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Dec 31 2013

One in six

It has come to my attention that I don’t have anxiety, and that a lot of people do, and that I’m damn lucky not to. Or maybe I mean I don’t have Anxiety, or an anxiety disorder. It’s not as if I never get unreasonably jittery about something. I’ve told you how absurdly jittery I get whenever I travel (and how promptly I get over it once I’m at the airport). But compared to real anxiety, that’s nothing.

Scott Stossel has a long article about his in the current Atlantic.

I’ve finally settled on a pre-talk regimen that enables me to avoid the weeks of anticipatory misery that the approach of a public-speaking engagement would otherwise produce.

Let’s say you’re sitting in an audience and I’m at the lectern. Here’s what I’ve likely done to prepare. Four hours or so ago, I took my first half milligram of Xanax. (I’ve learned that if I wait too long to take it, my fight-or-flight response kicks so far into overdrive that medication is not enough to yank it back.) Then, about an hour ago, I took my second half milligram of Xanax and perhaps 20 milligrams of Inderal. (I need the whole milligram of Xanax plus the Inderal, which is a blood-pressure medication, or beta-blocker, that dampens the response of the sympathetic nervous system, to keep my physiological responses to the anxious stimulus of standing in front of you—the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest—from overwhelming me.) I likely washed those pills down with a shot of scotch or, more likely, vodka, the odor of which is less detectable on my breath. Even two Xanax and an Inderal are not enough to calm my racing thoughts and to keep my chest and throat from constricting to the point where I cannot speak; I need the alcohol to slow things down and to subdue the residual physiological eruptions that the drugs are inadequate to contain. In fact, I probably drank my second shot—yes, even though I might be speaking to you at, say, 9 in the morning—between 15 and 30 minutes ago, assuming the pre-talk proceedings allowed me a moment to sneak away for a quaff.

If the usual pattern has held, as I stand up here talking to you now, I’ve got some Xanax in one pocket (in case I felt the need to pop another one before being introduced) and a minibar-size bottle or two of vodka in the other. I have been known to take a discreet last-second swig while walking onstage—because even as I’m still experiencing the anxiety that makes me want to drink more, my inhibition has been lowered, and my judgment impaired, by the liquor and benzodiazepines I’ve already consumed. If I’ve managed to hit the sweet spot—that perfect combination of timing and dosage whereby the cognitive and psychomotor sedating effect of the drugs and alcohol balances out the physiological hyperarousal of the anxiety—then I’m probably doing okay up here: nervous but not miserable; a little fuzzy but still able to speak clearly; the anxiogenic effects of the situation (me, speaking in front of people) counteracted by the anxiolytic effects of what I’ve consumed. But if I’ve overshot on the medication—too much Xanax or liquor—I may seem to be loopy or slurring or otherwise impaired. And if I didn’t self-medicate enough? Well, then, either I’m sweating profusely, with my voice quavering weakly and my attention folding in upon itself, or, more likely, I ran offstage before I got this far. I mean that literally: I’ve frozen, mortifyingly, onstage at public lectures and presentations before, and on several occasions I have been compelled to bolt from the stage.

Yikes. I don’t have that, or anything close to it. It sounds nightmarish. I feel as if I should do something to make it up to all the people who do have it. As I mentioned, that’s a lot of people. Stossel says so.

Anxiety and its associated disorders represent the most common form of officially classified mental illness in the United States today, more common even than depression and other mood disorders. According to the National Institute of Mental Health, some 40 million American adults, about one in six, are suffering from some kind of anxiety disorder at any given time; based on the most recent data from the Department of Health and Human Services, their treatment accounts for more than a quarter of all spending on mental-health care. Recent epidemiological data suggest that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetime. And it is debilitating: studies have compared the psychic and physical impairment tied to living with an anxiety disorder with the impairment tied to living with diabetes—both conditions are usually manageable, sometimes fatal, and always a pain to deal with. In 2012, Americans filled nearly 50 million prescriptions for just one antianxiety drug: alprazolam, the generic name for Xanax.

Life is harder than it ought to be.

21 comments

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  1. 1
    Ibis3, Let's burn some bridges

    My sister has diabetes *and* (as a menopausal side-effect) has suffered debilitating anxiety for almost 4 years now–couldn’t work anymore, difficulty leaving the house or doing anything other than read romance novels, avoiding almost all social interaction, etc. She tried several different medications (even including pot) and either they didn’t work or produced even worse side effects. Now she’s just waiting until the condition improves on its own (which it currently appears to be, thankfully). Man, I just hope that I get hot flashes instead, or that if I get anxiety like her, I can medicate successfully.

