Anxiety is an awful reality. You feel a horrible, paralyzing fear in the core of your chest or stomach, spreading to your arms and legs. The uneasiness gnaws away at you, or spreads into an overwhelming panic. It is paralyzing, and relief can’t come soon enough — only it doesn’t. There are anticipatory worries, debilitating fears, an inability to concentrate. There can be fear of heart attacks, strokes, etc. However, anxiety isn’t caused by something wrong with your biochemistry. The symptoms of anxiety come from neural circuitry, involving the amygdala — which regulates emotions like anxiety and fear — stimulating the limbic-hypothalamic–pituitary–adrenal axis, the sympathetic nervous system and hippocampus, which is implicated in emotional memory along with the amygdala. The key is that anxiety comes from emotional memories that are mapped as a result of one’s experience. The memories that generate anxiety are traumatic memories. It is traumatic experience that drive the limbic system’s response.
The myth that anxiety is a biological disease is false. The very idea that a pill can actually address the profound issues of the human psyche is an embarrassment on the face of it. The reason there is no evidence that human problems come from neurotransmitters and genetic defects is because it’s not true. We know that this ‘disease model’ has been promulgated by the APA and pharmaceutical companies. And sadly the sales job has been very effective. This wouldn’t be as dangerous as it is, if the biological treatments were harmless. They are anything but harmless. Not only that, but they interfere with the possibility for real treatment.
The specious biological treatment for anxiety are the Benzodiazepines. Benzodiazepines arrived on the scene with great fanfare — you know, “efficacious,” “non-addictive,” “no side effects,” “no habituation,” “no drug tolerance,” “no high” — starting with Librium and Valium. As always, the initial reports of problems were discredited and scorned. Information about a significant psychoactive drug effect — rage-reactions — was suppressed for a long time. When acknowledged, they were termed, “paradoxical” rage reactions. (as we will see, the rage is anything but paradoxical). Finally, suppressed evidence came out that was irrefutable that Librium and Valium are extremely addictive and habituating, never mind that they create significant highs. They fell into disfavor.
What ever happened to all the studies, all the papers, all the research that validated them?
But: fear not. Immediately new benzodiazepines popped right up to take their place — Xanax, Klonopin, Ativan, Versed, Serax, Restoril, et al. These, of course, are still touted as safe and efficacious. Worldwide sales in 2011 for benzodiazepines was $21 billion. This doesn’t even include the black market. It is admitted now that they are habituating and addictive, but the industry blocked the possibility of black box warnings.
The newest industry rules are that they shouldn’t be prescribed for more than 2-4 weeks. Withdrawal has to be carefully tapered and monitored which may last months to a year or more. Among the side effects are poor concentration, loss of memory, drowsiness, and unsteadiness. It may increase the risk for dementia and may produce memory loss. There are sleeping pills which are secretly benzodiazepines. There are legions of individuals who have been horribly addicted to these pills. This ‘cure’ for anxiety has ruined their lives.
I had a friend who was diagnosed with a stage 4 cancer. His primary care doctor thought he was anxious so he put him on Xanax. Fortunately, he miraculously lived for 5 years after diagnosis. Unfortunately, the whole first year was spent withdrawing from the Xanax; during which he was completely incapacitated. He needed to talk, to face it, sit with it, and deal with his cancer, not try to tranquilize it away.
To demonstrate the real story of anxiety, which is consonant with the brain and physical realities, I will use as an example my patient “Eddie,” from my book. His story illuminates the sadomasochistic mappings which reflect the trauma he was subjected to. Because of Eddie’s early abuse, in relation to his passive temperament, it was built-in that he would generate anxiety symptoms later in life, and he did. Everybody has their unique story. The particulars of traumatic abuse and deprivation are mapped into the “play” of consciousness of the individual. Abuse is mapped as a sadomasochistic war.
The central horror of Eddie’s mother was the absence of maternal love. From the beginning, she did not respond to his Authentic Being at all. He was an “it.” There was no genuine feeling from her and no feeling for him. Eddie’s very need for her love and care was an unwanted and an “unwantable” intrusion that drained her. Mother did not touch or hold Eddie with tenderness and warmth. Eddie adapted to his unrequited need for love with tears of rage, alternating with withdrawal into apathy. But his solutions to a cold and unresponsive world could not effectively protect him. His ongoing well-being remained in distress. All was limbically mapped.
