How does an identity crisis feel?

Who am I actually?

Young people in crisis, a case for the psychiatrist? In adolescence, young people have to master difficult developmental tasks, identity and self-esteem, individuality and autonomy have to be developed. In many cases, they get into a crisis. Although this is not necessarily an early sign of an approaching psychosis, you should not be left to your own devices in solving your developmental tasks. Franz Resch, the Medical Director of the Department of Child and Adolescent Psychiatry at the Psychiatric Clinic at Heidelberg University, advocates taking youth crises seriously. After all, during this time important courses are set for later life.

"... because no one who starts can know what he will find in himself. How can he even suspect it, since it does not yet exist? With borrowed tools he penetrates into the ground, borrowed and foreign, When he suddenly stands for the first time in front of something that he does not recognize, that came from nowhere, he is frightened and staggered: because that is his own. " wrote Elias Canetti (Karl Kraus, School of Resistance, 1965). Adolescence marks the transition from childhood to adulthood. The expulsion from paradise is not the correct picture, the child was confronted with shame and guilt long ago in preschool age. Rather, this period marks a great opportunity to discover what is one's own in self-reflection and to accept it. The young person is confronted not only with the greats, talents and successes, no, also with the weaknesses, bottlenecks and ailments: He looks for roots - biological and biographical - in order to express effectively and coherently what possibilities he feels in himself to be able to bring. The critical questions are: Who am I actually? Where am I from? Where is my seat? What is the point of all existence? The threat to the meaningfulness of a possible existential embedding comes primarily from the problem of finitude and death: Why all privations, planning, considerations and restrictions in the face of a foreseeable, all-destructive and thus all supposed success mocking end? Young people look for eternity, and wherever religion, tradition and convention offer no stabilizing practice, attempts are made to create something that is eternally valid from what is self. Time-boundness and provisionality are irritating because they run counter to the identity-forming feelings and their claim to absoluteness. What prompts the doctor, the psychiatrist, to turn to the youth on these questions? It is the crises, the breaks in biographical continuity, that can threaten a person's mental health in adolescence. In view of the youth crises, doctors are also called upon to offer their help. Adolescence is not just a link between childhood and adulthood. As a phase of profound changes, from physical changes to a paradigm shift in relation to the world, it represents an individual challenge to every person in the sense of a "normative reorientation". Contrary to the earlier depth psychological views, which every adolescent a physiological irritation, a "normative crisis" The modern concepts of developmental tasks and development topics show that, despite massive changes, adolescence can be managed productively without escalating into crisis. Adolescence is characterized by puberty and adolescence. Puberty is defined as the physical development of the secondary sexual characteristics in the sense of biological maturation, adolescence as the emotional confrontation with the physical and psychosocial changes on the threshold of adulthood. The following lines of development therefore characterize the development of adolescence: The development of the secondary sexual characteristics, the growth spurt and the physical changes based on it have a massive effect on the physical self-image; the body schema as part of the self-image must be reformed. An important phenomenon in this context is acceleration, which is characterized as a discrepancy between an accelerated physical development and a mostly still slowed down psychosocial and emotional development. This discrepancy leads to the fact that adolescents are treated like adults based on their physical appearance, contrary to their childhood emotional needs and expectations.

On the cognitive level, in adolescence thinking in formal operations replaces concrete, vivid thinking. The acquisition of the ability to form hypotheses and to develop solutions to problems in individual steps leads to a change in the previous evaluation and orientation systems. The ability for introspection and self-reflection increases and thereby the young person is faced with an existential challenge. With increasing critical faculties, he seeks his own personal opinion on the world and no longer takes over authorities and value systems unquestioned. Value crises can arise when young people identify different values ​​and expose their incompatibility in different areas of life in the family, their peer group, school, vocational training and leisure culture. Uncertainty with regard to the standard of value can make them cling to a high, ultimately unattainable ideal of values ​​to which all other people and often themselves can only be devalued. On the other hand, the diffusion of value attitudes can give rise to the development of a no-future perspective and a nihilistic basic attitude with regard to all ethical values. On the social track, young people are provisionally assuming new roles of adulthood and are increasingly having to recognize the need to take on responsibility. Particularly in adolescence, there is a special setting of the course for training and personal career, so that a protracted mental crisis during this time can lead to severe developmental disorders if too many opportunities for development and development fail beyond the failure line.

