When the Door Opens Again
On the day I was released, everyone gave me a hug. To some extent, we did our time together, including an elder lady who recently lost her lifetime spouse, a firefighter bothered by extreme stress, a teenage girl who was haunted by nightmare of drugs, and a former gang member escorted by the Police on the same afternoon that I was admitted in the same hospital.
Mental illness is such a politely indifferent force. We are all bonded by this strange god and trapped here all together. Though I have never spent time in jail, I felt how the psychiatric ward’s function was similar to a jail. When the newcomer was admitted, everyone would be so curious: why did you do your time here? What made you become one of us?
Before the door was opened, a nurse patted my shoulder, “I don’t want to see you come back again. If you are back someday, I hope you come as a doctor, not a patient.” The social worker who was responsible for our occupational therapy in those afternoons gave a disc of meditation music to me, “You’ll need it.” The door was closed. Another nurse escorted me to the Deposit Center. Driver license, purse, keys. And the Cab. Good evening, Buffalo.
In January 2015, I could hardly make it. I was on the edge of a relapse of depression. I was hesitant to stay in my doctoral program, or to go back to my home country. Later in the same month, the Atlantic ran an article that began with a suicide[1]. Luchang Wang, a sophomore mathematics major at Yale, posted a status on Facebook and boarded a plane for San Francisco:
“Dear Yale:
I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted.”
Five hours later, Wang jumped off the Golden Gate Bridge into San Francisco Bay and was confirmed as “an apparent suicide”. In the same year, the Yale Daily News [2]reported the story of another Chinese student Grant Gao. Despite he had presented medical diagnoses of depression and proof of his hospitalization in Connecticut Mental Health Center, Gao was still expelled by Yale because of his poor grades[3]. With his visa status jeopardized, his health insurance expired immediately. Gao was threatened with deportation, while he was suffering from depression.
This is how it works when a foreigner finds himself/herself trapped by mental illness. The society is just like a programmed robot, and you are like a tiny component. If one part of the machine is broken or missing, you the tiny component can be replaced immediately. Nobody gives a f**k.”
I always feel we are cripping in spacetime[4]. We are tripped by isolation from our home country, doing tough reading/researching/working loads in English as a second language, and we have difficulty in building productive relationships with our peers and professors. The mental health crisis is the “garden of forking paths.” Some of us are trapped permanently, some of us are still navigating, some are trying to secure an escape route and prevent others from being trapped.
Universities advertise and publicize counseling services during international student orientation. For example, the University at Buffalo usually packages the counseling service information session together with the immigration and UB police sessions (attendance required), which is a good strategy to make sure everyone is aware of the mental health services on campus. However, when someone is reaching out for help, they usually cannot be referred or scheduled for an appointment without delay, until the condition deteriorates into a mental health crisis, sometimes ending with suicide. The same-day crisis appointment is helpful, but it lacks enough information to determine whether your symptom falls into the “emergency” category. I point it out because in my observation, many Eastern Asian students tend to endure the “pain” and are reluctant to ask for help. One of the possible reasons may be from how we define “virtue.” I grew up in East Asia, where it is a virtue to endure whatever comes to you without seeking others’ help. It is usually not culturally accepted if you ask for help for “trivial” matters.
When students finally muster the courage to reach out for mental health services on campus, they will still face challenges due to a lack of access. One of the major challenges is the double standard in time. On the one hand, it is impossible to schedule an appointment for evaluation without delay, until the condition deteriorates into a real crisis. On the other hand, patients are required to be extremely strict with time. If they fail to keep the appointment by not showing up on time, they will be easily disqualified for further service from universities. For example, UB’s counseling services clearly stipulates that if you miss your appointment three times without cancelling ahead of schedule within 24 hours, you will be disqualified from using the counseling services on campus. Instead, you will be referred to another counseling service off campus.
