The Anxiety Pandemic

The spectrum of anxiety, depression and PTSD

Anxiety is a common household term now.  It has become the pandemic of the 21st century, occurring in all developed nations at a rather uniform rate.  But if you push for a definition, you may get a lot of different answers. 

Most people would describe anxiety as being a heightened state of emotional tension, walking around with an impending sense of doom or excessive worry.  Some may describe the occurrence of panic attacks – the sudden onset of the above coupled with heart pounding, sweating, chest pain, shortness of breath, nausea.  People who experience panic attacks often report they will wake out of deep sleep this way, and believe they are having a heart attack, or inexplicably about to die.  Anxiety and panic can manifest in crying, anger or hysteria.  It can be the outward manifestation of post-traumatic stress disorder (PTSD) and/or be coupled with depression.  However, chronic anxiety can be more subtle and not recognized by the person who suffers it, nor by those around them.  Being careless, incessantly clumsy, poorly focused, unable to maintain relationships, jobs or accomplish goals (either starting or finishing them) can be the only  obvious symptoms of underlying crippling anxiety. 

How does chronic anxiety develop?

This is complicated.  Currently, we tend to blame the external world, modern society.  The hustle bustle, the pressure to be in multiple places at once, to have everything, and for everything you have to be new and shiny.  The  distinct pressure to be forever young and successful.

After years of working with patients, and having experienced my own descent into chronic anxiety, I think the sense of modern standards caving in on you is more of a distracting sensitivity,  a provocation, but not the true source.  In fact, the modern state of our culture is nothing less than the end product of a mass of people living within a climate of anxiety and depression.

It is not to say that engaging in daily manic multitasking does not generate anxiety, lead to indigestion, inability to sleep well and a lowered immune system.  It does!  But for the now generational  fall-out of paralyzing panic attacks, the explanation of modern living overload doesn’t really suffice.  And  if it did, what would be the appropriate solution?  To drop out, John Muir-style and live "the good life"?  Even living off-the-grid, in the woods 3 hours from any major city, I still don’t want to ignore that 2019 is happening.  It turns out, it's complicated. 

There are several aspects of being alive and making choices that culminate in our ability to live peacefully, or not. 

The first fact is that life is traumatic.  If you live long enough, something devastating will happen to you.  And you must deal with it.  Many traditional cultures around the world have understood this reality and evolved practices that help people work through their experiences.   This is what we need to foster in modern life, in modern psychiatry.  This requires community to create it and then teach and disseminate these supporting practices to heal the people.  I will get back to this at the end. 

Let’s look at the brain under the influence of stress or trauma.  Going forward I will simply use the term trauma to refer to both.

First we must understand the very basic neurologic effect of trauma and why its fallout is so prevalent in the human population.  When something life-threatening happens to us, we automatically engage the sympathetic autonomic nervous system.  This is the branch of your wiring that generates the fight-or-flight response – the tightening of muscles, dilation of blood vessels and pupils, the cessation of digestion and the increase of heart rate.  The command center for this reflex is the amygdala, the reptilian brain.  Now there is a third possibility in this engagement that is really not discussed : that is the freeze response.  We’ve all experienced this, its the deer-in-the-headlights condition.  When you have been so scared you couldn’t move, or even fainted!  We see this in animals, though you may never have recognized what was going on.  In the animal kingdom there is major daily trauma going on – the owl and the mouse, the snake and the frog, the wolf and the deer, the lion and the antelope etc.  When a lion nabs an antelope there is a moment where the antelope gives up, and enters into an almost trance like state - this is the initiation of the freeze response.  Humans have experienced this, usually in near-death moments.  There are countless stories of being assaulted, falling or colliding where there is almost a peace that settles in, a no-pain zone of acceptance of the impending end, or of simply being completely disassociated.  Sometimes, though, the antelope gets away.  Or the mouse, or deer.  Or you walk away from the car wreck.  In these moments of transition of the freeze state to the flee state there is a mechanism of release: the animal literally shakes it off.  My daughter and I observed this recently.  A hummingbird flew into the open portion of our house addition, and crashed into a window.  She was obviously stunned, and sat motionless on the floor.  My daughter’s reaction was to try to scoop up the tiny bird and hold her.  As was mine.  But instead we resisted, and watched.  After about 2 minutes, the bird began to tremble, a high frequency full body shaking.  This lasted 15 seconds perhaps.  She then took off like a rocket and perched with perfect grace in the locust tree outside. 

