Loving ourselves …

You shall love your neighbor in the same way that you love yourself.  ~ Jesus, Matthew 22:39

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I’ve been waiting to write this post for a long time.  The subject is extremely dear to me, and  is one about which I am very passionate.  In every setting in which I have ever worked, I have tried to encourage colleagues, patients, AND myself to put a higher priority on this theme.  I believe it is truly the linchpin that, if firmly set in place in our moment-by-moment choices and daily habits, could and would pull our lives forward into having great positive impacts on the little worlds around each of us.

This subject is:  loving ourselves.  Now, in this phrase I am first and foremost referring to the word ‘loving’ as a verb.  That is, I’m not so much speaking of the emotional, feelings side of love.  I’m talking about how we treat ourselves; the things we do, or not, to take care of ourselves, our lives, on a daily basis.

Do you see what I am saying here?  I am not saying that liking ourselves, or feeling deeply in love with ourselves, is the big key here.  Actually, if you are like the vast majority of people I know, suggesting that you ought to like yourself, or have strong, passionate feelings of love toward yourself, would at first be an appealing suggestion, but it would have very little chance of happening simply by us deciding that, yeah, hey!  I’m going to really like myself today!  For whatever reason, it just doesn’t seem to work that way.  We seem to, most of us, not really like ourselves much at all, in fact.  And just deciding to do so would fade very quickly as our longstanding feelings of shame, guilt, inferiority, unloveliness, and unlikeability would soon take over once again.

So, what I’m actually suggesting here is to do an end-run, a “flanking maneuver”, in military parlance, around our feelings about ourselves.  I’m saying, let’s forget how we feel about ourselves, and see if we can use our powers of reason to come up with enough motivation to take good care of ourselves anyway, in spite of not really liking ourselves.  Does that seem doable?  I hope so, because if you’re like me, it ain’t gonna happen if I wait for the good feelings to come first, or to stay!

Alcoholics Anonymous has many slogans, some of which have been very helpful to me after I had learned of them.  One of these is “Fake it ’til you make it!”  This refers to the fact that when a real alcoholic first enters into recovery, he or she finds that they have to start doing a lot of things that, a) they don’t like doing;  b) they are not used to doing;  and c) seem pretty downright silly!  Things such as attending meetings with people you don’t know very well, telling your story (the whole truth!) to strangers, or picking up the phone and calling your sponsor when you’re REALLY craving a drink, are not fun things to do for these folks!  But, as oldtimers who have built up a lot of serenity and strength of recovery will tell them, that’s okay, just “fake it ’til you make it.”  Actually, this again points up one of the great, but little known truths about us humans:  we don’t long keep doing things that we feel are useless or pointless, even though they are very worthwhile.  Sooner or later, one or the other will change.  We’ll either stop doing those things, or our feelings about them will change toward the positive.  And that’s what we’re talking about here.

I want us to look at ways to treat ourselves better, despite the fact that we might think it’s selfish, or that we’re not worth treating well, or that it won’t matter in the end ‘cuz WE don’t matter.  I really believe that if we do begin making healthier choices for ourselves, and KEEP doing this, that eventually we WILL start feeling good about ourselves.  We will start liking ourselves.  We will begin believing that we have a good purpose here on earth, and that our future will be successful in the ways it was meant to be!   And then, one day we’ll find that we have made it!  That our feelings match up with our choices!  That will be a great day.

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Here are some quotes that I found helpful … hope you’ll agree:

To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.  ~ Thich Nhat Hanh

I have an everyday religion that works for me. Love yourself first, and everything else falls into line.  You really have to love yourself to get anything done in this world.  ~ Lucille Ball

He lives long that lives well, and time misspent is not lived, but lost.  ~ Thomas Fuller

Those who think they have not time for bodily exercise will sooner or later have to find time for illness.  ~ Edward Stanley

If I were given the opportunity to present a gift to the next generation, it would be the ability for each individual to learn to laugh at himself.  ~ Charles Schulz

Eat to live, and not live to eat.  ~ Benjamin Franklin

We are what we repeatedly do.  Excellence, then, is not a single act, but a habit.  ~ Aristotle

The day the child realizes that all adults are imperfect he becomes an adolescent; the day he forgives them, he becomes an adult; the day he forgives himself, he becomes wise.  ~ Aiden Nowlan

