Month: March 2021

On trying to cure my anxiety disorder

It was around the time of finishing my PhD, so well over twenty years ago, when bouts of my anxiety disorder manifested themselves so clearly that I sought professional help. The reason I want to write about my condition today is that, for the first time, I am hopeful to have found a way of curing it, to a considerable degree at least. I’ll begin by saying a bit about the condition and then move on to what I consider a potential step towards a cure. Since I don’t really understand my condition and the cure very well, I’m not sure that this will be of help to others. But perhaps adding my voice to the people who talk about such things openly can’t do harm. However, before you read on please note that I am not in any way an expert in these matters. All I have to offer is a personal story.

Being a hypochondriac. – Although I have some special anxieties like a fear of hights and fear of flights, my main problem is a more general disorder that goes by the name of “illness anxiety disorder”, formerly known as “hypochondria”. There is a lot I could say about this condition. The main issue is that, often following a perception of what I classify as a “symptom”, I assume to have some rather threatening illness. The kind of illness changes; what’s crucial is that I consider the worst-case scenario. The drama then typically unfolds as follows: I will first heighten the anxiety by paying selective attention to the “symptom” and indulging in refined self-monitoring. “Is it still there? Is it getting worse?” But now it’s not merely the object of my anxiety but knowledge of the anxiety itself that plays into the cycle: Knowing that I have the anxiety disorder suggests to me that my fears are overblown. But if they are overblown, I go on to think, it must be possible to find reassurance. Thus, I seek reassurance either by “investigating via google” or from people close to me, who will often confirm this and allow me to avoid seeking proper medical advice. This is my avoidance strategy. However, knowing that this is an avoidance pattern suggests to me that I am avoiding confronting the initial “symptoms”. Thus, reassurance amplifies the initial fear. This tangle works best in tandem with anxiety-induced symptoms such as an increased heart rate, but believe me it works with just about any kind of “symptom”. While proper panic attacks never last longer than 30 to 45 minutes, such anxiety cycles can go on for as much as five days. Often such cycles run for a couple of days. Then I have some days of gradual relief before they start again, often with a new perception of a different “symptom”. Since I have developed coping strategies that allow me to function well, I can go through these cycles without people around me noticing, unless I ask for reassurance. This means that the anxiety is often present at the back of my head, like an unpleasant noise in the background that sometimes spirals to very high volumes and then feels more like a disability.

For a long time, I didn’t realise that I had what people formerly called hypochondria. Simply because I sought reassurance, not through pestering doctors, but through other means. When I finished my PhD and lived on social security, the disorder worsened considerably. Among the “best of” of my worries was fearing to fall over in the street or during talks, job talks in particular. At the time, I had three meetings with a behavioural therapist. After understanding how anxiety works (especially understanding that its symptoms disappear after a certain amount of time), I felt relieved and got better again. But anxiety works in mysterious ways: Getting a permanent job in 2012 cured me of many existential worries. It’s been a game changer for sure. But something inside of me resisted the good news and clung to the strange belief that bad things will happen to me inevitably. Self-identifying as an optimist, I refused to embrace that belief consciously, but it seems to have worked its way up nevertheless. Having witnessed a number of troubles, illnesses and deaths in the family, I guess that this belief could take hold despite my avowals to the contrary. For quite a number of years, avoidance was my main coping strategy. Let’s look at some things I think were particularly unhelpful.

