Tuesday, August 14, 2012

Managing Anxiety

Daniel Smith suffers from chronic anxiety. One day, in the midst of an attack, he called his brother Scott, a fellow anxiety-sufferer. He recounted the experience in the New York Times.

He begins by recounting what he said to his brother:

I’m in a state of agitation, self-hatred and incipient despair!... I’m anxious — again! I’m anxious day and night. I wake up anxious and I go to bed anxious. I’m a total wreck. And I’m not doing anything to help myself! I know what helps and I’m not doing it! What’s wrong with me? Why am I not doing the things I know full well will make me feel better?

Scott did not express empathy. He did not explain how he had felt the same pain. He did not tell Daniel to explore the childhood roots of his anxiety.

On the contrary, Scott told Daniel that he was an “idiot.” In so saying, he shamed him.

Perhaps only a brother can say it. Precious few therapists would ever submit a patient to even the mildest form of shame. They would probably get fired on the spot.

Besides there’s very fine line between constructive and destructive shaming.

Most therapy training programs do not teach either one. More often they consider shame as something to be overcome, not something that is potentially beneficial.

Shaming someone for a therapeutic end is a very difficult and tricky enterprise. It is not for the young, the inexperienced or the faint of heart.

When you tell someone to act his age, you are engaging in a mild form of shaming. If you denounce him as a good-for-nothing you are engaging a harsh and often counterproductive form of shaming.

A football coach might shame his running back by telling him that he is running like a girl, but, for it to be effective he has to make clear that the back is performing beneath his potential. If the coach implies that the back can never run effectively, his shaming will be counterproductive.

Of course, we live in a therapy culture where good therapists are supposed to be empathic and sympathetic mother figures. They are supposed to feel your pain and to love you unconditionally.

This culturally-defined expectation makes it much more difficult for any therapist to employ even the mildest form of shaming.

Smith understood that when his brother called him an idiot he was not casting aspersions on his mental capacity. He was drawing attention to a character flaw.

When you know what to do to make things better and you do not do it, you are being lazy or slothful.

Smith explained what his brother was saying:

I should define “idiot” for our purposes. I don’t mean someone of low I.Q. or poor academic abilities. Intelligence as commonly conceived has nothing to do with it. By “idiot,” I mean exactly what my brother meant when he tagged me with the epithet: an impractical and unreasonable person, a person who tends to forget all the important lessons, essentially a fool, one who willfully ignores all that he has learned about how to come to his own aid. A person who is so fixated on the fact that he is in a hole that he fails to climb out of the hole. An idiot, in short, is someone who is self-defeatingly lazy.

When you get yourself in a hole and are so “fixated” on where you are or how you got there that you do not do what needs to be done to get out of the hole, you are suffering from sloth.

Of course, you might also be suffering through a form of therapy that insists that you cannot get out of the hole until you gain insight into why you wanted to get into it.

A character flaw can be corrected by willpower and by hard work. But that assumes something that some psychologists do not accept: that you have free will.

As I see it, the sin of sloth does not involve a transgression. It involves a failure to do the right thing, in this case, to work for one’s own good. It implies, in most theologies, that our failure to exercise our free will is a character flaw, something for which we can be held accountable.

As it happened Freud had no use for free will. His was a deterministic, even fatalist psychology. Among today’s cognitive neuroscientists there is an important debate over whether or not we have free will.

Since free will is a function of the mind, not the brain, I do not see how an experiment on the brain can prove or disprove the existence of free will. Still some neuroscientists claim that they have proved that we do not have free will.

Yet, if a neuroscientist persuades you that you do not have free will he will be encouraging a fatalism about your illness that will induce laziness or sloth. “A habit,” Smith says, “is not the same thing as a fate.”

Persuading people that they do not have free will deprives them of their initiative.

Smith grasps the point well:

Anxiety may come on like an affliction, but it persists due to habit. Or, to put this another way, just because you are afflicted with a mental disorder doesn’t mean that you can’t apply your conscious will to mitigating that disorder. Even if you use medication, as I do, to coax your nervous system in a more salutary direction, your will — your determination to act in a way that is counter to your nature — still factors in. Indeed, I am convinced it is essential to recovery.

True, he says, someone might contract anxiety because of a trauma. And yet, if the condition persists it persists as a habit. That means that it does not mask a repressed meaning and will not be attenuated by discovering the precipitating trauma or by uncovering the repressed meaning.

Smith explains that an affliction becomes a habit by wrapping itself in dramatic thoughts. It’s not just that the mind keeps running scenarios of imminent, catastrophic danger. It’s that the mind takes it all seriously, grants credence to it, and treats it as a realistic possibility. After a time the mind becomes good at concocting catastrophic outcomes. Most human beings are loath to abandon a skill in which they excel.

Since these scenarios involve future possibilities, they cannot be overcome by testing them against present reality. One cannot say with certainty that the world will not come to an end next week, so one needs to label them as more or less improbable.

Smith knows well that a habit of anxious thought, one that sees life in terms of perpetual drama can be managed by being replaced by more constructive habits of thought.

This can only happen when you mobilize your good character and set out to work at it, by exercising self-discipline and self-control.

Many psychologists have been trying to tell us that life is a story or a narrative. If so, then it is also a drama. In so doing they have been inadvertently advising you to get into the drama.

If you want to manage anxiety effectively, you need to step out of the drama. This can be done, Smith explains, through meditation and through cognitive-behavioral approaches. But, nothing will work if you remain mired in sloth.


Mark said...

Most interesting. I've copied this to my wife who's a budding trick cyclist. To modify Plato "A life without free will is not worth living."

The Dark Lord said...

One more example of talking about your problem that actually doesn't help to solve the problem ...

Ive been anxious my entire life but luckily nobody tried to cure me of it since for the most part I masked it with coping techniques.

Good thing too, since I believe it is like being an alcholic, you never "cure" it, you just learn to control it ...

Talking about it has never helped to control it in my case ...

Dennis said...

Almost exactly why I love the name of this site, "Had Enough Therapy?" There is far too much talk about problems, and most of it "ain't it awful," and not enough just helping a person become better.
I am so glad that I was naive and no one ever told me how bad and dysfunctional my early years were. It never occured to me to feel sore for myself.
Anxiety is a part of everyone's existence. In most cases it is something one has to learn to deal with. It is why the musician constantly practices good habits over and over again or the professional golfer hits thousands of golfballs with every club in his bag.
No matter the career or attribute of life developing good habits serve one when one is under pressure to perform. Life is a series of learned habits which one has the capability of making positive or negative. Just as an education can be used to build or tear down.
Far too much of a desire to treat symptoms and not cure the person. Why would anyone want to wallow in a kind of self pity? Had enough therapy lately?

Ana said...

I also experience anxiety and have eventually learned that "talk therapy" did nothing for it. So when I'm panicking that my husband might have died in his sleep I go check on him because that is the quickest way to put an end to that obsession. And when I'm worried that the dogs might get bit by a rattlesnake I ask if I'm willing to plow up all the property to look for snakes or is it enough to know that the vet's number is on the refrigerator? Reminding myself that the anxiety is irrational helps me to let go of it. Thanks for finding and sharing this story.

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