Shirah Vollmer MD

The Musings of Dr. Vollmer

Immaturity or Anxiety: Development or Psychopathology

Posted by Dr. Vollmer on February 26, 2014


Growing up involves making major life decisions which, if one pauses, can create tremendous anxiety and insecurity. When is a person trying to grow and when does a person have an anxiety disorder? As with all of psychiatry, the distinction is subjective, and so my rant begins.  I all too often see people who need to grow up, but are labeled with an anxiety disorder, and hence their self-assessment turns to one who is “ill” rather than one who has to meet the challenges of development. Cullen, fifteen, female, comes to mind. She paces, she skips meals, she sleeps poorly, and she has been on multiple psychotropic medications, for a diagnosis of generalized anxiety disorder. “Maybe you need to learn some coping skills,” I suggest. She looks at me stunned and appreciative. “Wow, that really makes sense to me,” she says, to my surprise. Cullen seemed to instantly respond to the idea that life is stressful and she is opting for coping mechanisms which detract from her objective of budding autonomy and self-sufficiency. The change in frame from “victim” of illness, to “agency” over stress was remarkable, despite my decades in practice. Cullen gravitated quickly towards inner exploration and deeper work. I stopped her “anti-anxiety” medications, as it seemed like she could navigate tough waters with thought and reflection, rather than with sedation. Usually, I think in baby steps. Cullen took a big leap. I hope for incremental change, but Cullen had a transformation. My surprise invigorates my work. Humans always amaze.

7 Responses to “Immaturity or Anxiety: Development or Psychopathology”

  1. Jon said

    It seems like Cullen is beginning to grow up. This is a good thing. Being able to learn how to cope with the world without the benefit (??!!???) of psychotropic drugs is a wonderful step towards being able to live a healthy life on her own. How wonderful that she will be able to have self sufficient coping skill to deal sanely with the insane world.

    That said, may she not grow to become too mature. By that, I am thinking of the sarcastic words of the science fiction grand master, Robert Heinlein, “It’s amazing how much ‘mature wisdom’ resembles being too tired.”

  2. Shelly said

    I don’t see why a person with a psychiatric illness is considered a victim. This allows him or her to use this as an excuse for their behavior in all things. While having a mental illness may be a factor of genetics or influences in the environment, it is still an illness that one needs to control. It is like someone saying that someone with heart disease is a victim of heart disease. S/he needs to make good life choices to take care of him/herself so as to control his heart issues–the same with mental illness. In addition, if Cullen sees herself as a victim, then her parents or boyfriend will constantly have to take care of her, since she will not be able to control the facts which make her ill or stressed. I realize that this is the purpose of your rant, but do people really think that mental illness excuses them from all the mayhem they cause?

    • The issue of personal responsibility versus being a victim of a mental illness is hotly contested and not clear. If, let us say that Cullen does have a psychiatric illness, this is a disease which came to her, and in that sense she is a victim, but you are right, she has still has personal responsibility to manage her behavior. Disease though does victimize, but, as you suggest, the victim, must learn to cope and take charge, and thereby learn to deal with an unfortunate circumstance. The question is whether a person focuses a disease in the victim frame, and/or whether they make it a background issue. Clearly, this, in part, depends on how ill someone is, but it also depends on the sophistication of their coping skills. Thanks.

  3. Ashana M said

    I think perhaps the view of illness in society is changing–I know my view of illness is different than yours. Illness is not a matter of passive victimhood and it is not meant to be a permanent state or an identity, and the sick person is by no means helpless. Illness is instead a call to action. If I am sick, I need to do something. I need to decide, first of all, what self-care to use which might involve a bit of informal research if it’s something I haven’t dealt with befoe. I also need to decide whether the illness is serious enough to require consultation with an expert. If it is, then I also need to seek out, evaluate, and follow the advice of that expert. Although the information about how to treat my illness may be coming from someone with more knowledge than I have, I am never relieved of my responsibility to evaluate the quality of that information, make decisions about my healthcare based on my evaluation of it, and to follow through appropriately with action. I think this is shifting to our more dominant model of how patients see themselves in the US. The change seems to be coming more slowly in the mental health field, but I think it will come.

    The client you describe is a minor, so none of that may really apply to this vignette. It does change what it generally means to be diagnosed with an illness. A diagnosis acknowledges the patient’s suffering and points to the need to act. I suppose the distinction between illness and growing up (at least for young people) is that the illness is disrupting normal developmental progress: without treatment, the person won’t grow up.

    What it may also mean in the future is an understanding that mental illness is not rare or uncommon. Just as physical illnesses and learning how to respond to them is a part of life, so are mental illnesses and learning how to respond to them.

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