College Teaching, Wntr 1998 v46 n1 p2(5)
Helping students in trouble: what they didn't teach in grad school. (Special Section: Writing Out of Bounds) Alice S. Horning.
Abstract: Faculty members are often not prepared for emergency medical or psychological problems they might face when teaching. In the 1990s, the student body brings a different set of concerns such as older students attending college, as well as students with disabilities, and the presence of alcohol and drugs in campuses. Most emergency cases in campuses are alcohol or drug related.

Full Text: COPYRIGHT 1998 Heldref Publications

The "what-ifs?" started before the EMS team wheeled my student out of the classroom: What if it hadn't been Wednesday morning, on campus, when offices down the hall from my classroom were open, and help in the form of phones and people was available? What if I had chosen not to call for help, unwilling to raise an alarm unduly? What if the student had been even more seriously ill than her collapse on the floor of my classroom suggested? Fortunately, none of those conditions applied to this situation--the first time in years of teaching that I had run into a true medical emergency during a college class. And more important, the student recovered and appeared at the next class meeting.(1)

That experience, followed in the afternoon of the same day by a phone call from a student in a psychological crisis, made me realize that there was a great deal I did not know about how to handle a variety of situations that are becoming increasingly common in college classrooms, and especially in English composition classes.

Nothing in our graduate preparation in English, rhetoric and composition, or related fields, prepares us to deal effectively with students' medical or psychological problems--or with situations involving violence or a threat of it. Because teaching writing can put us in a more intimate relationship with students than teaching math or French, teachers of English and of writing in particular are more apt to recognize students with difficulties than are most other faculty. But all faculty members need to be aware of the possible problems and to understand campus procedures to deal with them.

Changing Demographics

The student body looks very different now than it did, say, twenty or thirty years ago, partly because of people's need for lifelong education or advanced preparation in new technologies or new fields. At my own university, a medium-sized, public institution in the Midwest, the average age of students is twenty-six. Although the nontraditional population is frequently better motivated, they bring a different set of problems and concerns than do eighteen-to-twenty-two-year-olds.

A second change is a by-product of the passage of the Americans with Disabilities Act in 1990 (Harrison and Gilbert 1992, i-iv). The ADA has brought to campus students who might otherwise be excluded based on their disabilities, both physical and psychological. A growing number of students are in wheelchairs, or need a reader or scribe, sign language interpretation, and/or more time or special seating during exams. Because institutions are expected to make "reasonable accommodation" (Harrison and Gilbert 1992, 46) to meet such students' needs, students with disabilities present new challenges for many of us faculty and for many campuses.

A third difference has less to do with the characteristics of students themselves than with their access to and use of drugs and alcohol. More students can use more "mind-altering substances" now, partly because of their general availability in society at large. In a recent study on my campus, where about 10 percent of the students live in residence halls, a random sample of about 10 percent of the student body showed that nearly a third abuse alcohol (Fink and Talbot 1994, 6).

Comparison with a national database of college students Who completed the same survey shows that the results at my university are lower than the figures on many campuses (Fink and Talbot 1994, 17). Students over twenty-one, those with higher class standing, and male students are more likely than others to be binge drinkers who consume five or more drinks in one sitting (Fink and Talbot 1994, 7-8). Use of other drugs was a less-severe problem than the use and abuse of alcohol. Our students also come from families where substance abuse is an issue, with more than half the surveyed students reporting at least one family member with an alcohol or drug problem (Fink and Talbot 1994, 16).

In addition, students' jobs have changed. My state-funded university, a Carnegie classification comprehensive Master's I university with an enrollment of 13,600 students, is probably typical enough of schools across the country (Boyer 1994, 136). Most of our students work while attending college, many for more than twenty hours per week. Their reasons for working are sometimes related to the fact that they are adults who attend college part-time while supporting a family, but they are just as often working to earn money for tuition, fees, and books. Many students report substantial financial pressure, and it is a wonder, sometimes, that they manage to get their homework done and get to class in combination with all their other responsibilities. Thus, our students today are different from traditional college students: they may be older, differently abled, coping with drug or alcohol problems, and they are probably facing mounting financial pressure.