Long waiting times cannot substitute enough session time, even at the price of sacrificing our own “cripping time” to meet the efficiency-oriented time standard that capitalism values. After surveying mental health services from major public institutions to small elite colleges, STAT News[5] reveals a striking and worrysome pattern about mental health services: students have to wait for an initial intake review for their symptoms. If they need to see a psychiatrist who can prescribe or adjust medication, they have to wait for longer than at least two weeks. I have experienced the same painful time wasted in waiting for an initial intake review and related medical support, which caused me deteriorate and resulted in a later crisis in the same year.
Time is the quintessential assessment standard to determine who is a “good” patient that deserves help and who is not a good “investment” of time and effort. It is a one-way evaluation system. Often the students (patients) are disadvantaged and being “assessed”, rather than universities (the health providers). I personally find it unreasonable because we are using self-financed medical groups. As both customers and “sponsors,” we are still under-served.
Another barrier to access to mental health service is language. A Chinese friend confided in me that she paid out of her pocket to get a Chinese-speaking counselor outside UB, rather than relying on an English-speaking counselor assigned by UB. Language is a barrier for international students to select university mental health counseling services as their first option. Though I can speak fluent English and have used UB counseling services continuously for the previous four years, I still came across language barriers when working with English-speaking counselors. The article “Chinese, Studying in America, and Struggling” published by the New York Times singled out this problem[6]:
How can Chinese students convey the texture of their thoughts and moods in a foreign
language when the language barrier is a cause of their stress and inhabitation in the first
place? How do they communicate their nostalgia for mouthwatering homemade Chinese
dishes when the sympathetic therapist may not have ventured beyond Panda Express?
The language barrier is also addressed in “In Higher Ed’s Mental-Health Crisis, an Overlooked Population: International Students,” an article published by the Chronicle of Higher Education[7]:
“The first is the language barrier. Many international students have never faced situations
in which everyone speaks native English, making classes and social life difficult for even
the most proficient English speakers. “It’s not just about words, about sentences and
grammar and stuff,” Ms. Li (a Chinese student who agrees to speak to The Chronicle) says.
‘It’s about what kind of persona you display through your language.'”
If the students’ retreat and seek refuge among other international students that speak the same mother language, they will be less prone to practice English in their daily lives. They will fall behind and be less likely to keep up with their studies with the fellow American students. According to The Chronicle, it is a “vicious circle.”
The “vicious circle” in mental health service is reflected in two aspects. First, international students are not sure how much they can trust an English-speaking counselors’ ability to understand their distress, despite the fact that the counselors are licensed and well-intentioned to help. Second, international students can express their concerns in their mother language, however, it does not mean they can fully convey the information in English as a second language, which will certainly cut down the quality of the counseling experience. To illustrate this point, I will draw on my experience with UB’s counseling services. Though my counselor is well-trained and compassionate, I still find that my English can only reconstruct roughly 70 % of my concerns, anxiety, and distress. What happens to the rest of the 30%? Lost in translation. As a non-native speaker, I find I am disconnected from the real “self” and limited by the image presented through language, especially when speaking English has become the only way to prove I am capable and reliable, in both academia and other semi-professional settings. To some extent, Chinese international students are lost in translation. We are lost in the conflict of two value systems: one is “Be humble. Be mindful of the feelings of others on every occasion you need to speak. And do not trouble to others;” the other one is “presence and participation will be counted as your value and contribution to U.S. academic discourses and medical discourses.”
College ableism is hanging over our heads. Everyone is dealing with it, whether they are physically disabled, mentally disabled, or not disabled at all. For international students, we are clearly “crippled” the first moment we step on this land. We are navigating our path through a completely new “coding system.” English is our prosthesis to understand American society. It takes time. By referring to time, I mean a “broken time” or a “crippled spacetime”[8]. It means we need to confront the existing standard of “efficiency” that a capitalist society prioritizes and values. However, the current university ecosystem is designed and managed in the language of neoliberalism: everyone must prove to be a valuable contributor to academic discourse in order to be considered deserving to be treated as a member of the community. After revenue is collected, we are disposed of like a liability rather than an asset.
