Sick to my Stomach: How Intersectionality has Shaped our [un]Health Center

After having had several hiccups with the Health Center at Bryn Mawr College, I decided to seek out further information on why any mention of it or its employees elicits a certain look of discomfort, despair, distaste, or disenchantment from the average student. And, in doing so, I got more than I bargained for—potentially too much information to be comfortable with (given that really, the "Shaped" in the title of this paper should have a "Failed to have" in front of it). These discoveries and the resulting analysis provide the basis of this critique. In order to further explore and address institutional challenges and structural restraints isolating the Health Center from the student body, I will explore its inaccessibility in terms of students’ identities as college students, as coming from diverse socioeconomic backgrounds, and as participants in the larger Bryn Mawr pressure-cooker culture (in other words, the very essence of being a “Mawrter”), three identities that in many ways are closely interlinked. Each of these facets of identity ties together in creating a complex college environment that the Health Center must tune into for it to fully serve its purpose of providing adequate and accessible support for the student body

To begin with, there is an overall lack of accessibility that comes seemingly a result of little regard for its patients occupations as students. The Health Center is only open from eight in the morning to seven in the evening on weekdays and nine until two on weekends. These limitations send the message that the center has neglected the fact that 93% of students live in college-owned dorms or nearby college-affiliated housing (“Bryn Mawr College”) and thus need care beyond these sixty hours per week.

Appointments made in advance are limited to business hours (eight to four), and often are not even available then, further complicating accessibility. I have been informed that physicals are only available from 10:30 to 1:30 on Thursdays (McLaughlin) and also know that meetings with one of only two psychiatrists are likewise held only during few midday hours on Monday*. Such limitations cause stress for students who must schedule around both the Health Center’s limited hours and their own numerous daytime commitments such as classes, sports, and jobs.

A last problem rests in the fact that information that could be readily available through either word of mouth or printed information is not. Due to constantly changing wording of policies regarding payment for and the role of insurance in counseling sessions, inaccurate, confusing, and contradictory information is spread among students. (I only received a full explanation when I actively spoke to the Student Health Services director in person, who told me that more people are unaware because the center did not want to have to explain the insurance process to students.*) Additionally, pamphlets in the waiting rooms should be a way to easily obtain information; however, most of the several dozen come from other institutions and organizations and are impersonal and generic, rather than being tailored to our student body as the three school-published ones are. Even worse, several are painfully out of date: “Eating Disorders: What Everyone Should Know,” is from 1999; in this case, its age is actively detrimental, as it presents information which recent research has contradicted[1]. As a result of these widespread limitations, students are bound by the times during which they may receive care and are bound to struggle to find accurate information when those times are unavailable.

Coming on the heels of its inaccessibility to patients as college students is the Health Center’s inaccessibility to patients as predominately young people from diverse socioeconomic backgrounds. These shortcomings fall into two families: financial barriers and little publicized information about how to maneuver through them. The Health Center reinforces on its web site’s homepage that “no student is ever denied care because of inability to pay” (Health Center). However, many services beyond medical, gynecologist, and a limited number of counseling appointments require extra fees, including but not limited to lab work and cultures; tests for pregnancy, HIV, and STIs; and immunizations (Health Center).

Fees are further complicated by insurance. As evidenced by the confusion regarding counseling, it is clear the role of insurance (and how the college insurance interacts with any personal primary coverage) is not adequately clarified. In fact, the only information directly given to students is sent via a brochure that “each student should have received” according to the Health Center’s web site; however, in the email sent out to remind students to enroll at the beginning of each year, students are referred to the “plan documents that are available online” (Health Center; Student Health Division). With the bulk of the student body being of traditional college age and thus young enough to have had minimal experience with insurance, this lack of information is likely the source of the aforementioned misinformation.

To add to financial restraints, Bryn Mawr Hospital is the backup outside Health Center hours as well as during school breaks when the Health Center is closed altogether. But treating the hospital or other outside healthcare sources as viable options for all students is problematic both because services cost more and because insurance matters are even further complicated when taken off campus; even in terms of seeking out psychiatric care off-campus, I was advised that services in the Health Center were more affordable by the head of Student Health Services herself.* In order students to feel less alienated by class background, it is necessary that the Health Center: one, educate students about their insurance, and, two, not operate under the assumption that those students with financial barriers are the occasional exception to the rule.

