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.