If she were actually me she’d have a mouth. And it would be talking incessantly. Am I right, friends?!

“Feel the fear, then do it anyway”.

I love it. It sounds so darn simple, it might just work! I thought this for a good split second. And if it were to work, it would be the most perfect idea I’d ever come across when it comes to handling anxiety. Unfortunately, it’s way too simplistic for those of us who’s anticipatory fear is severe and debilitating. It’s almost like telling a coma patient to “just snap out of it and join us for dinner!”

For common everyday fears and anxieties among optimists and even pessimists, I get it. I’m scared to walk into that convenience store at night, but I’m really craving a Slushie and it’s not a bad part of town. I’ll just suck it up and go then! Easy. Done. No perseverating on what could happen to the point of feeling nauseous or faint. No dwelling on “could be” or “may be” or “what if” until you tuck yourself into your bed with the blankets piled high around you or you find yourself heading back home and drinking a bottle of vodka instead of that special sugary drink in order to settle your nerves and put you to sleep. No shaming yourself because you realize your fears are mostly unfounded and generally irrational and you feel like a freak and a wimp and an overall schmuck who constantly doubts himself.

My first experience with severe anxiety came in the form of a reserved 3rd grader named “Bree”.  She was a beautiful little girl with a friendly, yet shy disposition. She was intelligent and quiet. While she was outwardly eager to please others, on the inside she was very tough on herself. Her mother said that she was so sensitive to what others may think that sometimes Bree got upset at little things she had said or done even before anyone else would have time to react to it. No one would ever suspect this as she didn’t tell anyone. This self-judgment was never really an issue that could be seen for what it was. For the time being it went compartmentalized somewhere in the nether regions of her fast growing brain.

She was only eight years old when her mother was becoming more and more aware of her daughter’s need to please others.  What she didn’t see, though, was how much Bree depended on others’ acceptance for her survival in any peer-related activity. She got focused on this aspect of her daughters life so much so that she forgot to notice that Bree might have her own thoughts and feelings about situations and people, yet never expressed them overtly for fear that other’s might not agree.

Early on both Bree as well as her loving mother would never have suspected that if Bree didn’t speak on her own behalf than others would be more than happy to do it for her. And they did. And she found it to be easier that way. One doesn’t get in trouble if one hides behind others’ words and deeds. Blame comes even easier as well. You weren’t responsible for the damaging words your friend spewed forth toward that peer who just got a haircut and was crying in the corner because someone from your group said she had “a bad boys haircut”. Bree may not have liked what her friend said but a.) wouldn’t challenge her on it, after all, it hadn’t been she who had bullied this peer with the bad haircut; and b.) the bully was infinitely “stronger” than Bree, who wouldn’t dare to be on this bully’s bad side; and yet c.) a nonresponse is indeed still a response. Bree was grouped together as a “mean girl” simply by association. In reality she was a very nice, overly pleasing girl. Who was simply afraid. Of everything, it seemed.

“It was her idea!” She could say pointing blame at someone else (though in reality that only happened at home with siblings). And sweet,  sweet Bree could just slide right through childhood with her own opinions tucked away safely where no one could criticize them or disagree with them or even agree with them if they so chose. She was so far into her anxious self-protection mode, highly alert to potential judgment and ridicule from others that she didn’t use her own voice anymore. Maybe she didn’t even exercise her critical thinking brain enough to weigh out what she actually wanted or needed. It was safer to stay hidden behind those who would be quick to criticize.  That my friends, is called a secondary gain that Bree was experiencing, which only works to reinforce the behavior of hiding out behind stronger, more assertive peers. You see, it meant more to her to just “belong” in this group of angry ill-bred children than to be outside of them, where she, too, could be made fun of or left out by.

Life went on. Bree seemed so cooperative and compliant. The perfect little conformist. Teachers loved her. Friends liked to be able to boss her around. She found herself attracted to the “cool” kids that needed girls like her to control. Even as young as third grade kids get it. They know who they can manipulate and who will speak up against them.

It was also in third grade that Bree had a little sister who adored her along with two loving parents who were present and educated, loving and hopeful about each of their children’s futures.What was there to complain about? Since the family was expanding yet again, it was time to either add an extension to the home they loved or move. They decided to build on to the small family home before baby number three came.

Times were good, Bree was blossoming!…cheerleading for her school’s peewee football league…playing basketball…things her mother never imagined she’d want to do because of the social commitment contradicting her general shyness. This was a hopeful sign that her little girl was maturing. All of Bree’s friends were cheering as well so Bree was able to “belong” to something social and active. Mom was proud and excited.

In the meantime the house was steadily being built onto. Construction crews became daily reminders of change. It was inconvenient but the future rooms being built meant space to breathe to mom; a “man cave” to dad and a playroom for the kids. In the meantime a new refrigerator was replacing the old.