The important thing is not to stop questioning.  Curiosity has its own reason for existing.  ~ Albert Einstein

Our bodies are the gardens to which our wills are gardeners.  ~ William Shakespeare

If you aren’t good at loving yourself, you will have a difficult time loving anyone, since you’ll resent the time and energy you give another person that you aren’t even giving to yourself.  ~ Barbara De Angelis

To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.  ~ Ralph Waldo Emerson

Or do you not know that your body is a temple of the Holy Spirit who lives within you, whom you have received from God?  You are not your own, for you were bought with a very high price.  Therefore, honor your Creator with your body.  ~ I Corinthians 6:19-20

I see my body as an instrument, not as an ornament.  My body is not an object on display for pleasure or judgment.  It is a vehicle, equipped with legs that allow me to visit my favorite places; with arms that allow me to embrace the people I love.  It is my home; the bearer of my soul and the carrier of my spirit.  My body does not reflect my self-worth.  ~ Alanis Morissette

Plant your own garden and decorate your own soul, instead of waiting for someone to bring you flowers.  ~ Veronica A. Shoffstall

Self-love is not opposed to the love of other people. You cannot really love yourself and do yourself a favor without doing other people a favor, and vise versa.  ~ Dr. Karl Menninger

We are wont to condemn self-love; but what we really mean to condemn is contrary to self-love.  It is that mixture of selfishness and self-hate that permanently pursues us, that prevents us from loving others, and that really prohibits us from loving ourselves.  ~ Paul Valery

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The picture below is of a small church known as St. Leonard’s Church, located in the town of Wixoe, Suffolk County, England.  It is said to be well cared for, and sits at the heart of the village.  The belfry dates from the 15th century, and as you can see, compared to so many of the pictures of belfries I have posted here on these pages, this is a very modest and yet self-assured bell tower.  Like the old belfry on the campus of Radford University, this one seems perfectly OK with who and what it is, what its job is, and does it very well.  And the people who love it so much don’t mind making the effort to take care of it, knowing that this care will pay great dividends, both in their lifetimes and in those of Wixoe citizens’ lives yet to come.  So far as I could find, there is no reference to any person or persons having their names engraved on plaques or other monuments in or around this church or bell tower:

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Now here is another church with a bell tower, also described as very “well cared for”.  This is the  Church of St. Mary Magdalene, located in Sutton-in-Ashfield, which happens to be located in the county of Nottingham (ring any ‘bells’?) in England.  This church dates from the 12th century A.D.  It is very pretty, certainly.  The description also goes into great detail regarding the tidy (I am sure) sums that various members of the Sutton family paid to make sure this church and its bell tower were well cared for as time passed.  To make sure, their names are engraved on several plaques located in and around the church.  Do you think Walter, Gerard, Jordan, and William Sutton were more interested in the beauty of the church and its grounds, the clarity, tone, and volume of the belfry’s bells, or their own legacy, when they paid considerable sums to ensure that both the stones of the church as well as their names were well-preserved into posterity? As I said, though, this is a pretty church!

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One of the things I most appreciate about the small town in which I live is the small, Christian liberal arts college located here.  They now call themselves a University (ahh, modern times!), but I still know who and what they are and were meant to be (a college!), and I appreciate them for whom they are.  This College (yes, I AM obstinate!) has a very nice bell tower that sits atop the administration building.

Every day, from 8 a.m. until 8 p.m., the bells in this belfry sound out the time every 15 minutes, playing the old Westminster Chimes theme.  In the spring and summer months, when in the afternoons and early evenings I am likely to be outdoors in my back yard, pulling weeds, or pruning trees or perennial shrubs or flowers, or relaxing on the swing, or just walking around admiring God’s marvelous handiwork, those chimes fill me with peace and quiet joy.  Just hearing them makes me feel as if there are still little parts of the world that remain secure and steadfast, just as they were SUPPOSED to be.  Occasionally, such as at noon or around 5:00 p.m., the carrillonneur (the person who plays the bells) will play a hymn, and this makes it even better, in my opinion.