When baby Eddie was hungry, he cried. His insistent crying was irritating to his mother. He was on a rigid four-hour schedule. A slap or a shake would quiet him down. Her slaps generated a sadistic discharge as well as sadistic contact with Mother. After a number of rounds, Eddie got intimidated and suppressed his stoked-up rage. He submitted and acted “good” on the surface. The retaliatory suppressed rage remained inside. All was mapped. Otherwise, he was left to his own devices. He was never held by a soft warm body, nor comforted with tenderness.
Eddie was bottle-fed. The doctor instructed his mother that bottle feeding was superior and more sanitary. And she could control for the correct dosage of milk. His feeding was administered with brusque hands, harsh hands, cold hands. Besides, holding and tenderness were not her strong suit. Mother found body contact disgusting and dirty. All was limbically mapped.
Because he was the recipient of his mother’s cruelty on an ongoing basis, Eddie was already filled with a suppressed retaliatory rage looking for an outlet. There was no responsive modulation of aggression through which Eddie and his mother would be brought back close, never mind that closeness was decidedly lacking in the first place. All was mapped.
The content of Eddie’s emotional memory was his play. The basic story was written. It consolidated and took form as a textured and nuanced sadomasochistic drama. Eddie was ‘bad.’ The persona of Mother was ‘mad.’ She dished out sadistic punishment. He deserved it. The punishment fit the crime. There was no relatedness on the basis of respect and tenderness. Relatedness was on the basis of rage attack. To retain relatedness, and discharge his built-up sadistic aggression, fighting was the substitute avenue of engagement. It was mapped as such by his limbic system. His life from now on, would be experienced through the cortical top-down prism of this persona play. This dark play of sadism, anger, badness, hatred, war, emptiness, and emotional isolation would continue to deepen and extend itself throughout his childhood.
As Eddie grew older, each new thing replayed and extended what came before. To his mother, his diapers were the source of dirtiness and disgust. He was dirty and disgusting, and he inflicted it on her. The cut of his jaw and the shape of his body were seen as ugly. She despised the sight of him. When he didn’t speak in full sentences by age one, he was stupid and embarrassing to her. She knew of other babies who were already verbal. He was the ongoing object of ridicule and shame. All was mapped as such.
Eddie told me the following story when he was four,
“Margie and Clara had gone off to school, and my brother and I were looking out the window, watching them walk to the bus. He grabbed me, and I pushed him back. And he said, ‘I’m gonna tell on you.’
“So I said, ‘Go ahead,’ and knocked him over. He cried and screamed, ‘Eddie hit me!’ My mother stormed in with that look in her eye. She was yelling and hitting me wherever she could. ‘I told you to leave him alone!’ Her hits felt distant and didn’t bother me. They kept coming. When she was done, she grabbed me by the arm and dragged me to the corner. ‘You stand here ’til I say so!’
“‘No, I won’t!’ I said, and pulled away.
“She grabbed me and threw me back up against the wall, ‘What did I tell you?’
“I said in an even tone, ‘You said, “You stand here ’til I say so.”’ I was thinking, What an idiot. You don’t even know the stupid question you just asked me?
“She got madder and hit me on my back. ‘Don’t you talk to me that way! You think you’re so smart.’ I pulled away again, and she slammed me back into the corner. This time, I stayed there. She continued, ‘You should be more like your brother. He’s such a good boy,’ and on and on. She went back to the window and continued to mumble under her breath. I stood there. And I stood there for what must have been a half hour. At this point, she was reading to him.
“She turned back to me and said, ‘What do you have to say for yourself?’ I didn’t answer. ‘I said, what do you have to say for yourself?’
“Uhmm… ‘He started it.’
“Okay, this is it. You apologize, or you’re going to reform school. What do you have to say?
“I said… He started it.
“’Okay, wise guy, I’m calling right now.’
“She went to the phone and dialed what I thought was the reform school. I didn’t know what “reform school” was, but I knew I didn’t want to be there. I assumed it was jail. I was sure I was going, and they were coming for me. So I panicked and started to cry. ‘Don’t send me to reform school. I’ll be good.’
“She waited for a while and then said, ‘Okay, I won’t send you—this time.’ And she picked up the phone again and told them not to come.”
Mother beat Eddie every day. He countered her beatings by refusing to cry during the beating by numbing himself, physically and emotionally. This, of course, infuriated her and resulted in escalated violence. Since there was nothing he could do to stop it, he joined it — “Bring it on! Gimme your best shot! I don’t care!”
