Contemplation of the world we were born into can be daunting, to say the least. Our first reaction at the moment of departing the womb is a cacophonous wail, railing at the departure from a complex but still relatively simple environment into the assaulting abyss outside. Gifted with not just one or two senses but an astonishing five, we begin the process of trying to assemble those sensations into something coherent, reliable, predictable. Some sights and sounds occur together; touch can feel good or bad; smell feels like taste at a distance. Slowly, with millions of moments of trial and error, infants find regularity and consistency as the background with which to consider novelty, the as-yet-unknown.
But rather than an inexorable march toward a greater and greater proportion of knowns in a sea of unknowns — a growing wedge in the pie chart of knowledge — development progresses toward a greater appreciation of the scope of the unknown — an ever-expanding pie chart diameter.
The entirety of one’s known environment expands from womb to nursery to house to neighborhood to city to country to earth to solar system to galaxy to universe, at which point the infinite space between electrons brings to bear the depths of the micro-universe. And that is just a spatial dimension. The range of possible sensations, the complexity of the biome, and the conundrum of time also expand. However, the most perplexing of all, the dimension that appears to have the greatest contribution to this rapidly expanding pie chart, is the human condition. Why did that person do that? Why am I doing this (and not that)?
It is not surprising then that anxiety should flourish in such a milieu. With expanding knowledge comes expanding uncertainty. This is true as history unfolds across generations, as well as within a given generation or human life.
What is surprising is that culturally, we have only recently come to accept anxiety in any comprehensive sense, but so far that sense is relegated to pathology. Through the ministrations of big pharma and the neuroticism of many prominent 20th century writers and artists, North American culture has lifted the first veil. Anxiety is now an open discussion, and in children’s vocabulary. Unfortunately, this revelation has been met with bellicose intervention, a war with the very existence of anxiety. We have wars on cancer, obesity, drugs, crime, terror, and, so they say, Christmas. No surprise that we include newly appreciated emotional struggles. In doing so, anxiety remains the “other,” the enemy.
When I was young, we used to tease each other that “your epidermis is showing” on the playground. The basic ruse was the construction of a virtual in-group of those in the know. But it was much more cruel and insidious than that. On the surface, it was biased against younger and perhaps less savvy kids who did not know what epidermis was. The cruelty emanated from the difference between those who accepted their ignorance, thus denying the basic premise of the game like a kid who refuses to search for anyone once he is “it”, and those who cared to know, sometimes desperately. Whether by insecurity, anxiety about being on the outside (we didn’t call it FOMO then), or a fear of exposing something shameful, these were the kids who provided the game’s central sadistic pleasure.
Some feigned knowledge with certainty, which was quickly exposed either by their refusal to share what they knew or, eventually, a pathetically wrong guess. Others fitfully examined every part of their body, trying to identify the exposed culprit. Occasionally, the desperately shame prone would cry, unable to enact their go-to coping habit of hiding any potentially offending aspect of their selves. The true torture was in the arrogance and superiority of those that were in the know, those who knew a Greek term for something so simple, natural, ubiquitous, and real.
Today, we are but children with the application of “scientific” terminology for our basic human functions (don’t get me started with my tirade about all the doctors who proclaim an “-itis” as a diagnosis rather than a feeble description that something is swollen, a symptom not a cause). We have incorporated “anxiety” into our public — and public school — discourse with all the sophistication of playground epidermis accusations. We have a term, now let’s divide the world by that term. Watch how some feign understanding. Feel the otherness of those writhing with the struggle to understand. Most importantly, reinforce the hiding of those who feel exposed by some “flaw” they don’t understand.
In published research on anxiety, there is the inexorable reference to 10, 15, and sometimes 20 percent of the population that “has” anxiety. It is the primary justification for interest — we need to know more about this so we can relieve suffering. Don’t get me wrong, this is absolutely the right motivation. However, the purely clinical view of anxiety, in the framework of “disease”, makes the anxious into “them,” desperately scanning their being to find this epidermis of thought and feelings.
Digging deeper into prevalence rates starts to unravel that outgroup stereotype. Point prevalence — how many people are diagnosed or diagnosable (ala DSM criteria) at any one timepoint — is different from lifetime prevalence — how many people reach diagnosable levels of anxiety at any point in their lifetime. Lifetime prevalence rates are in the realm of 35–40%. These are people who would qualify for a diagnosis based on the presentation of a certain number of symptoms. If you are short by one or two symptoms, you are not diagnosed, even though anxiety may be interfering with your life. If we include those people, then lifetime prevalence may climb to 50% and beyond. If there is something that affects 50% of the population or more, it is either an epidemic or something pretty darn normal. Anxiety is not an epidemic.
First and foremost, anxiety is an emotion. It is the tension between the experienced now and the imagined future. In less intense ways, we experience anxiety many times a day. If I get to the gym too late will I be able to get the elliptical machine I like? I hope the rain will hold off so I can mow the lawn before the dandelions go to seed. I must have a salad tonight before the lettuce goes bad.
Anxiety is the engine of thought, propelling us forward into planning. It results from eons of evolution forming this wonderful cortex that allows artists to create their visions, scientists to test their hypotheses, parents to foster children’s development, and organizations to provide goods and services year after year. The imagined future may not always be rosy, but, motivated by anxiety, we can take action now to avoid or reduce potential negative impact. Such is the nature of being functional and effective in the world.
First and foremost, anxiety is an emotion.
Ah, but what about when anxiety is more intense? It is going to be awful when I have to fire my employee tomorrow. What if my manuscript is rejected? I hope she does not ask me about how I feel about X. Now the engine has shifted up a gear, making the consideration of the imagined future more pressing. Anxiety the emotion helps us to prioritize perceptions and thoughts about that imagined future. Attention is narrowed, other information is ignored, we are vigilant. Again, this is functional and helps us to be effective in the world. Anticipation begets preparation.
Anxiety the problem begins here as well. This narrowed focus comes at a cost. Maybe the other information is also important. There are other things to take care of besides your employee, manuscript, or relationship. As the intensity of anxiety increases, the myriad possibilities of the world get narrowed down to just two categories — things that are relevant to the anxiously imagined future and those that are not. In essence, intense anxiety moves the location of processing in the brain from the wonderfully flexible and adaptive cortex to the evolutionarily older and more rigid limbic system. The amygdala in particular becomes more dominant than usual, applying its efficient dichotomization mechanism to categorize incoming information as bad or good. Is that the bad thing? Is that evidence of the bad thing? How about that, is that the bad thing? Like a quality control worker on the factory assembly line — is this one broken? This one? This one?
So it is no accident that we bisect the world for the sake of anxiety. Uncertainty is always the largest wedge in the pie chart of knowledge. But rather than accept that uncertainty, we create certainty even if there is none to be had. Bisecting is one of the primary plots of the stories we tell ourselves. There are two kinds of people in the world…nature vs. nurture…man vs. nature…mind vs. body…dorsal vs. ventral…conservatives vs. liberals. Dichotomizing to achieve the illusion of certainty is a result of anxiety precisely because it relieves anxiety. We concoct stories that reduce the tension between the experienced now and the imagined future. We are entertained by stories built upon interpersonal or existential threat — will the protagonist get the love interest, die, escape, prevail over the enemy? The stories we use to narrate our own lives are no different, even if typically more banal than a bestseller.
All of this is great fodder for another post, however, as here I only want to point to the central meta irony:
We use our anxious dichotomization to create a bisected story about anxiety.
Anxiety the problem has become anxiety the disease, which only some people have. It is viewed as an organic defect, an invasion of the purity of the mind, the enemy from within, alien, other, the neurochemical equivalent of hemophilia, cancer, or lead poisoning. Viewed in this amygdalar “bad” category, it is easy to see it as something to be eviscerated, eschewed, excised, or exterminated.
Unfortunately, that is not how it works. Is anger, guilt, or sadness a disease? No. When people successfully return from living under intense anxiety’s grasp, do they no longer experience anxiety? No. Can parents prevent their children from ever experiencing anxiety? No. Would any of us want to live without anxiety? No.
The point is that the existence or occurrence of anxiety is not the problem. It is how we use that emotion as a signal, a motivation, a guide for our behavior. The best and most successful means to lasting relief from experiencing too much anxiety, cognitive behavioral therapy, is to provide the tools to work with anxiety when it arises. Successful therapy returns a person’s ability to use anxiety effectively, much in the same way that we can use anger, guilt, or sadness effectively but not excessively.
Hopefully, the next veil to be lifted from our understanding of anxiety is to not be anxious about it. The dichotomization of anxiety is one of the sources of stigma that, in its endemic recursive process, fosters greater anxiety. Anxiety is an emotion. We all have it. We all have the potential to experience it in a debilitating way. We all work with it day in and day out. Let’s work with it.