Things that didn’t really help. – (1) Being “reasonable”: For someone who enjoys – to some degree at least – things like thinking, understanding, and animated discourse, I found living with bouts of hightend anxiety or panic particularly frustrating, because understanding my own condition often did not help or even made it worse. Of course, understanding how anxiety plays out physically and knowing that I have the condition, for example, helped me seeing why things unfold the way they do. But at least my type of anxiety can get heightened through knowing that it might be partly irresponsive to reasons. Knowledge about anxieties can work like a self-fulfilling prophecy: If you know that your heart rate will go up with your next bout of panic, that very knowledge might actually increase the fear of your heart rate going up, and, as a result of this, increase your heart rate. (2) There is a common dualism according to which conditions like anxiety disorders are only or mainly “in your head”. Even if such claims are meant as a reassurance to someone worrying about their physical health, they don’t help in the long run. Apart from the fact that superficial reassurance can backfire quickly by initiating problematic cycles of seeking ever more reassurance, they underestimate the fact that anxiety comes in many physical manifestations. (3) Reassurance or confrontation? Reasonable reassurance that everything is fine (for good reasons) or confronting your fears, for instance, by going to the doctor can certainly help in singular instances. If a friend points out a good reason why a particular worry is unfounded or if I go to the doctor to get a proper check up, these are good things. The problem is that they are useless once they are turned into general coping strategies. Why? Well, it seems to me at least that anxieties will absorb any coping strategy into the anxiety cycle itself. – I’m not saying, then, that these ways of approaching things don’t ever help anyone. Rather, I wish to stress that they might not help in case you have an anxiety disorder. Of course, if you discover something about yourself that makes you worry, any of these approaches might help very well, but they can fail if they are turned into coping strategies. Why? I guess because using them as strategies makes them part of an anxiety cycle. The toxic thing about anxiety is that anything, even something perfectly helpful, can be turned into part of a cycle that ends up feeding the anxiety.

Moving forward. ­– Last year was particularly bad for most of us. Strangely enough, the threat of coronavirus did not overtly add to my anxieties. Rather, I learned to “embrace fatalism” a bit and became a bit more confrontational about my condition. Thanks to the suggestions of a good friend, I also managed to catch up with some medical check ups that I had avoided for about ten years. Worrying that my daughter Hannah might pick up my behavioural patterns, I also considered starting therapy again. Living in two different places during what is called lockdown, the fairly recent death of my father and some work-related pressures made this seem an even more appropriate consideration. I started behavioural therapy again now. But while I don’t want to pass judgement on this, what eventually made me take a good leap is something else.

What helped me, after all these years, is so strikingly simple that I still don’t know what to make of it, except that it definitely does help greatly. So what happened? After a conversation about a recent bout of anxieties, a dear friend sent me a video explaining a simple thing: to slow down my breathing (like in yoga), and providing an image to think about when doing so. Whenever I experience anxiety, I now take a few deep breaths and most of the problematic anxiety symptoms disappear. The heart rate slows down and I feel good. That’s it.

Why does it work? Don’t get me wrong. I have known that this kind of thing might help for a long time. I’ve been doing a lot of physical exercise for many years. In moments of hightend anxiety I instinctively took to slowing down my breathing anyway. There is nothing fancy about the breathing technique as such. Nothing I do is special; most of it isn’t even new to me. So why does it have such a great effect? I think there are two main aspects: First, the image I am thinking of when inhaling absorbs my attention, away from anxiety symptoms, to the positive impact of inhaling. Second, the fact that this video was presented to me as a personal response and gift turns the exercise into a relational act. Both aspects, simple as they may be, strike me as indispensable in explaining the effect it has on me. I am not saying that this has cured me of my anxiety, not least because I ultimately think that at least some of this disorder is the dark side of my personality, inevitably triggered in a certain kind of context. So I’m not saying I’m cured, but what seems to make a difference, for the time being, is that I can accept this, and yet break the cycle effectively. Even if it only works for certain situations, it restores a sense of agency that many of my coping strategies seem to have deprived me of. – I’m not sure this carries over or can help you. But perhaps a bit of hopefulness will inspire trying to look for unexpected resources.

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PS. It goes without saying that I am immensely grateful to many friends who helped along the way. You know who you are.

Is ADHD a disorder? Second thoughts about our conversation on ADHD and decision paralysis

After Martin and I talked, I found myself mentally revisiting our conversation more than once. I had been nervous to talk publicly about my experience with ADHD beforehand and that only increased once the conversation was put online for everyone to hear. In hindsight I realised that I had gotten the chronological order of some rather inconsequential biographical facts wrong and, moreover, I was left wondering if I had been good enough of an advocate for that amorphous, and mostly anonymous, group of philosophers who live with ADHD. All of that went through my head, all the while being fully aware that I couldn’t really fail anyone as I was not speaking on anyone’s behalf other than my own.

