Monday, January 16, 2012

The Opinionater on The Age of Anxiety

Before I start, two things: 1) if you'd like to hear our interview with Dan Rodricks on WYPR today, go here.  2) If you've ever been forcibly certified to a psychiatric unit and you haven't taken our poll yet, please do so here.  And now for our next post:
Over on the New York Times "Opinionator," Daniel Smith has an article called ""It's Still the Age of Anxiety.  Or is it?"  Smith talks about W.H. Auden's Pulitzer Prize winning1948  poem, The Age of Anxiety, (it's boring, he tells us, as well as 'illusive, allegorical and at times surreal') and he tells us about his own anxiety.   Smith writes,

From a sufferer’s perspective, anxiety is always and absolutely personal. It is an experience: a coloration in the way one thinks, feels and acts. It is a petty monster able to work such humdrum tricks as paralyzing you over your salad, convincing you that a choice between blue cheese and vinaigrette is as dire as that between life and death. When you are on intimate terms with something so monumentally subjective, it is hard to think in terms of epochs.

And yet it is undeniable that ours is an age in which an enormous and growing number of people suffer from anxiety. According to the National Institute of Mental Health, anxiety disorders now affect 18 percent of the adult population of the United States, or about 40 million people. By comparison, mood disorders — depression and bipolar illness, primarily — affect 9.5 percent. That makes anxiety the most common psychiatric complaint by a wide margin, and one for which we are increasingly well-medicated. Last spring, the drug research firm IMS Health released its annual report on pharmaceutical use in the United States. The anti-anxiety drug alprazolam — better known by its brand name, Xanax — was the top psychiatric drug on the list, clocking in at 46.3 million prescriptions in 2010.

Just because our anxiety is heavily diagnosed and medicated, however, doesn’t mean that we are more anxious than our forebears. It might simply mean that we are better treated — that we are, as individuals and a culture, more cognizant of the mind’s tendency to spin out of control.

Smith concludes that it's not the world we live in, and that it's perhaps dangerous to make that assumption.  He notes, " If you start to believe that anxiety is a foregone conclusion — if you start to believe the hype about the times we live in — then you risk surrendering the battle before it’s begun."

What do you think?  Are we more anxious than we used to be?  And why is that?  Is it the world we live in--now or in 1948?  Or is it just our own personal psyches?   

Note, the graphic above is from a book by Andrea Tome. 


Sunny CA said...

I think anxiety is what is leftover when the fight-or-flight instinct kicks in and you neither fight nor flee. Our forebears were much more physically active. I think an intense exercise program could take the place of anti-anxiety medications for many people.

I do not think I am more anxious than folks were in 1948, though if the majority of us are, it may be because we live in a more complicated and uncertain time. In 1948, WWII had just ended and America was at the beginning of an economic boom, with most people working. Now jobs have gone overseas, seemingly forever. Being unemployed certainly could cause a bad case of anxiety.

We also have too much noise in our environment that we are supposed live with; over-crowding in places like mass transit, city streets and schools; plus many choices to make in a given day. We also are expected to do too much on the job and at home and the impossibility of the task can be anxiety provoking.

We also have less time with family and thus the calming effect of social connection is reduced in our time.

Because anti-anxiety meds are "feel-good" medications for a lot of people, I think it increases the number of people who want to take them. In other words, all those prescriptions may not be necessary. We could learn to take a walk or a jog, spend time with loved ones, spend time outdoors, restructure things that need to get done, and make fewer decisions.

Anonymous said...

I think the anxiety numbers are bloated, both due to doctors over-diagnosing and due to drug-seeking clients falsifying symptoms.

As a person with Social Anxiety Disorder (generalized), I find people who call their fear of giving a speech, without actually affecting their ability to give a speech, social anxiety disorder highly disrespectful. It's even more of a piss off when a box doctor diagnoses it as an anxiety disorder and throws Xanax at it. They're not even meeting the required criteria for the diagnosis, yet mister box doctor ticks the box anyway.

I'm not saying that the speech-giver isn't suffering some anxiety, but I do believe it's being blown out of proportion, clinicalized and medicated unnecessarily when all it really required is a little bit of learning and some reassuring self-talk. Meanwhile, those whose disorders are actually affecting them to such a degree that they are literally incapacitated end up having their concerns shrugged off by our highly confused population as "we all have some anxiety".

I'm a perfect candidate for Xanax, but I won't take it because I certainly don't need to add an addiction to my plate. Meanwhile anyone with enough smarts to spout a few criteria can get their hands on it, just falsify an anxiety disorder.

Yes, we all do have some anxiety. It's normal to feel anxious sometimes - I'd be quite concerned about the person who never experiences some anxiety from time to time. But I certainly do not believe the statistics accurately reflect the true prevalence of anxiety within the population. Are we more anxious? No, we're just more aware of it, due in part to drug companies bringing disorders into the spotlight with their commercial drug advertising. Now the population is worrying about worrying and there's these lovely pills you can take to fix it and your doctor is beyond happy to prescribe it if you just spew off these symptoms we tell you about that actually sound perfectly normal because we're also conveniently leaving out that they need to cause a good deal of dysfunction. $$$!

distress counts said...

Anon, actually according to the DSM a psych disorder must cause dysfunction OR distress. Distress alone will do.

I spent years struggling in high school because I was told that I "wasn't depressed" since I was getting straight A's. I had to wait for my bipolar to get bad enough to kill my confidence in myself as a student before I could get the proper diagnosis and treatment. While I am annoyed by people who call simple mood swings "bipolar", I am more pissed at the system that ignored the distress indication of the DSM and forced me to drown before they would save me.

