The Topper Who Says She Is Fine
Ananya is a Class XII student who scored 94% in the pre-board examination. She sleeps about 5.5 hours on school nights, skips lunch three days a week to revise, and has stopped playing badminton, which she used to enjoy twice a week. She has headaches twice a week and cries after small mistakes, but she tells her teacher, 'I am not sick, so my well-being is fine.' Her parents compare her with a cousin who scored 98%, and her teachers praise her rank publicly. She avoids friends during breaks because she says they waste time. The school counsellor has only one free slot this week. Ananya refuses to be labelled as having a mental health problem, but agrees to 'talk about study habits' if the conversation does not become 'medical'.
1. Using a multidimensional well-being framework, assess which dimensions are compromised and which are relatively intact. Explain why Ananya's statement that she is not sick, so her well-being is fine is inadequate.
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Reasoning framework. Well-being is not the mere absence of diagnosed illness; it is a profile across physical, emotional, social, academic/occupational and spiritual/value dimensions, and these interact. Compromised: physical (5.5 h sleep, skipped lunch, headaches), emotional (crying after small errors, distress), social (withdrawal from friends and badminton), academic (results are high but sustained by deprivation and carry a burnout risk). Relatively intact: intellectual engagement and motivation, family support (though pressuring), and perhaps values around responsibility. Her statement treats one dimension - absence of disease - as the whole, ignores functional costs, and misses that high marks can coexist with poor well-being. It also frames help as 'medical', which blocks early action. A good answer should avoid diagnosing her and instead point to the mismatch between her reported functioning and the observable indicators. The conclusion is that she needs a low-stigma, practical plan targeting sleep, meals, social contact and stress, not a label.
2. Design a two-week plan that fits her refusal of medical labels and her examination timetable. Specify two measurable indicators and explain why you chose them.
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Frame the plan as an energy-and-performance experiment, not therapy. Week 1: set a fixed lights-out at 11 p.m. and put the phone outside bed; eat lunch on at least four school days, even if it is a short meal; take a 10-minute walk after school; message one friend twice; restore badminton once. Week 2: keep sleep at 6.5–7 h on at least five nights; add a 25-minute 'worry and planning' slot so revision does not expand into the night; practise one 5-minute breathing break before study. Use the single counsellor slot to negotiate the plan and explore what 'fine' means to her, not to impose a diagnosis. Measurable indicators: (1) sleep duration ≥6.5 h on at least 5 of 7 nights, recorded in a simple log; (2) lunch eaten on at least 4 of 5 school days. These are chosen because they are observable, within her control, and directly linked to the headaches, concentration and mood she reports. If headaches worsen or she reports hopelessness, escalate.
3. The counsellor has one free slot. What should be prioritised in that first meeting, and what should be deferred? Justify your priorities.
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Priority 1 is engagement and safety: explain confidentiality, ask open questions about sleep, mood and functioning, and ask whether she has thoughts of self-harm, without making it an interrogation. Priority 2 is a shared formulation of the link between her schedule, headaches, withdrawal and performance. Priority 3 is one or two negotiated changes and a review date. Defer labels, long family history and a full 'mental health assessment' unless safety concerns emerge; these can raise defensiveness and use the slot inefficiently. Justification: the first session with a help-resistant adolescent should reduce threat and produce a working alliance; safety screening is non-negotiable because high achievement can mask risk. The counsellor should also ask permission to coordinate with a trusted teacher or parent only as needed, and should not promise secrecy that cannot be kept.