We spent quite a bit of time talking about a very specific feature that I, in my own idiolect, call a form of decision paralysis.  It was the first time that someone pushed me to give such an elaborate description and get clearer on its meaning by contrasting the inability to make decisions with the, perhaps related, phenomenon of having to solve a difficult problem. As it was in many ways a first for me, much of what can be heard in the podcast on this is me trying to think this through out loud.

There is a lot to be said for paying this kind of fine-grained attention to giving a phenomenological account of our cognitive lives, but sometimes people want to see the forest, before they start focusing on single trees. There may be a possible world in which I elegantly weaved such a broader picture into the conversation, but I don’t think it’s the world we live in. The good news, however, is that I do live in a world in which it is possible to share these afterthoughts with anyone who is willing to take the trouble to read them (much obliged if this applies to you!).

As I found myself thinking about how to do this, Martin pointed out to me that Ingrid Robeyns, who blogs for Crooked Timber, was drawing attention to an op-ed in the Scientific American, in which it is argued that ADHD should not be understood as a disorder.*

Reconstructing and commenting on their argument will allow me to say something more general about ADHD. Again, the caveat applies that I am primarily speaking as someone who has testimony to offer.

The authors point out that – strictly speaking – ADHD is a concept used to describe behavioural patterns and that it is only meant to be a descriptive term. This is valuable, because it allows us to group comparable individuals together and study them, try treatments, etc.

According to the authors the DSM 5, the most recent edition of one of the most widely used manuals to diagnose mental disorders, confirms this: The diagnosis only describes behaviour. And consequently, it is silent on the causal origins of ADHD. As far as the DSM 5 is concerned it is an open question whether the cause of ADHD is environmental or the result of some kind of imbalance in one’s brain chemistry or both or some other possibility.
This is a problem, because in our ordinary language we use ADHD not as a descriptive term, but as an explanatory one. The authors are thinking over conversational dynamics like this one:
‘Why aren’t John and Mary paying attention?’
– Because they have ADHD.
In the authors’ interpretation we would be explaining John’s and Mary’s inattentiveness by saying that they are inattentive and that, we can all agree, would not be sufficiently informative.

Their argument for removing disorder from the term ADHD seems to be motivated by the assumed power that ordinary language has over how we interact with the world. Once persistent causal talk has led us to believe that ADHD is a cause that causes certain traits in individuals, we may be led to believe that there is a distinct way to treat it. By, for example, prescribing them a certain drug.  This, the authors warn us, is a problem, because we may have skewed expectations of individual children. If children mature less quickly or if they just happen to be younger than their class peers, they will be more likely to be diagnosed with ADHD. This kind of misdiagnosis, the authors suggest, may be remedied by delaying the school start of those children who have those traits that are associated with ADHD.

I think that the authors are correct that if we think about ADHD in one-dimensional terms and we would fail to take into consideration the individual’s environment, then we would be doing those who are affected by ADHD a disservice.

In my conversation with Martin I said something that was in the vicinity of what the piece is arguing for: When I have to make a decision and there are no clear criteria to go by, then I often find myself in state that I call decision paralysis. The example that we continuously returned to was of choosing an item from a menu, but there are less trivial ones too: Settling on a dissertation topic, buying a gift for a loved one, …
In my mind those trivial examples were, for a long time, rather detached from the more existential ones, and I just considered them to be a quirk of mine, but it was when I learnt that people around me were seeing this inability as an undue burden on them that I started to conceptualise it as a problem. That seems, to me, a fair example of why we should always be very cautious with locating the cause of any assumed problems that are associated with ADHD.

And yet, I was left feeling rather unsettled by the suggestion to do away with the term disorder altogether.

To see why, I remind the reader that the DSM 5 groups ADHD together with other neurodevelopmental disorders. To be diagnosed with ADHD the behavioural patterns that the piece alludes to must be persistently present both in time and in socially different contexts, in a manner that deviates from what is, generally, appropriate for the developmental stage of their lives.

Consider a variety of the John and Mary-example. They both are behaving in ways that are atypical for their age – they always seem to be loud, inattentive, impatient both in school and at home. But in this case only John is diagnosed with ADHD. They don’t know what is up with Mary.

Let’s focus on John first. Although we don’t know the causal pathway that are responsible for John displaying these traits, the term disorder does do some work here. Assuming otherwise ideal circumstances, it suggests that there are limits to the extent to which we can hold John accountable for being disruptive in class. It tempers expectations that educators may have of John. It suggests that John has educational needs that are different from those of neurotypical children. All of that can be articulated without knowing the precise cause of ADHD.