Lastly, in conjunction with our collective identity as students rests the identity of being at Bryn Mawr, and this is one identity which is given little lip service. As students, we refer to ourselves as Mawrters, an affectionate but dark playoff on “martyrs” in reference to our unhealthy relationship to academics. In their essay “On Being Transminded: Disabling Achievement, Enabling Exchange,” Anne Dalke and Clare Mullaney address a short story published in the 1900-1901 school year about an ill-fated senior in terms of its relationship to Mawrters because it epitomizes “the dynamic relationship between intellectual achievement and mental disability” (Dalke and Mullaney). The story is so appropriate because of the frequent allusions to, jokes about, and general attitude that students must pick between mental health and academics. Due to the high standards and rigor set by the college’s mission “to provide a rigorous education and to encourage the pursuit of knowledge as preparation for life and work,” as well as the college’s entire history as a school founded to provide women with an exclusive elite education to match that which men were receiving at the schools in the Ivy League, it is unsurprising that the academics win out. But this unhealthy attitude goes unacknowledged by the Health Center, and its results, untreated.

There is no information give during first years’ orientation week or during the required Wellness seminar on mental health and mental illness beyond advice on how to prevent stress and manage time. But even college- and Health Center-sponsored “stress buster” events are held only around finals periods, as if (severe) stress only occurs during those one- or two-week periods.

In addition to the lack of adequate attention paid to ensuring that students are aware of the need to prioritize mental health, care for students with mental illness is insufficient. Having spoken to three separate individuals who have had personal difficulties with mental health in the Health Center, several factors are evident: no assistance is given if a student wishes to see a counselor off campus because they are unable to develop a relationship with those at the Health Center; in spite of information otherwise distributed, getting an appointment with a counselor can take as long as three weeks; it is nearly impossible to get approval for a reduced course load for medical reasons; if a student presents severe mental illness such that they are a risk to themselves or others, they will be required to take a year off on medical leave; and, upon taking that year off, resuming studies is difficult and complicated, sometimes resulting in the decision to not return (“Health Center Support”).

This lack of support is even more worrying when considering the risk of mental illness for the average student. Mawrters, especially first years, are placed under stress as students beginning a new (and, as previously cited, frequently residential) course of education, and this stress is augmented by Bryn Mawr’s culture. Furthermore, traditional college students make up the majority of the student body, and mental illnesses are most likely to occur during this age range as well as among females (an added concern at a women’s college): as of 2012, 22% of females between the ages of 18 to 24 had a mental illness and 4.9% had an illness considered to be serious mental illnesses as defined by National Survey on Drug Use and Health standards (“Statistics”[2]).  

Overall, students who wish to seek out help may choose not to, feeling threatened by either the possibility in an undesired or unhelpful outcome or fear that they will have to leave. And the latter fear returns once again back to the rigorous culture of Mawrterdom: mental illness is already stigmatized in our current society and, at Bryn Mawr specifically, students with severe illness face the fear throwing off their education plans as well as blaming themselves for their mental illness and thus feeling shamed about not being “strong” or “tough” enough to prioritize academics over mental health—in other words, not being strong or tough enough to be a Mawrter.

The Health Center clearly has many problems to resolve; in short, it is out of touch: with the student body and its diversity, with the general needs of college students and the specific needs of Mawrters and everything in between that is required for students to succeed. That students must choose between health and financial stability, between health and attendance and class and activities, between health and fitting into a close-knit community, is inherently problematic.

Items marked with an asterisk (*) are all points I have garnered from meeting and asking questions—specifically, over the course of twelve separate appointments times since arriving. But healthcare is one field in which I should not have to go out of my way to be an “informed citizen.” As a student at this college, everyone should be informed directly, not via probing emails or a slew of odds-and-ends visits.

In considering these issues, I can address potential solutions, such as insurance information sessions, extended hours, and transparent communication (and also the updating of those awful pamphlets). But these are band-aids on a systematic wound: there is a troubling absence of awareness of students’ needs in Health Center policy. Moreover, though, many of these problems are tied to loopholes in state and federal law or can be attributed to insufficient funding, indicating a larger scale—the complexities of obtaining healthcare in America and the college’s lack of urgency in prioritizing students’ health, regardless of their class background. While one of these is a very large concern always in the works but unlikely to be fixed any time soon, the other is well within our hands as a student body with a strong voice in the policies of a normally forward-thinking college. Let’s get with it, Bryn Mawr.