Changing Health Care

Variations in the health care system must also contribute to differences in the student population. Although there are no readily available facts and figures, it seems possible that the spread of managed care has made a difference in treatment of psychological as well as medical problems. Typical managed care programs limit treatment for psychological problems to perhaps twenty sessions per year or fewer, and then only with a defined group of therapists. Additional sessions of psychotherapy require that the patient pay out of pocket, which is often impossible. The director of our counseling center says that in any given class, 20 percent of the students have serious psychological problems that warrant treatment--which they are not getting (R. Fink, personal communication, June 12, 1996). According to a recent report (Geraghty 1997), an increasing number are seeking treatment.

Some medical problems don't get treated either. Even though managed care may make it less costly to see a doctor, primary care physicians limit access to specialists who can treat more serious health problems. I speculate, without knowing for certain, that my student who collapsed may have needed more medical help than she was getting. Another student had Crohn's disease, a chronic disorder that caused her to miss several classes in a row several times during the term. I have no idea what level of care she was getting, though she did work through the Disability Support Services office at my suggestion to keep her college career going. Although some schools require students to buy medical insurance or include a fee for health care so that they can see a doctor at the student health service if they become ill, many do not have such a requirement.

Thus, the lack of health care is a major issue. Students with untreated or inadequately treated psychological and medical problems are in college classrooms today, and more such students will appear next fall, and the year after that. One result may be that more students will collapse on the floor of our classrooms. I wonder how many of my readers can answer this question right now: What would you do in such a circumstance? Despite years of professional experience, I had no idea what to do.

New Social Norms about Revealing Personal Problems

Changes in our culture have made students more willing to discuss their personal concerns. I quickly came to think of the class I had last fall as my Geraldo class, because in addition to the student who collapsed and another whose family was affected by depression, I had students with these problems: family violence (two brothers murdered in drug-related violence), rape, divorce, childhood sexual abuse (with charges brought against the abuser and the case just coming to trial for my student, the victim), and a young man who may have had a borderline personality disorder. Many of these problems were revealed in the students' writing assignments, and some students discussed them openly with me in conferences. I do not see that writing assignments such as "Describe a person or place that is significant to you" invite personal self-revelation, and certainly not in the second or third week of the term. Yet, that is what happened.

This new willingness to "tell all" is the result, I think, of students' exposure to repeated public discussion of highly personal issues on talk shows and in literary memoirs (Atlas 1996). The media encourage and even flaunt such discussion and imply that openness is not only acceptable, but to everyone's advantage. In an article in the New York Times, critic Caryn James indicates that television has taken up physical and mental health issues, even on situation comedy shows. She writes:

When the heroine of "Grace Under Fire"

(who apparently lives in a plague-ridden

neighborhood) decides that her neighbor is

suffering from depression, she said,

"Thanks to the advent of television talk

shows, we're now qualified to diagnose our

neighbors." The star, Brett Butler, puts a

mocking spin on her delivery of a self-help

cliche: "Until you admit you have a problem,

you do not begin to solve it," but her

use of it affirms how powerfully talk shows

have defined the way Americans discuss

and think about mental and physical health.

(James 1996, 2)

And perhaps this openness is a reasonable attitude; it may be healthier to discuss problems freely so that those suffering may get help. I am told that students bare their souls not only in composition classes but also in assignments for courses in sociology, where they write a sociological profile of their own families (J. Scherer, personal communication, fall 1995).

