"A brief, outspoken introduction to the meaning and history of anxiety and neuroscientific advice for sufferers"--
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About the Author
Faith Harper, PhD, LPC-S, ACS, ACN is a bad-ass, funny lady with a PhD. She’s a licensed professional counselor, board supervisor, certified sexologist, and applied clinical nutritionist with a private practice and consulting/training business in San Antonio, TX. She has been an adjunct professor and a TEDx presenter, and proudly identifies as a woman of color and uppity, intersectional feminist. She is the author of several highly popular “five-minute therapy” zines on subjects such as anxiety, depression, and grief.
Read an Excerpt
WHAT IS ANXIETY?
Don't you just love dictionary definitions? Anxiety is ... the state of being anxious.
Well, no shit.
As a nerd is wont to do, I looked up the Latin root of the word "anxious." It's anxius, which comes from the word angere. Which means "to choke." Fucking word gets that right.
Interestingly enough, the word "anxiety" (and its definition of "being anxious") isn't one bit modern. In fact the word "anxious" was used MORE in the early 19th century than it has been in the early 21st.
You know what that means? Anxiety is a human condition that we have been grappling with for centuries. To be sure, modern living is stressful as hell. But modern life is not the source of human anxiety. Humanity in and of itself is an anxiety-provoking experience for so many people.
The psychologist Rollo May noticed this huge societal movement toward anxiety long before I did.
His work as an existential therapist in the middle part of the 20th century focused substantially on the problem of human anxiety. He didn't have Google algorithms to tell him the word popped up in the 19th century and has been a thing ever since. But he was a fucking brilliant scholar of philosophy, and he totally grokked from those readings what was going on.
A major philosophical shift in how humans viewed themselves started in the 19th century. This was a movement towards technical reason: the idea that our best decision-making occurs when we are detached from our emotional reactions. This was a new thing. In the 17th century, the big philosophical idea was one of rational reason: the belief that even though you have emotions, you should make rational decisions for your life and not let those emotions control you. Technical reason, on the other hand, suggests that emotions have no place in decision-making at all. Instead of honoring the existence of emotions, people came to believe we should repress them.
So as Rollo May oh so dryly noted in his book The Meaning of Anxiety, "In view of this psychological disunity, it is not surprising that anxiety should have emerged as an unavoidable problem in the nineteenth century."
So I mentioned above that May was an existentialist. This means he believed that reason is not the source of meaning. And that meaning-making in general cannot be universalized. Meaning is unique within each of us. He was a follower of Kierkegaard in believing that our true vocation in life is to be our unique selves. So it makes sense that when being our unique selves is denied to us on such a huge cultural level, anxiety occurs.
I think there is a lot of truth there. BUT. There is more to it than that.
The whole field of psychology is based on the worldviews of European and European-American men with significant educational privilege and at least some level of financial privilege.
Being an educated white guy is by no means a background that protects you from anxiety, but you may experience anxiety in a different way than most other people. If you are an academic or researcher, your background will also shape how you theorize what anxiety is and how to manage it.
Then, in the 1970s, there was a pretty huge shift in the theoretical work of mental and emotional health. Something we now call Relational Cultural Theory (RCT) started being written about and talked about by women in academia. Women like Jean Baker Miller and Carol Gilligan had different experiences of privilege and different ideas about what wellness would really entail for the rest of us. There were two main ideas in their work that were hella fucking radical at the time, but make nothing but intuitive sense 50 years later. They are:
1) Human beings are hardwired to connect. We get better in healthy relationships and crave interdependence, not independence. But our general ideas about mental health are still focused generally on being independent rather than relating with others to support our wellness.
2) We are the products of all sorts of fuckedupedness. If your world is disrupted on a regular basis because of who you are, what you look like, and where you live, you lack privilege in those areas. And lacking privilege makes you far more susceptible to mental health issues and less likely to receive appropriate treatment for them.
What they were pointing out was not only had our entire culture shifted to one in which the prevailing idea of emotions was that they are total bullshit and have no place in decision making, but that we've also had huge shifts in how people perceive the importance of relationships. And the gaps between groups with privilege and groups without have gotten larger.
Emotions matter. Privilege matters. Relationships matter. And we live in a time where all these things are HUGELY disrupted. Rollo May had been the first to glimpse that historical shift when looking at how philosophical thought was changing throughout time. Short answer: these disruptions have been happening at warp speed since the dawning of the Industrial Age. In the 19th century.
It's really fucking hard to tolerate uncertainty, disruption, and change in all aspects of one's life at once when you don't even know exactly who you are and who you are supposed to be.
And when SO much is going on, it's too big to fear. Fear is specific. It is outward in the fact of a threat. When you fear something you have the opportunity to move away from it.
Anxiety is different. With anxiety, you don't know what the fuck to do, because it's all internal. There is no specific threat.
Which is why the symptoms of anxiety cover so much ground. At its coolest setting, it can be the experience of unease. At medium heat, it's distress. At a full boil, it's straight up panic. And as those ancient Italians well knew, it's a hugely somatic experience. That is, it's something you feel in your body as much as something that controls your thoughts.