If we bar the possibility that Mary is an exceptionally gifted actress, we probably should probably grant that she is an hyperactive child with an attention deficit. Yet the question whether or not it is a disorder is still a meaningful one, because we are interested in knowing whether these traits are persistently present over time as well as in socially different contexts.

Doing away with the term disorder would seem to give us fewer resources to discuss any potential differences between John and Mary.

I anticipate that the authors would respond by saying that removing the word disorder would not alter the diagnostic criteria: by re-coining ADHD as ADH we would have all the same resources at our disposal to determine whether Mary’s behaviour fits the criteria.

But here the power of ordinary language, that the authors attribute so much weight to, comes to the fore. We can very well imagine that Mary is hyperactive, loud, and struggling with an attention deficit, but that it was temporary, and that she never sufficiently deviated from the developmental norm. That is not to say that Marry doesn’t deserve our concern. It is also not to say that we know what was ailing her. The only thing that we can say for sure is that if we wanted to describe their respective predicaments, then the term disorder does allow us to differentiate them.

All of that is possible without pretending to know any of the underlying causes, but we do need a vocabulary for it.

NOTE

* The end of the article makes it clear that ADHD is merely meant as an example and that the argument is meant to generalise to all and any kinds of psychiatric conditions. In the authors’ own words: ‘drop the term disorder from all classifications.’ (Bolded emphasis added.) 

Meditation in philosophy. A conversation with Andrea Sangiacomo (podcast)

Meditation in philosophy. A conversation with Andrea Sangiacomo (podcast)

This is the fourth installment of my still fairly new series Philosophical Chats. In this episode, I have a conversation with Andrea Sangiacomo who is an associate professor of philosophy at Groningen University. In this conversation, we focus on meditation both as part of philosophical traditions as well as an approach that might be a resourceful factor impacting (academic) philosophy, teaching and academic culture. While Cartesian and Buddhist ideas* form a continuous resource in the background of our discussion, here is a list of themes in case you look for something specific:

  • Introduction   0:00
  • Meditation and Descartes’ Meditations   2:20
  • The notion of experience – and objections against experience as a basis in philosophy   9:00
  • Meditation in teaching   21:14
  • Why aren’t we already using these insights in education?   37:00
  • How can we teach and learn effectively?   44:36
  • How can we guide and assess?   52:50
  • Where is this approach leading, also in terms of academic culture?   1:03:00

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* The opening quotation is from Andrea’s blogpost What can we learn today from Descartes’ Meditations? Here is the passage: “Since last year, I appreciated the text of the Mediations as real meditation, namely, as a way of practicing a meditative kind of philosophy (for lack of better term), a philosophy more concerned with what it means to experience reality in this way or that way, rather than with what a certain set of propositions means.”

He has published four more posts on this topic on the blog of the Centre for Medieval and Early Modern Thought. They are:

ADHD, struggling with decisions, and the myth of autonomy in academia. A conversation about mental health with Jef Delvaux (podcast)

ADHD, struggling with decisions, and the myth of autonomy in academia.
A conversation about mental health with Jef Delvaux (podcast)

This is the third installment of my still fairly new series Philosophical Chats. In this episode, I have a conversation with Jef Delvaux who is in the third year of his PhD programme in Philosophy at York University in Toronto. Although we had a number of themes lined up, we ended up focusing on what is called Attention Deficit Hyperactivity Disorder (ADHD), which despite an increasing attention to mental health in academia still seems to be flying somewhat under the radar. Jef addresses this issue not as a specialist, but from the perspective of someone affected by it. The aim is to provide an understanding of the condition and how it can be addressed (and perhaps ameliorated) in academic settings. One thing we discuss in particular is the difficulty of deliberating and making decisions. It’s a long conversation. So if you feel like skipping bits or want to focus on a specific topic, here is a rough overview:

  • Introduction   0:00
  • Mental health and ADHD   2:00
  • Belittling ADHD   4:00
  • What is it like to live with ADHD?   7:20
  • Teaching students with ADHD: buddy systems* and autonomy   12:20      
  • Decision paralysis with and without ADHD: what is the difference?   22:15
  • ADHD during the pandemic   1:02
  • “What if I could talk to my undergraduate self?”   1:08

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* Regarding study buddy systems, I (Martin) state that Groningen has them for writing theses. But it turns out that we also offer them for BA and MA students generally.

