CAMBRIDGE, Mass. — The day before Elizabeth Shin set herself on fire, her parents drove through a spring snowstorm to see her at MIT.
They brought her a TV and VCR to cheer her up. They knew she had recently started seeing a psychiatrist to help her deal with academic and romantic troubles. But they say they had no idea that for months, the 19-year-old sophomore had repeatedly threatened suicide and slashed her arms with a knife. And they were clueless that some of Elizabeth’s therapists wanted her hospitalized.
Her parents set up the video equipment, then had a pleasant dinner with her at a favorite Chinese restaurant. “Always be happy,” Cho Hyun Shin remembers telling his daughter as he kissed her goodbye.
The next night, Elizabeth set herself on fire in her dorm room, sustaining burns over 60% of her body. Four days later, she died.
Nearly two years later, the Shins remain furious with the way the Massachusetts Institute of Technology handled Elizabeth’s illness. They plan next week to sue the university’s administrators, therapists and police for failing to prevent their daughter’s suicide in April 2000. They say the stellar scientific institution, which they paid $34,000 a year for Elizabeth’s education, should be held responsible for medical malpractice, gross negligence and wrongful death.
“How could they not let us know how serious the situation was?” asks Kisuk Shin, Elizabeth’s mother. “We trusted these doctors. She trusted them. And I think they neglected her.”
MIT disputes the claim. “The death of Elizabeth Shin was a tragedy for this bright young woman, her family and friends, and all those at MIT who tried to help her,” legal counsel Jeffrey Swope said in a written statement Thursday. “But it was not the fault of MIT or anyone who works at MIT.”
The Shins’ case highlights the growing problem of mental illness on campus and raises questions about whether universities can handle them. Universities face increasing pressures: rapidly rising caseloads, more seriously ill students and insurance companies that pay only for the briefest of hospital stays. And colleges must decide whether to involve parents in their child’s treatment. That’s an especially thorny issue given medical confidentiality laws that protect the privacy of patients who are 18 or older.
“College counseling centers are swamped,” says Robert Gallagher, a retired University of Pittsburgh vice chancellor who surveys centers for the International Association of Counseling Services. In the 2000-2001 school year, nearly 90% of 274 counseling centers on campuses in the United States and Canada reported hospitalizing at least one student for mental health problems.
About 30% reported at least one student suicide. At MIT alone, 12 students have committed suicide since 1990.
“What’s the extent of the duty of a university to its students?” asks David DeLuca, the Shins’ attorney. “Are they a community of surrogate parents, or are they a community of adults without any supervision or care?”
A counseling crunch
The transition from home to college has always been fraught with emotional peril. Adolescents experience difficulties when moving away from their families, and it’s the time of life when serious mental disorders such as depression and schizophrenia start to emerge.
Indeed, suicide has long been the third leading cause of death for college students, after accidents and homicide.
Today’s young adults face added stresses. Many endure more chaotic family lives, watching their parents divorce. They also must deal with increasing competition at school, where the focus on achievement begins at an earlier age. “It’s much harder to be a young person now than 20 years ago,” says Mark Reed, director of Dartmouth College’s counseling center, which treats 20% of the student body each year.
At the same time, universities are admitting more seriously ill students. With improved antidepressants and other psychiatric medications, students previously too sick to attend college function well enough to take classes. Yet some of these students stop taking their medications while on campus and start to deteriorate.
Many colleges are dealing with the crunch by hiring more staff and limiting patient visits. Other colleges resort to long waiting lists, making students wait 10 days or more for initial appointments.
Despite the caseload, many universities actively encourage students to consider treatment. “Many students who’ve committed suicide have not ever shown their faces at the mental health service,” says Richard Kadison, chief of Harvard University’s counseling service.
Many colleges have extensive outreach programs, which enlist faculty, secretaries, even cafeteria workers to help identify students in need. Dartmouth, in Hanover, N.H., gets many referrals from maintenance workers, who find vomit in wastebaskets. These students often have bulimia, an eating disorder.
But some of the most dramatic tragedies, which have resulted in lawsuits, involve students who were in therapy. New York’s Syracuse University is being sued by a woman who threw herself off the eighth floor of a dormitory in 1998. She says the university should have done more to prevent her suicide attempt. Brown University, in Providence, recently won a lawsuit filed by a suicide victim’s mother.
MIT rejects accusations
In the MIT case, the Shins say the counseling service didn’t treat their daughter properly and should have informed them of her dire condition. They say five therapists, three deans, a dorm supervisor and an academic counselor had clear evidence that Elizabeth needed to be hospitalized because of repeated suicide threats during her last six months.
“How irresponsible can anyone be?” Cho Hyun Shin asks. “If they’re not going to inform parents of a student’s serious mental condition, then they should be 100% responsible for dealing with it.”
