Psychiatric Treatment of Emerging Adults: Collaboration is the Key to Success

Young people caught in the psychological maelstrom that so often characterizes the years between 18 and 30 are undergoing the most significant period of neurological change the brain will hopefully ever see. Barring the ravages of stroke and dementia, the brains of emerging adults will never see as much reorganization. The brains of the young are in as much flux as their lives: choosing careers, romantic partners, and learning the ins-and-outs of 21^st century adulthood molds the brain, utilizing the heights of neuroplasticity to become whatever is practiced and demanded of it.
Often these processes of reorganization go awry, and the demands of life outstrip the capacities to meet those demands. It is no wonder then that 75% of people who will go on to suffer some form of mental illness experience the first signs of the struggles to come by age 24.

The treatment of emerging adults is full of pitfalls and possibilities. Successful interventions among patients that are so young offer the promise of entirely different life. Patients experiencing serious mental illnesses during this time of life, if afforded the right treatment, have the chance to live a full and meaningful life, rather than suffer the gnawing despair and humiliation meted out to the permanently disabled.

The rush to intervene in the lives of young adults is often fueled by the zeal to change lives as quickly as possible.  This is often where the developmental task of the Emerging Adult – separation from one’s family of origin and individuation into one’s adult identity – and the passion of loved ones and caregivers to help them come into conflict. Every parent wants to spare their son or daughter the difficulties they had to go through as young people; but, just as their parents could not save them from themselves, so too will they be powerless to take over and save their child from themselves.

As a psychiatrist specializing in the treatment of emerging adults, I have learned to make allies of former enemies. Where once the internet was a repository of hearsay and bad advice, I now encourage my patients to look up whatever treatment I recommend (as if I could stop them!). I ask every patient how interested they are in learning about what is happening in their brain to cause such suffering in their minds – there is always a shred of curiosity and more often a powerful urge to understand as much as they can about their struggles.

For the emerging adult, psychiatric treatment must be in accord with their developmental needs. To act under the old paradigm of “I am the physician with the knowledge and skill, and you are the patient who will dutifully and blindly follow my recommendations” is to invite regression into adolescence, where freedom means standing against authority. Treating the emerging adult as a fellow student of their mind, harnessing from their suffering the motivation to learn about what is happening in their brain-mind to cause them to suffer allows the psychiatrist a new kind of authority: where respect is earned through collaboration, not demanded as a right. Urging the emerging adult to learn about their medications, their illness, urges them to acquire knowledge, and through that knowledge to become empowered. As a powerful agent in their treatment, the emerging adult can stand with you in the battle for their lives.