Getting Stuck in the Sick Role

    Like a growing number of young people, Danielle found herself unready to be an adult at age eighteen. Off to college, overwhelmed, and back home to stay in a flurry of six months, her head was left spinning with the whole series of events. She had never imagined she was destined to end up in her old bedroom, Spurs dance team posters still on the wall from her high school days. It was supposed to be college and fun, then impressive business career in the big city. That was how it was done, she had always told herself. 
    She started having trouble as soon as classes began his first semester. Professors were boring and disorganized, and they were terrible teachers. In every course, some old guy in a bow tie or young woman with a shaky voice just stood at the front of a giant lecture hall droning on. Classmates sat in a sea of strange faces, never making eye contact, looking as though they all wanted to crawl back in bed. Danielle slept through a few classes, and then she stopped getting up and going. She couldn’t bear the discomfort. It was awful. Her roommate disappeared to a boyfriend’s apartment. Then Dani went to bed and stopped getting out of the room much at all. She stared mindlessly at re-runs of Adult Swim cartoons. She played the Sims on her laptop. Text messages from parents went ignored. No one knew she had stopped attending classes. Before she knew it, she had missed most of the semester’s seminars, and then missed exams, too. She was under water and had no solutions. By the time she moved home, Dani and her parents were calling her failure to function “the anxiety disorder.” They found her a counselor and brought her back home.
    Dani saw her counselor and her long-time family doctor for a prescription SSRI (selective serotonin reuptake inhibitor), which treats anxiety and depression. She met with the counselor one hour each week, she took two pills every day, and she waited to feel better. Six more months passed. She decided to let the counseling appointments trail off, because nothing was getting accomplished by repeating her story of college failure, and there was no point at all to digging into her generally stable childhood upbringing. She didn’t have anybody to blame, so she blamed “the anxiety disorder.” Whether the medication helped was uncertain. Little adjustments and big changes in the medication failed to produce dramatic improvements. She tried several different meds, but none of them changed things. If any of those meds did help at all, the effect was subtle. But since she could only blame anxiety for her failure, she thought she would keep taking the pills everyday to see if she found the confidence and the drive to try again. What else could she do? Without the weekly therapy appointments, she didn’t go many places. Prescription meds were handled in fifteen-minute check-ins that first came once a month, and then slowed to once every three months, and those felt like a waste of time. Try another pill. It probably won’t work either. 
    She didn’t know what to do with herself anymore. When she lived at home before starting college, she had been a full time high school student. Her life ran on the school schedule- a regular bedtime and up at six a.m. every day during the week, and then up late and sleeping in on weekends. The external structure of school had created a natural order for her life. No more school meant no more order. Minutes, hours, and days bled together. Without anyplace to be each day, her days and nights had become a blur of sleep for an hour or two or three intermingled with distraction with TV and Internet. And in that state of lost, frustrated inactivity, she sat, restless but unmoving. No motivation came. No drive. Dani was stuck up in her room wasting time, still waiting to feel better. Her life was reduced to the bedroom and the dinner table, with only an occasional outing to pick up something for her parents. She took up cigarette smoking, just to have something to do. At least she had a reason to get out and buy a pack of cigarettes at the corner store. 
     Month after month passed, and her Mom grew worried. She took Dani to a new counselor to try again. Three months later she quit that one, then nothing much changed for two more years. Still she sat. Stuck. Talk of returning to college stopped. No one spoke of career. Dani and her parents just assumed she suffered with disabling anxiety. Why else would she be like this? No life, no aspirations, nothing. Just a rotting shell of a young woman who had once been full of hopes and dreams for the future. 
    Dani was stuck in the sick role, but stepping away from her adult responsibilities didn’t seem to be helping her get better. In fact, she seemed to slip deeper and deeper the longer she stayed there. There was no place to get a foothold to help her climb out of despair. When friends or family asked what Dani was up to, or how she was faring, her parents would make jokes about young people these days, or change the subject. They had no idea how to comprehend, let alone explain explain what had gone wrong. They were scared and confused about Dani. How on earth could this happen? Dani had never had any problems growing up. Why was her entire life on hold and failing to progress? Anxiety seemed to have claimed her and taken away everything. 
