Can Emerging Adulthood Be Mistaken For Mental Illness?

A panicked mom called begging for an urgent psychiatric evaluation for her nineteen-year-old daughter. Would this be a true mental health crisis or, like so many others, just a bumpy course through the stage of emerging adulthood? 

Bree had thrived during her teen years, but nearing the end of her first year out of the nest, she was flailing. Drinking, staying out all night, neglecting key responsibilities . . . none of these new behaviors were consistent with Bree’s prior behavior. She had been such a good girl when she lived at home. It was as if she had become a different person. Wasn’t that clear evidence of mental illness?

Not necessarily.

Bree might just be struggling to navigate emerging adulthood. Emerging adulthood is a relatively new term, coined by developmental psychologist Jeffrey Jensen Arnett, PhD in his work on the evolving social roles of young adults (generally ages 18-25, though the emerging adulthood stage is not limited to a specific age range). Adolescence is the stage of attaining physical and sexual maturity, usually completed by age eighteen. Emerging adulthood is the stage of attaining psychological and emotional maturity, the time when one gradually takes on adult roles and responsibilities.

The study of emerging adulthood began with social roles, but over the past decade there has been a surge in neuroscience research on brain maturity in young adulthood. As it turns out, young brains are different. Brains aren’t “adult” in terms of maturity until at least age twenty-five, around the same time when we see a natural acceptance of the responsibilities of full adulthood. 

Often, the most appropriate intervention for a family like Bree’s is education about the stage of emerging adulthood, instruction in firm limit setting for the parents, and a heavy dose of reassurance. But when troubling behaviors, like blatant disregard for rules and safety or—on the opposite of the scale—low motivation and avoidance, become cause for seeking mental health assessment, too many young adults are overdiagnosed and overtreated. Unfortunately, many emerging adults like Bree are inappropriately labeled with mental health disorders by clinicians who fail to grasp the nuances of the emerging adulthood stage.

In the midst of campaigns aimed at reducing the stigma of mental illness and expanding services, we have seen an explosion in the diagnosis of psychiatric disorders in younger populations. Independent adults can choose to seek mental health care based on their own subjective emotional experience, but parents are often the driving force behind mental health evaluation in dependent kids. All manner of behavior problems, stage of life adjustments, and family conflict can get caught up in the net of mental health diagnosis when parents bring kids in for evaluation of problem behavior.

So how can parents protect emerging adult children from inappropriate labels and treatments? Step one is education. Parents who understand that neurological and psychological development are ongoing until age twenty-five are less likely to panic when a nineteen-year-old veers off course. Step two: maybe the doctor isn’t the first person to contact for a behavior crisis. If an emerging adult makes poor choices or fails to function, parents can start by consulting a life coach or a counselor. If the emerging adult’s behaviors exceed the expertise of these first line professionals, only then would a parent seek the opinion of a medical or psychiatric professional.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

Stop With The Unwanted Advice!

60-year-old Steve, aka Dad: “You need go to pharmacy school!”
Katie, adult daughter: “I’m sorry, what was that? Pharmacy school? I’m not interested in pharmacy school.”
Dad: “You don’t want to be a teacher. There’s not enough security in that. You need to get into healthcare. That’s a better deal.”
Katie: “Dad, what are you talking about? I don’t want to change my major! I’m three semesters away from graduation! Why do you always try to run my life? You’re unbelievable!”

After role-playing the interaction, he stared at me. “Am I unbelievable? I just want what’s best for my daughter. She left in the middle of dinner. Why was she so angry?”
 
If it’s confusing to you why this daughter was angry, then this article is for you. Settle in and read on…

Sometimes parent’s advice is helpful to emerging adults, most often when that advice is wanted. But when parents barge in to the lives of still-figuring-it-all-out young adults and push unwanted advice on them, doing so is not helpful at all.

Starting out on their own, young people have big decisions to make. Decisions about education, career, relationships. One of the primary tasks of the teen and young adult years is to “find” oneself. In order to discover the self, young people need to be making their own decisions. When parents invade and offer advice on those decisions, not only can it create conflict, it can also stunt growth in young adult children.