Again, when I go back to the day when I was released, the nurse told me, “I don’t want to see you come back again. If you are back someday, I hope you are here as a doctor, not a patient.” She may be 50% correct. I will not come back as a psychiatrist, but as another kind of doctor: who seeks to heal and give back to my community— my fellow international friends, studying and struggling in the United States.
[1] Giambrone, Andrew. “When Mentally Ill Students Feel Alone.” The Atlantic, 2 March. 2015. https://www.theatlantic.com/education/archive/2015/03/when-mentally-ill-students-feel-alone/386504/.
[2] Mao, Grant. “Mao: From Depression to Deportation.” The Yale News, 3 February. 2016. https://yaledailynews.com/blog/2016/02/03/mao-from-depression-to-deportation/.
[3] Megan, Kathleen. “Graduate Student Fights Dismissal by Yale.” Hartford Courant, 26 December. 2015. http://www.courant.com/education/hc-yale-chinese-graduate-student-20151226-story.html.
[4] Samuels, Ellen. “Six Ways of Looking at Crip Time.” Disability Studies Quarterly, vol. 37, no.3, 2017, http://dsq-sds.org/article/view/5824.
[5] Thielking, Megan. “A Dangerous Wait: Colleges Can’t Meet Student Needs for Mental Health Care.” STAT News, 2 February. 2017. https://www.statnews.com/2017/02/06/mental-health-college-students/
[6] Gao, Helen. “Chinese, Studying in America, and Struggling.” The New York Times, 12 December. 2017. https://www.nytimes.com/2017/12/12/opinion/chinese-students-mental-health.html.
[7] Turnage, Clara. “In Higher Ed’s Mental-Health Crisis, an Overlooked Population: International Students.” The Chronicle of Higher Education, 9 August. 2017. https://www.chronicle.com/article/In-Higher-Ed-s-Mental-Health/240891.
[8] Price, Margaret. Mad At School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: University of Michigan Press, 2011.
—. “Moving Together: Toward a Theory of Crip Spacetime.” National Women’s Studies Association. Montreal, Quebec, Canada. 13 November 2016, https://academicableism.files.wordpress.com/2017/09/price-moving-together-toward-a-theory-of-crip-spacetime.pdf.
当门打开时
出院那天，大家都过来拥抱了我一下。从某种程度来说，我们算是“狱友/院友”了：我们之中有突然逝去挚爱老伴的老太太，精神高度紧张压力超负荷的消防队员，被药物成瘾噩梦困扰的少年，甚至还有一个被警察送进来的有自杀企图的前帮派成员。我和那个前帮派成员是同一个下午入院，而且还收在了同一个病区。
精神疾病是一种彬彬有礼而冷漠的力量。我们被这个力量羁绊，作困兽斗。虽然我从来没有蹲过号子，但我总觉得病房的运作有点儿像监狱。每当新人进来的时候，每个人都格外好奇：你为啥进来的？你咋就成了我们中的一员？
门要开了，当班护士拍拍我的肩，“我不想看见你再进来了。如果将来你要回来，我希望你是作为一名医生，而不是这儿的病人。”负责我们的社工把一张冥想音乐的唱片塞给了我，“你出去后会需要的。”
铁门关闭。另一个护士把我护送出病区，到了入院物品寄存处。驾照，钱包，钥匙。出租车到了。晚安，Buffalo.
