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Diagnosis Normal: Bright, Conflicted, and Out of Sync

When inner conflict is a sign of mental health

What does mental health look like? For many of our brightest teenagers, the picture may not be what you think.


Teenage Girl

In newly published research, Dr. Carrie Lynn Bailey studied 70 high-ability high school students in terms of their level of personality development, using Kazimierz Dabrowski's Theory of Positive Disintegration (TPD). Dabrowski, a Polish psychiatrist and psychologist who was a student of Piaget,described a continuum of five levels of developmental growth, from "primary integration," through three levels of "disintegration", to the fifth level of "secondary integration," in which the personality is altruistic and fully formed. Dabrowski wrote that most of the population has at least some degree of primary integration, which is an egocentric level that precludes internal conflicts (and thus inner growth), but that some people have more potential than others to develop to higher levels.

Dr. Bailey found that 70 percent of her study participants were in Dabrowski's Developmental Level II, where disintegration and inner conflict begin. This level constitutes a "loosening" of the previous integrated personality, leading to negative emotions such as shame, anxiety, and despair. Only through intense self-reflection and a recognition that one is not who one wants to be--further disintegration--can these adolescents continue to move toward greater levels of growth. Dabrowski believed that getting stuck at Level II was a sign of negative rather than positive disintegration, of mental illness and psychosis rather than mental health, and that many people slip from Level II back to the more comfortable Level I:

Disintegration is described as positive when it enriches life, enlarges the horizon, and brings forth creativity; it is negative when it either has no developmental effects or causes involution. (Dabrowski, p. 10)

He urged that appraisals of mental health, especially for those with high abilities, should reflect "individual, almost unique, personality norms" and "their own personality ideals" rather than a one-size-fits-all view of what it means to be normal (Dabrowski, p. 113).

Out of Sync

Boy Graduate

photo credit: Sam LeVan

Boy Graduate

photo credit: Sam LeVan

Another complicating factor is that many highly intelligent children and adolescents experience and display asynchronous development; that is, their developmental levels--cognitive, emotional, social--are out of sync, not only intrapersonally but also in reference to age peers. For example, the very fact that young, voracious readers absorb information at a level beyond their life experience and emotional development leads to what we might think of as a mismatch of development; if they read books considered to be age-appropriate, they are under-challenged and quickly lose interest, but if they opt for titles at their actual reading level, they may encounter themes and topics beyond their emotional capacity to handle them. High ability does not mean high even abiltiy.

For high-ability students, being "out of sync" may be the developmental norm rather than the anomaly. Dr. James T. Webb, in a University of Wisconsin Medical School Grand Rounds presentation to the Department of Pediatrics on accurate assessments (available online), explains that the span of abilities increases with higher levels of intelligence. He gives the example of how, for high-ability children, "judgment lags behind intellect: the brighter the child, the greater the gap." Year by year, many of the gaps of asynchrony close, but in the meantime these students are at risk for common misdiagnoses of, among other conditions, OCD, oppositional-defiant disorder, anxiety disorders, ADHD, and Asperger's syndome, especially when parents and professionals do not understand how cognitive ability and other areas of development are related and often out of sync.

One of Dr. Bailey's goals with her research is "to help parents, teachers, and the students themselves understand the positive aspects of this growth period" rather than necessarily pathologize behaviors that may, in the end, be a catalyst for social and emotional development (personal communication, July 10, 2011). After all, disintegration happens because we are dissatisfied with ourselves in some way, and though it is often accompanied by anxiety and depression, we can use dissatisfaction to move beyond where we now are to become something more, such as more giving, more understanding, more disciplined, more skilled and knowledgeable, or more resourceful.

However, the behaviors that result from disintegration, according to Dr. Bailey, can "confound" teachers and parents. She stresses that "adolescents at this stage need guidance and understanding and a support system to help them to sort through their experiences" (personal communication, July 10, 2011), citing research suggesting that "the experience of being understood" is an "essential component of successfully navigating the transition from Level II to Level III."

Understanding sometimes does mean diagnosing potentially debilitating disorders early, but in other cases it means resisting premature diagnoses and helping teens to continue to work through their asynchrony and disintegration so as to become more healthy, integrated adults.

References and Resources

Bailey, C. L. (2011). An examination of the relationships between ego development, Dabrowski's Theory of Positive Disintegration, and the behavioral characteristics of gifted adolescents. Gifted Child Quarterly, 55(3), 208-222.

Dabrowski, K. (1964). Positive disintegration. Boston: Little Brown & Co.

Mendaglio, S. (Fall 2002). Dabrowski's theory of positive disintegration: Some implications for teachers of gifted students. AGATE, 15(2), 14-22.

Webb, J. T., Amend, E. R., Webb, N. E., Goerss, J., Beljan, P., & Olenchak, F. R. (2005). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, bipolar, OCD, Asperger's, depression, and other disorders. Scottsdale, AZ: Great Potential Press.