Steve has had a difficult time understanding why the advice is damaging the relationship with Katie. Katie had a rough time through adolescence. Her mother died when she was twelve, and Steve raised her alone. He thought he was a pretty good father. He was lovingly involved, protective, and in his opinion, he had always given his daughter pretty great advice. In middle school and high school, she seemed to appreciate his input. But as Katie has progressed through college, she increasingly becomes offended by her dad’s unwanted advice. 

Steve fails to see how Katie’s stage of life dictates a different relationship with her father now. Like so many young adults, Katie has taken the wheel and become the captain of her own ship. She doesn’t need her dad to tell her which decision to make anymore. In fact, when Dad jumps in with an unwanted piece of advice, Katie says she begins to doubt herself. What she craves more than anything is to have her dad say he trusts her judgment and he knows she will find her way through tough decisions with her growing courage and wisdom.

Unwanted advice can shut down the growth of a young person. Not only can the advice prove counterproductive, it can ignite conflict between the parent who gives the advice and the adult child whom he only wished to help.

If you are a parent whose kid is furious or withdrawing due to your unwanted advice, it’s time to learn to keep your silence. 
Don’t be so smart anymore. 
Stop knowing the answers. 
Let your child be the smart one who comes up with solutions. 
Assume your child has the answers she needs and decide you’ll be quiet so she can listen and find those answers on her own.
The last act of parenting is trusting your child to fly on her own. Trust and let go!

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

Be A Beacon of Hope For Your Loved One With Mental Illness

Do you know or love someone who suffers from a mental illness? If you answered “yes,” then you’re like most of us. According to the National Alliance on Mental Illness (NAMI), 1 in 17 Americans suffers from a serious mental illness in a given year. Mental Illnesses are gaining awareness in the national conversation, but many sufferers are still silent about their psychiatric problems with friends and family. More than half of those with mental illness may not be receiving treatment.

If you have a loved one who suffers from mental illness, this list of Do’s and Don’ts can help you be a source of support:

DO
•    Acknowledge the illness.
Mental Illness can leave people feeling isolated and alone. Making the disease subject taboo contributes to isolation.
•    Talk openly and offer support.
Mental health symptoms can be very distressing. Your loved one will likely need emotional support. Ask what you can do to make things easier.
•    Facilitate access to professional help.
Mental illnesses can be serious and disabling. If your loved one needs to see a physician, offer to help him find an appropriate mental health professional or team. 
•    Share your observations with doctors who provide care. 
Offer to attend appointments. Many mental illnesses include impaired insight, so ask if you can share important observations with the doctor.
•    Ask if any current medical problems or medications could be the cause of the mental health symptoms. 
Some mental health symptoms can result from general medical illnesses. Medical tests can rule out underlying medical causes for mental health symptoms. 
•    Attend a support group for families.
The National Alliance on Mental Illness (NAMI) offers groups for people who suffer from mental illnesses and for their families.
•    Report any serious side effects to the doctor.
When your loved one is receiving treatment, notify the doctor right away if he has any problems you believe may be caused by the treatment. All medications can have side effects, and talk therapies can have side effects as well. 

DON'T
•    Diagnose your loved one from a book or a list of symptoms on the internet.
With all the nuances of human mood and behavior, it’s easy to diagnose yourself or your loved one with incorrectly on your own. Make sure you seek a diagnosis from a trusted professional.
•    Encourage self-medication with substances of abuse.
Some people try to control mental health symptoms with alcohol, marijuana, or other substances. Discourage such self-medication. It could make the illness worse.
•    Be judgmental.
Many people who experience mental health symptoms find them embarrassing to tell others. As a result, people may not get the treatment they need. If you say things like, “You wouldn’t have these problems if you ate healthier foods,” you can make your loved one feel worse and drive him away from the care he needs.
•    Tell your loved one to pray or attend religious services instead see a mental health professional.
Although religious faith is a healthy source of strength for those with mental illness, many serious mental illnesses such as schizophrenia will not improve without proper medical treatments.
•    Let your loved one give up before treatments have a chance to work.
Treatments won’t cure symptoms right away. Encourage your loved one to hang in there and give treatments time to work. If he doesn’t get better, the doctor may adjust the plan.
•    Support changes to treatment without consulting the doctor. 
Changing medication or a therapy program without permission can lead to relapse or serious health consequences. 
•    Ask your loved one to stop treatment as soon as he/she starts feeling better. 
Many people want to stop mental health treatment as soon as they begin feeling better, but this is a mistake. Symptoms are likely to return without a long period of stability. Ask the doctor how long treatment should continue once symptoms are fully controlled. 

