Anxiety Disorders

Fear is the normal human response to imminent danger. It is an adaptive response, in that it is helpful to survival, and it occurs in almost all animal species. When our cave-dwelling ancestors were attacked by mountain lions, they probably experienced acute fear. This fear gave them an extra burst of energy to flee the danger, or, if flight were impossible, to turn and fight.

Today in most parts of the world, there is little danger of attack from wild animals. As areas develop economically and culturally, these kinds of acute dangers are systematically eliminated or at least drastically reduced. Close encounters with tornadoes, hurricanes, rattlesnakes, car accidents, etc., can still arouse full-blown fear responses, but most people in developed countries can go months – even years – without experiencing these kinds of situations.

Anxiety, however, is a different matter. Anxiety is essentially a fear response that doesn’t quite take off. It is a constant feature of modern life. Just as industrial and commercial development entailed the systematic reduction of acute dangers, it involved an equally systematic increase in situations that provoke anxiety. Indeed, it could be argued that the production and maintenance of anxiety is an integral component of modern marketing.

The purpose of commercials is to generate within people feelings of insecurity and concern. The range of worries that are exploited in this way is limited only by the imaginations of the marketers. From all quarters we are bombarded with anxiety-producing messages, such as: you are not attractive; your television set is too small; your car is too old; your clothes are out of style; your hair is too gray (or oily, or dry); your libido is inadequate; your kitchen is outdated; your breasts are too small (female); your penis is too small (male); your computer is too old; your house needs to be painted; you have too little hair on your head; you have too much hair every where else, etc., etc… The purpose of these messages is to generate within us feelings of anxiety and insecurity so that we will buy more stuff. Of course the “fix” is only temporary, and the process continues pretty much from cradle to grave.

It is not being suggested that the marketers invented anxiety. Our ancestors in the caves probably experienced concern and anxiety if they heard unusual noises from outside the cave at night. This kind of anxiety is useful in that it increases vigilance and prepares the organism for a rapid response should this become necessary. In modern life there are many situations in which a certain amount of anxiety is appropriate and adaptive. On the highway, for instance, a sudden increase in the traffic density usually elicits a measure of anxiety. This anxiety sharpens our attention and helps us avoid mishaps. Similarly, most people will experience some anxiety if caught out in a severe storm, especially in tornado country. These are natural stressors and the anxiety they provoke is appropriate and helpful.

In addition, people who have had unpleasant experiences will likely feel some anxiety if exposed to similar circumstances later in life, and, in fact, will generally go to considerable pains to avoid such circumstances. People, for instance, who were teased and taunted during childhood will often in later life avoid situations where they might be exposed to criticism or ridicule.

What the marketers have done, however, is they have taken this natural adaptive mechanism and exploited it endlessly for their own gain and to the detriment of the public. In this they have been extraordinarily successful, so that at present we experience worry and anxiety – not only with regards to genuine concerns – but also with regards to an enormous range of matters which are truly trivial and inconsequential. What used to be the land of the free and the home of the brave has degenerated into a nation of worriers and fretters. But the fundamental point is that anxiety, in and of itself, is normal – it is an integral part of our normal day-to-day existence, and serves a useful purpose. What the American Psychiatric Association and the pharmaceutical companies have done, however, is redefine anxiety as a pathology – an illness – that needs to be treated by taking pills.

The DSM lists the following anxiety disorders:

Panic disorder without agoraphobia
Panic disorder with agoraphobia
Agoraphobia with out panic disorder
Specific phobia
Social phobia
Obsessive compulsive disorder
Posttraumatic stress disorder
Acute stress disorder
Generalized anxiety disorder
Anxiety disorder due to a general medical condition
Substance induced anxiety disorder
Separation anxiety disorder
Sexual aversion disorder

And of course,

Anxiety disorder not otherwise specified (n.o.s.)

