Updated: Apr 5, 2019
Pathological fear and its manifold causes.
I guess you could say I’ve always been anxious. I was definitely an ‘anxious child’ – the kind that cried every morning before nursery or school because separating from home and my Mum was just too terrifying a prospect for my little mind. I’d go away on school trips and disturb the fun by being that child who is overwhelmed with homesickness. Even sleeping over at friends’ houses I’d get this horrible feeling in my stomach like something terrible was going to happen. At infant school I’d have to go into the dinner-hall 15 minutes before everyone else because trying to get through my lunchbox surrounded by the noise and chaos of all those other children was just too much.
But when did this, me being a typical anxious child, become me, suffering from a mental illness?
I remember being on holiday, just away in the caravan, about 10 years old, and being in the supermarket feeling like I couldn’t breathe. I’d get so bloated from hyperventilating (gulping air) that I could barely move. My stomach would feel like a balloon full of lead. In my mind’s attempt to protect myself from the supposedly dangerous situation which was triggering so much anxiety I would glaze over and I’d find myself feeling the most terrifying sensations of detachment- like I was suddenly dreaming or watching the world from a TV screen. I now understand this bizarre sensation to be ‘dissociation’ or ‘depersonalisation’ – physical and emotional detachment instigated by the brain’s defence mechanisms in times of intense stress.
These kinds of feelings, physical and emotional, have occurred hundreds of times over the last 15 years, triggered by various things: being away from home; eating out in restaurants; being in busy, crowded places that I can’t easily get out of (London, theatres, tubes, shops, clubs); along with the stress of secondary school and sixth form in general, to name but a few…
I was finally officially diagnosed with Generalised Anxiety Disorder at the age of 20 when my anxiety reached an unbearable limit at university.
The concept of being 4 hours from home, having to cook for myself, attend busy lecture theatres, contribute in seminars, manage an increasingly heavy workload and face the pressures of maintaining a social life through drinking and clubbing, was simply too much. I felt trapped. My OCD was spiralling out of control because of the increased anxiety and my mood was slowly dropping.
Seeing a therapist whilst at uni a. confirmed and affirmed everything I had been feeling and thinking over the last 13 years, and b. helped me understand my unhelpful ways of thinking and rewire those thought patterns.
Something therapy hasn't solved, however, is what is causing me to live my life in this state of irrational, all-consuming anxiety.
"We dread we know not what, we fear we know not why..."
I’ve always been naturally curious about the causes of this pathological fear that we call anxiety. I became so interested in its causes, and in particular its sudden influx amongst people today, that I even managed to dedicate my English dissertation to it (hit me up if you fancy reading 8000 words on the manifestations of anxiety in the 1600s!)
Whereas in my dissertation I argued that religion played a significant role in both causing and quelling anxiety in the early modern period, its contribution to modern day anxiety is far less relevant. I therefore came to the conclusion within my dissertation that anxiety was a culturally bound phenomenon which appears to manifest itself transhistorically in any stressful, anxiety-provoking epoch. However, there are many other supposed causes of anxiety, separated by different disciplines, all of which I am open to consider.
1. Cognitive: Although Cognitive Behavioural Therapy (CBT) is the most widely used therapy in addressing anxiety disorders, this does not mean that there is a causal relationship with faulty cognitions being the most likely contributor of anxiety. The thinking behind CBT however, is that people with anxiety have become wired to instigate the biological fight-or-flight response by thinking catastrophically ("I'm going to be sick", "I'm going to have a heart attack", "I'm going to die") when a slight feeling of anxiety (whether that be a symptom or just a thought) is triggered. The symptoms created by the activation of the fight or flight response will then confirm the sensation of fear, creating even more anxiety. This creates a vicious and seemingly inescapable cycle.
CBT teaches you to sit with these feelings of panic, to learn they are harmless and that they will pass, in turn challenging the catastrophic misinterpretations and breaking the cycle- though rewriting these thought patterns is definitely not as easy as it sounds.
The existential approach has some very interesting things to say about anxiety (see my previous post for an outline of what existential therapy is). It suggests that as soon as we initiate an awareness of ourselves as a living being, we become simultaneously aware of our inherent vulnerability and thus of the possibility of death.
