(Young Adult Through the Edler Years)
Adam Blatner, M.D.

Posted 12, 2011   See also Factors in Development (Infancy through Teens); the  Art of Case Formulation for further practical applications;
     the "Real Diagnostic Variables,"     Checklist for Diagnosing Depression;    and Broadening the Horizons of Psychotherapy  and review my papers by clicking above.

On another website, I list some of the many, many factors that can be relevant in assessing the emotional development of the young person. This webpage carries that forward. Adulthood used to be a time when little attention was given to further growth. One "grew up" and adulthood was merely the application of what had been learned. Instead, we've become more sharply aware of the extensive continuing challenges in adulthood, as well as the potential for growth. Alas, many adults cope with their challenges by carrying forward the subtle unconscious and conscious decisions and character patterns formed earlier in their life. They don't really evolve much in their consciousness. On the other hand, increasing numbers do change deeply, reinvent themselves, overcome some of their early tendencies and character patterns, make new decisions, start fresh.

Alas, again, some rise, sink, and some don't rise much again. On the other hand, others deal with their ups and downs by making deep psychological and spiritual changes. Appreciating the many factors involved here, let's go on to identify some of the kinds of themes operating in adulthood.

I confess that this list is hardly exhaustive. I just dared to start listing some things. If you want to email me with suggested additions and revisions, you're welcome to do so. (If you want me to use your name and I decide your suggestion worthy, let me know, give me permission, and I will!).
The challenge is to get a sense of the sheer richness and variety of life-lessons to be learned!

The following  “topic headings” are deceptively simple. In fact, when lived in life, they allude to rich stories that weave in many elements of individuality, the individuality of key others in the social network, and a rich texture of other elements. Rarely do these elements emerge in isolation---often they are combined with other themes, because, well, life is like that.

Some old friends, contacts, and family may argue against change. Other allies or teachers or models emerge. Social networks are fluid and re-form as roles shift. Often there are multiple sub-plots involved, such as, for eample, a new spiritual direction mixed with a new romance, etc.

Finding a Mate

    Living together, sometimes with support (emotional or financial) from parents
        .. Sometimes against their wishes or with their worries
    Getting married and all that entails
        – the politics of the wedding, relations of the two sets of parents (and nowadays,
            Possibly step-parents, other parent-partners)

“Having Kids”

    Chosen or accidental; decisions about birthing; issues about pregancy
    Challenges of new parenthood, overwhelmed or coping well
    How many kids, conflicts between the parents, religious issues


    Sometimes one finds ones vocation (which is related to the Latin, vocare, to be called). One studies and prepares for a career. Post-graduate education can easily take one through early adulthood, to the 30s.
    Often one goes through a series of jobs. Some are felt to be a major calling, and it falls through. Every time one is laid off or fired, there is more deep turbulence than the term suggests: why did it happen, what does it mean about me? Unemployment is more than stressful---maybe even traumatic---but certainly it stirs up lots of issues.
    Sometimes there are strange turns, pleasant opportunities, opening up into new ventures. Sometimes there are dead ends and a good deal of pain, anger, and confusion associated with relations with supervisors, their supervisors, peers, subordinates, customers, and those in other roles. These are thick stories---that's the point to be made here.
    Sometimes there is a major shift in the type of work, the field of endeavor. Why does that happen?


    What are the rules, how strict are the rules, what are the consequences for breaking the rules, how consistent is the enforcement, what is the emotional quality of enforcement (often parents agree on 2 or 3 of these but not on a 4th, so figuring out where the friction is becomes a bit of a detective process.

The Continuing Conflict Between Desire and Limits

    We can’t afford it, or can we? Credit card debt, buying more mortgage than you can afford; risk of loss of home; savings or no-savings.
    Money management and discussions, budget,
    Changes in the financial situation, getting laid off, trouble finding another job, or one with a comparable income
    Impact of either party losing a job

Finding Meaning

    Finding roots. Church, genealogy, extended family, making contacts. Ethnic history.
    Finding purpose: church, new religions, spiritual quests, changing religions
This is a very big issue and should not be minimized!

Finding Identity

    Mid-life gender change, sexual orientation change, divorce and re-marriage
    Mid-life career change (possibly more than one)
    Sabbaticals, pilgrimages, adventures to “find oneself”

Personal Development

    Psychotherapy, personal growth programs (e.g., est, encounter groups)
    Support groups, self-help groups
    New hobbies, activities


    Letting go of old friends and acquaintances, building new networks
    Moving, with every move involving a host of sub-themes:
        - what to keep and what to sell or give away
        - how to keep up connections with key others,
             especially if they, too, have moved away
        - criteria for choice of new church, social groups, etc. may change
        - fresh start, disorientation