The list is self-explanatory and is designed to cover as wide a range of anxiety-provoking situations as possible. The inclusion of the n.o.s. diagnosis at the end of the list ensures that anyone experiencing anxiety or worry concerning any matter whatsoever can be assigned a diagnosis and can enter the ranks of the “mentally ill.” DSM specifies that for a diagnosis to be made, the anxiety has to “interfere with the person’s functioning” or “cause marked distress”. In practice, these qualifiers are sufficiently vague that virtually anyone can be given an anxiety diagnosis. People who go to counselors for help with stress or life choices are often assigned a diagnosis of Generalized Anxiety Disorder. They are “enrolled” in the ranks of the mentally ill, and their numbers swell the already inflated statistics quoted in the first post (Proliferation of Mental Disorders)

Consider, for instance, a person who for several years has succumbed to the Madison Avenue hype. This individual has bought a new house, a big car, an entertainment center, membership at an expensive country club, etc. Although apparently wealthy, he actually has no money in the bank and is completely dependent on his paycheck to remain solvent. He now receives information that his company is considering lay-offs, and he fears that his name may be on the list. Meanwhile, he discovers that his sixteen-year-old son is doing drugs, his fourteen-year-old daughter is sexually active, and his wife has been “seeing” someone else. Understandably, he is becoming somewhat anxious. In fact, he is beside himself with worry. He’s not sleeping well. He’s gone off his food, and he’s beginning to make serious mistakes in his work. He doesn’t actually see much of his family, but when he does, he finds himself being increasingly irritable and grouchy.

Although this is a purely hypothetical case, there are a great number of people in our society who are living variations of this kind of scenario – sometimes for years on end. Their lives have become untenable, and their anxiety and worry are entirely appropriate. Things are out of control. They need to be worried, and they need to be taking corrective action.

If our hypothetical worrier goes to a mental health practitioner, however, he will be given a diagnosis of Generalized Anxiety Disorder (an invented illness) and a prescription for anti-anxiety pills. He is given the false and destructive message that the problem is simply an illness – a chemical imbalance – and that taking the pills will correct the imbalance in the same way that insulin injections enable a diabetic to function normally. The notion that his life is out of control and that certain fundamental changes need to be made is seldom even addressed.

For an excellent account of how a drug manufacturer promoted generalized anxiety disorder to market a new drug, see Brendan Koerner’s article “Disorders Made to Order” in the July/August 2002 issue of Mother Jones.

The APA’s criteria for a diagnosis of Generalized Anxiety Disorder are listed below:

A. Excessive anxiety and worry (apprehensive expectations), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children

(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of [another mental disorder]

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance…. or a general medical condition ….or [another mental disorder].

The reader will readily appreciate that our hypothetical worrier described above, and the millions more in the same boat, are easily embraced within the above criteria. If this individual goes to a mental health center, he will be given a “diagnosis” and a prescription for an anxiolytic. The chances are slim that he will receive any counseling with regards to stress reduction, relationships, or lifestyle. The essential message he receives is that his life and his habits are fine, but that he has a “chemical imbalance” in his brain that is causing him to feel upset and worried, and that the pills will take care of it.

In this context, it is important to remember that the vast majority of mental health diagnosing is based on the uncorroborated self-reports of the patient. If you tell a psychiatrist that you are very tense and anxious and that you can’t sleep, can’t focus on your work, and are irritable with your family – and if you make it sound convincing – you will be given a diagnosis of Generalized Anxiety Disorder and a prescription for an anxiety-reducing drug.

The APA and the pharmaceutical companies have jointly developed this spurious system in which all human problems, including normal reactions to stress, are declared mental illnesses which need to be “treated” with drugs. These tactics are focussed on people of all ages and all walks of life. Notice in the criteria for generalized anxiety disorder cited above, how much easier it is to assign this diagnosis to a child (one item instead of three).

Next Post: Posttraumatic Stress Disorder

  • John

    Hi Phil,

    I agree with your post for the most part but I had one question for you. How would you explain the more irrational type of phobias that people have? Let’s say something like the fear of elevators. I guess you could say that it is a fear of an enclosed space which can be evolutionarily rational in some circumstances. Regardless, what do you have to say about a fear that someone has no rational basis for?

