Young adult chronic patients: the new drifters.

Young chronic patients are faced with the same concerns and life-cycle stresses as others in their age group. They strive for independence, satisfying relationships, a sense of identity, and a realistic vocational choice. Lacking the ability to withstand stress and intimacy, they struggle and often repeatedly fail. The result is anxiety, depression, psychotic episodes, and hospitalizations; gradually many begin to give up the struggle. Such concerns may become intensified during the reassessment of life that takes place at about age 30. Denial of illness, the rebelliousness of youth, and issues of control and violence compound the problems. Since deinstitutionalization, patients can no longer take asylum from stresses in a lifetime of hospitalization. Many patients drift from one city to another, or from one living situation to another. Some ways of approaching these problems, such as working with younger patients while they may still be motivated to make changes, helping them develop appropriate rationalizations, and supporting realistic goals, are discussed.