Anxiety - the common cold of mental health

In my training days not a lot was said about anxiety. Which is interesting because I now find it is the commonest of problems, and though not always a presenting problem (what you brought to therapy), exists as a sort of dark shadow background to everything we do.

What is anxiety? We therapists tend to keep the word 'fear' for real feelings in a real situation. If you were facing a tiger on the loose in your backyard, you would feel fear. We can take this pretty much for granted. Anxiety is more the sort of stuff which anticipates a fearful situation. It's a 'what if' kind of thing. What if the boiler breaks down while I am out of the house? What if my partner is having an affair? What if my airplane fails in mid-flight? These are common enough anxieties that most people suffer from, from time to time. They represent fear of the unknown and uncertain - what could be rather than what is certain. The painful truth of human life is that we have to live with uncertainty a great deal. And for some people this is a tall order.

An added complication is that anxiety is likely to be unrelated to the episode, expectation or person we feel it is mostly about. If you are feeling scared about the tiger, this is probably the result of having to face a tiger! It's pretty straightforward. Feeling anxious about the boiler may or may not be realistic, depending on the state of your boiler! If your boiler is functioning and has given no trouble up to now, it is likely that the anxiety has not much to do with the boiler. In that case, you need to look for deeper causes. Is there fundamental uncertainty in your life around your relationships, your job, your housing or employment situation, your financial problems, your future etc.? It is surprising how quickly these basic insecurities will issue forth in attacks of panic over apparently trivial happenings, like cutting your finger or forgetting to take your pills at night (OMG!)

This is genuine anxiety - it is a 'what if' kind of thing. Not taking your pills is unlikely to kill you for one night or even now and again. It may be a deeper problem than that, which you struggle with and don't find easy to face. It could be related to the pills but in a less obvious way. For example, you may be struggling with a fear like 'what if I die alone' which is a more difficult fear to articulate, but which has become attached to the pills. The mind works in a less than rational way. 'If I take my pills then I won't die at night on my own." When actually, the pills will not prevent this from happening. You need to face this as a real insecurity in your life and talk about it to someone who might be understanding. And as I've already suggested, there aren't always easy answers. But getting them out in the open is a help.  

To avoid realistic fears, we take reasonable precautions. We buy insurance against disasters, get our cars regularly serviced, avoid walking alone along dark canal paths after midnight and so on. One of the merits of good insurance is that it may allow you to stop worrying! Though some people have a huge mistrust of insurers, and this may be to do with our modern obsession with getting the cheapest possible bargain for everything, without regard for its quality. But even then, insurance only claims to deal with what has already happened. The fact is there is no way of ensuring that the washing machine will not break down two days before the wedding. There is a sod's law that all too often it does! 

This is where living with uncertainty comes in, and with it the ability to keep calm amid life's ups and downs. First of all, accept that a bit of trouble now and again is part of life. Some people seem to feel that there is a cosmic law which says that they are entitled never to have to face a crisis, a problem, an accident! And therefore, if a crisis occurs, it must be somebody else's fault. I'm afraid this is also a myth. You can spend forever struggling to find out who was to blame, when you might have done yourself a bigger favour by using what energy you had to cope, as well as you could, in all the circumstances, without driving yourself and everyone else nuts about something you cannot now change.

How do we learn to live with uncertainty, and therefore cope better when things turn out worse than we expect? I think it's something about having a solid basis in your existing mental health. Oh, great, you may be thinking!- and how do I achieve that? Well, choosing your parents well is a good start. Mentally healthy parents are likely to breed mentally healthy children. But many of us chose badly, to be candid. For this, you can take a long course of psychotherapy or counselling, to find out how it worked to your disadvantage and advantage. (Trust me - there are advantages in having a bad start in life!) It all helps. But above all, there are a few basic rules of good mental health, which everyone should know, and practising them is not a waste of time. They are beginning to percolate out from among our complicated culture and its often screwed up messages. Here are a few to think about:

1. Be aware of your deeper feelings as much as you can, since these are the foundation of good mental health - and assume that a trivial feeling of, say, anger, is likely to conceal a whole cartload. You were, you say, 'a bit upset' - because this is polite, isn't it? When the truth is you were furious! Get to the truth of it - don't keep avoiding. Try making a list or writing a diary of your current strongest feelings, and when one of them strikes you, you are less likely to avoid or repress it in favour of something that seems easier to cope with - i.e you will be less convinced that the pills are the root of the problem of your night fears.  Ask yourself what people or circumstances most often arouse this feeling, be it anger, sadness, shame, envy and so forth. Bear in mind that we can have two strong feelings at the same time. Yes, really. I told you we are not rational creatures! Those two (or more) feelings could be in direct conflict with each other. I love him but I hate him.This is what Freud called 'ambivalence'. Being in a state of conflict means you often feel frozen, passive, unable to act, and then get angry with yourself for being so, which is your way of holding yourself together. But it solves nothing in the long run.