One night, at age fifteen, Eddie and his friends got jumped by some college football players. They were walking home at midnight after a prank for which Eddie had tagged along. Some of his friends got seriously beaten up. Some ran. Eddie held his ground, despite his fear. Miraculously, he didn’t get punched. As a result of this event, Eddie was terrified to walk the streets at night for years, He felt a paralyzing apprehension in his chest. This anxiety was a secret shame, which he never mentioned to anyone. This state, in fact, was generated in resonance with the violent anger he carried from the beatings by Mommy Dearest.
Eddie told me that he routinely felt anxiety—at dusk, in social situations, if he ventured into unfamiliar places alone, even if he drank a glass of wine. Under ordinary circumstances, he never told anyone about his anxiety. He just lived with it. He said that he was so used to it that he didn’t consider it noteworthy. In actuality, he was secretive about it because he was too ashamed to expose this “weakness” to anyone.
Eddie was a quiet, studious, even-tempered senior in college. One afternoon he had an argument with his professor. Although the professor was in error, Eddie submitted to his authority. For the rest of the evening he was subject to a nameless anxiety that he felt gnawing away in his chest. He had a hard time falling asleep that night.
What transpired during Eddie’s argument with the professor was loaded with his underlying war. There was a disparity between his conscious awareness and his invisible play. His internal drama was not seen, felt, or known. Yet it was happening. During and after the argument with the professor, Eddie was aware only of a content disagreement. He thought his professor was stupid and unreasonable. This is what he ruminated about. However, this intellectual disagreement was the vehicle for activating the battle between his inner personae. The sadomasochistic aggression of his hidden cortical play was activated by the argument in a powerful way. Yet Eddie had no awareness of being filled with impotent rage. If he had been asked, he would have denied any anger at all. Eddie was unaware that his activated phantom drama was intensely percolating throughout the discussion and into the evening.
The ‘tell’ was the anxiety that gnawed away in his chest. The play was present and operating as invisible top-down processing during his fight with the professor. In his theater, the ongoing fighting between Eddie’s internal personae occupied a tremendous amount of his brain activity. His personae were fighting, just as if they were in an actual battle in physical reality. This fierce and consuming battle was a steady state of murderous rage between them. Eddie’s anxiety didn’t come out of the blue at all. It was generated by the masked, intense, war of his internal play. If there had been no impotent rage in his “Eddie” persona, there would have been no anxiety. Eddie dreamed that night that he killed a monster who was stalking him. His anxiety disappeared.
After a bad acid trip Eddie broke down into an anxiety state of unrelenting terror, which resulted in the beginning of therapy with me.
A turning point in the Eddie’s therapy happened when he was denying his anger at a girlfriend who had broken up with him and who had called him out of the blue to go to a lecture with her, after which she was gone again. The old rejection pain had come back in full force. I said to Eddie, “It wasn’t really about the lecture; it was about Cathy. ‘Friends,’ in this context, is always bogus. You knew that, and so did she.”
“No, it’s not her fault. She was up front with me. I agreed to go on her terms, as ‘friends.’”
“I don’t even think she should have asked you. You were hoping she’d come back. The pain that followed was 100 percent predictable.”
“No, it was me. I messed it up. You’re just taking my side because you’re my therapist.”
“That’s not true. Obviously, you played a major role, but she is still responsible for hurting you. And besides, even though I don’t know how exactly, I think it was manipulative on her part.”
“You’re just blaming her because you don’t like her… Now you’re real angry at me!”
As he spoke, the little finger of his left hand visibly twitched. At this point I felt a tension in my chest and my arms, my resonance with his denied and suppressed anger. I said, as I usually did when he was mistakenly certain that I was the one who is angry, “No, I’m not angry.”
Then he looked at me funny and said,
“Maybe you’re not… I’m the one who’s angry! I’m really angry! I feel a rage!” The twitching stopped.
This may seem like a small event, but it was major. His normal persona designations had been that I was the angry attacker, while he was the deserving recipient of attacks. Remember, his masochistic orientation was really maso-sadism, an inverted expression of his own anger, by which he was the designated object of attack from others. He had located his anger as mine, rather than his. He had been uncomfortable sitting with these unacceptable feelings as his own. At this juncture, Eddie re-internalized his own projected anger. He literally retracted his projection off of me and located it inside himself, where it belonged. Eddie dared to own that the anger was his not mine for the first time.