What kind of thing is the canon?

“Our language can be seen as an ancient city: a maze of little streets and squares, of old and new houses, and of houses with additions from various periods; and this surrounded by a multitude of new boroughs with straight regular streets and uniform houses.” Ludwig Wittgenstein

Given the ever-increasing amount of initiatives on diversifying the canon, it is striking that one crucial question does not seem to be tackled much: What kind of thing is the canon?* While I have sketched my view on the function of the canon in an earlier post, I don’t really have found an answer either. I find this question crucial because it will tell us something about the fate and success indicators of the initiatives. What if it turns out that the canon is a kind of thing that cannot be altered? Or at least not in the way envisaged in the current projects? In what follows, I’d like to suggest that it’s crucial to see that, like a standard language, a canon has both a descriptive and prescriptive dimension.

Description and prescription. – Like in music or literature, the canon in the history of philosophy is a historical and normative entity. It has grown over a long time and is related to a larger set of norms and conventions interwoven with our habits and actions. Here, the canon is not just something adhered to; it’s a point of reference equally for those who wish to maintain it and those challenging it. If I write atonal rock music, I know that I do that against a canon of tonal music. My writing atonal music might be a challenge to the canon or might slowly be integrated. Both is possible. What’s crucial is that it’s not under my control whether my pieces alter the canon. The same might be said of the way we speak and write or even the way we build our cities. For me, the upshot is that the canon has at once a descriptive and prescriptive dimension. It tells us how things were and became. But it also tells us how things should be done. And whether your or my contributions figure in that is not for us to say.

The canon as a standard language. – Given the co-presence of descriptive and prescriptive aspects, the canon might be compared to a standard in a language, like Standard English as opposed to certain dialects. It is a historically grown entity as well as a set of rules determining what counts as “proper”. In this sense, we can compare canon diversification projects such as Extending New Narratives to attempts at ameliorating linguistic practices by suggesting different words or grammatical features so as to make underrepresented groups linguistically visible. The emphasis on more diverse and chosen pronouns, for instance, resembles the attempt to make minorities visible in the history of philosophy. Likewise, the political backlashes and difficulties are on a par with those in historiography. But just as language is only partially under our conscious control, the (philosophical) canon cannot be altered simply by adding so called “minor figures” to it. Adding expressions to the standard language does not mean that they will be used in conversation or seen as a (new) standard. But they may be. Who knows?

Can we change the past? – If canons are both descriptive and prescriptive, attempts at altering the canon are not only prescriptive and designed to nudge us into a different future practice of (history of) philosophy. They are also descriptive, and that means they describe the past in an altered way, for instance, by including hitherto underrepresented figures. For this reason, they are often met with the silly objection that they would distort or even erase history. The objection is silly because it identifies the challenged canon with the past or with history. But the canon is not the past. The canon is a way of approaching the past. And such a way is always guided by values and thus selective.

If this is correct, however, it means that attempts at diversifying the canon are not an attempt to give a more complete or accurate picture of the past. It rather means that we (want to) change how we approach the past and who or what we think counts as relevant. The goal of doing history of philosophy is not to present an accurate picture of the past, but to present an accurate picture of what we think matters for our present and future. If diversity matters for us, it also matters in our approach to the past. In this regard, it’s helpful to consider Wittgenstein’s likening of language to an ancient city. Like the philosophical past, the ever changing city has been there and yet is present in our life. But which precise places and streets we go to and build on is something that is up to us. It took a long time until, for instance, mosques in Berlin were not only found in backyards anymore but also in clearly visible places of town.

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* That said, a number of questions have been tackled, especially in Lonneke Oostland’s recent MA thesis “Canon ‘Enrichment’ and the History of Philosophy”. Besides Lonneke, I’d like to thank Han Thomas Adriaenssen, Daria Drozdova, Martin Krohs, Laura Georgescu and Felipe Romero for intriguing conversations about the status of the canon.