What we know about traumatic events and the people who live through them, is that there is a dividing line – the people who were able to mobilize and those that were not.  Animals, especially prey animals, live in a constant world of impending doom.  Most humans do not, (though unfortunately there are always some that do).  But considering most of us are going to our otherwise safe jobs, getting take out, and going out on the weekends with friends, why are we seemingly the ones living in emotional agony and not the antelope?  We don’t see antelope going off to cry behind rocks, the antelope does not have trouble getting out of bed in the morning, nor does he awaken in the middle of the night with unsubstantiated chest pain.   The answer is the lack of a release mechanism.  We don’t know how to “shake it off”.  I am not talking about getting up, brushing ourselves off and being told to suck it up.  That’s the exact pathway into anxiety, not out of it.  Consider this: we (the science and medical community) know that people who try to escape their assailant, or fight back, people who take the wheel and try to steer away, or simply who are able to scream “NO!” do much better in the long run than those that became paralyzed.  Not everyone is wired to do that, so not everyone can.  It is indeed the person who lies motionless, dissociates from their body and makes no attempt to flee or fight that mentally and emotionally continue to be incapacitated in the long run.  I will talk more about how we actually feed this traumatized circuit and create the response of chronic anxiety in a moment.  There is a little more to understand in the uniqueness of the higher functioning brain.

Having higher brain function allows for some unique mental abilities, like having  an imagination.  However, the higher function often clashes with the more primitive functions of the brain.  Specifically in humans, it appears to be the push and pull between the amygdala ( aka the reptilian brain, where our base urges and reflexes are generated) and the cerebrum, specifically the neocortex ( where the higher functions, reasoning, language and fine motor function like dancing and playing an instrument  and having abstract desires, lie).  This system is what makes us amazing and unique but it is not wired to function in perfection.  Sometimes the amygdala wins, but often times the neocortex takes over with its loud voice of reason.

For example, have you ever been startled and found yourself jumping backward before you even processed what was going on?  That’s the reptile in you doing that.  On the other hand have you ever hesitated so long trying to pull out into traffic that you nearly caused an accident?  That’s the nervous Nelly neocortex at the wheel.  This becomes particularly problematic when faced with trauma.  As we agree, life is traumatic, it is impossible to live without having a traumatic experience at some point.  It really doesn’t take much.  We now understand that you do not have to be a war veteran or, be raped, to be traumatized.  Small children undergoing anesthesia for surgery, near death experience in a car wreck, or even vicarious experiences like dealing with other people’s trauma through your job ,can hard wire you to be on-alert inappropriately.  It is the neocortex that latches onto these events and inhibits the amygdala from generating a release action.  We become consumed with thought:  “surely, this could happen again, I must always be looking out for this….”.

So the concept of how this ultimately goes right (we fight, flee or process in some other way, thereby releasing) or wrong (we hard wire a traumatized circuit) is based on brain plasticity.  This is the brain’s ability to form the connections of its own wiring – more specifically the ability to connect, disconnect and reconnect with new patterns.  Long gone is the concept that the brain is hardwired.  While it is difficult to teach an old dog new tricks, it is not impossible.  Especially if the dog is willing.  We are learning more about just how capable we are of making and repairing connections in the brain throughout our entire lifetimes, and how to efficiently tap into that process.  The way we lay down our pathways is complex ,and humans specifically face a unique challenge. 

