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.
PS. It goes without saying that I am immensely grateful to many friends who helped along the way. You know who you are.
9 thoughts on “On trying to cure my anxiety disorder”
Thanks so much for this. Would you happen to still have a link to the video available to share?
Many thanks for your kind note. Unfortunately, the video isn’t publicly available. But as I said: it’s a very simple exercise, so there must be tons of videos available. One I looked at and found helpful is this: https://www.youtube.com/watch?v=8VwufJrUhic
I guess having something other than the anxiety symptoms to focus on seems most important in this.
It seems to me that you’ve stumbled into the technique of mindfulness breathing. There is good evidence on its behalf! If you want to expand your techniques of mindfulness meditation, check out “The Mindful Way Through Anxiety” by Lizabeth Roemer and Susan M. Orsillo. Their professors and psychologists (and they wrestle with anxiety, too). It is a good read.
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I suffered crippling panic attacks for about 5 years. The only thing that I found really worked was Cognitive Behavioral Therapy.
Thanks! Yes, that’s what I am having again now, but it’s early days.
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If CBT is helpful for you and you’ve benefitted from a breathing exercise (which is right out of mindfulness), you may like MBCT (Mindfulness Based Cognitive Therapy). It takes CBT and adds on various breathing and meditative techniques from mindfulness.
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Thank you for sharing something that is so personal, and yet simultaneously so universal, as many others struggle with the same or similar issues. I admire your courage to speak out, both on a public forum, but also in your private sphere, to friends and family. Both take considerable courage I’d say.
One thing that strikes me personally about anxiety (and I wonder whether you share this experience) is the sense of its ultimate undirectedness, as a reference without a referent. Yes, different forms of anxiety issues seem to be about something: a fear of illness in hypochondria, a fear of wide open spaces in agorafobia, the fear of fear itself in generalised anxiety etc. However, in all these cases it seems that the anxiety is, in the end, not really directed at those things. E.g. the fear of a certain illness in hypochondria might, at first glance, be directed toward that particular illness. Yet, simultaneously, there is the awareness that this illness is not present: we know, rationally, that we do not have said illness. Still the anxiety is present and real. And thus, it has nowhere to go. Instead, it runs through our system with no object to attach to and, thus, no straightforward course of action that can calm it down. Which is problematic, for anxiety is an emotional state that, maybe more than any other state, calls us to act.
I’ve read somewhere a claim from someone who suggested that people struggling with anxiety issues might actually flourish, to some extent, in crisis situations. For in those situations there actually is a course of action that can be taken. In a concrete crisis, there are things to be done, thus the adrenaline rush of anxiety has an object to attach to and can do its work. Anxiety can become action and that calms it down.
I do not fully know what the point is of my philosophising here. Except perhaps the idea that an anxiety issue might actually not be about a specific object, but instead is a more generalised form of extreme fear frantically searching for an object to attach to, so a suitable course of action can be taken.
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Thanks so much for your kind words and intriguing thoughts which strike me as spot-on.
You write: “Instead, it runs through our system with no object to attach to and, thus, no straightforward course of action that can calm it down. Which is problematic, for anxiety is an emotional state that, maybe more than any other state, calls us to act.” –
Yes, I agree that the object is, in some sense, irrelevant. In fact, whenever I emerged from a strong cycle of anxiety because I could rule out a certain illness, I could feel my mind racing and looking for new objects to cling to.
Some people (e.g. Heidegger in Being and Time) assume that the ultimate underlying “object” of anxiety is death. But while I agree that this might be true of certain more generalised kinds of anxiety, I don’t think it fits all of them.
(By the way, I never thought of Wittgenstein’s beetle illustration in the PI that way, but he might have had emotions in mind, too, when talking about sensations and privacy, concluding that the object cancels out as irrelevant.)
Your idea that people suffering from anxiety might flourish in crises strikes me as pertinent. Going from my own experience, I think I decidedly ’embraced fatalism’ in the corona crisis. But I also have to admit that my self-perception and the way others perceived me can differ. I had some arguments during which I was confronted with the accusation that I would take certain decisions solely out of fear, while I was thinking I was free of fears.
A final thought about a specific anxiety (fear of heights). Seeing how and when my fear of heights kicks in, I began to think that it is owing to a dysfunction in the perceptual system, in the sense that my perceprtion from certain heights can’t relate distances to the size of my body. When you’re close to the ground you perceptions include information about things like “it would take my arm such and such a movement to reach this or that object”, but from a certain amount of distance this information is lacking. My hunch is that, in such moments, perceptions “fail” and signal that lack of information. – I have no idea whether there is research on this, but going from a theory of perceptual affordances this would make sense. If this is the case, then such anxieties could be equally said to be problematic, because they lack a proper object and the body “doesn’t know” how to act on them.