2. Be willing to express your feelings, in words, when you can. Being aware of feeling angry is good, speaking anger is better, and speaking those words to the person or situation that is making you angry is better still. It isn't always possible, needless to say, but is often more possible than we want to admit. We have the advantage in our species of being able to use to words as a substitute for action. This is the function of the prefrontal cortex. It gives us the option of stopping and thinking. Speaking your anger does not make violence more likely - a common fear. Indeed, we do not have to fight so long as we can say, "I felt furious when you said/did that." Once said, it is out in the open, and can be discussed, maybe dealt with. Anything never said builds up inside like a corked bottle that is being perpetually shaken but never exploded! Until one day, the build-up is too great and emotion shoots all over the place! Don't wait until you are brim full of frustration, fear, sadness, anger. Say it sooner rather than later. If you deal with difficult feelings at the beginning, they are not going to build up into a megastorm later. 

3. The most common strategy employed by those who cannot express feelings is what I call the 'walk away' approach to life. This approach of course can be amply justified on all sorts of apparently rational grounds, like "I'm a good person, a peace-maker,' and "I didn't want to make anything worse than it already was,' and "Talking makes no difference, they just do it anyway.' Be clear that talking may make no difference to them but it makes a hell of a lot of difference to you. What you have done is exercised your own being, your sense of self, your entitlement to have a different point of view. This is the foundation of self-confidence. You will not learn to feel like a worthwhile, confident person, unless you are prepared to speak your mind, at least some of the time. And yes, there are times when it's not appropriate. I wouldn't say, "I wish you would piss off..." to somebody drunk and already in a rage! Here's where the mind comes in. Reason is not a waste of time - it's how you use it that makes it rational!

3.  Don't overdo the 'doing for others' as a way of feeling wanted, loved, secure. It doesn't tend to work, in my experience. The people you are doing for are basically getting away with not having to do it for themselves! It is good to allow others to learn how to do things for themselves! After all, you had to! Don't try too hard to take away other people's feelings, especially their painful ones. You are only encouraging them into bad emotional habits like repression. If they are upset, allow them that time and space to be upset. Being upset is normal and ok if something bad has happened. It passes. If someone is angry, allow them to express their anger, and prepare yourself to accept it - it's a bit like imagining yourself as a sponge, who can absorb it all and not be destroyed! If you are volunteering to be a sponge every day, however, when nothing has been done to deserve it, something is wrong. Get help with that one. Men often fear women's expressions of feelings because they believe they then have to fix the problem! So for problems they can't fix they go away - the garden shed is a testimony to male inability to deal with complaining partners. Please disabuse yourself - what is wanted most of the time is not a fix but a good listening ear.

4. The two most commonly feared and repressed feelings in our culture are anger and sadness. We don't like feeling either and will go a long way to cover them up. Anger is problematic since we fear being out of control, fear the damage to relationships, fear disgracing or shaming ourselves, fear provoking violence. Try to be aware, though, that mostly other people are less horrified than we think about our anger! Anger expressed does not destroy relationships - it helps to build them on a more solid foundation of truth. Sometimes it is the only way to bring about change. People who speak out their anger rarely get out of control - they have not got a backlog of resentments a mile high, and they don't need to offload it all in one go! N.B. (and this is important) If you fear being angry with someone violent, don't be with that person. Ask yourself whether it's time to move on?

Sadness is perpetually avoided for complex reasons, often to do with not wanting to appear like a wimp, to upset others, to look as though you cannot cope. Almost we fear it is impolite! The social equivalent of a fart, perhaps. All these 'reasons' are spurious - norml people expect us to be sad when we have a disappointment, a betrayal, or lose someone or something precious to us. The idea that we somehow have to grit our teeth and soldier on is medieval! We don't have to. When we are sad enough we cry, male and female together, and this is fine and normal behaviour. Why apologise for it? A disappointment is painful, a hurt feeling hurts! You are not a wimp for feeling this way. Quite the reverse. You are a strong, mentally healthy person who knows how she or he feels, and is not about to be talked or bullied out of it by fear of how other people will react. Their reaction is their problem - not yours!

5. Communicate, for God's sake!  Talk to the people around you - those close enough to be interested, as opposed to the woman opposite in the train who was just looked forward to a sleep! If someone asks how you are, tell them! Don't spend a fortnight explaining it, just tell the truth, simply, in plain words. "I'm a bit tired and fed up with this job." "I'm feeling the loss of my wife a lot. It feels lonely without her." And so forth. There is nothing wrong with saying this, and you are not asking for pity, simply telling it like it is. If the other person cannot cope, you will soon find out.

6.  Choose those you are going to be open with carefully. Some people can hear your admission of feeling, and simply be a good listener, which is mainly what you want. Others cannot listen, will use it as an opportunity to tell your their own troubles.  'So you're sad, well I'm far sadder!" etc. We aren't in a feelings competition! Both can be sad without diminishing either, but we need to be able to receive others' feelings as well as expressing our own. This is what it means to have a good relationship. 

All of these pointers may seem to you to have little to do with anxiety, but you are wrong. The 'what ifs' of life seem to diminish when you know who you are. The fact that your parents weren't models of relating no longer seems to matter. You can sometimes even stretch to a bit of compassion for their struggles. After all, they were only human, and probably suffered from worse anxiety than you!