PTSD is not just a "war thing."

Post-traumatic stress has a long reach.

But one of its most misunderstood qualities is that it only applies to soldiers who have served in the battlefield.

In fact, it can affect people of any age and stripe - including teenagers and young adults who live in the peaceful fields of suburbia.

And anyone can encounter the kind of heartache and mental anguish that many soldiers feel when they struggle in their return to civilian life.

This is the story of Jill Manges, as reported by insidehighered.com:

Jill Manges guesses that if she’d suffered an epileptic seizure that day in class, she’d still be enrolled at Eastern Illinois University. But Manges, who has post-traumatic stress disorder, instead suffered a flashback during French history that led her to shout and sob uncontrollably.

“I can’t deny the fact that what happened was disruptive,” says Manges, who was sentenced to a year-long suspension by the university judicial board last month for violating two sections of the student conduct code barring the disruption of university functions and the academic environment in particular (see standards Id. and IVa. of this document).

“But I wonder if they would do this to someone who had an epileptic seizure in class or had a hangover in class or had an asthma attack, because that’s disruptive too.”

In a letter to Manges dated September 17, Eastern Illinois’ assistant director of judicial affairs writes that given Manges’ admission that she violated the two code of conduct standards prohibiting disruptive behavior during the September 5 “incident” (in other words, the in-class flashback), and “the seriousness with which the board viewed this incident, it is their recommendation that you be suspended from the university, effective immediately, for a minimum of an academic year through the Spring Semester, 2008, during which you would be prohibited from being on the campus without prior permission of the vice president for student affairs or his designee.”

“This was a very difficult decision for the board because they recognize that you have made progress in dealing with the situation but the board is concerned about your well-being as well as the well-being of the greater EIU community. Therefore, the board encourages you to seek a medical withdrawal from the university,” the letter continues, indicating that should that be Manges’ choice, the board would not submit its suspension recommendation to campus leadership.

“In consequence, as a condition of your readmission to the university,” the letter says, “you will need to provide documentation as evidence of your continued improvement and ability to keep your condition under control....”

Eastern Illinois officials won’t comment on the specifics of Manges’ case. But speaking more broadly about how they handle mental health issues on campus, they stress that they always have students’ best interests at heart.

“Since we’re in such a rural area and some of our services are limited, we realize this may not be the best environment to really serve all students and we also recognize that sometimes a student may not be good in this environment for other students,” says Heather Webb, director of judicial affairs at the university.

“Everything is done on a case-by-case basis,” says Sandra Cox, the director of the counseling center. “Usually when information goes out there, [people] only have a very small portion of the truth, they have a very small portion of the behaviors that are brought up. They have a very small portion of the whole picture.”

A Flashback and its Fall-Out

While enrolled at Eastern Illinois, Manges says she saw a private counselor off campus to deal with her diagnosis of PTSD — a result of the sexual abuse she experienced from 1999 through 2000, when someone she knew not only abused her but also collected money from other men who did the same.

She was sitting in French history class September 5 when she could feel a flashback coming. Trying to leave but unable to exit the room in time, she collapsed before reaching the hallway.

“I don’t remember what happened because I was disassociating, but what witnesses said, what my professor said, is that I started sobbing uncontrollably, shouting, screaming. I was unresponsive; I was just lying on the floor,” Manges says.

For the 10 to 15 minutes the episode lasted (of the 50-minute Wednesday afternoon class), the other 15 students “responded by sitting quietly and letting those of us who needed to act do so,” says David Smith, the professor teaching the course. “I was extremely proud of how the students responded.”

An ambulance came, and Manges declined to go to the hospital. She says it’s her understanding that at least two classes, including her French history class, were canceled, and one other was moved. There were six or seven classrooms on the hall, Smith says, and other professors came into the hallway to see what was going on.

Manges experiences such severe flashbacks – which she describes as akin to reliving a traumatizing event – once every two weeks or so. This was the first time one happened in a public academic setting at Eastern Illinois, she says, although she had a similar experience in a classroom at a community college that she previously attended (she transferred to Eastern Illinois in January of this year).

Upon returning to her room on September 5, Manges says she had two voice-mail messages waiting: one from judicial affairs, asking her to see a campus counselor, and one from the counseling center. Wanting to comply, she called the judicial affairs official, who met Manges to walk her over to the counseling center. The next day, Manges met with judicial affairs for a meeting, and her parents came to the university for a second meeting the day after. “Pretty much the gist of it was she told me how much of a disruption I had caused,” Manges says.

Smith, who says that he was interviewed by several college officials about the incident, adds that in his conversations, judicial affairs staff focused on the flashback and the disruption of classes.

After a hearing September 13, Manges says she learned of the year-long suspension and her option to accept a medical withdrawal. She chose the latter so her family could get her tuition money back. Because of that, she says she can’t appeal the judicial board’s decision. She’s living in her off-campus apartment, with plans to get a job, move to Boston in January and apply to finish college there. She was a junior history major and writing minor at Eastern Illinois. She has no plans to sue, saying she has neither the money nor the time.

Manges says she had come up on judicial affairs’ radar screen once previously, back in the spring when she spoke with a professor about experiencing suicidal thoughts. Manges says she was asked by college officials at that time to sign a behavioral contract agreeing to continue psychological treatment and keep up her academic coursework. Manges, who says she is not suicidal now, signed the contract.

