a burning building with Herculean effort. With anxiety, you just feel physically ill – a sweaty, shaky, nauseous bundle of nerves. This contributes to a feedback loop – you feel physically full of fear; and this adrenaline might cause a panic attack. After that has subsided, you look for reasons as to why it happened – leading to ruminations and obsessive thoughts searching for a legitimate cause. You spend a lot of time fearing another episode of panic and that leads to extra adrenaline … and on and on.
The other symptom of GAD that I always find overpowering is the feeling of impending DOOM it can bring. I remember visiting a local supermarket with my mother several years ago, when I suddenly felt as though the world was about to end. The colours in the shop felt all wrong, and everyone around me looked sinister and unfriendly. I could feel my emotions plummeting, as though a dementor from Harry Potter had sucked all of the joy out of my body. From nowhere, I felt utter dread, as all the while people were just buying their dinner. The doom sensation is incredibly scary – you feel like there must be a reason for it – just as with adrenaline rushes, it’s hard to shake it off and chalk it up to anxiety when every part of you is telling you that danger is approaching.
This feeling of doom is not unique to me or my fellow sufferers in the twenty-first century. In 1773, London physician George Cheyne wrote The English Malady, a book in which he addressed his own anxiety, describing his ‘fright, dread and terror’.[35] He might not have experienced it in his local Sainsbury’s, but the feelings are the same.
I’ve described some of the anxiety illnesses most commonly seen. But maybe you don’t get the doom, or the panic attacks, or the weird eye-twitching. That doesn’t mean you don’t have anxiety, or that your experience is abnormal. I could write a book on all the various symptoms alone, or a PhD which would entirely consist of the mad thoughts and neuroses that I’ve had in my life. Nobody would read it though, probably not even me. I say this to reassure you that even if none of this sounds like you, it doesn’t mean that your anxiety is less awful or somehow not as life-affecting as anybody else’s. Mental health is not a Top Trumps game (this probably dates me horribly), and if anxiety has given me anything positive, it’s taught me to be more empathetic with others who struggle in life. We all have bad brain stuff. Don’t minimise your stuff, or compare it with other people’s. Having a loving family or a good job doesn’t mean you have to stay quiet when you’re struggling with mental-health problems – however small you think they are. You know better than anyone else whether something in your brain feels wrong – and if it does, seek help. Anxiety disorders usually get worse without intervention – whatever that ends up meaning for you. The things that have worked for me have been therapy, drugs and running. Your version of help might be different, but do make a serious effort to seek it out. It’ll be the best thing you can ever do for yourself, and for those who love you.
Anxiety is nothing new. Ancient Latin and Greek literature repeatedly references fear and worry. In the seventeenth century, the Oxford scholar Robert Burton described anxiety in his book The Anatomy of Melancholy, in which he wrote ‘what cannot be cured, must be endured’[36] – a pretty good saying even now. Panic attacks were referred to as ‘panophobias’ in the eighteenth century, and we’ve all heard the phrase ‘attacks of the vapours’. In 1869, American doctor George Miller Beard described neurasthenia – meaning nervous weakness – as a condition that the middle class was increasingly suffering from.[37] He believed that they were overcome by the rapid advance of modern society. Come talk to me about rapid advance now, Beard: just try to use a parking meter without a phone, a credit card or a degree in maths.
Sigmund Freud wrote that ‘anxiety [is] a riddle whose solution would be bound to throw a flood of light on our whole mental existence.’[38] He spent a lot of time thinking about this particular mental-health problem, and initially thought that anxiety had something to do with the trauma of being born. Later he suggested it was probably also about the death instinct or some form of aggression operating within ourselves. Above all, he thought it was connected to the helplessness of infants – who can’t survive without the assistance of other people, creating a trauma that sticks with us. Then again, Freud came up with the Oedipal theory, so I’m shocked, that like Philip Larkin, he didn’t chalk anxiety up to your mum and dad fucking you up.
But despite this wealth of material, anxiety as a stand-alone mental illness was not recognised properly until the 1980 publication of DSM-3, which had a chapter on anxiety disorders.[39] These included phobic disorders, social phobia, panic disorder, GAD, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Wahooo! We were recognised! It’s nice to finally get some recognition … I’d like to thank my family, my friends and my dog.
This stand-alone diagnosis is important – no longer would anxiety be lumped in with other mental-health issues (though of course, many overlap). And that coincided with the introduction of treatments that might actually work. Thank God we now live in an age where medicine is not only effective but also has the added benefit of not being utterly punishing. Not for us the hideous ‘have a bash’ treatments that the mentally ill suffered through the ages – trepanning (having a hole drilled into your head to reduce pressure), lobotomy (which involved severing neural connections in the brain so as to relieve certain severe mental conditions), diathermia (using a current on the brain to jolt patients with psychosis), or being submerged in freezing water to treat women with hysteria. Hysterical women crop up a lot in history – from Hippocrates, who thought women’s wombs wandered (what a band name), to English doctor Thomas Sydenham, who wrote that hysteria was a malady which nearly all women suffered from – ‘there is rarely one who is wholly free from it.’[40] The Victorians were mad for trying to give women orgasms – whether or not they wanted them – to stop women being unhappy or angry, or maybe just not the perfect subservient wives that men expected. Between 1864 and 1889, entries at one asylum in Virginia recorded the reasons that patients were said to have become unwell. These included: laziness, egotism, disappointed love, ‘female disease’, imaginary female trouble, jealousy, religion, asthma, masturbation and ‘bad habits’.[41] Worryingly vague, and although not given as the main reason for admission, they seem hard to disprove …
As an aside, if you want to read more about how women with mental-health problems have been treated over the years, read Mad, Bad and Sad by Lisa Appignanesi.[42] It’s fascinating on the subject of how women are still much more often categorised as mentally unwell or ‘unbalanced’ than men.
The most effective treatment for anxiety is usually agreed to be talking therapy, which many credit Freud with bringing to the fore. His famous description of Josef Breuer’s treatment of the patient Anna O. (later revealed to be Austrian Bertha Pappenheim, the founder of the League of Jewish Women) is widely regarded as the beginning of psychoanalysis. Guess what she was diagnosed with? Yup, hysteria.
Cognitive behavioural therapy (CBT) is now seen as one of the most effective types of treatment for anxiety disorders – and the one recommended by the NHS.[43] Developed in the 1960s by Aaron Beck, it’s a form of therapy which involves re-examining your thought patterns and challenging negative behaviour. CBT is also recommended in the treatment of depression, schizophrenia and bipolar disorder and there is evidence it can help with chronic fatigue, anger issues and sleep problems. Having had therapists in the past who were very keen to start right back in my early childhood and work through my entire life in a bid to find the one key thing that made me anxious, I was relieved to try CBT and cut out much of this process. The first thing I was given was homework – a sheet of paper with boxes on it. In these, I had to write down my big irrational thoughts and what I thought would happen if the worst came true. Sometimes the sheets would look like this:
Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?
Likelihood: HIGH.
Conclusion: I’ll have to live in an asylum and I’ll never see my family again.