It is very common that when a patient is approaching owning his unacceptable rage I’ll hear “I was talking to my primary care doctor, she said you shouldn’t be suffering from anxiety, I’ll give you Xanax.” Then there is a discussion, wherein I address how destructive Xanax is. My patient argues “How do you know? Maybe it is biochemical. You’re the only one who doesn’t think so. And maybe you’re wrong.” But eventually the pills are set aside and the therapy proceeds.
Anxiety is not biochemical. All feeling is expressed through the body. The limbic system is operating though one’s emotional memory caused by a damaged play of consciousness. When that play is mourned through a relationship of trust and caring the emotional memory of abuse no longer rules the limbic system. A new play is written that is grounded in authenticity and love. The limbic system is then responsive to a different reality and the anxiety is deactivated. This is also how the therapy of trauma operates.
Keep in mind that we are dealing with human beings here. When one has been damaged, it always leaves scars. The old memories are still lurking there, available to be activated. One learns, when the anxiety returns, to use it as a signal to pay attention and — hopefully — recover from it. A few years after therapy was over, Eddie wrote me a letter. Things had gone well, and he had gotten married to his new girlfriend. It was a loving relationship. He had fallen into a pit of suspiciousness and jealousy, and he wanted to check in with me. His letter continued: “Here’s what you would say to me …” He then spelled out quite accurately what I would, in fact, have said. Then he concluded the letter: “I don’t really need to come see you now. As I wrote this letter, it allowed me to remember you remembering me, and that was what I needed. I just needed to touch base with that, and I just did.”
When an event triggers a reactive symptom of anxiety, it is not that difficult to deal with. This is often accomplished during the psychotherapy evaluation. It usually is caused by a suppressed rage by someone who is uncomfortable with his anger. By giving permission for the anger in such a patient, the anxiety dissipates. The real issue, however, is the underlying susceptibility to anxiety which has become built into the personality. The more the aggression has been systematically suppressed in an abused patient, the more deeply one must go to explore and mourn the pain of abuse and deprivation. I’ve had patients who would say about a person they are enraged at, “I’m really worried that so-and-so is flying tomorrow, I hope that nothing happens to the plane.” This is quite far from the patient who says, “I wouldn’t want to do anything myself, but I kinda hope that something does happen to the plane.” And then, “I’m mad and I’d like to decimate him myself!”
When the limbic system has been overwhelmed by traumatic memories, it is a symptom of abuse that one has endured. The symptom tells us we need to address the underlying damage in a real way. Anxiety, like depression, results from the aggression of a hidden, ongoing internal war. Anxiety symptoms are simply behaviors that people with a passive, introverted temperament arrive at when they follow the mappings of their experience. (see “The Creation of a Bully, The Creation of Anxiety: How an Active or Passive Temperament orients our personality”) This is parallel to similar mappings that generate so-called depression in people who have a predominantly Internalizer temperament. (see – ‘Smashing the Neurotransmitter Myth.”) There are other temperamental combinations that with trauma can also generate anxiety. Anxiety is a symptom – signifier – that alerts us to the fact that there is something problematic in one’s damaged “play.” What needs to be treated is the damaged play, not the signifier. We need to heal the damage in psychotherapy; not mask it and — and thus grow it — with a drug. This symptom always points to a human problem which exists in the patient’s theater of consciousness, and needs to be dealt with by mourning and then by rewriting – and rehearsing – a new play.
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Anxiety is another one of these syndromes masquerading as a disease. I can think more than one source for anxiety attacks, which can have several dietary triggers, none of which the average psychiatrist will treat, dietary treatments being the property of quacks and not of real doctors like themselves.
But I do have a question; if a scientist were to induce anxiety and/or panic in somebody using amphetamines, or of course we all know that neuroleptics can cause extreme feelings of anxiety and restless… does this mean the drug somehow does it through some sort of psychological… magic?
Identify the Core Belief
Identifying a core belief is like solving a mystery of the illusions in your mind. You have to follow some clues to get down to the hidden beliefs in the unconscious. Let’s use the example of fear of public speaking. Fear of public speaking isn’t a core belief. It is an emotional reaction to a belief. The thought a person has is that, “They will think I’m a stupid idiot.” This is the fear, but not the belief. Fears associated with what other people think of us are very common. This same dynamic can occur in the mind when asking for a raise, asking someone out on a date, or asking for what we want.