And then I find myself appreciating and mentally thanking all of those persons who, a hundred or so years ago, advocated for the building of that belfry and the purchase of those bells, and the many other persons who have, over the decades, maintained that tower and the bells, as well as the ropes and chains from which they are suspended.  None of them did this for me.  They did it because it was right and good in their eyes.  They took the time and effort, and paid out the money, so that the present and the future of the college and the town in which it sits would be a little bit better because of the wonderful tone of those bells in that tower!  I strongly doubt that any of them has their name engraved on a bronze plaque over at that college (errr … University!).  As I said, I am very grateful.

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Taking good care of ourselves is about just that:  taking … care … of … ourselves.   It is a mindset, a commitment, an attitude, and a set of practices that is very, very hard for us to introduce into our lives, and to build into habits.  It requires, for most of us, making changes in our lifestyle.  Remember, it does NOT require us to FEEL LIKE making changes.  And, it does not require us to feel “sick”, or that we’re “getting old”, or that there is something wrong with us in any way.

Similar to the contrast that we drew a few weeks ago between mental health and mental illness, good self-care does not imply the existence of some kind of disorder or illness, but neither does it imply the absence of such.  Self-care, caring for oneself – one’s body, mind, soul, time, talents, interests … everything that comprises each of us – is really the verbs that would comprise loving oneself, again, in the non-emotional sense we talked about above.

Many people have told me that they interpret Jesus’ quote from Matthew at the top of the page above to mean that since God knows that we are hopelessly selfish and “in love with ourselves”, we should use our ‘boundless, ego-centered love for self’ as the measuring stick by which we ought to boundlessly love others.  It was God “giving in” to our self-centered nature, knowing we would never stop loving ourselves, so He was just commanding us to give at least as much time and effort caring about others as we give ourselves!  Well, I am certainly no theologian, but this does not jive with what I know about God (who in my belief is, after all, all-knowing), and about us!  Not at all.

In my view, the commandment is indeed twofold.  We are instructed to love our neighbors AND to love ourselves.  And what did Jesus mean by the use of the word, ‘love’?  Did he mean the passionate, romantic feeling kind of love we often think of?  Apparently not, as the very next thing he said, in response to the question, “And who is my neighbor?”, was to describe a set of almost incredible (especially to the Jews who sat there listening) and selfless actions of a Samaritan (whom the Jews apparently despised) in caring for a Jewish man who had fallen prey to robbers who beat him and left him for dead.

Now, ’tis true that the main thrust of this command is to do just the same as the Samaritan for anyone whom we see in need around us, when we have the opportunity and ability to help.  But the command does, indeed, also refer to loving ourselves!  And, whether or not we believe Jesus is being somewhat resigned about our selfish natures, it is clear that he expects us to be looking after the needs of ourselves in the same mindful, compassionate, and selfless way.

As you might imagine, I work with a lot of people who are or have been very depressed.  I can tell you that in almost every case, most of these persons are the kind who would rather take care of others than to take care of themselves.  In many cases, shame and guilt drive them to try to please others by serving them all day long.  While there may be unhealthy beliefs at work underneath this “others-first” mindset, I really believe most of them are very unselfish.  When I talk with them about exercise, or speaking up for themselves, or eating in a healthy way, or resting when they are tired and are at their limit, or simply saying ‘no’, they almost invariably shrink away, as they believe this would be “selfish”.

On the surface, so it might seem.  And certainly, you could do some very good things for yourself FOR selfish motives and reasons!  In fact, “looking out for #1!” was an American national catchphrase through much of the 1980s and 90s!

But, as the Karl Menninger quote above describes, when we do ourselves a favor and take care of ourselves, such as going to bed at an early hour, we are really doing others a favor, as this makes us better people!  It helps us be better able to take care of them!  I discuss with people all the time how, if they can’t be with their lover or their spouse, or their children or grandchildren, or anyone else whom they care for, by taking good care of themselves now they will be the very best friend/lover/spouse/mother/father/grandparent, etc. they can possibly be when the time comes that they are reunited!  So whatever your motives are, Love-ing yourself is a good and kind thing to do.

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So, how do we get started?  Well, lots of ways.  But we’ll have to flesh this out over time.  I want to look with you at several different ways in which we can take better care of ourselves.  We will talk about exercise, about eating (and drinking!), about rest, about dressing and grooming, about taking care of our minds, about having fun, and about taking care of our souls and spirits!  Maybe even one or two things that will come up as the winds change!  So please stick around!

