Generally, Serious Mental Illnesses Occur Between the Ages of 18-21: HealthyPlace.com

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Kathryn Cohan Who am I now?

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For the vast majority of persons with serious mental illness, onset occurs at ages 18-21. Perhaps this may have something to do with the brain being the last organ to mature.

Psychologically speaking, the timing is interesting. Nearly all of the major schools of practical psychology (i.e. the kind upon which therapies are founded) mark this period as a crisis on the way to formation of adult identity. In Erikson's Stages of Psychosocial Development, for example, adolescence is characterized by the conflict of "identity vs. confusion" and early adulthood by the conflict of "intimacy vs. isolation." Persons with mental illness do not stop in our journeys through these conflicts as a direct result of having a mental illness, but the diverse experiences contained within the category of human behavior described by the term "mental illness," sure do complicate the process of working through these "normal" steps to maturity. The timing of the event of a first episode of mental illness is, for this reason, not insignificant.

With rare exceptions most schools of thought -- psychology, emotional and intellectual development, philosophy, education -- have written off persons with mental illness as being so "abnormal", and our experiences are perceived as being so inaccessible, that there is almost nothing written about the process of growth, the formation of identity, and the path towards maturing with a mental illness. A review of the literature finds a lot of material that describes and classifies symptoms, makes treatment recommendations in a broad way and based on the medical model, and cautions against the use of traditional therapies in work with persons with extreme states. We have been left out of most contemporary thinking about the human condition, and have been abandoned to concepts like "maintenance" and "rehabilitation" to describe the very best of which we are capable. It appears from the literature that once mental illness begins, all other development stops. Once the label -- whatever it is -- has been applied, the person's identity is subjugated to the extraordinarily powerful description of the label. Thus, the label becomes the focus, and the person is lost.

A clue to this shunning of the mad may be found in Simi Linton's book Claiming Disability: Knowledge and Identity, which identifies and reviews six categories of global historical experience of persons with disabilities. The first, most primitive, societal response to disability is termed "pariah."

The first thing the word pariah conjures up is the dictionary definition of "social outcast." I notice that I envision lepers, homeless people, drug and alcohol addicted people who have hit "bottom," people who, for a variety of reasons, have either abandoned or been abandoned by mainstream society. But nowhere in my musings on the term pariah do persons with mental illness exist.

I ask myself why that would be so, and conclude that persons with mental illness are not included in the pariah list because, in fact, we do not think of the mentally ill at all. Persons with mental illness are cultural pariahs in the extreme. We have been disappeared from consideration, we are the outcasts of outcasts. In all my childhood thinking of the possibilities for myself as a grown up, it never once occurred to me that I'd be mentally ill along with all the other things I am. I knew I had an uncle with some sort of psychiatric problem, but that was his problem, not mine. The family stories that were handed down did not include him. It never occurred to me to ask why. I learned early on, like most people, that mental illness is so far out of reach that it doesn't deserve consideration.

While this is, unfortunately, an accurate description of the way many persons with mental illness are regarded in society, it also has personal meaning, and is given personal expression in the lives of persons with mental illness. On an individual level, the way some of us internalize or understand "pariah" is denial. The literal "casting out" of the labeled self. In psychoanalytical terms, this is "introjection." We take in the messages and meaning assigned to the experience of having mental illness, which are all extremely negative when they exist at all, and close off from ourselves that part of our being that contains the negative message. We wall it off and decide it just doesn't exist. We are disappeared by mainstream culture because of our extreme states, and, consequently, we disappear our extreme states, drive them underground, cleave them away from our valued self in an effort to maintain a sense of personal integrity.

In any other human endeavor, denial is seen as protective. It is viewed as a natural human response to trauma, including death, loss and natural disaster. It is here that the exceptionalizing of the experience of mental illness begins. Because to have a denial response to the event of mental illness is not viewed as a normal response to a traumatic event, it is, rather, viewed as proof of the condition of being mentally ill. There is a great deal of literature on the topic of denial as it pertains to mental illness. Denial is thought to be causal in "non-compliance" with our medication and "lack of insight" into our illness. Instead of viewing denial as a natural and necessary part of coming to grips with a catastrophic personal event, denial is pathologized.

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