MIT rejects responsibility for Elizabeth’s death.
“According to information provided by the family’s own lawyer, she had suffered from serious emotional problems that began at least as early as high school,” legal counsel Swope says. “While MIT regrets the need to do so, it will defend against the claims that have been brought against it and the members of its community who had tried to help her.”
Elizabeth’s parents learned after her death that MIT lagged behind similar schools in providing mental health services.
In a 2001 MIT task force report that compared the university’s service with eight other schools, MIT was the only college that didn’t offer evening counseling hours. Also, it had so few therapists that more than one-third of students had to wait at least 10 days for their first appointments. Since the report was issued, the university has added evening hours, increased clinical staff and hired “residential life associates” to help students cope with campus pressures.
Those pressures are considerable: 74% of students surveyed by the MIT task force said they had an emotional problem that interfered with their daily lives.
A rapid descent
Elizabeth Shin was the last person her parents suspected would commit suicide. Passionate about books and classical music, she was full of life and loved to giggle, they say. The daughter of Korean immigrants, Elizabeth was the oldest of three children. After serving in the Peace Corps, she wanted to become a geneticist.
“She was so responsible and so mature for her age, we really had no concern that she’d get into any type of trouble,” says Cho Hyun Shin, 51, a Manhattan real estate broker.
But failure distressed Elizabeth. When it became clear she wasn’t going to be her high school valedictorian because of a mix-up about taking one test, she briefly contemplated suicide. Her father says he didn’t learn about her state of mind then until two years later.
Elizabeth’s first months at MIT seemed to go well. But her stress began to build over schoolwork. In February 1999, she took 15 Tylenol with codeine and stayed in a local mental hospital for a week, medical records show.
The Shins say Elizabeth insisted she wasn’t trying to harm herself and took the medicine to get some sleep before a test. They say they were reassured when they learned that she was getting psychological help. “I felt very good,” Cho Hyun Shin recalls. “I was always full of confidence that anything MIT offered was the best in the world.”
Elizabeth seemed to do relatively well for the next six months. But at the beginning of her sophomore year in fall 1999, she began threatening suicide in conversations with her friends, therapists and a professor. She repeatedly cut herself with a knife, medical records show.
By the spring of 2000, she was even worse. She was rushed to the infirmary one night by a dorm supervisor who found her sobbing uncontrollably. The supervisor notified the Shins because Elizabeth was supposed to be going home for spring break that day. Her father says the supervisor cited confidentiality rules that protect patients’ privacy and told them little except that she had been hospitalized.
Her father hurried to pick her up, but he says he couldn’t get her to talk about what had happened. For the next few days, “she was so normal,” he says. He says he didn’t realize she had a psychiatric condition in which patients often act normally but then fall apart. Kisuk Shin says she tried to comfort her daughter about her love life and encouraged her to open up to the campus psychiatrist.
A few weeks later, when the Shins brought Elizabeth the TV, they had no idea that she had threatened suicide again. The night before, campus police had taken their distraught daughter to the infirmary after she had told a friend she wanted to stick a knife in her chest. A psychiatrist spoke with Elizabeth by phone and decided she could return to her dorm, says DeLuca, the Shins’ attorney.
Hours after the Shins left her, Elizabeth sat in her room in the dark, four candles burning on the floor. She tapped into her computer: “Here I am, typing away aimlessly, hoping to exorcise my demons.”
Her friends heard her threaten suicide again and told the dorm supervisor. A psychiatrist discussed hospitalizing her, DeLuca says.
It was a discussion that had begun several days before. Her therapists had found an appropriate in-patient program in Boston but discovered it would take a week to get her admitted, the lawyer says. By then, Elizabeth was dead.
Her mother says the university should have notified her about Elizabeth’s condition, although she thinks her daughter feared getting her parents involved. “If we’d known how serious the problem was, we wouldn’t have just left it alone,” she says. “We would have brought her home. They took that choice away from us.”
The Shins also say MIT didn’t respond to their inquiries after Elizabeth’s suicide, a sharp contrast with the university’s actions after a freshman drank himself to death at a fraternity pledge party in 1997. After that incident, MIT President Charles Vest made sweeping changes in fraternity rules, personally apologized to the family and paid them $6 million, $1.25 million of which was for a scholarship fund in the student’s memory.
Universities say severe mental health cases among students are especially complex. Therapists are legally bound to protect a patient’s confidentiality once they turn 18, unless they are an imminent threat to themselves or others. That’s an often difficult judgment call.
Therapists often try to convince student patients to let them contact parents, says Kadison of Harvard. But if they refuse, counselors must weigh whether breaking confidentiality will cost them their patients’ trust — and push them toward suicide.
“It’s a terrible bind.” he says.