"Existential anxiety or Angst is that basic unease or malaise which people experience as soon as they are aware of themselves." (van Deurzen)
Ironically, it is said that it is the freedom of life, the endless choices and responsibility required, that causes anxiety. For those who have the courage to accept life as it is, c'est la vie, anxiety only strikes on occasions when their protective cocoon is temporarily pierced (the protective cocoon, as proposed by Giddens, is that which allows us to observe suffering and only be momentarily affected).
For others, like me, however, this nonchalant attitude is not so easily acquired. The existential approach puts forward the belief that anxiety is the attempt to control and protect an existence which could at any moment be annihilated by death. It therefore encourages people to face life squarely by "coming to terms with the risks of active living". Again, not so easily done.
In the early modern period it was believed that imbalanced bodily humours (bile, blood, phlegm and choler) resulted in mental afflictions and general abnormal behaviour. Turns out this theory was pretty inaccurate, but, funnily enough, ideas about mental health are now coming full circle as the focus of research is finally returning to the body, and in particular, the gut.
University of Cambridge Professor, Edward Bullmore, has recently written a book, The Inflamed Mind (*affiliate link to buy*), which outlines how mental illnesses may be rooted in the immune system as inflammatory proteins (Cytokines) in our bodies can directly change the way our brains work and thus the thoughts we have. According to Bullmore, causes of inflammation include high percentages of body fat, old age, increased risk of infection (during Winter) and stress. Obviously there is no avoiding the ageing process, and most of us don't have the luxury of popping over to Australia to avoid harsh winters, so until the necessary drugs are created to tackle this inflammation, the solution here lies in a healthy diet that involves prebiotics and practising mindfulness (e.g. meditation) to reduce stress.
4. Neurobiological: Neurological approaches suggest anxiety is caused by chemical imbalances in the brain. Low levels of serotonin can effect mood; an imbalance of norepinephrine alters the fight-or-flight response; an imbalance of dopamine can destabilise energy levels; and an imbalance of gamma-aminobutyric acids (GABA) can jeopardise the balance between feelings of calm vs feelings of agitation- hence why medication is so common for people suffering with anxiety; it restores the neurochemical equilibrium. There is also the genetic theory, in which it is said a person with anxiety is said to be 8x more likely to have a parent, sibling or child with anxiety. For a long time I've believed a chemical imbalance in my brain is the cause of my anxiety. Both this and the genetic theory are easy options which take away blame and responsibility. However, this brings a pretty demotivating outlook, as it makes a person believe anxiety is something they have no choice but to live with, with the symptoms quelled by constant medication, but the root cause never fixed.
5. Psychoanalytical/ psychodynamic:
In the psychodynamic approach Freud suggested that repressed childhood trauma may resurface later in life as anxiety. Other psychoanalysts, such as Winnicott, believed that deficiencies in a baby's relationship with their mother or their environment may lead to 'psychotic anxieties'. Similarly, Bowlby argued that early attachment issues leave a person vulnerable to 'personality disturbances' such as anxiety. In unearthing these issues and addressing them through psychodynamic talking therapy it is believed that the inner conflicts causing the anxiety can be resolved.
6. Socio-cultural: And of course, there are socio-cultural, environmental factors, and it is this which seems to be the greatest target of blame today, especially in regards to the ever-increasing rise in anxiety. With more and more people experiencing anxiety, it is easy to assume that such mental illnesses are cultural conditions of modernity; a culmination of the fast pace of modern life, technology, social media, long working hours and the cost of living. I'm not going to say the word, but socio-political disorder in general definitely doesn't help either. However, with the corresponding rise of awareness and gradual decrease in stigma, it could be argued that people are simply more readily, and even too readily, self-diagnosing, in the mere expectation of having mental ill health. Whatever the case, the solutions here are fairly obvious: mindfulness; meditation; exercise; escaping; stepping away from technology; getting enough sleep; creating balance; talking about how we are feeling.
Clearly anxiety is multi-dimensional, and perhaps the best way to look at it is holistically, with all the above causes, or contributory factors, in mind.
If any of you reading this have suffered with anxiety I'd love to know your opinion on its various causes and where you think your own anxiety has originated from.
Whatever your conclusion may be, what I have tried to outline throughout is that every cause has a solution, or at least a way in which you can manage it. In no world are you trapped by your anxiety; it is not inextinguishable; it does not have to control you, nor does it have to define you. It may take years, but with the right mindset and a little bit of courage, you can conquer anxiety.