Let’s begin to think of our lives as if they are gardens, and we have just been hired to be the gardeners.  And as the bells chime out the hours from the belfry in the distance, we’ll work to make those gardens wonderful and beautiful for the “neighbors” we’re loving!

Craig Meek, M.D.

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“My nerves are shot!”

For the uninitiated, “My nerves are shot!” is a phrase very commonly heard by this wandering pilgrim in his days seeking to help those suffering from seemingly insurmountable anxiety and stress.  It basically means, “I can’t take all this anxiety anymore!!  I’m completely beaten down by all of it!  Please help!!!!”

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After hunting around, I managed to find some pictures that illustrate the following fact:

Even though I myself might not have the courage to trust in rickety, rusty, rotting stairs to climb to the top of tall belfries, and then to lean out over the top to look down at the tiny buildings, cars, and people below, some folks DO possess this bravery, and I tip my hat to them!

For example, these young ladies certainly had a lot of intestinal fortitude while mounting up to this belfry at the top of the Basilica in Quito, Ecuador:


But, once they reach the top, what a view they received as their reward!!

Amazing!

And then here is another young man who overcame, undoubtedly, tremendous fear to climb out onto the precipice of imminent disaster to capture great photos:

I’ve got to hand it to him … he’s got a ton of courage!  Courage which I do not possess.  And likely never will.  Which, taken with the long range view in mind, is perfectly ok by me.

I do very much appreciate the photographs he has given the rest of us, though!

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As we decided in our last installment (well, at least I decided!) anxiety is the degree to which our bodies are activated, in any given situation, moreso than is needed to deal with that situation.   And as we also talked about, anxiety disorders are extremely common, with as many as 40% of American adults having a diagnosable anxiety disorder at some point in their lives (in many cases, for their ENTIRE lives!).  That means 2 of every 5 of us will be impaired by anxiety in some way, shape, or form during our journey!  This outnumbers almost any other illness we might ever face.  And as such, anxiety disorders ought to be taken very seriously.

Now, we also discussed the fact that there is a very big difference between having an “anxiety disorder”, and having an “anxious” or “fearful” state of mind.  This is a huge distinction, and we’ll talk more about that later on, down the road.

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Currently, the most common form of treatment for anxiety disorders is medical, i.e., medication.  Whether it ought to be or not is a debate for another venue and time.

There are 3 primary classes of medicine used to help people with anxiety disorders:

1)  Tricyclic Antidepressants:  The word “tricyclic” refers to their chemical molecular structure.  The word “antidepressant” means that all of these medicines were originally marketedas antidepressants.  It has very little to do with how they actually work within the nervous system.  And they are used to treat far more than just depression.  Anxiety, chronic pain, insomnia, migraine prevention, etc. are all within their purview these days.   The class includes:  Amitriptyline (Elavil), Nortriptyline (Pamelor), Desipramine, Imipramine, Clomipramine (Anafranil), Doxepin, and Trazodone, among others.

2)  SSRIs (aka, Selective Serotonin-Reuptake Inhibitors):  This class also is primarily considered to be “antidepressants”, but once again, we find them being used to treat other problems, most especially anxiety.  The list includes:  Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Fluvoxamine (Luvox), and Escitalopram (Lexapro).  All of these medicines can lessen anxiety, though they typically take longer to achieve this dampening effect.

3)  Benzodiazepines.  This is by far the most effective class of medicine if you simply want to lessen anxiety in its global context.  It includes:  Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Chlordiazepoxide (Librium), Clorazepate (Tranxene), etc.

The problem with “Benzos” is that they have developed a negative connotation and reputation for many people, both inside and outside of the mental health profession.  ‘Tis true, some people do abuse benzodiazepines.  A slender few become addicted to them.  Not even close to a majority, but that fact seems to matter little to many people.  In my experience, VERY few people who truly do struggle with a real anxiety disorder will ever abuse their medicine.  They simply want relief!  NOT to get high.  But, as with so many things, a few people with selfish or unhealthy intentions can often ruin things for many others, and this has been the case with these medicines.  However, it is also true that many prescribers have too often written scripts for these medicines without really finding out whether and to what degree their patient actually has a crippling anxiety problem.  I have been guilty of this at times.  Most of the time, though, when I prescribe such a medicine for someone, I have been careful in the diagnosis, but I do often choose to trust people until such time that they might prove to be not trustworthy.  The vast majority of the time my trust in them has been well-founded, and they end up very grateful for the help with this hugely disabling condition!