She says that she upheld it and that the contract — and the suicidal ideation she experienced in the spring — did not come up during her judicial board hearing, which focused on the PTSD. She says that a letter from her therapist certifies that she is not a threat to herself or others.

And as Gary Pavela, author of Questions and Answers on College Student Suicide: A Law and Policy Perspective (2006: College Administration Publications), points out, “Research indicates that the odds that a student with suicidal ideation will actually commit suicide are 1,000 to one.” Several national reports following the 1999 Columbine High School shooting show that “it is inadvisable to create the impression that there is some kind of automatic, hair-trigger response to behavior that is viewed as disruptive or that falls outside of the area of disruptive into suicidal ideation,” Pavela says, as the perception of harsh penalties can prevent students from seeking help.

“I don’t know what we can do except to make students aware that this is happening at the campus,” says Manges, who describes a general lack of awareness of mental health issues. “Honestly, because there’s not a lot of knowledge about mental illness, mental illness still has a huge stigma. People don’t understand it; people are scared of it because they don’t understand it.”

“I was certainly disappointed at the outcome,” says Smith, the professor of the French history course. He testified on Manges’ behalf at the judicial board hearing.

“I certainly hoped that the student would be returning to the class, wanted her to come back” — as, he says, did the other students in the course.

“I would hope that in the wake of terrible tragedies like at Virginia Tech that universities don’t close themselves off as places where students can deal with difficult issues.”

Psychology and Behavior

Eastern Illinois administrators say they make a concerted effort to help students deal with their problems while staying on campus. “Whenever possible, we try to work with the student to help them through their mental illness,” says Webb, the judicial affairs director. She mentions the behavioral contracts cited by Manges as one example. A number of situations, including excessive alcohol consumption and suicidal ideation, could result in students being asked to sign a contract, which outline a set of expectations.

“It doesn’t say we expect you not to experience mental health issues. We expect that,” Cox of the counseling center says. “What we look for are changes in behavior.”

Webb says that, whenever it’s appropriate, she contacts the counseling center to see if a voluntary withdrawal might be an option for a student facing charges in the judicial system. In fact, when asked whether there were any inaccuracies in a student newspaper story outlining Manges’ take on what happened, officials clarified a policy stipulating that when mental illness is impacting student behavior, the possibility of a voluntary medical withdrawal is always discussed prior to judicial proceedings.

“[What’s been] put out there is that Eastern has suspended students based on mental health reasons. And that is incorrect,” says Cox. But, she adds, “if there are long-term or consistent behaviors that are in violation of the student conduct code…then we have to look to see, do we have the services for someone who is struggling to a significant extent?”

While Cox says she processes a handful of voluntary withdrawals per week at the university of about 12,000 students, not once in her 11 years at Eastern Illinois has the university had to complete its mandatory withdrawal process for psychological reasons, reserved for the most extreme cases involving threats to the self or others and an inability to take care of oneself.

Yet, while Manges technically signed a voluntary withdrawal form, to her it might as well have been mandatory. “I was between a rock and a hard place. I chose a hard place,” she says. “I’ve always been under the impression that people who take a medical withdrawal do it for themselves. For me, it was something that I was pretty much forced into doing.”

The Bigger Picture

While what Manges says happened at Eastern Illinois may not be common, nor are such experiences uncommon, says Karen Bower, a senior staff attorney at the Judge David L. Bazelon Center for Mental Health Law. Bower says she routinely (more than once a month) gets calls from students who are forced to leave college for mental health reasons.

“They all feel very betrayed by the school and say that being out of school isn’t going to help them,” says Bower, who was involved with recent lawsuits on similar issues against George Washington University and Hunter College of the City University of New York that both ended in settlements.

“We have urged that schools not use disciplinary action for behavior that’s a result of mental illness,” Bower says — echoing Professor Smith’s sentiment that a judicial board hearing didn’t seem like an appropriate venue for addressing his student’s situation.

“I am concerned that judicial affairs as a body is designed to handle certain kinds of cases that this kind of event — when someone is not operating in a voluntary manner — they’re not well-equipped to deal with,” says Smith.

In its model policy, the Bazelon Center recommends that involuntary leave only be used in a situation where an individualized assessment determines that a student is a direct threat to the self or others. Under the Americans with Disabilities Act, Bower adds, colleges are required to provide reasonable accommodations for students. That could mean, in this case, she says, waiving the rule about class disruptions for Manges, or mitigating any sentence.

“I think they think it’s objective, but discrimination based on conduct that’s the result of disability is the same as discrimination based on disability,” Bower says. “The use of the disciplinary system as a whole is really a way of removing students from an environment instead of finding out what kinds of supports and services they need to stay in school and be successful.”

Although college leaders say they have the students’ interests at heart — in addition to the interests of other students — when advocating medical withdrawals, Manges says in her case, at least, the time off won’t be helpful.

“Being in school is extremely important to me and it is part of the healing process. It is my way of reclaiming my life; it is my way of getting back what was stolen from me when I was younger,” says Manges.

“I can’t do anything right now. I can work, I can go to therapy, but I was going to therapy while I was in school.”