Susan Schultz, “The Language of Care…” continued
I present here an autobiographical account of how this came to be, this fusion of neoliberalism and mental-health care, or, as Kendall Atterbury writes, “mental health itself takes on a kind of commodity form, and mental health services are reconceptualized along an enterprise model…what was once a discourse of political challenge shifts to a discourse of market relations.”[1] Hence, mental health resembles a top priority, but instead becomes a facade for the university’s claim to care for its students. In another context, Sara Ahmad has written about the way universities promote diversity, while not enacting it: “Commitments to diversity are understood as ‘non-performatives’ that do not bring about what they name.”[2] The neoliberal university promotes mental-health care in the same hollow fashion.
The first problem was one of silence, not language. In 2014, a young man named Abel Pelligrino fell to his death from a staircase near the dorms at UHM. The community was not informed of his death. Counselors were sent to the dorms, but the student suffering immediate trauma in my class the next day had not made it onto these counselors’ lists of affected witnesses. In 2015, two young men fell from the dorms; one died, and the other was badly injured. The university made no announcement, although the incident caught the attention of local media outlets.
As I began to lobby for a death protocol at my university, I came up against a pervasive system of call and no response.[3] In meetings with students and faculty, the responses were all positive: “we care.” “We have spent time in our office talking to grieving parents.” Except when the subject of death came up. Then Hawai`i became a culturally unique place where talking about death was taboo, and announcing deaths to students would traumatize them. So when administrators talked about death, they talked about the need not to talk about death. Even after both undergraduate and graduate student governments voted that they wanted such information, it was not given.
There have always been suicides. They have never been announced. Because contagion. Because death. No one knows how many. I wrote to the Medical Examiner’s office and was sent a list of deaths at UHM from 2010-2015. Even I could see there were gaps. When I asked at a meeting, the head of the Counseling and Student Development Center (CSDC) did not know how many students die of suicide each year. If you did know, you’d have to think about death, and if you knew about suicides, you’d recognize the possible failure of the counseling center.
I asked that the CSDC go public. Until recently, the counseling center did not advertise its services. Someone from another campus came to UHM in early September 2015 and asked 215 random students and sixteen faculty members if they knew where the counseling center is located. Five students did. No faculty members. The student newspaper reported these facts. The official response was that the polling technique was somehow flawed. The CSDC is in a building far away from the UMH Health Center; it is on a higher floor of the building; there are no signs on the front of the building that communicate to the public that the center is located there. The CSDC flyer is completely inadequate. One of the members of my group, an intrepid undergraduate, drafted a newer flyer. It was summarily rejected several years ago and the old flyer, which says more about fee schedules than about why you might need mental health services, remains on the front table in my department’s main office. At least it is there now.
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In early 2016, a group of us held a memorial service for community members who had died, including a Botany Department post-grad, whose suicide in the Botany building in December 2015 was left unacknowledged by the university. The acting chancellor was moved; two members of the counseling center came, in case someone became distraught. Despite the fact that many campuses hold such memorials annually, no other such services have been held since. The university has no bereavement policy, another gap I pointed out to the Interim Vice Chancellor for Students. Later, I heard through a member of the student government that the Interim VC was working on one. That was over a year ago. (Note: many administrators are “interim” at the neoliberal university.)
And then, success—we thought. The university put a death protocol deep into a statement with other rules and regulations. Two deaths that I remember (but not all of them) have been announced to the campus in recent years. The CSDC came out of hiding, participating in fairs at Campus Center (including a “Love Life” event where balloons and information were handed out). In the last year, this counseling center has issued four announcements to the community about the availability of services. This office was responding to pressure and, more importantly, to need.
And yet, the problem of long wait lists at the center has continued. For example, students were told at the Spring semester’s end that they would need to wait until the Fall semester to get closer to an appointment for counseling assistance. Or students were told their situation was not dire enough, that they should find help in the community (where counseling services are also very hard to find). The CSDC website, year after year, reveals that therapists have left, and that this campus of approximately 18,000 students has had only one half-time psychiatrist in recent history.
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So what progress in mental health care happened that only seemed to happen? Let me look at several writing samples from the administration to show how they have moved from silence to a language of care without changing much. In June 2019, several of us sent a letter to University President David Lassner; it was signed by over twenty members of the college community. In this letter, we told him about the long student wait lists (eighty and more), and about students who had to reach for mental-health appointments out of state. We told him that many in-take interviews and crisis consultations at the center are done by unlicensed and unsupervised interns. We asserted that this state of affairs was unconscionable, and we ended with a plea to the university president to “improve management and to provide adequate services to students who are suffering.”