Mid-Life Crisis

    Sexual: Seeking adventure; risking divorce; secrecy; getting caught;
    Becoming single. Some become promiscuous; others isolated
    New “life” through car, plastic surgery...
    Religious crisis, philosophy. "Pain makes man think; thinking makes man wise; wisdom makes life endurable."
    Mood shifts, medicines, menopause,

Relations with Relatives

    Dealing with elderly parents as they become frail or senile
    Dealing with mental illness, depression, other conditions in adult children
    Dealing with social problems in which the son or daughter is “in denial”
        Becoming caught up as their advocate
        ... and sometimes discovering they were lying
    Dealing with their life choices that feel like disrespect for your values, abandonment
        your not respecting their values—they seem tacky
        their marrying out of their race, religion, class

Relations with New Relatives

    In-law kids, their parents
    Where do adult kids do their holidays,
     feeling neglected, included, considered, not considered
    Grandchildren, frequency of visits, feeling put upon with too much “baby sitting”
    Financial support as young adult kids go through their own life challenges
        Divorces, Addictions, etc.


    Discovering that one is addicted or habituated in this or that way, severely or mildly
        Alcohol, books, hoarding, other drugs, doctors’ visits, news, shopping,
         gambling, sex, work, any hobby, television, golf,
    Dealing with it, episodes of cleaning up, relapse, recovery again
        Joining a recovery support group, AA, etc., dropping out, dropping back in


    Coping with more or less easily fix-able conditions, increasing in frequency
        Eye disorders, glasses, surgery, hearing aids, dental problems and dentures
        Replacements of hips, knees, other organs
        Cancer screening, low grade or chronic cancer support programs (e.g., prostate)
        Cancer treatment, recovery, relapse

Dealing with medical establishment

        Unclear diagnoses, different consultations, confusing instructions
        Toxicity from side effects of medications
        Confusing options, this way or that... elective possibilities

Culture Change

    Increasing intensity and loudness of music, scene changes more rapid in movies,
      spicier foods, faster talking, more dialect in songs so they can’t be understood,
     sexuality more overt, language more laced with obscenity,
     personal ornamentation more shocking (haircuts, tattoos, pierce-ings, etc.)
    Information Glut—beyond explosion—leading to “overchoice”
    Varieties of subtle falling into burn-out
    Seductions to do, have, be “more,” and limitations of organism to do it all
    Lack of support for putting limits on efforts, for saying “enough”
    Ever-new versions of computers, new gadgets, complexities of building-up
     skills to master the latest gadgets
    Pressure to joint this or that social media networks
    Falling behind as to which celebrity is popular with the younger crowd


    Retirement, role-meaning, welcome or resisted, what else to do?
    Feelings of status loss, stereotypes about ageing
    Sexual or romantic desireability, attractiveness issues
         Erectile dysfunction, sexual activity changes
    Philosophy of life, reflections, sense of humor, temptation to get grumpy

Dealing with Death

    Of elderly parents, some peers and relatives
    Of kids or grandkids
    Thinking about one’s own mortality, making arrangements or falling into denial

... and so forth.


     Some disillusionments are neither always unpleasant or a bad thing—some illusions that are let go of may not be that useful. Some of these involve unrealistic standards or the hope that if only I would ... then everything would be better----what I call the "Dingle-Derry Complex."

     In a world that is changing at an ever-increasing rate, "keeping up".has become impossible. It seemed quite possible in the mid-20th century, and, indeed, there was a mild moral imperative to do so. This is one of many deep changes in expectations and standards occasioned by the massive expansion of everything---information, sub-types of activities, fields of endeavor, alternatives, etc.

   Indeed, one of my coping maneuvers has blended with an interest: What is all this about? How is the world’s changing making a difference in my understanding of all this. (I see us on the cusp between the modern and postmodern era and paradigm—which means that I think we need to learn new ways to think. This gives me a sense of purpose. But I don’t suppose my life is at all typical. On the other hand, considering all the variables to be weighed, I doubt that many people have that luxury. On the other hand, they seem to find satisfaction in many activities I find boring. So I’m more sharply aware of the sheer range of interests people have.

In my role as psychiatrist (retired), though, I have done this exercise to remind myself of the sheer complexity of people’s life stories. I suspect that a good deal of what passes as anxiety and/or depression, or what sustains addictions and drug abuse, are the pressures from the issues mentioned above. In this era that tends to believe in conditions that can be treated by medication, there is a diversion of attention away from the manifold stresses of contemporary life.

I further distrust most approaches to therapy that are based on their own theories rather than taking stock of the full range of aforementioned events and the challenge of trying to maintain a sense of orientation and self-esteem in the face of our socio-cultural variables. I am inclined to encourage students to be more sharply aware of all the aforementioned pitfalls—and I suspect that this list is only a fraction of the permutations and variations of issues that come up in life. The purpose is to be suggestive rather than exhaustive, meaning that if you think of some other factors that belong on this list, feel free to email me with your suggestions and whether I can use your corrections. 

For responses, email me at adam@blatner.com

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