  2. 2
    Shatterface

    It’s very hard to explain how crippling social anxiety is to someone who doesn’t have it. I have Asperger’s which is, in itself, at least to the degree I have it, not hugely disabling – I prefer to think of it as a difference in cognitive style than a disability – but social anxiety comes with it and that’s the real problem as far as I’m concerned. The rest I can live with, it’s part of who I am, but being around people I don’t know well is truly terrifying.

    And it’s not like it’s easy to describe what I’m scared of. It’s not like I think they’re going to attack me, or take the piss, it’s just like I can’t predict what’s going to happen next and I can’t adjust to events in real time. It’s like being a rabbit caught in the headlights: I don’t know which way to jump – and really it shouldn’t matter because other people make faux pas all the time and manage to shrug it off.

    And to make matters worse people see this as a moral failing because they use the term ‘anti-social’ to describe someone who would simply rather not be there instead of ‘asocial’ or ‘unsociable’ – as if wanting to be elsewhere is the same as smashing a beer glass in someone’s face.

    A couple of years back I had to explain to my line manager at that time the difference between Asperger’s and psychopathy. I hadn’t realised until then how badly other people misunderstood my condition. Despite what some people think they’re almost mirror images of each other: Aspies have difficulty reading people but do have affective empathy while psychopaths read people easily but don’t care about them. And psychopaths are pretty much free of anxiety and ‘live in the moment’.

    Which is pretty ironic since the CBT course I’m undergoing for anxiety involves exercises about living in the moment and not worrying about every possible consequence. Blocking out those possible consequences is why some of us self-medicate on alcohol or other drugs.

  3. 3
    Shatterface

    One of my symptoms is alexithemia which means I’m not always aware of my emotional state. That means other people may become aware of my increased anxiety before I do. That’s rather scary in itself.

  4. 4
    dmcclean

    Well said, shatterface, I would describe what happens for me largely the same way.

  5. 5
    cedrus

    You can remind people that it’s treatable. I finally admitted that I’ve got an anxiety disorder and went on meds…this was a month ago, so it’s early, but I’m frankly astonished by how much this helped. I wish I’d done it a decade ago.

    Living with anxiety is like walking an enormous, poorly trained dog. Some days it trots along at your heels, but other days (usually when you can least afford it) you’re spending all your energy just dragging the dog where it needs to go. Want to ask the secretary for a petty cash form? Battle of wills with the dog. Want to check your email? Fight the dog, fail, go hide in the bathroom and collect yourself, then try again. It isn’t fun.

    I always figured it was a character flaw. If I were better at managing the dog, if my dog-wrangling muscles were stronger, then I wouldn’t have this problem. And I fought hard. (Remember that phone line you could call to get the correct time? I had a problem with making phone calls, so I started there, and systematically desensitized myself until I could call strangers and ask for stuff.)

    But it just wasn’t enough, and I was ashamed of that. I started bawling in the doctor’s office when I admitted why I was there. I’m so glad I did, though. The dog is basically gone. Now I’m realizing how much of my life was structured around coping with anxiety, and how much that really wasn’t normal. Better living through chemistry…it might work for you too.

    (For what it’s worth, I am on Zoloft. I’ve got Ativan as well, but find it too sedating.)

  6. 6
    Shatterface

    I’ve found that being in a small group with three or four other people is easier than just one or two others because I can withdraw into myself a little from time to time while other people talk without leaving awkward silences.

    Larger groups I can’t handle at all.

  7. 7
    chigau (違う)

    I really like the internet.

  8. 8
    Shatterface

    I read an article once that said the internet is Braille for Aspies. I think that goes for anyone with social anxieties.

    It’s a leveller. Those of us who have difficulties communicating in real time get to gather our thoughts and the rest get a taste of what it’s like to have to attend to words when context and intention aren’t always clear.

  9. 9
    theoreticalgrrrl

    I’ve had social anxiety my whole life. It’s more than shyness, it’s this overwhelming, crippling fear of social situations that makes everyday interactions with people, not just extreme situations like public speaking, almost impossible to deal with.

    Like Shatterface said, it’s hard to describe exactly what you’re afraid of. I’ve been told many times that I look like a deer caught in headlights when I’m in public. A friend once said I should try to droop my eyelids a little to counteract that, but that just makes me look like I’m stoned. ^_^

    Then I developed panic disorder in my late teens, which is a hell I cannot even begin to describe. It feels like you are about to drop dead, like your body is shutting down on you and you are struggling with every last fiber of your being just to hold on to consciousness. My doctor had to prescribe a stronger, more long-acting anxiety medication for that. The attacks come out of the blue, so the anticipatory anxiety when out in public can almost be as crippling as an actual attack. Without my anti-anxiety medication I don’t think I’d be able to leave the house at all. It makes holding down a job very difficult.