Sensory Overload

As I said, it is not just traumatic experiences that generate anxiety circuits. The way we live day to day has a lot to do with what we generate internally.  There is a yoga practice called Pratyahara.  It involves the “withdrawal” of the 5 senses.  I won’t detail it here, but it is based on the fact that even centuries ago, people recognized that over stimulating yourself caused problems.  When we eat too much, talk too much, expose ourselves to prolonged noise pollution, it taxes the body and therefore the mind.  What would Pantanjali think of us today?!

Here’s another way to say it – everything you take in you must digest.  Yes, I am saying you eat with your eyes and your ears.  All that Facebook scrolling, the Netflix binging, is food, and like the rest of the American diet there tends to be a lot of calories on the plate without a lot of nourishing content.  We need to become mindful about engaging in sensory overload.  Rolling into your office in the morning with a quad shot latte and the music blaring is a recipe for being on edge and stirring up some juicy heartburn…. At least.  Or simply scrolling social media at night in bed, or waking up and immediately checking emails, this sets a mental/emotional tone.  It is no wonder we cannot sleep and everyone is so easily emotionally triggered.   You are what you eat.  Do you want your brain to be 1,200 Twitter posts?  Do you want your inner voice to be a high volume fast talker?  Internalize what it is you wish to be.  There are no short cuts or loop holes here.

Encoding – Generational Lessons

This last one is important, and perhaps simultaneously as confounding as it is liberating.  The stress, worry, fear, phobia and in general behavioral tendencies in an individuals life, may not be all their own.  Ayurveda has long contended that we carry the baggage of our lineage, not every thing that comes out of us is ours de novo.  That means the trauma of your great great grandmother can live in you and play out in your body, mind and life.  It may sound like fairy tale but we are actually proving this with science.

Mouse studies demonstrate that learned behavior, especially that which derives from fear, can be encoded and passed onto subsequent generations without active teaching.  This is huge.  And as I said, it can lighten the burden of things being “all you” but at the same time how does one free one’s self from such a thing?  The answer is, "We can", though that is a process and beyond the scope of this essay.  Just know that this concept is real, that how you feel is not your fault.

Just as we learn more about the brain’s ability to rewire so too can your DNA recode, in a way.  The field of epigenetics has explained the inconsistencies of life by making genetics vastly more complicated than was initially thought.  We can turn gene expression on and off, and actually extend and shrink the physical strands themselves.  Before we get to what to do about all this, one last thing.

Feeding the feel-bad circuit

We have ways of keeping ourselves in this revved-up mode.  One of the ways we tend to reinforce the default reflex circuit of being hyper-stressed is via positive reward.  Most of us don’t see it as such, but consider this: I get triggered at work by a coworker, I go outside and smoke a cigarette.  The act of smoking, or drinking, or eating sugar or shopping – whatever the drug of choice – positively reinforces the trigger circuit.  Physiologically, this says when I freak out I get a reward.  So, it is GOOD to freak out.  It may not be a healthy reward, it rarely is, but it is a momentary release, a sweetness, a thrill that takes away the overwhelming sensation of anxiety, stress, depression etc.  And the more the circuit is reinforced the more easily it is accessed.  Which is how you find yourself going ape-shit in your car when someone cuts you off in traffic.  The stress response circuit becomes so well developed and easily accessed, that it can be triggered with the least bit of provocation.

Also, understand the brain loves routine, it loves the known.  Even though the know may suck, it’s a familiar place and familiar = safe.  Safe = live sustaining.  Your brain unconsciously operates on the premise that if your normal is stress and anxiety then stress and anxiety keeps you alive. 

Anxiety is killing you

We know now beyond any doubt that stress and anxiety are at the root of most chronic disease states.  Diabetes, cancer, heart disease, early death… all these conditions and many more stem from years of living in anxiety, from the chemical milieu the body dwells in due to chronic stress conditions, to the subsequent compensatory habits that people who live in stress tend to choose – like smoking or drinking, or recreational drug use, eating disorders, gambling or video game addiction. 