And it's the most uncomfortable feeling ever. Your body is intentionally making you feel off balance so you have to attend to it. There's a fancy term for that: Disequilibrium.
So here is our working definition: Anxiety is a state of full body disequilibrium at a level of intensity that demands immediate attention and corrective action on your part. It can be in the face of a real or perceived threat, either present or anticipated.
That right there is why anxiety is so hard to ignore. The whole point of the body producing that feeling is to demand your full attention like a naked, raging toddler running through the street in a snowstorm with a fist full of gummy bears in one hand and a bloody machete in the other.
Quite a visual right? Sure as hell not something you can readily disregard in the course of your day.
Anxiety demands every ounce of attention we have, no matter how inconvenient the time or unnecessary the anxiety actually was to begin with. If you have the kind of history that tells you to constantly be on guard, it's really easy for anxiety to be the default setting.
Anxiety Really Does Sound a Lot Like Stress
Yup, totally. And anxiety often comes from chronic stress. The big difference? Stress has external triggers. I know, I know, so does anxiety, but hang with me.
Stress can produce anxiety, but it can also produce a ton of other emotional responses (depression is probably the biggest). Anxiety is an internal response to stressors.
Think of it as a workflow process. If stress, then anxiety. Or any other number of uncomfortable emotional states. It all happens so fast it ends up mashed together in our brain. But there is definitely a cause and effect thing going on between the two.
A good book if you are interested in learning more about this is Why Zebras Don't Get Ulcers by Robert Sapolsky.
So Where Does this Anxiety Shit Come From?
Generally speaking, the human body works hard to maintain its chill point. So why is the body intentionally making you all bonkers-batshit with this anxiety thing? That makes as much sense as cheerfully banging your head into a brick wall, dunnit?
It all comes down to brain wiring.
Short version: We are wired to have strong emotional responses because those responses keep us alive. Feeling anxious is absolutely an important survival skill.
Longer version: If something triggers an anxiety response, your body gets flooded with norepinephrine and cortisol. Here's what those do: Norepinephrine is released through your central nervous system (Hah! Nervous!) in order to prepare your body (which includes your brain) for action. It increases your focus and attention as well as your blood flow, blood pressure, and heart rate.
Cortisol is the classic stress hormone. It increases blood sugar and suppresses the immune system. Many people with chronic stress also gain weight, specifically as "belly fat," due to the constant cortisol production. The important thing to know here is that when cortisol is released with its partner in crime, norepinephrine, it creates strong memory associations with certain moods, to create warning signals of what you should avoid in the future.
The interesting thing here about anxiety as a stress response? The good thing? Anxiety means the body is still fighting back. This is fundamentally different from depression, which is essentially a wired response of learned helplessness (this is Robert Sapolsky stuff again).
Anxiety symptoms are active coping skills in the face of threat. The problem is only when the brain has decided that most everything is a threat.CHAPTER 2
WHAT ANXIETY FEELS LIKE
Thoughts and Feelings Symptoms
* Excessive worry
* Rumination (hamster wheel thinking patterns)
* Irritability/anger (Weird, right? Anger is the culturally allowed emotion so we substitute that one a lot for what we are really feeling.
* Irrational fears/specific phobias
* Stage fright/social phobias
* Hyper self-awareness/self-consciousness
* Feelings of fear
* A sense of helplessness
* Obsessive behaviors, pickiness, perfectionism
* Compulsive behaviors
* Self doubt
* A sense that you are "losing it" or "going crazy"
Physical Body Symptoms*
* Trouble falling asleep or staying asleep
* Inability to rest
* Muscle tension
* Neck tension
* Chronic indigestion
* Stomach pain and/or nausea
* Racing heart
* Pulsing in the ear (feeling your heartbeat)
* Numbness or tingling in toes, feet, hands, or fingers
* Shortness of breath
* Chest pain
* Feeling hot and cold (feeling like having chills and fever without running a temperature)
* Shooting pains/feeling like you have had an electric shock
You are probably reading the physical body checklist and thinking ... this is the same list for everything from anxiety to Ebola. Which is why so many people end up in emergency rooms thinking they are having a heart attack when they are having an anxiety attack. It's ALSO the same reason many people have missed the fact that they were having a heart attack because they were also having an anxiety attack. In Mental Health First Aid training (mentalhealthfirstaid.org), we suggest that if you see someone with potential anxiety attack symptoms, you ask them if they know what is going on and has it happened before. If they say "no" then treat it like the potential emergency situation it may be and call 911.
Of course there are tons more symptoms. These are the more common ones and a complete list of all the things you may experience with anxiety would be an entire pamphlet of list-ness. You can find lots of great lists all over the interwebz, including ones that break down all the different categories of anxiety symptoms.
A lot of other things we do are adaptive to managing anxiety as well. Obsessive-Compulsive Disorder is totally an anxiety response. Cutting and other self-injury behavior may not stem from anxiety in all people, but it does for many. So many diagnoses out there stem from just a few core issues. Anxiety is totally one of them.
But yeah. Anxiety symptoms. There is a lot of nasty shit our bodies do to us to get our attention and make us correct course.