Among the developmental tasks of adolescence, the development of identity deserves special mention. Identity includes the definition of a person as unique and unmistakable by the social environment as well as by the individual himself. Identity cannot finally be grasped by experience as a unity of self-concept, identity always remains a construct, a working hypothesis that has to be confirmed daily by new evidence in a self-reflexive manner. From a psychosocial point of view, identity represents the temporal continuity of experienced unity in a social association. The experience of identity refers to the experience of continuity in biography, the experience of demarcation, the evidence of being separated from others, and the experience of consistency , the current uniformity even with different emotional states, as well as the experience of activity, self-determination in action, and vitality, one's own liveliness. The psychiatrist Scharfetter defined these I-experiences to maintain I-consciousness.

An important mechanism for acquiring identity in adolescence is the mechanism of identification. Disturbances in this decision-making process for a subjectively binding assumption of a social role lead to identity diffusion. If there is too great a discrepancy between different parts of the self, if emotionally contradicting self-experiences are made that they are incompatible with one another, the phenomenon of depersonalization occurs. A patient says: "Sometimes I feel downright strange in my skin. Then I hear my own voice not as normal, but differently, and my movements appear mechanical and automatic to me."

The question of self-worth is also one of the developmental tasks of adolescence. A person's self-worth develops from experience of competence and acceptance. Cognitive skills, physical attributes, but also energetic valences such as temperament, initiative and perseverance can only contribute to self-worth if they are embedded in social acceptance and can therefore be updated as skills in an interactive style. Skills must also be ascribed to a person. Simply having them is not enough. A leeway for developing one's own competence must be granted. Competence and acceptance are interrelated, because the child's skills, which the youngster can recognize in himself and update from himself, can only develop in a climate of emotional embedding. Especially in adolescence, increasing critical ability and self-reflection lead to a critical period of self-esteem stabilization. If competence and acceptance do not take into account one's own ideals, this can lead to a self-esteem crisis. "Because these external associations and borrowed feelings carry the young people over the dangerously soft emotional soil of those years, where you have to mean something to yourself and yet are still too unfinished to really mean something. ... When you are there If such a young person could make the ridiculousness of himself aware of himself, the ground would collapse beneath him, or he would fall like an awakened nightwalker who suddenly sees nothing but emptiness. " (Robert Musil: The confusions of the pupil Törless, 1930). One speaks of a physiologically increased narcissistic overestimation of oneself, in which a fragile self-experience is linked with lofty ambitions, devaluations, idealizations, increased vulnerability and anger. We can assume that this narcissism is physiologically necessary. The normal development of a person can only take place through concepts and ambitions that go beyond the person and their conditionality, from which the person can grow and through which he is challenged. In our own investigations we were able to establish that a loss of narcissistic overestimation was detectable in adolescence, especially in patients with psychoses from the schizophrenic group of forms. There is much to suggest that the adolescent's increased narcissism has a protective function. Further investigations will investigate this question.

The development of individuality and autonomy are also part of the tasks of adolescence. Independence and independence develop in the area of ​​tension between striving for autonomy and attachment. Stierlin calls the feat of a synthesis of both endeavors "related individuation". The success of the same is strongly linked to a stable self-worth and a successful identity formation. The replacement tasks can upset young people who were previously in harmony with their families. A farewell too late or an unsuccessful farewell, which leads to a humble return to the family, is just as dangerous to development as a farewell too early, which exposes young people to age-typical risk behavior in a special way. The development tasks described can be developmental incentives as well as triggers for mental illness. This raises the old controversial question: Is every crisis of adolescence an expression of psychological vulnerability and thus indicates an increased risk of later mental illness? Or should adolescent crises be understood as a physiological adjustment problem that does not entail an increased risk of psychiatric illnesses? These questions cannot be answered with the simple linearity that was introduced into the discussion. Whether adjustment crises in adolescence are the result of a mental illness or the cause of one can only be answered in a more differentiated manner. In order to approach this question, the principle of vulnerability must be used.

