When I was 5 years old, I was terrified of admitting that I couldn’t finish the gelatinous beef stew we summer program kids had been given for lunch. So much so that I smuggled my little paper boat of brown glop into the bathroom and hid it behind some rolls of paper towels. When the teacher discovered it, she furiously demanded that the culprit come forward or there would be no play time. I felt horrible, but there was no way I could raise my hand. I sat there, heart pounding, staring at the chipped formica desktop. I also peed myself. There was no play time, and I had to go change. This is one of my earliest memories of what I now know as Anxiety Disorder.
At 8, I listened to the stories my Catholic school teachers told of the saints who mortified their flesh with thorns in order to share in the suffering of Christ. The other children in the class drew doodles or passed notes – religion was the most boring class – but I absorbed every graphic word. At night, I was tormented with visions of bloodied backs and barbed wire, and when I dreamed, I saw my soul, white and diaphanous, round as a Communion wafer. I watched as black, fleshy slugs ate holes in it. When I awoke, screaming, my parents comforted me. The slugs disappeared when I opened my eyes, but I continued to have the dream for most of elementary school.
At 14, I learned to cry silently in bathroom stalls before school and between classes. I wasn’t sad. I just couldn’t control the crying. Usually, I could feel it coming and would make it to a stall in time. I carried wads of Kleenex and a little vial of Visine for my red eyes. I also planned my wardrobe around blouses that would not show excessive perspiration. I never knew when my sweat glands would activate like a faulty sprinkler system, even in an air-conditioned building.
At 19, a boy broke my heart. I grieved in the normal way. But then, I slipped into a gray despair so thick that I couldn’t find my way out of it and into a classroom. It lasted for months. I got dressed every morning, packed my books up for college, and then ended up at the beach, staring at the waves for hours. I nearly flunked out that semester, and I didn’t care.
At 25, I was a newlywed living in the big, bright metropolis of Tokyo. Every day, after my husband left for work in his crisp suits and polished shoes, I crawled back into bed. I would wake in time to shower and fix my hair before he returned. I pretended I had spent the day exploring shops and studying kanji.
At 30, I was officially diagnosed with clinical depression. Ten years after that, I was diagnosed with Generalized Anxiety Disorder. The puzzle pieces of my life had been shaken into place. For nearly 40 years, I believed that my struggles were the result of a weak and flawed character, of my own personal failings. I do, of course, have many personal failings, but learning that anxiety and depression were legitimate psychological conditions was a profound relief.
Still, it is hard to undo years of programming, even with diligent therapy. Recently, a friend shared an article pithily titled “Your Anxiety Isn’t An Excuse To Be An Asshole” by Chelsea Fagan. My body reacted as any anxiety sufferer’s does, by producing copious amounts of cortisol and adrenaline. It was as though someone had traveled back into the time vault of my adolescent mind and plucked out the worst fears that festered in its dank corners, “Your anxiety is not an excuse to be an asshole. It’s not an excuse to not follow through on things, or be caring, or be dependable. If you break the social contract and decide to be the full asshole your anxiety-riddled self wants to be, fine. But you don’t deserve close friends, because no one deserves that. No one has to put up with your bullshit, and if you don’t actively work on making yourself a better and more rewarding person to be around, no one should wait around for you.” If you do not get over your anxiety, you will be alone and unloved, and this is what you deserve. Lord, I am not worthy.
For a few moments, I was catapulted back into that bathroom stall. You are broken. You are weird. You are pathetic. My pulse roared in my ears. As I’ve learned to do when this happens, I began breathing, slow and deep. In therapy, one of the techniques they teach you to use when an anxiety attack occurs is to challenge the troubling thoughts.
So, let’s begin with the facts.
Anxiety disorders, as opposed to plain old anxiety, which is the body’s normal reaction to stress, affect 18% of adults in the United States in any given 12 month period. Think of ten of your friends. Two of them are probably experiencing some form of anxiety. Maybe you are one of the two.
Over the course of their lifetime, 22.8% of adults in the U.S. will experience an anxiety disorder. 4.1% of them are experiencing severe anxiety. Women are 60% more likely than men to have an anxiety disorder and the average onset age for anxiety is 11.1 Think about that. 11 years old. Imagine being 11 years old and not understanding why your body reacts to certain stimuli as though it is being pursued by a knife-wielding lunatic. Imagine not being able to control these reactions.
Sometimes, as in my case, you experience anxiety at a much younger age. I have a beautiful little niece who was diagnosed with social anxiety at the age of 3. On a recent visit to Hawaii, my sister brought her to the airport to greet us. I ached to swoop that baby girl into my arms, but I knew better. She regarded us solemnly, and then she pulled out a pair of plastic sunglasses and put them on. Seeing that, I ached with recognition, because I knew what she was doing. I still do that myself. Those sunglasses were her way of shielding herself from strangers, of making herself feel safe. I was so grateful that, because of her diagnosis, we could understand her behaviors, and they weren’t written off as mere shyness, as mine were. Instead of viewing her reticence as a barrier to overcome, we knew to treat it as a boundary to be respected. I recalled this moment as I read Fagan’s article. The thought of someone, anyone, labeling my niece’s behavior as self-indulgent or assholish made me growl. I wanted to take those words in my teeth and in my fingernails. Anxiety is not a choice. A 3 year old does not choose to move through the world in fear, with only her mother’s hand and a pair of sunglasses to protect her.