There are other medicines commonly used to help with anxiety, but they are usually fairly unique-type meds, not a part of a larger class.  Examples include Buspirone (BuSpar), Hydroxyzine (Vistaril or Atarax), Gabapentin (Neurontin), and a couple of other more obscure medicines not used much in a number of years.

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However, there are other ways beside medicine to treat anxiety disorders.

There is what is called, “Cognitive Therapy”.  This is a form of treatment in which you work with your therapist to identify some of the “automatic thoughts” that go through your head in certain situations.  In this case, these would be situations in which you ordinarily begin to feel symptoms of anxiety arise within your body.  Then, while you are in a safe and calm place, you begin to REALLY examine these thoughts, as well as the beliefs that underlie them, and see just how true and accurate these beliefs and thoughts actually are.  For any of us who do this sort of exercise, we quickly realize that there is an incredible amount of pure junk (I wanted to use a word that includes a large case ‘B’ next to a large case ‘S’ here, but as this is a “family” forum, I’ll stick with ‘junk’!) percolating around in our minds, and it has a huge impact on our lives.  But, again, that’s a discussion for another day.

As you identify the falsehoods and silly thinking or logic that permeates your belief systems, you begin to try to change those automatic thoughts with other self-talk which you, yourself, script out.  Some people will actually write down a few “true” statements on a 3×5 index card and carry it around with them, to pull out whenever they start to feel anxious.  You could also write a few such lines on your cell phone.  As you begin to practice responding with more accurate statements about yourself, the situation, the worst case scenario, and other “outside-the-box” choices you can make for yourself in that instant, and as they become more habitual for you, the less your anxiety and worry become.

Almost all forms of therapy are really exactly like this, though other forms don’t have the specific “homework” assignments that cognitive therapy does.  They are all about looking at what we do (and feel and think), why we do it, and how unsound our thinking is that undergirded the reasons why we did so.  Then we look deeper to find truths about ourselves and others around us, and try to build our future upon more truthful and sound foundations.  Some therapies will have us delve back into our childhoods, or walk through traumatic experiences over again, or examine the relationships we had with our parents, or siblings, or various authority figures, etc.  But the goals are still pretty much as I’ve laid out above, when you distill them all down.

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Other forms of treatment are not exactly “therapy” in the common lingo, but they are still ‘therapy’ in the purest sense of the word!  These other forms I categorize as “Mind over Matter”!  Or, in this case, “Mind over Body”!  These forms include such things as Biofeedback, Deep (Abdominal) Breathing Techniques, Progressive Muscle Relaxation, and Visual Imagery.  In addition, while they are not specifically treatments for anxiety problems as the things listed above are, Yoga, T’ai Chi, Pilates, and other forms of exercise which emphasize breathing, flexibility, and mindfulness, are excellent tools for people to explore who deal with anxiety disorders.

In all of these endeavours, the goal is for the person practicing these things to maximize one’s control over one’s body.  To slow things down to at least a manageable level.  When we again think about how the body automatically begins spitting out huge amounts of adrenaline (epinephrine) and norepinephrine in response to, say, standing on the parapet of a 500-foot tall belfry, and how this leads to dramatic increases in heart rate, breathing rate, cold sweats, dizziness, churning guts, shaky hands, weak knees, and a strong feeling that we may very well die, the one thing we would most wish for is the ability to control some of this, so we could make it go away!  If by deepening and slowing our breathing, or by closing our eyes and imagining ourselves in a “safe place” (for me, it’s always been sitting on the sand at Holden Beach, North Carolina, on a warm, breezy summer day, with the constant and soothing sound of the surf driving all fear from my mind!), we can actually direct our bodies to shunt some of that adrenaline away and feel quickly less tense and panicky, so much the better.  The best thing about these techniques, if practiced repeatedly, is that they can be called upon at any time in any place, and no external chemical is needed!

