“So you’re doing better then, all together?”
He paused, sitting there, round-bellied, balding, a half-grin on his ruddy face.
“Yeah, Doc, I guess so. But, you know, I don’t sleep, I’m not eating as much as I used to. I have this pain in my little finger here, and my shoulder is always hurting me. I feel dizzy a lot. I get tired. My stomach stays upset.”
“So, you have a lot of little physical things that worry you every day.”
“Doc, to be honest with you, I think I was born to worry.”
A mostly normal, adaptive response to variation in our daily routine. It is a a feeling that is always at minimum a little bit uncomfortable, at maximum debilitating and relentless.
Think about one of those times that you were facing something new. A date with a person you didn’t know. A difficult academic exam. A visit with the doctor when you were sick. You most likely felt a a little mild fear and trepidation, a heightened sense of awareness of your surroundings, and a weird “I think I may have to get up and run away” kind of vibe. You knew it was strange and not all together pleasant, but it was not going to keep you from going on the date (which you enjoyed), taking the test (which you passed because you had studied) , or having the checkup with the doctor (which was entirely normal).
Mild anxiety, adaptive and normal, helps us to focus on the task at hand. It helps us prepare for a challenge. it sharpens our senses, increases our cognitive processing power, makes us more alert, and gets us ready to make decisions. You’ve no doubt heard of the fight or flight response. Anxiety helps get us ready for making the decision necessary to take a stand, or it gets us ready to run like hell in the other direction.
Now, in medicine in general, and in psychiatry in particular, I see a lot of people who are anxious. I would argue that on many days, anxiety complaints outnumber depression symptoms by a wide margin. I know that medical problems can mimic anxiety disorders, and that I need to be vigilant for them. Thyroid problems (over or underactivity) may have a prominent anxiety component. Someone in the hospital who is extremely anxious and short of breath with chest pain may be having a pulmonary embolism or heart attack. Chronic obstructive pulmonary disease may lead to decreased oxygenation and physical difficulty with breathing, leading to anxiety. Substance abuse, especially abuse of things like cocaine, PCP, meth, and stimulants, will lead to extremes anxiety in some people. The hallmark of mental illnesses such as generalized anxiety, panic disorder, and general or specific phobias is subjective anxiety.
Debilitating, extreme, paralyzingly anxiety that might come from those problems listed above or many others is not normal. It is very uncomfortable, it makes you afraid, it keeps you from getting out of bed or leaving your house or talking to people. It causes you to abandon a full shopping cart of groceries in Wal Mart and to run, not walk, back to the safety of your car in the parking lot. Of the handful of folks I’ve seen in the past who were successful at killing themselves, two thirds of them did it primarily because they were so extremely anxious that they could not stand it any more. They saw suicide as their only viable option for peace and as a way out of insurmountable suffering.
Mild anxiety is normal, and even helpful.
Unfortunately, we have been conditioned in our modern world to think that any little ache or pain, any twinge, any mild, fleeting anxious moment, any night or two of disturbed sleep means that we are sick, that we are ill, that we have a mental illness or cancer or worse.
I spend a lot of time nowadays trying to convince people that what they need is not another prescription for Xanax, but the courage to stand up for themselves, vote their convictions as it were, and make good decisions without fear or guilt. I try to convince them that a night or two of tossing and turning and not sleeping well is not a sickness or sign of impending doom. An episode or two of decreased concentration or outright forgetfulness does not mean you automatically have Alzheimer’s disease and dementia.
It would be very nice if we all started to view mild anxiety as a tool in our toolkit of life. It is a marker, a signpost that lets us know how we’re doing, how far along a road we have come and what obstacles might be in our way up ahead. It primes us to act, to accomplish and to succeed.
We were not born to worry.
We were born to live.
Anxiety is one of those normal things that we must sometimes deal with along the way.