How do we rewire the brain? 

The most concise answer is through repetition.  The same way you became entrained into your current state.  Again, no short cuts.  It is daily practice of new habits.  Ancient wisdom and science converge here.  There are several basic ways we tap into the brain’s plasticity and therefore its ability to rewire.  The route to rewiring is through the repetitious practice of:

1.       Mindfulness, either by simply redirecting thought or through meditation, the fact that you just learned a lot about your anxiety is a form of mindfulness, becoming aware and conscious

2.       Connecting to the physical body, done with simple exercise, yoga asana, meditation, etc

3.       Rest, real rest, not just enough sleep but the ability to engage in true relaxation, sitting and watching the clouds go by with a sense of awe and joy

4.       Diet, this one is hardly ever mentioned in books and journal articles. We use the body as a major conduit to the mind. In order for that to occur efficiently we must hone our bodies into superior tools

Sound too simple?  It really is, actually, but that does not make this easy.  And there is a lot to learn to in order to engage in some of these practices effectively.  My initial advice is to find someone to teach you to meditate, and go from there.  Get right with your body, improve your diet and move away of some of those “positive rewards”, like smoking, alcohol or sugar.  Western medicine nutritionists are not educated to really talk about having a truly healthy diet and dietary lifestyle.  But they can be a good place to start.  If possible find someone in the Eastern medicine crowd for this.  As far as exercise goes, you do not need to run a half marathon to get physical.  This is where the power of subtle practices like somatic therapy come into play.

Somatic therapy

As a primary care physician, I have worked with anxiety sufferers for years.  I have seen first hand the effects of stress on the body and the mind.  I believe people’s inability to cope with internal conflicts nor make changes they so direly wish for, is the core of all frustration felt by physicians with their patients.  I have lived in the limitations of my profession, having no truly useful tools to offer, only chemicals that suppress symptoms.  And at the end of the day, that practice only makes things worse.

 (Please note, I am NOT criticizing antidepressants or antipsychotics.  They are incredible tools to help patients work with themselves going forward.  I am, however, criticizing the practice of using them as monotherapy.)

The practices and wisdom offered by Ayurveda and somatic therapy have been demonstrated to me, personally, to be the best medicine for the afflictions of anxiety, depression and PTSD.....and just about any other chronic disease you can think of.  We are demonstrating their efficacy in the science realm as well.   Both of these practices combined provide the tools and establish the avenues of the 4 major practices listed above.  Ayurveda teaches about the body, and how to support it and keep it youthful.  Somatic therapy provides the avenues to appropriately tap in and orient yourself, to yourself.  It gracefully engages the mind-body through combined mindfulness and exercise.

Below are references for the information in this post.  Additionally, please see the resource page of this site for recommended sources on Ayurveda and somatic therapy.  If you are local, please join me for Pocahontas County’s first somatic therapy group for women, starting November 2, 2019.  See the Somatic Therapy and Events pages for more detail.

Be well.

Peace.

Shalom.

Namaste.

Payne, Peter, et al. Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Front. Psychol. 04 February 2015. https://www.frontiersin.org/articles/10.3389/fpsyg.2015.00093/full

Young, Alexander, et al. Persistent Depression and Anxiety in the United States: Prevalence and the Quality of Care. Psychiatric Services, December 2008. vol 59 No 12

“Waking the Tiger: Healing Trauma”. 1997. Peter Levine

“The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma”. 2014. Bessel van der Kolk

“Embody the Skeleton”. 2019. Mark C. Taylor

“Why Zebras Don’t Get Ulcers”. 1994. Robert M. Sapolsky

“Wisdom of the Body Moving: An Introduction to Body-Mind Centering”. 1989. Linda Hartley

https://www.nytimes.com/2013/01/17/science/mouse-study-discovers-dna-that-controls-behavior.html