The director of our counseling center has suggested that some of this self-revelation is the by-product of changes in the structure of the American family. Because many students are from both single-parent families or families in which both parents are present but working full-time, they are likely to seek responsive teachers with whom they can try to engage in a parental kind of relationship. "For many students this level of interest by a faculty member touches on a very needy sensibility and hope of help" (R. Fink, personal communication, spring 1996). My experience in composition is not unique, as writing teacher Carole Deletiner (1992) has shown in "Crossing Lines" and as Richard Murphy makes clear in The Calculus of Intimacy (1993). Discussing the relationship of writing teachers to students in his exquisitely accurate description of our work, Murphy points out that writing teachers see a side of students not often seen by others, including parents, friends, lovers, clergy, or therapists (Murphy 1993, 4). He says that "we need to remind ourselves of just what a complicated and intimate act teaching is. The more closely we look, the more we will see" (Murphy 1993, 8). In The Calculus of Intimacy, Murphy discusses case after case, student after student, who has revealed himself or herself at some very personal level in Murphy's course. Although some of the cases he describes are ones that concern me (a student with anorexia, for instance, or one who disappears from the class after, and perhaps as a result of, writing about experiences of great personal significance), Murphy does not deal with the practical problems we face and to which we must be prepared to respond.

Solutions

When I read the paper of my student who was a victim of child sexual abuse, I was stumped. Do I respond to the writing and ignore the plea for help? Or do I address the plea for help and ignore the writing? Do I encourage revision, even though I was not sure I wanted to read a revised version of a fairly graphic description of the abuse experience? What should we do when confronted with psychological problems, medical problems, reports of violence, stalking, and rape? As you may realize, most new-faculty orientation programs and handbooks don't address these issues, or if they do, the material may be ignored.

My college does not have a faculty handbook that covers the new situations. Even where there is a handbook, it may not provide the specific information needed. Our vice president for student affairs advises thinking carefully about a response to each of these situations and perhaps visualizing the necessary steps. She has also begun working toward having emergency telephones in all buildings. Finally, she suggests that we teachers contact resource people on campus whom we can call in an emergency for advice and help (M. Snyder, personal communication, May 23, 1996). Because many teachers are not likely to take these steps, the next section gives broad guidelines for coping with psychological and medical crises that may interrupt our classes, or that we may read about in students' writing, and guidelines for appropriate responses to threats or reports of violence.

Psychological Emergencies

Psychological emergencies are distinct from other kinds of difficulties that may warrant professional help. My own experiences offer a couple of good examples. I was sitting quietly at the dining room table reading freshman papers when the sexual abuse paper rose to the top of the pile. I have had enough experience with student writing to recognize that this student was intensely troubled and needed help. I called the campus counseling center for guidance on how to urge the student to get help, and ultimately, the student did begin seeing a therapist there and seemed to be coping pretty well. Other times, students have written about the loss of a friend from a drunk driving accident or a break-up with a significant other that is still on their minds. Students in psychological crisis present a different picture from those working out more ordinary personal or developmental issues.

Students who are in some state of crisis are most likely to report feeling anxious or depressed, according to the director of our counseling center (R. Fink, personal communication, June 12, 1996). They will complain of difficulty with concentration or motivation. Boredom is a particularly noteworthy complaint, because students' use of the term may show their sense of alienation and disconnection that is consistent with depression, rather than lack of interest in subjects and activities. Sometimes, they will report that they are obsessed with studying, or feel confused in ways they can't quite describe. Or they may show erratic patterns of attendance, dress, or performance. Any of these can indicate a "cry for help" that we can respond to usefully.

Although we faculty members should not take on the role of psychotherapist, we can certainly reflect back what the students say and indicate our concern, along with making referrals to counseling resources. Sometimes, students know they are in trouble and need help, and they need someone with authority to give them "permission" to get help. In my own experience, pointing out that treatment for mental health problems should be similar to treatment for physical ailments sometimes works well. Students understand easily that if they would readily see a medical doctor for a high fever and sore throat, they should just as readily see a psychological expert for an emotional illness.

Students with more ordinary kinds of psychological problems are difficult to respond to. Our vice president for student affairs says that faculty members can and should set standards of classroom behavior for disruptive students and then watch for any significant changes among students in response to those standards: worsening patterns of disruptive behavior in class and/or deterioration in dress or attendance are signals that there may be trouble. Students who avoid interaction for reasons other than shyness may be asking for help. We can ask if a student is okay, either after class or perhaps in a conference.