Any of those hit home? You probably aren't reading this if the answer to begin with was "Nah, I'm always chill."CHAPTER 3
DO I HAVE ANXIETY OR AM I JUST ANXIOUS SOMETIMES?
You ask the most awesome questions! Like any other mental health issue, the answer lies in whether or not anxiety is controlling your life, rather than being a legit way of your body telling you to get off your ass and do something.
Clinically speaking, if you say it's a problem, I will agree that it's a problem. You know you the best.
Some people want a more formal way of self-check. There are a lot of anxiety assessment scales out there. The one you see quite often is the OASIS (which stands for Overall Anxiety Severity and Impairment Scale). It's well backed up by research and it's free to use, since it was developed by the National Institutes of Health (NIH).
OASIS doesn't have a magic cut-off number (as in: below this you are fine, above this you are batshit anxious). But it can be a good starting point for opening a conversation with a treatment provider or even just to reflect on your experiences.
The OASIS questions ask for you to reflect on your experiences over the past week and rate them on a scale of 0-4, with 0 being no probs, 1 being infrequent, 2 being occasional, 3 being pretty frequent, and 4 being constant fucking companion, thanks for the reminder.
Yeah, I'm translating a bit there. You can see the entire scale with the exact wording online, download it and print it if you want. (http://tinyurl.com/jnubjvx)
The exact questions themselves are as follows:
* In the past week, how often have you felt anxious?
* In the past week, when you have felt anxious, how intense or severe was your anxiety?
* In the past week, how often did you avoid situations, places, objects, or activities because of anxiety or fear?
* In the past week, how much did your anxiety interfere with your ability to do the things you needed to do at work, at school, or at home?
* In the past week, how much has anxiety interfered with your social life and relationships?
Having a "holy shit that's me!" moment? You are so not alone. The Kim Foundation notes that about 40 million American adults ages 18 and older (18.1 percent of people) in a given year meet the criteria for an anxiety disorder and 75% of individuals with an anxiety disorder had their first episode before age 21.CHAPTER 4
DEALING WITH ANXIETY
Sometimes we know straight up what our triggers are gonna be.
We know a first date or a public speaking engagement or a meeting with our boss is going to send our anxiety through the roof. We know a road trip where we can't find a clean rest stop with a non-sketch bathroom is gonna cause a freak out (And why is there NOT an app for that??? The struggle is REAL).
But sometimes? Not a fucking clue. Like all other mental health issues, we may have a genetic predisposition to anxiety and/or it may be a product of the environment we grew up in or live in now. And that can make figuring out our specific triggers difficult.
A mood tracking diary (either an app or old school paper one) feels like a lot of work, but can really help with figuring out your triggers. You can use the super-simple template on the facing page. If you need help figuring out the exact right word to describe what's going on in your body, do an Internet image search for "feelings word wheel."
Any of the exercises in the next section can be used to help manage anxiety in the moment. Give your anxiety a goofy name or persona. Carry ice to hold as a reminder. Do some deep breathing exercises.
And then, when you aren't feeling anxious, you can work on longer-term self-training to rewire your brain.
Disrupting The Signal: Short-Term Anxiety Management
Even once you've figured out your triggers, anxiety isn't something you can willpower your way out of.
As you saw, we have the asshole twin chemical combo going on. So in the here-and-now moment of anxiety or a straight up panic attack, you gotta do something to metabolize out those chemicals. When anxiety hits, you have to fight it head on.
Here is some stuff to try:
1) Deep Breathing and Progressive Relaxation. Yeah, yeah. That shit is hard to fucking do when you are spun up. But it's important to at least try. Because the chemicals released during an anxiety or panic attack are designed to get your breathing ramped up and your heart racing. So it's going to add to the sense that you are going to have a heart attack or that you will stop breathing. Of course, that isn't going to happen. Try reminding your brain and body about that. Making a conscious effort to breathe and un-tense will slow the heart rate back down and help you get more oxygen flowing. It's a literal chemical counter-balance. Want detailed instructions for this? They're in the next chapter.
2) Name That Bastard. Give your anxiety an actual persona to inhabit. Name it after a heinous ex, a shitty grade school teacher, or Kim Jong-un. Create a whole character for your anxiety. Anxiety feels so nebulous that giving yourself someone to battle really helps. Then you can have convos with Donald Trump's Epic Hair Swirl (or whomever, but personally I think all panic attacks should be named after that hair) whenever it comes calling. You can focus on that entity the way you would an actual person that was threatening you in a real-world situation. You can negotiate, you can yell back, you can lock it in a box. Whatever works.(Continues…)
Excerpted from "This Is Your Brain On Anxiety"
Copyright © 2018 Dr. Faith Harper.
Excerpted by permission of Microcosm Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
What is Anxiety?,
What Anxiety Feels Like,
Do I Have Anxiety or Am I Just Anxious Sometimes?,
Dealing with Anxiety,
More Shit that Helps,
Living with Anxiety,
Being a Friend to Someone with Anxiety,
A Couple of the Books I Shouted-Out Herein,
Great Movies About Anxiety,