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults. 

Mental Illness and Mass Violence

On May 23rd, Elliot Rodger went on a killing spree in Isla Vista, California. Unlike many of America’s growing number of mass killers, Rodger not only used a gun, but also a knife.

Why do mass shootings/stabbings occur? 

Can anyone answer the question of why? The mass killers have several things in common. They are angry loners, usually isolated, usually paranoid (they detect some kind of personal meaning in the actions of others). However, many people with the same characteristics don’t go on killing sprees.

Some people say guns are the reason why massing killings occur. But Elliot also used a knife. Others say mental health funding is the reason. But Elliot was actively receiving mental health services.

I cannot dispute that a madman with an automatic weapon is a very dangerous thing. I cannot dispute that funding mental health clinics is important and necessary. These things are true.

But as a professional, treating some of the potentially dangerous individuals, I see another side. The truth of the recent killer in California was that he was showing signs of dangerousness, and people were concerned. His family, mental health professionals, and law enforcement took action. They tried to do something. The police went out to check on him. And here’s what I know that the general public does not: everyone did their job. They followed all the rules.

When the police went out to his residence on April 30th, they would have spent time observing Elliot Rodger. They would have looked for signs of dangerousness and mental illness that might impair his ability to take care of himself or make him a risk to others. Elliot held himself together long enough to reassure the officers. The officers left, and Elliot continued plotting until he carried out his plans on May 23rd, less than one month after the officers visited his apartment.

So why did this happen? Why didn’t they take Elliot into custody? Put him in a hospital? Protect the public?

The law requires officers personally to observe concerning behavior before taking an allegedly mentally ill person into custody. If they do not observe bizarre or threatening behavior first hand, officers cannot take a person in.

To understand why this is necessary, let us consider the scenario from another angle. What if my loved one could call law enforcement and have me taken into custody for mental illness, simply because my loved-one asserted that I was dangerous? What if my therapist could do the same? It would be a set-up for serious abuses of power. For example: what if my spouse could declare me mentally ill and have me hospitalized to prevent me from getting custody of our children in a divorce? Or what if my concerned loved one was paranoid, seeing mental illness in me instead if realizing he or she needed help?

Elliot’s parents did the right thing by asking police to go out and perform a safety check. The officers followed the law when they checked on Elliot but didn’t take him into custody because they found him to be calm, pleasant, and cooperative. 

I sit down with a family at least once a month and explain why I may not be able do anything to help their mentally ill or disturbed loved-one. The reason is this: in America, above all else, a person has the constitutional right to freedom. If a person with mental illness has not committed a crime or made a very clear threat, he or she has a constitutionally protected right to be free from incarceration. Even those with severe mental illness, if they are not hurting anyone, have this right to freedom.

America used to lock away the mentally ill in institutions, not so many years ago, in fact. And then lawmakers decided than institutionalization was expensive, most often unnecessary, and (most importantly) a violation of the civil rights of mentally ill people.

But we need a better system. 

Motherjones.com has published a timeline of mass shootings/killings in America over the past 32 years. It is apparent from viewing the timeline that these types of horrific events are increasing in frequency. The result, in addition to the tragic loss of life, is that mental illness is further stigmatized. Patients fear a diagnosis like Schizophrenia or even Autism will evoke fear and discrimination. They shy away from treatment.

To end the epidemic of mass violence in America, we need to reduce stigma (without overlabeling normal life as mental illness.) We need treatment for the severely mentally ill. We need research to guide us, training for law enforcement and mental health personnel for reporting and treating potentially dangerous individuals, qualified professionals to assess for signs of dangerousness, and funding to provide people like Elliot Rodger with the treatment programs they need.

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.