We should be a conduit to help if that is in order. If the student is unwilling to get help, perhaps he or she might be willing to accept a phone call from resource people on campus.

Medical Emergencies

Before my student collapsed in class, she had come into the room not looking quite right to me. When I asked if she was all right, she said "No" and asked if I would call her parent, which I did. I went down the hall to an open office and used a phone there to summon her father. This was a commuter student whose family lived fairly near, though the father said it might take him thirty-five or forty minutes to arrive on campus. When I returned to the classroom, the student looked much worse and was asking for water and fumbling in her backpack for medicine. Guessing that the situation was disintegrating, I went back down the hall and asked the secretary in the open office to summon our public safety officers.

Later, I learned that if I had dialed the 911 emergency line, I would have gotten the campus public safety dispatch rather than local city emergency services. Had I been teaching off campus, perhaps 911 would have been a better choice. Campus officers all have some medical training and are full deputies of the local law enforcement agency. Waiting for the public safety officers was probably the longest minute or two I have ever lived through. The other students remained in the room, but it wasn't clear to me what we were supposed to do.

Fortunately, two officers arrived in about two minutes. They cleared the classroom immediately, and later one of the officers said that that is always the first thing to do. Perhaps one student can stay behind with the student who has fallen ill, but the rest should leave. To my relief, the officers sent me out of the room also and used cellular phones or radios to summon the EMS team. They asked me to go to the end of the hall and get the building's only elevator, take it to the first floor, and wait for the EMS folks to come with a stretcher so they could ride upstairs with it quickly. I did this, and stayed in the hall while the EMS team did its work. Just when they had removed her to the waiting ambulance downstairs, the student's father showed up. I let the officers and EMS team handle him.

Later in the day, I tried to figure out whether to call the student's home or not. I honestly wanted to know how she was. On the other hand, I did not want to intrude if she were seriously ill. My sense, based on some other things, was that she had had some prior and ongoing medical problems, though exactly what they were I did not know. For instance, she had written about a lengthy hospitalization in somewhat vague terms. And she occasionally came to class with an IV lead in her hand. So I was unsure how to proceed and ended up, not very happily, doing nothing.

It did not occur to me that perhaps there was a procedure to follow in medical emergencies of this kind. The officer who told me I should always clear the classroom as a first step also told me that such experiences are more common than any of us would like to think. I did not find this a particularly comforting remark. When the student returned to class at the next class session, the other class members asked if she was okay, and then we went on from there. My guess is that she really didn't want to talk about what happened or explain her medical problems, so I left the situation alone and decided I had made the right choice not to call her family in the evening.

I have given some thought to carrying a cellular phone with me. Suppose, as I said at the beginning of the article, it had been an evening class, or an off-campus class without access to campus public safety officers? What then? Most campuses have specific procedures for dealing with medical emergencies. On my campus, public safety officers come before an ambulance is called. While waiting for help, faculty members must use common sense and adult judgment. Before an emergency arises, we should visualize the situation of a student with a seizure, heart problem, or perhaps an allergic reaction in the classroom and think through the best course of action.

In each classroom where you work, think about where there is a phone in the building or an office likely to be open when you are teaching. One colleague of mine had a student fall ill in class, but in the same class, another student was a trained EMS technician and was carrying a phone. The EMS-trained student took over the situation, calling for assistance and attending to the ill student. I wish that I had been so lucky. Most campuses have a public safety office, and any faculty member who wants to be fully prepared to handle medical emergencies may want to contact its director or coordinator to learn the local rules and requirements for responding to medical problems. Updated information should be posted in every classroom, including whom to contact for medical help during various hours.

