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Content warning: Mentions of abuse, suicide, and self-harm; descriptions of depression, anxiety, and other psychiatric conditions.

On Monday, Sept. 25, I presented myself to the emergency room for acute suicidal ideation.

My struggles with mental health were nothing new. In high school, my growing awareness of my sexual identity threatened a South Asian identity grounded in gendered assumptions. The pressure to purge my queerness collapsed my internal sense of self into depression.

But afraid that a therapist would out me to my parents, I disregarded my escalating need for care, and instead, constructed the facade of stable productivity that would eventually allow me to escape to an out-of-state institution distant from an abusive household.

When I arrived at Harvard in fall 2022, I immediately reached out to Counseling and Mental Health Services. However, I was unable to receive the care I needed. Sessions with a CAMHS therapist left me feeling that I was too feeble to fight my depression and anxiety; later efforts to connect with an external provider were equally demoralizing embodiments of my inadequacy.

As I struggled to secure sufficient care, my mental health worsened. A return home during spring recess triggered intense suicidal ideation, so much so that I attempted to add myself to my state’s voluntary “Do Not Sell Firearms” list. Convinced that I would end my life without intervention, I called the SHARE hotline — a resource for Harvard students impacted by interpersonal violence — within an hour of my return to campus.

Thankfully, SHARE provided me with life-saving support, connecting me with multiple trauma-informed providers. Though I swallowed their antidepressant prescriptions, I brushed off more daunting recommendations to consider hospitalization. To me, institutionalization was an admission that I was intrinsically broken, too inadequate to survive without a drastic suspension of my agency.

Over the summer, my mental health worsened. An intense fear of loneliness, PTSD nightmares, and deepening anxieties over my sexual and gender identity drove me to substance abuse, destabilizing routines, and suicidal rumination.

My providers again suggested hospitalization. But, now aware of rumors that institutionalization would trigger a forced leave of absence and other requirements from the College, I clung onto my internalized stigma and resigned myself to suicidal thoughts.

This September, I reached a crisis point. After a Friday night of reckless drinking, I violated the emotional boundaries of close friends. Facing rejection, I attempted to harm myself.

Terrified that I would be forced off campus, I continued to maintain a facade of normalcy; only after a concerned friend’s intervention did I finally accept that I needed help stabilizing myself. Even then, the College’s ambiguous protocols hung over me: On the way to the hospital, I called the SHARE hotline in a futile attempt to devise a plan to hide my impending institutionalization from Harvard.

Thankfully, my fears were partially unfounded: After finding out about my hospitalization, my dean informed me that I would not be subject to forced leave policies. Freed from the threat of housing insecurity, I was empowered to faithfully engage in treatment.

I accepted a diagnosis of borderline personality disorder, a condition that offered an explanation for my intense fear of loneliness, boundary violations, and drastic reactions to interpersonal conflict — and, more importantly, a safe path forward through dialectical behavior therapy, the only empirically supported treatment for BPD.

But, in the 11 days that I was hospitalized, the College’s protocols still interfered with my care. Unlike the privacy standards of my medical providers, the College requires administrators to contact a student’s legal family for overnight hospitalization — a paternalistic mandate that can quickly turn deadly, particularly for LGBTQ+ students, who face disproportionate rates of familial rejection.

My first night in the emergency room, with an uncharged phone that would soon be taken away, I unsuccessfully tried to advocate that other supportive adults be contacted over my family. I went to bed terrified not only of an impending transfer to an unknown psychiatric facility, but also of the potential of my parents withdrawing health insurance and tuition assistance.

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Later, my treatment team admitted that they prolonged my stay at the psychiatric ward beyond what was necessary. Convinced that my safety was reliant on my return to the College, they sought to reassure Harvard that I was connected with additional out-patient support. In effect, my treatment plan was no longer dictated by my treatment team — who knew me and my health best — but opaque procedures at Harvard.

When I finally returned to campus, administrators called me brave. But I felt guilty: I caused intense pain for those who cared for me and recklessly hurt others. My sense of inferiority only deepened when the College had me sign a contract allowing them to contact my family if I failed to meet the expectations of the agreement. I felt like a walking liability.

Reflecting on the past year, I am deeply ashamed that I did not listen to the many providers who recommended hospitalization: I could have stabilized earlier and not harmed those I care for. And I am immensely grateful that the psychiatric ward was life-saving, in no small part because of incredible Harvard administrators who advocated for me.

However, I am also deeply troubled that the College’s ambiguous protocols, rather than my wellness, dictate my journey to stability. I wish that this institution recognized that its assumption that all students have a safe home compounds the dehumanization and fear inherent to institutionalization — especially for queer students like me, whose identities are disproportionately rejected by family, peers, and the medical system.

If you or someone you know needs help at Harvard, you can call the Suicide & Crisis Lifeline at 988 or text HOME to the Crisis Text Line at 741741. You can call the SHARE 24/7 confidential hotline at (617) 495-9100. You can contact the Office of BGLTQ Student Life at bgltq@fas.harvard.edu or (617) 496-5716.

Aaryan K. Rawal ’26 is a Government concentrator in Eliot House. His column, “Queer Queries,” runs bi-weekly on Tuesdays.

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