然而2015年，我又感觉快要撑不下去了。在复发的悬崖边，我一直在犹豫：到底是应该继续留在美国读博，还是干脆回国。同一个月，大西洋月刊[1]刊登了一篇以自杀开头的报道：耶鲁数学系大二学生王璐畅在脸书发出了一条状态，然后登上了前往旧金山的航班。
“亲爱的耶鲁：
我喜欢这里。我只希望我能有更多的时间来解决事情，和等新药疗效开始生效。但是在学校我做不到这些，我不能接受整整一年的休学，或是休学却永远无法被再次录取。”
5小时之后，王璐畅在旧金山湾区跳下了金门大桥，已确认自杀身亡。同一年，耶鲁大学新闻[2]报道了另一名中国留学生Grant Gao。尽管他已经被确诊抑郁症，而且能出具在康乃狄克精神卫生中心的入院记录。他却仍然因为成绩记录不理想[3]被耶鲁开除，签证被立刻吊销，医疗保险也被立即终止。尽管当时饱受抑郁恶化困扰，他却被要求立刻离境。
这就是当一名外国公民在异乡美国被精神疾病困扰的窘境。这个社会就像是一个预设好程序的机器，你只是一个小零件。但凡机器上的一个零件损耗或是丢失了，你这个小零件就会被立刻替换。没人在乎你是什么状况。
我们在时空中被困住了，困住我们的是离开家乡的孤独，海量的阅读/研究/工作量，而且还是我们的非母语—英文。更艰难的是，我们很难和我们的同辈/同行和教授建立起富有成效的社会关系。心理健康危机就是“小径分岔的花园”：我们中有的被困住了，有的开始在探索，有的在力图找到一条出去的逃生路来防止后人被困住。
虽然大学在国际学生入学时会努力宣传大学附带的心理咨询服务。例如我来UB那一年，校内心理咨询介绍是被放在国际学生签证信息服务和校警服务一起的，而且这场宣讲需要签到，这是一个非常棒的宣传策略。但是，当学生真正需要帮助和心理咨询服务的时候，他们很难及时地预约到初始心理健康评估和咨询。虽然学校提供当日紧急咨询，但是我们缺乏信息来判断，“我到底属不属于紧急情况”。我特别指出这一点，是因为根据我的观察，很多来自东亚的国际学生更倾向于忍耐痛苦，其中一个可能的原因是来源于我们东亚文化对“美德”的定义。在我长大的这个环境，忍耐是一种美德，而不是轻易地诉诸于外界帮助。
当学生最后鼓足勇气寻求校内心理健康支持时，仍然面临着窘境。其中影响最大的一个因素：对时间的双标。一方面，学生（病人）很难及时地预约到首次全面心理健康评估，以至于病情延误到精神状况出现巨大危机。另一方面，学生（病人）却被训规要求严格遵守时间。如果三次不按时赴诊，就会被学校取消继续使用校内心理健康服务的资格。以UB为例，取消预约必须至少提前24小时，三次无法按时赴诊，将被取消使用校内使用资格，而被转到校外服务机构。
长时间的等待换不来相应的就诊时长，即使我们大量牺牲自己的“跛行时间[4]”来竭力满足资本主义优先考虑的“效率”。在调查了美国高校的精神健康服务之后，STAT新闻[5]的报道揭示：不管是美国大型公立大学还是小型名校，学生只能通过等待，才能获得初始的精神健康评估，只能通过等待。如果学生需要预约精神科医生来获得药物处方或调整药量，至少需要等待半个月。我也曾长时间等待评估就诊，因此病情延误恶化。
时间是一个微妙的测量标准，它决定了谁是“值得”帮助的“好”病人，谁是“不值得投资时间和精力”的“”病人。这是一个单方面的测评系统：通常被评估被审视的是学生（患者），而不是医疗服务提供者。这十分不合理，作为自费医疗的群体，我们既是客户也是这个国家医疗系统的“赞助者”，然而我们没有被服务覆盖周到。
国际学生使用精神健康医疗服务的另一个障碍是—语言。一个中国朋友向我透露，她是自掏腰包去寻找一个能讲中文的心理咨询师，而不是使用学校提供的英文心理咨询服务。我能理解她的做法。因为我自己也能讲相当流利的英语，而且连续使用学校提供的心理咨询服务长达四年之久，同样在英文心理咨询中遇到了语言障碍。纽约时报刊登的《那些在美国大学里痛苦挣扎的中国留学生》也指出了这个问题[6]：