Actually, one of the best non-specific treatments for anxiety is to simply exercise.  Walking or running, or any of the numerous forms of dance-type exercises now popular … really, any kind of what is called “aerobic” exercise … will help build resistance in your cardiovascular and respiratory systems to the over-stimulating effects of adrenaline.  I often tell my patients of the stories I saw a number of years ago during a summer olympics broadcast of a couple of marathon runners who first started out running, in response to their doctor’s recommendation that they start exercising as a way to prevent or lessen panic attacks.  Lo, and behold!  They became world-class long-distance runners, and had no more panic attacks to boot!  Now, of course, one does not need to run 26.2 miles in 3 hours or so in order to overcome panic disorder … but you get the idea.   🙂

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I’ve very superficially described only a few of the many treatments available for anxiety disorders.  Some of these disorders, such as Obsessive-Compulsive Disorder, require very intensive treatments that have to be tailored to that person’s specific patterns and O-C drives.  Social phobia or specific phobias (such as fear of heights!) will often require a form of therapy known as exposure, or progressive desensitization, to help someone go from the panic caused by even the mere thinking about the thing they dread, to actually being able to be in that situation for several minutes, and to see that you CAN live through it and do okay.

The one thing I have hoped above all in these last two posts is to convey the truth that if you or someone you care about is dealing with some kind of anxiety disorder, there is hope.  In many cases the hope is that it can be managed better, feel better, and NOT be an obstacle to living a normal and happy life, or to achieving your goals and dreams.  In some other cases, there is good hope for a complete cure … learning and finding a way to live free of whatever anxiety has haunted you for so long.  Either way, I urge you to seek help, as it is out there.

I wish you calmness and peace.

Craig Meek, M.D.

High Anxiety!!

Are you scared of heights?

I am.  I’ve stood and walked along with my feet supported only by the narrow edges of two 2×12 boards, two stories above a base floor, my mouth bone-dry and my hands sweating like crazy.  I’ve leaned out to look over the side of a number of cliffs, with my heart pounding and legs shaking, feeling very lightheaded, and desperately hoping no one would push me from behind.  I’ve been up in the Washington Monument and a number of other tall towers and places, and aside from the steel-vise grip my hands had on the hand rails, all I could think about was how happy I would be once we got back down onto solid ground!

If you had been standing next to me in those moments, it is very likely you would not have had a clue of how nervous I was feeling.  I, like most people out there, are often very good at hiding these internal symptoms.  But that does not mean those symptoms are not there, and are not wreaking major havoc in the lives of many thousands … no, make that millions, of people who suffer from them.

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Here are a few pictures, looking down from various belfries around the globe.  As you can see, bell towers can provide wonderful viewpoints from which to see the world around you.  This is one of the reasons why I like to imagine myself sitting or pacing around inside belfries as I contemplate various human problems.  Unfortunately for me, looking down from them, or even simply viewing pictures others have taken while looking down from them, causes a little fear to grow inside me … even as I type this my hands are just a tiny bit sweaty!

Now, here are a couple of views from the top of the world’s tallest building.  Unfortunately, it is not a bell tower (yes, I cheated … sorry!), but it IS very tall!  This is the Burj Khalifa building in Dubai:

I realize that for many of you these fears about being or standing in high places may seem puzzling, silly, or even ridiculous.  I am quite certain most of these amazing guys would agree with you:

By the way, this famous picture, entitled, “Lunch Atop A Skyscraper”, was taken by a man named Charles Ebbets, and was published in the New York Herald Tribune in September, 1932.  These guys were working to build the GE Building in Rockefeller Center, and they are sitting 800 feet off the ground while eating their lunch and smoking their smokes!

Here are two or three of them who posed as if napping afterwards:

Simply amazing.  I do not see any way you could get me to sit out on a 20-inch wide beam and eat my lunch 800 feet off a very hard earth.

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However, whether or not heights get to you, or spiders, or snakes, or dark alleys, or elevators, or crowded stores, or talking to women, or speaking in front of an audience, or being slid into a very narrow MRI or CT tube, or having a gun pointed at you, or driving on I-65 amongst a sea of speeding trucks, if you are human then there are certainly some things that trigger in you what most of us would call fear.  You simply are not being entirely honest if you deny this.