    I look at people who are comfortable in their own skin, who can socialize with relative ease, and it’s like watching an alien species. I am completely fascinated by people for whom that comes naturally. I wish I knew what it was that gives them that confidence.

    I can relate to Scott Stossel’s difficulty in finding the right combination of medication that doesn’t make you all drowsy and loopy or causes you to slur your speech. I don’t mix alcohol with my meds, It’s not a good idea. I just need the right combination of anti-anxiety meds with a stimulant like coffee so I can be alert and relaxed enough to deal with the outside world.

  10. 10
    H2s

    I have crippling anxiety about 85% of sexual situations I’m in.
    It completely shuts me down, and it’s destroyed a lot of the relationships I’ve had. This is because I’m so scared of the panics that I’ll delay sex forever, increasing the pressure.
    I have to admit this has brought me close to suicide before.
    It’s incredibly hard for anyone to understand and that includes partners – who just feel insulted in the main.
    Anyway it would be a good thing if this was more widely understood.

  11. 11
    Bernard Hurley

    Robert Sapolsky thinks depression is the worst disease you can have; his talk here: https://www.youtube.com/watch?v=NOAgplgTxfc is great. For over a year now I have been taking 100mg of the anti-depressant sertraline a day.[1] Depression can be crippling in that everything seems like a terrible effort. You can end up in court for not paying bills, not because you don’t want to or refuse to do so but because just opening the reminders seems such a tremendous effort and if you do open them, doing anything about it seems to involve even more effort. I can recognise all the symptoms Sapolsky talks about in his talk except the rhythmic patterns. As a child I used to self harm in a big way. I would cut my hands with broken glass and would swallow washing up liquid etc. Strangely nobody seemed to notice.

    I have suffered from both anxiety and depression and, quite honestly, I don’t think there is much to choose between them in terms of badness. Anxiety can ruin your life: for days before you have to do something trivial like introducing a speaker at a meeting, something that nobody will recall a day later, you can feel totally stressed out with anxiety. I can identify with the idea of “thoughts racing.” At the height of anxiety attacks I would say to myself “my thoughts are racing”, but only to myself – I didn’t want to tell anyone else as I was afraid they would think me insane or maybe I was afraid I was actually going insane.

    Because of the stigma attached to anxiety and depression it’s very easy to turn to “self help” books. These are almost always totally useless. It’s no help telling someone who has spent the best part of the day rehearsing what he is going to say to the clerk when he buys a train ticket only to find himself completely tongue tied in the event that the way to get that crucial loan or that pay rise is to spend some time imagining what you are going to say at the interview. Then about two thirds of the way through you discover that the author has a religious agenda and you feel totally foolish for having been taken in so easily. That having been said, I did find Alice Miller’s and Fritz Pearls’ books useful and insightful but these are not regular self help books.

    One of the worst things about these illnesses is the misunderstandings that can arise. Sometimes I feel I just have to be on my own, but I’ve been told it’s best not to stay alone at home or in my room, but to go down to the bar or pub or meeting room or whatever even if all I can bring myself to do is to sit alone in a corner somewhere. Often people think I am snubbing them, but there are also people who have some insight into what is going on. Sometimes someone will come over and say “Why not come over and join us? you will soon cheer up!” My usual response is something like “Thank you, I will when I’m ready but for now I just have to be alone for a bit.” Most people respect my feelings even if they don’t really have much idea of what is going on in my head, but the people that really annoy me are those that insist I have to be happy and have to join in with what everyone else is doing.

    The anxiety seems to have gone away over the years; I still get anxious, of course, but it isn’t the totally debilitating kind. However depression is another story.

    Since Shatterface has brought up CBT, I have to say that I am deeply suspicious of it. The part I don’t like is the “re-conceptualisation” phase. The idea here is that if only you think differently about the world then you have a good chance of feeling better. I can accept that that may well be true but it’s probably also true that if I accepted Jesus as my saviour I would feel better. I have been told by a CBT therapist that I shouldn’t[2] concern myself overmuch with things like FGM because I can do pitifully little about them. This ignores the fact that a million pitifully littles can add up to quite a lot, but more importantly, from my point of view, it ignores the fact that such concerns are a major part of the way I see the world. I am simply not prepared to trade that for feeling a bit better. As Ernest Hemingway said about ECT, “It was a brilliant cure but we lost the patient.”

    Footnotes:
    [1] This is the largest dose a GP in the UK can prescribe. The drug also cannot be put on a repeat prescription so you have to be reassessed every couple of months. A common side-effect is anxiety – out of the frying pan into the fire – but it hasn’t had that effect on me.