However the thought is not a core belief. One has to be careful here because they are often misleading. When solving a crime you follow the money. When finding core beliefs you follow the emotion. Full Article → http://pathwaytohappiness.com/writings_falsebeliefs.htm
It seemed like a good idea doing benzos to over ride the physiological reactions to beliefs, that crappy feeling of anxiety that gets in the way of things, inhibition, but it doesn’t work for long then tolerance withdrawals and you end up with more anxiety then you started with.
That freedom from blocking out anxiety just doesn’t last, the chemical solution just doesn’t work , it would be cool if it did but it doesn’t.
Great stuff, as usual, Dr. B. I imagine Eddie could not feel safe anywhere, given that his developmental life was chronically dangerous thanks to what seems to be sadistic mothering. How on earth could he find safety with that program in his head? And in his bones, too, that stuff really gets into our cells, like radiation.
I could see how that would create enormous chronic anxiety that would screw us up in every way, including physically. I just recently became aware of role of the limbic system in all this, a client brought it to my attention. I thought it was extremely interesting.
Over-the-top anxiety, which peaked and undermined my functioning in the middle of my college years, was my primary symptom which signaled to me that something was amiss. I went to see my first therapist at the campus counseling center and mostly I talked about how I was at that college to please my dad, and there was really no way I was comfortable dropping out, even though I was not a good match for this school; nor did it have the program I wanted to study. This was all a very big deal in my family and a lot of focus went on it while I was in high school.
She asked if I wanted medication to alleviate symptoms! Seriously, that was the first thing she thought of to say to me. I turned that down, and at the time I did not know what to make of that, but it made me feel as though something were wrong with me, like a permanent deficiency or something, which took the focus off my family issues–which was way too bad, it turned out.
I believe someone with your perspective would have gotten right to it and I more than likely would have avoided 20 years of ultimately disastrous psych drugs, and temporary disability.
Indeed, it was my play that needed rewriting, along with the role I was playing. Instead, I had years of attracting the same dynamics time and time again, and I believe that having masked and suppressed with psych drugs all of my post traumatic stress from toxic family dynamics is a huge part of that reason.
I was not working through anything nor growing spiritually, and even hardly emotionally; I was merely taking psych drugs so that I could function the way I was expected to function–which I did, totally disconnected from who I was. I had a life, but it felt as though it had nothing to do with who I was spiritually, so it was compromised, one way or another.
And I was poorer for it, this was costly care, but I thought I required it. Certainly, was I was led to believe, and I didn’t question it for a good long while–not until the drugs completely disabled me, after 20 years of taking them and functioning well enough.
Finally, I broke the spell, and it was as you say, by rewriting it all, starting with tapering from all 9 drugs–which included Ativan and Klonopin, the K being the roughest and toughest of all to release, but I finally did it. And then also by refusing to buckle to the outrageous stigma that came flying my way as I entered the public system. That started in my 40s, so the issues were hefty by then, lots had accumulated, including a damaged brain and other organs, which regenerated through excellent herbal care I found. Overall, I challenged myself in many ways because I was desperate to heal and get on with things. This was the time to bust through all of that anxiety, once and for all. I had to take a lot of risks, which paid off rewardingly, but not without transitional growing pains, naturally. Part of the process.
It’s an incredible feeling to find that power and sense of personal creativity. We really can design our own reality with this awareness. Thank you, as always, for your very inspiring and, obviously, truth & passion-driven work.
A client has shared links with me that speak to the biology of trauma, and these offer a vast array of healing pathways, thought I’d share here, I found that, while doing all of that core shifting of my reality, it was vital to have support on a physical level, as so many changes are occurring at all levels. It’s such a re-birth, down to our cells. What we put into our bodies, as well as to where we direct our focus, can support our inner harmony, and this translates to inner peace.
Definitely Great stuff, Dr B.
Anxiety is probably the driver of “schizophrenia” but
it’s possible to overcome dreadful anxiety without medication.
Psychologist Rufus May has some very good advice on his website on this subject.
CBT also is ‘designed’ for anxiety. (I suffered from “high anxiety”when I withdrew from neuroleptics and CBT works).
I’m sorry if some of my comments (above) are a bit off topic. I’m also in a position to discuss most of my personal issues and worries with another person.
Great article, thanks for writing (I think the whole paradigm of “eliminating” symptoms is tragically short-sighted).
Sorry I meant to post that to the article in general, however I do think anxiety often a big role in schizophrenia (often hidden).
Very well described.
Thank you. I wish more people understood this process – and the fact that it can be undone and changed, later in life via a different, healing relationship (therapy) as you have described happened finally for Eddie.