What happened next would open up a whole other realm to her. One that was not expected or welcomed. “It” was making itself known. “It” was a presence and would now need to be dealt with; but first they needed to find a name for this beast that had begun a slow erosion of a young person’s confidence level. This thing had sent second and third guesses running amuck throughout her brain waves; it had triggered false alarms to even the most mundane of experiences. “It” kept her awake at night with worry, brain humming with static. “It” told her she was not good enough or worthy or pretty or smart. “It” told her she needed to be afraid all the time. Of everything. “It” said the only place you’re safe is in your house and up the stairs into your room. And “it” said not to trust anyone. Among those ruminating falsehoods, she was told not to eat. If she were to eat she might throw up like a classmate did in math class yesterday. It was disgusting and kids laughed and made gross noises and kept making fun of the little boy even as he took his leave to the office to await his mother’s rescue.   

She went to sleep thinking of this moment…the smells and the sights…her classmates howling laughter and teacher’s urges to get someone healthy to walk this sickly little boy to the office; the maintenance man’s grey one-piece jumpsuit, mop, gloves, bucket of sanitizer. The way the mop slushed all the gross vomit-filled chunks around the small area before picking any of it up…her head spun and her stomach twisted and turned. She felt nauseated herself. There was no way she was going back to school. She too might throw up in front of the classroom of mean kids. She felt like she knew she would just die if that happened.

The next morning before school the new refrigerator arrived while Bree’s mother was finished cleaning up the old and getting it ready to remove. Bree was at a loss. She wanted to scream and cry and hurt herself because her head was still spinning and her old refrigerator was leaving their house. After a short period of observing crews sizing up the situation regarding the old one out and new one in, she’d had enough. Her brain flooded. She couldn’t breathe, her heart pounded out of her chest, she could feel her face flush and her body sweat, she felt like she was on overload. Without any warning whatsoever, Bree did something completely foreign to anyone who knew her quiet, timid nature. She opened her mouth and screamed a full octave highter than usual, while reaching for the old refrigerator door that hung open:

WHY? WHY MOM?! THERE IS NOTHING WRONG WITH OUR REFRIGERATOR! I DON’T WANT ANOTHER REFRIGERATOR, MOM! DON’T LET THEM TAKE OUR REFRIGERATOR!!

Everyone stopped. The crew set the new one down on that spot as if on command. The father who’d previously suggested it was time to get to the office, stood expressionless. The mother stood motionless beside the old refrigerator, wearing gloves still dripping with a cleaning solution onto the floor.

A cycle that would take years to understand and learn to cope with successfully would now begin for Bree and her family. Anxiety disorder, along with Depression, is a family disorder. It takes all hands on deck to support and reinforce healthy coping skills. The mother would later say how fortunate they were that “it” was caught early so that when Bree was a teen she would be better able to cope with her medical condition. A condition she likened to her own asthma in the sense that it can require medication to help stabilize to the point where better, healthier coping skills can be learned and utilized to possibly prevent future cycles from occurring, though not a guarantee.  

According to scientists, just as heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic, environmental, psychological  and developmental factors. They have actually been able to track anxiety down into several areas of the brain, however there are two distinct brain parts that show, through brain imaging devices, the key factors in the production of fear and anxiety: the amygdala and the hippocampus.

According to The National Institute of Mental Health (www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml) “the amygdala is an almond-shaped structure deep in the brain that is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret response. The emotional memories stored in the central part of the amygdala may play a role in anxiety disorders involving very distinct fears, such as fears of dogs, spiders, or flying.

The hippocampus is the part of the brain that encodes threatening events into memories. Studies have shown that the hippocampus appears to be smaller in some people who were victims of child abuse or who served in military combat. More research is necessary to determine what causes this reduction in size and what role it plays in flashbacks, deficits in explicit memory, and fragmented memories of the traumatic event that are common in PTSD.”

Who is at risk?  Some facts:

•  Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population).
• Women are 60% more likely than men to experience an anxiety disorder over their lifetime.
• In a classroom of elementary school aged children roughly 1 out of 7 is clinically anxious (as determined by at least six months of excessive, irrational fear and dread).
• A large national survey of adolescent mental health reported that about 8% of teens ages 13-18 have an anxiety disorder, with symptoms commonly emerging around age 6. However, of these teens, only 18% received mental health care.
• Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment.
• Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill, according to “The Economic Burden of Anxiety Disorders,” a study commissioned by ADAA (The Journal of Clinical Psychiatry, 60(7), July 1999).
• More than $22.84 billion of those costs are associated with the repeated use of health care services; people with anxiety disorders seek relief for symptoms that mimic physical illnesses.
• People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.
•             
• Does anyone you know sound like this? Do YOU? Get the help you need and pass it on. There is no shame in self preservation and being the best YOU that you can be!

Reliable sources (just to name a few):

• The National Institute of Mental Health   http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
• Anxiety Disorders Association of America   http://www.adaa.org/
• NAMI: National Alliance on Mental Illness  http://www.nami.org
• Freedom From Fear: Anxiety and Depression Resource Organization  http://www.freedomfromfear.org/
• Teen Mental Health  teenmentalhealth.org