The president did not respond. Instead, he sent the letter to the Interim VCS and the head of the counseling center to draft a response. About a month later, we received a response from this Interim VCS. We were assured that “the CSDC faculty, staff, and doctoral-level trainees met to review the letter, discuss its contents, and provide a perspective of the clinical concerns raised.” What followed was essentially an ad for services: “The CSDC offers an array of clinical services including individual, couples, and group counseling, case management and referrals to community providers for students with healthcare insurance, and crisis intervention.” The CSDC head referred to her program as “robust,” mentioning the Counselor-in-Residence Program, as well as the “Love Life” event the center had organized. She admitted that there were staff shortages at the CSDC, including the lack of all but one-half a psychiatrist. But she added that, “thus far most of the applicants have not met minimum qualifications. We continue to prioritize these vacancies and are in a continual cycle of recruitment for hiring.” Note that as of my writing this in Spring 2021 that the CSDC still has but one-half a psychiatrist on staff. The last full paragraph of the CSCD head’s letter lists an award the internship program received from the American Psychological Association (APA), along with “unprecedented re-accreditation” for 10 years. In fact, the Interim VCS and the head of this counseling center are both adept award winners. That does not mean the CSCD services are adequate for UHM students.
In mid-July, we sent a response to this non-response, enumerating areas in which CSDC does not follow national “best practices,” including failure to organize “an interdisciplinary task force or committee that works on campus wide strategy and planning related to emotional health and substance abuse prevention on campus.” (In the vernacular acronym, this is often called a BIT, for Behavioral Intervention Team.) To this response, we received no response. Then again, that same month, I followed up with a letter to the chair of the University Board of Regents about mental health problems at UHM. Once again, I got no response.
As I was originally drafting this talk for our colloquy “Poetics & the University in Crisis,” which took place in early March, an email popped up on my screen from the CSDC to members of the UHM community. It was addressed, “Aloha UH Manoa Ohana,” and the email declared that “You are not alone.” In an earlier November 5, 2020, announcement, the CSDC mentioned some of the reasons for student distress: “homelessness, financial strain, adjustment to online learning, disrupted plans, and barrier to travel/return to their home countries.” But the response to these rather major issues and mental-health symptoms of our neo-liberal university economy simply is to provide “drop-in support spaces and group therapy.”
Which brings me to the way in which my neoliberal university has been navigating its mental health crisis, as well as the criticism of its work. Communication of care, which they now perform, does not indicate real care. The truth is that the CSDC is providing less care than they offered in the past, although language now is used to promote the illusions that full care is being given. “Through products such as managed care contracts,” Atterbury writes in her dissertation on neoliberalism and the mental health crisis, “time-limited services, and audit demands, recovery-as-policy is able to both claim recovery principles by recognizing not all recovery happens in the clinic and use that to justify constricting a person’s access to services while masking the more significant motivation of cutting the public cost of mental health services.”[4] In the absence of any real outreach, such as a BIT or CARE team at my university, “the proper neoliberal subject [the student] knows it is her responsibility to recover her own mental health.” As Atterbury puts it, “the consuming individual is substituted for a flourishing humanity,”[5] which is gestured to in the address line, “Aloha . . . `ohana.” If you’ve seen Lilo and Stitch, you know a bit about the word `ohana, as dressed up for the movies. The word, like many other words in the Hawaiian language, is used by administrators to signal that we are a “Native Hawaiian Place of Learning.” Enacting that idea is, of course, another thing entirely.
A “flourishing humanity” is part of the UHM 2015-25 Strategic Plan, which the CSDC refers to in its notice last January. Under a Strategic Plan section, entitled, “Enhancing Student Success,” is included the item “advanced health and wellness services,” the sole mention of mental health in the document. And, of course, “wellness services” are referred to without using the term “mental health.” Under “Advancing Student Success,” we read that the university will be “grounded in the holistic development of students to facilitate the emergence of their best selves. Transformational student success entails the holistic intellectual and affective development of students where they acquire the skills that will empower them to thrive in their communities and to achieve their fullest potential.” Ah, the language of neo-liberalism: “best selves”; “acquiring skills”; “empowerment”; “thriving in communities”; “fullest potential.” It’s all bad Emerson, very bad Emerson, albeit cloaked in a document that calls for UHM to be a Native Hawaiian place of learning. Of course, real Native Hawaiian learning would be less individualistic, less driven by markets, less focused on the “technologies of the self.” But who is to get in the way of good Strategic Plan verbiage?
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What are these services offered to students (as faculty must go to another place for counseling)? Among the language descriptors are the following neo-liberal tags: “brief solution-focused counseling via tele-mental health and telephone consultations” (1/11/21 UH News) and “self-help workshops focused on maintaining mental and physical wellness during the pandemic. . . such as establishing a healthy sleep routine, managing stress, and cultivating mindfulness.” (11/5/2020 UH News).[6] These new, and also very diminished services, are good—because they help students to avoid stigma! According to one psychologist, “The new services are meant to offer students opportunities to connect with mental health resources and each other but without the pressure of ‘going to therapy’ or stigma that might prevent asking for help when needed” (11/5/20). So getting less care—including less face-to-face therapy— results in less stigma for the student, who seeks out “opportunities to connect with mental health resources.” Atterbury puts this new regime of care brilliantly when she writes: “Recovery thus becomes manifest to a broader public in the form of boutique interventions and concierge approaches to wellness.” In too many cases, it is like offering the provision of facials for what might well be skin cancer.