Most psychiatrists simply don’t want to admit that the basis for our feelings and emotions is in our experiences as that removes their stated ‘area of expertise’ from the domain of ‘medicine’ completely.
Nice description of how horrid child rearing can produce later anxiety.
I wonder how widespread the belief that anxiety is a biochemical problem though? My impression in the UK is that people unquestiongly take the drugs rather than beleive their anxiety is caused by a biochemical problem. They do tend to believe in biological causes of depression, though that might be fading, and for schizophrenia (not that I believe this is a valid diagnosis, but many do)
Dear Dr. B,
I very much appreciated this article. I took a few benzos, not many, and these did not figure significantly in my 34 years or so as slave to the System. However, I did see much addiction, much denial, and was shocked at how rapidly these pills ruined other patients’ lives. There was no “addictive personality.” You took it, and if you kept at it, your body got hooked. Many patients were totally convinced that “my anxiety is so bad that I need this dose.” Or, “My trauma was terrible and that justifies these pills.” And, “I need these pills and no one understands!” I heard about “the good doc” and “the bad doc” and I noticed that benzo addicts defined a good doc as one that prescribed and defined bad docs as ones that refused or ones that called them addicts, whether with good bedside manner or not-so-good bedside manner.
Yes, it was true, both docs and patients could be in denial. Docs should know better than to take a patient off cold turkey. But on the other hand, docs couldn’t keep prescribing like candy. When you know someone’s addicted, what can you do? I faced this as fellow patient, and I still face this today, as friend to people who still take these drugs. I don’t always know what to say nor where to draw the line, but I can only say I must deal with each situation individually, that there are no blanket rules for how to handle addiction when I pinpoint it.
The only time using these drugs is truly justified (I only saw this once) is as muscle relaxant for rare muscle disorders when there is no other option.
I saw a male patient at Massachusetts General Hospital’s ER in awful shape, sitting right next to me, geez, I thought one guy would have a seizure right in front of me, he was shaking and sweating, telling me his insurance would not pay, he had been laid off, and there were no medical staff in sight, only “security” personnel. I wanted to just sit with him but what would i do if he had a seizure or if I suspected his blood pressure was hitting the roof and he was at risk of stroke? I was a “mental patient,” rail thin anorexic. Who would believe a person like me, even though I was telling the truth? The man could barely speak, he was almost sobbing. Each time I knocked I was ignored. Much of the time, the little booth was empty anyway. Yet I knew benzo withdrawal could be fatal. I heard him beg, “Please, please give me something!” That was around New Year’s, around the holiday, 2010 to 2011. What a lovely way to begin a lovely year. (I had been sent there by my therapist because I told her I had a cracked molar, by the way.)
I got friends who think their benzos are great, I got friends who have gone on to painkillers and onto heroin when the painkillers just aren’t enough. I got friends who rejoice when they get a new “diagnosis,” especially one that verifies that they got pain. It means more pills. All because initially, they were given benzos and they got hooked.
Back in 1982, I had never heard of these pills. My friend was hooked on Ativan. She and the other patients, also hooked, described their “anxiety,” just as you described above, the pounding heart and feeling like you will die, in groups, and stating over and over that the pills saved their lives. Months later I saw addiction and much fighting with staff over the pills. The pills, not the original anxiety, which was most likely resolved, became the new problem, the new anxiety. On and on.
As a person who had come to that program with an eating disorder (the year was 1981), I felt left out. I felt unserved. I could not relate. I can tell anyone here I didn’t experience what the other group members were experiencing and I was torn between “I don’t belong here and I should leave,” and “These are nice people and I wish I fit in better.”
I finally went to my PCP, without telling anyone. I asked, “What should I do?” The PCP had no answers for me. This PCP was a Harvard Community Health Plan doctor. Over three decades later, that one single visit that I had made in 1982 was still on record in Harvard Vanguard’s electronic records, when I fired MGH in 2013. So I found that Harvard Vanguard’s records incorrectly recorded me as “bulimic.” I suppose that was a secretary error. I corrected and they took it off.
What about those who have generalized anxiety? You don’t feel this is biochemical? When there is no real trigger for the general anxiety.
There’s no such thing as generalized anxiety. It just means one is removed from the trigger and the story. I’d be very interested in knowing the biochemical mechanism.
Good point, as it’s often a catch all. Athough, sometimes there is no known cause, but I thought that was at least stated, even when kind of implying something else.
