By Melissa Deuter, MD
“In a given year, over 40% of U.S. 18 to 29 year-olds meets criteria for psychiatric disorder, a higher rate than for any other adult age group.” -Jesse Viner and Jennifer L. Tanner
A mental health diagnosis in young adulthood tends to follow a person throughout the adult years. But what if the diagnosis is wrong?
Incapable of taking the necessary steps to find a job or enroll in school, many emerging adults end up in mental health treatment. Some who land in my office don’t really need a psychiatrist. For example, Mark.
Twenty-year-old Mark began diagnosing himself with psychiatric illnesses off the internet. His inertia was depression; his avoidance, social anxiety; his scattered plan, ADD. He could certainly be made to fit checklists of criteria, but Mark didn’t appear mentally ill. With no signs of taking responsibility for himself, I suspected he had more of a complicated failure to launch issue than a mental disorder. He didn’t seem depressed, anxious, or more scattered than average; he just seemed lost.
Mark wasn’t finding work because staying home, in many ways, had proven easier. I wonder if he would be working if he didn’t have a Mom to take care of him.
What is notable to me about Mark (like many of the young adults who are failing to launch) is that he is unhappy and he has the power to change his situation, but he hasn’t taken the necessary steps. He complains of low self-esteem and even shame, yet continues to spend his days on his mom’s sofa playing Xbox instead of making a life plan. He doesn’t research options or apply for jobs. Mark has no experience (yet) with financial or emotional independence. He stays in an unhappy circumstance because, without experience, he doesn’t quite know how to run his own life.
Now almost a year into his young adulthood, Mark feels trapped in a situation he doesn’t like very much. Worse, Mark sees no way out because he has always been completely financially dependent on his parents. When Mark decided to stay with his mom after high school, he expected it would be temporary refuge, and then he would find a terrific job, support himself, and quickly move on. But it hasn’t worked out that way.
I think my profession’s prevailing wisdom is to diagnose and treat, just in case. But what harm could be done if I diagnose Mark with depression, social anxiety, or ADD? What if I lead him to believe he is too ill to work or attend trade school? What if he believes he is sick, and the sickness becomes part of his lasting view of himself? And what if I treat him for a disease he does not have? What about risks and side effects?
Physicians need to talk more about support and education for non-illness problems, and move away from “just in case” diagnosis and treatment, especially for those on the verge of independence—when so much is at stake for a young adult’s future.
Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.