    [2] Notice the moral language used here.

  12. 12
    rnilsson

    O carp. These sharings point out sharply my own priviledge in so many ways I hadn’t thought about. Very courageous of you all. Thank you!

    For whatever that is worth, I sincerely hope things will get better for you.

  13. 13
    johnthedrunkard

    I’ve had some very nasty experiences with stage fright. Only in auditions though. In concert, or in a role in an opera I’ve always been completely comfortable.

    I took minimal doses of Inderal (propranolol) for auditions for some time. The physical manifestations of stage fright: the full body shaking, clenched fist etc. did not recur, but I think the effect was probably a placebo after the first few times.

    Alcohol is a LOUSY anti-anxiety drug by the way. It can cause anxiety attacks just as easily as it can provide a quick depressant.

  14. 14
    WMDKitty -- Survivor

    That reminds me, I need to talk to my doctor about upping one of my meds.

  15. 15
    Ophelia Benson

    Yes, what Roland said @ 12. Thank all of you. It’s hugely enlightening, and I hope it’s also useful to you.

  16. 16
    Martin Cohen

    I recommend taking classes in improv comedy. This forces you to interact with and pay attention to other people. I have been doing this for the past year, and I think it really helps.

    Other things I have done are take dance lessons (and go to social dances) and read my poetry at open mic readings.

    These were all difficult at first Isince I am a nerd for life), but they have really helped me.

  17. 17
    Robert B.

    That’s much worse than what I’ve got. My anxiety mostly shows up as guilt – I worry about things that already happened instead of the present or future. For example, thirty-second awkward patch in a conversation – no one angry or upset or objecting, I just said something awkward – can leave me flinching with guilt at random times for weeks. It’s bad, but I rarely need to medicate it like the person quoted in the OP.

  18. 18
    Bernard Hurley

    Martin, I took some classes in singing 19th century German Lieder and in Orchestral Conducting. I found both very helpful. I have also started chairing meetings of the Philosophical Society of England. It sounds very posh but it’s actually only a group of people sitting round a table in a pub! It was hell the first time I did it but I think that too has helped a lot.

    Robert, I think guilt has a lot to do with it. Roman Catholicism are really does guilt well and the Irish variety of Catholicism does it superbly. I remember once calling a “gob stopper” a “god stopper,” and being told I was going to go to Hell for doing so. I was in tears for the rest of the day and my older sister kept saying that God would probably forgive me because I was so little and being told that it wasn’t up to her to decide what God was going to do. The thing is that I actually thought they were called “god stoppers” but nevertheless I still had to feel guilty. I’m not sure if such incidents are the cause of my depressive illness, but they couldn’t have helped.

  19. 19
    Ophelia Benson

    Jesus fucking christ, Bernard.

    It’s interesting that whoever told you that said it wasn’t up to your sister to decide what God was going to do while apparently feeling perfectly confident that it was up to ___self. “It’s not up to Older Sister, it’s up to ME.” Oh yes? Because?

    God I hate that shit. Let’s make the small child miserable, because god.

  20. 20
    Bernard Hurley

    It would have been one of the good ladies from the Catholic Women’s League, looking after us for the afternoon. They are very into “good works” so she would have done it for no reward, except the feelings of goodness and holyness it would induce in her.

  21. 21
    medivh

    Shatterface: fellow aspie here. I find it’s the combination of too much information to process in real time combined with, for me at least, the years of ostracism and occasional beatings that came from peers realising I was significantly different. I’ve got a hard limit of four people in a conversation including myself. Every extra person adds more details to keep track of, more eggs to juggle. Histories, what topics I need to avoid, what topics I need to bring up, who’s getting annoyed with my hogging the conversation, who’s getting frustrated that I just won’t step in, who’s getting frustrated that I seem to cut them off, how frustrated I am that I can’t finish or sometimes even start a sentence, trying to find appropriate gaps in other people’s speech to step in, finding decent break-points in my own speech… As soon as a fifth person enters a conversation, I usually slip out without even bothering to excuse myself.

    What’s worse is that I can deliver a public speech with ease. A previous boss suggested that I join a speech-giving group in order to get social skills up. Problem was that I never had problems that speech giving would solve, and no-one understood how I could be anxious at dealing with five people when I could speak to 20 thousand if necessary.

    BTW: I also hate the antisocial label. I’ve started shouting people down over it. Sometimes it helps people to understand that antisocial and social look the same right up until the antisocial person has spread gossip and lies around a group to make it self-destruct. Then again, others just don’t listen because they just know better than some idiot aspie, apparently.

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