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.

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