And if you are one of the very fortunate and very small minority for whom only a few things in life make you feel fearful or scared, then good for you.  God has gifted you with wonderful chromosomes!  And please don’t feel too highly about yourself … it truly is, according to research and the common sense of many of us who work in mental health, the luck of the reproductive draw, more than any other factor, that gives you the ability to feel calm in the face of so many things that most of your brothers and sisters recoil from.  Not only this, but I believe that part of what comes with this blessing is that you have a duty in life to help encourage those around you who unfortunately are more naturally fearful.  It is part of your calling to help them face their fears, and do things they need to do to fulfill their own callings in life.

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So let’s talk about anxiety.  The various symptoms I described above, as well as many others we humans have all experienced in life, are all various ways that anxiety can manifest itself.  Sweaty palms and/or forehead, lightheadedness, feeling jittery, nausea, feeling our heart racing, pounding, fluttering, or skipping beats, breathing faster, breathing shallower, feeling as if you can’t breathe, or as if you’re smothering, feeling a tightness in your chest, “butterflies in your stomach”,  tingling sensations in your fingers, hands, or arms, dry mouth, a “lump in your throat”, your voice cracking when you try to speak, feeling unable to concentrate, weakness or wobbling in your knees, feeling “rubber-legged”, feeling like the “walls are closing in” on you, and any kind of a strong desire to get away from whatever situation you’re in when you feel any or all of these things … all of these and probably other symptoms, too, are part of what we refer to as anxiety.

As you can see, most of what I’ve listed here are what would be considered “physical” symptoms.  That is, almost all of the above are things that our bodies feel.  They are part of our physiology.  There are also, of course, “emotional”, “mental”, and even “spiritual” symptoms of anxiety and fear.  In fact, very few things in life so well illustrate the connections between soul, mind, brain, and body as the whole experience of anxiety.

To a large degree, anxiety is a highly biological phenomenon.  It really could, in a sense, be measured on a meter or gauge, if such a meter could be properly wired up.  In its most basic sense, anxiety is simply a heightened level of biological arousal.  It can be triggered both by our bodies, such as by a sudden and loud crash of thunder when we’re sitting at home or work, previously unaware that a storm was brewing, or by our minds, such as when we look at the clock and then realize we’re about to be late for work or class, and then our brain tells our body to get hyped up and get moving!

Anxiety can be slight, medium, high, or “through the roof”!  In small amounts, anxiety can be very helpful to us.  To accomplish almost anything other than sleeping requires that our energy, both mental and physical, be mobilized in order to do the tasks we need to do.

Arousal, or the lack thereof, can be pictured as a continuum, from lowest to highest:

1) Comatose (essentially no higher brain functioning);

2) Asleep, deeply;

3) Asleep, medium depth;

4) Asleep, lightly;

5) Asleep, in dream phase, or REM;

6) Stuporous (half-asleep, half-awake);

7) Awake but drowsy, sluggish (aka, lethargic);

8) Awake, calm, slow-moving, slow-thinking;

9) Fully awake, alert, normal-thinking, moving around at normal pace;

10) Awake, moving around quickly;

11) Mildly anxious and tense;

12) Moderately anxious and a little fearful;

13) Highly anxious and nearly panicky;

14) Full panic / “crawling-out-of-our-skin fearful” mode.

The level of arousal or anxiety we experience at any given moment is controlled through our nervous system (which is more than just the brain – it also includes the spinal cord and many, many nerves coursing through our bodies – but for the moment to simplify things we’ll just refer to it as our brain).  The way our brain does this is mostly via electrical impulses sent through nerve fibers to various parts of the body, as well as back and forth to and from the thinking and emotional parts of our brain.  Some of those nerve impulses go to various glands in the body, telling those glands to release or to withhold various hormones that either raise arousal levels, or lower them.  One such pair of glands are the adrenal glands, located right next to our kidneys.  The adrenal glands produce several hormones, but the chief of these has long been known as “adrenaline”, named after the glands.  The more correct name for this chemical is “epinephrine”.