Further, according to the CSDC’s therapist Alexander Khaddouma, “if you notice that your level of stress or anxiety is interfering with your ability to accomplish your goals or feel happy, it is highly recommended to seek help from a mental health professional.”[7] These two items, “goals” (which is listed first) and “happiness” (second), have to do with a student’s ability to get work done, and to her American pursuit of happiness. These one-hour workshops are for students of “various identities,” which include not only LGBTQ+ students, but also “student-athletes, on-campus residents, and international students.” Odd concatenation. More recently, the UHM Athletic Department, using outside funding, has signed a contract with an on-line counseling service, Talkspace. The Athletic Department director was quoted as saying, “The well-being of our student-athletes has and will always be our top priority.” Without a functioning university counseling center, one gathers.
The Athletic Department is being entrepreneurial in its role as facilitating consumers of mental health care; lucky for the athletes—because the rest of the student body is left to its own devices, often at a time of intense mental distress. Atterbury quotes J. Fisher and P. Lees, suggesting that “’Neoliberalism emphasizes a particular form of individualism consistent with a market-based economy.’'“[8] Neoliberal care offered by the CSDC, then, is at best hollow, concerned more with a frugal neoliberal campus-services economy rather than authentic care itself. Not only is “care” hard to access, despite all the words to the contrary, but as one of the co-organizers of our colloquy, Tyrone Williams (also published in this CDLS issue) said in an early response to my talk proposal: “Yoga does not cure neoliberalism.” Neither does group therapy or drop-in sessions, or even face-to-face therapy. But, according to the most recent Annual Report of the American College Health Association, counseling that uses a treatment model—one that provides for more consistent and regular care—is more effective than inconsistent care that might save the university money.
I began my advocacy for better health care in 2014 with a call for better communication. What was gained? Lots more “communication,” but very little said. This is communication lacking content. Or communication as mask, rather than as lens. The goal of such communication is to make the neoliberal university sound like a caring institution. What sounds good is good. Communication about suffering, after all, is bad public relations for a public university. Any parent wanting to send his or her child to the university might draw back in fear of a place that talks too much, and too transparently, about its emphasis on mental health care in an era when depression and anxiety are spiking, and suicide rates are climbing. This is not good copy to put on your website, or your glossy university flier. So the problem is much wider than that of my own university’s counseling center (though that’s a real problem). The problem is how we use language, and the way we communicate—in an era when all communication is considered to be marketing and public relations, because the bottom line is always financial, always about selling something, not necessarily about telling the truth.
As a poet and a student of poetry, I argue is that there is a necessary “poetics” that enables us to read the institutional language about “care,” language that is at once creative and perverse. I agree with Paul Naylor, a poet and long-time publisher of Singing Horse Press, who is quoted in a 2013 interview after making it clear that poetry (possessed of use not exchange value) and therapies like meditation are both political in their abilities to push back against the mind-body divide—and all the other divides—that neoliberalism in our institutions instantiates. He states: “Practices that cultivate attention to the concrete natural processes at work beneath or behind the abstractions of contemporary consumer culture are vital and immensely useful because the widening of perspective jars and destabilizes the whole system.”[9] For the past half dozen years, I’ve taught creative writing as “attention,” asking students look at the world—to attend to it—not as they like to think about “the world.” In my poetry writing classes, we walk a lot, and we stare at raisins. We watch our animals, and we eavesdrop on public conversations. The process of attending to the world is healthy, I believe, though it will not cure mental illness or capitalism, at least not directly. The governmental and academic systems are intent on monetizing the liberal arts (poetry), and mental health (therapy). They do so in ways that perpetuate a neoliberal belief system; they aggravate the suffering the same system spawns and enforces. What to do about these facts will have much to do with our attending to the false language of care perpetuated by increasingly vacuous university programs offering mental health care. We need replacing that false language with one that celebrates community over consumerism. The critique that poetics offers to language might have something in the future to do with that shift.
[1] Kendall Atterbury, Far from Just: Neoliberalism and the (Re)production of America’s Mental Health Crisis, Dissertation, NYU Silver School of Social Work (2019): 140.
[2] Sara Ahmed, On Being Included: Racism and Diversity in Institutional Life (Duke UP, 2012).
[3] See Susan M. Schultz, “Why UH Manoa Needs a Student Death Protocol,” The Hawaii Independent, August 24, 2015, at
https://thehawaiiindependent.com/story/why-uh-manoa-needs-a-student-death-protocol
[4] Atterbury, 151.
[5] Ibid.
[6] UHM news items can be found at
[7] Alexander Khaddoumai’s words are quoted at
https://www.hawaii.edu/news/2020/11/05/mental-health-services-expand-during-pandemic/
[8] Atterbury quotes P. Fisher & J. Lees, “Narrative approaches in mental health: Preserving the emancipatory tradition,” Health: An Interdisciplinary Journal for the Social Study of Health, Illness, and Medicine, 20.6 (2016): 599-615.
[9] Paul Naylor is quoted in Nathan Hauke, “Disrupting the Monologic of the Solitary Singer: An Interview with Poet/Publisher Paul Naylor,” Drunken Boat, 18.