“语言障碍正是中国留学生压力和抑郁的根源，然而他们怎么能够用这门外语表达自己的想法和情绪呢？尽管治疗师满怀同情，但他们连熊猫快餐之外的中餐都没品尝过，中国留学生怎么能对他们讲得明白自己对家乡美味佳肴的思念呢？”
语言障碍也出现在了高等教育月刊[7]的报道《高等教育精神健康危机中被忽视的人群—国际学生》：
“第一个就是语言障碍。许多国际学生从来没有面临过所有人的母语都是英语的全英文环境，即使对那些英文流利的（第二语言习得者）来说，课程学习和社交生活也是压力重重。一个来自中国的国际学生小李对记者说，“这不是关于语言文字，也不是关于语法和其他东西，而是关于这个语言展现出的你是怎样的一个人。”
如果国际学生退回和自己同一母语的国际学生中扎堆儿，他们就更不愿意在日常生活中继续练习英语，也更容易落后于身边的美国同学。高等教育月刊把这称为“恶性循环”。
针对国际学生的精神健康服务中关于语言障碍的“恶性循环”体现在两个方面。第一，国际学生无法确认英语母语的心理咨询师能够理解自己精神健康方面的困扰，虽然咨询师有专业认证。第二，即使国际学生能用母语完整流利地表述自己的困扰和担忧，但在英文语境却不一定能完全做到，咨询体验因此会大打折扣。对此我有切身体会。尽管我的咨询师有专业执照，受过良好训练，也有共情能力，然而我用英文也顶多只能表达出70%自己的困扰、焦虑和抑郁，其他30%想要表达的内容都遗失在了不同语言切换中。作为一个母语非英语人士，我有切身体会，用英语展现出的那个“我”和母语展现出的我是断裂的。这在学术界或其他半职业场景需要用英语证明自己的能力的时候，尤其明显。中国留学生在语言切换和翻译中迷失了，我们也在两种价值体系中迷失了：一种是“要谦虚，要谨言慎行，不要给人添麻烦”，另一种却是“你在美国学术体系和医疗体系的价值和话语权，是由你的存在、参与和贡献来决定”。
高等教育行业中的体能歧视高悬我们头顶，无处不在。每个人都在生活中接触这个议题，无论你是身体残障，精神残障，或是没有残障。对国际学生来说，我们来到这个国家的第一天，我们就挣扎着起步，在这个全新的“代码环境”中探索着解码。英语就像是我们理解美国社会的“义肢”。我们需要时间，这里我指的是“断裂残缺的时间体系[8]”。我们更需要来对抗这个以“效率”优先的资本主义价值体系。但是，我们大学的生态体系运作是以新自由主义话语体系建构的：每个人都必须先只先证明自己是在学术圈内有价值的提供者，他/她才有资格被认定为圈子中的一员。价值被收割之后，我们却像债务一样被抛弃了，而不是像资产一样被对待。
我现在仿佛回到了出院的那一天，护士告诫，“如果将来你要回来，我希望你是作为一名医生，而不是这儿的病人。”她说准了一半。虽然我不是作为精神科医生归来，但是作为另一种含义的“医生”回归，来对我身处的社区做出贡献—那些在美国大学里痛苦挣扎的留学生。
- 作者记
创伤后精神紧张性精神障碍+抑郁。2013年两次入院ECMC，2015年复发。2017年在专业医疗指导下成功停药康复。
社会进步不是单单一个人前进一大步就能解决的，而是一百个人作为一个社群迈出的每一小步。倡导呼吁精神健康议题需要创造力、想象力和聪明才智。我相信MITA在正确的时间做着正确的事情。语言不应该成为母语非英语读者的障碍。我因此决定用英文和中文进行双语创作，虽然这花费了我更多的时间和精力，但感谢MITA给我提供这样一个“实验室”，还有无法衡量的巨大支持。
- 关于作者
Xingyu Chen来自中国，现为纽约州立大学布法罗分校全球性别研究项目博士在读。她是UB Community of Global Health Equity(全球健康与公平) LIGHT Fellow，同时也是2019年社会影响力Fellow.