    Thanks,
    John

  • John: Thanks for your question. As always, when dealing with human behavior there are multiple paths to any given point. I can think of at least two ways that people might develop the kind of irrational fears that you mention. The first stems from the almost universal practice in our culture of showering solicitous attention on a child who expresses a fear. Parental attention is a powerful secondary reinforcer, and behavior that elicits this kind of attention tends to be very strongly established. For instance, many years ago I knew a child who at an early age expressed a fear of tunnels. So whenever the family was driving through a tunnel, a great deal of fuss was made of Jane (not her real name). She was encouraged to get down on the floor, close her eyes, etc.. Her siblings would even sing songs to her to distract her from the terrors of the tunnel. She continued to emit this behavior well into adulthood and continued to receive solicitous attention in this regard – not only from family, but now also from adult friends. It’s tempting, of course, to say that she is not “really” afraid of tunnels, but this gets us into the thorny realm of definitions. She would certainly have met the DSM criteria for specific phobia.

    It’s also easy, in cases of this sort, to “bash” the parents and certainly there are more and less sensible ways of responding when our children express these kinds of fears and concerns.

    A second way that a person might acquire an irrational fear is through a process known as classical conditioning. The paradigm example of this was an experiment conducted by Watson and Rayner in 1920. It was known by then that a sudden loud noise elicited a natural fear response from newborn babies. In other words, they didn’t have to learn this fear, it was built in, so to speak, in the newborn’s physical apparatus. What Watson and Rayner did was they took an 11-month-old baby named Albert. They established that he did produce a fear response to a loud noise, but did not show any fear response when presented with a white rat. They then presented the rat followed immediately by a loud sudden noise. They did this seven times. By that stage, the rat – by itself – elicited a fear response from the child. In ordinary language, the child developed a fear of the rat because it had been paired with a “natural” fear response. We don’t know what became of little Albert, but it is conceivable that he remained fearful of white rats indefinitely. The point is that people do develop irrational fears through accidental associations with “genuinely” fearful objects.

    A third way that irrational fears can develop is through imitation or modeling. A good many people in our culture – especially females – express a fear of spiders. (I have actually heard Freudians say that it is a reaction against their fathers because both spiders and fathers have hairy legs!) My own position is that this particular fear is almost always modeled from the mother. The small baby encounters a spider and begins to approach curiously. Mother reacts strongly – “No, no” etc.. So the child develops a fear response towards the spider.

    Another aspect of this whole matter is the question of individual differences. Several years ago I was in St. Louis, Missouri and I took the little train ride to the top of the St. Louis Arch. St. Louis ArchThis is truly a technological wonder – over 600 feet high. From the observation windows at the top the view is spectacular. However, I could feel the structure swaying beneath my feet, and whilst I did not emit a full-blown fear response, I was definitely disconcerted and was happy to be back on terra firma. Other people in the arch at the time displayed no concern. Similar considerations apply to air travel, road traffic, etc.. Some people feel nervous, fearful, etc., others don’t. Undoubtedly there are genetic differences in native fearfulness, but most of the variability derives from our experience. If, for instance, I got a job as a guide on the St. Louis Arch, I would become desensitized to the movement and it would cease to be a source of concern for me. The reality, however, is that most of us shun the sources of our fear, and so the opportunities for desensitization are denied. In this way fears acquired in childhood can remain strong throughout life.

    An additional factor in this area is the movies. Movies need a good story line, and they often show scenarios such as elevators falling, bridges collapsing, etc., to heighten the suspense value of the film. These stories then enter our collective consciousness and reinforce the normal anxieties and concerns that have developed in us over the years. In Victorian England there was a great deal of fear of premature burial. Various devices (bells, etc.) were patented and marketed to enable a revitalized “corpse” to signal his plight, and sitters were hired to stay by the grave for a number of weeks after burial to respond to the buried person’s signals. Today a morbid preoccupation with matters of this sort would undoubtedly qualify one for a DSM diagnosis.

