21 January 2020
In previous articles (see ‘Depressed’ or just going through a rough patch – have you been misdiagnosed? and Who says you’re depressed or anxious? Pfizer does), I’ve expressed my deep misgivings about the ‘diagnostification’ of human psychological suffering that goes on in medicine, especially psychiatry.
Applying diagnostic labels to the disturbing thoughts, distressing emotions and unpleasant physical symptoms that plague us as we struggle to face life’s many challenges may make doctors feel more competent, and may give their patients at least a temporary sense of relief – “At least there’s a name for this terrible thing that I’ve been going through!”
But it also has a dark side. Psychiatric diagnoses have an insidious tendency to become part of the labelled person’s identity. How many times have you heard a rambunctious child referred to as “an ADHD kid”? I’ve even overheard parents saying that their child “is ADHD”!
Here’s a quick experiment. Read the following statements out loud:
- “I have anxiety.”
- “I’m having a lot of anxious thoughts and feelings.”
What do you notice about the differences between these two statements? The first feels permanent, like “having” blue eyes; the second reflects the experience of the moment. The first phrasing makes most people feel helpless and victimised; the second invites curiosity and problem-solving.
The second phrasing is also far more appropriate when it comes to describing human psychological distress which – unlike a physical disease condition, such as diabetes or cancer – comes and goes, depending on what we’re focusing on at any given time.
Why does any of this matter? Quite simply, the lens through which we view psychological distress changes the way we see it and the way we attempt to deal with it, and that has broad and potentially long-lasting consequences.
If we see human psychological suffering as a ‘mental health condition’, due to unfortunate genes or biochemical imbalances in the brain (a completely discredited theory), we’ll stick diagnostic labels on people, prescribe them drugs, and more often than not, assume that they’ll be saddled with this ‘illness’ for the rest of their lives.
If we see this suffering as an inevitable consequence of life – ‘the human condition’ – then we’ll encourage people to take an honest inventory of their lives, identify their self-defeating behaviours and develop effective strategies for overcoming them, marshal their coping resources, and identify and take action on meaningful and achievable goals that will allow them to flourish.
A study recently published in the Journal of Affective Disorders provides support for taking the second approach. Titled Achieving complete mental health despite a history of generalized anxiety disorders: Findings from a large, nationally representative Canadian survey, the study examined survey data from a population-based sample of over 21 000 Canadians, roughly one-tenth of whom had previously been diagnosed with generalised anxiety disorders (GAD).
The World Health Organization’s definition of GAD is comprised of five elements:
- Excessive anxiety and worry about at least two different events or activities that lasted at least six months;
- Finding it difficult to control the worry;
- The anxiety and the worry were associated with three or more of the symptoms associated with anxiety;
- The focus of the anxiety and worry was not confined to features of an Axis 1 disorder (such as panic disorder, social anxiety disorder, post-traumatic stress disorder, mood disorders, eating disorders and substance use disorders); and
- The anxiety, worry, or physical symptoms caused clinically significant distress or significant impairment in social, occupational, or other important areas of functioning.
The findings were encouraging: of those who had previously been diagnosed with GAD:
- 72% been free of it for at least one year;
- 58% had been free of all mental illness in the past year (i.e. not just GAD, but depressive episodes, major depressive disorder, bipolar disorder, alcohol or drug dependence, and suicidal ideation – highly significant, because GAD often clusters with such conditions in the same individuals); and
- 40% rated themselves as currently in ‘complete mental health.’
As the study authors noted,
“Complete mental health is defined as the state of having both the presence of positive mental health (i.e. feeling good about oneself, one’s relationships with others, one’s connections to community or society and being able to function well in daily activities) and the absence of current mental illness.”
That’s quite a high bar. It’s difficult to reconcile the fact that so many people who had previously been diagnosed with GAD had made complete recoveries and were now “happy and/or satisfied with their life on an almost daily basis and had high levels of social and psychological well-being”, with the notion that these people ‘have’ chronic mental health conditions driven by genes and brain chemicals.
The researchers took it a step further, identifying the factors that were associated with recovering from GAD and enjoying complete mental health.
Those who had a history of GAD but were now enjoying complete mental health were more likely to be:
- Female;
- Older;
- Married (including de facto/common law)
- In good to excellent physical health
- Free of chronic insomnia; and
- Able to manage household activities without difficulties;
and to
- Use religion or spirituality to cope;
- Have a confidant; and
- Have never had a major depressive disorder nor substance dependence.
Obviously, we have no control over our sex, not all of us have found a life partner, and in general people become more emotionally stable as they get older, which reduces anxiety. But of all these factors, the researchers found that
“Having a confidant appears to be the strongest correlate of positive mental health among those with anxiety.”
In fact, those who reported having at least one confidant – a person in their lives who provided them with a sense of emotional security and well-being – were 3.65 times more likely to report complete mental health than those who lacked one.
This is unsurprising, given the large body of research documenting the relationship between social support and mental health.
Both anxiety and depression are inextricably related to the health of our social relationships. Human beings are the most social species on the planet, and every goal that we set for ourselves has ramifications for our standing in at least one of the four domains of human relationships: family, romantic love, friendship and trade.
People become anxious when they perceive that the odds of achieving their socially significant goals are heavily stacked against them, and depressed when they fail to achieve such goals.
Being able to confide in another human being who cares about you, and values you even if you have failed to achieve your goals or doubt that you can, provides you with a sense of inner security which gives you the courage to try again, even when success is not guaranteed. If you don’t currently have a confidant, it makes sense to invest time and energy in building friendships that will help you meet this crucial human need (and give you the opportunity to meet this need for others).
Likewise, having faith that there is a larger purpose to life, whether this is provided by institutional religion or emanates from a deeply-felt intuition that ‘there’s something that’s bigger than me’ helps to put our psychological suffering in context, making it more bearable. Those who have religious faith can deepen their connections with a faith community and immerse themselves in prayer and studying their faith’s texts; those who don’t can get involved with secular charities or environmental causes, and spend more time immersed in the natural world, which tends to elicit feelings of awe and wonder.
And taking actions to improve your physical health, such as eating a nutrient-dense wholefood plant-based diet, getting regular physical activity and prioritising sleep, also offers a significant pay-off when it comes to recovering from anxiety and enjoying complete mental health.
In summary, the Canadian study implicitly challenges the medical framing of generalised anxiety disorder as a biologically-based mental illness, gives hope to those who are currently plagued with anxious thinking, and offers vital clues about how people can extricate themselves from anxiety and enhance their psychological well-being: cultivate loving relationships, confide in trusted others, deepen one’s religious faith or spiritual grounding, and take care of one’s health.
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