People tend to think of anxiety as a mental illness, wrapping it up with depression as if it is the same thing. It is true that depression often does accompany anxiety – when you are in pain (and anxiety can be very painful indeed) the future can look very bleak, but I don’t think that they necessarily accompany each other and it is best to separate them out when thinking about what to do about them. Depression is about low mood. Anxiety is always fundamentally a feeling of being unsafe. I have yet to come across a patient who describes their anxiety as being anything other than just that: feeling unsafe.
I want to say that anxiety, which can be terribly painful, comes in more than one form. Sometimes it is specific, by which I mean that it attaches to particular thoughts. I might feel anxious, for instance, about getting ill or about professional failure. Sexual jealousy, I would suggest, can be associated with anxiety that one may be left. Social anxiety, which can be crippling, can be related to a feeling that you will be looked down upon. On the other hand, anxiety can be more generalized: it just descends as a feeling of shakiness or unease without having a particular focus. Whatever the case, it is always, consciously or unconsciously, about feeling unsafe.
My first point is that I do not think that anxiety is essentially a mental illness. At bottom, we are all anxious. Indeed, we are born anxious. As babies we are born screaming, looking for food and for safety from someone (we call this attachment). At first that someone is usually our mother, and she offers us her breast or a bottle, as much for emotional comfort as for food. The mother who is doing it right is soothing us; and she and our other attachment figures go on to do that through our childhood, through holding us, feeding us, rocking us, singing to us, attuning with us, being with us. Psychotherapy has tended to think, and this is now being borne out by neuroscience, that our ability to be soothed is learned from our attachment figures; learned because ultimately we internalize the ability to soothe ourselves through appreciating that the world is a safe place and space.
But this learning how to soothe ourselves does not always go as well as it ought to. Possibly our attachment figures have been more anxious or unhappy or preoccupied than they ought to be, and they haven’t been able to show us what to do. This is not a matter of blaming them – perhaps they themselves never learned how to soothe themselves, or something bad has happened meanwhile. Plus our ability to soothe ourselves can be rocked by later events: trouble at home; problems at school, then work; bereavement; divorce; physical trauma through illness or accident.
So often we have to engage with finding ways to soothe ourselves which are not so automatic and some of us do it better than others. The less creative of us use drink and recreational drugs to lessen anxiety – I call them uncreative because the short-term relief they provide is well counteracted by the long-term worsening of symptoms. Psychiatric drugs, which we call anxiolytics, can be useful in the short term, though they have the same addictive qualities as their less-legal counterparts. On the other hand, distraction can be helpful, as can getting more sleep. The chronically anxious benefit a lot from building exercise into their lifestyle – exercise releases feel-good chemicals into the brain and relieves muscle tension which builds up through anxiety and makes things much worse.
Of course the options which I can offer are psychotherapy and counselling. Talking through anxieties can help a lot, partly because you can learn that anxious thoughts are only thoughts and that you can have the thoughts without allowing them to have you; and partly because if you can explore your anxieties in a safe place you may be able to get your mind to accept that you are not unsafe and that the world is not out to get you.