CHARACTERISTICS OF AN ACUTE CONFUSIONAL STATE IN COLLEGE STUDENTS

An acute confusional state has been described, occurring in young adults in colleges in the Chicago Area with specific characteristics as to genesis, presenting complaints, onset, course, and treatment. Psychodynamic reconstruction is as follows:

In childhood these patients were bound in an extraordinarily strong dependent relationship to their parents through guilt and fear, engendered by parental instability and disharmony. With subsequent dependent gratification and support these patients were able to achieve a conforming type of adjustment and gain success in academic and social achievements. However, in young adulthood when they attempted to find their own identity, through choice of heterosexual partner and choice of career, in the college environment, devoid of dependent gratification, their previous adjustment was inadequate to meet their needs. Sexual temptation or commitment led to guilt, which led to retreat. Retreat, in turn, led to shame and ridicule from the peer group. To avoid the shame, another attempt at conforming sexual behavior is attempted, and once more guilt, retreat and shame. In this way, either thrusts toward accomplishment or retreat from it are associated with anxiety. Under these circumstances, if the dependent gratification from parents is cut off due to their criticism or disapproval, the patient regresses to an early childhood fixation point, associated with primary anxiety, rage, and confusion, where he feels isolated, worthless, mistrustful and depressed. Recovery from the confusion occurs when the patient, who desperately seeks help, finds someone to lean upon. If inadequate help to meet his needs is found, introjection or projection of rage may result.

Further study to delineate this confusional state would include: 1. Psychological tests for independent verification of our results, 2. biochemical tests to compare the chemical changes in this condition with that found in anxiety states associated with other conditions, 3. further understanding of treatment and preventive measures, 4. sociological study of the college community to elucidate factors related to the development of security in young adults in college, 5. study of the background (family as well as the community) from whence these patients came and 6. control studies on college students without confusion.