More fun facts: there are different kinds of anxiety.
There is Generalized Anxiety Disorder, characterized by pervasive and persistent anxious thoughts that the sufferer cannot dispel even when he or she realizes that they do not make sense. It can run in families and environmental stress factors can also play a role in it. Maybe you’re born with a predisposition, maybe you acquire it. Research is ongoing. It often manifests in the early teens. Symptoms include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, tremors, sweating, nausea, lightheadedness, frequent urination, and hot flashes.2 Glamorous, no?
With Panic Disorder, the sufferer experiences sudden attacks of fear. During an attack you may experience a pounding heart, sweating, difficulty breathing, weakness, dizziness, hot flashes or chills, tingling, numbness, and chest or stomach pain. It usually peaks within 10 minutes, and then it passes. An attack doesn’t necessarily mean you have panic disorder – sometimes that’s all it is, an attack. 6 million Americans do suffer from Panic Disorder, and it appears that the propensity is inherited. (Again, not a CHOICE.) If untreated, PD can lead to agoraphobia and it is often accompanied by depression, drug abuse and alcoholism.3
Then, there’s Social Anxiety Disorder. From the National Institute of Mental Health:
“People with social phobia tend to:
- Be very anxious about being with other people and have a hard time talking to them, even though they wish they could
- Be very self-conscious in front of other people and feel embarrassed
- Be very afraid that other people will judge them
- Worry for days or weeks before an event where other people will be
- Stay away from places where there are other people
- Have a hard time making friends and keeping friends
- Blush, sweat, or tremble around other people
- Feel nauseous or sick to their stomach when with other people.”
Other anxiety-related disorders include phobias, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Major Depressive Disorder, and Persistent Depressive Disorder (PDD).4
Not only are Anxiety Disorders more common than you may have realized, but research shows that they actually change your brain and body. In other words, it isn’t just all in your head.
When you experience anxiety, cortisol levels rise. Cortisol, the stress hormone, tells your body to release stores of energy, usually by raising the levels of glucose in your blood. It can also diminish immune function. And here’s an interesting tidbit: cortisol levels also rise when you are shamed.
When you experience shame (say, maybe because some jerk on the internet thinks you’re an asshole for having anxiety), your cytokines increase. Cytokines are molecules your immune cells use to communicate with other cells in your body. They promote cell growth and inhibit viral reproduction. They also control your cells’ inflammatory response – inflammation is how tissue responds to infection.5 Basically, anxiety and shame change your body on a molecular level. Shaming can actually be physically harmful.
In her completely unsubstantiated rant (other than the bona fides she gives of having herself been diagnosed with GAD) Fagan laments the glorification of “Introvert Culture” and the glamorization of anxiety. She refers to Tumblr as one of the most egregious offenders – a place where “coddled youth” are encouraged to think of themselves as “Special Anxiety Snowflakes” and use their condition as an excuse to evade personal and social responsibilities. I’m ignoring the introvert part, because that’s just a personality type. It’s not a disorder, and it’s not even necessarily related to anxiety. Many extroverts and ambiverts have anxiety disorders.
I went to Tumblr to investigate. I typed in #depression in the search bar, and this is what came up.
I got the same result for #anxiety. My conclusion is that the Tumblr search algorithm has more compassion and sense than Ms. Fagan.
She also asserts that the positive self-talk memes that proliferate on social media and various sites (Sweatpants & Coffee is one of them) are useless and enabling. She says, “Do you know where someone would be if they practiced this terrible, indulgent advice? Jobless, friendless, and very possibly homeless.”
The good news is that this is incorrect. As it turns out, self-talk can actually alter not only your behavior, but possibly your perception of yourself. What you say is what you end up believing. Numerous studies have shown that positive self-talk and visualization improves the performance of athletes.6 The neural pathways you use when performing an action are the same pathways you use when envisioning an action. You can change your own brain with the right kind of self-talk! Stuart Smalley was onto something.
If you have anxiety or depression, or if you think you might, there is hope. You are not an asshole, and only an asshole would try to make you feel that way.
First, talk to someone. Preferably your doctor, but you can start with a friend if that’s easier. You can visit websites like 7 Cups of Tea or To Write Love On Her Arms or Hopeline. Next, make an appointment to see your primary care provider who can evaluate you and recommend the next steps. These may include Cognitive Behavioral Therapy, medication and life-style changes regarding exercise and diet. I’ve had quite a bit of success with a combination of all three, and though I am not free of anxiety and depression, I manage these conditions, much the way any other chronic condition must be managed. Above all, do not let yourself be shamed into silence. I know this is a really hard one.
Fluffy self-help memes and open talk about anxiety may be irritating to people like Ms. Fagan, but the truth is, I don’t give a shit. Shame leads to silence, and silence can kill. So, I’ll keep talking and writing, even though my hands may shake at the keyboard. I hope you will, too.
5 Dickerson, S. S., Gruenewald, T. L. and Kemeny, M. E. (2004), When the Social Self Is Threatened: Shame, Physiology, and Health. Journal of Personality, 72: 1191–1216. doi:10.1111/j.1467-6494.2004.00295.x
6 Zourbanos, Nikos, et al. “The social side of self-talk: Relationships between perceptions of support received from the coach and athletes’ self-talk.” Psychology of Sport and Exercise 12.4 (2011): 407-414.