Responding to Threats or Reports of Violence

In my Geraldo class, a young woman came in one day nominally to discuss her paper. She also had a second item on her agenda, which was to discuss a rape that had been done to someone she knew in the residence hall. Sometimes, students say something happened to a friend when they themselves are the victim. In this case, though, I am pretty certain this was a secondhand report. Drawing on some reading I have done on crisis intervention, some common sense, and what I hoped a faculty member would say if my daughter were the reporter or victim, I told my student to encourage the rape victim to seek medical help at the health center, at a minimum. I suggested the RA in the dorm, and when the student said the RA was not a good choice, I suggested the counseling center. The student might also have called a local community crisis counseling hotline.

An additional issue is whether or not to press charges against the perpetrator, and I pointed out that the victim could go to the campus police for that purpose. Our assistant dean of students said that all my counseling was appropriate for the student's report (N. Schmitz, personal communication, June 12, 1996).

The main issue in situations of actual violence or threats of violence is that faculty must respond promptly to the student's difficulty. In the case of stalking, for instance, the victim must keep a log of the harassing behavior and must have clearly communicated to the stalker about the demand for no contact. It is sometimes difficult for female students to confront and be direct with someone who is harassing them. The problem may be compounded by cross-cultural differences or misunderstandings (N. Schmitz, personal communication, June 12, 1996). Students may also report domestic violence or other marital problems. Faculty responding to any of these reports can encourage students to seek the help of law enforcement agencies on campus or off. The campus public safety staff is once again a good resource for information and guidance.

I surveyed a random group of colleges and universities for the availability of a faculty handbook with procedures for responding to students' problems.(2) At some schools, like mine, there is no faculty handbook or readily available compilation of information to help us respond to students' needs. At others, there may have been a handbook, but it was so difficult to get, and the information in it so obscured by numerous other procedural details as to be useless. And even when there was a handbook and/or numerous leaflets or publications dealing with key issues, it is not clear that the materials are mailed to all faculty including part-time, off-campus, and other groups who might need the information.

This situation needs to be corrected immediately. If my analysis of the changes in the college student population is correct, chances are good that many college faculty members will have urgent and growing need for information this year, next year, or sometime soon. All faculty members would benefit from finding out what appropriate responses and resources for students with problems are available on their campus. Some academic leaders might be able to help, but a better bet is to check with the directors of the campus counseling and medical centers and perhaps the head of the public safety office. Faculty should ask for a handbook or current information on how to handle emergencies if this information is not readily available to them. And up-to-date information also should be posted in classrooms.

Specific information on how to handle psychological and medical emergencies, and violence or the threat of it, is particularly important. Getting close to students in the personal and intimate act of teaching leaves faculty members particularly vulnerable to personal revelation and perhaps urgent needs of students. Our "calculus of intimacy" must include paradigms for appropriate response.

NOTES

(1.) I would like to thank the following people for their assistance: Wallis Andersen, Robert Fink, Richard Murphy, Nancy Schmitz, and MaryBeth Snyder.

(2.) Among the schools I queried are the Citadel, Charleston, South Carolina; Colorado State University, Fort Collins; DePaul University, Chicago; Florida Atlantic University, Boca Raton; University of North Carolina, Chapel Hill.

REFERENCES

Atlas, J. 1996. The age of the literary memoir is now. New York Times Magazine, 12 May: 25-7.

Boyer, E. 1994. A classification of institutions of higher education. Princeton: Carnegie Foundation for the Advancement of Teaching.

Deletiner, C. 1992. Crossing lines. College English 54:809-17.

Fink, R. S., and B. Talbot. 1994. Alcohol and drugs at Oakland University: Students' use, perceptions and attitudes. Unpublished ms.

Geraghty, M. 1997. Campuses see steep increase in students seeking counseling. Chronicle of Higher Education, 1 August.

Harrison, M., and S. Gilbert, eds. 1992. The Americans with disabilities act handbook. Beverly Hills: Excellent Books.

James, C. 1996. Making tragic topics the stuff of sitcoms. New York Times Magazine, 19 May: 2-4.

Murphy, R. 1993. The calculus Columbus: Ohio State University Press.

Alice S. Horning is a professor of rhetoric and linguistics in the Department of Rhetoric, Communication, and Journalism at Oakland University in Rochester, Michigan.