Although, it’s not helpful for me. As years of physical abuse of parents, including my mom suffocating me. I consider the fear to be legitimate, yet a therapist said I’m playing a victim role, because I didn’t think CBT was worth trying. Also I’m told stuff like there is evidence of underlining depression in addition to trauma. What is the typical person with my experiences supposed to look like?
All human beings are prone to self protection and anxiety can be a knock on effect of this.
When I was in “high anxiety” I was in real drama – with CBT what I found was that if I could detach for a few hours my mind worked differently – and then even real problems didn’t frighten me.
The difficult thing was detaching.
Hi, I commented befor I read this, and the comment was clarifying my original point. I realized I made two, and one was unrelated. I’m, not sure if that’s what I’m going for, but in any case, I’m not sure if it’s possible when having a flashback. Besides I don’t want to detach from real danger.
Glad it was helpful, anyways, but I get flashbacks of being suffocated. I also fear that can be a problem, all this ditching from potential threats. Not you particular, but that mindset.
To clarify, not saying the artical was not helpful. Saying, I don’t know why people sometimes assume if they can identify a cause than it will automatically fix stuff.
CBT has worked in the longterm for me – It wasn’t easy; or a quick fix (as sometimes people seem to describe it).
Hi kayla – so sorry to hear you are being told such appalling things by “a therapist”. A decent therapist should be capable of hearing what you have to say about your experiences and how you feel about your situation, not label you because you don’t feel what they suggest is right for you.
CBT doesn’t work for many people with significant experiences of childhood abuse anyway as people with such experiences have learned from the very beginnings (as Dr. B has described with the case of Eddie), that human beings in general are simply terrifying and so, there is good reason to be very scared of them and want to hide from them. It can take a much deeper kind of therapy than CBT, a kind that is about feelings and relationships – learning for the first time ever that a relationship with another human being can, in fact, be ‘safe enough’, to help.
Of course you have very legitimate reasons to be anxious – even terrified and, it can be very common for people who have experienced severe childhood traumas to also feel very depressed as a result of that.
Having very good reasons to be anxious (terrified) and very good reasons to feel depressed can often go together. That still doesn’t mean that the cause of the depression is bio-chemical – just as you have good reason to be anxious, you have good reason to feel depressed and it’s addressing the reasons that helps most.
This isn’t the same as ‘identifying the reasons’ though. Just knowing why you feel so bad (what some of your bad early experiences were) isn’t enough to change the way you learned so early on to feel about and with other people.
The good part is that with therapy of the kind as described in this piece by Dr. B – therapy that actually addresses the causes of your distress and helps you learn that a relationship with another human being can be safe, unlike your first experience of a relationship with another human being which definitely was not safe for you, this can change and you can, in time, feel better.
In the end though there is no “typical person” with any type of experiences really. Everyone is, and their experiences are, unique. But, it sounds very very reasonable for someone with your types of childhood experiences to feel very very anxious and upset, even depressed for much of the time.
Hope you are able to find a therapist who is capable of being with you through your fear and pain, who can help you learn that your flashbacks are in the past, and no longer need to feel as if you are experiencing what happened then, now. That helps, in the long term, as many short-term ways of doing therapy (or treating with drugs) don’t.
Thank you for addressing Kayla’s situation so beautifully. I hope it is helpful to her.
Kayla, Kallena is very right that your therapist was full of bullshit to say this… and also on the right track, I think, to suggest that dealing with relationships and feelings at a deeper level than most CBT does might be quite useful to you. Psychoanalytic psychotherapy is my favorite.
Along the lines of my favourite too BPDTransformation.
The most important thing though, rather than the actual theoretical model followed by the practitioner, is always the ‘fit’ between therapist and client.
It’s the relationship itself that heals, as so much research repeatedly shows, and any of the many forms of psychoanalytic psychotherapy allows this relationship to develop.
Much of the work from Winnicott and then Kohut’s psychology of the self onwards, incorporating also the many advances from Bowlby, Ainsworth, Trevarthan et al’s work on infant development and attachment theory and more recently, findings in developmental neuroscience that support their earlier findings, have been invaluable to the development of understanding in how this form of therapy ‘works’.
Intersubjective systems theory (Stolorow and Atwood) has added much toward explaining how this type of relational holding can best be fostered.
“We need to heal the damage in psychotherapy; not mask it and — and thus grow it — with a drug. This symptom always points to a human problem which exists in the patient’s theater of consciousness, and needs to be dealt with by mourning and then by rewriting – and rehearsing – a new play.”