Xingyu Chen和Shuko Tamao联合创立了UB Group for International Graduate Students（获得UB正式资格认可），为国际学生建构同伴支持系统，对精神健康议题进行倡导。Xingyu加入了UB警察局的公民警察学院，推动国际学生和社区的服务和交流。她同时也是母校南京师范大学金陵女子学院旗下“金陵-姐姐来了”的专栏作家，MITA的中英双语作家。
[1] Giambrone, Andrew. “When Mentally Ill Students Feel Alone.” The Atlantic, 2 March. 2015. https://www.theatlantic.com/education/archive/2015/03/when-mentally-ill-students-feel-alone/386504/.
[2] Mao, Grant. “Mao: From Depression to Deportation.” The Yale News, 3 February. 2016. https://yaledailynews.com/blog/2016/02/03/mao-from-depression-to-deportation/.
[3] Megan, Kathleen. “Graduate Student Fights Dismissal by Yale.” Hartford Courant, 26 December. 2015. http://www.courant.com/education/hc-yale-chinese-graduate-student-20151226-story.html.
[4] Samuels, Ellen. “Six Ways of Looking at Crip Time.” Disability Studies Quarterly, vol. 37, no.3, 2017, http://dsq-sds.org/article/view/5824.
[5] Thielking, Megan. “A Dangerous Wait: Colleges Can’t Meet Student Needs for Mental Health Care.” STAT News, 2 February. 2017. https://www.statnews.com/2017/02/06/mental-health-college-students/
[6] Gao, Helen. “Chinese, Studying in America, and Struggling.” The New York Times, 12 December. 2017. https://www.nytimes.com/2017/12/12/opinion/chinese-students-mental-health.html.
[7] Turnage, Clara. “In Higher Ed’s Mental-Health Crisis, an Overlooked Population: International Students.” The Chronicle of Higher Education, 9 August. 2017. https://www.chronicle.com/article/In-Higher-Ed-s-Mental-Health/240891.
[8] Price, Margaret. Mad At School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: University of Michigan Press, 2011.
–. “Moving Together: Toward a Theory of Crip Spacetime.” National Women’s Studies Association. Montreal, Quebec, Canada. 13 November 2016, https://academicableism.files.wordpress.com/2017/09/price-moving-together-toward-a-theory-of-crip-spacetime.pdf.
PTSD and Depression. Hospitalized twice in ECMC, 2013. Relapsed in 2015. Successfully completed the drug withdrawal from medication under the professional guidance in 2017.
Social progress is not achieved through one giant leap by one single individual, but through every little step by one hundred people as a whole community. Advocacy for mental health issues needs creativity, imagination, and capability. MITA is doing the right thing at the right time, I believe. Language should not be the barrier for readers whose native language is not English. That is why I write in both English and Chinese, which takes me more time and efforts. Thanks go to MITA, for providing this “lab” to me with unmeasurable support.
Xingyu Chen, born and raised in China, is a doctoral student in Global Gender Studies at the University at Buffalo—The State University of New York. She is the Local-International Global Health Talent (LIGHT) Fellow of the Community for Global Health Equity at UB, and 2019 Social Impact Fellow.
Xingyu Chen and Shuko Tamao co-founded UB Group for International Graduate Students (UB GIGS, officially recognized by UB GSA) to strengthen the peer-support network and advocate mental health issues for international students in America. She is also accepted by Citizens Police Academy at UB Police, aiming at bridging the gap between international student community and the rest of university. Chen is the featured columnist of Peer-support Network for Career Diversity “金陵-姐姐来了”for her alma mater Ginling Women’s College, Nanjing Normal University in China, and the featured bilingual writer for Madwomen in the Attic in Buffalo, New York.
Madwomen in the Attic 
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