Anonymous said...

"distress counts"

Intense anxiety or distress, disproportionate to the amount of anxiety or distress one normally feels in such circumstances. Nearly everyone gets the jitters before a speech, not everyone hyperventilates and vomits before getting up there, and most people do not go for nights without sleep because they're preoccupied with the fear of giving the speech. Yet frequently you will find people who claim they have social anxiety disorder whom are simply suffering a normal amount of anxiety about giving a speech and believe this normal occurrence is "social anxiety". These people go to their box doctors, whom totally overlook the necessity of impaired functioning and/or intense distress.

"The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia."

Feeling a little shaky while standing backstage: normal
Worrying about messing up: normal
Insomnia for days prior to a speech: not normal

The level of anxiety must cause some level of dysfunction, whether it be insomnia, being unable to complete work tasks, skipping events or calling in sick all the time, forgetting to pick up your children from school afterwards, spending the next week avoiding your boss because you're certain he'll fire you, etc.

I avoid speeches. When I'm forced to endure them I spend days prior crying continuously, experience shakiness on stage to such a degree that it can be heard in my voice, I sweat so much my hair dampens, I feel tight in the chest and find it difficult to breathe, I become light-headed and fear that I will faint, and I spend the following weeks (weeks!) worrying that I will be criticized for doing a poor job. Everyone praises me for doing well, but I know I did poorly. I can't imagine having to endure that again.

Joe Blow over there gets shaky legs before going on stage and worries that he'll make a mistake, while on stage his palms get a little sweaty, but afterwards realizes he did quite well and after a good night's sleep wakes up as if it were any other day. Joe Blow, however, doesn't like that feeling he gets before a speech and, thanks to all those commercials out there telling him anxiety is badbadbad, he deems this social anxiety.

Hopefully, if they leave the rejiggered duration requirement in the DSM 5, this will be taken care of. But that'll only happen if box doctors actually take these changes into account, which given they can't even determine the difference between normal anxiety and clinical anxiety I highly doubt will happen.

While your situation very clearly sucks, and your doctors were idiots, it doesn't mean doctors should start over-diagnosing and medicating the world "just in case". You're right, your doctor should have noticed that you were in distress, however in the case of anxiety either doctors are overlooking the requirement, or they're taking normal and acceptable levels of anxiety and turning them into scary monsters (or a mixture of both).

Anonymous said...

I agree with many of the comments that Sunny CA said - we have more responsibilities, more noise, more on our plate etc.

I have an anxiety disorder. It sucks, I hate it... on occasion I use xanax. It is comorbid with the bipolar.

I have found exercise and CBT to be effective in managing it.

Public speaking? not a problem/ Going to the grocery store and dealing with the people? - a huge problem... especially when there are time that the kids are hungry and there is no food in the house.

I think the anxiety affects people differently. Either way, it really, really sucks.

jesse said...

This is such an interesting subject! Dinah has a real gift for being able to ask simple questions which when addressed comprehensively amount to an analysis of western history for the last two hundred years. So, like the other posters (and I agree with all the comments above) I will just throw in a few random observations.

Anxiety is a word which was little used before psychoanalysis, which postulated that anxiety is used as an intra-psychic defense to keep us from becoming aware of conflicted thoughts and emotions. As psychoanalysis became popular, so did anxiety.

Now some question whether we have more anxiety than our forebears. Anxiety in this sense does not mean danger: we live in a world in which danger is vastly less than it was when cholera, plagues, childbirth, even a bad fall would cause death.

The pharmaceutical companies, and the psychiatric establishment itself, has defined illnesses in such a way that they translate readily into the use of this or that product. So while psychiatric symptoms of course can be severe, and treatment necessary, the inexactitude of terminology and nomenclature allows great latitude in diagnosis and treatment prescribed.

It is a rule of thumb that we diagnose readily what we know, and the incidence of every known ailment will increase accordingly. This is particularly true when a purported solution that is easy and cheap exists.

So as the pharmacologic solutions increased, the effort to be reflective, thoughtful, and examining of what might be underlying the anxiety decreased. A person who becomes anxious before a speech might reflect on what exactly has triggered that anxiety. Does he fear that not all will agree with him? Is he afraid that if one person whispers to another that would mean he has not impressed the audience as the genius he wishes to be? Is he paying so much attention to the audience that he loses track of that which he is saying? Is he a perfectionist who fears one mispronounced word reflects badly on him? Or is it related to severe shyness that he had since a child? A built-in protective mechanism to avoid perceived danger?

Anonymous said...

I think anxiety has always been around, but more people are coming forward for treatment.

Back in my grandparents, parents and even my early days, any kind of mental illness was not talked about and definitely stigmatized. "Looney" "crazy" "coocu" "Nutty" come to mind. Why would anyone experiencing symptoms of anxiety want to admit it to themselves much less seek treatment for it?
It took me quite some time to seek treatment. I knew something was wrong, but just didn't want to admit it. Didn't want to have a "mental illness". This would mean that I was somehow defective. I am in research science where it's all about the brain and how smart you are - can you imagine?
Someone else in my family who has obtained TWO high level degrees from two top ivy league schools had the same issue I did.
The difference here, is that we had the courage to admit to ourselves that something was not right and the fortitude to do something about it.
I really feel in our case, and in the case of many others, because in the slowly changing tides in how various mental illnesses are viewed, we are able to accept ourselves, anxiety and all and get help.