On February 17, 2014, Dr. Jonathan Perry, former director of counseling at the University of Arkansas, sparked a lively debate on the listserv of the Association of University and College Counseling Center Directors (AUCCCD) by warning about the likelihood and dangers of underdiagnosing borderline II disorder. Standing out among the many thoughtful responses to Dr. Perry was one the following day from Dr. Lee Keyes, director of counseling at the University of Alabama. Here, slightly revised, are their divergent views, which encapsulate some central questions in understanding and treating college students. Dr. Jonathan Perry offers the view that bipolar II disorder (BP II) is given far too little attention for such a serious disorder, and that BP II is notoriously difficult to diagnose. BP II is tricky to medicate and the use of anti-depressants in cases of BP II can lead to exacerbation of the disorder symptomatically. Bipolar disorder is apparently increasing in younger populations and if we are not routinely insisting on bipolar disorder as a hard rule-out in every presentation of depressive symptoms, are we running a risk of missing a bipolar diagnosis and misdiagnosing and mistreating? Dr. Lee Keys offered a different view--stating that every now and then an article will be published concerning a particular diagnosis or condition which, using a fine-grained analysis, will suggest that mental health professionals may be overlooking a cluster of symptoms. Dr. Keys states he is not an expert on diagnosing, certainly not on bipolar II disorder, but he does know that young adults are functioning in a context which is often pathogenic in and of itself. Dr. Keys states that he has personally worked with many young folks who "looked" bipolar), but who were really experiencing intense emotion that they could not articulate in language or manage to soothe. The intense emotion was, more often than not, a result of a pathogenic environment of people, places, and things, some of which they created themselves.