As you might imagine, knowing how commonly we refer to adrenaline in the context of being “hyped up”, epinephrine is a highly stimulating chemical.  As it is released into the bloodstream and then flows throughout the body, attaching itself to receptor proteins on the outside of cells in blood vessels, muscle fiber bundles, the heart, breathing muscles, airways, etc., all things tend to be mobilized for our basic biological “fight or flight” mode.  Epinephrine’s close cousin, norepinephrine, is primarily a stimulating neurochemical.  At the same time that epinephrine is being released into the bloodstream, norepinephrine is being spit out from the ends of stimulating nerves to receptor proteins in heart, airways, muscles, the GI tract, the pupil muscles in the eye, nerves that control hearing, sweat glands, even the tiny muscles that make the hairs of our skin “stand on end”.

The end result of all of that is that we become ready for action, with blood flow being maximized to places we need it most if we’re going to “fight or to flee”, and minimized to those places, such as the skin and GI tract, where it won’t be needed until things are calmer.  Our hearing and vision are keener, our brain is ready for quick decision-making, less so for humor or reflective thinking, and our heart and lungs are working quickly to keep the troops (the muscles of the arms, legs, and core) well-supplied for their mission.

When there is a good balance set in the amounts and timing of these stimulating actions, we are ready and able to go out and play a basketball game, or to get the house straightened up when we find out that friends are coming over in 15 minutes, or to deal with a power outage, or any of a number of tasks that are common for all of us in life.

However, when, as is very often the case, our nervous system easily goes too far in its arousing activities, we find ourselves far more stimulated than we need to be.  This “overkill” is what I call “anxiety”.  It’s the degree to which our system activates itself more than it needs to for a given situation.  Many, many of us have such nervous systems.  They are geared to go overboard to prepare us for certain situations, or they overreact when we are faced with “alarms going off”.

When such nervous systems routinely over-prepare or overreact, to such a degree that it causes problems for these persons, this is what we call an “anxiety disorder”.  Anxiety disorders include:  1) Generalized Anxiety Disorder, in which these folks are almost always mildly to severely anxious, in almost all situations, which makes life very uncomfortable (although, they rarely suffer what are called panic attacks);  2) Panic Disorder, in which people do have sudden panic attacks, or severe explosions of debilitating anxiety, either in certain situations such as in crowded malls or crowded elevators, or just anytime, including even while they’re sleeping!  3) Social Phobia, in which people are very fearful and anxious whenever they are have to be around unfamiliar people or have to perform in front of folks;  4) Post-Traumatic Stress Disorder, in which persons who have been in, suffered, or closely witnessed near-death or severe trauma, or repeatedly or continually have been in mortal danger (such as soldiers in Vietnam or Afghanistan, for example), experience recurring memories of the trauma, are almost constantly hyper-aroused due to the trauma, and try to avoid anything that might trigger memories of the events, and live very anxious lives because of it;  5) Obsessive-Compulsive Disorder, in which people live very anxiously because of some fear-inducing obsessive thoughts that drive them to do compulsive things over and over again, to such a degree that it keeps them from living normal lives;  and 6) various other less common disorders, all with the common theme of overriding anxiety that manifests itself more than normal.

In the United States, anxiety disorders are the most common form of mental illness in adults, as around (by most sane estimates) 40% of adults have or will have a diagnosable anxiety disorder at some time in their lives.  This compares to ~20-25% for Major Depression, 2-5% for Bipolar Disorder, and 1% for Schizophrenia.  As you can see, this is a huge issue for many people!

Most people with anxiety disorders, as I mentioned earlier, are wired this way from the time of conception.  Some people develop them due to having experienced severe traumas, abuse from parents, other adults, or bullying kids while growing up, overly protective parenting as children, and other experiences which somehow taught them to think or live in very tense ways.  For others the anxiety disorder arises from a combination of the two (genetics and life experience).

The bottom line is that anxiety and anxiety disorders do not arise due to mental or spiritual weakness, social incompetence, or a lack of faith in oneself or in God.  And no one should feel ashamed or inferior if they find that they are frequently running into obstacles in their lives because of anxiety in one of its forms.

But, is there hope?  There certainly is.  We will see in our next installment that there are very good, fairly simple, and quite effective ways of reducing, managing, and learning to live better with, anxiety.  We will also see that there is a big difference between anxiety, as we’ve been discussing herein, and fearfulness.  Fearfulness, or “being anxious”, is more of a state of mind, and that is a different kind of animal.  No one HAS to live in a state of fearfulness, but we’ll talk more about that next time.

Please stay tuned!

Craig Meek, M.D.