    The central theme of this blog is that these various phenomena are not illnesses. They are manifestations of normal human life unfolding in all its complexity and beauty.

    Thanks for your comment and very insightful question. If I can be of further help, don’t hesitate to come back.

  • John

    Thank you for your detailed response.

  • Some interesting material here, particularly the concept of the development of fear ‘through imitation or modeling’. I had previously never considered this theory, but now that you point it out, it can be commonly observed in day to day life. There seems no reason other than imitation that many people possess a fear of snakes, or to quote your example, spiders. It’s fascinating to think that anxiety can be seen as a result of social conditioning. It would be interesting to analyse how fears differed in various cultures, and if indeed differences were discernable.

  • Marylyn

    This was an extraordinary read. Thank You!

  • Phil_Hickey

    Marilyn,

    Thanks for your comment.  The commercial exploitation of anxiety is one of the very sad features of twentieth century development.

  • Mike

    Hi,
    These articles are great! Keep up the good work. I know everything written here about Anxiety is true personally because I suffered from it for three and a half years after what one might call a “nervous breakdown” at work, where I thought I was going nuts because of the physical fear symptoms and the flashbacks to the first time I felt fear: smoking marijuana. Of course I avoided pot from then forward, but symptoms continued aggravatingly after my job got very tough and I became the subject of ridicule and felt the inevitable sense of dread about going to work. My performance suffered until I began to “feel” i was living in a dream. I had to quit work and tell everyone how I was suffering. Similar to your schizophrenia article, my complaints were encouraged and sympathized with by parents and friends, when they my symptoms probably would have been alleviated had somebody said, “hey, suck it up! it’s just a physical feeling.” No one did that and I feel into hell for years. Suffered from paranoia, depression, obsessions. I have come out of it with the help of a counselor, and with a lot of knowledge on the subject. It feels like a miracle to be writing this, but it took realizing all my negative habits and the fact that I was encouraging them by talking about them, paying attention to them, and not letting myself have fun. When I began to “have fun” which I consider my primary antidote, I was able to let go of the seriousness with which I regarded my symptoms. I learned a great many things from my terrible reactions to stress, and a big one was the realization that I was in denial: I was not letting myself enjoy life, was overly strict with myself and my beliefs. Perhaps one of the greatest gifts of the struggle was it forced me to find new hobbies. Since my “nervous disorder,” I have written two books, hundreds of poems, learned how to longboard, started dating regularly, found a succesful career with almost zero supervision, gone on road trips and many adventures. Though I had to get help from people, I consider it God’s work that got me out of it. It could have gone on longer and the people couldn’t have been there, nor the awareness of the right path.

  • Phil_Hickey

    Mike,

    Thanks for the encouraging words, and for the amazing story. I’m glad that things are going so well for you now. Many people in the
    situation you were in formerly get sucked into the psychiatric maw, and, frankly, never come out. It’s a downward spiral of reduced expectations, drug cocktails, and stupor.

    So congratulations on your achievements, and best wishes for
    the future.

  • Chris

    It’s nice that you think there’s no such thing as an anxiety disorder. It’d be nicer if you came to the real world where people can’t function because they’re so anxious for no good reason. If you haven’t experienced it yourself, you have no authority to dismiss it as being “normal”.

  • cledwyn bulbs

    I think one can locate the source of social anxiety within the crucible of childhood experience, where character and the very structure and functioning of the brain, are largely forged.

    Social anxiety, I would say, is like an experientially conditioned emotional reflex; for many children, their formative years are largely characterized by fear and anxiety, which over the years come to strengthen their roots in his mind, blossoming into almost crippling anxiety in adulthood.

