Underachievement in Exceptionally Gifted Adolescents and Young Adults: A Psychiatrist’s View

In 34 years of psychiatric practice, no clinical problems have been more intriguing to me than underachievement and self-destructive behavior in exceptionally gifted adolescents and young adults. Early in my career as an associate clinical professor in Tufts University School of Medicine’s Department of Psychiatry, I was stimulated by the challenge of establishing a community-based mental health service (Morrison, Shore, & Grobman, 1973), organizing and running a psychiatric clinic in a municipal court, and developing and supervising the extensive clinical work in a group psychotherapy training program (Grobman, 1978, 1980, 1981). Later, as a senior staff psychiatrist at Lenox Hill Hospital, I had the opportunity to learn about and treat patients whose depression and anxiety were caused by cardiac surgery (Collins & Grobman, 1983). In addition to these activities, I have always maintained a private practice. It has been in this setting that I have encountered the 15 exceptionally gifted adolescents and young adults who are the subjects of this paper. Writing about the clinical problems I encountered and the patients I treated has always served several purposes. It helped me organize my thinking, helped me learn what others thought in the fields of community psychiatry, group psychotherapy, and consultation/liaison psychiatry, and it allowed me to share ideas I considered to be useful. This paper, about the psychodynamics of underachievement and self-destructive behavior in exceptionally gifted adolescents and young adults, is written in the same spirit. This report is not based on a research study. As with my other publications, it is a report of my accumulated clinical experience. These young people had unique sets of exceptional gifts and unique ways of expressing them. Yet, when they explored their developmental histories and motivations for underachievement and self-destructive behavior, several patterns emerged. My hope is that this description and analysis of the difficulties these young people encountered will add an important dimension to the general description of what we know about gifted underachievement. As Coleman and Cross (2000) stated: