To live in anxiety is to be human

Many people are anxious at times in their lives but, for some, anxiety can take over their lives
By Chong Siow Ann, Published The Straits Times, 26 Jul 2014

"SOME people believe football is a matter of life and death... I can assure you it is much, much more important than that," said the legendary manager of Liverpool Football Club, Bill Shankly.

In the wake of that humiliating trouncing of the Brazilian football team in the semi-final of the World Cup - a defeat that assumed the proportion of a national tragedy - that quotation doesn't seem so ridiculous.

Various explanations have been advanced for this inexplicable and spectacular failure of a football powerhouse. Much had been said about the excessively high expectations placed on a team whose nerves were stretched as they inched closer to that coveted trophy that represented so much more to the Brazilians.

Signs of a potential meltdown were evident in the ill-concealed strain on the faces of the players and their occasional tearful outbursts. The team was already, to steal that line from the 19th-century poet Robert Browning, dangerously close to the edge of things.

On that day and on that pitch, the Brazilian team could not show grace under pressure. Instead, they buckled and crumpled under the German onslaught.

Collectively, they seemed to have "choked".

"Choking" is the sports colloquialism for that stress reaction that happens under high-pressure situations and where athletes become self-conscious, over-think their actions, and end up not being able to perform.

It is a classic illustration of the Yerkes-Dobson law. Robert M. Yerkes and John Dillingham Dodson were two Harvard psychologists who, a century ago, demonstrated that moderate levels of anxiety improve performance by focusing the mind and readying the body for action, but only up to a point. In a trajectory that can be graphically depicted as an inverted U-shaped curve, the level of performance increases with anxiety until it reaches a peak. Thereafter, it barrels downhill as the anxiety continues to ratchet up.

The state of anxiety

THE word anxiety has been applied and used quite variously. Social commenters like to describe our present time as the age of anxiety (a label appropriated from W.H. Auden's poem, The Age Of Anxiety) to refer to that abstract collective sense of uneasiness in the face of the constant threats of religious fundamentalism, terrorism, economic crisis, unemployment, devastating viral pandemic, et cetera. It also has different meanings in philosophy, theology, psychology and neuroscience.

But as that commonplace emotional condition, anxiety is something that besets us occasionally. We have experienced that sense of unease and tension that comes from uncertainty and imagining the worse, and which can be accompanied by physical symptoms like tightness of chest, palpitation, and even that sensation of choking. (The etymological stem of anxiety bears remarking - anx comes from the Latin word and angere also means to choke.)

But for someone who suffers from an excessive form of it, anxiety means misery, distress and impairment in life. These extreme forms have been described and classified as the various types of anxiety disorders in psychiatry such as generalised anxiety disorder, panic disorders, obsessive compulsive disorder, specific phobia, social phobia and post-traumatic stress disorder.

As a group, they are the most common type of mental illness.

The National Institute of Mental Health of the United States estimates about one in six Americans is suffering from some kind of anxiety disorder. A recent review of 87 studies conducted across 44 countries (published in the journal Psychological Medicine last year) found that anxiety disorders are common worldwide, with one out of 14 people having an anxiety disorder at any point in time.

Journalist Scott Stossel, who is the editor of the American magazine The Atlantic, suffers from a dizzying array of phobias, ranging from the prosaic such as claustrophobia, acrophobia (fear of heights) and fear of public speaking, to the rarefied such as emetophobia (fear of vomiting) and turophobia (fear of cheese).

On top of these, he also has other anxiety disorders. Since the age of 10, he has been receiving a miscellany of different therapies and ingested a prodigious variety of medicines.

He detailed these in his book, My Age Of Anxiety. In this 400- plus-page book, he melds an unflinchingly frank autobiography of the travails of living with this legion of anxieties (he had run off in the midst of interviews and speaking engagements; "choked" during tennis games; loosened his bowels at the most inopportune times; and almost passed out at his wedding) with a historical, philosophical, sociological and scientific exploration of the concept of anxiety.

Other than describing his genealogical tree which is full of relations with various mental illnesses including his great-grandfather who was a dean of Harvard College and who was subsequently institutionalised, he listed a number of what he called "successful and exalted people" from the past to the present who have suffered serious anxiety disorders.

The list includes Charles Darwin whose social anxiety was so severe that he was housebound for years; actors like Laurence Olivier, Hugh Grant and Barbra Streisand who had stage fright; and Mahatma Gandhi who suffered from "the awful strain of public speaking".

Reading Stossel's farcical and often humiliating personal accounts might give readers some voyeuristic pleasure but, because anxiety in its varying manifestations is so much part of what it means to be human, there is also empathy that comes from some degree of identification with the afflicted. For those suffering from these disorders, there might be a sense of relief in the discovery that they are not alone, and perhaps some hope that despite these distressing symptoms, it could still be possible to do well in other aspects of life.

The grace of bravery

STOSSEL has admitted that he was wary of disclosing his struggles with anxiety and, until the publication of the book, had successfully hidden the problem from friends and colleagues for fear that the revelation would diminish him in the eyes of others.

"I was very nervous about coming out as anxious," he said in a subsequent interview. "And now it's too late and I can't un-come out. It hasn't been a cure, but it has been something of a relief, I now feel that there are practical things I can help with, like trying to reduce the stigma around anxiety."

And it does take courage as in the case of Stossel to talk openly about something within us that we would rather keep covert.

Paradoxically, bravery is often found in those with excessive fears over other things. Mahatma Gandhi might have been fearful of addressing crowds who adulate him, but he showed redoubtable moral and physical courage in standing up to the might of the British Empire.

Stossel described an Italian called Pietro with agoraphobia so severe that he could not wander more than a block from his home. He lived through World War II in Pisa and, when that city came under attack, Pietro would run out after each bombing to surrounding buildings (as long as they were within a one-block radius of his house) and rescue people from the rubble.

To those afflicted with anxiety disorders, such exemplars "hold obvious appeal; in their anxiety lies not just redemption but a source of moral heroism and even, perhaps, a strange sort of courage", writes Stossel.

For the overwhelming majority who lead a more commonplace existence, bravery is found in the struggle to keep going in the face of such debilitating anxiety.

And this is something that as a psychiatrist I'm often blind to when it comes to my patients - focusing on their excessive anxiety and at times getting impatient and exasperated with them, rather than giving them credit for going on and trying to live a decent and useful life even when they feel they don't have the strength to do so.

The writer is the vice-chairman, Medical Board (Research) of the Institute of Mental Health.