    There is a lot of research out there looking at how behavioral and emotional habits are strengthened over time within the very structure of the brain, the more they are indulged in and experienced respectively, the brain creating sustaining networks, hence why a behavior once learned, or a response to a stimulus once conditioned, can be very difficult to overcome, although the situation is of course made much worse by the disempowering messages of psychiatrists

    Now to neuromaniacs with no understanding of the reciprocal relations between the human brain on the one hand, and human activity and engagement with the environment on the other, to such people this may sound absurd, but the facts are the brain bears the impress of experience.

    None of this should be construed as an endorsement of the provision of psychiatric services as primary “treatment” for people with severe anxiety; to say so would constitute a lapse in logic of equivalent proportions to saying that because cancer can cause psychological symptoms and can indirectly cause stress, primary treatment should be provided by psychologists (the brain may be involved here, but I don’t think it is at the root of these problems).

    By the way, I say much of the foregoing, as well as what is to come, with the authority vested in me by pretty much most of my thirty years dealing with anxiety and the great effort I have expended in trying to use my resources to understand the sources of my distress.

    As I learned from bitter personal experience, school is for many children a manufactory of long term distress, containing the seeds of much of the emotional suffering considered symptomatic of “mental illness”.

    For bullied children, the psychiatric ward is a logical progression from their career as victims at school, much as the army, the police, a life in business, or a life in sport, is a logical progression, for the bully, from their careers as victimizers at the same place.

    When these children leave school (having internalized the image their oppressors have of them, pupils and teachers), making their way through the emotional minefield of human society becomes too much, after the years of torment they have been subjected to in an environment that primes many people to be fearful of their fellow human beings, hardly surprising given that the average child is a merciless narcissist who views other people merely as means to ends, as instruments of his/her will to power, and the average teacher little better.

  • cledwyn bulbs

    Continuing my comment, it is hardly surprising that many people take up careers as psychiatric patients having spent their formative years surrounded by little nano-thugs, in whom the finer sentiments of which man is capable never stir.

    Also, one mustn’t lose sight of the role of the chaos and clamour of modern life, its topography and cadence, in generating anxiety.

    Problem is, people are too used to their own age to see it clearly; just as modern man is blind to the evil of his age, its politics, its customs, its institutions, its social arrangements, its values, its beliefs, because of the sense- and faculty-dulling effects of habit, likewise, he is blind to the sources of what ails him for the same reason; because he is too habituated to his own age.

    Couple this with the inculcation, by the social hegemony, of false consciousness in oppressed peoples, and it is no wonder psychiatric patients are blind to what ails them.

    Indeed, false consciousness is a concept that perfectly sums up the problem here.

    Psychiatric patients have been taught to identify with the worldview of their oppressors, a view that blinds them to the instruments of their oppression and the structural causes of their misery, which is why it is essential that critics do everything to inculcate, in its broadest sense, that critical consciousness Freire propounded in his work, so that socially disadvantaged people can fight back against oppression through critical engagement with the immediate and wider environment.

    This false consciousness is a recurring theme in the history of man’s oppression of his fellow man. The oppressed victim internalizes the image reflected back to him/her by her oppressors, largely obviating the need for the use of force.

    Oppression feeds upon false consciousness.

  • cledwyn bulbs

    Excellent discussion about advertising generating anxiety. Indeed, the mass audio-visual media is like an inexhaustible fount of misery, fear, paranoia, insecurity, and anxiety, emotions carefully nurtured and manipulated to sell whatever product is being sold, literal or metaphorical, be they ideas, laws, aggressive foreign interventions, or commercial products.

    The mass audio-visual media also meets the definition of a moral entrepreneur, exploiting people’s susceptibilities to “raise awareness” of so-called social evils.

  • cledwyn bulbs

    That should be “psychiatric patient”, not “psychiatric ward”.

  • cledwyn bulbs

    That should be “the role of the psychiatric patient”.

  • cledwyn bulbs

    All in the penultimate paragraph, that is.

  • Phil_Hickey

    Chris,

    Thanks for coming in. Are there any specific issues on the post that you would like to discuss? Please feel free to come back.

    Best wishes.