Our Age of Anxiety

Now that the Covid-19 pandemic taught public health authorities the joys of subjecting the population to involuntary screening, why not expand the process to include something everyday, like anxiety. 

Dan Henninger examines the issue in the Wall Street Journal this morning (via Maggie's Farm):

The Covid-19 pandemic is winding down amid a broad reckoning about the restrictive policy recommendations scientific authorities made and imposed on the public. This striking headline appeared recently in the publication Education Week: “The Pandemic Was a ‘Wrecking Ball’ for K-12, and We’re Still Tallying the Damage.” Including anxiety.

It comes to us from the federal government, so you might be disinclined to have much confidence in the recommendation:

A medical advisory group to the federal government has just recommended that all adult Americans age 19 to 64 be screened for anxiety. Earlier this year, the U.S. Preventive Services Task Force—which advises both the Department of Health and Human Services and Congress—recommended anxiety screening for children 8 to 18.

So, the government is getting into the business of producing customers for mental health professionals. 

The task force’s recommendation that virtually all adults be screened for anxiety will be significant if support builds for its adoption as standard care. That would move what most people consider a recurring condition of life—such as happiness or sadness—closer to something that would be submissible for control by formal institutions, including the state. 

And, not just for mental health professionals:

It’s already clear that a post-Covid care industry is emerging. Anxiety mitigation would provide lifetime work in schools, medicine and the media.

Not to be overly cynical, but our nation has been churning out mental health professionals. Now, it has to find something for them to do. It needs to provide them with a steady flow of patients. One needs to mention that most of these professionals today are female and that, whether male or female, their track record treating mental illness is shabby, at best.

To be clear, these recommendations are only indirectly about the disease of depression. They focus explicitly on generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder and phobias.

Of course, depression and anxiety are not the same thing. But, Henninger does not distinguish them well enough. Depression involves self-deprecating thoughts-- as in I am worthless; I never get anything right. Anxiety involves the anticipation or even the dread of future events. In psychoanalytic literature it has been associated with guilt, which is anxiety about being punished for having committed a crime. Or even a sin. Religions treat anxiety by requiring confession and offering penance.

Anyway, for the record, Freudian treatment is largely designed around the primacy of anxiety, and not of depression. That it has systematically failed in this task should have been taken into account.

In today’s practice, mental health professionals treat depression either with SSRI medication or with cognitive treatment. One suspects that medication is more common than cognitive therapy, and one understands that both are somewhat helpful, though it depends on the practitioner. For a nation that is afloat in antidepressant medication, much of it prescribed by primary care physicians, one thing it does not need is more pills. 

As for anxiety, it may be treated by some cognitive techniques, though, rumor has it, yoga and mindfulness exercises are also effective. And one notes that phobias, a class of anxiety, is often treated through behavioral deconditioning, or perhaps with some medications. 

The government report does suggest that these treatments are of limited value. Why that would lead them to try to produce more anxiety and to get more people hooked on psychiatric medication, I do not know:

The panel “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit.”

As to therapies and treatments, psychological intervention produces “a small but statistically significant reduction” in anxiety symptoms. Psychopharmacologic drugs—mainly antidepressants and benzodiazepines—benefit some people. But that raises an age-old question similar to administering drugs for ostensibly hyperactive boys in grade school: Would anxiety screening put many more millions on a lifetime regimen of pharmaceuticals?

Small but statistically relevant means-- for the most part it does not work. As happens with talk therapies, it depends in large part on the practitioner. The result of the screening process will be to put more and more people on a lifetime diet of medication. 

By the way, the task force notes that a positive screen for anxiety would then require a fuller, confirming diagnosis. The screenings themselves, especially in schools, could become a source of dread.

Yes, of course. Won’t children and even adults feel anxious about being screened for anxiety? The government bureaucrats running this study seem not to care:

 We saw a great shift occurring away from calmer, more outward-looking lives toward predominantly self-directed obsessions when campuses created “safe spaces” for students who couldn’t cope. The Preventive Services Task Force provides 30 footnotes of research behind its recommendations but makes no attempt to explain how we arrived at a state of mass anxiety or what did this to us. 

Aside from blaming it on social media-- which is too easy-- or showing how childhood emotional distress was compounded by school lockdowns, why would you not be anxious for living a country whose leader suffers from senile dementia and whose backup is a moron. Does that inspire confidence?

Moreover, the massive national campaign of thought reform, the systematic effort to undermine institutions and even social  identities, has certainly contributed mightily to the dislocations and anomie that we are seeing as anxiety.

You are no longer a mother or a father; you are a parent. You are no longer a husband or a wife; you are a partner. You are no longer a man or a woman; you are a person. And besides, your country, in which you normally feel pride, has been trashed beyond recognition as an organized criminal conspiracy. You are no longer a proud American; you are a co-conspirator in a massive manifestation of criminality.

Why would you not feel anxious?