I do so wish my therapist had been as wise and ethical as you, instead she had me massively drugged to cover up the sexual abuse of my four year old child, for her ELCA pastor and friends. I dealt with three and a half years of doctors denying the abuse, prior to some decent and disgusted nurses finally handed over my family’s medical records, with the medical evidence of the abuse in my child’s medical records.
Knowing my concerns of the abuse of my child were correct did help me, and I hope my child will not suffer in the future, as I did get him away from the child molesters quickly, provided him with a loving home as best I could while being made psychotic, via anticholinergic toxidrome poisoning. And I kept my child away from the psychiatrists, much to my psychiatrist’s dismay. And I did address the sad reality as best I could with my child. So far he’s doing quite well, but I do worry about the long run.
I do wish my ex-religion would stop covering up child abuse in this manner, but they have no desire to get out of the child abuse covering up business, based upon my understanding. One former pastor from my ex-religion did also write this book out of similar disgust.
It’s a greed issue, no doubt. At least the Catholics are acknowledging the problem within their religion. Although their solution to the problem does still seem to be paying psychiatrists to turn abused children into “bipolar” patients with the antidepressants, according to a family I met in a self help group. I recommended Whitaker’s book to them. The ELCA bishops are still denying the problem, and profiteering along with the psychiatrists according to John Read’s research, off of covering up child abuse. This is bothersome, still, to me, obviously.
I hope our society will go back to arresting the child molesters again some day, rather than police telling people that “the regular people must make sacrifices.” Just an FYI, keeping young children with child molester parents does not appear to be a wise societal choice either, since two out of three of the children of the people who raped my child, did get arrested prior to the age of 21. This would imply to me, at least, that these children may have actually been better off with different parents.
If we don’t discuss the problems in our society, we’ll never be able to fix them.
Great article, thanks for writing (I think the whole paradigm of “eliminating” symptoms is tragically short-sighted).
I found this very illuminating. Really insightful and well done! I would disagree with the bit that says, basically, a slow taper over a period of months or a year is what is recommend by medical practitioners. While it is recommended by experts, generally doctors recommend 1-4 weeks. Obviously this is to blame for the rampant misdiagnosis of persons suffering from withdrawal symptoms months or years after they have withdrawn.
I know many people who have not had traumatic childhoods who have severe anxiety since childhood, so how could that be?
Hi suzzeeb – this is all dependent on your definition of “trauma”.
In terms of our earliest development, there does not need to be anything that happens that can be remembered that actually ‘fits’ with the types of things that we normally associate with the word (things that might also qualify for the term “child abuse”).
For an infant, it can be experienced as “traumatic” if there is simply a not ‘good enough fit’ between the infant’s temperament and the temperament of the primary carer. An infant feels a sense of distress – for whatever reason – and the carer, despite wanting to do their best, can be unable to find a way of soothing the infant and instead responds to the infant in a way that the infant may not relate to which then increases the experience of distress, rather than soothes it. To an infant – if that happens repeatedly – that can be traumatic and can easily result in the person, as they grow, not being able to learn how to soothe themselves (calm their anxiety and not feel anxious), as this is a skill that we are not born with. It is learned in the first few years of life via repeated experiences of being soothed, then distressed, then soothed again and again by a carer who is ‘well-enough attuned’ to the needs of the infant.
A carer may be trying to soothe their baby as hard as they can yet – somehow – it just doesn’t work and so, it may happen that the young person, as they grow, learn that their ‘default way of being’ is “anxious” and they are unable to soothe the sense of tension and fear in themselves as they simply never learned how to.
Robert et al,
Here’s an article on Astra Zeneca’s new drug, Zombiestra, which I found rather entertaining:
This supports my idea that the main function of psychiatric drugs is to stop people feeling fully alive.
As Donald (and Mussolini before him) says, “It’s better to live for one day as a lion, than a hundred years as a sheep.” Far better to have the courage to face your feelings and not undergo the process of zombification (drug taking), than to become one of the millions of American sheep who bleat idiotically about having “mental illnesses” and needing their “meds” to keep themselves in “remission.” So pathetic.
“Donald”??? You’re on a first name basis with the T-word? And quoting Mussolini as an inspiration? Or don’t I get the joke?
Mussolini has also been quoted as saying something to the effect of fascism being a state in which you can’t slip a cigarette paper between business and government. In which case he would be very comfortable living in the present day U.S.
The ad spoof is pretty good though.