     Dani is not the only one stuck at home, receiving treatments that don’t help. A growing number of young adults move home to re-group, and sometimes don’t manage to regroup at all. Some, instead of formulating a new plan to take on adulthood bit-by-bit, opt to return to childhood roles and behaviors. They return to their childhood bedrooms complete with their childlike decor on the walls. They fire up the old Xbox and laptop and they park their butts on their Barbie beds and there they can sit indefinitely.
    Whatever the initial path out, and whatever the path back home, getting stuck at home starts off as an attempt to double back and start over for most of the young people affected. They start off, they fall off, and then they try to start over. Some of the young adults who end up stuck in an un-adult role moved back home in a crisis. Depression and anxiety are commonly blamed as primary causes. Some of those who are stuck were caught up with drugs or alcohol abuse. Still others came home for an unnamed problem, an invisible barrier between them and life success: they got placed on academic probation at college for failing grades, or they washed out of basic training, or got fired from a first job. Some racked up too much debt and couldn’t stay afloat. At least a crisis makes for a comprehensible reason that a person gets stuck back at home. But a crisis is not a prerequisite. Some stuck young adults came home because the rent was too steep, or simply because they completed some kind of training, even graduated from college, and then they came home to decide what was next.
    There can be countless reasons for going back, and no matter the reason. Coming home creates a whole host of potential problems. Lack of structure, comfortable parental support or likewise parental resentments, or an absence of good ways to measure progress can all contribute to going back home and getting trapped there. 
In high school, most teens were marching toward a goal of adulthood. They were focused on graduating, or applying to college. These goals were externally defined, and as kids, they were constantly reminded to move toward them. And they wanted to graduate. They wanted to go on to college. Time was moving through a series of stages, marked by semesters and academic years and diplomas and graduation ceremonies. Now back at home, especially for those out of school, there are no semesters, no goals, no external pushes to get applications in by deadlines. Now back at home, there is simply a partially formed young adult, lacking in plan, structure, or skill, trying to sort out what she should do next, and often not progressing very successfully.
    Not only does moving home create the conditions that lead to inertia, but also moving home because you’re sick with depression or anxiety or Bipolar Disorder or alcoholism compounds things further. Sicknesses require treatments and then time and healing. But when a young adult suffers from a hidden illness like a mental disorder, how will she or her parents mark her improvements and readiness to return to functional roles? And how will they tease out the difference between being too sick to start over, and simple being scared of change, especially when she has yet to succeed in those adult roles? It can be hard to measure the progress for a young adult like this. When is she healthy enough to return to a normal life? When she feels confident? Wouldn’t a young woman like Dani be afraid of failure after her first big plans for an independent adult life fell apart? How good would she have to feel to step out again, and how likely is she to get there just by feeling better in the safety of her parents’ home?
    Perhaps she thought that the family home was the best possible place she could go to get better. Mom’s cooking and the familiarity of the family would provide her with the clarity she needed to heal and decide what comes next. She assumed her parents would provide nurturing and comfort and that comfort would be a source of healing. Then Dani came home and her parents tried to support her like a sick person and saw that their love didn’t heal her. She didn’t get better. Love and nurturing was nice, but didn’t answer the issues at hand. 
     Maybe nurturing her served as some sort of enabling. Parents might take the opposite stance and start with a hands-off approach. They would welcome her home expecting to find an independent adult woman, capable of clearing her own dishes and applying for jobs and figuring it out on her own. They would imagine she will be motivated to move forward. Then she doesn’t function like an adult, because she doesn’t know how, especially if she is eighteen or nineteen and never experienced adulthood in a successful way. And in that case parents are quickly disappointed, compounding the feelings of lostness and sadness. Either way, going home can have negative consequences. Disappointed parents aren’t spring boarding kids into success.
