels questioned by a trusted figure would be unproductive and anxious even for someone who did not already suffer from Athena’s conditions. I agree with LCAMC, after listening to Athena and after reading Prof. Shedinger's latest post, that no harm was meant. However, I've read it multiple times, and like LCAMC, I can't twist the first few paragraphs into anything but skeptical, even if there was no harm meant. There was some icing on it, but it was skeptical. Prof. Shedinger had an opinion on mental health treatment and attitudes, and framed his interaction with Athena to fit it in the blog, although yes, meaning no harm. Here are those paragraphs: "Recently, a student asked me for an extension on a paper, informing me that her anxiety and depression had been acting up making it difficult to concentrate on her work. I try to be sympathetic to the mental wellbeing of my students, so I granted the extension. But the way she talked about her anxiety and depression I found troubling. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), one does not merit the diagnosis "depression" unless one has been experiencing the symptoms of depression most every day for at least two consecutive weeks. We call this condition "chronic depression" for a reason. It is not episodic. People with depression generally struggle with depressive symptoms chronically for an extended period of time. My student, however, right up until the time she asked for the extension, showed few signs of depression. She was attending class regularly, engaging in the class discussions, engaging with her peers, and smiling and laughing just like everyone else. Of course, people can hide their pain, but truly depressed people normally exhibit significant behavioral changes too. In addition, the language she used—"my anxiety and depression have been acting up recently"—seems not to fit with the DSM criteria. Depression is not something that "acts up" from time to time like arthritis. It is chronic. I think my student is the victim of diagnostic inflation." -----------------------------------------------------------------------------------

 Prof. Shedinger was skeptical because the student hid pain, and said that truly depressed people normally do not. He furthermore was skeptical because of Athena’s use of language. I think he took the language literally, without realizing, even though he has suffered from the conditions himself, that a depressed and anxious person is not going to want to say a 3-hour tome on the details of their condition to a professor, no matter how grateful they are for the extension. (And yes, my eldest had called me with their anxiety about asking for the extension, and had later come away from the granting of the extension with relief, and gratitude to a professor they thought really ‘got’ their condition and their needs.) 

My biggest concern is shared with LCAMC, which is privacy. Yes it is a public blog, but it is mostly specific to the Luther community. As my own mom used to tell me, ‘don’t put anything in writing you don’t want to be out there permanently’. In modern times, we know that once you put something on the Internet, you can never have control of where it goes and who reads it. Indeed, Athena saw this because of a mention on Facebook, with a link.

 I am also surprised that the moderator of the blog has read the blog, but her only caveat was that she wanted commenters to not post as ‘anonymous’. No privacy alarm bells were set off when a professor wrote a detailed account of a recent situation, describing it and the student so specifically that the student, myself, and the student’s roommate and closest friends, all members of the Luther community, would immediately know who the student was. Ms. Shockey Tritten did not see that complication in her position as moderator. I wish she had.

 Guidelines for the blog include 'respect'. Athena was not shown respect. Now that the blog is out, I am glad for the wonderful discussions here. However, I would have preferred the issue to have come up without Athena’s involvement. I don’t understand why Athena’s story was used in a public place without any warning or request for permission.
I do not like that Athena had to reveal personal information in order to get some sort of closure. When a student signs up for a class, they don’t sign a release of all private information to the instructor; yet, my eldest had to reveal a lot about in order to counteract the skepticism. 
Again, I believe Prof. Shedinger meant no harm. I’ll say behind Athena’s back that I have heard them talk about how much they love the class, and how they are learning much. And as a parent, although I try not to be a helicopter, I still thank you for the extension. At the time you granted it, you relieved much stress for your student. The anxiety and stress caused by this post was extensive, however.
  • May 17 2018 at 1:27 am
    A concerned student

    Sonja, your comment moved me to tears. The amount of support you have for your daughter is incredible. And Athena, I want you to know that there are so many individuals on this campus who are advocating for more mental health awareness at Luther. Thank you both for stepping into the light and revealing your names. That takes a lot of courage. You are not alone.

  • May 18 2018 at 4:55 pm
    Julie Shockey Trytten, blog administrator

    Thank you for all of the comments and conversation on this blog post! I just wanted to step back into the conversation for a minute for a couple of items.

    To Athena: You're brave, and I'm thrilled you took the time, energy and effort to respond to this post. We need more people to talk about mental health to help break the stigma around it. I'm sorry for the undue anxiety this post caused and for our part in that especially.

    To Professor Shedinger: Thank you for opening the door on this conversation. Regardless of my opinion on this post, it is an important conversation that needs to happen with greater frequency and empathy.

    To the Active Minds Club: Thank you for your post and for reaching out to me in person for clarification and answers. It was great to get to talk to your representative, and I hope I was at least helpful if not informative. 

    To Mama Sonja: Thank you for your post as well. When I originally read the post, I thought that Professor Shedinger was vague enough that privacy wasn't an issue. If as many students ask for extensions as they did when I went to Luther (more than a few years back) I saw no indication that this would out any particular student. As a pretty fierce mama bear myself, I can completely see your point and wish to apologize for not taking privacy into stronger consideration. 

    To future readers, commenters and bloggers: Some clarification about our blog commenting policy that Active Minds asked about. The reason for the "no anonymous posts" clause is specifically to guard against the trolls. People can be jerks online and can/will comment on blogs, social media posts and the like for the sole purpose of ruffling feathers or being straight up mean. They hide behind the "mask of anonymity" so that they can say things without fear of consequence. We totally understand that folks may need a little anonymity from time to time for very valid reasons-and that's OK with us. It's when our bloggers get veiled (and not-so-veiled) death threats or insensitive/hateful comments from anonymous folks that is not OK and force us to have that rule. We're not going to (in most cases) pull a comment just because it's anonymous.

    All that being said-I'm thrilled at the amount of openness and conversation on this post. This is the reason for this blog-to be able to have open and honest dialogue around difficult, sensitive, bold and/or timely ideas that are on the minds of our faculty, staff, students and alumni (and parents and friends of the college too!). Like I mentioned earlier, we need more folks to be honest about the way they are feeling and be willing to have a conversation about it. Not just to talk, but to really listen, contemplate and engage with the person and the idea. I've asked Active Minds to start blogging for the Ideas and Creations blog once a semester, because I do think this is a great place to have this conversation.

    Much love and many thanks,

    J

  • May 19 2018 at 10:02 pm
    Sonja Langsjoen
    Wow. This is the mom again. Athena fell in love with Luther after their high school visit, and didn't want to visit other colleges afterwards. (They had taken classes from the U of MN and had serious scholarships offers there. Aalso, I had recommended my alma mater, Gustavus Adolphus College, which is awesome in similar ways. Tons of colleges wanted Athena, but Athena wanted a place they could call home, and that had a variety of majors and activities. They wanted challenging courses, a challenging college, but they were skeptical of 'snob appeal'.) Athena has had a lot of success at Luther. Luther's support system encouraged Athena reaching out before classes started, and offered time and help. I'm stunned by the roommate-choosing system. Luther must be unique in having staff work on the project rather than computer algorithms. The result was lovely. Thank you, Lienne, for being an awesome roommate. Thank you staff, for the extra work in helping students have compatible roomies. Julia Shockey Trytten, you summed up what I thought. Luther, and its community, are all the better for this series of blogs and comments. I am also thrilled by the Active Minds Club, both in its existence at Luther, and its status as a national club. What a gem, and what an asset to Luther you are! Sending love, warm thoughts, and if I could, chocolate-chip-MnM cookies.... Sonja.

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