Adjustment crises as disturbances that prevent the young person from accomplishing his age-typical and situation-appropriate life have to be analyzed according to the following aspects: Which developmental conflicts exist? Which forms of coping and risk behavior are used? What psychopathological symptoms are involved in the adjustment crisis? In which experience environment, in which social framework is the young person currently located?

Through genetic patterns and early biological and psychosocial influences from their biography, adolescents bring with them a certain disposition, which in the developmental context of adolescence in some cases turns out to be vulnerability, i.e. a reduced ability to solve adolescent developmental tasks. Under the pressure of these tasks and current fateful environmental influences, the young person can get caught up in a network of possible risk behaviors. These are, for example, alcohol and drug use or abuse, approaching and integration into a delinquent group, escalating interaction problems with parents or teachers, withdrawal, decline in performance or changes in lifestyle in everyday life with sleep restrictions or changes in eating habits. Depending on what dispositional prerequisites the adolescent has, he can develop an adolescent crisis with unspecific psychopathological form, a psychiatric illness in the narrower sense, or the dangerous decision to delinquent in the network of such risk behaviors. Young risk behaviors develop in the area of ​​tension between developmental tasks and fateful life events and - depending on the dispositional prerequisites - lead to crisis, illness or delinquency. Already existing psychopathological symptoms at the transition to adolescence can accelerate and intensify the adoption of risk behaviors, conversely, these can in turn increase the likelihood of psychopathological derailments.

If one examines a population of adolescents who seek psychiatric help in the stage of an acute adjustment crisis in adolescence, they have one thing in common, even with different psychopathological classification: the phenomenon of depersonalization. More than half of the adolescents who sought help in a psychiatric outpatient clinic in the course of an acute adjustment crisis showed the phenomenon of self-alienation. Various hypotheses about the origin and meaning of depersonalization experiences have been formulated over the past hundred years. Such experiences are described as symptoms of complaints in a wide variety of neurological and psychiatric diseases of all ages, such as epilepsy, poisoning, encephalitis, manic-depressive illness, hysteria and other neurotic diseases. Depersonalization phenomena also become manifest in the context of an acute experience reaction and from full mental health after overtiredness, sleep deprivation, drug abuse and sensory deprivation. They are important insofar as they can indicate the onset of schizophrenia according to the basic disorder concept according to Huber and Klosterkötter. Transitions from prodromal depersonalizations to schizophrenic diseases have been described again and again. The question, however, is whether one can infer specific preliminary stages of the onset of schizophrenia from such general phenomena of self-alienation. To do this, we searched 107 patients with adolescent crises for the characteristic basic symptoms that became tangible in schizophrenic developments. We found that practically every depersonalization typical of adolescence is also associated with so-called schizophrenia-characteristic symptoms, such as subjective thought disorders, perceptual disorders or disorders of body perception. It is therefore not possible to differentiate between schizophrenia-characteristic and general development-related depersonalization in cross-section on a phenomenal level. Such symptoms must therefore be viewed more as general, unspecific signs of irritation than as schizophrenia-specific early signs or vulnerability indicators for approaching psychoses. Only a quantitative difference in the extent and spread of such unspecific complaints in the field of experience emerges between patients who are directly at risk for psychosis and development-related self-alienation. We will continue these investigations longitudinally.

Adolescence therefore harbors the risk of increased irritability in adolescents, which can lead to disease-related development or decompensation of - including genetically preformed - vulnerabilities and dispositions. This has consequences for the psychotherapeutic approach to adolescents with the need to help them solve their developmental tasks regardless of a possible psychiatric illness, because otherwise they will remain caught in a fateful area of ​​tension in their risk behavior and could become a victim of their own self-development process. In the event of a crisis, the adolescent can become increasingly distant from himself, whereby this alienation carries the risk of psychological derailment if he is vulnerable.Based on our research, we are not yet able to say whether adolescents who are vulnerable to schizophrenia can escape the lot of acute psychosis with suitable support. However, it is important to take youth crises seriously, and it remains a social challenge not to simply leave the future people to their own devices in setting such an important course. Growing up must not be blocked by ignorance for young people who are beginning to look for themselves on a risky path.

Prof. Dr. Franz Resch
Psychiatric Clinic, Dept. for Child and Adolescent Psychiatry, Blumenstrasse 8, 69115 Heidelberg,
Telephone (06221) 97 04 41