     And then there are the problems outside of the household that affect a young adult like Dani, for example problems in the way we diagnose and treat mental disorders. We are experiencing the height of of diagnostic inflation in psychiatry. Labels like depression were once reserved for the most severe cases of sadness, low energy, and despair, in people who needed to be treated for months in locked facilities. Anxiety disorders were crippling and people suffering with them could not live normal lives. Today those labels get applied more loosely, so much so that even the experts and the leaders in psychiatry are often appalled. Anxiety and depression (the symptoms) are part of the universal human experience. Now these diseases can be diagnosed in almost anyone experiencing stress. 
     Dr. Allen Frances literally wrote the book on mental disorders (the DSM IV, a book that outlined the criteria used to diagnose all accepted mental disorders) and now has written a book on how the criteria he helped write are being used to diagnose everyone with a disease, from ADHD to Anxiety to Major Depression to Bipolar Disorder. In his book Saving Normal, Dr. Frances argues that the diagnostic criteria are so vague, that all of us could be diagnosed with something. I tend to agree. We have medicalized normal human experiences, and now with the help of our physicians, too many of us seek to take pills to rid ourselves of all emotion that is unpleasant. 
    Clinical psychiatry is full of normal people seeking diagnoses to explain why life is so hard. They want medication to lessen the struggle and searching for a pill to make us feel better is a culturally sanctioned action to take. You are told you can diagnose yourself from WebMD, and then “Ask your doctor” for the prescription you saw on a TV commercial. You invest your time and money and you risk negative side effects of medications, never told that the treatments only work for the worst cases. Normal people aren’t helped much with their painful emotional experiences by taking psychiatric medications. Contrary to lay people’s perceptions, antidepressants aren’t happy pills. Medications like Prozac don’t make people happy. Medications only treat serious diseases. If you’re neurobiologically healthy, medication of the type that we prescribe for depression or anxiety isn’t going to do you much good. The loose diagnostic criteria for mental disorders allow us to diagnose anyone who is going through a rough time, but for the ones who aren’t so sick, treatments don’t work very well (if at all). 
    When young adults get stuck at home, even the ones who are not waiting on a psychiatric treatment to make things better rarely function well. A childhood family home is a place to relax and let someone else take care of you. Whether they possess with college degrees or job experience, going back into their parents’ home leads many young adults to regress, acting younger, less mature, and less responsible. Returning to parents’ home can lead to lounging around with their feet on the coffee table, leaving laundry for Mom, and disregarding curfew. Impatient parents begin to pressure them to act like adults. And then being at home is not warm or supportive anymore. This dynamic can leave young adults overwhelmingly anxious and frozen in their tracks. They look to Mom and Dad to provide. They appear to work surprisingly hard at avoiding responsibility, and they appear unwilling to work at “adulting.” They may act like defiant teenagers, refusing to participate in responsible adulthood. Stuck young adults can do their most efficient work at avoiding, manipulating, and skirting growth. 
    When a soft call of a diagnosis meets a failure to launch situation where young adult starts bucking parental authority or deferring every tough decision to parents, the result is medications that don’t do anything to help, and permission to be in an non-restorative sick role without much hope for recovery. What’s the endpoint from there? Believing she is sick and will get better with medical treatments, a young adult like Dani moves home, wanting to get better. She follows all the instructions she is given: she sees the counselor and she takes the meds. Maybe she even changes her diet and starts an exercise routine. But she doesn’t feel any better. And the situation gets discouraging after a while. 
     From their young adult perspective, they feel overwhelmed and confused. Perhaps even ashamed. The plans meant to lead them into adult life failed, and now they are trapped at home, terrified and embarrassed at the possibility that a high school classmate or family friend will approach in the grocery store and ask, “What are you doing these days?” Stuck young adults don’t know where to begin. Their parents are disappointed in them, and they are disappointed in themselves. Everything seems impossible. They wonder what is wrong, and they wonder how to fix their broken lives. They wonder why their parents lack compassion and why society has such unreasonable expectations. They want to hide underneath the covers and cry. If a mental disorder wasn’t the cause in the beginning, one certainly can come and add intolerable weight to the failures and confusion of young adulthood.



Posted on June 27, 2016 .